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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by europerep on May 25, 2011, at 15:43:28
Hello there...
I thought I was just gonna share my plan of what I'm going to try next with you guys, and I'd appreciate any comments.. maybe some people will say that this is a bad idea, and matter of fact it *is* a bad idea, but all the good ones haven't worked, that's why I am going to go with this now..
for those who don't know me, it's about treatment-resistant unipolar depression for which I have already tried more than a dozen different drugs and combinations, plus obviously psychotherapy, exercising, good nutrition and so on.Here's the thing:
The only point during the past couple of years in which my mood was "good" was at the end of last year, when - despite my promise to myself to not do it - I smoked a small amount of weed (<0.1g) while simultaneously being on tranylcypromine (Parnate; 50mg/d). Obviously, mixing more or less anything with an MAOI is not a good idea, but I just decided to try it (after not having smoked for a year or so) and I felt "great". Not "great" in the sense of some trippy high, but in the sense of feeling good about myself, wanting to engage in a conversation and so on.. you know, normalcy. Back then I was already on the point of going off of tranylcypromine because it made me actually feel worse, not better. I attributed the improvement after smoking solely to the active ingredients in cannabis, so my further plans were clear from that point on: going off tranylcypromine and starting with either dronabinol (semi-synthetic THC; Marinol) or medical cannabis. Long story short, I did find a doctor who prescribed me dronabinol (it's available for prescription in Germany), but it didn't work. It made me feel somewhat "intoxicated" but not in a positive sense, and it has no antidepressant effect at all. I then decided to try regular cannabis, in small amounts that would allow me to balance antidepressant effects without being too impaired to go about my daily life (needless to say I would not drive a car, but that's no problem in a huge city with public transportation). Yet again, cannabis made me feel "sort of high", but without an antidepressant component to it. Thus, the only possibility that's left - unless the positive experience described above was due to placebo or something - is that there was a synergistic effect of tranylcypromine and (a low dose of) cannabis. So far, so good, I did not experience any kind of negative side-effect from smoking weed on Parnate, i.e. no hypertension, no hyperthermia, no serotonin syndrome, so it appears that combining tranylcypromine and cannabis for me is more or less "safe". However, while that combination had a positive effect on my mood, I would still be stuck with other aspects of my depression that tranylcypromine did not help at all, namely being unable to get up at a decent time (i.e. anything before 12Am to 1PM which it is now). Hence my idea to bring in another agent that did help me with that issue, namely amitriptyline. (There is a small but reliable amount of literature documenting the efficacy and safety of combining tranylcypromine with amitriptyline despite it being a TCA. Clomipramine and imipramine are absolute no-no's because of their strong serotonergic action, but amitriptyline has been and can be combined with tranylcypromine in severely treatment-resistant patients. The German-language "FAQ" that is available to doctors who prescribe the German version of Parnate ("Jatrosom") explicitly mentions the possibility of that combination, along with a limited number of other agents as well.)So, my plan goes as follows:
I am already taking 50mg of amitriptyline in the evening. Starting next weekend, I will very slowly reintroduce tranylcypromine, starting at 2.5mg (i.e. a fourth of a 10mg tablet), then going to 5mg, then 10mg, and increasing it by 10mg/d each week. I will keep an eye on my BP all the time of course. If all goes well, I'll first of all go up to 30mg tranylcypromine/50mg amitriptyline and stay at that for a week or two. if that combination is stable and safe, I will then smoke a tiny amount of weed to see where that gets me. Depending on how that goes, I may decide to go up further on tranylcypromine if necessary. But I will see about that when I'm there.If anyone has any comments, I'd be glad to hear them. I know, I know, this whole thing seems pretty dangerous, but what's the worst that can happen? Right, I could die, but seeing where I am right now, I am beginning to think of that more and more in terms of something positive, so that argument doesn't count. ;) No seriously, during my previous Parnate trial I had no problems whatsoever side effect- or BP-related, so if that should be any different with that combination, I will immediately drop the amitriptyline. However, right now I really don't see any other option. That point where I smoked weed a couple of months ago was as close as I have been for years to anything resembling a sustainable and positive mood, so I will do everything I can do recreate that moment. If it turns out that it doesn't work, ok, then I'll think about ECT or something, but until then I am dead-set on finding a way to make cannabis work for me.
By the way, there is a study out there showing that tranylcypromine increases CB1 receptor binding while decreasing anandamide content in certain parts of the brain. The latter would explain why I felt worse on parnate, and the former would explain the synergistic effect of tranylcypromine and cannabinoids.
