Posted by Erewhonian on October 21, 2012, at 0:26:20
In reply to Re: Emsam poop out, a new maoi?, posted by gigantor on October 18, 2012, at 11:06:19
Xanax is different. As far as I'm aware, the MAOIs and their effect on dopamine isn't supposed to build up a tolerance. Still, if you feel able and willing to experiment with that, you could try.
Emsam partly metabolizes into amphetamine and methamphetamine, and that might be some of what you've built up a resistance to. It's been too long for me to remember all the details I used to know about Emsam, like the metabolism at different dosages, and at what point it loses selectivity for MAO-B.
Why are you hesitant to increase to 9mg? Are your side-effects at 6mg just barely tolerable?
You might get results from switching to another MAOI, like Nardil or Parnate. Nardil worked for me, and that's why I haven't posted here again until now. Sorry, but guess that's pretty much how these things work once you start to feel better, you don't want to go back and obsess over all this stuff again.
But let me fill you and the rest of the forum in on what's happened since I started this thread ten months ago. Since we had a somewhat similar experience with Emsam this might be relevant for you, though I had atypical depression and no fibro. The literature says good things about MAOIs for treatment resistant atypicals, and I'm another one of those successes.
I tapered off the Emsam and received a referral to a pdoc that wasn't afraid to prescribe Nardil. I quickly titrated up to 60mg (over a week, if I recall correctly) and then, a few days later, it worked. It really, really worked to the extent that I was hypomanic for a couple of days. It's been nine months now, and the depression is still gone. (The effect on the anxiety is a little more uneven, but not the fault of the drug I feel legitimately stressed sometimes as I have to work myself out of the hole this long depression put me in.)
I decreased to 45mg after a couple of months to reduce the side-effects. The low blood pressure and insomnia I was experiencing both improved at this lower dose, without any reduction in anti-depressant effectiveness.
I've found the warnings about the interactions with food to be vastly overstated, but I still remain a little cautious about eating things containing tyramine I'm not accustomed to. Everyone is different, and YMMV on the food issues.
Good luck, keep trying. Seems you're getting close to some lasting success.
poster:Erewhonian
thread:1005595
URL: http://www.dr-bob.org/babble/20121018/msgs/1029319.html