Posted by tensor on February 18, 2023, at 14:56:05
In reply to Re: An update » tensor, posted by SLS on February 17, 2023, at 21:25:04
Hi Scott!
> I would say that MAOIs can stop working, but not nearly as often as SSRI do - "SSRI poop-out". In my estimation, Nardil is more likely to stop working than Parnate. However, there are plenty of people who continue to respond to Nardil for decades, or indefinitely. I'm into my third year of remission with the addition of Nardil to my treatment regime. I'll give some thought as to what you can do pharmacologically to help lower the risk of relapse while taking Nardil.That's nice to hear, I hope you will continue to do well on Nardil. I remember one guy on this forum had a strategy re MAOIs, or maybe it was a friend of his, anyway, he switched between Nardil and Parnate, like when Nardil stopped working or the response was not enough he switched to Parnate, and then back to Nardil when it happened again and so on. You are probably aware of this but I brought it up just in case. May work for some people. I think I would love the anxiolytic effect of Nardil, and since I've been on Parnate, the idea of taking an MAOI doesn't scare me. I'm more concerned about sexual s/e for instance, which I have read can be quite severe.
> One absolutely crucial non-pharmacological treatment that will both make one more likely to respond to a medication and less likely to relapse while taking it is to REDUCE STRESS ON THE BRAIN. Most people are born with a brain that is mostly resilient to physiological stress. The grief that comes with the loss of a loved one does not usually precipitate a prolonged mental illness. One must be pre-disposed to a mental illness in order for normal challenges and psychosocial stress to trigger it. Brain function becomes persistently altered, although not always irreversibly. The dynamics of one's internal psyche is as much responsible for the severity of the stress placed on the brain as are the challenges encountered in the external environment. Given the same challenge, three people might demonstrate three different reactions, depending on how their psyche interprets the challenge. One gets happy. One gets sad. One gets anxious. This is the domain of psychotherapy.
> 1. Reduce psychosocial stress = Increases the probability of a treatment response.
2. Reduce psychosocial stress = Reduces the risk of a relapse.
> * Tip: A trick that the first two generations of psychopharmacologists used when a patient relapsed while taking Nardil was to discontinue it temporarily - a "drug holiday" for a minimum of three months. Upon restarting Nardil, an antidepressant response can be "recaptured".
Yes, I agree to some extent. I think it was in 2016 I gave up fighting to stay in working life. My application for disability pension was approved. I thought that this will give my mind some time to heal, since my focus uptil then had solely been to get back to work asap. Since my mental energy was never par for the course for working, even part time, it felt like a huge yoke had been lifted off my shoulders. I would for several years only do things I wanted to do. However, since then, seven years later, I have never had a period in remission where I felt like I could work, not even part time, well maybe for a day or two but not for a week or longer. It just doesn't happen anymore. My doc compared this to a beaten path in the jungle, whatever happened in my brain during depression would be more likely to happen again.
The pattern is pretty clear. When I was working, the length in remission got shorter and the length of my sick leaves got longer. Does it qualify for some kind of brain damage? Could it have been avoided? I don't know, my depression has always felt very "biological", i e stemming from internal factors. Like it feels like it would have happened regardless if I was living a hypothetical stressless life in the jungle eating bananas the whole day.
There is no moral to this story, just a reflection.
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There's more to this, from an evolutionary perspective, looking at nature, to me it seems a single individual is not important enough. It's all about the survival of the species, a lot - if not everything - in nature revolves around reproducing, incredible amount of sperm cells are produced everyday for example. A single individual can be sacrificed. So an individual in nature - before we had developed any kind of medicine - has some mechanisms to stay alive, we can heal a small wound, but we can't regenerate limbs, if a lung gets punctured or we brake an arm or a leg, we are done, dead. Hopefully we already managed to produce an offspring. If you are born with some form of defect, tough luck, you are not gonna make it.
This makes me wonder why nature would provide us with mechanims to heal a severe depression or any other serious mental disorder, in nature we would just die off. Today we have therapies in different forms and we carry each other, so a person with a disability can have a meaningful life instead of starving to death in the forest. Medication can mask/relieve symptoms of severe psychosis or depression, but do we have inbuilt mechanisms to allow our brains to rewire themselves and become healthy and/or more resilient? I don't see why we would have, a single individual is not that important from nature's perspective. Not to be a downer, it's just how I look at it as a layman, I'm gladly proven wrong and I felt like ranting (sorry).> - Trileptal: A "cleaner" version of Tegretol. It is not sedating the way Tegretol is and does not have the propensity to produce agranulocytosis. I don't know that it helps with a true anxiety disorder, but I haven't researched it. I would definitely look at any untried treatment as being a potential miracle. I liked Trileptal. I found it to be clean and somewhat energizing. If Trileptal were to work, it wouldn't be because it acts as a sedative or an anxiolytic. It would be because it helped to remodulate dyregulated systems upstream. It has the potential to produce hyponatremia as a side effect. It is not common, though. Unlike Tegretol, Trileptal can be combined with Lamictal without affecting each other's metabolism.
- Depakote: Has a mild anxiolytic effect in addition to its anticonvulsant, anti-manic, and mood stabilizing properties. It acts to increase GABA neurotransmission by blocking sodium channels. GABA inhibits and dampens excitatory tracts, and can reduce anxiety. I would use the word "smoothing" to describe how Depakite affected me. This smoothing effect always remained in the background, regardless of how it altered my mood and cognition. Depakote wouldn't be my first choice, but I wouldn't want to dissuade you from trying it. It might be your miracle.
- Lamictal: Is most often recommended to treat bipolar depression. I have a vague recollection that the rate of response to Lamictal was higher for bipolar depression than to unipolar depression. You'd have to check me on that. For depression, most people respond to 200 mg/day. For me, 300 mg/day is ideal.
Thank you for the information! I remember when I took Lamictal the first time, it had a slight disinhibitory effect, maybe there was something that happened because of clonazepam, some synergy. Anyway, it was quite pleasant, always wondered if Trileptal would feel like that but stronger, is it something you've noticed? It's difficult to explain it, but the closest is possibly the social feeling you get from a small amount of alcohol. I don't think Lamictal otherwise ever did anything for my depression. As it stands, there's room for one more medication, tiagabine as you mentioned earlier or perhaps Trileptal.
Valproate looks absolutely horrible on paper, like clozapine in terms of potential and dangerous side effects. How bad is it in real life?> Mine:
Nardil - 90 mg/day
Nortriptyine - 100 mg/day
Lamictal - 300 mg/day
Lithium - 300 mg/dayThat's a solid combo!
> Good luck.
Good luck to you too!/tensor
poster:tensor
thread:1121774
URL: http://www.dr-bob.org/babble/20230117/msgs/1121822.html