Posted by SLS on March 5, 2016, at 9:57:29
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 6:12:40
Hi Jade
> > Possible diagnosis: 296.53 (F31.4):
> > Bipolar I Disorder; Most Recent Episode Depressed, Severe Without Psychotic Features
> Could be. The pdoc I now see hasn't given me a formal diagnosis although I guess he must have one for billing purposes.
> > a psychotic reaction to drugs indicates Bipolar Disorder I if the manic reaction persists after the offending drug is discontinued.
> Here's where I'm confused. I've always assumed it was the parnate that caused my psychosis. But it started after I/we added Dexedrine. The Dexedrine was removed but the psychosis continued for nine months. It stopped when parnate was removed AND I was put on a heavy dose of Geodon.
>
> Any thoughts as to which was the offending med or was it possibly both?In my experience, I would say that the Parnate was a necessary component to the induction of your manic episode. Whether or not the amphetamine acted in synergy with the Parnate must be considered, but I doubt it would by itself be sufficient to trigger mania. So, if you must return to a MAOI, I would try it first without the amphetamine while remaining on an antipsychotic other than Geodon. (Geodon is theoretically incompatible with a MAOI). If, then, you feel the need to add the amphetamine, I would not be terribly afraid of doing it.
What are your thoughts on this?
Are there people around you who you trust to identify the emergence of another manic episode and who you would listen to?
Are there any concerns you have with using Zyprexa for the long term? Weight-gain? Diabetes?
> > If you are concerned about a MAOI-induced psychotic reaction, you should consider:
> >
> > 1. Taking an antipsychotic or mood stabilizer right from the start to be used as a prophylactic. Once you respond to the MAOI and are stable for awhile, you can then try discontinuing the antipsychotic or mood stabilizer. You are likely to be Bipolar I based upon the severity of your psychotic reaction. Our cases are very similar.
> >
> > 2. Start the MAOI by itself and take an antipsychotic (Zyprexa) as an emergency drug if psychosis develops. The problem with this strategy is that it often happens that the patient does not recognize the onset of psychosis early enough to want to act on it. Once the emergency has passed, you can then choose to use another antipsychotic with a more acceptable side effect profile.
> I am very concerned and I would definitely choose #1. Sick mind doesn't know its sick. I absolutely did not ever recognize that I was ill until it was over. In addition, I would likely continue on my Zyprexa while on an MAOI. Just can't risk it.> Geodon caused severe anxiety and hypersomnia in me (unless it was a result of the abrupt withdrawal from parnate)
As I mentioned earlier, Geodon is theoretically incompatible with a MAOI due to concerns regarding serotonin syndrome. However, severe anxiety and profound fatigue are possible side effects of abrupt Parnate discontinuation. Hypersomnia can occur with Geodon by itself or be a withdrawal effect of amphetamine discontinuation.
My guess is that the anxiety was a result of Parnate discontinuation and hypersomnia the result of a high dosage of Geodon. The timing of these effects might help you tease out cause and effect. It really doesn't matter much, though.
1. You need to avoid Geodon one way or another.
2. Parnate withdrawal can be difficult to suffer through.
3. You will likely need to be on an antipsychotic or mood stabilizer to avoid medication-induced psychotic mania (at least with MAOIs).
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1086626
URL: http://www.dr-bob.org/babble/20160131/msgs/1086735.html