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Re: Scott - medication responses? » SLS

Posted by JohnX on October 14, 2001, at 17:52:33

In reply to Re: Scott - medication responses? » JohnX, posted by SLS on October 14, 2001, at 15:09:25

> > I'm looking over your med list. Maybe we can
> reason through to find a pattern that will help
> you reach an end to your search. This has worked
> well for me. Maybe it is psychosomatic for me, but
> my working theories seem to correlate well with
> responses I get from various meds.
>
>
> Hi John.
>
> I really appreciate that you have taken an interest in me.
>
> I guess I can give you an idea as to which drugs helped and which ones hurt. I am a DST non-suppressor.
>
>
> These produced partial or brief improvement:
>
> imipramine
> desipramine
> amitriptyline
> nortriptyline
> tranylcypromine
> phenelzine
> clorgyline
> venlafaxine
> paroxetine
> d-amphetamine
> lamotrigine
> gabapentin
> bromocriptine
> olanzapine
> viqualine
> thyroxine
>
>
>
> These produced significant exacerbations:
>
> amoxapine
> protriptyline
> triiodothyronine
> bupropion
> moclobemide
> reboxetine
> mirtazepine
> idazoxan
>
>
>
> Drugs I haven’t tried:
>
> nefazodone
> citalopram
> sertraline
> fluvoxamine
> topiramate
> tiagabine
> sibutramine
> pramipexole
> pergolide
> amisulpride
>
>
>
>
> 1. Tricyclics have made me feel 100 percent well for two or three days beginning on the 13th day of treatment. The switch into depression is abrupt and dramatic.
>
> 2. A combination of tranylcypromine + desipramine produced the only long-term remission I have ever experienced in the last 25 years. I was functionally 100 percent, but I experienced residual anhedonia. This remission lasted for 6 – 9 months before a dysphoric or mixed-state mania developed. These drugs were withdrawn, and I was treated with lithium and clonazepam. Lithium produced a mild antimanic effect. The addition of clonazepam helped a great deal. I relapsed into depression 8 weeks after the discontinuation of the antidepressants. My doctor elected to use only tranylcypromine. I received some mild benefit, but it was episodic and inadequate. Subsequent trials of the TRL + DMI were unsuccessful. I was taking lorazepam and triazolam for the entire nine-month period.
>
> 3. Several months later, I was switched from tranylcypromine to phenelzine. I experienced a dramatic improvement within two weeks. This state of normothymia lasted for about a month, and then waned. I was left in a mixed-state with some hypomanic features.
>
> 4. D-amphetamine can produce a moderate antidepressant effect that begins within an hour of the first dose. This response lasts for two or three hours before disappearing. I received no benefit from increasing the dosage or continuing the treatment for a few weeks.
>
> 5. Bromocriptine produced a mild improvement that lasted for three days immediately upon adding it to an ongoing trial of tranylcypromine + desipramine.
>
> 6. I received a small, but perceptible benefit upon adding thyroxine to a combination of tranylcypromine + desipramine + d-amphetamine.
>
> 7. Sulpiride produced a mild improvement within an hour of the first dose. It lasted several hours and then disappeared.
>
> 8. Modafinil produced a mild improvement within an hour of the first dose. It lasted for no more than an hour.
>
> 9. Placebo was no better than placebo.
>
>
> Thanks for trying to brainstorm this stuff, John.
>
>
> Sincerely,
> Scott
>
>
> - It seems that the brief 3-day response to various drugs is pervasive amongst people with TRD. For me, this has been the case with tricyclics, MAOIs, d-amphetamine, bromocriptine, and atypical neuroleptics. Not 2 days. Not 4 days. I am hoping that a drug like memantine will allow for these antidepressant responses to remain stable beyond this 3-day period.

Thanks for the information. I really
hope you can get something that sticks. My
list of meds was over about a 2.5 year span,
and nothing is more frustrating than having these
little blips of depressive relief only to relapse.

I've been extremely fortunate to run into Lamictal.
This pulled me out of some severe dispair, but
I don't believe I am anywhere near cured. I
still have some really crummy days. And it does
interfere in psychological ways. For example I'll
string together a number of good days and make
obligations thinking I'm fine, but then I'll hit
a slump and feel hopeless and paralyzed (like this
morning).

Memantine was where I was going with this too.
It seems as though you should be able to at least
get some sort of sustained anti-depressant response
on something strong like d-amphetamine.

Have you had a chance to try memantine, or
are the logistics getting in the way? PS
those meds like clonodine and guanfacine
inhibit NMDA transmission. I say just go
to the source (glutamate).

There is a cheat to this which may work but
seems a little dangerous is to use
dextromethorphan in combo with a drug that
supresses cyp2d6 like quinidine (or maybe
Paxil?). See US patent 5,863,927. www.uspto.gov.

In high doses the nmda antagonists can be dangerous as glutamate
stimulates gaba neurons in some areas of the brain.

Memantine appears to be the least problematic due
to its "competitiveness" that we talked about.
You may also want to look into Baclofen. You
can get this in the US, it is also an anti-spasmodic.
If you go on medline you will also see a lot
of references to Baclofen (a GabaB agonist) preventing
addiction (which hopefully in our cases can mean
no poop-out).

I really wish the best for you Scott. Please
don't give up, you haven't tried everything and
neither have I. But it seems apparent that for
the number of meds you have run through (which
you are correct, makes me look like a light
weight), that alternative answers are needed.

PS. have you been screened for metabolism
of liver enzymes (like poor cyp 2d6 metabolizer,
etc)?

Btw, I had some luck with Serzone, and I think
this has both to due with its alpha-1 antagonism
and its 5ht-2 antagonism. Again, it made me drowsy
but all of a sudden I could take stimulates like
caffeine and get a consistent buzz. I would consider
taking Serzone again if I could take a medication
that would alleviate the drugged out problem.
The other thing I would wonder is how I would
respond to any med I took *before* taking lamictal
if I now added it to lamictal. Maybe serzone
wouldn't zone me out.

Good Luck,
-john


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poster:JohnX thread:81196
URL: http://www.dr-bob.org/babble/20011007/msgs/81298.html