Posted by bleauberry on September 8, 2009, at 13:06:35
In reply to Should I switch from Parnate?, posted by Ezrahite on September 7, 2009, at 19:38:46
I don't know. This is a tough call. Sometimes I feel confident giving suggestions. This time I think the best I can do is just offer some thoughts that went through my head.
The first was the word generic. That to me was the very first place to point a finger at a possible suspect. Obviously the generic is doing something as evidenced by the blood pressure. But is it doing the clinical equivalence of brand in terms of the brain? We don't know. All we know is there is a ton of anecdotal evidence of generics and brands not being of the same clinical value, not always, but often enough that it has to be a consideration when a generic med is not working. Has to be. No ifs ands or buts about it. It also makes the most sense in terms of weaning, withdrawal, new meds, etc. Makes sense to optimize the first med before moving on. To this point, that has not been done.
Adding a stimulant or a TCA to the Parnate was another thought. And of course, the brand versus generic thing might be a consideration with that as well.
Apart from those ideas, there is the SNRI/SSRI + Antipsychotic route, maybe with a stimulant. Or the SSRI/SNRI + TCA route.
Another completely different option, especially considering the frustrating history, is to recruit the help of an Integrative MD onto your team. Someone who knows how to look at a wide array of things your psychiatrist and family doc never will.
Just pure logic tells me that when a wide variety of potent psychiatric meds are not doing what they were intended to do, then it is really pretty simple...they are all missing the target. That doesn't really help to point out what mechanism you need to feel better, but it does at least tell you which mechanisms won't, and so no sense in continuing with those.
Maybe you are one of those people that just needs super high doses? Doesn't have to be Parnate. Whatever it is, really high doses, above the top limit.
poster:bleauberry
thread:916036
URL: http://www.dr-bob.org/babble/20090902/msgs/916093.html