Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Prometheus on March 21, 2000, at 17:13:35
I've had major depression for approximately 25 years. I've been through doctors, threats, assinine medication directions, ECT, and once was threatened by a doctor with lobotomy.
I've been through every psych medication, therapy, and wrong direction provided by doctors' conflicting ideas. About five years ago, I read Listening To Prozac. Not having money for a docotr AND medication, I decided to purchase the Prozac on my own. After several weeks of no result, I began raising the dose every two weeks until it did help -- and boy did it! This level was between 160-200mg per day. When I ran out of money, I took a nose dive again.
Last year, after relaying this to my (then) doctor, over and over again, him having taken me through the usual conflicting ideas, ECT, and wrong medications and combinations, he relented and sent me to the University of Michigan for a second opinion by a team of three doctors. These doctors agreed that the high dose Prozac was the way to go, so my doctor prescribed 160mg per day. Though I had told all the doctors that I had to regulate the dose between 160-200mg/day, they ignored me and went with the lower, and 400mg/day Wellbutrin. I have felt much better, but without the regulation, have been let down by Prozac every 7th or 14th day (which is 180 degress from what I had been), which hadn't occurred before.
Recently my father-in-law died. I really loved him. I stayed strong for my wife through the funeral, then I came home and saw something I had meant to give him, and I broke down. Immediately following, my wife and I had two very bad fights. I almost succeeded in death, again, but woke up in the ICU and then transferred to the psych ward.
My doctor doesn't make hospital visits, so he passed me off to the hospital staff. The doctor said he thought the suicide attempt was different than my usual depression. He kept me on the high dose of Prozac and he and the Social Worker worked out all the details to have me enter Lifeways (community mental health). I told them my main concern was that another doctor would not understand the history or rationale behind the Prozac. They assured me that the Lifeways doctor they had scheduled me with, would not change the medication.
After meeting with this doctor last week, she immediately stated she would not continue the Prozac because of her "comfort" level. She admits she has no idea what her treatment plan would be, except taking Prozac away. I told her that my current prescription would run out this week, but she stuck with her decision and told me she'd see me in three weeks.
I been down this road with doctors before, and I know that if it isn't a dead end, then it surely needless detour which may never get me back on track. My experiences have told me to distrust doctors, yet Lifeways expects me to implicitly trust this doctor who has no treatment plan. I know for a fact what will happen when the Prozac is discontinued, but you can't force the stubborn horse to drink.
Within two weeks my depression will gain full force and take me down a long spiral. I'm so very tired of teaching, convincing, begging doctors, and putting up with their mistakes and/or threats. My insurance ends in November, and I can't afford the UofM doctors or other private doctors. Although I don't look forward to the depression, at least I know it intimately, and have become acceptive of its arrival.
I feel well right now, but with this conflict have started to become very weary and pessimistic again. I don't know what to do.
Posted by Chris A. on March 21, 2000, at 20:10:23
In reply to High Dose Prozac, posted by Prometheus on March 21, 2000, at 17:13:35
Have a copy of the consult from the U of M docs to this new doc and while you're at it have them send you one for your records, too. My docs are fairly respectful of what an expert consultant from the medical school says. There is a basic principle that states a professional doesn't practice beyond the level of their training, competence and licensure. Often this gets interpreted as not practicing beyond one's comfort level. Prozac is not always a benign drug - just ask me.
I wish you health.Chris A.
Posted by Mark H. on March 21, 2000, at 21:03:57
In reply to High Dose Prozac, posted by Prometheus on March 21, 2000, at 17:13:35
Few people in the medical profession have the clinical insularity to support someone who needs 10 to 20 times the "one size fits all" marketing plan passed off as a dosing guide by the manufacturer of Prozac. This leaves you in the same situation as chronic pain sufferers whose doctors and pharmacists have been prosecuted by the DEA for providing adequate medication appropriate for their conditions.
