Posted by jedi on May 1, 2011, at 2:12:06
In reply to Suggestions for further medications, posted by Deepreason on April 29, 2011, at 10:04:28
> Brief history:
>
> 36 year old male
> OCD, SAD, GAD leading to depression since early twenties.
> Deterioration in condition 2.5 years ago that led to an incident of serotonin syndrome. Struggled mentally ever since.
>
> Medications tried: 5+ SSRI's in my twenties/thirties. Pregabalalin. Quetiapine.
>
> Mirtazapine 30 mg + Venlafaxine 300 mg for the last 2 years. Good response when Sodium Valproate 1200 mg added to the Mirt + VFX combo. Zolpidem 10 mg as a sleeping aid for last 2 years.
>
> I have recently gone through a full washout from the Venlafaxine/Mirtazapine combo whilst staying on the Valproate/Zolpidem combo, in order to switch to Phenelzine. The reason for this is that the VFX was making me feel too "wired". It was a painful couple of months but the thought that Phenelzine could be the answer to my problems sustained me
>
> I have only been on the phenelzine at 60 mg for 3 weeks but have just seen my pdoc who wants me to try reducing the dosage to 30 mg as my anxiety levels are increased in the last week. I'm scared that I'm heading towards yet another failed drug trial and that this is now the end of the road with nothing else left to try.
>
> Thankyou for reading my story and I'd be unbelievably grateful if anyone can offer any suggestions / hope that there might still be options out there for me. I'm terrified that at my next appointment my pdoc will say we've run out of things to try and this is how my life will remain.Deepreason,
When I first started phenelzine, more than a decade ago, I had the initial stage of hypomania that you describe. For me this passed rather quickly and phenelzine augmented with clonazepam has been the only combo to work for me. I initially took high doses of clonazepam, up to 4mg daily, until the phenelzine kicked in. This took almost a month for me after titrating up to 75mg. However, when the MAOI kicked in, it was like flipping a switch. My depression is atypical along with the social anxiety. The phenelzine and clonazepam was the only cocktail, out of over 45 different combinations, that worked for me. I believe the two medications work synergistically for atypical depression with social anxiety. I have never had the OCD.I would try to stick out the phenelzine at your current dose or higher and take something to take the edge off the anxiety until it has a chance to kick in. Many PDOCs will try to discontinue with the hypomanic switch, but this is a very common side effect when first starting phenelzine. Many people with long term depression misinterpret the hypomania as the true antidepressant effect of phenelzine. It is really a side effect. For me it felt good since I had been depressed for so long. I would think that the valproate would act to lessen the switch to mania, but I have not studied the drug.
I have tried to discontinue phenelzine, because of the side effects, at least a half dozen times. Each time, within a few months, my major depression returned. At this point, I am a lifer on the medication. Many people have posted that they have been on it for several decades. That will be me also.
This sure isn't my whole story. I have been posting about this medication for years on this forum. Feel free to Google my posts, as I have probably written hundreds of pages about my experiences with this medication. I still believe that phenelzine is the gold standard for atypical depression with social anxiety. It will often work where many other drugs have failed.
Good luck and be well,
Jedi
Jedi
Treatment resistant, atypical, double depression with social anxiety.
Nardil + clonazepam
poster:jedi
thread:984054
URL: http://www.dr-bob.org/babble/20110418/msgs/984260.html