Posted by King Vultan on November 5, 2004, at 13:03:21
In reply to What To Do Now? (anhedonia/dysthymia), posted by SFY on November 4, 2004, at 14:41:58
I take Parnate myself and have also tried Nardil, along with about ten other meds. I think Parnate is a good choice for your symptoms, but there is a good possibility it will give you insomnia. If it doesn't, great, but you do need to have a gameplan in case it does. A very low dose of Risperdal was actually something I was considering myself because this drug apparently blockades serotonin 2A receptors very selectively at low dosages, which has a number of therapeutic benefits, at least in theory. Improving sleep would be one of them, but there are others. What makes me wary is the paradoxical responses I've had to some other drugs that also blockade serotonin-2A receptors, such as nortriptyline and trazodone. Still, I may discuss it with my pdoc at some point.
For insomnia, it's hard to go wrong at least trying Ambien if it's affordable on your insurance (it really isn't on my mine). There are a number of other possibilities, but I think they generally have more drawbacks and side effects than does Ambien, which many doctors will let you use every night. Risperdal at a very low dosage might not be such a bad alternative, though, as it is so selective for the 5-HT2A receptors that there may be very little blockade of the dopamine D2 receptor. I feel that blockading that particular dopamine receptor is not a great thing to be doing for someone with anhedonia.
I don't know if the super-doc you talked to had any thoughts on your paradoxical reaction to selegiline, but reactions opposite to what generally happens suggests to me that you may have hypersensitive autoreceptors in one of your major neurotransmitter systems. That is, you may have too many inhibitory receptors, which react to the release of the neurotransmitter by inappropriately slowing or shutting down the firing rate of the neuron. Selegiline is extremely dopaminergic, and your paradoxical reaction suggests a possible problem in your dopamine system, as does your anhedonia and lack of motivation.
Parnate is also dopaminergic, but less so than selegiline. If you are able to work up to a high enough dosage, which might be anywhere between 40-80 mg/day for solid therapeutic effects, I think you might find it be a very effective drug, and one that I would hope and think would induce less sexual effects than the selegiline. If you try it, I would give it time to work also. In my case, it induced periods of outright depression after some of my dosage increases, but these subsided after several days to a week. The insomnia I've suffered on it remains by far my biggest problem, but I will eventually find a med or a combo of meds that are affordable and work.
Todd
poster:King Vultan
thread:411757
URL: http://www.dr-bob.org/babble/20041103/msgs/412182.html