Posted by Ame Sans Vie on August 21, 2003, at 12:11:59
In reply to NARDIL- THE ONE THAT GOT AWAY, posted by matt66 on August 21, 2003, at 9:18:56
It's possible that a higher dose of Nardil will work for you, though I'd say unlikely, since I very rarely hear of a medication pooping-out on someone and then starting to work again, even at a raised dosage. I was on 120mg for six months (for social phobia, agoraphobia, panic disorder and depression, primarily) and it didn't work at all for me, unfortunately. But the point is, as long as your prescribing physician is comfortable with it, a higher dose is certainly an option. And if it ends up working, but only partially, you *can* augment with another medication (stimulants seem to work best, though the atypical antipsychotic Zyprexa also show great promise). I know stimulants are "contraindicated", but many people safely take stimulants with MAOIs. You just have to start at a very low dose and titrate upwards very gradually. And of course keep some Thorazine or nifedipine on hand in case of a hypertensive crisis.
And that leads to another possibility -- have you ever tried a stimulant to treat your depression? Or a narcotic pain-killer, for that matter? There are plenty of doctors that are willing to try these options out on you once all else has failed. I too have tried just about every med out there. The only ones I can think of offhand that I *haven't* tried are Parnate, several of the tricyclics, and about a dozen of the antipsychotics. Nothing has ever helped my depression, save a few tricyclics (but the side effects were just to awful to continue them). So I brought in some research to my doctor on the use of Ultram (tramadol, an opioid painkiller that also possesses serotonin/norepinephrine reuptake inhibition qualities) in treating depression and OCD (which I also have, to a moderate degree). To my complete and utter shock and disbelief, he immediately agreed to start me on a trial of it several months ago, and my depression and OCD symptoms haven't reared their ugly heads once since then. Another narcotic that has been studied for use in depression (with excellent results) is buprenorphine, brand name Subutex. Just fairly recently it was FDA-approved in a sublingual form (dissolves under the tongue) to treat opiate addiction, though people have been using the injectable form (Buprenex) either sublingually or intranasally for years before the new form was released. Often though, if a doctor is going to prescribe buprenorphine for depression (or probably just about anything else for that matter), they'll give you a form called Suboxone, which is also sublingual. Same active ingredient, but it also contains naloxone, an opioid-receptor antagonist, to prevent addicts from injecting the pills -- the naloxone prevents the buprenorphine from working and causes withdrawal symptoms when injected. Taken orally though, it doesn't have an effect.
As for the stimulants, many people with treatment-refractory depression respond amazingly well to treatment with methylphenidate (Ritalin, Metadate, Methylin, Concerta) or an amphetamine (e.g. Adderall [dextro- + levo-amphetamine], Dexedrine [dextro-amphetamine], Desoxyn [dextro-methamphetamine]). I take Dexedrine Spansules (the extended-release form of the drug) for my ADHD. I find that occasionally when I miss a dose of my Ultram, the Dexedrine keeps the depression at bay.
Also, you didn't mention benzodiazepines in your post... have you tried them? I know, I know -- they're anti-anxiety drugs, and you didn't mention in your post that you have any issues with anxiety. But several of the benzos are also quite useful in depression -- Xanax, Ativan and Serax in particular. And now that a long-acting version of Xanax has been released to market (Xanax XR), it makes it a lot more practical since it requires only once- to twice-daily dosing. These seem to be the most reliable benzos for treating depression, though some find that Klonopin works better for them. Oh, and a benzodiazepine with antidepressant activity is another option for augmenting an MAOI.
Hmm... what about things that are even a bit *more* off the beaten path? In other words, anti-Parkinsonism drugs -- dopamine agonists. Many people find great relief from depression, increase in libido, and increased motivation and cofidence taking one of these medications. The two that are most likely to help are Mirapex (pramipexole) and Requip (ropinirole). I took Mirapex myself for several months and was thrilled with the results. Unfortunately it began to make me very sleepy at times, so I discontinued it. But if you decide to try one of these meds and that ends up being a problem, Provigil or another stimulant medication could take care of that side effect. Keep in mind that not everyone experiences that side effect, either. Another Parkinson's drug, though you may have already tried it since it's an MAOI, is Eldepryl (selegiline). At lower doses though, it only effects MAO-B, not MAO-A. The result is an increase in available dopamine, and no need to strictly adhere to dietary restrictions. At higher doses however, it inhibits both MAO-A and -B and is said to act similarly to Parnate.
Other than that, all I can think of at the moment is the drug Rilutek (riluzole), the only FDA-approved medication for amyotrophic lateral sclerosis (Lou Gehrig's disease). There are currently studies underway that are testing its efficacy in treating depression and anxiety, and judging solely from its mechanism of action, it looks pretty promising. You may want to research it a bit.
Finally, I really hope you're in therapy -- in the opinions of most medical professionals and patients, medication plus therapy is the only way to go.
~~Michael
P.S. Just thought I'd let you know (I think you're new here -- correct me if I'm wrong) that you're probably going to receive a PBC from Dr. Bob for using certain language in your post. There are some pretty straightforward civility guidelines that help keep this board as relatively safe as it is. You can access those guidelines here:
http://www.dr-bob.org/babble/faq.html#civil
poster:Ame Sans Vie
thread:252711
URL: http://www.dr-bob.org/babble/20030818/msgs/252764.html