Posted by Elizabeth on April 4, 2002, at 23:21:28
In reply to Treatment Resistant Depression Parnate vs. Lithiu, posted by M in Boston on April 2, 2002, at 12:24:54
Hi M. It sounds like you have a lot of the classic features of atypical depression (mood reactivity is a necessary part of the definition of atypical depression, BTW). MAOIs are really effective for this stuff -- rejection sensitivity, overreacting to disappointment, etc.
MAOIs generally *lower* blood pressure, as long as you don't eat the wrong thing. I've posted "my version" of the MAOI diet, which is evidence-based and really doesn't require much lifestyle change for most people. Also, if you keep some nifedipine (a calcium channel blocker that lowers BP rapidly) handy and learn to check your BP, acute hypertension is very easy to identify and treat. If you're really worried about the possibility of hypertensive crises, talk to your pdoc about how you would deal with it.
I think you might find that MAOIs are very helpful and tolerable. Also, Nardil and Parnate (the most common ones in the USA -- I believe you can get Marplan, but it's not used much) have different side effect profiles, so if you have trouble with one, you have the option of trying the other.
I think that lithium is less likely to work than MAOIs are. Li+ is more useful in augmenting antidepressants, although it sometimes works by itself for unipolar depression. If you find that the MAOIs are partially effective, you can add Li+, of course, and that might well prove to be the answer for you.
BTW, can I ask where you see your pdoc (private practice or clinic? if clinic, which one?)? Just curious; I lived in Boston for a long time and know more about the psychiatric establishment there than I care to.
-elizabeth
poster:Elizabeth
thread:101480
URL: http://www.dr-bob.org/babble/20020402/msgs/101903.html