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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by cubbybear on January 22, 2005, at 6:05:21
Despite reassurances about my AD Parnate from 2 doctors and others(that's part of my problem-- forever fearing the worst), I would like to know--how do you know if youranti-depressant is pooping out? Sorry if these sound like dumb questions. Do you get depressed again immediately? Just anxious or what? Are there any "warning signs" that an AD is pooping out?
In another vein: I'd be especialy interested in hearing from people who a) get bad anxiety as the flip side of depression, or b) anxiety that can lead to depression. and c) whose AD ordinarily keeps depression AND anxiety symptoms in check. If you got some mild/moderate break-through anxiety after feeling good for so long, does it mean that your AD is losing some of its power, or not necessarily?
Posted by linkadge on January 22, 2005, at 10:31:43
In reply to How do you know if your AD is pooping out?, posted by cubbybear on January 22, 2005, at 6:05:21
I know my AD is pooping out when the horrendis pessimism starts setting in.
THe fact that you are asking weather your ad is pooping out might be a sign that it is. Thats not the end of the world.
However, sometimes the AD is doing its job very well, but for whatever reason your depression is superceeding the effects of the drug. This may mean that other tools in the chest might get you over a hump.
Linkadge
Posted by cubbybear on January 23, 2005, at 5:17:12
In reply to Re: How do you know if your AD is pooping out?, posted by linkadge on January 22, 2005, at 10:31:43
>
> THe fact that you are asking weather your ad is pooping out might be a sign that it is. Thats not the end of the world.
Sorry for the long-winded reply, but I need to talk about my problem in more depth and hope that you can help. I've seen your name on this board for a long time.
I am the kind, personality-wise, that always fears the worst, and I've always been terrified of the thought that the (fabulous MAOI) Parnate might be pooping out (whenever I felt anxiety reoccur without depression). But each time I was proven wrong--the Parnate had not pooped out. (I suffered with intermittent, severe anxiety spells for many years before it evolved into my first major depressive episode.)
What's happening now is that there were several outside, uncontrollable events going on in my life that triggered mild anxiety for a few days. It passed. Then the anxiety came back a few days later and it's very bad today. It has become apparent that the severe emotional stress that my mother is going through now---and fear of losing her-- is probably the reason for my latest anxiety. I ask myself, shouldn't the Parnate be putting the lid on this? Is it pooping out, or is it normal to have break-through anxiety when certain situations arise? Compounding the problem is that I fear the Parnate really is pooping out because I have such an idealized attitude about how it has rescued me from the most debilitating depressions over the past 20 years.My former pdoc in New York (whom I speak to occasionally from home here in Bangkok) advised me to increase my long-established maintenance dose of 30 mg. to 40 mg/day, and use some Xanax as an adjunct. He has always felt confident that the Parnate is not pooping out, but this time, I'm feeling terrible anxiety and compounding it by worrying about the AD itself. Pls. tell me what you make of all this.
cubbybear>
Posted by Optimist on January 23, 2005, at 10:01:15
In reply to Re: How do you know if your AD is pooping out? » linkadge, posted by cubbybear on January 23, 2005, at 5:17:12
Is the Parnate dosage increase and Xanax helping at all?
I think that many people with mood disorders have a distorted view of what real emotions feel like sometimes. After remission, if we feel any periods of transitory depression or anxiety it may freak us out a little. We may worry that it's more than temporary and will start deteriating any progress we may have made.
But, you have to remember even "normal" people have temporary periods of lowered mood and anxiety to extreme stressful events in their lives. If you're on an antidepressant or antianxiety medication it makes sense that there would be a breakthrough from time to time to stressful events.
Hope that helps :)
Brian
Posted by linkadge on January 23, 2005, at 21:15:39
In reply to Re: How do you know if your AD is pooping out? » l » cubbybear, posted by Optimist on January 23, 2005, at 10:01:15
40mg for parnate is actually kind of low. There are many possabilities. Sometimes the AD helps certain symptoms better than others.
With MAOI's you need enought to adequately inhibit MAO. Taking a dose on the low end may be more likely to lead to relapses.
Another thing to remember is that even though Parnate is considered an effective medication,
having a breakthough episode needn't be the end of the world.I would consider increasing it, making sure you are adequately nourished. Exercise a little, and take your ativan.
Have you considered nardil ?? For me, Parnate was not at all good for anxiety, it was good for depression, but only in the absence of anxiety.
There are also *many* cases where a simple swich from parnate to nardil has been an effective stradegy.
Nardil is supposedly less sharp than parnate, and better for anxiety. It is a little more serotogenic and has additional effects on GABA which can quell anxiety.
