Posted by SalArmy4me on August 4, 2001, at 21:50:03
In reply to MAOIs and sleep problems, posted by Grouch on August 4, 2001, at 21:26:44
Things to consider:
You could try adding small doses of atypical neuroleptics like Risperdal (Risperidone) to MAOI's for sleep:
(Stoll, Andrew L. MD 1,2. Haura, Gail MA 1. Tranylcypromine Plus Risperidone for Treatment-Refractory Major Depression. Journal of Clinical Psychopharmacology. 20(4):495-496, August 2000:
All five of the nonpsychotic depressed outpatients in this trial had treatment-refractory and prolonged unipolar or bipolar depression and responded to the combination of tranylcypromine plus risperidone. Four of five patients experienced a dramatic and sustained antidepressant response to the combination. Despite the lack of psychosis and previous MAOI monotherapy (in four of five patients) that was less than successful, these patients responded to the combination of tranylcypromine and risperidone. Further studies are required to determine whether the risperidone alone or the combination of tranylcypromine and risperidone was responsible for the antidepressant effects observed in these patients. All patients, except for one who experienced overwhelming sedation, tolerated the medications well. Although not necessarily causal, the tranylcypromine and risperidone were started simultaneously in the three patients with the most dramatic responses...").You could switch to Moclobemide:
(Magder, David M. MD. Tolerability and Efficacy of High-Dose Moclobemide Alone and in Combination With Lithium and Trazodone. Journal of Clinical Psychopharmacology. 20(3):394-395, June 2000.
"Moclobemide is a selective reversible inhibitor of monoamine oxidase-A that is reported to have comparable efficacy and a safer side effect profile compared with traditional irreversible monoamine oxidase inhibitors (MAOIs).1, 2 Furthermore, numerous studies have demonstrated that moclobemide is as effective and tolerable as selective serotonin reuptake inhibitors and tricyclic antidepressants.3-5 In all instances, the dose range of moclobemide reflected standard prescribing recommendations, not to exceed a dose of 600 mg/day. However, when higher doses were used (750 mg/day), moclobemide was judged to be tolerable and effective in the treatment of dysthymia and double depression...")You can switch to Selegiline:
(Sunderland, Trey MD. High-Dose Selegiline in Treatment-Resistant Older Depressive Patients. Archives of General Psychiatry. 51(8):607-615, August 1994:
"Selegiline appears to be an effective antidepressant in older patients with treatment-resistant depression. While low-dose selegiline (10 mg/d) may have some mood-lifting effects in nondepressed subjects, such as patients with Parkinson's disease or Alzheimer's disease [12,76], or when low-dose selegiline is given in combination with phenylalanine [17], our data suggest that higher, non-MAO-B selective doses of selegiline may be required to reverse moderate to severe depression in the elderly. In fact, the data from our study of high-dose selegiline (60 mg/d) support earlier data from our laboratory indicating that MAO-A inhibition and the subsequent consequences of this inhibition rather than MAO-B inhibition alone may be required for antidepressant efficacy [77,78]. Data from our study combined with those from a previous study involving younger adults [11] suggest that nonselective MAOI dosages of selegiline between 30 and 60 mg/d are required for adequate antidepressant response, much more than the 5- to 10-mg doses of selegiline recently suggested in the American Psychiatric Association's practice guideline for major depressive disorder in adults [79]. In fact, because the CSF MHPG values were reduced only by 50% with selegiline compared with previous reports of 80% to 95% reduction with clorgyline and other mixed MAO inhibitors [62], it is possible that selegiline doses higher than 60 mg/d would provide even better antidepressant responses..."You could try something like (Sonata) zaleplon, or zolpidem (Ambien).
poster:SalArmy4me
thread:73594
URL: http://www.dr-bob.org/babble/20010804/msgs/73597.html