It's not about the competence of your doctor (or even her arrogance or lack of courage); it's about the fact that doctors are not free to prescribe what you need without concern for losing their insurance protection or even their licenses, unless they are part of a large and prestigious program with sufficient clinical documentation to prove that they can greatly exceed normal dosing guides without promoting "drug abuse." Everyone else is considered guilty until proven innocent, involving long and costly federal lawsuits and even criminal prosecution.
Until this madness of government intervention in private medical assessment and treatment changes, you and others like you will continue to be marginalized and undertreated most of the time. Nevermind that it will likely cost thousands more annually to care for you with inadequate medication than it would for you simply to be given what you need.
I hope you find a miracle. I have a friend who may have to move to Baja with his family in order to receive the care he needs.
Posted by Mark H. on March 21, 2000, at 21:11:35
In reply to Re: High Dose Prozac, posted by Mark H. on March 21, 2000, at 21:03:57
Chris A.'s posting was much more optimistic and useful than mine. I apologize for my sense of despair about the medico-legal entanglements of obtaining adequate care. And, of course, I meant 8 to 10 times, not 10 to 20 times -- in my memory, I mixed up how much you were taking of what. Good luck, and thanks to Chris A.
Posted by JohnL on March 22, 2000, at 1:39:16
In reply to High Dose Prozac, posted by Prometheus on March 21, 2000, at 17:13:35
There's nothing at all wrong with such a high dose of Prozac. It's not common, but not unwarranted in some cases. I read at Dr Ivan Goldberg's Depression Central that doses up to 200mg are used by 'experts'. Anyone not experienced in using such a high doses is probably not an expert, and they haven't yet learned some important lessons.
This is just an idea, but you might want to do this. Click on 'tips' at the top of the main page. When you get there, look on the left side for Depression Central, or Ivan Goldberg. Click on that. When you get there, you'll have to explore around. I don't remember exactly where it was he talks about high dose Prozac, but it's there somewhere. Maybe in the 'Collected Writings of' section. When you find it, print it out and carry it with you.
Dr Goldberg is a noted national psychiatrist with considerable experience and respectability. Having his info on-hand for any of your doctors to read should help make your case. You wouldn't be the first to be treated successfully and safely at 200mg, and you won't be the last. I hope you can find what I'm talking about, because I really think having it in writing will be important when confronted with a hesitant doctor. JohnL
Posted by JohnL2 on March 22, 2000, at 2:07:34
In reply to High Dose Prozac, posted by Prometheus on March 21, 2000, at 17:13:35
I just wanted to re-emphasize that expert psychiatrists do indeed prescribe Prozac in the 100 to 200 range.In addition, since you are accustomed to self-medication, there is a website called International Antiaging Systems (IAS) who have recently added Prozac and Zoloft to their available mailorders from overseas. You don't need a prescription. You can order up to a 90 day supply at a time legally. I think that's based on 20mg, so you would probably have to place several orders a few days apart to build up a good supply. The delivery wait is about 3 to 4 weeks. Since you already know for a fact from experience what keeps you feeling well, I hope some hesitant doctor doesn't try to steer you in a different direction. If it aint broke, don't fix it, right? Why experiment with anything else when you already know for a fact what works?
I saw a controlled research study that tested three different approaches to partial responders on Prozac. One third of the patients had Lithium added to their Prozac. Another third had a tricyclic added. The final third had the dose of Prozac increased to a high range. The results...the high dose Prozac group had the highest improvement rates.
You didn't mention if you were using insurance or paying cash. If paying cash, here's an idea. Get two or three regular family or health clinic doctors. The cheapest ones you can find. See them separately. Get prescriptions for 80mg Prozac from each. Just tell each one you've had depression before and 80mg works. Have them filled at different pharmacies.
I don't mean to sound like I'm endorsing self medication. But quite frankly, there are some people (small minority) that can and do treat themselves better than a doctor. You have alread proved that. Do you know how many of us struggle month after month to find the right medication? Year after year? You already know what works. Run with it, any way you can think of. Be well, stay well. You already know what the rest of us are struggling to find.
