Posted by DSCH on September 28, 2003, at 9:12:46
In reply to Re: Parmodalin? » DSCH, posted by francesco on September 27, 2003, at 9:38:34
> The antipsychotic in Parmodalin is Trifluoperazine (brand name Stelazine). In a capsule of Parmodalin there is 10mg of Parnate and 1mg of Trifluoperazine. At this low doses Trifluoperazine acts like an anxiolytic ... but there are still a couple of points that makes me think.
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> 1. Tardive Diskynesia it doesn't seem to be related with dosage (correct me if I'm wrong). if Parmodalin works great for me I could take it for years. I don't know if 25-40% of chances of having my life ruined is worth the eventual benefits of Parmodalin.As if that is not enough there is also Neuroleptic Malignant Syndrome (NMS).
http://www.rxlist.com/cgi/generic3/trifluo_wcp.htm
> 2. I would have to bear also the side-effects of Trifluoperazine. For ex. Parnate is supposed not to have sexual side-effects but antipsychotics of course have. I red a couple of italian's posts (on italian sites) complaining about impotence on Parmodalin. (does Italian government has something against meds that *don't* have sexual side-effects ? are they a price dued if you're a bit strange ? chemical castration for bad genes genes' owners ? sorry, today I'm in a preacher mood ;-)Perhaps it is the belief that, of all people, Italians should not have their sexual interests or ability increased as they are "high" enough as it is! ;-) (just joking)
Concern over sexual side effects by the professionals and the pharmaceutical industry was slow to get going here I believe (the old attitude: "be thankful that you aren't mentally ill anymore rather than complaining about your sex life"). But with the trend going towards more sophisticated medications with fewer side effects anyway, momentum has finally built up here. The industry realizes now, in this "post-Prozac" era, that a psychoactive drug that doesn't have sexual side effects is more likely to be a money-generating "hit"; and money is why they are ultimately in the business anyway (as a capitalist myself, I don't mean that badly). :-)
> 3. Parnate should affect positively dopamine, and this effect should be counteracted by Trifluoperazine (to some extent, don't know which). So one of the reasons to try it (avoid anedhonia-apathia given by meds) should be not a good reason ...
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> Any input ? : )
>I think this line of reasoning is logically flawed; just because you have some SP symptoms *ON* Anafranil does not mean you should take an anti-SP drug. Your underlying condition is (probably) ADHD rather than SP so treat the ADHD unless your intent is to base a cocktail around Anafranil (and I don't see a good way of going about that either).
My philosophy would be: see what you can find in a replacement that keeps the good aspects of Anafranil (improved focus and overall mental function) while dropping the bad ones (this collection of symptoms borrowing from OCD, ODD, and SP). I think exhausting the possibilities of the "cleaner" tricyclics given your treatment history and the difficulties surrounding stimulants in your country is the best route forward. After that would come Reboxetine and then, if you can get it, Strattera. I would leave Ritalin as the final option at this point (but that's just my thinking anyway). I'm not wise/exeperienced enough to suggest a good way to make this happen with conservative pdocs who don't want sophisticated input from their patients regarding their own treatment. The one thought that occured to me was going back to the one who prescribed Anafranil to you in the first place and maybe simply mentioning to him/her that you have read that desipramine and nortriptyline have the least frequent and severe side effects of all the tricyclics.
Going back to the BP2 issue, what were your conclusions from reading that article that discussed the similarities and differences between them?
poster:DSCH
thread:260422
URL: http://www.dr-bob.org/babble/20030928/msgs/263890.html