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Re: Anybody respond to Nardil after failing Parnate?

Posted by JohnL on February 11, 2000, at 7:48:38

In reply to Re: Anybody respond to Nardil after failing Parnate?, posted by Stephan on February 11, 2000, at 5:15:16

I've been on this kick lately of encouraging the urgency in trying a different class of drugs when several antidepressants fail. 75mg Nortrip + 80mg Prozac is pretty hefty. Especially in light of the fact that Nortriptyline blood levels are doubled or tripled when combined with normal doses of Prozac. Not to mention 80mg doses. Your blood levels of Nortriptyline are probably double to triple--and maybe a lot more--than the 75mg dose you're taking. If your current meds and previous MAOI trial didn't do the trick, then to me that suggests an urgency to look elsewhere.

I've come to believe that if three or four antidepressants of various classes fail, then remedy is found quicker by trying other classes of drugs instead. The underlying cause of the depression may have little to do with serotonin or norepinephrine in a particular individual's case, making antidepressants nearly useless. It could be chemical or electrical instability, requiring a mood stabilizer. It could be NE/dopamine failure, requiring a psychostimulant. Antidepressants might work through a long drawnout trickle down effect, if they work at all. It could also be dopamine excess(we usually think in terms of deficiency, but too much can cause depression too), easily countered with a small dose of an antipsychotic. We don't need to be schizophrenic to respond nicely to an antipsychotic.

In any case, to me it makes sense to jump to a different class of drugs--the stimulants, the mood stabilizers, antipsychotics--to test them out. If they too fail, then back up and see what might have been overlooked. Usually by then though you will have discovered some unexpected drugs that helped a lot, and perhaps one alone or a blend of your favorites will keep you well indefinitely. The closer a drug is to correcting the problem directly without a trickle down effect, the shorter time it takes to work and the more robust the response. In your case it just seems justified to put other classes of drugs besides antidepressants at the top of the priority list. If antidepressants are going to work with you, you would probably have had at least some decent response by now, considering the wide spectrum and high doses you have tried. I don't know, that's just how I see it. I think a lot of us who are frustrated with poor response to antidepressants are actually assuming the wrong underlying chemical imbalance.




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