Posted by Psydoc on March 7, 2002, at 4:46:24
In reply to Re: High Dose Prozac, posted by JohnL on March 22, 2000, at 1:39:16
The matter of high doses of Prozac is mentioned at http://www.psycom.net/depression.central.expert.html. Only a few people require doses even close to 200 mg/day. Some people with depression, OCD, or Borderline Personality Disorder only respond to doses that high.
Best regards . . .
Ivan
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by SLS on March 12, 2002, at 6:07:14
In reply to Re: High Dose Prozac, posted by Psydoc on March 7, 2002, at 4:46:24
Hi.
I suffer from a severe bipolar depression that has been unremitting for over ten years. I have experienced dramatic responses to a few classic antidepressant medications, but they last for only hours or days. Still, these brief "awakenings" occur only after having taken these drugs for two weeks, as one would expect. It is an uncommon presentation for which severe mania occurs only in conjunction with antidepressant use. I have tried high- dosage Parnate several times, but thus far it has represented a dead-end, even when combined with tricyclics and stimulants. I must say, though, that I receive some benefit at 120mg that I do not at lower dosages (80mg or 100mg).
I came across an abstract on Medline years ago that tried to investigate what actions Parnate produces at higher dosages that do not occur at lower dosages. They found that it acted to antagonize 5-HT2 receptors, a property shared by antidepressant drugs like Remeron and Serzone, and the atypical neuroleptics for which antidepressant properties have been demonstrated. Their results might have been errant, of course, and I don't know that any other experiments have performed to repeat them.
- Scott
---------------------------------------------168: J Neural Transm Suppl 1994;41:127-34
Comparisons of the actions of high and low doses of the MAO
inhibitor tranylcypromine on 5-HT2 binding sites in rat cortex.Goodnough DB, Baker GB
Department of Psychiatry, University of Alberta, Edmonton, Canada.
Tranylcypromine (TCP) is a commercially available antidepressant
drug, and recent literature reports suggest that high doses of this
drug may be particularly effective in treating refractory
depression. Down-regulation of 5-HT2 receptors in rat cortex is an
effect produced after chronic administration of several
antidepressants, and we have conducted a chronic study comparing
low- and high-dose TCP in this regard. Male Sprague-Dawley rats
were administered TCP (0.5 or 2.5 mg/kg/day) or vehicle (distilled
water) via Alzet minipumps implanted subcutaneously in the dorsal
thoracic area. Groups of rats were killed 4, 10 or 28 days after
pump implantation and whole cortex was dissected out and utilized
for preparation of a membrane fraction. Binding studies were
performed with this fraction using 3H- ketanserin as the
radioligand. Down-regulation (decrease in Bmax) of the 5-HT2
binding site was observed in high-dose animals after 10 and 28 days
but not after 4 days. Low-dose TCP had no effect on 5-HT2 densities
at any time interval. The affinity of 3H-ketanserin for the 5-HT2
site was not affected by either dose at any time interval. These
results suggest that down-regulation of the 5-HT2 site may
contribute to the efficacy of high-dose TCP in the treatment of
refractory depression.PMID: 7931218, UI: 95016589
Posted by SLS on March 12, 2002, at 9:56:11
In reply to Re: High Dose Prozac, posted by Psydoc on March 7, 2002, at 4:46:24
Oops.
Sorry, doctor.
After rereading the abstract, I see that it is not 5-HT2 receptor antagonism that was concluded to occur, but rather, receptor downregulation.
What do you make of this?
- Scott
> ---------------------------------------------
>
> 168: J Neural Transm Suppl 1994;41:127-34
>
> Comparisons of the actions of high and low doses of the MAO
> inhibitor tranylcypromine on 5-HT2 binding sites in rat cortex.
>
> Goodnough DB, Baker GB
>
> Department of Psychiatry, University of Alberta, Edmonton, Canada.
