Psycho-Babble Medication Thread 1031588

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Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 20, 2012, at 10:16:20

My pdoc had me on Parnate 60mg this summer -- it was the only medication that had ever given me relief, but was certainly not enough.

A history:

While on bupropion monotherapy about two years ago, my condition worsened into the worst depression of my life. I exhibited melancholic features.

A change to venlafaxine 300mg and mirtazapine 30mg was completely ineffective but my symptoms (predictably) shifted towards atypical depression. I dropped out of graduate school, gained 70 lbs (!!) and was sleeping all day.

Switching to tranylcypromine was the best thing that happened to me: Found a job, bought a car, moved into an apartment.

But after 3-4 months of a honeymoon, my condition began to deteriorate. In mid-September my pdoc reached her limit with MAOIs (refusing to increase dosage past the 60mg FDA limit or augment w/ nortriptyline) and switched me back to bupropion and added lamotrigine (which, despite the complete lack of side effects even reaching 300mg, has been worthless).

Now I've been in a downward spiral for two months, having lost all the friends I've made. I'm back to not sleeping and navel-gazing all day. Paradoxically I'm eating way too much. But I can't even take out the trash and it has taken all of my energy to maintain a stable image at work. I get anxiety from the bupropion that I never had with tranylcypromine, and alprazolam does nothing to help.

I have a pdoc appointment in early December... what do I suggest? At my last appointment I suggested augmenting with gabapentin but she denied its efficacy. What do I do? What medications do I suggest? Parnate was the only thing that had ever worked but pdoc continues to be mum; my insurance also complained about the cost.

Anything histaminergic would be a big no-no considering the massive amount of weight I gained on mirtazapine (which I lost entirely while on Parnate...). Other than that I'm at a complete loss. Phenelzine seems like a good option but I'm a bit worried about weight gain since I gained weight so dramatically. Also worried that since it's an MAOI, my pdoc will flat-out refuse to try it.

I appreciate your advice... and your taking the time to read my life story.

 

Re: Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 20, 2012, at 10:31:39

In reply to Parnate helped, but pdoc switched me to junk, posted by ikasug on November 20, 2012, at 10:16:20

And for a bit of dx history:

Officially my diagnosis is MDD, Severe, w/o psychosis & GAD. Pdoc maintains that my illness mimics Bipolar II but cycling to normal instead of hypomania. This is not the case; I maintain a normal public image when I'm forced into business due to obligations... but completely neglect self-care. I am also acutely aware of my depressed mood while I'm pretending to be okay.

 

Re: Parnate helped, but pdoc switched me to junk » ikasug

Posted by Phillipa on November 20, 2012, at 11:27:25

In reply to Re: Parnate helped, but pdoc switched me to junk, posted by ikasug on November 20, 2012, at 10:31:39

My question was going to be diagnosis. I felt the discription above did sound bipolar. Thinking mood stabalizer lithium as would go with an maoi if doc lets you get it again. Phillipa

 

Re: Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 20, 2012, at 13:29:58

In reply to Re: Parnate helped, but pdoc switched me to junk » ikasug, posted by Phillipa on November 20, 2012, at 11:27:25

If I were truly bipolar II then maybe the lamotrigine would be indicated, but I'm now on 300mg with no noticeable effects except being a little more scatterbrained than usual. I think it's probably worsening my motivation because of the dampening.

Lithium scares me because of the weight gain, and is especially scary if I combine it with Phenelzine. I want to see what pdoc thinks about Emsam (which I found in my pharmacy plan's formulary!!).

Fortunately I think by my next visit it will be completely apparent that I need something stronger -- going from an MAOI to a common first-line antidepressant and the totally dubious lamotrigine doesn't make any sense to me. I understand that she wants to start with familiar territory for her practice, but when an ordinarily high-functioning person with a promising career can't take care of himself, reaching out seems to be in order.

 

Re: Parnate helped, but pdoc switched me to junk

Posted by jono_in_adelaide on November 20, 2012, at 16:51:16

In reply to Re: Parnate helped, but pdoc switched me to junk, posted by ikasug on November 20, 2012, at 13:29:58

I'd ask if you could go back to Parnate - put it to her exactly as you put it to us.

