Posted by Sarah T. on March 7, 2005, at 23:58:25
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 6, 2005, at 7:13:01
> > > > Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared,
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> An infrequently embraced observation is that amphetamine can act as an antimanic agent.That's fascinating. I'd like to understand how that is possible. I'd also like to know how some antidepressants induce mania in susceptible individuals. By the way, did Parnate alone cause problems for you, or was it only when it was combined with the other medications? Have you ever taken dexedrine as monotherapy?
> > > and my circadian rhythms improved.
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> How so?When I was on Parnate alone, I had "attacks" of severe daytime somnolence, almost like narcolepsy. When the urge to sleep hit, I HAD to sleep. This was most inconvenient, not to mention dangerous. I'd sleep whenever the urge hit, which was usually during the day, and then I couldn't sleep at night. I'd go to bed around the time that most people wake up. I went to a new doctor who was familiar with this problem. He prescribed a small amount of Ritalin, which I took in the morning and at noon. I think it was either 2.5 or 5mg, twice a day. That stopped me from sleeping during the day, and I was better able to sleep at night. My circadian rhythms were still out of phase, but not nearly as bad as they had been. I have been interested in trying Selegiline if it ever comes out in the patch, but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well. You are probably aware of this, but just in case you haven't heard, several of the newer dopamine agonists that are prescribed to patients with Parkinson's Disease also cause those uncontrollable daytime sleep attacks. As I mentioned in the previous post, Parnate is considered to be one of the most dopaminergic AD's. I wonder what it is about dopamine that causes "narcolepsy."
> Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
What are its metabolites? Selegiline is converted to several amphetamines, but I think they are the "nasty" ones, the l-isomers, which cause the unpleasant/intolerable peripheral effects, like tremor, palpitations, etc.
> Did you glean any antidepressant effect from Parnate at all?When I took Parnate, I thought it had an antidepressant effect, but that was probably because I was so glad to be off of the "dumb drugs," like Elavil and imipramine. In retrospect, I think that Parnate functioned primarily as a stimulant for me, and that is most definitely not the same as an antidepressant. When I wasn't having the sleep attacks, I was pretty active physically and I lost the TCA-induced weight gain and edema, but my mood was pretty negative. I also had tremendous difficulty reading on Parnate. I'm not dyslexic. I love to read and usually don't have problems with it. I still don't know why I couldn't read well. When I was able to read, I had a lot of difficulty retaining what I read or learning. Perhaps that was caused by the sleep disruption. Aren't memories consolidated during certain stages of sleep?
> > 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.
Just recently I read that REM sleep and dreaming occur in different parts of the brain. I will try to find the reference.
> 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.
It sounds like a nightmare. That would have made me so depressed, I would have walked out. Did you actually stay at NIMH for nine months? My insurance company wouldn't pay for nine days, or nine hours for that matter. I have another medical condition that requires follow-up CT scans and MRIs at regular intervals. The last time my doctor ordered a CT and MRI, my insurance company refused to pay for both. They said that they would pay for one or the other, but not both, as if they were interchangeable! Oh-oh, this is another one of those "Don't get me started" topics.
> 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.What was their priority?
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.
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That's disappointing and disturbing to hear that NIMH, of all places, was behind the state of the art. Was/is there any place that is state of the art?Is there a seasonal variation to your depression? Do you feel better during the spring and summer? Do you have seasonal affective disorder? As I mentioned above, I was interested to know whether you've ever tried Dexedrine as monotherapy, or has it been prescribed only as an augmentor to another AD? I thought Dexedrine was a much better antidepressant for me than Parnate. Unfortunately, most people find that frequent "drug holidays" are necessary to stave off tolerance.
poster:Sarah T.
thread:463648
URL: http://www.dr-bob.org/babble/wdrawl/20050228/msgs/468084.html