Posted by Robert_Burton_1621 on July 20, 2015, at 10:42:18
In reply to Re: Personal MAOI diet experience: + other AD's, posted by SLS on July 20, 2015, at 7:58:05
> > Looks like it's prohibited in USA now too. I can't find a Dr. that will prescribe the 2 meds. But its not the government in control now anyway, its the insurance companies.
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> Agreed.
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> Currently, I am taking a combination of Parnate and nortriptyline. It is contraindicated, but not illegal in the USA.
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> The main drugs to stay away from are those that inhibit the reuptake of serotonin (SRIs). Serotonin releasers might cause reactions too. Methamphetamine is an example of this. Serotonin syndrome is the reaction to be avoided with these.
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> Drugs that act as NE mimetics (agonists) are to be avoided. These would include pseudoephedrine and phenylpropanolamine - drugs that are used as decongestants.
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> - ScottThere was a study published in 2014 in the J Aff Disorders by Stewart and McGrath (from Texas and Columbia respectively) on MAOI treatment of refractory depression. It was a small study (28 patients) but 82% of patients remitted in either one of the 5 phases (which were designed in binary stages consisting first of a cumulative phase of tranylcypromine treatment and augmentation and then, if remission had not been achieved, a cumulative phase of phenelzine treatment and augmentation)of the trials or in post-study follow-up. 64% maintained their remitted status for six months.
What is interesting, in light of the proscription even in the US now of combinging dexa.amph with parnate, is that the third cumulative phase of the parnate stage was augmentation with the stimulant. Presumably, the authors must have obtained some concession or waiver in order to use this combination.
The highest proportion of remitters (33%) did so in response to above recommended daily parnate dosages up to 120 mg/day.
Scott, I'm interested to know how you are going on nortriptyline as an adjunct, and what dose you are taking. It's been recommended to me by a retired psychiatrist who's an expert on medication interactions and MAOIs, however my current psychiatrist - although I'm enormously lucky that he does prescribe (and is the *only* specialist I have found who will prescibe) MAOIs and is very knowledgeable about them - won't add nort.
I have had a trial of nort. alone for 6 weeks (which kept me generally stable but had no other antidepresant effect)and with sertraline for 6 weeks (which combination was less effective than nort. alone) prior to starting parnate. If I've only had a mediocre response to nort., is there benefit in seeking to add it to parnate?
I am on 130 mg/day of parnate. I feel I could benefit from 140. I had a trial of lithium for one month but became worse and hypothyroid (this was disappointing, because some people do tend to respond dramatically well to the addition of lithium to parnate). I now have a script for lamotrigine as the next adjunctive strategy but have not filled it yet.
I have no bi-polarity at all: these medications aren't for mood stabilisation but for anti-depressant enhancement, at least that's the theory.
poster:Robert_Burton_1621
thread:360926
URL: http://www.dr-bob.org/babble/20150629/msgs/1080647.html