Posted by Elizabeth on May 12, 2001, at 21:10:52
In reply to Oy Vey: Opiates » kazoo, posted by SalArmy4me on May 12, 2001, at 0:28:47
> I'm willing to bet that the people endorsing opiates for depression have not tried every more convential treatment for depression.
"Every?" You mean, like, every one of the 10 or so tricyclics, 5 SSRIs, 4 MAOIs (more in some countries), 6 or so miscellaneous atypical ADs, and augmentation with every mood stabilizer, lithium, BuSpar, pindolol, every antipsychotic, all available psychostimulants, high-dose alprazolam, ECT, folate, total and partial sleep deprivation...do I have to go on? Or do you get the idea?
I've taken pretty much all of the above. Here are the exceptions:
- only tried 3 TCAs (desipramine, nortriptyline, and amoxapine) and didn't tolerate them due to typical anticholinergic/antihistaminic TCA side effects that are known to be *worse* with other TCAs
- only tried a couple antipsychotics (Zyprexa most extensively, also Seroquel, Risperdal, Moban, Mellaril) and only, except for Zyprexa, in augmentation doses (Mellaril and Moban knocked me out at minimal doses, Risperdal caused unacceptable exacerbation of my RBD)
- only 3 SSRIs (Prozac, Paxil, and Zoloft)
- skipped Tegretol, Topamax (but other AEDs were useless)
- ECT is, in my judgment, less safe than buprenorphine (which I know first-hand to be safe and effective), so I never bothered with it
- never took antidepressant doses of trazodone for more than a couple days
- didn't bother trying to order Manerix from overseas because it has such a lousy rep, especially compared with the traditional MAOIs which I did try (Nardil, Marplan, Parnate, *and* high-dose selegiline)
- haven't tried taking high-dose Xanax around the clock
- haven't tried some of the weaker stimulants that are marketed for weight loss (e.g., phentermine) or Desoxyn (did try modafinil)
- never tried high-dose (60-90mg) buspirone
- I am absolutely uninterested in St. John's wortSo there's your counterexample. I think that it's unreasonable to expect me to try a RIMA when irreversible, nonselective MAOIs didn't work, or to keep trying SSRIs or TCAs. Also please bear in mind that I'm not bipolar or psychotic.
I have a minor interest in trying Aricept or Desoxyn, but it's nontrivial to convince a pdoc to prescribe either of these (Aricept because of my REM sleep parasomnia, Desoxyn because, well, it's methamphetamine -- although it might be safer with MAOIs than Dexedrine or Adderall). I would also consider high-dose buspirone, or possibly Meridia (Effexor is out due to a life-threatening ADR).
> I maintain that if one writes a list of psychotropic medications one has taken, I can always find 10 other viable and legitimate medications to try.
Please, by all means. Me-too drugs (like other SSRIs, TCAs, stimulants, or neuroleptics) don't count. Anything that has to be ordered from overseas is only marginally "viable." Anything that is only available through premarketing trials is out of the question (I usually don't qualify for clinical trials because they require you to be off all AD meds, which my doctor and I both feel is an unacceptable risk in my case).
So, there are the rules. I think they're quite fair given the grandiosity of your claim. Go for it.
-elizabeth
poster:Elizabeth
thread:61760
URL: http://www.dr-bob.org/babble/20010507/msgs/62672.html