Psycho-Babble Medication Thread 360926

Shown: posts 2 to 26 of 26. Go back in thread:

 

Re: Personal MAOI diet experience: update on cheese!

Posted by King Vultan on June 27, 2004, at 11:33:48

In reply to Personal MAOI diet experience: update on cheese!, posted by gardenergirl on June 27, 2004, at 9:34:01

Yes, I've also tried yogurt with no problem and have had parmesan garlic bread. As for other cheeses, I've had some cheeseburgers and sub sandwiches with American cheese with no problems, either. American cheese is very similar to the pasteurized process cheese slices that are also indicated as okay. For those wondering, the cheese that McDonald's uses on their quarter pounder is American, and I've eaten these with no incident.

I am a pizza eater also and have consumed a considerable number of pizzas since I went on Nardil in March. However, I have limited myself to a relatively small number of brands that I trust, and in all cases, the cheese has been mozzarella only. At Papa Murphy's for instance, they typically use a three cheese blend, and I specify mozzarella only, which they are able to accomodate.

I have been avoiding absolutely everything that has cheddar cheese in it, no matter how small the amount. I know that in many of these cases I could probably get away with eating the item, but I don't want to get in a mode where I gradually start taking more and more chances with cheddar, as a hypertensive crisis is inevitable if you consume enough of it. Maybe I am being overly cautious, though. I'd be interested in hearing others' thoughts on consuming snack foods with small amounts of cheddar in them (Chitos, chips, crackers, etc.) What about the Kraft macaroni and cheese in a box?

Todd

 

Re: Personal MAOI diet experience: Cold Meds?

Posted by Ktemene on June 27, 2004, at 13:33:18

In reply to Personal MAOI diet experience: update on cheese!, posted by gardenergirl on June 27, 2004, at 9:34:01

Does anyone have any experience with cold/flu medications that are compatible with MAOI's? I was looking through my local pharmacy's Cold & Flu section and every medication I picked up had a warning for people taking MAOI's not to use it.

Is there any medication for cough or runny nose that is not incompatible with MAOI's? What do people on MAOI's do when they have a cold or flu? Just tough it out? Or are there some medications that are OK to take with MAOI's?

 

Re: Personal MAOI diet experience: Cold Meds? » Ktemene

Posted by King Vultan on June 27, 2004, at 14:38:11

In reply to Re: Personal MAOI diet experience: Cold Meds?, posted by Ktemene on June 27, 2004, at 13:33:18

I've usually just toughed it out myself when I've had a cold or the flu, so the restrictions on those meds were really of no consequence to me. You can take plain Benadryl or another pure antihistamine, for whatever good it might do for your symptoms, but I believe that all of the decongestants are out.

Todd

 

Re: Personal MAOI diet experience: update on cheese! » gardenergirl

Posted by maddog on June 27, 2004, at 18:50:37

In reply to Personal MAOI diet experience: update on cheese!, posted by gardenergirl on June 27, 2004, at 9:34:01

Hi GG,

Sorry to hijack your thread but I have just washed out from Paxil and I am about to begin Nardil. I suffer from anxiety including social anxiety.

I am wondering how your experience on Nardil is developing? How long have you been on N and has it helped your symptoms, etc.

Thanks!!
maddog

> Hi folks.
>
> I just wanted to report that I finally got up the nerve to try two things that research or others' experience has reported as relatively safe due to low tyramine contents: yogurt and Kraft parmesan cheese. Others have reported here eating these safely, but I just now tried.
>
> The yogurt was very fresh, at least a month away from the expiration date. And the parmesan cheese was Kraft canned stuff---awful if you are used to fresh grated, but still, better than none. Please note, I used less than a tablespoon of the Kraft.
>
> Anyway, no reaction, no change in my blood pressure at all. Of course your mileage may vary, so think carefully if you decide to try forbidden fruits.
>
> but yeah! 'specially about the yogurt.
>
> gg

 

Re: Personal MAOI diet experience: Cold Meds?

Posted by Maxime on June 27, 2004, at 19:13:29

In reply to Re: Personal MAOI diet experience: Cold Meds? » Ktemene, posted by King Vultan on June 27, 2004, at 14:38:11

Hi

I know I am not the norm when it comes to MAOIs. I take 80 mg of Parnate and can eat whatever I want with the sole exception being soy sauce.

