Posted by SLS on May 28, 2000, at 21:06:00
In reply to Withdrawal from three drugs., posted by cathy y on May 26, 2000, at 23:08:52
> Hello fellow sufferers. There certainly seem to be lots of us out there. I'm a "double depressive" -- dysthymic since the start of adolescence (I now know), and first major depression (atypical)about 8 years ago.
> All the SSRI's I tried made me sleepy; Wellbutrin was partially successful; high dose of Zoloft as well. Finally the best approximation I have had is an awful lot: 300mg Zoloft (at bedtime), 300mg Wellbutrin, and 40mg Ritalin.
> ANYWAY, it occurred to me taking these three seems to be covering the three major neurotransmitters so would it be fitting to try an MAOI, Parnate particularly?
> And, if so, how on earth am I going to be able to withdraw these drugs with minimum fuss? Does anyone have any ideas? Thanks, Cathy
-Hi Cathy.
MAO inhibitors would certainly make a good choice at this point. I am a big proponent of their use, as they have been underutilized in the past. Parnate might be the one to go with, seeing as how it has some amphetamine-like qualities, and you seem to get be helped by both Wellbutrin and Ritalin. However, this is highly speculative. Nardil may work as well, if not better. It is often hard to predict. Another reason why you might want to try Parnate first is that it usually produces fewer side effects and is easier on the liver. Right now, I'm having a hard time deciding for myself which one I should try next. I've been on both.
Is there any social anxiety involved? OCD? Panic attacks?
Do any members of your family have bipolar disorder?
Double-depression can be difficult to treat, as the dysthymic component is often very stubborn. For what reasons have you been diagnosed as having double-depression? From what I can see, an alternative explanation may be indicated. Perhaps you suffered an onset in adolescence of a mild to moderate depression that later developed into a more severe depression - both presentations being different degrees of the same disorder, major depression. If you are a double-depressive, then both components remitted completely with your first treatment using 50mg of Zoloft. That's pretty good. When Zoloft stopped working for you, did you relapse into major depression (go all of the way down) or sink to a level comparable to the depression you experienced in adolescence? You describe experiencing the former rather than the latter. In addition, you have not experienced a period of stable dysthymia since the onset of severe depression. It doesn't sound like you have double-depression. While this may seem like a moot point at the moment, this distinction may have some utility as you progress through different treatments.
Of course, I really don't know. I am not a doctor. I am just making a few observations.
I am not advocating that you put off using an MAOI, but there are a few good drugs that you have not cited. It may not have been your intention to list everything you have tried (many of the lists one finds here are pretty long). If you have not tried Effexor, you may want to consider it. Even if it is only partially effective, it can make a good base for adding Wellbutrin, Remeron, or Serzone. Actually, Wellbutrin makes a good augmenting agent for just about anything, including MAOIs. Personally, I don't find MAOIs to be such a big deal to use.
By the way, it sounds like you have a good doctor. He should be capable of designing a schedule for you to wean off of the drugs you are currently taking. Actually, I would be tempted to keep the Ritalin.
Don't forget, you can add stuff to Parnate too, including Ritalin.
Good luck.
- Scott
poster:SLS
thread:34807
URL: http://www.dr-bob.org/babble/20000526/msgs/35015.html