Posted by SLS on November 13, 2010, at 15:12:13
In reply to Why do I feel like jumping off a bridge?, posted by maxime on November 12, 2010, at 21:53:57
> I don't feel good ... at all. Not physically and certainly not mentally. Yes, the Parnate helps to a degree but I am still really depressed whilst taking it. It is still the best med that I have taken for my depression to date. Why can't I have total remission?
Who says that you can't?
I know, I know.
I hope to be surprised one day. You never know what drugs will become available in the future.I never expected to respond at all to agomelatine. However, I experienced two 3-day improvements that were unmistakable (to me) as being antidepressant responses. My doctor and I are perplexed as to why my responses last for exactly 3 days, no matter which drug is being used. If agomelatine can produce a positive reaction in me with my stubborn brain - even for 3 days - I have to imagine that it might be an effective treatment for other people.
Regarding your somatic pains, I hope desipramine works for you. Some researchers are of the opinion that it is the mixed NE/5-HT reuptake inhibitors that are most effective for pain. Cymbalta might be the best of these drugs for pain. Of course, any of these drugs would be absolutely prohibited for you to take in conjunction with Parnate. If I found myself in your situation, I would try desipramine. It might act synergistically with the pro-serotoninergic properties of Parnate. If nothing else immediately available helps, you might need to return to nortriptyline or try a low dosage of amitriptyline if hyperprolactinemia does not become a problem. Have you ever tried doxepin? A friend of mine once responded robustly to a combination of Nardil and doxepin. Doxepin can help with insomnia and anxiety, and is thought to be safe in combination with MAOIs.
"Combinations of MAOIs and TCAs may occasionally be used in specialist practice; but not all specialists have sufficient knowledge or experience to do this safely; it is uncertain how much is to be gained from the technique. The main danger is serotonin syndrome which can be fatal. This is likely to be caused by:-- MAOIs (including RIMAs such as moclobemide) when they are combined with 'SSRIs', or any TCA which is also a serotonin reuptake inhibitor (SRI) i.e. clomipramine and imipramine. Dual action drugs are also dangerous viz. venlafaxine, sibutramine or milnacipran (see other serotonin toxicity notes for details). TCAs that are essentially only noradrenaline reuptake inhibitors, which is in fact most of them-- see (5) are quite safe when combined with MAOIs. So adding a small dose of amitriptyline, nortriptyline or doxepin to improve sleep (via H1 blockade, and perhaps 5-HT2A/C blockade) in a patient on MAOIs is most unlikely to cause any major side effect problems and does not give rise to any risk of serotonin syndrome."
http://www.psychotropical.com/maois_full.shtml
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.
poster:SLS
thread:970034
URL: http://www.dr-bob.org/babble/20101107/msgs/970098.html