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Re: Starting Parnate after 15 yrs treatment-resistance

Posted by europerep on February 5, 2015, at 16:10:51

In reply to Re: Starting Parnate after 15 yrs treatment-resistance, posted by Robert_Burton_1621 on February 5, 2015, at 4:53:28

Hello there!

> Psychiatry might like society to think that the number/proportion of treatment-refractory patients is small, but in reality it is (unfortunately) huge. (Ed)

I was thinking the same thing when I read Robert's post. A review article I read about two or three years ago by a European study group for treatment-resistant depression put the number at 30-45%. Of course, those are the patients corresponding to the clinical definition of it, i.e. a failure to respond to two adequate trials of antidepressants. That definition probably has some clinical value, but it's really not representative of the whole subgroup of treatment-resistant patients.

> I had not thought of putting the issue this way. Your observation identifies, perceptively, a plausible cause of the general lack of awareness of the actual extent of treatment-resistance. (...) My suspicion is that its usage in this way evacuates it of much clinically significant content; (...) (Robert)

I think I agree, if I understand you correctly that is ;-)... In my eyes, part of the problem is actually generated by people who mean well. One attempt to fight stigmatization of mental illness, or depression in this particular case, is to go with the "one in three individuals experiences a depressive episode at some point in their lives." What this does, I think, is that people go like "ah, right, back when Jenny's parents divorced she was really down for a few months, sometimes she wouldn't even show up in class, but then after a while it got better and now she's fine again." Jenny is of course just a random example I'm making up.

But this makes people think that that is what depression is, and if you're still stuck in it after a year, it's because "you're not trying hard enough" or "you're focusing too much on the problem" or "you need to change your mindset" or whatever.

In a way, people who know a little bit about depression are more problematic than people who just know nothing, because the former really think they understand depression even though they have no idea how broad the spectrum of depression is, and how dark one end of that spectrum is.

Anyway, regarding tranylcypromine. Over here, the generally recommended procedure is to start at 10mg/d, stay on it for a week, and then continue raising the dose by 10mg/d each week until positive effects appear. I think starting at 30mg/d or rapidly raising the dose should probably be limited to urgent cases.

The food restrictions are indeed not as bad as many people think. I too exposed myself to gradually increasing amounts of foods of that middle category that's allowed within limits, and that worked fine. Of course, those foods that are still completely forbidden must really be avoided, but I'm sure you know all that...

As far as side effects are concerned, I struggled with pretty bad insomnia too. I eventually started using zolpidem, but quickly 10mg weren't enough anymore, and I sometimes went up to 30 or 40mg per night, which I think is really not a good idea. What did help was exercising though. I'm not sure how I would have dealt with the insomnia had I had to stay on tranylcypromine long term. But I eventually tapered off again because it actually made my depression even worse. A doctor with much experience with MAOIs said that this happens very rarely though.

That's all I can think of right now. I wish you good luck with trial, there are people for whom it works really really well!





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