![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Triss on January 5, 2002, at 4:38:44
First of all, let me make it clear that I am fully
aware of the dire risk of producing serotonin syndrome
(which, of course, can turn fatal) by combining an SSRI
with an MAO inhibitor (and thus why professional
references strenuously forbid against attempting such
a cocktail).Now, my situation... I'm attempting to transition away
from an SSRI (fluvoxamine) to an MAOI (phenelzine).
However, the last time I attempted this (following my
doc's conservative -we must go it very slow- directions) during the lag time
between transitioning from the old drug to the new drug,
I had a devastatingly rapid relapse which sent me to hospital, where
I required ECT treatments just to get me partially out of what to
me was the most hopessly desolate and urgently horrible bout of
depression I have ever fallen into in so short a time.
I had tried to discontinue fluvoxamine many times before,
only to quickly return to it when depressive symptoms started
to become too much for me to be able to handle while waiting for
the extended process (i.e. for old drug to eventually leave my system
-plus a few days medication free for even more safety-
and then (to ward against nasty surprises) begin the
MAOI at subclinical dosages and then in the weeks ahead
gradually work dosages up ever so slowly until (someday)
reaching the usual effective starting dose.Therefore, (and this is where my upcoming query stems from),
I am without my doc's knowledge currently in the process
of transitioning from fluvoxamine to phenelzine by my own
desperate method of choice, by overlapping the dosage-with
drawal process of the former with the commencement and
dosage-build up process of the latter. So far I've
reduced the fluvoxamine dosage from it's previous
200mg/d to 112.5mg/d; and I've managed to (slowly;
by increments of 7.5mg/d) increase the phenelzine up
to 30mg/d. (Usual effective starting dose for phenelzine
is 45mg/d.)
So far, I've experienced no signs or hints (both subjective
and objective) suggestive of any degree of serotonin syndrome.
However, considering that my knowledge and medical skills
in this enterprize are not in any way sophisticated, I
realize I have only been very lucky, so far. But my
aim still exists to keep increasing the phenelzine,
whilst decreasing the fluvoxamine, in tandem, trying
to maintain "complementary homeostasis", as it were,
(i.e. decreasing fluvoxamine while taking enough phenelzine
to prevent a serotonergic-withdrawal syndrome and/or
depressive relapse), until I can comfortably stop the
fluvoxamine altogether and be stable on the phenelzine instead.Now, I guess my query is then for any information (preferable
from a professional with experience specific to this)
which can be offered me to help me complete this
SSRI to MAOI transition -whilst overlapping the two- as
safely and successfully as possible; an attempt to change
antidepressants _without_ having to experience a painfully
dangerous relapse while escaping the odds of development
of a life threatening serotonin syndrome. Thank you,Triss
Posted by jimmygold70 on January 5, 2002, at 12:40:22
In reply to Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 5, 2002, at 4:38:44
I have a creative idea - use selegiline (CARBEX, ELDEPRYL -a MAO-B inhibitor) while your're tapering off fluvoxamine. There is little interaction between the two. This will prevent the sudden fall of dopamine, which might have been the reason for your relapse. Then, switch to Nardil and take he dose high very fast. Of course, you'll suffer many side effects, but not RISK YOUR LIFE !
Another option is to switch from fluvoxamine to a noradrenergic tricyclic agent - maprotiline, prtriptyline, desipramine, and then take Nardil together, there is less risk of fatal interaction between norarenergic tricylics and phenelzine.
Take care !!!
Jimmy
Posted by Triss on January 5, 2002, at 19:34:37
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction » Triss, posted by jimmygold70 on January 5, 2002, at 12:40:22
Thank you very much for your feedback. However, I do know at least that my dependence on fluvoxamine (which is a Selective _Serotonin_ Reuptake Inhibitor, after all) is tied specifically to fluvoxamine's direct effect on _serotonin_ levels; not any direct effect on levels of norepinephrine or dopamine.
Triss
> I have a creative idea - use selegiline (CARBEX, ELDEPRYL -a MAO-B inhibitor) while your're tapering off fluvoxamine. There is little interaction between the two. This will prevent the sudden fall of dopamine, which might have been the reason for your relapse. Then, switch to Nardil and take he dose high very fast. Of course, you'll suffer many side effects, but not RISK YOUR LIFE !