>
> Tranylcypromine (TCP) is a commercially available antidepressant
> drug, and recent literature reports suggest that high doses of this
> drug may be particularly effective in treating refractory
> depression. Down-regulation of 5-HT2 receptors in rat cortex is an
> effect produced after chronic administration of several
> antidepressants, and we have conducted a chronic study comparing
> low- and high-dose TCP in this regard. Male Sprague-Dawley rats
> were administered TCP (0.5 or 2.5 mg/kg/day) or vehicle (distilled
> water) via Alzet minipumps implanted subcutaneously in the dorsal
> thoracic area. Groups of rats were killed 4, 10 or 28 days after
> pump implantation and whole cortex was dissected out and utilized
> for preparation of a membrane fraction. Binding studies were
> performed with this fraction using 3H- ketanserin as the
> radioligand. Down-regulation (decrease in Bmax) of the 5-HT2
> binding site was observed in high-dose animals after 10 and 28 days
> but not after 4 days. Low-dose TCP had no effect on 5-HT2 densities
> at any time interval. The affinity of 3H-ketanserin for the 5-HT2
> site was not affected by either dose at any time interval. These
> results suggest that down-regulation of the 5-HT2 site may
> contribute to the efficacy of high-dose TCP in the treatment of
> refractory depression.
>
> PMID: 7931218, UI: 95016589
Posted by johnX2 on March 13, 2002, at 7:23:48
In reply to Re: High Dose Prozac » Psydoc, posted by SLS on March 12, 2002, at 6:07:14
Hi Scott,Tecnically....
If I'm reading this correctly the high dose Parnate does not "antagonize" so to speak the 5-ht2 receptors.
It was my thought that an antagonist such as Serzone or Remeron is a chemical that would bind to the receptor but not activate the receptor and "block-out" serotonin.
(Note: it does however downregulate the receptor, i.e desensitize it over time..just to confuse you).However for regular SSRIS, MAOIS, over time, it was my understanding that larger pools of the serotonin monoamine in the synaptic cleft may desensitize (or decrease the number of receptors) for a particular subclass such as the 5-ht2 through a genomic mechanism.
This would leave a fewer number of receptors
for available serotonin to bind too. This delay
may account for the time for an anti-depressant
response.If I'm interpreting this abstract correctly, the
Parnate is NOT an antagonist, but merely desensitizes the 5ht-2 site.Sorry if I type to much, I know it makes you
more depressed. Me too at times.Hang in there buddy!
Best wishes
John
> Hi.
>
> I suffer from a severe bipolar depression that has been unremitting for over ten years. I have experienced dramatic responses to a few classic antidepressant medications, but they last for only hours or days. Still, these brief "awakenings" occur only after having taken these drugs for two weeks, as one would expect. It is an uncommon presentation for which severe mania occurs only in conjunction with antidepressant use. I have tried high- dosage Parnate several times, but thus far it has represented a dead-end, even when combined with tricyclics and stimulants. I must say, though, that I receive some benefit at 120mg that I do not at lower dosages (80mg or 100mg).
>
> I came across an abstract on Medline years ago that tried to investigate what actions Parnate produces at higher dosages that do not occur at lower dosages. They found that it acted to antagonize 5-HT2 receptors, a property shared by antidepressant drugs like Remeron and Serzone, and the atypical neuroleptics for which antidepressant properties have been demonstrated. Their results might have been errant, of course, and I don't know that any other experiments have performed to repeat them.
>
>
> - Scott
>
>
> ---------------------------------------------
>
> 168: J Neural Transm Suppl 1994;41:127-34
>
> Comparisons of the actions of high and low doses of the MAO
> inhibitor tranylcypromine on 5-HT2 binding sites in rat cortex.
>
> Goodnough DB, Baker GB
>
> Department of Psychiatry, University of Alberta, Edmonton, Canada.
