Psycho-Babble Medication | about biological treatments | Framed
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Posted by SLS on November 15, 2000, at 19:46:36

In reply to Re: ZYPREXA OR AMISULPIRIDE? SLS, posted by Ant-Rock on November 14, 2000, at 19:03:24

> Thank you once again Scott, for all your valuable information/advice. I definitely can relate to the parnate's lack of efficacy in the apathy dept. Actually, every time I've restarted this med it has lost potency, and now I feel no difference regarding depression whether I am on a high or low dose. It basically makes me get up in the AM, which is why I always go back to it.
> Anyway, my p-doc has been suggesting ECT to me for years, but I made the decision to try every option available before even considering it. So on goes the battle...
> Sincerely,
> Anthony

Dear Anthony,

I do not believe that it is time for you to go to ECT, although I have no real aversion to using it if it is indicated given your position in your treatment algorithm or current mental status. I had 12 treatments in 1991. 6 unilateral left followed by 6 bilateral. Bilateral sucks for memory and cognitive side effects, but it was my experience that they were gone completely within a few weeks. The experience would have been worthwhile had it worked. In my recent correspondence with Max Fink, he was reluctant to divulge with certainty his position regarding unilateral right versus bilateral. His position in this issue is not in accord with many experts, including my own doctor at NYU. A while back, someone posted a study, the results of which indicated that *high-dosage* right unilateral was as effective as bilateral, but somewhat inferior to high-dosage bilateral. In addition, in my estimation, the difference in cognitive side effects between both high-dosage treatments was negligible. My suggestion would be to decide first whether you want to try low-dosage right unilateral or high-dosage bilateral. I don't see any advantage to high-dosage right unilateral.

I also have experienced diminishing returns with Parnate over the years. It was a combination of Parnate 60mg + desipramine 150mg that got me nearly 100% well in 1987 for over six months. I don't want to go into it here, but my doctor at the time discontinued this treatment in favor of Prozac, which had just come out. I have not responded to this combination ever again.

If I were you...

* Remain on lithium 300mg - 600mg (unipolar augmentation dosages)

* Keep praying

* Keep hoping - you haven't tried a whole bunch of stuff - I guarantee it.

* Keep smiling.


1. Add:
- sulpiride 50mg - 200mg or amisulpride 50mg - 100mg if you are not averse to procuring foreign drugs. You will get an answer witching 7 days.
- Zyprexa or Risperdal or Zeldox (when it come out - spring?)

1. Add desipramine or nortriptyline to the above.

2. Do not add an SSRI, Effexor, or Serzone

3. Add a combination of stimulants along with the the above: one from group A and one from group B

Group A:
- Adderal
- Dexedrine
- Ritalin
- Cylert

Group B:
- Mirapex
- Parlodel
- Permax

4. Add thyroid hormone with the above:
- Cytomel T3
- Synthroid T4 (my preference)

5. Switch to Nardil or, perhaps later, Marplan: all other medications remain in place.

7. Try other things your doctor suggests

8. Switch back to Parnate and combine it with what you have found most successful.

6. Ask JohnL about the usage of Remeron in this algorithm.

7. Ask AndrewB about the usage of Eldepryl (selegiline) in this algorithm.

8. Brainstorm some more

9. ECT - when you are ready to try it. Last or sooner.

* The band had a hard time keeping up with the Vice-President as he waltzed across the stage. They had no algorithm


- Scott




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