>
> Another option is to switch from fluvoxamine to a noradrenergic tricyclic agent - maprotiline, prtriptyline, desipramine, and then take Nardil together, there is less risk of fatal interaction between norarenergic tricylics and phenelzine.
>
> Take care !!!
> Jimmy
Posted by OldSchool on January 5, 2002, at 21:16:12
In reply to Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 5, 2002, at 4:38:44
> First of all, let me make it clear that I am fully
> aware of the dire risk of producing serotonin syndrome
> (which, of course, can turn fatal) by combining an SSRI
> with an MAO inhibitor (and thus why professional
> references strenuously forbid against attempting such
> a cocktail).
>
> Now, my situation... I'm attempting to transition away
> from an SSRI (fluvoxamine) to an MAOI (phenelzine).
> However, the last time I attempted this (following my
> doc's conservative -we must go it very slow- directions) during the lag time
> between transitioning from the old drug to the new drug,
> I had a devastatingly rapid relapse which sent me to hospital, where
> I required ECT treatments just to get me partially out of what to
> me was the most hopessly desolate and urgently horrible bout of
> depression I have ever fallen into in so short a time.
> I had tried to discontinue fluvoxamine many times before,
> only to quickly return to it when depressive symptoms started
> to become too much for me to be able to handle while waiting for
> the extended process (i.e. for old drug to eventually leave my system
> -plus a few days medication free for even more safety-
> and then (to ward against nasty surprises) begin the
> MAOI at subclinical dosages and then in the weeks ahead
> gradually work dosages up ever so slowly until (someday)
> reaching the usual effective starting dose.
>
> Therefore, (and this is where my upcoming query stems from),
> I am without my doc's knowledge currently in the process
> of transitioning from fluvoxamine to phenelzine by my own
> desperate method of choice, by overlapping the dosage-with
> drawal process of the former with the commencement and
> dosage-build up process of the latter. So far I've
> reduced the fluvoxamine dosage from it's previous
> 200mg/d to 112.5mg/d; and I've managed to (slowly;
> by increments of 7.5mg/d) increase the phenelzine up
> to 30mg/d. (Usual effective starting dose for phenelzine
> is 45mg/d.)
> So far, I've experienced no signs or hints (both subjective
> and objective) suggestive of any degree of serotonin syndrome.
> However, considering that my knowledge and medical skills
> in this enterprize are not in any way sophisticated, I
> realize I have only been very lucky, so far. But my
> aim still exists to keep increasing the phenelzine,
> whilst decreasing the fluvoxamine, in tandem, trying
> to maintain "complementary homeostasis", as it were,
> (i.e. decreasing fluvoxamine while taking enough phenelzine
> to prevent a serotonergic-withdrawal syndrome and/or
> depressive relapse), until I can comfortably stop the
> fluvoxamine altogether and be stable on the phenelzine instead.
>
> Now, I guess my query is then for any information (preferable
> from a professional with experience specific to this)
> which can be offered me to help me complete this
> SSRI to MAOI transition -whilst overlapping the two- as
> safely and successfully as possible; an attempt to change
> antidepressants _without_ having to experience a painfully
> dangerous relapse while escaping the odds of development
> of a life threatening serotonin syndrome. Thank you,
>
> TrissI actually had a psychopharmacologist tell me that its possible to combine an SSRI with an MAOI in severe treatment resistant depression. I told some people about it and a few of them told me I ought to report this doctor to the medical board. LOL
If it was me Id play by the rules and go 15 days washout between SSRI and MAOI. Some cut it short to ten days.
How about this idea? Switch from the Luvox directly to a tricyclic antidepressant like Elavil or Surmontil? And use the tricyclic to keep you afloat for the two week washout? Then add the MAOI...you can safely combine MAOIs with certain tricyclics, thats an old time expert psychopharmacology trick.
Then pull the tricyclic off when you go on the MAOI. This way you dont crash when you go off the Luvox.