Anyhow, I have taken Neo Citron and Nyquil while taking Parnate and nothing happened.

Sometimes I wonder if there is something wrong with me. I have been over 30 meds and they either don't work or they poop out on me. And it's not that I am a large person either. I'm actually really petite. so I don't know why. I'm on 80 mg of Parnate and still have depression (but not the suicidal depression I used to have).

Sorry for rambling.....


Maxime

> I've usually just toughed it out myself when I've had a cold or the flu, so the restrictions on those meds were really of no consequence to me. You can take plain Benadryl or another pure antihistamine, for whatever good it might do for your symptoms, but I believe that all of the decongestants are out.
>
> Todd

 

Re: Personal MAOI diet experience: update on cheese!

Posted by gardenergirl on June 28, 2004, at 15:34:03

In reply to Re: Personal MAOI diet experience: update on cheese! » gardenergirl, posted by maddog on June 27, 2004, at 18:50:37

> Hi GG,
>
> Sorry to hijack your thread but I have just washed out from Paxil and I am about to begin Nardil. I suffer from anxiety including social anxiety.

No problem about hijacking. I just wanted to celebrate a bit. My diagnosis is atypical depression. So your mileage may vary, as it were.

> I am wondering how your experience on Nardil is developing? How long have you been on N and has it helped your symptoms, etc.

I started on 45 mg of Nardil back in Sept. 03 (roughly, I'm not so good with dates). When I first took it, the thing I noticed the most were that I was no longer sleeping all day long, and thus missing class or work. Also I felt much more confident, suggesting that my depression has an underlying anxious component of which I was not aware. My goofy side came back out, and friends and family said I seemed like the old GG again. That was nice to hear.

Eventually, the not sleeping all day long shifted to insomnia (early awakening) and the confidence which had an *almost* euporhic flavor, shifted to plain old not feeling depressed.

I went through a period of increased depression around the holidays, so I increased my dose to 60 mg. For a time, that seemed to make me feel worse. I may have been more depressed because I was on vacation, and thus missed three or so weeks of therapy, which might have contributed. I went back down to 45 mg, and felt worse again, and was involved in a great deal of school/work stress, so I am back to 60 mg now which seems to be keeping me stable as far as depressive symptoms, considering there's been a huge increase in external stress.

I doubt I would go any higher, out of a fear about side effects. They are quite tolerable to me at 60 (mostly hyperreflexia, which doesn't bother me at all, but also urinary retention and accompanying edema, which I would not want to get any worse.) Others, though have gone much higher and seem to tolerate any SE's they have.

Good luck to you. I really believe Nardil is *the* drug for my atypical depression. And I have read and heard about its great effect on social phobia and anxiety.

Take care,

gg
>
> Thanks!!
> maddog
>
> > Hi folks.
> >
> > I just wanted to report that I finally got up the nerve to try two things that research or others' experience has reported as relatively safe due to low tyramine contents: yogurt and Kraft parmesan cheese. Others have reported here eating these safely, but I just now tried.
> >
> > The yogurt was very fresh, at least a month away from the expiration date. And the parmesan cheese was Kraft canned stuff---awful if you are used to fresh grated, but still, better than none. Please note, I used less than a tablespoon of the Kraft.
> >
> > Anyway, no reaction, no change in my blood pressure at all. Of course your mileage may vary, so think carefully if you decide to try forbidden fruits.
> >
> > but yeah! 'specially about the yogurt.
> >
> > gg
>
>

 

Re: Personal MAOI diet experience: Cold Meds?

Posted by Ktemene on June 29, 2004, at 13:45:26

In reply to Re: Personal MAOI diet experience: Cold Meds? » Ktemene, posted by King Vultan on June 27, 2004, at 14:38:11

> I've usually just toughed it out myself when I've had a cold or the flu, so the restrictions on those meds were really of no consequence to me. You can take plain Benadryl or another pure antihistamine, for whatever good it might do for your symptoms, but I believe that all of the decongestants are out.
>
> Todd

Thanks Todd. I had not thought of Benadryl. I tried it for my wretched summer flu and it was lots better than nothing. It helped the runny nose and it put me to sleep, so I didn't have to spend another night wide awake and coughing every thirty seconds...

