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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 David on April 11, 1999, at 5:56:03
Hi all! I have suffered serverly from atypical depression which apparently flipped to major depression for 13 years. However I have had it mildly all my life.Virtually nothing worked well at all. Nortriptyline kept me at a stage of hell for about 5 years. ECT did not do the trick either.I have graduated to MAOI's on my insistance about 3 years ago. I received nearly a total remission for about 4 months and have slowly struggled backwards ever since. The maoi makes me very drowsy. We tried dextroamphetamine,again on my insistance with so,so results. They make me tired now so I quit them.I want to augment this Parnate with an anti-depressant of some sort but am not sure the best step to take. I get tired of doing my own reaserch and wish I could find a doctor who would just do it for me. That is easier said then done,esp. when you are not feeling well. Any stories of sucess may be just what the DR. ordered. If it were not for my unrelenting will I would not even have made it this far. Thank you David
Posted by Elizabeth on April 12, 1999, at 9:40:10
In reply to Parnate and ?????, posted by David on April 11, 1999, at 5:56:03
Hi David.
I think this may have been different in the past, but "atypical features" can occur in both major depression and dysthymia. Some regard atypical depression as less severe than "typical" depression, but I don't know if I agree with this.
But anyway, in terms of treatment options...nortriptyline is not indicated for this sort of depression, except maybe if a number of other things have failed. The MAOIs and amphetamines are, as you've seen, better choices.
I notice you haven't tried the newer antidepressants (Prozac, Effexor, etc.). These might be worthwhile. Prozac has the longest track record, but it would be a problem if you found it didn't work and decided to switch back to the MAOI, so a shorter-acting SSRI might be a better choice. Effexor often works for people who don't respond to SSRIs.
In terms of MAOI augmentation, you might check out Dr. Bob's psychopharmacology tips site, as I think there are some ideas in there. It's http://www.dr-bob.org/tips/. Some things that I have heard of people using in combination with MAOIs are bupropion (Wellbutrin), thyroid hormones (e.g., Cytomel), lithium (which is an antidepressant as well as a mood stabilizer), anticonvulsants (less evidence than for lithium, but lamotrigine in particular is believed to be something of an antidepressant), buspirone (if you're going to do this, you *must* be able to monitor your BP, as increases have been reported), and pindolol.
The only antidepressants that I can think of offhand that definitely must not be used with MAOIs are SSRIs (including clomipramine) and Effexor. I'm not sure if there have been any problems combining them with other newer antidepressants (nefazodone, mirtazapine), but I personally wouldn't want to be the guinea pig in that experiment.
Good luck with things.
Posted by David on April 15, 1999, at 21:00:55
In reply to Re: Parnate and ?????, posted by Elizabeth on April 12, 1999, at 9:40:10
> Hi David.
>
> I think this may have been different in the past, but "atypical features" can occur in both major depression and dysthymia. Some regard atypical depression as less severe than "typical" depression, but I don't know if I agree with this.
>
> But anyway, in terms of treatment options...nortriptyline is not indicated for this sort of depression, except maybe if a number of other things have failed. The MAOIs and amphetamines are, as you've seen, better choices.
>
> I notice you haven't tried the newer antidepressants (Prozac, Effexor, etc.). These might be worthwhile. Prozac has the longest track record, but it would be a problem if you found it didn't work and decided to switch back to the MAOI, so a shorter-acting SSRI might be a better choice. Effexor often works for people who don't respond to SSRIs.
>
> In terms of MAOI augmentation, you might check out Dr. Bob's psychopharmacology tips site, as I think there are some ideas in there. It's http://www.dr-bob.org/tips/. Some things that I have heard of people using in combination with MAOIs are bupropion (Wellbutrin), thyroid hormones (e.g., Cytomel), lithium (which is an antidepressant as well as a mood stabilizer), anticonvulsants (less evidence than for lithium, but lamotrigine in particular is believed to be something of an antidepressant), buspirone (if you're going to do this, you *must* be able to monitor your BP, as increases have been reported), and pindolol.
>
> The only antidepressants that I can think of offhand that definitely must not be used with MAOIs are SSRIs (including clomipramine) and Effexor. I'm not sure if there have been any problems combining them with other newer antidepressants (nefazodone, mirtazapine), but I personally wouldn't want to be the guinea pig in that experiment.
>
> Good luck with things.Thank you Elizabeth,Ya I have tried the ssri's,the problem is I have this so bad i deteriorate so quick it is just mentally impossible to quit the parnate.It has worked the best all in all. I will heed some of your suggestions though,Thank You David
Posted by Elizabeth on April 17, 1999, at 9:41:30
In reply to Re: Parnate and ?????, posted by David on April 15, 1999, at 21:00:55
David, I know what you mean about being afraid to discontinue the Parnate, and quitting an MAOI can cause a devastating rebound depression if you don't decrease it slowly. (So if you've tried to quit "cold turkey" in the past, that may be the reason you had such a bad time with it.)
One thing I forgot to mention is that you can combine an MAOI and a tricyclic, but it has to be done very carefully (especially if you're adding the tricyclic to the MAOI) and results have been equivocal - it doesn't seem to improve the response in general. I'm also not sure it would have much utility in atypical depression, for which tricyclics are notoriously ineffective. Still, something to think about if other things don't work.
Good luck - I'll be interested to hear what you decide on.
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