Old School
Posted by Dennison on January 6, 2002, at 10:27:32
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by OldSchool on January 5, 2002, at 21:16:12
> > First of all, let me make it clear that I am fully
> > aware of the dire risk of producing serotonin syndrome
> > (which, of course, can turn fatal) by combining an SSRI
> > with an MAO inhibitor (and thus why professional
> > references strenuously forbid against attempting such
> > a cocktail).
> >
> > Now, my situation... I'm attempting to transition away
> > from an SSRI (fluvoxamine) to an MAOI (phenelzine).
> > However, the last time I attempted this (following my
> > doc's conservative -we must go it very slow- directions) during the lag time
> > between transitioning from the old drug to the new drug,
> > I had a devastatingly rapid relapse which sent me to hospital, where
> > I required ECT treatments just to get me partially out of what to
> > me was the most hopessly desolate and urgently horrible bout of
> > depression I have ever fallen into in so short a time.
> > I had tried to discontinue fluvoxamine many times before,
> > only to quickly return to it when depressive symptoms started
> > to become too much for me to be able to handle while waiting for
> > the extended process (i.e. for old drug to eventually leave my system
> > -plus a few days medication free for even more safety-
> > and then (to ward against nasty surprises) begin the
> > MAOI at subclinical dosages and then in the weeks ahead
> > gradually work dosages up ever so slowly until (someday)
> > reaching the usual effective starting dose.
> >
> > Therefore, (and this is where my upcoming query stems from),
> > I am without my doc's knowledge currently in the process
> > of transitioning from fluvoxamine to phenelzine by my own
> > desperate method of choice, by overlapping the dosage-with
> > drawal process of the former with the commencement and
> > dosage-build up process of the latter. So far I've
> > reduced the fluvoxamine dosage from it's previous
> > 200mg/d to 112.5mg/d; and I've managed to (slowly;
> > by increments of 7.5mg/d) increase the phenelzine up
> > to 30mg/d. (Usual effective starting dose for phenelzine
> > is 45mg/d.)
> > So far, I've experienced no signs or hints (both subjective
> > and objective) suggestive of any degree of serotonin syndrome.
> > However, considering that my knowledge and medical skills
> > in this enterprize are not in any way sophisticated, I
> > realize I have only been very lucky, so far. But my
> > aim still exists to keep increasing the phenelzine,
> > whilst decreasing the fluvoxamine, in tandem, trying
> > to maintain "complementary homeostasis", as it were,
> > (i.e. decreasing fluvoxamine while taking enough phenelzine
> > to prevent a serotonergic-withdrawal syndrome and/or
> > depressive relapse), until I can comfortably stop the
> > fluvoxamine altogether and be stable on the phenelzine instead.
> >
> > Now, I guess my query is then for any information (preferable
> > from a professional with experience specific to this)
> > which can be offered me to help me complete this
> > SSRI to MAOI transition -whilst overlapping the two- as
> > safely and successfully as possible; an attempt to change
> > antidepressants _without_ having to experience a painfully
> > dangerous relapse while escaping the odds of development
> > of a life threatening serotonin syndrome. Thank you,
> >
> > Triss
>
> I actually had a psychopharmacologist tell me that its possible to combine an SSRI with an MAOI in severe treatment resistant depression. I told some people about it and a few of them told me I ought to report this doctor to the medical board. LOL
>
> If it was me Id play by the rules and go 15 days washout between SSRI and MAOI. Some cut it short to ten days.
>
> How about this idea? Switch from the Luvox directly to a tricyclic antidepressant like Elavil or Surmontil? And use the tricyclic to keep you afloat for the two week washout? Then add the MAOI...you can safely combine MAOIs with certain tricyclics, thats an old time expert psychopharmacology trick.
>
> Then pull the tricyclic off when you go on the MAOI. This way you dont crash when you go off the Luvox.