Ktemene

 

Re: Personal MAOI diet experience: Cold Meds? » Maxime

Posted by Ktemene on June 29, 2004, at 21:15:20

In reply to Re: Personal MAOI diet experience: Cold Meds?, posted by Maxime on June 27, 2004, at 19:13:29

Hi Maxime,
Don't worry about rambling- it was nice of you to take the trouble to answer the question, especially since it was kind of a trivial question anyway. It is really interesting that you have no problems with meds like Nyquil even though you are taking 80mg Parnate. Does your pdoc have any theories about why you have no problems with the forbidden meds and foods when so many other people do? Maybe that is why you haven't had a problem taking Adderall with Parnate. (If I am remembering correctly that you did recently start taking Adderall to augment Parnate.)

For more than a year now I have been taking 10-20mg Adderall per day, and my experience has been very good. I’ve never needed to up the dose of Adderall. And I always had the sense that Adderall was not only acting as a stimulant but was also augmenting the antidepressant effects of the AD I was taking at the time (Wellbutrin up until this spring, Selegiline now- they both effect dopamine so maybe that is the reason Adderall worked well with both of them). I also take Provigil, and find that a particularly useful med especially late in the day, when taking Adderall might interfere with sleep.

By the way I wanted to mention how much I have gotten out of your posts since I discovered Psycho-Babble six months ago. You consistently offer encouragement and helpful advice and useful information to others even when you are obviously in a lot of pain yourself. I just wanted to say how much I appreciate it, and that I’m really hoping that Adderall will give you some relief. If anyone deserves a break, you do.

Hang in there,
Ktemene

> Hi
>
> I know I am not the norm when it comes to MAOIs. I take 80 mg of Parnate and can eat whatever I want with the sole exception being soy sauce.
>
> Anyhow, I have taken Neo Citron and Nyquil while taking Parnate and nothing happened.
>
> Sometimes I wonder if there is something wrong with me. I have been over 30 meds and they either don't work or they poop out on me. And it's not that I am a large person either. I'm actually really petite. so I don't know why. I'm on 80 mg of Parnate and still have depression (but not the suicidal depression I used to have).
>
> Sorry for rambling.....
>
>
> Maxime
>
>
>
> > I've usually just toughed it out myself when I've had a cold or the flu, so the restrictions on those meds were really of no consequence to me. You can take plain Benadryl or another pure antihistamine, for whatever good it might do for your symptoms, but I believe that all of the decongestants are out.
> >
> > Todd
>
>

 

Re: Personal MAOI diet experience: Cold Meds? » Maxime

Posted by cubbybear on June 30, 2004, at 10:42:03

In reply to Re: Personal MAOI diet experience: Cold Meds?, posted by Maxime on June 27, 2004, at 19:13:29

> Hi
>
> I know I am not the norm when it comes to MAOIs. I take 80 mg of Parnate and can eat whatever I want with the sole exception being soy sauce.
>
> Anyhow, I have taken Neo Citron and Nyquil while taking Parnate and nothing happened.
>
> Sometimes I wonder if there is something wrong with me. I have been over 30 meds and they either don't work or they poop out on me. And it's not that I am a large person either. I'm actually really petite. so I don't know why. I'm on 80 mg of Parnate and still have depression (but not the suicidal depression I used to have).
>
> Sorry for rambling.....
>
>
> Maxime
>
> Maybe the fact that Parnate has not alleviated your depression is precisely why there has been no adverse interaction with the forbidden meds. I would guess that maybe the Parnate has not brought about the necessary inhibition of monoamine oxidase, for whatever crazy reason, and so there would be no risk for you in taking the cold medicines. I'm no psychopharmacologist, but it seems logical to suppose this is the case (hope what I've said makes sense!)

 

Re: Personal MAOI diet experience: + other AD's » Ktemene

Posted by Fonzie on June 15, 2015, at 4:36:50

In reply to Re: Personal MAOI diet experience: Cold Meds? » Maxime, posted by Ktemene on June 29, 2004, at 21:15:20

Hello, I am new to MAOI's, and have recently begun taking Adderoll.
Now, along with all the many food reactions possible, and other medication reactions, I do read on here and hear of people taking MAOI's in combination with other AD's such as SSRI's and SNRI's in low(ish) doses. Which on the strictest of terms in the literature given to me with Adderoll.
I am only now taking the MAOI rout because I've been on at least 30 other AD meds with little to no success. Except for one, mirtazapine which I was on for around 3.5 years and thought it to be working. . . until . . . I found myself making very thorough and defined things to end my own life in such a way that I 1)could not be stopped 2) my folks or anybody I knew would NOT be the ones to find me 3) would (if something hadn't stopped me) would have been definite success. I absolutely ran out of options regarding meds, so I do have doubts or concerns regarding the question of 'if Adderoll doesn't work, what then???'
But as I stated earlier, I read that people have used it in combination with other (normal) AD's like SSRI's and SNRI's.
Can this really be done? Is it wise? Etc.

