Posted by SLS on August 29, 2000, at 10:58:24
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please » SLS, posted by shellie on August 28, 2000, at 18:35:48
> Hey Scott. If I had to get off Nardil for three months, I'd probably kill myself, even though it's doing very little now.
>
> >
> > How much S-AMe did you take? How long did you take it for? Did it help at all?
>
> I went up to 1600 mg of sam-e, maybe doubling every week from 400. Didn't help at all. That's as high as Dr. Brown says to go up withoutÊa good reaction. If you get a partial good reaction at 1600 then you can try 2400. I felt worse--had an agitated depression. Are you trying sam-e? shellie
Hi Shellie.Thanks for answering.
I went out and bought some S-AMe (original abbreviation) two days ago. I have been feeling terrible over the last few weeks, and I might get worse yet. It was my hope that S-AMe would moderate things enough so that I could make it to the appointment I have with a new doctor in mid-September without having to start any new medication.
I took my first dose of 200mg Monday evening. By bedtime, I was experiencing some unfamiliar feelings that included some mild anxiety and a slight increase in energy. The next day, I took 200mg at 7:00AM and 3:30PM. I did feel better during the day, and the original "unfamiliar" feeling disappeared. In the evening, I began to deteriorate, but then picked up a again by 11:00PM. However, the severity of depression has varied in this way prior to taking S-AMe. I was planning to take 400mg for a few days and raise the dosage to 600mg if I didn't experience an improvement. So far, today has been pretty bad. I took 200mg at 5:30AM, and have not experienced any energizing or antidepressant/antianxiety effect.
I am a "gun-shy" about taking anything new or "exotic" right now due to my recent adverse reactions with Neurontin and Provigil. I would rather go in to see this new doctor taking nothing but Lamictal. Right now (10:56AM EDT), I have decided not to take any more S-AMe. My goal at this point is to be able to function well enough to make it into the city to see the doctor. If I can do that without taking S-AMe or Parnate, I'll be able to give him a clean slate to work with.
Did you experience an energizing effect initially when you began taking S-AMe?
I have been resisting the temptation to begin taking a combination of Parnate and desipramine. I usually benefit from this, as it provides me with a mild improvement. Actually, it was this combination that produced my only true remission in 1987. It lasted for about nine months. Since then, I have not responded to this treatment adequately enough to justify its continuation. However, it was the recommendation of my current doctor and a consult to return to this combination and add more stuff to the mix - a strategy that I have already tried without success. Of course, there are a few drugs that I have not tried as adjuncts. My fantasy is that the new doctor will say, "Hey, I would like to try a completely different treatment that I have had great success with in cases like yours. It has no side effects, you only have to take one dose, it works for everyone, and it lasts forever. It is also free because the drug rep gave me some samples." I would find such a statement to be somewhat encouraging.
Have your doctors recommended trying anything to substitute for Nardil? My current doctor and the consult both recommended that I not waste my time with SSRIs based upon my diagnosis of bipolar depression, my symptom profile, and my experiences with Prozac and Paxil. However, I did get a little something from Paxil, and experienced an initial boost from Effexor. I am curious if your doctors have mentioned Celexa and Serzone, possibly in combination.
Effexor + Remeron is supposed to be a potent combination. I once tried Remeron monotherapy for a few days. I thought it was beginning to make me feel a lot worse. I may have discontinued it prematurely, partly because I equated it with a drug that I had previously tried that greatly exacerbated my depression. It was an investigational drug called idazoxan. Both drugs block NE alpha-2 receptors. So when I experienced even a hint of feeling worse, I bailed-out of the Remeron trial.
Given your experience the time when you unintentionally stopped and restarted Nardil, I think it makes sense to try it. Again, I don't know how long a period of discontinuation is necessary, but perhaps you can let your previous experience guide you. If this proves unsuccessful, I would place switching to Parnate, or perhaps Marplan, high on your list. If you have not tried adding a tricyclic to an MAOI, this can be an effective alternative. My experience with this combination is that using Parnate is more tolerable. For me, Nardil plus a tricyclic produces a great deal of orthostatic hypotension and the inability to urinate. (Due to the nature of the latter effect, I found that I didn't get pissed-off as easily). I prefer either using either desipramine (Norpramin) or nortriptyline (Pamelor) as the tricyclic, as these side effects are milder.
- Scott
poster:SLS
thread:43904
URL: http://www.dr-bob.org/babble/20000822/msgs/43996.html