>
> Old SchoolHi- I was taking efflexor before going on Parnate another "maoi" as is nardil, I waited only 4 days didn't have even a hint of a problem. Course efflexor does have a real short half -life. Real Quandry is if your're on Prozac and are switching to an maoi- " 5 week washout" period yikes!!! Long half-life of prozac and it's metabolite norfluoxetine-good in a sense if you're just going off prozac period, sense likehood of withdrawal is considerably less, but 5 weeks whew that is a toughie!!! Btw cyproheptadiene and methylsergide which quickly relieve serotonin syndrome and are used as standard anectdotes, are sometimes given to people just in case serotonin syndrome happens to manifest itself. They are also sometimes given to people on ssri's with sexual difficulties resulting from serotonergic effects to be used on a "prn" basis before planned sexual activity.
Posted by spike4848 on January 6, 2002, at 13:43:47
In reply to Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 5, 2002, at 4:38:44
Hey Triss,
If you feel serotonin plays an important role in your depression/mood disorder .... I think the safest and most reliable medication to transition with is lithium. Lithium is known to enhance serotonin transmission ..... works ratherly quickly in 3 to 5 days ..... and there is no risk of hypertensive crisis. You do risk that with a TCA ..... and having a stroke will definately ruin the rest of your life.
Spike4848
Nardil user of 4 years
Nardil transitions: 6
Posted by jimmygold70 on January 6, 2002, at 16:23:09
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 5, 2002, at 19:34:37
Sure, but the noradrenergic tricyclics are at least as effective. You're not 'tied' to serotonin-specific drugs ! Depression is not caused from lack of serotonin. rather, all monoamine-active drugs influence other, some known, some yet to be discovered chemicals in the brain (like desensitization of central alpha receptors). The effect of noradrenergic drugs is much more profound on depression than the serotonergic drugs, but they have more side effects and are activating rather than calming, like serotonergic drugs. Don't switch from fluvoxamine to maprotiline / prtriptyline / desipramine directly - take them together for two weeks, than taper fluvoxamine for another two weeks. After that, wait two weeks when you're only on maprotiline / prtriptyline / desipramine, and start taking Nardil along with them. While you take Nardil dose up, taper the noradrenergic drugs quickly.
Sure this will be a much smoother 'switch'.
Jimmy
Posted by OldSchool on January 6, 2002, at 16:30:10
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by spike4848 on January 6, 2002, at 13:43:47
> Hey Triss,
>
> If you feel serotonin plays an important role in your depression/mood disorder .... I think the safest and most reliable medication to transition with is lithium. Lithium is known to enhance serotonin transmission ..... works ratherly quickly in 3 to 5 days ..... and there is no risk of hypertensive crisis. You do risk that with a TCA ..... and having a stroke will definately ruin the rest of your life.
>
> Spike4848
> Nardil user of 4 years
> Nardil transitions: 6
Thats an OUTSTANDING idea to bridge the gap between SSRI and MAOI! You could also use Lamictal instead of lithium, as you can add Lamictal to the MAOIs. Lamictal has strong AD propertiesOld School
Posted by spike4848 on January 6, 2002, at 16:59:37
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by OldSchool on January 6, 2002, at 16:30:10
> > Hey Triss,
> >
> > If you feel serotonin plays an important role in your depression/mood disorder .... I think the safest and most reliable medication to transition with is lithium. Lithium is known to enhance serotonin transmission ..... works ratherly quickly in 3 to 5 days ..... and there is no risk of hypertensive crisis. You do risk that with a TCA ..... and having a stroke will definately ruin the rest of your life.
> >
> > Spike4848
> > Nardil user of 4 years
> > Nardil transitions: 6
>
>
> Thats an OUTSTANDING idea to bridge the gap between SSRI and MAOI! You could also use Lamictal instead of lithium, as you can add Lamictal to the MAOIs. Lamictal has strong AD properties
>
> Old SchoolHey Brother,
I like the way you think Old School ...... OUTSTANDING AS WELL. Lamictal, like you mentioned, is a GREAT option ....
Talk to you later.