Love to hear what the small community here has to say about it. AND what others have read/heard on the subject of boosting the MAOI's efficiency.

Stay well folks

Fonzie:)

 

Re: Personal MAOI diet experience: Cold Meds? » Maxime

Posted by Kirkglen on June 18, 2015, at 11:54:03

In reply to Re: Personal MAOI diet experience: Cold Meds? » Maxime, posted by cubbybear on June 30, 2004, at 10:42:03

I've been using MAOI's for many years. I've found things that effect an MAOI. I currently use Nardil but have tried Parnate with no success.

I use 1mg of Klonipin at night which works well with Nardil.

Dangerous drugs are the SSRI's, SNRI's, and older AD's. OTC decongestants I've been to the ER 3 times.

The dangerous ones are easy to find but their are other foods I avoid as I find the next day my depression/anxiety surge.

NO SUGAR, strive not to eat a lot of other carbs, tomatoes, no nuts of any kind.

It's hard but strive to maintain your calories with meats, fish, other vegis,

I promise you'll have a better response to MAOI's if you'll follow this type diet. Why these things dump , I don't know but I will continue to read.

 

Re: Personal MAOI diet experience: Cold Meds?

Posted by ikasug on June 18, 2015, at 23:40:51

In reply to Re: Personal MAOI diet experience: Cold Meds? » Maxime, posted by Kirkglen on June 18, 2015, at 11:54:03

I have never followed the MAOI diet and I have not ever had elevated BP in the years that I have been on them. I have had panic attacks from drug interactions but not elevated BP. Nonetheless please follow the advice of your prescribing physician.

 

Re: Personal MAOI diet experience: + other AD's » Fonzie

Posted by Robert_Burton_1621 on July 3, 2015, at 23:44:49

In reply to Re: Personal MAOI diet experience: + other AD's » Ktemene, posted by Fonzie on June 15, 2015, at 4:36:50

> Hello, I am new to MAOI's, and have recently begun taking Adderoll.
> Now, along with all the many food reactions possible, and other medication reactions, I do read on here and hear of people taking MAOI's in combination with other AD's such as SSRI's and SNRI's in low(ish) doses. Which on the strictest of terms in the literature given to me with Adderoll.
> I am only now taking the MAOI rout because I've been on at least 30 other AD meds with little to no success. Except for one, mirtazapine which I was on for around 3.5 years and thought it to be working. . . until . . . I found myself making very thorough and defined things to end my own life in such a way that I 1)could not be stopped 2) my folks or anybody I knew would NOT be the ones to find me 3) would (if something hadn't stopped me) would have been definite success. I absolutely ran out of options regarding meds, so I do have doubts or concerns regarding the question of 'if Adderoll doesn't work, what then???'
> But as I stated earlier, I read that people have used it in combination with other (normal) AD's like SSRI's and SNRI's.
> Can this really be done? Is it wise? Etc.
>
> Love to hear what the small community here has to say about it. AND what others have read/heard on the subject of boosting the MAOI's efficiency.
>
> Stay well folks
>
> Fonzie:)

Hi Fonzie,

I don't know where you have got your information about combining an MAOI with an SSRI or SNRI, but it ought not be done because of the risk of serotonin syndrome. These classes of medication should be off the cards. Any significantly serotonergic medication or with significant serotonin reuptake inhibitor potence should be avoided. This includes SSRIs, SNRIs, clomipramine and imipramine.

As for augmenting agents, first line would be lithium, others include nortriptyline, buproprion, aripiprazole, lamotrigine.