So, yeah, that's where I am right now.. again, any comments are greatly appreciated! So much for now..
ER
Posted by MadBull on May 26, 2011, at 14:43:01
In reply to Ok, so here's my plan... (comments appreciated), posted by europerep on May 25, 2011, at 15:43:28
Just curious how much dosing control you think you can get on the THC?
Posted by europerep on May 26, 2011, at 16:18:08
In reply to Re: Ok, so here's my plan... (comments appreciated), posted by MadBull on May 26, 2011, at 14:43:01
> Just curious how much dosing control you think you can get on the THC?
Excellent question. I have worried about that quite a bit. I will use only one variety of weed in order to have a more or less stable composition of different active cannabinoids, and I will use a scale that allows me to weigh the amounts with a precision of 10mg. I think I will actually start with an amount of 10mg - which is almost nothing - in order to be on the safe side, and then work my way up in steps of 10mg. Of course, since cannabis is a natural product, there will be a rather significant fluctuation of active ingredients compared to pharmaceutical products, but I hope I'll be able to manage that.
In any case, what I will find out is whether the effects I experienced are reproduceable and remain even with regular use. That's what's most important to me for the moment: to find out whether this can be a sustainable solution, or whether even with careful dosing the effects are only transient and will disappear due to "tolerance".
Posted by floatingbridge on May 27, 2011, at 9:26:16
In reply to Re: Ok, so here's my plan... (comments appreciated) » MadBull, posted by europerep on May 26, 2011, at 16:18:08
europerep, does tolerance build on thc? I'm not convinced it does in the typical way we think of AD's and tolerance. I think when used recreationally, what might be called tolerance is really learning compensatory behaviours for being stoned--the way a person can learn to function while drunk.
I hope your plan works. I know someone who uses (smokes) a small amount of some prescribed strain (there is quite a
science to it) daily, and it helps enormously with mood and function. He has Parkinson's, which is very often accompanied by depression, and his dosing hasn't increased for over three years.I'm routing (or is it rooting) for you.
fb
Posted by europerep on May 29, 2011, at 15:38:41
In reply to Re: Ok, so here's my plan... (comments appreciated) » europerep, posted by floatingbridge on May 27, 2011, at 9:26:16
> europerep, does tolerance build on thc? I'm not convinced it does in the typical way we think of AD's and tolerance. I think when used recreationally, what might be called tolerance is really learning compensatory behaviours for being stoned--the way a person can learn to function while drunk.
>
> I hope your plan works. I know someone who uses (smokes) a small amount of some prescribed strain (there is quite a
> science to it) daily, and it helps enormously with mood and function. He has Parkinson's, which is very often accompanied by depression, and his dosing hasn't increased for over three years.
>
> I'm routing (or is it rooting) for you.
>
> fbHi FB..
Yeah, I am not really sure about tolerance. I am sure there will be some degree of tolerance, but unless the mood improvement was a regular euphoria as recreational users experience it, I am sure some effect would remain. I will see about that.
By the way, I was able to reconstruct when exactly I began taking tranylcypromine last year, and I was only on 30mg/d when I smoked weed. I increased it up to 50mg only later. So I'll just have to wait until I'm at 30mg to see whether it'll work or not. That saves me two weeks, that's great. I'll post my experience in any case.
Thanks for rooting for me.. (I think it's rooting, not routing, but I am not even a native speaker so don't take it from me ;) )..
bye!ER
Posted by europerep on June 1, 2011, at 17:25:47
In reply to Re: Ok, so here's my plan... (comments appreciated), posted by europerep on May 29, 2011, at 15:38:41
I decided to grab a little deeper into my pocket and buy a scale with a sensitivity of 0.001g, i.e. 1mg. Now, real lab scales with that sensitivity cost $2500+, so I didn't opt for that kind of scale, but if I weigh a dose of 5mg on mine and it'll turn out to be 4mg or 6mg, that's still allright.
Maybe I'll discover some new treatment strategy. Few people would combine tranylcypromine and cannabis, and certainly not such low doses of cannabis. Who knows? :)
Posted by desolationrower on June 5, 2011, at 16:41:15
In reply to Re: Ok, so here's my plan... (comments appreciated), posted by europerep on June 1, 2011, at 17:25:47
i think cannabis increases melatonin synthesis. Given your sleep schedule problems, you might want to try taking melatonin (probably 2-3 h before desired bed time).
might also want to play around with including paracetamol, since it is an anandamide reuptake inhibitor.
-d/r
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