Spike
Posted by Triss on January 7, 2002, at 0:57:52
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction » OldSchool, posted by spike4848 on January 6, 2002, at 16:59:37
Well as of today, I've upped the Nardil to a
"full" 45 mg/d and I've taken my last fluvoxamine
dose (my own arbirary decision, based on nothing
more than a hunch). In the next 24
hours I should know if I need to worry any longer
about serotonin syndrome (if I'm not in a coma,
that is < g >). But in the next few days, I expect
to know (based on my past experience withdrawing
from fluvoxamine) whether I still need to worry
about another re-emergence of severe
depression or not. Thanks for all the helpful
responses. I'll try to keep you all posted on
what happens. :)Triss
Posted by Triss on January 24, 2002, at 22:08:45
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 7, 2002, at 0:57:52
Some of you may recall my recent post describing my independent decision to switch from Luvox to Nardil... Anyway, I've successfully made the switch... (although depression and anxiety did re-emerge afterall, having done so, and continuing to do so, with a vengence I might add -I had to admit myself to the hospital; at which time my pdoc got very angry with me...). My doc now has me taking lithium (750 mg/d) in addition to the Nardil (60 mg/d). I've now been on the combination for a little over a week and -although too soon for the lithium to kick in, I realize- I'm feeling rotten as ever. Clearly the Nardil has not kicked in at all. Anyhow... I'm rambling.
All I'm really posting for is to ask if there are any others out there who have experience with this combo. (Right now I'm feeling like 'how long do I have to 'muster all my willpower' like this, to hang-on, as it were, until I experience some relief. I feel so isolated, bleak, irritable, frazzled, and lonely-yet-unsociable... I'm sorry to ramble on here folks. I'm not holding it together very well right now.)Triss
-------------------------------------------
On Jan 7th, I wrote...
> Well as of today, I've upped the Nardil to a
> "full" 45 mg/d and I've taken my last fluvoxamine
> dose (my own arbirary decision, based on nothing
> more than a hunch). In the next 24
> hours I should know if I need to worry any longer
> about serotonin syndrome (if I'm not in a coma,
> that is < g >). But in the next few days, I expect
> to know (based on my past experience withdrawing
> from fluvoxamine) whether I still need to worry
> about another re-emergence of severe
> depression or not. Thanks for all the helpful
> responses. I'll try to keep you all posted on
> what happens. :)
>
> Triss
Posted by spike4848 on January 27, 2002, at 17:32:20
In reply to Lithium Augmentation of Nardil, posted by Triss on January 24, 2002, at 22:08:45
Hey Triss,
I remember your post from a while back. Glad you wrote back. It usually took 2 to 3 weeks for the nardil to start working for me at the right dose. Lithium ... usually gives a quick boost ... increase serotonin post-synaptic receptor effectiveness .... usually in 4 to 7 days.
Hang in there. Your on a very powerful combination which should blow the socks off any depression or anxiety. You will be better soon.
Spike
Posted by Triss on January 29, 2002, at 1:30:59
In reply to Re: Lithium Augmentation of Nardil » Triss, posted by spike4848 on January 27, 2002, at 17:32:20
Thanks for your reply, Spike. Though I'm still feeling horrible (or described more aply, trapped in an one long, seemingly hopeless experience of abject horror), each day for the last two or three days does seem to be just an insignificant tad less horrible than the day preceeding it. So, though I have a hard to getting myself to believe it in my heart, I realize in my head that you are very much right. Someday sooner or later I will 'rediscover' what it means to feel like living again.
Triss
PS: My pdoc just increased my Nardil to 75 mg/day. If nothing else, this is giving me some sense of hope because the last time Nardil made me feel well (and we're talking over 20 years ago now), I had (on my own -out of semi-suicidal desperation and disappointed disillusionment with a disinterested, '3 month wait between visits' then pdoc) increased the Nardil dosage to 90 mg/day. I had begun to feel terrific after a while. (Unfortunately, eventually the "success" came to an end as I went into hypomania, precipitating some pretty careless behavior, alarming my family, with word reaching my pdoc, who upon learning that I had been tinking with my medications without his permission indignantly told me he would no longer be seeing me.)