 

Re: Personal MAOI diet experience: + other AD's » Fonzie

Posted by SLS on July 4, 2015, at 6:27:07

In reply to Re: Personal MAOI diet experience: + other AD's » Ktemene, posted by Fonzie on June 15, 2015, at 4:36:50

> But as I stated earlier, I read that people have used it in combination with other (normal) AD's like SSRI's and SNRI's.
> Can this really be done? Is it wise? Etc.

No!

MAOI + SSRI / SNRI is perhaps the most dangerous combination there is for precipitating serotonin syndrome.

I would just add to the comments of Robert_Burton_1621 that the dosage range for lithium when used as an augmenter in unipolar depression can be as low as 300 mg/day. As a mood stabilizer in bipolar disorder, dosages usually fall in the range of 900 - 1500 mg/day, depending on clinical results and blood levels.


- Scott

 

Re: Personal MAOI diet experience: + other AD's » Robert_Burton_1621

Posted by former poster on July 18, 2015, at 23:36:26

In reply to Re: Personal MAOI diet experience: + other AD's » Fonzie, posted by Robert_Burton_1621 on July 3, 2015, at 23:44:49

I took Nardil with Dextroamphetamine 5 years. Also took Emsam 6mg to 18mg with Vyvanse for 5 years without a single problem except over stimulation. Cymbalta with Vyvanse 5 years...

 

Re: Personal MAOI diet experience: + other AD's » former poster

Posted by Robert_Burton_1621 on July 19, 2015, at 12:25:11

In reply to Re: Personal MAOI diet experience: + other AD's » Robert_Burton_1621, posted by former poster on July 18, 2015, at 23:36:26

> I took Nardil with Dextroamphetamine 5 years. Also took Emsam 6mg to 18mg with Vyvanse for 5 years without a single problem except over stimulation. Cymbalta with Vyvanse 5 years...

Yes. My point, and Scott's point, wasn't that MAOI's cannot be combined with other medications, it was that they cannot be combined with medications with *significant* serotonergic activity because of the high risk of serotonin syndrome. Dextroamphetamine as an adjunct to an MAOI increases the risk of hypertensive crisis owing to increased noradrengic CNS transmission, but under appropriate supervision is safe, as you have experienced (unfortunately, the combination is prohibited in Australia).

 

Re: Personal MAOI diet experience: + other AD's » Robert_Burton_1621

Posted by former poster on July 20, 2015, at 1:03:29

In reply to Re: Personal MAOI diet experience: + other AD's » former poster, posted by Robert_Burton_1621 on July 19, 2015, at 12:25:11

Looks like it's prohibited in USA now too. I can't find a Dr. that will prescribe the 2 meds. But its not the government in control now anyway, its the insurance companies.

 

Re: Personal MAOI diet experience: + other AD's

Posted by SLS on July 20, 2015, at 7:58:05

In reply to Re: Personal MAOI diet experience: + other AD's » Robert_Burton_1621, posted by former poster on July 20, 2015, at 1:03:29

> Looks like it's prohibited in USA now too. I can't find a Dr. that will prescribe the 2 meds. But its not the government in control now anyway, its the insurance companies.

Agreed.

Currently, I am taking a combination of Parnate and nortriptyline. It is contraindicated, but not illegal in the USA.

The main drugs to stay away from are those that inhibit the reuptake of serotonin (SRIs). Serotonin releasers might cause reactions too. Methamphetamine is an example of this. Serotonin syndrome is the reaction to be avoided with these.

Drugs that act as NE mimetics (agonists) are to be avoided. These would include pseudoephedrine and phenylpropanolamine - drugs that are used as decongestants.


- Scott

 

Re: MAOI + other AD's (Nort.) (nm) » SLS

Posted by Robert_Burton_1621 on July 20, 2015, at 10:36:51

In reply to Re: Personal MAOI diet experience: + other AD's, posted by SLS on July 20, 2015, at 7:58:05

 

Re: MAOI + other AD's (Dext. + Nort.) » SLS

Posted by Robert_Burton_1621 on July 20, 2015, at 10:42:18

In reply to Re: Personal MAOI diet experience: + other AD's, posted by SLS on July 20, 2015, at 7:58:05

