Posted by SLS on April 20, 2012, at 7:22:30
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Alexei on April 19, 2012, at 14:46:50
> Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.
> May I ask your opinion on Parnate?
I like Parnate more than Nardil because it has milder side effects. In addition, I find that Nardil produces a euphoric effect that I would prefer to do without. Everyone reacts to these two drugs differently. Some people do not respond to Parnate who do respond to Nardil. In my experience as a TRD patient, I have found it necessary to take a MAOI in order to respond well to treatment. I have always had to combine a MAOI with a tricyclic in order to glean a lasting improvement in depression.
> How would you rate its efficacy compared with ssri & snri meds?
MAOI > SNRI > SSRI
> Does it have any merit for OCD?
There are several anecdotal reports for success in treating OCD using either Parnate or Nardil. These drugs have not been the focus of study in this disorder. One study of Nardil (phenelzine) reported negative results, but its design had some significant flaws.
Do you have any other types of anxiety disorder?
> I'm finding venlafaxine to be merely average.
There are plenty of studies demonstrating the efficacy of clomipramine, fluoxetine, and fluvoxamine. Only a few studies exist using venlafaxine or paroxetine.
> Do you prefer nortriptyline to desipramine? If so, why?
I have used both drugs, and while I find them both effective in my case, nortriptyline produces better results. The autonomic side effects tend to be milder with nortriptyline. I experience a greater elevation of heart rate and palpitations with desipramine. I also get more dry mouth and blurred vision with desipramine. Sometimes you don't have a choice between the two. There are people who respond only to desipramine just as there are people who respond only to nortriptyine.
> Also, you've spoken of some type of synergy between abilify and lamictal.
I do better when I take both drugs together than when I take either one alone. I also know someone with depression who takes only these two drugs. She does not take any of the standard antidepressants, although she has tried most of them. Her system needs both drugs for her to feel well.
> Could you elaborate a bit on this?
I am going to have to disappoint you on demonstrating an explanation for the mechanics of interaction of the two drugs to produce a synergy. I don't know of any scientific studies investigating this. I have proposed my own pet theory which might explain a dopaminergic synergy between of these two drugs. Abilify seems to increase DA tone in neurons that are hypoactive in the nucleus accumbens via D2/D3 partial agonism. I think that Abilify is more of a modulator than it is a stimulant. Lamictal might produce an increase in DA activity in the nucleus accumbens via disinhibition. Lamictal reduces glutamate release in the thalamus. These glutamate circuits normally travel to the nucleus accumbens whereupon they act to reduce DA activity when activated. Lamictal reduces GLU activity in the thalamus and thus allows for increased DA activity in the the nucleus accumbens.
> I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.
These things are very ofen startup side effects that disappear within a week or two. However, there are enough people who continue to react badly to Abilify that aborting a trial is necessary.
What dosage of Ability did you start at?
It may be that people with unipolar depression are more sensitive to Abilify than those with bipolar disorder. I had no problem treating my bipolar depression with a starting dosage of 20 mg. People with unipolar depression often respond to dosages of 5 mg and lower. Some respond well at 2.5 mg, but suffer intolerable side effects at 5 mg.
So, what's your plan?
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw