Posted by Scott L. Schofield on January 11, 2000, at 13:32:09
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 20:41:36
> There's no evidence that verapamil augments ADs in unipolar depression, some evidence that it doesn't, and I think there have even been reports of it triggering or exacerbating depression. See why I'm a tad concerned?
I’ve seen similar reports regarding verapamil as well. I don ‘t think that this phenomenon is exceedingly rare. Several years ago, I read an anecdote describing a woman who had been depression-free for several years while taking a tricyclic (desipramine I think). When she developed cardiac trouble, she was given verapamil. She immediately relapsed into depression, and adjusting the dosage of the tricyclic had no positive effect. It was decided to discontinue the verapamil to see what would happen. The depression lifted quickly. The doctor thought it was worthwhile to try adding back the verapamil to make certain that her relapse was indeed induced by the verapamil and not by some fluke coincidence. Again she relapsed. Lucky for her, the antidepressant effect was recaptured.
I don’t recall if there was a discussion in the article regarding the possible mechanisms by which this reaction occurs. I guess one obvious possibility is that verapamil blocks the calcium channels located at the terminal of the neuron, thereby inhibiting the vesicular release of neurotransmitter.
> > I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy.
> I'm a walking testament to this!
> > If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
> Nope. Depakote didn't do a thing when I took it with Parnate. They're not all identical, and lithium is by far the best-studied.Hooray for Cabe!
It’s a good thing that they are not all alike. I doubt as many people would get well if they were.
> > I imagine if you were bipolar, mania would probably have made an appearance by now.> It did, when I was taking Effexor, but it was in the context of serotonin syndrome. I think I may have been a tad hypomanic (mixed) on Paxil.
My personal impression of Effexor is that its effects on dopaminergic pathways have been underestimated.
If this is true, I can see how this drug may be capable of producing mania in vulnerable individuals. It is also my guess that the DA thing is responsible for its reputation of inducing a more rapid onset of an antidepressant response. Early on, many of the investigators of Effexor touted it as being a “non-MAOI MAOI”. I have seen this drug often chosen before others as a therapy for treatment-resistant bipolar depression.I guess whether or not you were hypomanic must be a tough call. Would the word “excitability” apply at all? What was it about your experience that suggests that hypomania may have been involved rather than any other phenomenon?
I’m probably asking too many questions, but I am interested to know what caused the serotonin syndrome and how it manifested. Can serotonin syndrome produce a manic-like state?
> > Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.> What is the "typical bipolar profile?"
I was under the impression that bipolar depression tends to resemble atypical unipolar depression in most cases. The symptoms usually include psychomotor retardation, anergia, hyperphagia, and hypersomnia
> > However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin.
> How was that combination for you?The combination at that point in time got me as well as I could ask for, although I subsequently realized that there were things missing in retrospect. I would be very glad to accept it back, though – no questions asked. I definitely felt smarter. I know doctors don’t like to say that intelligence is affected during depression, but I would have to argue that, in my case anyway, “functional intelligence” is definitely reduced.
> Do you recall what doses you were on?
Parnate 60 mg/day and Norpramin 150 mg/day.
> Any side effects?
The usual, I guess. Postural hypotension was definitely “irritating”. I don’t think that Parnate contributed to the anticholinergic side-effects that I experienced. If it did, it was minimal. Desipramine was more the culprit, but its effects definitely mitigated over time. Also, Parnate caused retrograde ejaculation along with a change in the experience of orgasm, and perhaps even a bit of difficulty reaching it. These effects also seemed to disappear. Oh yeah, one more. I could have a woody all day long if I wanted to (not priapism).
> > I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria.
> Ow. Mixed mania is the most horrible mood state, I think.It’s hard to say. It sure is draining, or at least it feels that way. I know that the grass always looks greener,… yadda, yadda, yadda, but at least I didn’t feel like I was chained to the bottom of some deep, murky sea.
> Manic episodes that happen when you're taking antidepressants aren't supposed to count towards a diagnosis of bipolar disorder, no.
I guess this is the crux of the issue. My case definitely presents this way. WZ Potter diagnosed me as being bipolar. He was the first clinician to do so. I’m sure he was right.
> But some people who don't have spontaneous manic episodes nevertheless become manic on ADs...in these cases, a mood stabilizer seems indicated.
That sounds about right to me.
Do you treat a syndrome, or do you treat a biological entity? If the biology of a “unipolar with drug-induced mania” turns out to be quite similar to that of bipolar, but significantly different from “unipolar without mania”, I think the identification of the biological etiology would better serve to choose treatments. This would be extremely important early in the course of affective-illness, and I think it should be the first step in treating the index episode.
I guess we’re not there yet. Nevertheless, you may want to keep the possibility of extant bipolarity somewhere in your unipolar mind. :-)
("bipolar III" is a term I've heard used by researchers and clinicians -- I've never heard the list you mention except posted on the internet)
Yeah, I tried to search the newsgroup archives using Deja News, but couldn’t find it. I’m quite sure it was posted and I do remember who posted it. However, I don’t know what source he got the information from.
> > I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic.
> Yes, it is.You know the rapid-cyclicity deal, as arbitrary as it may be, can be a good index for deciding how to attack the illness. Does your “episodic” course resemble rapid-cyclicity?
If it does, you may want to stuff that fact somewhere too. (you probably have a place picked out already) ;-)
> > Have you ever been successfully treated?
> Sure. MAOIs work well for my depression…Another correlative fact.
> …but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble.
???
> I also have some irritating problems with MAOI side effects: Parnate causes spontaneous hypertensive episodes while Nardil and Marplan cause sugar cravings and weight gain!
To describe this stuff as being nothing more than “irritating” shows that your sense of humor may still be intact.
Later…
- Scott
poster:Scott L. Schofield
thread:17762
URL: http://www.dr-bob.org/babble/20000101/msgs/18720.html