Posted by jd on February 19, 2000, at 22:02:46
In reply to Re: maoi or bust, posted by JohnL on February 19, 2000, at 4:09:56
Ryan,
Just a note to say that I totally agree with JohnL's post above. If you haven't yet tried a med that targets dopamine, it might be worth trying wellbutrin or selegiline before heading for the full-scale MAOIs, but there's still a good possibility that the real answer doesn't lie with conventional antidepressants at all. Once again, a truly experienced pdoc will be able to assess your situation and med history and come up with a more-or-less ordered list of medications worth trying: this list may include MAOIs or other antidepressants you haven't yet tried, but he/she may well want to try completely different meds, as these are often the most effective in people who haven't been responding to regular antidepressants. The odds are with you that something will help!
best,
jd
> Ryan,
>
> I have not tried the MAOIs, so understand I do not speak from experience. But I had some points I wanted to throw into the discussion.
>
> First, I think all too often the medical world assumes antidepressants treat depression. While this is often true of course, it fails to recognize that any of several chemical imbalances can cause the exact same symptoms in mood, and only a few of them are addressed by antidepressants. And in a significant number of patients, it is actually a drug from a different class that normalizes the chemical imbalance--not an antidepressant. I believe that when 3 or 4 antidpressants have yielded substandard results, the priority has shifted to immediately trying other classes of drugs instead. For example the stimulants, stabilizers, antipsychotics, benzos. Within one of those groups will be found a best-fit. The best-fit drug will make itself known very quickly once it is tried. And it often ends up being one of the stimulants, as they correct a wide variety of organic problems in the brain.
>
> It's just my opinion, but I believe exploring other classes of drugs makes sense before trying an MOAI. Especially since they can be done relatively quickly compared to the time it takes an antidepressant to work (if it ever works). Medication reactions with you so far point to the clues that your symptoms are caused by something beyond serotonin/NE deficiency. But whether you try an MAOI first or not, you are far from 'MAOI or bust'. There are drugs that target other chemical imbalances that, with you, have so far been overlooked. Any of those other chemical imbalances can cause your symptoms. Treatment for you so far has only focused on serotonin/NE low, without considering dopamine low, dopamine elevated (antipsychotics), chemical instability (lithium), electrical instability (depakote, tegretal), NE/dopamine failure (stimulants), low blood flow in parts of the brain (stimulants), poorly functioning patches of the brain (stimulants), or GABA low (benzos).
>
> This is an overly simplistic way to look at it, but I just wanted to make the point that when multiple antidepressants disappoint, that is a pretty obvious clue to me that there is something else going on that will respond to a different class of drugs.
poster:jd
thread:21954
URL: http://www.dr-bob.org/babble/20000209/msgs/22593.html