Posted by tom2228 on June 21, 2010, at 19:46:31
Anyone on or been on Trileptal with any MAOI? Or even carbamazepine (tegretol), please respond!
So here's the story, I've got ADHD, social anxiety, and some sort of bipolar, I suspect cyclothymia. I started cycling some time in childhood but I can't pinpoint when.. I'm 18 now and the cycling has gotten more and more rapid .. from months to weeks and days at one point. Heavy weed smoking and all the antidepressants and stimulants (I've been on 18 meds and many more combos) have probably contributed to this, though it could be the natural progression of the disorder too.
Anyway daily and weekly mood swinginess has greatly leveled out since starting trileptal in March.. things have slowed down a lot. Long story short, I'm pretty sensitive to meds so I was taking the oxcarbaz 4x/day to minimize SEs. OXC has a short half-life and "wears off" within a couple hours, the active metabolite is what allows for the usual twice-daily dosing. OXC itself is active and releases serotonin and dopamine in the in the limbic system.. another reason I kept on the QID schedule, it just felt nice, lol. But it left me with an antidepressant effect as the receptors eventually downregulated (I've been on plenty of serotonin meds, trust me I know the feeling).. I started to get all serotonin'd out (all flat and "mushy brain" feeling). Spacing the doses out a little more, and eventually switching to 3x a day, dealt with this nicely and I felt pretty good. SSRIs have sucked *ss for me but serotonin action JUST in the limbic system (none in the pre-frontal cortex, which throws my judgement way off, makes me impulsive, moody and I usually wind up in a mixed state) was nice!
Definitely not depressed, sorta happy really, but my drive (sexually and motivationally) and pleasure were lacking. Content, stable mood but "Where's the spark?" -- you guys know how it is. So we went down to the standard BID dosing and the pseudo-SSRI effect disappeared. Major depression set in but now that the d/c syndrome is done now I'm left with the chronic atypical dysthymia that I've had all my life. Plus the social anxiety. Oh and my stimulant won't work anymore as a result -- I can still focus OK but now the Vyvanse just makes me really anxious and I have no motivation to attend to anything important.
There's not much left to try. My Life As A Medicated Motion Picture, screenplay written by 3 docs and starring: Lexapro, Wellbutrin, Abilify, Risperdal, Lamictal, Prozac, Adderall, Focalin, Dexedrine, Zoloft, Remeron, Neurontin, Geodon, Buspar, Daytrana, Trileptal, Vyvanse... I'm starting at Boston University in a lil over 2 months so I don't have any more time to waste on the med-go-round. I want something to WORK.. I've read a lot of posts on here of treatment-resistant ppl who felt that they had basically wasted their lives suffering, and others who said they wished they had tried an MAOI 20, 30 years ago.. NO WAY is that happenin' to me, I'm gonna LIVE my life whether it means I'll never eat Annie's aged cheddar creamy mac n cheese again!!!
So when I on the phone with my doc the other day and said I didn't wanna try a tricyclic, I was THRILLED when he brought up MAOIs as what's left (I was hesitant to bring them up myself)-- I've only seen this guy 3 times, he's awesome!! Thing is I'll be doing a pre-med track w/ major in neurosci so I told him I was real worried about my ADHD and having to go off stims. And he goes "well, in low doses the combo is pretty OK" -- SERIOUSLY, this guy is awesome! But I'm really sensitive as it is -- anything over 20mg Vyvanse is too much for me -- that's the lowest dose so I don't think I could take a stim with an MAOI. Who knows though, when I wasn't depressed I tolerated the Vyvanse muchh better. But given that it's not even working because of the depression.. no point in holding onto it.
He suggested Emsam and I agreed, as it would probably be the best MAOI to handle ADHD symptoms as well. If unsuccessful he agreed to try Parnate next. So today is day 2 on the patch.. so far it's nice, stimulating and calming. I'm going to wind up on the 9mg/24hr or 12mg; I'm not being overambitious/ pessimistic or anything, I just know that I need some serotonin to feel content and "happy" .. and to balance the dopamine, and for the ADHD -- I have a lot of trouble switching tasks on stims alone.
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If you're still with me at this point here's where the real concern is. So trileptal (and tegretol) are contraindicated with MAOIs for some reason.. possibly because of structural similarities to tricyclics it could cause serotonin syndrome. But clinically who knows.. except you guys maybe? (I'm hoping)My doc understands that trileptal is working well and that I'm actually tolerating it, so he said the benefits outweigh the risk so we're sticking with it -- and lowered the dose from 300-375 to 150mg (75mg BID). Which is pretty damn low -- trileptal usually STARTS at 600!
I have also read that carbamazepine can increase the plasma levels of MAOIs twofold.. oxcarbaz doesn't have the same enzymatic pharmacokinetics as CBZ but who knows, and I'm worried because if it DOES, then I'm getting more than the 6mg/24hrs, and the MAO-A action could start up.
In which case the tyramine IS an issue then... so should I do the diet just to make sure?!
The diet is manageable though... the REAL concern is that if the selegiline loses its MAO-B selectivity, then the possible serotonin syndrome could be very problematic. I know trileptal dose have some serotonin releasing properties, which i CAN feel, but again, I'm on a very small dose.. but still this is my life we're talkin about.
Sooo is anyone on trileptal/tegretol + MAOI?!? If so, what is your doc's take on the contraindication/ interaction?
Thanks for reading all of this!!
poster:tom2228
thread:951790
URL: http://www.dr-bob.org/babble/20100615/msgs/951790.html