>
> Tranylcypromine (TCP) is a commercially available antidepressant
> drug, and recent literature reports suggest that high doses of this
> drug may be particularly effective in treating refractory
> depression. Down-regulation of 5-HT2 receptors in rat cortex is an
> effect produced after chronic administration of several
> antidepressants, and we have conducted a chronic study comparing
> low- and high-dose TCP in this regard. Male Sprague-Dawley rats
> were administered TCP (0.5 or 2.5 mg/kg/day) or vehicle (distilled
> water) via Alzet minipumps implanted subcutaneously in the dorsal
> thoracic area. Groups of rats were killed 4, 10 or 28 days after
> pump implantation and whole cortex was dissected out and utilized
> for preparation of a membrane fraction. Binding studies were
> performed with this fraction using 3H- ketanserin as the
> radioligand. Down-regulation (decrease in Bmax) of the 5-HT2
> binding site was observed in high-dose animals after 10 and 28 days
> but not after 4 days. Low-dose TCP had no effect on 5-HT2 densities
> at any time interval. The affinity of 3H-ketanserin for the 5-HT2
> site was not affected by either dose at any time interval. These
> results suggest that down-regulation of the 5-HT2 site may
> contribute to the efficacy of high-dose TCP in the treatment of
> refractory depression.
>
> PMID: 7931218, UI: 95016589
Posted by SLS on March 13, 2002, at 11:27:22
In reply to Re: High Dose Prozac » SLS, posted by johnX2 on March 13, 2002, at 7:23:48
Hi John.
> Hi Scott,
>
> Tecnically....
>
> If I'm reading this correctly the high dose Parnate does not "antagonize" so to speak the 5-ht2 receptors.
Yes, I know. I followed up my first post with an "Oops" post. It had been awhile since I read the thing. I knew that it had something to do with something doing something to something else, so I was pretty close. :-)The chronic, but not acute, administration of some other antidepressants also produce a downregulation of 5-HT2 receptors. Such is also the case with other types of receptors. NE beta receptor downregulation had been the focus for many years, but I don't know if any explanation as to its relevance has been established. It's just that these compensatory changes take two weeks to appear, a time course that coincides with the two weeks it usually takes for someone to respond to most antidepressant medications. I know you know this stuff. I just wanted to make sure that I did.
- Scott
Posted by johnX2 on March 13, 2002, at 11:52:25
In reply to Re: High Dose Prozac » johnX2, posted by SLS on March 13, 2002, at 11:27:22
Hi Scott,My own oops.
I didn't read your follow up oops.
I figured you should have known better on this one. ;)BTW, are you onto the Nardil trial?
And have you always been diagnosed Bipolar?Do you maintain Lamictal with the other medicine trials?
You couldn't pry Lamictal out of my cold dead fingers. ;0
John
> Hi John.
>
>
> > Hi Scott,
> >
> > Tecnically....
> >
> > If I'm reading this correctly the high dose Parnate does not "antagonize" so to speak the 5-ht2 receptors.
>
>
> Yes, I know. I followed up my first post with an "Oops" post. It had been awhile since I read the thing. I knew that it had something to do with something doing something to something else, so I was pretty close. :-)
>
> The chronic, but not acute, administration of some other antidepressants also produce a downregulation of 5-HT2 receptors. Such is also the case with other types of receptors. NE beta receptor downregulation had been the focus for many years, but I don't know if any explanation as to its relevance has been established. It's just that these compensatory changes take two weeks to appear, a time course that coincides with the two weeks it usually takes for someone to respond to most antidepressant medications. I know you know this stuff. I just wanted to make sure that I did.
>
>
>
> - Scott
Posted by SLS on March 13, 2002, at 18:42:18
In reply to Re: High Dose Prozac » SLS, posted by johnX2 on March 13, 2002, at 11:52:25
Hi John.
> My own oops. I didn't read your follow up oops. I figured you should have known better on this one. ;)You overestimate me, my friend.
> BTW, are you onto the Nardil trial?
No. Not yet.
I had been taking:
Lamictal 300mg
Effexor 300mg
nortriptyline 75mg - 100mgI've switched from nortriptyline to imipramine because there was no stable therapeutic window for me. 75mg is too little and 100mg is too much. No amount of finessing seemed to work. Taking too much of nortriptyline feels in some ways worse than taking too little. I experienced a more crushing depression along with anxiety. I first attempted the switch while I was still taking Effexor. I felt better during a two-day washout period before beginning imipramine. I even experienced a small withdrawal rebound improvement, which is typical for me. Unexpectedly, I reacted badly to the addition of imipramine within the first few days in a way similar to the exacerbation produced by nortriptyline. Imipramine and I are buddies, and I respond quite predictably when taking it.
