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Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 20, 2012, at 10:16:20

My pdoc had me on Parnate 60mg this summer -- it was the only medication that had ever given me relief, but was certainly not enough.

A history:

While on bupropion monotherapy about two years ago, my condition worsened into the worst depression of my life. I exhibited melancholic features.

A change to venlafaxine 300mg and mirtazapine 30mg was completely ineffective but my symptoms (predictably) shifted towards atypical depression. I dropped out of graduate school, gained 70 lbs (!!) and was sleeping all day.

Switching to tranylcypromine was the best thing that happened to me: Found a job, bought a car, moved into an apartment.

But after 3-4 months of a honeymoon, my condition began to deteriorate. In mid-September my pdoc reached her limit with MAOIs (refusing to increase dosage past the 60mg FDA limit or augment w/ nortriptyline) and switched me back to bupropion and added lamotrigine (which, despite the complete lack of side effects even reaching 300mg, has been worthless).

Now I've been in a downward spiral for two months, having lost all the friends I've made. I'm back to not sleeping and navel-gazing all day. Paradoxically I'm eating way too much. But I can't even take out the trash and it has taken all of my energy to maintain a stable image at work. I get anxiety from the bupropion that I never had with tranylcypromine, and alprazolam does nothing to help.

I have a pdoc appointment in early December... what do I suggest? At my last appointment I suggested augmenting with gabapentin but she denied its efficacy. What do I do? What medications do I suggest? Parnate was the only thing that had ever worked but pdoc continues to be mum; my insurance also complained about the cost.

Anything histaminergic would be a big no-no considering the massive amount of weight I gained on mirtazapine (which I lost entirely while on Parnate...). Other than that I'm at a complete loss. Phenelzine seems like a good option but I'm a bit worried about weight gain since I gained weight so dramatically. Also worried that since it's an MAOI, my pdoc will flat-out refuse to try it.

I appreciate your advice... and your taking the time to read my life story.




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