Posted by Avenarius on July 18, 2011, at 21:21:14
In reply to Re: Atypical depression - medication no longer helping » policebox, posted by hyperfocus on July 10, 2011, at 21:45:08
My situation is very similar to that of the original poster - atypical with anxiety. After 18 years of partial improvement on paxil and effexor severe anticholinergic side effects forced me to search for something I could tolerate. In June I had a consultation with Dr. Steven Dubovsky (he's mentioned a bit on this site; I highly recommend him if you can get to Buffalo, NY; $350 for an hour but I would have paid 10 times that amount.) Following his advice, I've just completed a washout period during which I relied on 50mg / day Desipramine and occasional clonapin. It sucked but tomorrow I start taking Selegiline (oral, not the Emsam patch). For some reason I'm confident it's going to work out for me. I've heard that it can help to make sure you take it with food, perhaps true of other MAOIs as well. If it doesn't there are other options along the lines of what hyperfocus has spelled out.
Incidentally, I came across an interesting algorithm for the diagnosis and treatment of depression published by Harvard:
I wish the doctors I've seen over the years could have executed this properly. It might have saved me a good 27 years of trouble
> If you responded partially to Wellbutrin then you should have tried meds with a strong NE effect like Effexor or Pristiq or Cymbalta or Remeron, or TCAs like amitriptyline or desipramine. You could also try combinations of these drugs like Effexor + Wellbutrin. MAOIs are sort of the nuclear option - they tend to work but the side-effects are serious. But if you want to stick with the Parnate you should give it at least 4 weeks. I think the fact that you responded to it for the first week is very encouraging. Nardil also seems to have this acute positive effect for the first few days, which then diminshes, until the true AD theraputic response appears weeks later. I know it's tough to stick it out for a couple of weeks on a med you're not sure is gonna work, but you can get through it. If you've waited a lot of years to find something that can really help, like most of us, then another couple of weeks won't be that bad. If it doesn't work you could try Nardil which could help a lot with the social anxiety, or step back from the MAOI plate and try some of the NE-meds.