Posted by Ritch on March 1, 2003, at 9:50:03
In reply to Re: New Thoughts » Ritch, posted by Peter on March 1, 2003, at 0:30:28
> > Hi Mitch:
> I finally saw my doc today. I tried to adhere to the MAOI dietary restrictions for the last 2 days-just to get an idea of how I'd cope with them. I gotta say that, with my anxious/hypochondriacal temperament, it was very difficult. But I was still under the impression that Nardil was the direction we were going in. But as we got into the meeting, he decided that the MAOI wouldn't be a good choice for me now; as he put it: 'it's like I'd have to give you another drug to help you to take the Maoi.' He didn't say this harshly or anything-he and I are always joking around. I told him what I mentioned on a post here about that if I did start up on another med, I'd prefer it to be something most likely to help in the long-term (not just another med that will ultimately end up exacerbating instead of helping my mood trends, thus requiring further med trials). He said there's no guarantee that the Nardil would help anymore than anything else, so it's not quite worth my taking it, what with all the anxiety I have about it.
> If you recall, my original other choice was Straterra; but he told me that he's been treating many patients with Straterra since it came out, and over the last week or two he's been getting a lot of complaints about it causing agitation/irritability. He also said that Straterra or a TCA would help my SP only to the extent that my SP is driven by my general mood; in other words, they do not directly treat social anxiety like MAOI's or SSRI's.
> Believe it or not, he decided the best thing to do would be to keep me on the lamictal 100mg, using it as a mood-stabilizer, and start Prozac at very low doses. Firstly, he said I always took depakote with the other SSRI's and the replacement of the depakote with the lamictal with a SMALL dose of an SSRI-especially Prozac- might just be what I need to balance out the SP/periodic depression.
> As for Prozac in particular, I've never tried it, and he said it has a good balance between energizing yet calming effects. And if it only works for a few months for me, its long half-life causes its cessation to not produce the level of withdrawal symptoms of an SSRI w/ a short half-life (like zoloft).
> It seemed like a strange choice at first, especially after all he had said in the past about SSRI's NOT working well with me, but he was very convincing today in his reasons for my taking Prozac. What do you think?
> BTW, have you taken Prozac? Also, out of curiosity, ever taken Nardil?
> Hope all is well,
Hi Peter, Never taken an MAOI. My depressions never reach the severe level. At their worst it gets tough to make it to work (a few days per major episode) and my cognitive function is primarily impaired and I make mistakes and I am very TIRED, HUNGRY, and I gain weight and sleep a lot. I've got two different "times" of depression-the seasonal thing I just mentioned (bi-annual) and short-term chronic(few days) depressions that occur during my three week mood cycle that churns away nonstop through the year.
Your doctor may think you are becoming more stable on the Lamictal (you sound more stable now than ever BTW) and doesn't want to "rock the boat" big time with an MAOI. You said you would have to reduce your Adderall (creating one potential problem), become vigilant with your diet (creating more anxiety), and needing to carry around or take a high blood pressure med to enable you to maintain the Adderall (more polypharmacy). I don't think he fully realized the impact of the change. OTOH, he possibly was wanting to reassure you that he would be willing to try it (MAOI) and wanted you to go over all of the ramifications of taking it well before a decision was made (your literature on food restrictions, etc.) to gauge your full reaction to the idea.
I think your doctor is correct about TCA/Straterra helping your SP sx only to the "extent that it was driven by your mood". My SP symptoms are VERY driven by what mood state I happen to be in. I withdraw socially when I get depressed and experience more anxiety generally. When I get hypomanic I'm the one with the lampshade on, and going up to strangers and asking their name and shaking their hands, and BS'ing with them. Meds that get me up and MOVING are the ones that help the best when I am depressed.
Prozac was my favorite SSRI as far as what it did for my *head*. I have IBS problems and all SSRI's and lithium just wreak havoc on the poor nerves in my gut. I also had improved attention on Prozac. It was the only SSRI that helped with that (not even Effexor helps much in that dept., but easier on the tummy). Zoloft gets me off my ass and motivating, but it caused a lot of nausea and the worst sleep disturbances of any of them. The only AD's that consistently improved attention for me have been desipramine, Prozac, and Wellbutrin (not as well as the former two). And Prozac reduced anxiety whereas the other two tend to make it worse. I still want to try a *little* Straterra with my Effexor, though. You may get a similar effect with the Prozac. It sounds like a good pick!----good luck, Mitch