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Re: MAOIs Bob

Posted by Jedi on November 21, 2005, at 1:51:22

In reply to Re: MAOIs Jedi, posted by Bob on November 20, 2005, at 20:06:25

> It seems like it would be very difficult to tolerate Nardil along with Nortriptyline! Those are two heavy drugs.

Bob,
I only augmented with 100mg of nortriptyline. I had no additional side effects. There are quite a few controlled studies that show that an MAOI augmented with some tricyclics can be beneficial for treatment resistant depression. There are also some studies which show that augmenting with tricyclics can reduce the problems with ingested tyramine. The nortiptyline did not seem to add any additional benefit for me. So when I got my MAO inhibition up to a therapeutic level, I dropped the nortriptyline.

> I didn't know that adding clonazepam would help depression. I thought benzos would only calm someone down, but that's it.

Many people on this board think that clonazepam causes worsening of depression. There have been some resent studies which show that at least 3mg of clonazepam added to an antidepressant can have a synergistic effect.

Example:
Nihon Shinkei Seishin Yakurigaku Zasshi. 2004 Apr;24(2):75-8.
[Clonazepam as a therapeutic adjunct to improve the management of depression]
Morishita S.
Depression Prevent Medical Center, Jujo Hospital, 32 Hattandacho, Kishoin, Minami-ku, Kyoto, 601-8325 Japan.

Clonazepam, which is a benzodiazepine structurally related to chlordiazepoxide hydrochloride, diazepam and nitrazepam, has been available for the treatment of seizure disorders in the USA since 1976 and in Japan since 1981. Increasingly, clonazepam has been used in the treatment of a variety of psychiatric disorders. The effect of clonazepam on depression was first reported by Jones and Chouinard in 1985. Since their report, many investigators have reported on the antidepressive properties of clonazepam. A daily dose of at least 3.0 mg clonazepam in augmentation of ongoing antidepressant treatment should be considered in depression. Regarding clonazepam augmentation therapy, if a patient does not show improvement by the end of four weeks, the treatment regimen should be altered. Age at onset of the first depressive episode and a history of family psychiatric illness should be considered the predictor of prognosis. The author discusses specific guidelines for the use of clonazepam in depression.

> Are you saying that you have had success controlling your weight with exercise, that you have not been able to exercise because of your depression?

My weight has gone up and down on Nardil. When I am able to exersise for an hour or two per day, the weight comes off. Without medication, my atypical depression makes it almost immpossible to exercise. I just can't force myself out of bed.

> I assume that since you are taking a relatively high dose of Nardil and that you have augmented with different things that you experienced at least a partial fade out with the therapeutic effects of Nardil?

You assume correctly. I would call the level of depression that I suffer on Nardil, intermittent dysthymia. The augmentation that I try is to control this and the side effects. The two times I have been off Nardil in the past decade, I have regressed to major depression within a couple of months.

I have had partial responses with other medications. Effexor and Celexa combined with Wellbutrin SR have given partial response. The main problem with the SSRIs and SNRIs is a level of anhedonia and apathy which keep me from doing anything productive.

As mentioned before, I'm a lifer. I'm still hoping for that miracle medication to come along, but until then it is Nardil with augmentation.
Take care,
Jedi


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poster:Jedi thread:579730
URL: http://www.dr-bob.org/babble/20051119/msgs/580788.html