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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by fresh air on June 24, 2011, at 16:26:03
"Breakthrough Depression"--Please Read My Story
I am posting this message for a male friend named Steve who presently has no easy access to a computer.
He says, "I am a generally healthy male of 62 who is of ideal weight and blood pressure. I have been taking MAOI anti-depressant Parnate/tranylcypromine for about 25 years (!) at a maintenance dose of 40 mg/day for nearly the entire time. Previous attempts in 2002-2003 to try three other A.D.s were unsuccessful. I've concluded long ago that this A.D. is the only one suitable for my needs.However, I am presently plagued by lingering up and down "breakthrough" depression and anxiety. How did this happen? In March, I spoke with my pdoc and we decided to see if I could try dropping the dose to 30 mg (for purely practical reasons). All seemed OK for about two months, then I was blasted by several extremely stressful incidents and situations including the possibility of long term incarceration, health/dental worries, theft of personal belongings, etc.--one on top of another.
I started feeling moderate depression and anxiety for the first time in years. I wondered if the decreased dose had made me more vulnerable to such overwhelming stressors and put me below the threshold of resistance--even a mere 10 mg. decrease.
(What do you think?) My pdoc increased my dose back up to 40 mg. on June 3, yet as of June 21 (18 days later), I was still feeling very worrisome ups and downs, some depression symptoms such as early awakenings, occasional heart palpitations, and a general feeling that on some days, I was OK again, but on others, I was still "wobbly" or somewhat depressed and not out of the woods yet.I wonder if it would normally take the incremental dose increase as much time to kick in (3-4 weeks, usually) as it does for most any A.D. to kick in initially. Your experience?
On the other hand, would it be unusual/possible for an A.D. to "poop out" after being so successful for 25 years? If not, why does breakthrough depression and anxiety occur?
And, if I should have no lasting change after about one month at 40 mg., would increasing the dose to 50 mg. be the next step?
Lastly, what other medication(s) would be safe and viable to augment this MAOI, if necessary? (hopefully not).Your experiences and input would be very much appreciated."
Posted by jono_in_adelaide on June 24, 2011, at 18:22:27
In reply to Breakthrough Depression - Parnate user, posted by fresh air on June 24, 2011, at 16:26:03
Not sure what the answers are - but i thought I might suggest asking your doctor about a couple of things
- adding nortriptyline in a dose of say 75mg at bedtime
- having a benzo such as Xanax 0.5mg to take "as needed" when you feel especialy tense and anxious.
Posted by desolationrower on June 24, 2011, at 20:54:04
In reply to Re: Breakthrough Depression - Parnate user, posted by jono_in_adelaide on June 24, 2011, at 18:22:27
I think JONO's suggestions are good. Lithium is another augmenter of note. maybe olanzapine PRN.
I would ask Friend what his health concerns are. It is not BS that it is called "mental HEALTH".
I do think it is an unstudied question if breakthrough depression can be compared to intial onset depression. I don't know that you can just cancel out "life long depression" and "parnate that fixed my life long depression" and then X is an antidepressant, you can take it and it will help with your (breakthrough) depression.
-d/r
Posted by jms600 on June 25, 2011, at 4:03:32
In reply to Breakthrough Depression - Parnate user, posted by fresh air on June 24, 2011, at 16:26:03
> "Breakthrough Depression"--Please Read My Story
>
> I am posting this message for a male friend named Steve who presently has no easy access to a computer.
> He says, "I am a generally healthy male of 62 who is of ideal weight and blood pressure. I have been taking MAOI anti-depressant Parnate/tranylcypromine for about 25 years (!) at a maintenance dose of 40 mg/day for nearly the entire time. Previous attempts in 2002-2003 to try three other A.D.s were unsuccessful. I've concluded long ago that this A.D. is the only one suitable for my needs.
>
> However, I am presently plagued by lingering up and down "breakthrough" depression and anxiety. How did this happen? In March, I spoke with my pdoc and we decided to see if I could try dropping the dose to 30 mg (for purely practical reasons). All seemed OK for about two months, then I was blasted by several extremely stressful incidents and situations including the possibility of long term incarceration, health/dental worries, theft of personal belongings, etc.--one on top of another.
>
> I started feeling moderate depression and anxiety for the first time in years. I wondered if the decreased dose had made me more vulnerable to such overwhelming stressors and put me below the threshold of resistance--even a mere 10 mg. decrease.
> (What do you think?) My pdoc increased my dose back up to 40 mg. on June 3, yet as of June 21 (18 days later), I was still feeling very worrisome ups and downs, some depression symptoms such as early awakenings, occasional heart palpitations, and a general feeling that on some days, I was OK again, but on others, I was still "wobbly" or somewhat depressed and not out of the woods yet.
>
> I wonder if it would normally take the incremental dose increase as much time to kick in (3-4 weeks, usually) as it does for most any A.D. to kick in initially. Your experience?
>
> On the other hand, would it be unusual/possible for an A.D. to "poop out" after being so successful for 25 years? If not, why does breakthrough depression and anxiety occur?
> And, if I should have no lasting change after about one month at 40 mg., would increasing the dose to 50 mg. be the next step?
> Lastly, what other medication(s) would be safe and viable to augment this MAOI, if necessary? (hopefully not).
>
> Your experiences and input would be very much appreciated."
If anxiety is a major issue, what about switching to Nardil? Parnate is stimulating and can aggravate anxiety in those suffering from it. Just a thought.
This is the end of the thread.
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