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.
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.