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Re: Nardil Woes- PLEEEEESE HELP!!!!

Posted by bigcat on October 25, 2005, at 23:08:04

In reply to Re: Nardil Woes- PLEEEEESE HELP!!!! » bigcat, posted by ed_uk on October 25, 2005, at 14:21:54

Hey Ed:
Great to hear back from you.

> Given your current Dexedrine side effects, I think it would be best to discontinue the Dexedrine and replace it with something else. I was wondering whether you might respond to Abilify, at a low dose. Have you ever tried it?

I think I gave Abilify a VERY brief trial. Is it an atypical antispsychotic in the same family as Geodon? I definitely didn't give it much time to work (it may have kicked up the obsessing/social paranoia initially, but my memory is lost in a whirlwind of years riding the med merry-go-round. I do remember being in the hospital one time, and a psych patient there was put on Abilify, and within hours he was quite impressed with the calming effect it produced and felt as if the mental haze and clutter were somewhat alleviated. I think the main reason I went off the Abilify was for economic reasons. The good news is that I'll have health insurance in a month (I currently pay out of pocket for my scripts). So without monetary restrictions, I'll lobby hard with my doc to try that option. Does it combine safely with the Nardil?

> Wellbutrin... Have you tried it on its own? Wellbutrin tends to improve depression, but not anxiety. Are you suffering from a lot of anxiety at the moment?

My anxiety is inseparable from my depression. When I go into true remission as I have with the Nardil, it clears the whole board, the light switch goes on and my anxiety dissapears. I must confess that I've cut MANY med trials short because of severely increased anxiety/social paranoia/mental incompetancy upon starting a new drug. The tricyclics all seemed to kick my anxiety into high gear. In hindsight, I'm curious if I may have started with doses that were too high, or if we titrated the dose too rapidly for my brain to adjust. Klonapin, Xanax, and Valium don't touch my anxiety, though it's concievable I need an extremely high dose, as I seem to be rather med-tolerant. Wellbutrin is a bit of a question mark for me. Once again my memory is very poor and my psychiatrist has wholly insufficient charts on me, so I have little to go on but a memory that can't be trusted, as I was racing through med trials because of my panicking and dangerously severe state of despair. I know my mom says she recognizes the "wellbutrin look" in my eyes (maybe dilated pupils are a side effect?) On my most recent trial of Wellbutrin, I took it on it's own, and I had this radically disjointed and pressurized speech, where I would start a sentence with a rush of anxious excitement and force, and then find myself flailing and frequently unable to finish my ideas or find basic words or phrases. It was very embarrasing to become flustered and freeze up mid-sentence, forgetting what I was saying or how to link ideas together intelligibly. I was so noticeably out there and profoundly confused. I'd say it gave me inflection in my voice, which is a positive change from the monotone of a deep depressive state, but I felt somewhat agitated and restless on it, and am not sure where it was leading me.

> Provigil is modafinil. Adrafinil is not marketed in the US, it's a French drug. Modafinil and adrafinil are chemically related to one another. Provigil is often a good med to relieve daytime drowsiness.

I read a few posts where people seemed to prefer Adrafinil to Modafinil and I believe I can order both online, so which would you consider my best bet? I have severe lethargy and positively no energy, napping constantly.

> I remember you saying that you haven't responded well to the TCAs or SSRIs. Which TCAs have you tried? How did you respond? Btw, have you ever tried Remeron?

TCA's: Elavil, Tofranil, Anafranil, Pamelor, Vivactil, Gamanil (imported), Desipramine, Nortiptaline...I just became a wasted zombie upon starting most of these. It wasn't so much the side effects that interrupted trials as it was an exacerbation of the depression (I summoned attention to myself as I radiated and reeked of such profound misery and anxiety. I was astonishingly unable to function on the most basic levels). All my instincts would betray me, and I became insanely self-consious/socially phobic.

>Have you ever tried Remeron?

Remeron has actually been one of my big question marks and frequently sparks my curiosity, as I'm SURE I never gave it a fair trial. I was in bed most of the day at the time we considered using it, and since I'm aleady very lethargic and low energy, I shied away because of the notorious sedation issue. But it is high on my list of meds to try if I can't work out an effective Nardil combo.

> >Regarding Serzone difficulties...

Have you ever taken trazodone? Trazodone is related to Serzone, but tends to be quite a bit more sedating. Nardil + trazodone was formerly a popular combination. The trazodone was used to treat the MAOI-induced insomnia and increase its antidepressant efficacy. Unfortunately, trazodone tends to cause more side effects than Serzone. I find it very difficult to predict how you'd react to trazodone.

Hey, it's another option I wouldn't rule out. On it's own, Trazodone didn't seem to touch me, just the sedation which was definately bearable, and I welcomed the restful sleep at the time. I wouldn't write it off as I never tried it with the Nardil, and I'm a novice in the field of combining meds with Nardil, so I figure you never know, and that they could potentially play off eachother to reduce the negative side effects of eachother and produce a solid and LASTING antidepressant effect.

Parnate and other MAOI's haven't worked for me.

> What dose did you try? Any side effects?

I was on 90 mgs of Parnate for approximately 3 months (I'm 225 lbs, in case that is a consideration).. The insoimnia was nasty. I tried hitting it with Klonapin, Haldol, and Chloral, none of which worked very well. HOWEVER, I never tried using Seroquel at the time to help the insomnia, and it has now proven to be a great sleep med for me. The Parnate did nothing for my depression or anxiety, but it did make me rather creative. Drawings and writing from this time support that belief. Since I unpredicatably resonded to Marplan after four or five fruitless trials, I could see myself back on the Parnate at a higher dose with an effective sleep med in conjunction.

Ed, you really can't understand how much hope you have given to a desperate person. I am no longer in a state of utter despair and fear, as you confidently present options which neither me nor my doctor would ever come up with. I can't even fathom the amount of research you have done to asrrive at your level of expertise. I find it an unfortunate irony (though I can't say I'm surprised) that you could radically upstage any psychiatrist out there just based on wour iron will, keen intuition, and uncanny ability to synthesize information and experience while offering informed and enlightening advise. I truly believe my mood has recently improved as find myself excited to return to my computer, finding solace and hope as I absorb the many viable options you (and others) present. What a phenomenal resource. I feel empowered, a great feeling which depression and med failures have so often washed away. Not to gush, but your a bit of a miracle maker. I'm curious how YOU have you been doing lately, what meds your on, and what treatment-related ideas are most pressing on your mind?

One Love My Brother,
Matt

(Sorry about the length, but writing to a responsive audience is therapuetic in itself).


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URL: http://www.dr-bob.org/babble/20051024/msgs/571957.html