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Re:BEST NARDIL AUGMENTATION?)))d/r

Posted by desolationrower on December 4, 2008, at 13:22:04

In reply to Re:BEST NARDIL AUGMENTATION?)))d/r, posted by that_guy23 on December 4, 2008, at 1:39:32

>You say for gabaergics are best for anticipatory anxiety, I guess tou mean generalized anxiety?

well, i mean the anxiety that occurs ahead of time, not during social interaction. Here is a description:

->>>Clinically, an early differentiation between brain systems that contribute to panic
attacks and those that generate anticipatory anxiety was based on the observation that
first-generation BZ antianxiety agents (e.g., chlordiazepoxide and diazepam) were not
as effective for controlling either panic attacks or separation anxiety as tricyclic antidepressants
(e.g., imipramine and chlorimipramine). Although such tricyclics turned out
to be excellent antipanic agents, they had comparatively modest effects on anticipatory
anxiety (Klein and Rabkin, 1981). This pharmacological distinction no longer holds for
the newer and more potent BZs. For instance, alprazolam and oxazepam are effective
antipanic agents (Schweizer et al., 1993), but BZs are also effective inhibitors of separation
distress in some species (Panksepp, 2003). It is not yet certain whether these
effects are due to direct BZ receptor influences, or perhaps alternative paths such as
the facilitation of serotonin transmission or reduced beta adrenoreceptor activity. Of
course, the ability of some new antianxiety agents to reduce panic may also indicate
that the fear and separation distress systems also share certain inhibitory influences.
The massive interactions of highly overlapping emotional systems, (Panksepp, 1982)
highlight difficulties we must confront in brain research as well as clinical practice.
Since quite a bit is known about the brain localizations of the separation distress/PANIC
and FEAR systems, such issues could be empirically disentangled.

> I guess that does make sense, and quite a possibility, but i'm more concerned for anxiety, which I think comes first and would probably releive depression allot afterwards. I know I am gonna be careful with stims, but I get my blood pressure checked, which is quite low, and stims. also helps this. Although I will check your suggestion because of the addiction.
>
> I can't remember nortriptyline, but as you said maybe i didn't give it the right amount time or dose, but also I am looking for something fast acting right now, such as provigil or ritalin. Do you think concerta would be better than ritalin, or ritalin with longer acting tabs? I've heard of easier come downs, but also that it is gonna be discontinued.

Well, the nri would help with blood pressure, but in a more consistant way, which might be beneficial. And might be a bit less likely to get tolerance. I guess i think some of anxiety is ibhibition and lack of energy around people. At least it is for me, and it sounds like we have some of the same symptoms. I didn't notice adrafinil (very similar to modafinil) until i had been on it a week. A week or two doesn't seem like too long to wait, and getting scheduled drugs refilled can get expensive long-term because you have to see the doc every month.

I'm not totally sure how well the longer-lasting methylphenidate preperations work, or what is generic. There are a few newer options that are not generic that might be best, the daytrana patch, and concerta has the longest release of the pills. The other thing is usually at least for me, I have time to try to socialize after work, in the evening, so having stimulant work in evening is important. I'm not sure if racemic methylphenidate is different as far as blood pressure the way that racemic AMP has more effect on blood pressure.

> I agree I would never go with an amphetamine with maoi's!And bupropion I just found good for sex se's and think I'll check out the one you
> mentioned.

Well, my impression is that AMP is much better at increasing extroversion than methylphenidate is, so if the mpd doesn't work, consider amp.

> Did you mean a pure nri could make you feel people are focused on you, or the methylphenidate?

dopaminergics can cause paranoia. i don't think this is common in uncomplicated social phobics, but something to keep in mind.

> No I don't have a history of mania, so does that mean a mood stabilizer wouldn't be helpful to me, or just leave as a later resort?

theres not much evidence for most of them wrt unipolar. so i would leave them until you've tried otehr options, like nris, t3, stimulants

> My sexuall function is the only se right now that I can't tolerate. So I think I will check out the cyproheptadine, especially since it's cheap and safe.

I think its good to have around if you're on an MAOI in case of serotonin syndrome. if you haven't look up the sypmtoms and memorize them so you know if you are having it. its probably less likely than a hypertensive crisis, but still dangerous.

> yes, I will be researching that stuf as well, this is great, I love having options.
>
> Roboxetine, heard of that, din't here of desipramine. Attomoxetine, I will still have to check it out for more options, this would show my new doc. that I have done the proper reserch and that I know, pretty much what I want

desipramine is the cleanest of the tcas. its a very nice antidepressant. There is some slight concern it could be related to breast cancer risk, but the risk is small, and theoretical. Still, it woudl make me consider desipramine a second choice after nort or reboxetine despite its good side effect profile and being cheap.


> Oh one more thing. If the nardil didn't work out, is it true that I can start another maoi right aawy?

there was a report of someone having a stroke after directly switching, i think that is why many pdocs want people to wait a week or two. Keep in mind there is always risk of hypertensive crisis unprovoked by tyramine (i had my only one like this) so the new MAOI if dose is too high can cause this; i think this is more of a risk at the begining of treatment before the body adjusts to the drug. But i think as long as you start at low titration it is not a risk, and have a hypertensive antidote, i like clonidine personally; i haven't found any good evidence for which one is best, i think nifedipine is common, but with that one rebound hypotension is a problem, and is actually more dangerous. So i would personally say go right to 10mg of TCP for a few days, but you doc might want a washout. I did selegiline->TCP directly.

good luck. we have some very similar issues so its always nice to hear what works.

-d/r


 

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poster:desolationrower thread:863270
URL: http://www.dr-bob.org/babble/20081204/msgs/866674.html