I discontinued the Effexor in the hopes that it was responsible for adulterating actions of tricyclics. I then went back to nortriptyline to see if would respond well to it in the absence of Effexor. I liked the way I felt on nortriptyline during the brief periods when it helped. In addition, I would have preferred to combine Nardil with the tricyclic having the more mild anticholinergic effects. No such luck. Same window thing. Sooo, I switched back to imipramine, raised the dosage to 300mg., and added back the Effexor. Logical, I think. It has only been 2 days of taking Effexor, so we'll see.
> And have you always been diagnosed Bipolar?
No. I arrived at the Columbia Presbyterian (NYC) research program depressed and ultra-rapid cycling. 8 days of a severe anergic depression followed by 3 days of euthymia. No mania, though. I was diagnosed with atypical unipolar depression. Then, 5 years later during my only extended period of euthymia (6 months), which was brought about by a combination of Parnate and desipramine, mania began to appear. It developed into a psychotic mixed state over the course of 2 or 3 months. Still, my doctor continued to treat me as a unipolar. It wasn't until I entered the NIMH program that the word bipolar was used. William Z. Potter came to this conclusion after a brief interview with me. I don't know what else he based his opinion on. I suppose he read through my case history.
I sometimes wonder if I have something other than affective disorder causing my symptoms. Something "organic". I don't know. Maybe a brain tumor or an endocrine malfunction or some weird autoimmune thing.
I'm not married to the bipolar diagnosis. I would welcome any input. Some people might consider me to be unipolar with drug-induced manias. Others define this pattern as a subtype of bipolar disorder. I would favor the second diagnosis because of the 2-year period of rapid-cyclicity, the anergic presentation with reverse-vegetative symptoms, and brief mild improvements brought about by lithium and gabapentin monotherapy, and the addition of valproate to MAO inhibitors. I'm sure H. Akiskal would find some bipolarity in there somewhere.
> Do you maintain Lamictal with the other medicine trials?
Yes. It helps me maintain a mild improvement when used in combination with a tricyclic or MAOI. I have tried several times to reduce the dosage below 300mg, but I deteriorate within two days.
> You couldn't pry Lamictal out of my cold dead fingers. ;0
I hope I never get the chance to try.
I do appreciate your input and value your knowledge and understanding. I have learned quite a bit from you, and I'm sure that I'll continue to.
- Scott
Posted by JohnX2 on March 13, 2002, at 19:45:34
In reply to Re: High Dose Prozac, posted by SLS on March 13, 2002, at 18:42:18
Hi Scott,This is my opinion. Take it with a grain of salt, you've been through so much, I can't even imagine how much heart and determination you have. I consider myself a persistent person, but you really inspire me.
Anyways, I think its important to understand that everbody is different and that there is a bell shape curve so to speak of responses. There is going to be people on the fringe of these statistical curves that don't fit into the standard "flow chart" diagnosis. So I wouldn't be too concerned about what label is applied to your illness and more concerned about how it needs to be treated.
For example, I say my disorder is treated with membrane stabilizers and chemical boosters. This is what works for me. You can use this to treat a number of labels: bipolar, depression, epilepsy, anxiety. Whatever. Who cares about the label.
What is important from a scientific approach, is to look at your response to medications and make flexible changes in treatment aproaches based off those responses.
For a long time you have been stuck with this persisestant poop out snag. And now you even had clear cut manic sympoms with very clear cut cycling. Without putting a label on it, and just thinking about chemistry, there are certain classes of medicines to try that are best suited to stabilize and improve these situations. Now it just so happens that they usually are used for Bipolar Disorder. That doesn't mean you are Bipolar. It just means your odds of improving your situation improve substantially if you use novel techniques to steady your mood and control poop out rather than beat down the standard antidepressant path (unless they come up with something else in the mean time, endocrine etc).