Posted by Triss on January 30, 2002, at 0:22:53
In reply to Re: Lithium Augmentation of Nardil, posted by Triss on January 29, 2002, at 1:30:59
I forgot to add in my post yesterday that my pdoc, after having been his patient for almost 18 years, proclaimed [I paraphrase], 'I'm going to be seeing you once every week ("just like the old days, when you first came for help"; and I'm going to try absolutely everything that exists -even if it means resorting to [so called] "heroic drug strategies", such as combining Nardil -or the more potent MAO-inhibitor antidepressant, Parnate- with tricyclics or amphetamines/stimulants or all three, in order to try whatever it takes trying in order to finally break this [what both of us are now nearly convinced is a 30 year old, never adequately treated/resolved] clinical depression.' While these are only words and not tangible results at this point obviously, I am encouraged as this is the first time a pdoc has decided to pull all stops in his treatment of my condition; something I had always secretly felt was the kind of approach I needed and wished for but never thought my condition -my daily struggles with my mood and fatigue, for almost as far back as I can remember- should ever be believed, understood or accepted well enough to elicit that kind of professional treatment effort. Yet I'm not excited. I needed this kind of concerted professional effort 20 years ago, when I first sought treatment. It's kind of too late for any hope for some kind of 'cure' to count for a whole lot now. Too much of life has gone by, while I've completely stood still... those many years of opportunities for growth lost... youth squandered on struggling just to make it through each day with nothing (no energy) left over for friends, a lover/spouse, children, a career, or even to just have some 'crazy' good times to look back on with nostalgic fondness in later days... years a whole new generation has grown up within... lost years no cure can ever retrieve.
Triss
Posted by petters on January 30, 2002, at 1:07:02
In reply to Re: Lithium Augmentation of Nardil » Triss, posted by Triss on January 30, 2002, at 0:22:53
> I forgot to add in my post yesterday that my pdoc, after having been his patient for almost 18 years, proclaimed [I paraphrase], 'I'm going to be seeing you once every week ("just like the old days, when you first came for help"; and I'm going to try absolutely everything that exists -even if it means resorting to [so called] "heroic drug strategies", such as combining Nardil -or the more potent MAO-inhibitor antidepressant, Parnate- with tricyclics or amphetamines/stimulants or all three, in order to try whatever it takes trying in order to finally break this [what both of us are now nearly convinced is a 30 year old, never adequately treated/resolved] clinical depression.' While these are only words and not tangible results at this point obviously, I am encouraged as this is the first time a pdoc has decided to pull all stops in his treatment of my condition; something I had always secretly felt was the kind of approach I needed and wished for but never thought my condition -my daily struggles with my mood and fatigue, for almost as far back as I can remember- should ever be believed, understood or accepted well enough to elicit that kind of professional treatment effort. Yet I'm not excited. I needed this kind of concerted professional effort 20 years ago, when I first sought treatment. It's kind of too late for any hope for some kind of 'cure' to count for a whole lot now. Too much of life has gone by, while I've completely stood still... those many years of opportunities for growth lost... youth squandered on struggling just to make it through each day with nothing (no energy) left over for friends, a lover/spouse, children, a career, or even to just have some 'crazy' good times to look back on with nostalgic fondness in later days... years a whole new generation has grown up within... lost years no cure can ever retrieve.
>
> Triss
Hi...Litium augmentation of any antidepressant, will make the antidepressant to work better. In other world it often boost or replenish the antidepressant effect.
Litium in combintation with MAO-inhibitior is an usuall combination in bipolar disorder or refractary depression.
Best Wishes...//Petters
Posted by Triss on February 4, 2002, at 15:33:57
In reply to Re: Lithium Augmentation of Nardil, posted by petters on January 30, 2002, at 1:07:02
> Hi...
>
> Litium augmentation of any antidepressant, will make the antidepressant to work better. In other world it often boost or replenish the antidepressant effect.
>
> Litium in combintation with MAO-inhibitior is an usuall combination in bipolar disorder or refractary depression.
