Posted by SLS on March 6, 2005, at 7:13:01
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 6, 2005, at 1:33:22
Hi Sarah.
> You mentioned that you had brief, psychotic, manic reactions to some antidepressants. May I ask which AD's caused this reaction?
Parnate + desipramine
Parnate after pretreatment with Paxil and desipramine
Nardil discontinuation rebound maniaThe one antidepressant that caused a psychotic reaction for me was Parnate. I'm uncertain whether my reaction was caused by the fact that Parnate is one of the most dopaminergic medications, or by the fact that it caused severe disruption of sleep and circadian rhythms, or something else altogether.
Good thinking. All three, probably.
> Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared,
An infrequently embraced observation is that amphetamine can act as an antimanic agent. I didn't know that Ritalin could do the same thing.
> and my circadian rhythms improved.
How so?
> Dexedrine was the most stabilizing medicine I've ever been on,
Case in point. (I hadn't read down this far yet) :-)
> something I would have never expected after my initial reaction to Parnate.
Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
> Oh, one other point about Parnate-induced psychosis. I read that Parnate suppresses REM sleep more than just about any other AD, and while some doctors believe that REM suppression leads to antidepressant activity, it did not have that effect on me.
Did you glean any antidepressant effect from Parnate at all?
The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
> Is diagnosis very important to you and/or your doctor?
Yes and no. He first described what I experienced as a deficit syndrome, much like that encountered with the negative symptoms of schizophrenia. That I am bipolar probably rests on the observations that I became manic on medication, had been an ultra-rapid cycler, and display reverse vegetative symptoms like an atypical depressive. However, I am not mood-reactive. The diagnosis was first placed on me by William Z. Potter, MD at the NIMH.
> Diagnosis serves a function, but I think too much importance is placed on it,
On the contrary, I think it is showing itself to be increasingly important as it seems the diathesis seen in the bipolar spectrum disorders is different from that of true unipolar depression. The differences in neurobiology between the two is indicated by the pattern of response to antidepressants and mood stabilizers.
> and it can detract from understanding and treating the patient as a person.
I'm sure this is true of a great many doctors. With affective-disorders, sometimes treating individual symptoms is the best you can do as a palliative measure in the absence of true remission.
> A relative of mine who is a physician knows one of the doctors who co-wrote one of the DSMs. My relative said that "Dr. DSM" was one of the most boring people he'd ever met.
What would you expect? They are basically statisticians. :-)
> Reducing psychiatry to diagnostic labels is sort of like saying that biology should be reduced to taxonomy.
The beauty of the DSM is that it does NOT associate symptom clusters as discreet biological entities. They are merely describing what is observed empirically.
> Classifying organisms into genus and species serves a purpose, but if that's all there were to biology, the study of it would have died off long ago. And one of my biggest gripes is the fabrication of diagnostic labels for the purpose of marketing a drug. For example, as a female, I am all-too-well acquainted with "PMS," but "PMS" wasn't good enough for drug companies. I heard that the diagnostic label "PMDD" (pre-menstrual dysphoric disorder) was coined for the purpose of marketing Sarafem, which is just Prozac, re-packaged and re-named.
As far as PMS versus PMDD, I am mostly ignorant of their study. I don't know if they represent varying expressions of the same phenomenon along a continuum of magnitude or are actually discreet biological phenomenon. Do women taking Prozac still get PMS? That would be an interesting place to start.
> Perhaps I shouldn't have posted that I stopped stimulants abruptly. It seemed to be the right thing for me at the time, but it is probably not the best way to go about withdrawal, and I don't encourage others to stop "cold turkey."
As you had indicated previously, different drugs might require or allow for different discontinuation strategies. I was not on methylphenidate nor amphetamine long enough to assume that my system had developed a biological state to produce withdrawal syndrome. I do know that whenever I discontinue Parnate quickly, I experience profound fatigue.
> The reason that I mentioned the Mayo Clinic is that a couple of doctors have suggested it to me. I have another medical condition that contributes to my depression, and my doctors thought it might be helpful for me to be evaluated and treated by a team of doctors from different specialties. I don't know. I'm so discouraged and fed up with most doctors. I think I'd just be used by the team for teaching purposes, and then, thousands and thousands of dollars later, I'd leave, no better off than when I arrived.
I know the feeling.
> I have nothing against teaching hospitals, but I'm tired of paying others so that they can learn from me without giving anything in return.
With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures. In return, I left there taking an MAOI named clorgyline that could not be appropriated anywhere else in the world. Unfortunately, I responded to it episodically at first and only partially thereafter. I stopped taking it after I had been home for a few months for lack of efficacy.
After nearly every medical appointment, I am further depleted of energy and money, and yet, the help I need is not forthcoming. Do you think you got anything out of your stay at NIMH?
In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well. As far as the other subgroup is concerned, they seemed to be much more dedicated to sending their patients home healthy. Unfortunately, their approaches were not at all novel. I felt they were actually several years behind the state of the art.
In 1992, while I was there, the entire budget of the NIMH was only about 6 hundred million dollars. There were less than 20 beds devoted to the study of affective disorders. It was pitiful. Over the last 3 years, the budget has increased to 1.3 billion. However, the dollar is worth quite a bit less now. Considering that depression alone costs the American workplace more lost productivity than any other illness, this remains a nonsensical number.
- Scott
poster:SLS
thread:463648
URL: http://www.dr-bob.org/babble/wdrawl/20050228/msgs/467250.html