> > Looks like it's prohibited in USA now too. I can't find a Dr. that will prescribe the 2 meds. But its not the government in control now anyway, its the insurance companies.
>
> Agreed.
>
> Currently, I am taking a combination of Parnate and nortriptyline. It is contraindicated, but not illegal in the USA.
>
> The main drugs to stay away from are those that inhibit the reuptake of serotonin (SRIs). Serotonin releasers might cause reactions too. Methamphetamine is an example of this. Serotonin syndrome is the reaction to be avoided with these.
>
> Drugs that act as NE mimetics (agonists) are to be avoided. These would include pseudoephedrine and phenylpropanolamine - drugs that are used as decongestants.
>
>
> - Scott

There was a study published in 2014 in the J Aff Disorders by Stewart and McGrath (from Texas and Columbia respectively) on MAOI treatment of refractory depression. It was a small study (28 patients) but 82% of patients remitted in either one of the 5 phases (which were designed in binary stages consisting first of a cumulative phase of tranylcypromine treatment and augmentation and then, if remission had not been achieved, a cumulative phase of phenelzine treatment and augmentation)of the trials or in post-study follow-up. 64% maintained their remitted status for six months.

What is interesting, in light of the proscription even in the US now of combinging dexa.amph with parnate, is that the third cumulative phase of the parnate stage was augmentation with the stimulant. Presumably, the authors must have obtained some concession or waiver in order to use this combination.

The highest proportion of remitters (33%) did so in response to above recommended daily parnate dosages up to 120 mg/day.

Scott, I'm interested to know how you are going on nortriptyline as an adjunct, and what dose you are taking. It's been recommended to me by a retired psychiatrist who's an expert on medication interactions and MAOIs, however my current psychiatrist - although I'm enormously lucky that he does prescribe (and is the *only* specialist I have found who will prescibe) MAOIs and is very knowledgeable about them - won't add nort.

I have had a trial of nort. alone for 6 weeks (which kept me generally stable but had no other antidepresant effect)and with sertraline for 6 weeks (which combination was less effective than nort. alone) prior to starting parnate. If I've only had a mediocre response to nort., is there benefit in seeking to add it to parnate?

I am on 130 mg/day of parnate. I feel I could benefit from 140. I had a trial of lithium for one month but became worse and hypothyroid (this was disappointing, because some people do tend to respond dramatically well to the addition of lithium to parnate). I now have a script for lamotrigine as the next adjunctive strategy but have not filled it yet.

I have no bi-polarity at all: these medications aren't for mood stabilisation but for anti-depressant enhancement, at least that's the theory.

 

Re: MAOI + other AD's (Dext. + Nort.) » Robert_Burton_1621

Posted by SLS on July 21, 2015, at 15:36:44

In reply to Re: MAOI + other AD's (Dext. + Nort.) » SLS, posted by Robert_Burton_1621 on July 20, 2015, at 10:42:18

Hi.

Sorry to take so long to respond.

I was once on Parnate 120 mg/day + desipramine 200 mg/day + amphetamine 20 mg/day + thyroxine + bromocriptine. The antidepressant response did not last for more than a week, but the combination was well tolerated.

> There was a study published in 2014 in the J Aff Disorders by Stewart and McGrath (from Texas and Columbia respectively) on MAOI treatment of refractory depression.

I was first diagnosed and treated at Columbia in 1982. I saw Dr. McGrath about 15 years ago for consultation. He seemed to really like Parnate. Unfortunately, he didn't have much to contribute to my treatment plan.

> It was a small study (28 patients) but 82% of patients remitted in either one of the 5 phases (which were designed in binary stages consisting first of a cumulative phase of tranylcypromine treatment and augmentation and then, if remission had not been achieved, a cumulative phase of phenelzine treatment and augmentation)of the trials or in post-study follow-up. 64% maintained their remitted status for six months.

The ONLY time I experienced a remission (6 month period) was during treatment with Parnate and desipramine in 1987.

> What is interesting, in light of the proscription even in the US now of combinging dexa.amph with parnate, is that the third cumulative phase of the parnate stage was augmentation with the stimulant. Presumably, the authors must have obtained some concession or waiver in order to use this combination.

What about methylphenidate? I don't feel a thing with amphetamine, but dexmethylphenidate produces an increase in mental energy. I tend not to use it, though, because it only lasts for about 5 hours, and I don't want to bounce up and down or develop a tolerance to it.

> Scott, I'm interested to know how you are going on nortriptyline as an adjunct, and what dose you are taking.

