Posted by BrightEyed+Blueberry on July 12, 2008, at 4:06:48
In reply to Re: Considering an MAOI » BrightEyed+Blueberry, posted by christophrejmc on July 12, 2008, at 2:27:09
First wanted to thank you for responding-- i appreciate it. Thank you! ( naturally starts to follow from the "write-down 5 things you're grateful for every day, first thing in the morning"--intervention to combating depression! So far....)
Several years ago I would occasionally take Temgesic (buprenorphine .2 sublingual) - I was only on SSRIS at the time, and Wellbutrin (though for a short time I was overseas for 6 months and weaned off all ADs (subsequently getting depressed, which I wouldn't have believed, laying on beaches in tranquil off-the-beaten trackm cheap tropical enclaves--damn biological depression!... The usual occurred--lost all interest in doing anything-type depression returned, along with sleeping, and more sleeping (atypical))
In either case, on above ADs or off all ADs, the Tems helped me - especially the Next/NEXT day (but it really made me nod out--id take it in the evening, give it 45 minutesm and then I'd go cross-eyed on my laptop/book and that was my cue to just lay down and sleep--then I'd nod in and out of "sleep" and have movie-like almost lucid "dreams." However, the next day I'd have to take naps throughout the day, sleep off and on. I didn't "feel" obviously euphoric, but was told by others that I seemed mellow and lacking in my more typical...irritable/cranky/ even "hard-edged" "good" moods.
So, it mellowed me out--as opposed to having really obviously stimulating ("hard-edged") effects of EMSAM or wellbutrin or amphetamine-class substances (btw, ive never had a euphoric response to cocaine--while everyone else was "blowing" away and having a good time. Talk about hard-edged irritability - no thanx). But either I was really sensitive to it or took too many (2-4? tis been so long) .2 tablets under the tongue [i was always confused of the dosage; i took nowhere near what apparently is taken for heroin-addiction <gasp>! Damn I dont think I'd ever wake up on those dosages!]
0I'm guessing Tems the anti-depressant effects are re:opioids, (which I haven't ever researched because I know my doc would NEVER go there) as opposed to the "3 muskateer" monoamine standards: serotonin, norep, and dopamine? Anyway, with EMSAM, with wellbutrin, with Adderal - I've got the hard edge without the serotonin-ahhh feeling - which i liken to having a good stretch....but i have energy, motivation, focus, to varying degrees....
Anyway, I'm not ready to start ordering tems from overseas, I'm sure it's not as easy as it was back in 2000, and I'm not as quick to experiment now that I've started the MAOI route. I feel I had a strong response to it in the past, and I don't know if being on EMSAM would make me even more sensitive to it (therapeutic) or less. In addition, I guess , when going up to 9mg, EMSAM will act as an MAO-a inhibitor as well as MAO-b...and that will bring the "serotonin" effects back into my life. At that point its more like Nardil & Parnate....I just hope going to 9mg doesn't make me apathetic like Effexor did, add back in the usual sexual side effects, and ...I don't know, I just don't know what to expect (from EMSAM 9mg, from tryibg bupe again while on EMSAM/an MAOI), and Effexor just put me off SSRIs for good ( i know its an SNRI technically). OH, curiously, I just remembered - I did try tems while on Effexor/Wellbutrin...a couple years ago...It had less to no effect on me-nada. So, something to do with the norepinephrine reuptake inhibition cancelled out bupe's effects on me? Yes, no? Why?!
I've digressed and babbled and wandered as I wondered, going from the subject of buprenorphine's past therapeutic effects on me to the subject of MAOI-a's to the subject of 9mg EMSAM=NArdil/Parnate to the subject of dopaminergic/noaradrenergic's "hard edges" vs serotonin's "soft" edge's and possible relationship to apathy and sexual side effects to the subject of Effexor /its NRI(?) aspect cancelling out all therapeutic effects of Tems for me and my wondering why?
I'm thinking of hustling in to CBT shortly - otherwise I feel like I'm relying to much on PDOC & Meds Russian Roulette, which makes me feel like a minor league drug addict and codependent (and a child constantly being denied permission to try or have my ideas really listened to.) And I'm not judging addicts or codependents; I would not speak on issues about which I know!
Unfortunately I don't have a doctorate, but i do have a graduate degree in clinical psych and did focus on biopsych/neuropsyc, but that was ages ago, and I don't think my doctor...appreciates that? she bats down my ideas one by one as I walk in her door-so i send her long, researched and cited emails ahead of time to make her have to do some thinking first! Guess I'm a toe-stepper with my current pdoc--eventually may have to part ways.
good night! lookin like another EMSAM one!
*Bright
> Sleep was difficult for me, too, with EMSAM. I think Xanax worked but I don't develop tolerance to its sedative effect. I'm sure I also used Ambien with some success. Trazodone is probably something that you definitely want to avoid. I'm not sure how much risk there is of serotonin syndrome at small dosages used for sleep, but it's just not worth the danger.
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> I have used Wellbutrin with EMSAM. I think it was the XL version although I'm not sure. Wellbutrin tends to make me slightly anxious (at least at first) and gives me headaches; EMSAM seemed to make both side-effects worse (but it wasn't an occipital headache and my blood pressure was never very high while I was on them). I forget the current view of Wellbutrin's mechanisms, but I do believe it increases the release of norepinephrine. This isn't necessarily bad, but if you don't have as many enzymes available to break it down, it's obviously going to add to the effect. I've never heard that Wellbutrin affects serotonin, but I don't think it's in any way that really matters; it has very low affinity for serotonin receptors or the uptake pump and I don't think it directly affects its release in any way that would make it dangerous in that regard. (I'm relying on my [very much flawed] memory here, you should look it up and present the research to your doc if you want to try it.)
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> I had the exact same experience with Provigil--no serious side-effects, but the ones that I had had from Provigil without EMSAM were magnified. The headaches were much worse than with Wellbutrin. I've also used Provigil and Parnate before and that was actually smoother than with EMSAM.
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> I've also taken Ritalin and Dexedrine with MAOIs. There were actually much fewer side-effects from this than with Wellbutrin or Provigil. It is potentially dangerous, though.
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> I believe there is a reasonable amount of evidence that buprenorphine can be combined with MAOIs. But you would have to have a very open-minded and trusting doctor to receive buprenorphine even by itself... and it doesn't sound like you have one of those doctors. (My doc lets me try all kinds of things that are off-label and appreciates when I bring in research, but I'm quite sure there's no way, even after seeing her for nearly ten years, that she would consider giving me bup.)
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poster:BrightEyed+Blueberry
thread:826622
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/839400.html