I found some interesting links on theories behind treatment resistant depression/bipolar/ultra radian cycling/poop out and posted them way down below (with your name on it). A lot of things I see on this stuff suggests strategies regarding regulation of synaptic plasticity and calcium channels.
So I hope you get in with some good doctors.
At least it sounds like your getting in some
fun. Except the wild mood swings must suck?BTW, I think that antipsychotic med you were looking at is very interesting.
please take care and stay in touch.
Let us now if you go down any nover treatment paths to help with the cycling or poop out.
(I hope you do).Best Wishes
John> Hi John.
>
>
> > My own oops. I didn't read your follow up oops. I figured you should have known better on this one. ;)
>
> You overestimate me, my friend.
>
> > BTW, are you onto the Nardil trial?
>
> No. Not yet.
>
> I had been taking:
>
> Lamictal 300mg
> Effexor 300mg
> nortriptyline 75mg - 100mg
>
> I've switched from nortriptyline to imipramine because there was no stable therapeutic window for me. 75mg is too little and 100mg is too much. No amount of finessing seemed to work. Taking too much of nortriptyline feels in some ways worse than taking too little. I experienced a more crushing depression along with anxiety. I first attempted the switch while I was still taking Effexor. I felt better during a two-day washout period before beginning imipramine. I even experienced a small withdrawal rebound improvement, which is typical for me. Unexpectedly, I reacted badly to the addition of imipramine within the first few days in a way similar to the exacerbation produced by nortriptyline. Imipramine and I are buddies, and I respond quite predictably when taking it.
>
> I discontinued the Effexor in the hopes that it was responsible for adulterating actions of tricyclics. I then went back to nortriptyline to see if would respond well to it in the absence of Effexor. I liked the way I felt on nortriptyline during the brief periods when it helped. In addition, I would have preferred to combine Nardil with the tricyclic having the more mild anticholinergic effects. No such luck. Same window thing. Sooo, I switched back to imipramine, raised the dosage to 300mg., and added back the Effexor. Logical, I think. It has only been 2 days of taking Effexor, so we'll see.
>
> > And have you always been diagnosed Bipolar?
>
> No. I arrived at the Columbia Presbyterian (NYC) research program depressed and ultra-rapid cycling. 8 days of a severe anergic depression followed by 3 days of euthymia. No mania, though. I was diagnosed with atypical unipolar depression. Then, 5 years later during my only extended period of euthymia (6 months), which was brought about by a combination of Parnate and desipramine, mania began to appear. It developed into a psychotic mixed state over the course of 2 or 3 months. Still, my doctor continued to treat me as a unipolar. It wasn't until I entered the NIMH program that the word bipolar was used. William Z. Potter came to this conclusion after a brief interview with me. I don't know what else he based his opinion on. I suppose he read through my case history.
>
> I sometimes wonder if I have something other than affective disorder causing my symptoms. Something "organic". I don't know. Maybe a brain tumor or an endocrine malfunction or some weird autoimmune thing.
>
> I'm not married to the bipolar diagnosis. I would welcome any input. Some people might consider me to be unipolar with drug-induced manias. Others define this pattern as a subtype of bipolar disorder. I would favor the second diagnosis because of the 2-year period of rapid-cyclicity, the anergic presentation with reverse-vegetative symptoms, and brief mild improvements brought about by lithium and gabapentin monotherapy, and the addition of valproate to MAO inhibitors. I'm sure H. Akiskal would find some bipolarity in there somewhere.
>
> > Do you maintain Lamictal with the other medicine trials?
>
> Yes. It helps me maintain a mild improvement when used in combination with a tricyclic or MAOI. I have tried several times to reduce the dosage below 300mg, but I deteriorate within two days.
>
> > You couldn't pry Lamictal out of my cold dead fingers. ;0
>
> I hope I never get the chance to try.
>
> I do appreciate your input and value your knowledge and understanding. I have learned quite a bit from you, and I'm sure that I'll continue to.
>
>
> - Scott
This is the end of the thread.
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