Take your time, do what you think is best for the time being. If things don't improve then there *are* many more options.
If you'd like to hear some, then let me know:)
Linkadge
Posted by cubbybear on January 23, 2005, at 22:20:11
In reply to Re: How do you know if your AD is pooping out? » l » cubbybear, posted by Optimist on January 23, 2005, at 10:01:15
> Is the Parnate dosage increase and Xanax helping at all?
It's only 6 days since I increased the Parnate dosage so I imagine it's too soon to know about that. If it normally takes an AD about 3-4 weeks to kick in when you first start it, does the same time interval generally apply for dose increases much later on, would the improvement come faster, or --what's your take on this?
As far as the Xanax goes, I've found that the .25 mg. after bkfast and .25 mg. after lunch do absolutely nothing for me when the anxietty is bad, and the .50 mg. for sleep definitely don't prevent me from waking after about 3-4 hrs. (Nomally I sleep only 5 hours anyway). So I suspect that the benzo dosage should be raised, and I'll probably ask the dr. if I could switch to Klonopin for steadier, more long-lasting relief. I also have to force myself to be less fearful of taking it on a regular basis at times like this.
>
> I think that many people with mood disorders have a distorted view of what real emotions feel like sometimes. After remission, if we feel any periods of transitory depression or anxiety it may freak us out a little. We may worry that it's more than temporary and will start deteriating any progress we may have made.
>
> But, you have to remember even "normal" people have temporary periods of lowered mood and anxiety to extreme stressful events in their lives. If you're on an antidepressant or antianxiety medication it makes sense that there would be a breakthrough from time to time to stressful events.
>
> Hope that helps :)
> > Brian
It definitely makes sense and several people have said this to me, but you know how it is--one can get all the reassurances in the world, but you'll still feel awful, panicky, and worried.
Posted by cubbybear on January 23, 2005, at 22:36:55
In reply to Re: How do you know if your AD is pooping out?, posted by linkadge on January 23, 2005, at 21:15:39
>>
>
> Have you considered nardil ?? For me, Parnate was not at all good for anxiety, it was good for depression, but only in the absence of anxiety.
I've been doing plenty of research comparing both Nardil, Parnate and even Marplan. From what I can see, Nardil probably wouldn't be a very good choice; the Marplan looks like a good compromise. But keep in mind that for me, Parnate attributes and side effects have always been pretty much OPPOSITE what most people report, i.e. I have always experienced weight GAIN on Parnate (which I like!) and it has always been excellent in cutting my anxiety. So, that's why I've been so scared this time--to experience anxiety again to this degree. People have been saying that what I'm feeling is only "normal" (well up to a point) because my mother has not been well, and THAT'S what has triggered this episode.
>
>
Posted by Optimist on January 23, 2005, at 23:08:36
In reply to Re: How do you know if your AD is pooping out? » Optimist, posted by cubbybear on January 23, 2005, at 22:20:11
<If it normally takes an AD about 3-4 weeks to kick in when you first start it, does the same time interval generally apply for dose increases much later on, would the improvement come faster, or --what's your take on this?
It would make sense that it would take 3-4 weeks to "kick in" or achieve greater therapeutic effect. Mostly likely it is a steady curve that levels out after a few months. So the good news is that it is probably kicking in already at some level but no where near where it will be in a few months.
I'm not very educated with regards to benzo's. Is the dosage of Xanax a very high dose that you're taking or could it probably be increased?
Brian
Posted by cubbybear on January 24, 2005, at 2:17:35
In reply to Re: How do you know if your AD is pooping out? » cubbybear, posted by Optimist on January 23, 2005, at 23:08:36
>
(Sorry about the double post--I forgot to click on two boxes.)
> I'm not very educated with regards to benzo's. Is the dosage of Xanax a very high dose that you're taking or could it probably be increased?
>
The Rx is for .25 mg. after bkfast, .25 mg. after lunch, and .50 before bed=1 mg. That's rather small. Based on plenty of experience with benzos Xanax and Klonopin, I'm sure that it could be safely increased to about double or more., but I'd ask for a switch to Klonopin, since it's less habituating and the effects last longer. The downshide to benzos is having to wean off gradually after you've been taking them for more than a couple of weeks.
I appreciate all the other info you've said and you're very reassuring--especially about being patient.
Posted by Sebastian on January 25, 2005, at 20:32:14
In reply to How do you know if your AD is pooping out?, posted by cubbybear on January 22, 2005, at 6:05:21
then you stop it and feel better.
This is the end of the thread.
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