My current treatment regime has produced a 35 - 40% improvement - primarily in mental energy and psychomotor retardation. My affect is less flat. I am overall more functional, but anhedonia persists. I am not experiencing a "complete" antidepressant effect, despite an improvement in vegetative symptoms.

Parnate - 120 mg/day
nortriptyline - 100 mg/day (therapeutic blood level)
Lamictal - 200 mg/day
lithium - 300 mg/day
Abilify - 10 mg/day
prazosin - 30 mg/day

> It's been recommended to me by a retired psychiatrist who's an expert on medication interactions and MAOIs, however my current psychiatrist - although I'm enormously lucky that he does prescribe (and is the *only* specialist I have found who will prescibe) MAOIs and is very knowledgeable about them - won't add nort.

What are his concerns?

> I have had a trial of nort. alone for 6 weeks (which kept me generally stable but had no other antidepresant effect)and with sertraline for 6 weeks (which combination was less effective than nort. alone) prior to starting parnate. If I've only had a mediocre response to nort., is there benefit in seeking to add it to parnate?

I didn't like sertraline. It left me in a fog and feeling somewhat dysphoric. I don't do well on SSRIs in general. However, sertraline is a fairly potent sigma-1 receptor antagonist. (Note that fluvoxamine is a potent sigma-1 receptor agonist). That might have something to do with my reaction to it.

I thought you might be interested to see this:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881105/

I do somewhat better with venlafaxine and duloxetine. Venlafaxine 300 mg/day + nortriptyline 75 mg/day helped, but not enough. In retrospect, I probably would have done better with a higher dosage of nortriptyline. A friend of mine is doing very well on a combination of desvenlafaxine and bupropion.

> I am on 130 mg/day of parnate. I feel I could benefit from 140. I had a trial of lithium for one month but became worse and hypothyroid (this was disappointing, because some people do tend to respond dramatically well to the addition of lithium to parnate).

Yes. I wish I were one of them. I take lithium 300 mg/day. The dosage is optimized for depression, not mania. It helps. Also, there is some suggestion that low dosages of lithium reduce the risk of developing Alzheimer's Dementia.

> I now have a script for lamotrigine as the next adjunctive strategy but have not filled it yet.

It might be worth adding aripiprazole to the lamotrigine should lamotrigine be insufficient. They seem to work well together.

> I have no bi-polarity at all: these medications aren't for mood stabilisation but for anti-depressant enhancement, at least that's the theory.

I was unipolar right up to the point that I was bipolar. :-)

On a few occasions, I have had severe manic reactions to antidepressants that persisted, despite drug discontinuation. It was William Potter who affirmed my diagnosis in 1992. It is good that the new DSM 5 includes this presentation as a form of bipolar disorder.

I hope you find something here helpful.

Take care of yourself.


- Scott

 

Re: MAOI + other AD's (Dext. + Nort.)

Posted by Lamdage22 on July 28, 2015, at 10:13:54

In reply to Re: MAOI + other AD's (Dext. + Nort.) » Robert_Burton_1621, posted by SLS on July 21, 2015, at 15:36:44

makes me think about 300mg Lithium.

 

Re: MAOI + other AD's (Dext. + Nort.)

Posted by Lamdage22 on July 28, 2015, at 10:22:46

In reply to Re: MAOI + other AD's (Dext. + Nort.), posted by Lamdage22 on July 28, 2015, at 10:13:54

i suppose the typical lithium side effects are not as prominent at 300mg?

 

Re: MAOI + other AD's (Dext. + Nort.) » Lamdage22

Posted by SLS on July 28, 2015, at 11:26:01

In reply to Re: MAOI + other AD's (Dext. + Nort.), posted by Lamdage22 on July 28, 2015, at 10:22:46

> i suppose the typical lithium side effects are not as prominent at 300mg?

I experience no subjective side effects at all. Also, the risk to kidney and thyroid functions are minimal.


- Scott

 

Re: MAOI + other AD's (Dext. + Nort.)

Posted by Lamdage22 on July 31, 2015, at 7:25:55

In reply to Re: MAOI + other AD's (Dext. + Nort.) » Lamdage22, posted by SLS on July 28, 2015, at 11:26:01

ok i may give it a shot. I am seeing my pdoc only every six weeks.


This is the end of the thread.


Show another thread

URL of post in thread:


Psycho-Babble Medication | Extras | FAQ


[dr. bob] 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.