Posted by Elizabeth on July 3, 2001, at 14:38:51
In reply to Re: Elizabeth-hold my hand on this one, please, posted by Lorraine on July 1, 2001, at 11:15:34
Oops, was there a post I should have responded to but didn't? I'm sorry about that!
> None of the SSRIs have worked for me; Effexor worked first time with intolerable side effects (40 lb weight gain; sexual dysfunction); Wellbutrin and Serzone also don't work for me. I'm knocking at TCAs door, I'm afraid.
Same general situation here -- SSRIs and Serzone don't seem to do anything, Effexor caused miscellaneous bad things to happen ("serotonin syndrome"), Wellbutrin just made it worse. The MAOIs have been relatively helpful, but they don't solve the problem completely either (still have lots of fatigue, disinterest). I just started on desipramine (just 25mg). It doesn't seem to have any side effects so far. I feel like I should give the TCAs a chance before throwing in the towel altogether.
> OK. How about Effexor reset my anger set point so that I just NEVER got angry and, for the first time in my life, could not understand why other people created so much havor in their lives with anger.
That's an interesting one. Did it bother you, or did you feel better?
> Or, Wellbutrin made me "jealous", which is not typically one of my issues and also made me compulsive about time--shock the h*** out of my hubby when I was the first one in the car for an outting or yelling at everyone else to get in the car for gods sake because WE ARE GOING TO BE LATE.
Wellbutrin is a weak stimulant (structurally, it's related to methcathinone ("khat")). As such, it can be expected to make obsessive-compulsive type thoughts and behaviours worse rather than better. A number of people become irritable (or more irritable) on it, although I don't recall specifics.
> These experiences though have made me very tolerant of other people (ie my time police husband) and their "peculiarities" which I now understand may not be changable.
Hmm. I think that if those "traits" could be brought on by drugs, then they probably could be alleviated by drugs too (different drugs, obviously). We've all heard the stories of dramatic personality change in response to SSRIs; MAOIs, Wellbutrin, Effexor, benzos, etc. can definitely bring on major changes too.
A question I've always had in my mind is, can people who experience "personality changes" on drugs use that experience to teach themselves to be different without the drugs?
> With Wellbutrin, I outright hallucinated when I went from a dark room into a light room or upon awaking in the morning (i now believe that this may have been seizure like activity).
What sort of hallucinations? (if you don't mind talking about it)
> Imagine the hazard of driving like that a night with headlights coming at you
I don't drive, but I certainly can imagine.
> I believe that I may be one of those people with a cytochrome enzyme p450 issue because I require very low doses of meds usually and develop side effects easily. How would I get this test?
A hospital or internal medicine clinic could do it. The only such test that is used clinically that I'm aware of is for CYP 2D6 ("debrisoqin hydroxylase") deficiency. They give you a drug metabolised by CYP 2D6 (I think they usually use dextromethorphan, but I'll use debrisoquin as an example). Then, 8 hours later (the length of the wait may differ depending on the drug used), they check the ratio of the urinary concentration of the drug to the concentration of its main hydroxylated metabolite (e.g., 4-hydroxydebrisoquin). If the ratio is unusually high, it means you failed to metabolise the drug normally. (This could be because you're a slow hydroxylator, or it could be because you're taking another drug that inhibits and/or competes for the enzyme.)
> Elizabeth: I am on currently on Selegiline, Adderral and Neurontin. I have played with varying doses of each of these trying to find the "right" combo, without success. I increase the Neurontin and get sedated; increase the Adderral or Selegiline and my physical anxiety becomes unbearable.
How rapidly do you try increasing one or the other of these? Have you tried, for example, increasing the Neurontin by 100 mg (taking the extra 100 mg at bedtime, of course)? Sedation and activation are side effects to which people often grow tolerant; it might just require patience.
You could also try increasing both the Neurontin and one of the stimulant drugs simultaneously, by a small amount (100 mg of Neurontin and, e.g., 2.5 mg of Adderall). Alternatively, you could try adding a different drug that is neutral with regard to activation/sedation. (Although I hate to suggest that to someone who's already on 3 different meds.)
> As it is I do not have sufficient mood support and am hyperventilating as well.
Tried Inderal for the hyperventilation? (Works well for me -- I had some hyperventilation problems when I first started taking Parnate.)
> I hate the thought of a washout and a long "start up" time. It's summer; I have kids.
I understand.
> I'm diagnosed with depression and the anxiety is a new component that started last November with Moclobemide and has never gone away--even when I am drug free.
Agitation/jitteriness is a common side effect of moclobemide (one of the many reasons I decided not to go to the trouble of trying it!).
> So can I augment with something?
Yes. I don't think that other anticonvulsants would substitute for the Neurontin, though. What about adding Klonopin on an as-needed basis?
> Is it time to move on to a TCA? (which given the withdrawal reports on Parnate seems like a better way to go). How long do TCA's take to become effective?
A few weeks, same as most antidepressants. You could probably safely add one of the ones with little effect on serotonin (like nortriptyline or desipramine) without having to go off the MAOI.
MAOI withdrawal sucks, but it's not unmanageable and usually doesn't last very long. (I think that tapering is best, but not a very slow taper like you would use if you were going off, say, Xanax.) I find benzos helpful (that, and staying away from other people as much as possible!).
> Also--if you don't mind--what is the difference between major depression and meloncholy depression.
"Major depression" is a very broad category. "Melancholic depression" is a subtype of major depression that is characterised by nonreactive mood (i.e., pleasant occurrences don't cheer you up significantly), complete or near-complete loss of the ability to feel pleasure, early-morning awakenings, feeling worst in the morning, appetite loss, psychomotor agitation or retardation, and inappropriate or excessive guilt. Melancholic depressions are experienced as being qualitatively different from feelings of grief or loss: the depression can't be described by comparison to other feelings the person has had (whereas nonmelancholic depressions may resemble grief, in quality if not in magnitude).
Some data suggest that TCAs, Remeron, and Effexor work better than SSRIs do for melancholic depression. The efficacy of ECT is best-established in this subtype. I would expect MAOIs to work too (possibly in higher dose ranges than for nonmelancholic depression), but there has been little research on MAOIs for melancholic depression. (I'd like to see a well-designed and -executed RCT comparing, say, Parnate to imipramine.)
I hope this helps. Keep in touch. :-)
-elizabeth
poster:Elizabeth
thread:67742
URL: http://www.dr-bob.org/babble/20010701/msgs/68831.html