If that fails, I'd try an SSRI plus nortriptyline (start at 75mg then adjust in light of blood tests and response)

 

Re: Parnate helped, but pdoc switched me to junk

Posted by jono_in_adelaide on November 20, 2012, at 17:00:31

In reply to Re: Parnate helped, but pdoc switched me to junk, posted by jono_in_adelaide on November 20, 2012, at 16:51:16

and as Phillipa says, it might be worth trying a different mood stabaliser - just occasionaly, ones psychiatrist may be right!

 

Re: Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 24, 2012, at 16:18:55

In reply to Re: Parnate helped, but pdoc switched me to junk, posted by jono_in_adelaide on November 20, 2012, at 17:00:31

I'm extremely worried about antipsychotics, lithium, etc.. I can tolerate taking an antiepilptic, but I feel like slowing everything down with lithium or Seroquel would be a complete disaster for my job and my writing.

I'm required to be on the top of my mental game every weekday, and Ive already had a taste of the histaminergic nightmare of mirtazepine.

 

Re: Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 26, 2012, at 14:04:42

In reply to Parnate helped, but pdoc switched me to junk, posted by ikasug on November 20, 2012, at 10:16:20

Good news everybody! After getting an emergency appt with my pdoc, she agreed that I was much, much better on Parnate. She's still iffy about 60mg so she put me on Nardil instead. I'm feeling very positive because I've had much more success with MAOIs than any reuptake inhibitor.

 

Re: Parnate helped, but pdoc switched me to junk » ikasug

Posted by ChicagoKat on November 28, 2012, at 10:25:25

In reply to Parnate helped, but pdoc switched me to junk, posted by ikasug on November 20, 2012, at 10:16:20

Hi Ikasug,

Perhaps it would be worth it to give Nardil a try. It's great for anxiety and can be very effective for depression. Of course, it is true that weight gain can be a real problem. I can testify to the fact that it makes you feel like you have a huge hole in your stomach and you have to keep eating to try to keep it filled.

Another option might be Marplan. Another MAOI that is purported to have reduced side effect issues than the other MAOIs. I've read that switching to another MAOI can often work for people even if they fail on a different one.

And btw, gabapentin can certainly be quite effective. It really helps me b/c I'm so tolerant of benzos they are pretty much out for me.

Good luck, I hope you find a solution that works for you soon.
Kat

 

Re: Parnate helped, but pdoc switched me to junk

Posted by ikasug on November 29, 2012, at 12:21:06

In reply to Re: Parnate helped, but pdoc switched me to junk » ikasug, posted by ChicagoKat on November 28, 2012, at 10:25:25

Thanks for the support and advice, ChicagoKat!

Today is day 4 on Nardil 45mg. (I was in imminent trouble if I didn't jump the gun on the washout period)

I was surprised by friends the same day I had my emergency appointment and figured -- why not go out, anything is better than staying at home wanting to die. So I went out and drank. The next day at work I had a mysterious ghost of a hangover... but I was called out again after work.

By Wednesday afternoon I looked dead. I slept 12 hours and woke up with the window lifted. I know this is not the Nardil Euphoria (been there with Parnate) but it is immensely satisfying. I think it may be both the social interaction combined with everything speeding up now that lamotrigine isn't holding certain things back.

I see pdoc Dec. 10 and plan to ask for a dose increase so I can get to the MAO Inhibition threshold and also some modafinil, because i am not available even to myself from about 12:45-3:00.

Got over the first bout of constipation with brute force. Yikes.

I'm amazed at how fast I went from acute crisis to relatively smooth sailing.

 

Re: Parnate helped, but pdoc switched me to junk » ikasug

Posted by ChicagoKat on November 29, 2012, at 12:30:05

In reply to Re: Parnate helped, but pdoc switched me to junk, posted by ikasug on November 29, 2012, at 12:21:06

Glad to hear that you are improving. Nardil can be such a wonderful drug. Too bad it pooped out on me. But I am very happy for you.

As far as the constipation, I took 500mg of Magnesium citrate every other day, and never had a problem with constipation while I was on Nardil. Mag works great for the big C.

I hope you continue to feel better!
Kat

 

Re: Parnate helped, but pdoc switched me to junk » ChicagoKat

Posted by Phillipa on November 29, 2012, at 20:56:57

In reply to Re: Parnate helped, but pdoc switched me to junk » ikasug, posted by ChicagoKat on November 29, 2012, at 12:30:05

I take magnesium citrate health food store tablets 300mg a night for same reason unrelated to a med. But it works. Phillipa


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