Posted by cybercafe on December 15, 2004, at 21:19:56
In reply to Re: Treatment Resistant ( sorry a little long ), posted by King Vultan on December 15, 2004, at 20:06:22
> > I wonder if anybody out there has some suggestions as how I can obtain 100% remission from treatment resistant recurrent depression. I've been depressed on and off for 14 years. I had full remission of symptoms from around 1995 -2001. I was on a combination of Wellbutrin XL and Effexor XR ( 450mgs and 225mgs respectively) and Klonopin on an as need basis. In 2001 I experienced my 3rd major episode and am currently still having symptoms. I have been on every class of drugs including an MAOI..which I am currently on...Parnate ( up to 60 mgs)currently on 40mgs due to side effects ( insomnia especially and anxiety). I am also taking Klonopin on a daily basis..apprx. between .75mgs and 1 mg daily. I feel I've reached a level of about 65-70 % remission .I have been on Parnate since August. I am unhappy with the remission leevel and I told my doctor no sense being on the dietary restrictions if I still have to live with the depression. Does anyone have any ideas or suggestions and/or have been in a similar situation. The doctor wanted to add Provigil but I was afraid of it intesifying insomnia and anxiety. I was thinking of asking the dooctor to maybe re-try Wellbutrin and replace the Effexor with Cymbalta. Any responses and or suggestions and experience would greatly be appreciated. The only thing I won't consider is ECT. By the way I am also in CBT but both my doctor and therapist feel I have a very biological and genetically based problem because things are going very well in my life and the depression sort of gradually came out of nowhere. I appreciate any help.
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> I am on 60 mg Parnate, and while I appear to have achieved a somewhat better remission than you have, I am not quite where I want to be in a few areas. I am also suffering from severe insomnia from the Parnate and have finally come up with a sleep med scheme that is reasonably effective; however, my anxiety levels are apparently quite a bit lower than yours are.
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> What I intend to ask my pdoc about at my next appointment is adding a low dose of an atypical antipsychotic that is selective for blockading serotonin-2A receptors (I have a paper that suggests 0.5-1.0 mg/day Risperdal). There is some persuasive evidence that this can have a synergistic effect in augmenting drugs that increase serotonin transmission, of which Parnate would be one example. Drugs that blockade the serotonin-2A receptor will also tend to help with sleep, as stimulation of this receptor causes insomnia in some people (I am someone who suffers particularly bad insomnia on SSRIs and Effexor, so it makes sense to try in my case).
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> My own experience with Parnate has been that there was a significant improvement in a number of areas going from 50 to 60 mg/day. While 60 mg/day is ostensibly the maximum as indicated in the Physician's Desk Reference, taking 70 or 80 mg/day is not that uncommon and IMO is not an imprudent amount for individuals who don't fully respond at lower dosages. If you want to take full advantage of this drug, I feel you really owe it to yourself to work with your doctor in finding some sleep med or combination thereof that will allow you to take a higher dosage.
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> One other option you might want to consider if you haven't already tried it is Nardil, which IMO is a better med for anxiety than is Parnate. The insomnia does not generally seem to be as bad on Nardil (It was still terrible for me because any drug that increases serotonin transmission will give me insomnia), but Nardil is not nearly as dopaminergic as Parnate and is a much poorer med if you have ADD type symptoms as I do. Nardil also has more side effects in general than does Parnate.
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> Toddi added low dose abilify (got rid of insomnia) and ritalin (for ADD, boredom, depression?)
poster:cybercafe
thread:430034
URL: http://www.dr-bob.org/babble/20041211/msgs/430091.html