Posted by SLS on July 21, 2015, at 15:36:44
In reply to Re: MAOI + other AD's (Dext. + Nort.) » SLS, posted by Robert_Burton_1621 on July 20, 2015, at 10:42:18
Hi.
Sorry to take so long to respond.
I was once on Parnate 120 mg/day + desipramine 200 mg/day + amphetamine 20 mg/day + thyroxine + bromocriptine. The antidepressant response did not last for more than a week, but the combination was well tolerated.
> There 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.
I was first diagnosed and treated at Columbia in 1982. I saw Dr. McGrath about 15 years ago for consultation. He seemed to really like Parnate. Unfortunately, he didn't have much to contribute to my treatment plan.
> 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.
The ONLY time I experienced a remission (6 month period) was during treatment with Parnate and desipramine in 1987.
> 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.
What about methylphenidate? I don't feel a thing with amphetamine, but dexmethylphenidate produces an increase in mental energy. I tend not to use it, though, because it only lasts for about 5 hours, and I don't want to bounce up and down or develop a tolerance to it.
> Scott, I'm interested to know how you are going on nortriptyline as an adjunct, and what dose you are taking.
My current treatment regime has produced a 35 - 40% improvement - primarily in mental energy and psychomotor retardation. My affect is less flat. I am overall more functional, but anhedonia persists. I am not experiencing a "complete" antidepressant effect, despite an improvement in vegetative symptoms.
Parnate - 120 mg/day
nortriptyline - 100 mg/day (therapeutic blood level)
Lamictal - 200 mg/day
lithium - 300 mg/day
Abilify - 10 mg/day
prazosin - 30 mg/day> 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.
What are his concerns?
> 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 didn't like sertraline. It left me in a fog and feeling somewhat dysphoric. I don't do well on SSRIs in general. However, sertraline is a fairly potent sigma-1 receptor antagonist. (Note that fluvoxamine is a potent sigma-1 receptor agonist). That might have something to do with my reaction to it.
I thought you might be interested to see this:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881105/
I do somewhat better with venlafaxine and duloxetine. Venlafaxine 300 mg/day + nortriptyline 75 mg/day helped, but not enough. In retrospect, I probably would have done better with a higher dosage of nortriptyline. A friend of mine is doing very well on a combination of desvenlafaxine and bupropion.
> 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).
Yes. I wish I were one of them. I take lithium 300 mg/day. The dosage is optimized for depression, not mania. It helps. Also, there is some suggestion that low dosages of lithium reduce the risk of developing Alzheimer's Dementia.
> I now have a script for lamotrigine as the next adjunctive strategy but have not filled it yet.
It might be worth adding aripiprazole to the lamotrigine should lamotrigine be insufficient. They seem to work well together.
> 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.I was unipolar right up to the point that I was bipolar. :-)
On a few occasions, I have had severe manic reactions to antidepressants that persisted, despite drug discontinuation. It was William Potter who affirmed my diagnosis in 1992. It is good that the new DSM 5 includes this presentation as a form of bipolar disorder.
I hope you find something here helpful.
Take care of yourself.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:360926
URL: http://www.dr-bob.org/babble/20150629/msgs/1080677.html