>
> Best Wishes...//Petters
(Written and saved Friday, Feb. 1) Thanks for your input and kind interest. Being that my pdoc increased my Nardil from 75 mg to 90 mg last week, I'm beginning to feel more positive about life and less wistful of the past, etc., and I am able to relax in relative emotional comfort in the evening when by myself at home. But this little benefit is at great cost to my self-identity as a thinking, alert and attentive, ‘able-to-remember-information’ human being and worker. Instead of being better off, this last week I've spent a horrible time getting through *work as I'm feeling SO heavily "drugged" and "intoxicated". Even my sense of balance is off... similar to what it's like when a person is, both, a bit drunk and drowsy, at the same time.*{I am only so very fortunate that the ward where I work is currently very light (in terms of patient to staff ratio. Plus my coworkers and superiors are aware and supportive of my current struggle to beat this depression.}
The use of coffee barely 'cuts through' the present extreme, half-awake, dopiness. Today, out of desperation I did a no-no and tried a fraction of a tablet of Dexedrine (my pdoc would ‘abandon’ treating me in disgust if he were to find this out) to try to salvage some of this day by 'waking me up' and clearing my head a little. [Recall that Dexedrine or any other noradrenergic type stimulant is normally contraindicated for anyone taking an MAO-inhibitor due to the dangerous risk of excessive noradrenergic stimulation; the risks of which entail the likes of serious rise in blood pressure, excessive heart rate, and theoretically at least, some increased risk for spontaneous ventricular-fibrillation (though I don't think any of these are likely to occur when careful monitoring of vital signs and skillful caution is exercised).] Previous to stopping the old Luvox-Dexedrine combo and starting on this MAO-inhibitor, my morning dose of Dexedrine was 40 mg. In contrast, today I took one-eighth of a tablet (0.625 mg). However, when it became clear that 1/8th of a tablet didn't do anything (not increasing my blood-pressure or heart-rate at all) I took another 1/8th tablet, after which I experienced some (though very little) increase in alertness, concentration, and wakefulness. My heart rate and blood pressure rose only slightly.
Update Sunday, Feb. 4: I’ve stopped using trazodone to get to sleep at night. (With my pdoc’s approval/direction, I was using 1/4 of a tablet, or 12.5 mg trazodone to counter insomnia.) Since then I’ve noticed less of the above problem of being so mentally addled (though it is still there; only less disabling now). Now (sigh), to find an alternative way of dealing with the problem of the MAO-inhibitor (i.e. Nardil) related insomnia...
Triss
Posted by bookgurl99 on February 25, 2002, at 11:11:24
In reply to Query: Serotonin syndrome...SSRI+MAOI interaction, posted by Triss on January 5, 2002, at 4:38:44
I just have a question bec. I'm new on Luvox;
were you able to quit Luvox? I have been on it for a week and feel a 'crash' whenever it starts to wear off. Is this the sort of thing you experience, sort of a depression due to no more Luvox?I would just like to know as I am reconsidering using it.
Posted by Triss on February 26, 2002, at 22:55:02
In reply to Re: Query: Serotonin syndrome...SSRI+MAOI interaction, posted by bookgurl99 on February 25, 2002, at 11:11:24
> I just have a question bec. I'm new on Luvox;
> were you able to quit Luvox? I have been on it for a week and feel a 'crash' whenever it starts to wear off. Is this the sort of thing you experience, sort of a depression due to no more Luvox?
>
> I would just like to know as I am reconsidering using it.
I don't know whether or not the term, "crash", would describe it. What happened in my case was... in about three days after abruptly stopping the Luvox I found myself having difficulty sleeping, feeling more down about things than usual, and unable to relax, etc.
Following that, nausea began to develop and the above symptoms progressively got worse with each day. I became very restless and feeling like I desperately needed to go somewhere or do something, even though I had nowhere to go and no activity I did would bring relief. I could find no sense of peace.Bear in mind that what I experienced, while occurring in response to (or being triggered by) my stopping Luvox (i.e. 200 mg/day stopped all at once), was not merely antidepressant withdrawal. It was (as diagnosed) major depression. Luvox itself is a very good antidepressant. It's just that in my case it didn't work for all my symptoms, prompting me to want to stop it and try something else, whereupon the withdrawal process triggered something horrible that usually just does not occur with most people who withdraw from Luvox.
Take care,
Triss
PS: And yes, I did successfully quit the Luvox. I'm now depression free (except for certain, long medication-resistant, residual symptoms) on 90 mg/day of Nardil.
This is the end of the thread.
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