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Re: Not that I'm complaining, but... Adam

Posted by SLS on September 29, 2001, at 10:38:10

In reply to Not that I'm complaining, but..., posted by Adam on September 27, 2001, at 21:10:33

Hi Adam.

I do hope you remain well, whatever you decide to do.

> I've been off of selegiline for almost a month and a half now. Its antidepressant effects should have worn off a long time ago.

This is not necessarily so. The one time in my life that I felt almost normal (for more than a few days) was while I was taking a combination of Parnate + desipramine. After 6 months of normothymia, hypomania developed which, over the course of 2 months, became a severe dysphoric mania. Both drugs were discontinued and the mania was treated with lithium + clonazepam. After four weeks without the return of depression, I thought I was cured! By the end of eight weeks, depression reappeared.

Because of my case history of severity, chronicity, and treatment-resistance, it seems pretty clear that my doctor should have placed me back on an effective antidepressant regime after the mania had been controlled. Actually, I am not so sure it makes sense to withdraw antidepressants in this kind of scenario. I don't know that there is any data to support this course of action. Mood stabilizers or anti-manic drugs are to be administered anyway, so why not leave the antidepressants on-board?

> Whatever is maintaining a euthymic state right now, it's not selegiline.

It might be a sort of functional inertia. For those people who are to relapse after drug discontinuation, most will do so within four months. You are not out of the woods as far as this temporal window is concerned, so it's best to be wary of the signs that depression is reemerging. The key is to recapture the antidepressant response as soon as possible, or you risk becoming non-responsive to the previously effective drug.

Since you know plenty of my history, you'll know where I'm coming from when I say that were it me, I'd stay on selegiline (or some other therapeutic agent) indefinitely.

I wish you well. I never want to see you reappear on Psycho-Babble in search of a new drug. That way, you will continue to have nothing to complain about.

Good luck.


Sincerely,
Scott

 

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