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Re: Parnate...Adderall...Zyprexa, etc.

Posted by Ron Hill on April 7, 2005, at 0:13:39

In reply to Parnate...Adderall...Zyprexa, etc., posted by Whit_in_Texas on April 4, 2005, at 20:01:48

Whit,

Thanks for your well written post.

Just curious, have you ever tried the dopaminergic medication Selegiline (l-deprenyl) to treat your atypical depression? As I'm sure you know, Selegiline is a selective MAOI-b at or below around 10 mg/day.

If you tried it, I would greatly enjoy hearing how it affected you. If you have ruled it out, I'd enjoy hearing your rationale (since you sound well versed in p-meds).

As an aside, how risky do you think it would be to take a very low dose of Adderall in conjunction with 10 mg of Selegiline? I'm a novice when it comes to pharmacology, but my first impression is that it would be risky to co-administer a dopamine reuptake inhibitor (Adderall) with an MAOI-b.

I pose the above question because I'm considering replacing my low dose of Adderall XR with a trial of Selegiline. However, one of my concerns is that if the Selegiline trial fails and I have to discontinue it, then it might be risky to return to Adderall right away because Selegiline is irreversible (and, therefore, the mao-b enzymes remain artificially low for several months after discontinuation of Selegiline).

-- Ron

BP II and OCPD

600 mg/day Lithobid

900 mg/day Trileptal

50 mg/day Lamictal (level limited by rash)

5 mg every other day of Adderall XR as tx for atypical depressive symptoms; more frequent use causes "pstim burnout" symptoms.

Note: If I add deprenyl, I plan to discontinue Adderall XR.
------------------


> Brief History: Been on psychobabble for a couple of years, just starting over with a new name...I am bipolar type 2 (more accurately "other than specified" in DSM jargon) and a veteran of treatment resistant depression since 1991...my wife is a licensed psychologist with a Ph.D. from UT and she may post or reply in my name from time to time...my wife and I are starting her private practice in the Dallas/Ft. Worth area...anything responding to any post I put out may be used and/or published anonymously. We have found this website to provide an invaluable resource to those suffering from depression and/or bipolar disorder and hope to contribute positively.
>
> Message: I am going to start a new med regimine made up of everything that has ever had a positive effect on my depression: Parnate, Adderall, and (probably) Zyprexa. I am currently on Desipramine 250mg but will be quitting as I feel no effect whatsoever. I am already taking 10 mg Zyprexa at night and 60 mg (regular) Adderall daily, with periodic 48 hour "holidays" to counteract tolerance (as anyone who's been there knows...pure hell).
>
> I came to the conclusion about six months ago that, while Adderall has provided the most robust relief from depression for me, it cannot be relied on alone for long-term relief. Tolerance is inevitable and the rebound depression is very severe. I tried using tricyclics (currently Desipramine) as a mainline anti-depressant most recently, but after 8 weeks or so have given up on it. About a year or so ago I found moderate relief from depression with Parnate after an unsuccessful trial with Nardil; however, I eventually quit Parnate due to tolerance to above recommended dosages (don't recall specific dosage).
>
> Anyway, I intend to start a medication regimen using Parnate as a baseline anti-depressant augmented with Adderall and mood-stabilized with Zyprexa (most effective with me in the past). First I need to find a new pdoc in my area that is okay with this combo, but it should be soon since my wife knows the doctors in the area pretty well.
>
> From my own experience, I have found regular Adderall to be superior to Adderall XR and any other stimulant at quickly relieving depression. I have even noticed a small difference between brand-name Adderall and its generic, with brand-name providing a slightly better response. I tend to acquire tolerance very rapidly to all drugs, with Adderall being no exception and I need at least 40 mg in the morning to initiate a positive effect and another 20 mg around lunchtime to extend the effect. I have found that going beyond 60 mg is dangerous and that even at 60mg per day I need a 48 hour or more "holliday" from Adderall every 2 weeks or so to restore effectiveness.
>
> I guess that's it for now. I will add a new thread with this post and intend to follow-up regularly once the medication regimine is initiated. Thank you for tolerating my long-windedness!
>
> Whit_in_Texas


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