Posted by desolationrower on December 18, 2008, at 12:01:10
In reply to Re: TRD --SLS, CPTAmerica » desolationrower, posted by SLS on December 18, 2008, at 6:37:51
> > Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason?
> Not really. I just remember that, during the first few days of modafinil treatment (added to imipramine and Lamictal), I felt some pretty good stuff, and just wondered if it might not be a great augmenter of an MAOI. Unfortunately, toward the end of the first week, I deteriorated; an increase in the severity of my depression that lasted for weeks after the discontinuation of modafinil. Was there a glutamatergic antagonism by modafinil of Lamictal that caused this? I can't be sure.
> If one really thought they could hand-pick drugs based on their properties, I guess there would be no concrete rationale that I am aware for why there might be a synergistic effect between the two drugs. I am still not convinced that modafinil is fully understood, and that dopamine reuptake inhibition explains its wake-promoting effect. If anything, it might help with vigilance. Wake promotion seems to be the result of orexin (hypocretin) interactions in the hypothalamus and reticular formation. One wouldn't necessarily think of this as being important in the etiology of depression. I have yet to read about just where and how dopaminergic flow is enhanced by modafinil.
> - Scott
Yeah, it seems to be one of the least understood meds. I think it also increase 5ht efflux in pfc, so that would make it one of the few meds with 5htergic properties that can be taken with an MAoi, although i guess a number have similar downstream effects. Also interesting the 'hibernation' theory of depression vs. antiD effects of sleep deprivation, hypocretin activation.