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Re: LAMICTAL usage for soft Bipolarity, Jeff

Posted by SLS on April 9, 2002, at 9:33:30

In reply to Re: LAMICTAL usage for soft Bipolarity, Jeff, posted by polarbear206 on April 8, 2002, at 20:49:45

Hi.

Sorry for butting in.

> Are you having any nasty side effects with the Parnate verses the other AD's you tried in the past?

When I have taken MAOIs, I have experienced little or no side effects after a few months have passed. If you are a virgin to Parnate or Nardil, be prepared for some big-time hypotension. The first time I tried Parnate, I had to sit or lay on the floor at times, regardless of where I was. However, this pretty much resolved completely. Paradoxically, some people react to Parnate in the opposite fashion. Their blood-pressure rises significantly, if not dangerously. This is idiosyncratic of the individual, and usually shows up early in treatment.

MAOIs can be combined with many other antidepressants, and just about all stimulants and mood-stabilizers. The only real exceptions are those drugs that are potent serotonin reuptake inhibitors. These would include the SSRIs (Prozac, Zoloft, Paxil, Luvox, Celexa, Lexapro), Effexor, and Anafranil. Such combinations can produce a sometimes fatal reaction known as Serotonin Syndrome. This reaction is the result of too much serotonin accumulating, as MAOIs prevent excess serotonin from being properly disposed of and disassembled within the neurons (catabolized by the MAO enzyme) while at the same time having an SSRI prevent these neurons from sweeping up after themselves after having released their serotonin into the gap between them (reuptake inhibition).

"The symptoms of the serotonin syndrome are: euphoria, drowsiness, sustained rapid eye movement, overreaction of the reflexes, rapid muscle contraction and relaxation in the ankle causing abnormal movements of the foot, clumsiness, restlessness, feeling drunk and dizzy, muscle contraction and relaxation in the jaw, sweating, intoxication, muscle twitching, rigidity, high body temperature, mental status changes were frequent (including confusion and hypomania - a "happy drunk" state), shivering, diarrhea, loss of consciousness and death."
(The Serotonin Syndrome, AM J PSYCHIATRY, June 1991)

I have combined both Nardil and Parnate separately with desipramine and imipramine, along with Ritalin, Dexedrine, and Parlodel. At one time, I was taking Parnate 120mg + desipramine 200mg + Dexedrine 15mg + T4 thyroid hormone.

> I just don't know how I would get through the washout period?? How did it go for you? To tell you the truth, thats what scares me the most!!

Some people have used stimulants like Ritalin, Dexedrine, or Adderall to create a "bridge" until beginning the new medications. I think Ritalin is chosen more often - probably because it is not so nefarious a drug. Some have had success with S-AMe (S-adenosyl-methionine). (For some reason, the erroneous acronym "SAM-e" has been adopted and perpetuated by both the pharmaceutical and medical communities. I find it comical. The "S-" is the organic chemistry nomenclature for the arrangement of a chiral center in a molecule: S-sinister R-rectus. "Me" is the abbreviation for the amino-acid methionine. It is very, very silly to remove the hyphen from the (S) designation and move it over to break up the "M-e". Rant completed). I have often wondered if Zyprexa would be helpful in these situations. It would be pretty neat if someone could verify this with personal experience. I also think a benzodiazepine like Ativan might be of help, but I haven't read anything on that specifically.

If it were me (treatment-resistant and TCA partial-responder), I would keep the tricyclic and discontinue only the Paxil. Paxil is sort of like an SSRI with a TCA personality. You'd only have to experience half of the Paxil withdrawal syndrome, plus optimize your chances of obtaining an antidepressant response with the MAOI-TCA combination.

Just a few thoughts while my coffee is brewing. Actually, it's probably stale by now.


- Scott

 

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