Posted by SLS on September 30, 2000, at 22:27:04
In reply to Re: Stopping MAOI: new game plan » SLS, posted by shellie on September 30, 2000, at 16:22:14
Hi shellie!
> So, I also went for a consultation with a new pdoc.Yay!
> My main question was going to be "do I restart Nardil or change to Parnate?" Anyway, I was in for a surprise. This doctor had earlier this year written an article for The Washington Post health section called "making the three tenors sing", which I had actually read.
Cute.
> I had no idea he was the guy who wrote it. It was of course about how the brain's neurotransmitters must "harmonize" and during our session he asked me questions to figure out where I stood with the three. (after which he brought out his visual neurotransmitter pie chart).
I wish I could see this chart.
> Didn't want me on either nardil or parnate. Felt they were too limiting, although he said he used to be a huge MAOI fan. First, as first part of combination suggested either paxil or remeron.Effexor + Remeron is one hell of a combination. I don't recall if you had tried Effexor. Both Remeron and Wellbutrin make good augmenting agents to just about anything. I don't recall having seen Remeron combined with an MAOI, but I can't think of any reason why it couldn't be. (That I can think has not yet been established using a placebo-controlled double-blind protocol, I don't think).
> I said no to both (didn't want to deal with side effects and ssri withdrawal) and felt that this consultation was going to be over fast.
You don't have to withdraw a drug that works, right? As bad as some of the posters here describe their experiences when discontinuing Paxil or Effexor, I don't feel that these peoples' experiences can be extrapolated to you. In most of these cases, the weaning period was too short and/or no methods were used to minimize the withdrawal syndrome.
Some of the things I have seen used:
1. Substitution with Prozac.
2. Benadryl or some other CNS antihistamine.
3. Benzodiazepines such as Ativan> But then he came up with a serzone/adderal combination
Interesting. I can see how this combination might act synergistically to get the dopaminergic pathways of the prefrontal cortex (the hypoactivity of which is suspected of playing a major role in the pathophysiology of depression) to become more active.
In other words, these two drugs might work to increase brain activity in an area needing it via different routes. The end result is greater than the sum of the two parts.Have you ever tried Serzone (nefazodone), Desyrel (trazodone), Remeron (mirtazapine), Zyprexa (olanzapine), Seroquel (quetiapine) or Norval (mianserin)?
> and said if I couldn't tolerate the adderall, it was fine with him if I substituted adrafinil instead.
Why wouldn't you tolerate Adderal? Adrafinil is certainly worth a try, but it wouldn't act at the same site (prefrontal cortex) as do Adderal, Dexedrine, Ritalin, Cylert, Parlodel, Mirapex, or Symmetrel. Actually, it makes sense to try adrafinil first, as it is the only drug (aside from Provigil) of these that works only on non-dopaminergic neurons, yet eventually causes dopaminergic pathways to become activated. On the other hand, you can buy Adderal at the corner drug store without the necessity of wrestling your way through a pack of Customs agents with Napoleonic complexes.
> So I'm on my third day of serzone (no side effects--it's actually energizing for me).
This sounds like an excellent sign of things to come. You should feel encouraged. I think that I will put Serzone on my short-list. I have been contemplating this quite a bit recently. My old doctor (who had conducted clinical trials of Serzone) was adamant that it would not be worth a try. We'll see.
> Tomorrow I add on adderall.
Good luck.
> So, not at all what I expected.
Yay!
> (by the way, Scott, what was the result of adding Risperdal to your combination? Did I miss that?) Shellie
What a coincidence that you should ask this question. Today, I decided not to continue with it. I was beginning to show signs of an abnormal gate and a lack of foot dorsi-flexion while walking, tremors, and leg weakness. Gone. I get the feeling that, of the newer "atypical" neuroleptic antipsychotics, Risperdal carries the greatest risk of producing EPS (extrapyramidal symptoms) and perhaps tardive-dyskinesia. Unfortunately, you are another example of this.
I don't believe that Risperdal was helping at all. Sometimes it's hard to tell, especially when the changes are subtle or come on gradually. It's when you stop taking the drug that you find out that it was helping after all. If I feel that I have lost some kind of improvement for having stopped Risperdal, I might try Zyprexa in its place. I am not afraid of Zyprexa. I was of Risperdal when the doctor first suggested it.
Thanks for asking.
Love,
Scott
poster:SLS
thread:43904
URL: http://www.dr-bob.org/babble/20000926/msgs/45567.html