Posted by SLS on November 17, 2009, at 6:13:17
In reply to Should I discontinue Adderall as Parnate 'augment', posted by Girlnterrupted78 on November 17, 2009, at 4:23:25
I think your doctor is taking a reasonable course try to build a combination treatment around Parnate - at least for now. I have not tried Adderall, but I have tried Dexedrine (d-amphetamine) in combination with Parnate 120mg. I felt a little better for the first few days, but that was it. I am not much of an example, though. It seems that I am not very responsive to anything anymore. My doctor now shies away from the idea of adding a stimulant. I think I'll have another conversation with him about it.
There are people on Psycho-Babble who report having success when adding a stimulant to Parnate. I just don't know how long it takes start working once treatment is initiated. One would think that it would be within a matter of days rather than within a matter of weeks as long as the dosage of Parnate is adequate.
I hope people who have actually tried Adderall or Dexedrine chime in. My guess is that this treatment doesn't help the majority of people. There really are no statistics to support it one way or another. If it were me, and Adderall had not shown efficacy over the course of weeks, I would discontinue it. One of the disadvantages of taking amphetamine chronically is that it facilitates neurotoxicity via the loss of DA uptake sites in the striatum and nucleus accumbens. It can also form free radicals because it is very oxidative.
Parnate is a drug that traditionally has been considered a good candidate to combine with lithium, even for unipolar depression. There are a few other things you can use as augmenters. You just need to be careful not to use a drug with significant serotonin reuptake inhibition. Such a combination is very likely to precipitate serotonin syndrome, a potentially fatal reaction. I would advise using either nortriptyline of desipramine if you plan on adding a tricyclic. Even imipramine is too serotonergic. Certainly, clomipramine is. Desipramine is probably more activating than nortriptyline, although nortriptyline is not usually sedating except for early in treatment. With nortriptyline, I would advise having blood tests to assay drug levels. Most people respond within a range of 50-150 ng/ml. Obviously, if you don't take enough, you won't respond. However, nortriptylne is a weird one. If you take too much, you actually lose the response. This behavior is called having a therapeutic window. Most people respond at dosages between 75mg and 100mg.
Sorry for writing so much. I just don't like dissuading people from trying something that might be effective, as long as it is safe. People differ so much in their responsivity to different drugs. What works for me might not work for you. Even methylphenidate is a drug worth considering. I probably wouldn't make it my first choice, though.
- Scott
poster:SLS
thread:926000
URL: http://www.dr-bob.org/babble/20091117/msgs/926005.html