![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by M in Boston on April 2, 2002, at 12:24:54
I have treatment resistant depression that has been defined as atypical and reactive with a high degree of rejection sensitivity. Over many years I have tried more than 10 anti-depressants (including a range of SSRIs and Tricyclics - none with any significant success. My condition has worsened lately, due to a number of circumstances and reaction to an ended relationship, etc. My psychiatrist has reccommended for some time that I try an MAOI, but, having high blood pressure, I have been afraid of the apparently unpredictable and sometimes deadly potential for a hypertensive crisis, and the anxiety produced as a result. Another alternative that was suggested was to try lithium (about which I know little, particularly its efficacy in atypical reactive depression. Does anyone have any thoughts on the pros and cons of each, or which order of trial between the two makes sense?
Thanks so very much for your help.
Posted by Lia Mason on April 2, 2002, at 23:15:34
In reply to Treatment Resistant Depression Parnate vs. Lithiu, posted by M in Boston on April 2, 2002, at 12:24:54
I have (it sounds like) your kind of depression. Heavy, oversleeping, lethargic but reactive. I've tried everything.
I will say this about MAOI's. I found them a big pain in terms of side effects, but NArdil cut through my depression when absolutely nothing else did. As far as blood pressure... I had problems with blood pressure lowering and blood pressure drops on MAOI's. It would seem that if you're high BP that wouldn't be a problem. Parnate worked great for my depression, too. Moclobemide and Marplan did not. I thinK Parnate and Nardil are very effective powerful drugs for this kind of illness. The diet didn't bother me. I gained weight on Nardil, but it was water weight--swollen ankles and such. And the sexual side effects bummed me out.
I'm assuming you've tried effexor which is, many think, comparable to MAOI's in terms of effectiveness. I'm on Sam-e now at a high dose. I'm not doing so great now, due to mostly situational stuff, but I got a solidly good year out of Sam-e. I also got more mileage out of Prozac by adding Depakote.
Hope some of this helps.
Lia
Posted by Elizabeth on April 4, 2002, at 23:21:28
In reply to Treatment Resistant Depression Parnate vs. Lithiu, posted by M in Boston on April 2, 2002, at 12:24:54
Hi M. It sounds like you have a lot of the classic features of atypical depression (mood reactivity is a necessary part of the definition of atypical depression, BTW). MAOIs are really effective for this stuff -- rejection sensitivity, overreacting to disappointment, etc.
MAOIs generally *lower* blood pressure, as long as you don't eat the wrong thing. I've posted "my version" of the MAOI diet, which is evidence-based and really doesn't require much lifestyle change for most people. Also, if you keep some nifedipine (a calcium channel blocker that lowers BP rapidly) handy and learn to check your BP, acute hypertension is very easy to identify and treat. If you're really worried about the possibility of hypertensive crises, talk to your pdoc about how you would deal with it.
I think you might find that MAOIs are very helpful and tolerable. Also, Nardil and Parnate (the most common ones in the USA -- I believe you can get Marplan, but it's not used much) have different side effect profiles, so if you have trouble with one, you have the option of trying the other.
I think that lithium is less likely to work than MAOIs are. Li+ is more useful in augmenting antidepressants, although it sometimes works by itself for unipolar depression. If you find that the MAOIs are partially effective, you can add Li+, of course, and that might well prove to be the answer for you.
BTW, can I ask where you see your pdoc (private practice or clinic? if clinic, which one?)? Just curious; I lived in Boston for a long time and know more about the psychiatric establishment there than I care to.
-elizabeth
Posted by M in Boston on April 8, 2002, at 21:47:51
In reply to Re: Parnate vs. Lithium » M in Boston, posted by Elizabeth on April 4, 2002, at 23:21:28
Thanks so much for your really helpful perspectives. Perhaps the MAOI need not be quite so ominous after all. After having tried so many other medications, the thought of one with seemingly (though perhaps not inevitably) unpredictable and severe interactions is a bit scary.
Elizabeth, in response to your question, I see a psychiatrist in private practice in Belmont.
M
P.S. By the way, Elizabeth, since you said you used to be in Boston - might you possibly know of a psychiatrist who is psychopharmacologically astute, as well as smart, compassionate and open (a very very tall order, admittedly!), from which I might get an additional perspective, or even begin to see. My therapy appears to be a bit stagnant, I'm afraid!
Posted by Elizabeth on April 10, 2002, at 11:51:00
In reply to Re: Parnate vs. Lithium, posted by M in Boston on April 8, 2002, at 21:47:51
> Thanks so much for your really helpful perspectives. Perhaps the MAOI need not be quite so ominous after all. After having tried so many other medications, the thought of one with seemingly (though perhaps not inevitably) unpredictable and severe interactions is a bit scary.
I found them to be predictable and, for the most part, treatable.
> P.S. By the way, Elizabeth, since you said you used to be in Boston - might you possibly know of a psychiatrist who is psychopharmacologically astute, as well as smart, compassionate and open (a very very tall order, admittedly!), from which I might get an additional perspective, or even begin to see. My therapy appears to be a bit stagnant, I'm afraid!
I hesitate to make recommendations. There is someone who comes to mind, a guy who I saw briefly for "medication management." Fairly young, easy-going, has a good knowledge of recent developments in psychopharmacology, open-minded about trying new things, generally reasonable.
What do you mean by stagnant? Can you say anything about what you're finding unsatisfactory about your current situation?
-elizabeth
Posted by TR on May 3, 2003, at 21:20:41
In reply to Re: Parnate vs. Lithium » M in Boston, posted by Elizabeth on April 10, 2002, at 11:51:00
Just wanted to add some words of encouragement concerning Parnate. It helped me when nothing (and I mean nothing) else did. Lithium is indeed mainly affective as an augmenter to ADs. You get used to the diet pretty quick, and any good doctor should take your blood pressure occasionally. But unless you get up to the really high doses, I wouldn't be overly concerned with that.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.