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Re: LITHIUM, as the sole AD? Mitch

Posted by SLS on October 5, 2001, at 23:41:59

In reply to Re: LITHIUM, as the sole AD? SLS, posted by Mitch on October 4, 2001, at 13:06:02

> > Hi Mitch.
> >
> > There seems to be a widely held belief that Parnate is the MAOI of choice when treating bipolar depression. I'm really not sure why. I don't know that there is any real evidence to support this practice. It might be that since Parnate is amphetamine-like and often energizing, it would seem the appropriate choice for the anergic depression that bipolar disorder most often presents with. Although Parnate may not really be statistically superior to Nardil, it is usually more forgiving with respect to side effects. If for no other reason, this might be a good reason to choose it first. However, given that you also suffer from a comorbid anxiety disorder, Nardil might end up being the better of the two for you. If you don't respond to Parnate, it certainly makes sense to try Nardil as well. Many people do much better with one than the other.
> >
> > I don't know if the manic switch rates for Parnate or Nardil are any lower than the SSRIs. Actually, SSRIs were once thought to have a reduced potential to induce mania than both the tricyclics and MAOIs, but I don't know if there have been any studies focusing on this issue. Both Parnate and Nardil have caused me to switch into mania whereas such was not the case with tricyclics, SSRIs, Wellbutrin, and Effexor. If there is any one drug least likely to induce mania, it would be Wellbutrin, which is one reason it is often chosen first when treating bipolar disorder. I think it might also have a greater rate of producing an antidepressant response. I don't recall seeing very many people become manic on Serzone.
> >
> > I think choosing an MAOI is very sensible for you at this point, but it might be prudent to take at least one mood-stabilizer concurrently to minimize the risk of mania. It might even improve your chances of successfully treating the depression. Historically, I think Depakote has been shown to be the most effective when treating mixed-states. I don't know how Lamictal, Neurontin, Topomax, or Gabitril compare in this regard. Although Lamictal does exert some antidepressant effects upon me, 200mg/day was absolutely useless in preventing a Nardil-induced switch into a dysphoric mania. Depakote 1000mg - 1500mg has been a potent antimanic for me. Lithium has not been.
> >
> >
> > - Scott
> Thanks Scott, for the response. I suppose I would need to clarify some stuff. I am what my pdoc calls "hyperresponsive" to meds. There have been situations where 1.25mg of Celexa (i.e.), triggered a potent hypomanic episode (like smoking grass) for about 2-8hrs after taking it. Another incident that was far more intense was taking 37.5mg of Effexor which also triggered a robust hypomanic episode that was also quite intense and brief (about 5 hrs). But...those type of meds make me more sociable and settle down panic and reduce anxiety generally. I was on Adderall (5mgAM) with no AD's and my cycling STOPPED and my sleep/wake cycles normalized and I had NO depression (poof!), but...I was cool distant quiet unhumorous. Then I got a thyroid tumor! Could you share some insights into this?
> Mitch

Hi again.

Believe it or not, stimulants can sometimes help to stabilize mood when used in combination with other drugs and paradoxically act as an antimanic agent. So, too, can high dosages of T4 (not T3) thyroid hormone help to stabilize mood and encourage an improvement in depression when used as an adjunct.

- Scott




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