Posted by YOGI BRONX on December 16, 2008, at 16:23:03
In reply to Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 12, 2008, at 1:42:34
Dear Jeff,
We have something in common. I found that only extreme cardiovascular exercise alleviated my profound lifelong depression until Paxil in 1995. I have completed over twenty marathon foot races. (With a PR of 2:56! I try to squeeze in this fact regardless of the conversation.) High dosage Paxil, (90mg./day) worked for me for ten years. Subsequently, Lexapro at normal dosage did.
However, I still want more for myself and for others of whom I care whose depressions are still refractory.
The FDA was supposed to act on the approval of a drug named, "Ixel, (Milnacipran)", by the end of last October. Its an SNSRI, a Selective Norepinephrine Serotonin Reuptake Inhibitor". It inhibits the reuptake of noephinephine/serotonin at a ratio of 3/1. The other drugs curretly on the US market that inhibit reuptake of these neurotransmitters, (Effexor & Cymbalta), inhibit the uptake of serotonin/norepinephine at the rate of 33/1. The effect increases the availability of norephinephrine at a massively higher rate, and, obviously, at a more even pace with serotonin.
It is the only truly NEW drug for depression of which I know, rather than a reformulation of an existing drug or family of drugs.
The FDA failed to meet the October deadline and, instead, sent out a notice to that effect without posting a new deadline.
Thereupon, I ordered the drug from Great Britain. I'm not sure of the legality of this. If it hasn't been designated a prescription drug in the US, is one prohibited from buying it?
Various health product websites in Great Britain sell it openly to US residents, but not the residents of GB or the EU where it has been prescribed for ten years.
My experience, in the one day that I took it earlier this month, at a dosage of 25 mg. in the morning and 25 mg. at night, (half the normal adult dosage), was that in that one day I experienced a significant improvement in energy alertness, and, "drive", (for want of a better word), in the afternoon, a problem time for me. (I can't judge its specific antidepressant effect because I am doing OK on Lexapro at the moment. However, I find Lexapro's sexual side effect to be annihilating even to the concept of sex.) I was pleased and hopeful.
However, after taking the second 25 mg. dosage at bedtime, I experienced terrible ischuria all night long, having to get up to urinate every ninety minutes. Each time, I was able to coax just enough urine out to stop my bladder from hurting before returning to bed and repeating the entire drill 90 minutes later. It was a long, long night.
I took no more Milnacipran and the ischuria disappeared gradually the next day.
Upon further research, I have learned that this is a not uncommon side effect, (although the literature states that it affects only 2.7% of patients), that it can be alleviated with, "Flomax", and that patients have found success with it at as low a dosage as 15 mg./day, (v. 100 mg./day according to the patient instruction sheet).
One member on this board said that he used it successfully, after a refractory depression that defeated every drug in the world AND a failed course of ECT, at 6mg, 3X daily.
The same poster said that he actually didn't know of anyone who DIDN'T benefit from the drug, those people who discontinued it having to do so because of side-effects, (principally hypertension, dysuria, and what I would describe as hypertense, staring uselessness.)
He also said that the dysuria went away over time.
I haven't recommenced the drug yet but I intend to do so at the 6 mg. 3 x daily dose rate initially. Currently, I am trying to figure out how to divide, conveniently, one 25 mg. capsule into four 6 mg. doses at a bulk level. I am also waiting until the time feels absolutely right to do begin again.
Hope you find this helpful and that I am not carrying coals to Newscastle.
Cordially,
YOGI
poster:YOGI BRONX
thread:868231
URL: http://www.dr-bob.org/babble/20081214/msgs/869126.html