Posted by Ame Sans Vie on October 28, 2003, at 17:36:15
In reply to Re: Temazepam Dependent?, posted by cbwarejr on October 28, 2003, at 11:11:20
That really is a tough situation... maybe your wife could avoid the MAOIs altogether, until some better drugs are released (i.e. Cymbalta, substance P antagonists, selective mu1 opioid agonists)? Central nervous system stimulants can be absolutely wonderful for depression, especially when it's at its worst. I have a bit of ADD and take DextroStat (dextroamphetamine) at 10mg three times daily, but my doctor prescribes me double that each month because he understands that I find a single 30mg dose to be very helpful during my most severe depressive phases. Dexedrine/DextroStat (d-amphetamine), Adderall (d-amphetamine and racemic amphetamine), Desoxyn (d-methamphetamine), and Ritalin/Concerta/Metadate (methylphenidate) can all be incredibly helpful. Cylert (magnesium pemoline), another stimulant, may also be helpful but it's not a first-line med as it has great potential for causing serious liver problems. Provigil, while much milder in it's stimulant effect, is also an incredible medication, and doctors are less afraid to prescribe it due to its Schedule IV controlled substance status (as opposed to Schedule II like the amphetamines/methylphenidate). And although most opioids are Schedule II, some doctors are willing to prescribe them for treatment refractory patients -- methadone, Subutex/Suboxone (buprenorphine), and Ultram (tramadol) are most commonly used for this purpose, though OxyContin (oxycodone), Dilaudid (hydromorphone), morphine, codeine, and others have been used. It may seem rather drastic, but desperate times -- desperate measures. For what it's worth, I found Ultram to be absolutely wonderful for my mood. It's a non-scheduled opioid that has an effect I describe as a cross between Vicodin and Effexor, and not being a controlled substance makes doctors much more willing to prescribe it.
There are so many other options... has your wife tried dopamine agonists (i.e. Symmetrel [amantadine], Mirapex [pramipexole], Dostinex [cabergoline], Parlodel [bromocriptine], Requip [ropinirole])? Or Sinemet CR (carbidopa/levodopa)? These all increase dopaminergic activity and can have profound effects on mood, motivation, drive, confidence, energy, etc.
And what about Xanax (alprazolam)? It tends to have a terrific antidepressant effect, in most people, and has the added benefit of being tranquilizing and perhaps mood-stabilizing (not sedating though -- that side effect passes within a few weeks of taking it continuously). Now that Xanax XR, a 24-hour version of the drug, has been released it's a lot easier to take the drug. The immediate-release formulation that's been around for over 20 years lasts a good four or five hours at most.
There's also Xyrem (sodium oxybate [GHB -- formerly known as "the date rape drug"]). Though it can be a pain to get a prescription for, it really is a wonder drug. It would eliminate her need for sleeping pills, I guarantee you that. It's taken at night and knocks you out into a *natural*, extremely recuperative sleep; the next day you awaken with a dopamine rush which helps to eradicate negative thoughts and feelings. I'd look into it if I were you -- http://www.xyrem.com
A few last things that pop into my head at the moment are, first of all, a new drug called Emend (aprepitant)... I can't recall its method of action (NK-1 antagonist... agonist?), but it also has been shown useful against depression; secondly, a drug for amyotrophic lateral sclerosis (Lou Gehrig's disease) called Rilutek (riluzole) which is undergoing clinical trials to treat depression right now; lastly, the anticonvulsant Gabitril (tiagabine) has been reported by at least one person on this board to be useful for depression and perhaps anxiety.
Finally, supplementation, proper diet, and some sort of physical activity are a must. I doubt there's a person in this world who cannot be helped via this method. Diet is up to her, of course, but I recommend VERY highly a low-carbohydrate or low-glycemic-index diet. As for supplements, I have to suggest several things from personal experience as well as the experiences of many, many others (I used to counsel people on this and acted as sort of a naturopathic doctor at a health store -- I treated many people with mental difficulties). First and foremost, fish oil, fish oil, fish oil. Buy it only from a reputable source that keeps it refrigerated, and try to find capsules/gelcaps that contain at least 360mg EPA/240mg DHA per 1,000mg of oil. She should be very liberal taking these -- just go to the Alternative treatments board on this site -- so many people are swearing by fish oil, and I'm one of them. Next, DL-phenylalanine (DLPA) is a terrific supplement. It is a combination of the D- and L- forms of the amino acid phenylalanine. The L- form primary becomes a part of the brain's catecholamine system -- that is, it becomes alpha-phenethylamine, dopamine, norepinephrine, and epinephrine in the body. Wonderful for anergia and depression. The D- form is just as great -- it inhibits a certain enzyme which breaks down your body's "natural morphine", endorphins/enkephalins. Thus, levels of these natural mood-elevators/pain-relievers are raised and a great decrease in depression and feelings of physical and emotional comfort may ensue. It, like the L- isomer, also partly "degrades" into alpha-phenethylamine, a chemical made famous as "the chocolate amphetamine". It's found in chocolate (duh, lol) which probably accounts a great deal for the purported aphrodisiac and comforting effects of the food, and is also quite prominent in the brains of those who are in love/falling in love. Amphetamine itself, by the way, is just a hop, skip and a jump away from this substance -- it's beta-phenethylamine (which means, chemically, it differs only by the position of one group of atoms on the molecule; it's attached to the third carbon in the chain rather than the second). Beyond this, I always recommend a good B-complex vitamin (preferably in sublingual liquid form, as it is much more efficiently absorbed), a whole-food multinutrient and herbal supplement (for the millionth time on this board, I must endorse "Super Earth Formula", manufactured by Bluebonnet, which is absolutely wonderful -- http://www.bluebonnetnutrition.com/multivit_minerals/superearth.html), at least 1,200 I.U. vitamin E, and powdered vitamin C. NADH, kava kava, ashwagandha, eleuthero root (a.k.a. Siberian ginseng), and reishi fungus are also among the more helpful supplements. Finally, there are 5-HTP (5-hydroxytryptophan) and L-tryptophan (both precursors to serotonin), St. John's wort, and SAM-e, though these should be taken only after consulting with a doctor as they have potential to react with her other meds. As an aside, L-tryptophan (and possibly 5-HTP) could also eliminate her need for sleeping medication (as can many herbs... Valerian Poppy Supreme, by GAIA Herbs, is wonderful -- I don't respond to trazodone, Remeron, Elavil, Halcion, Dalmane, Restoril, ProSom, Doral, Sonata, Ambien, chloral hydrate, secobarbital, phenobarbital, amobarbital, or pentobarbital -- but this stuff works!!) Believe me, the natural route may just surprise you if you can get her to give it a chance. And I'm always here if you decide to go this route and have any questions -- just post them on the Alternative board.
Michael
poster:Ame Sans Vie
thread:274180
URL: http://www.dr-bob.org/babble/20031025/msgs/274397.html