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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by sophia04 on June 17, 2007, at 2:00:38
Hello,
I feel as though I've given all my drug trials fair shakes - most recently 11 exceedingly difficult weeks on Parnate. I'm looking for a new drug and your advice. The following is a list of all the antidepressant meds I've tried in the last 11 years (not in chronological order) and a number ranking their effectiveness + tolerability. I have had relatively bad luck. My symptoms are depression, obsessive thinking, and anxiety.Nortriptyline 7 - pooped out after 1 yr.
Lexapro 0 - no impact / + side effects
Imipramine 8 - pooped out after 3+ yrs.
Wellbutrin 0 - no impact / + side effects
lithium 0 - no impact / side effects
Buspar 0 - no impact/ no side effects
Remeron 0 - no impact/ side effects
Effexor 0 - no impact / ++ side effects
Paxil 0 - no impact / + side effects
Celexa 4 - some impact / few side effects
Luvox 1 - some impact / few side effects
Prozac 0 - no impact / few side effects
Zoloft 0 - no impact / + side effects
lamictal 0 - no impact / few side effects
Parnate 0 - no impact / ++++ side effectsYikes! That's a lot.
Sophia
Posted by clarence on June 17, 2007, at 4:18:07
In reply to Going Off Parnate, next drug - your insight?, posted by sophia04 on June 17, 2007, at 2:00:38
Sophia, I am sorry you have had such a hard time in getting an agent to suit you or work for long term. I do have to ask, however, how long and at were the dosages of the said meds at the maximum tolerable dosages and lengths of time to determine thier effectiveness. Just curious.
Snapper
Posted by Phillipa on June 17, 2007, at 11:25:05
In reply to Re: Going Off Parnate, next drug - your insight? » sophia04, posted by clarence on June 17, 2007, at 4:18:07
Looks like your best results were the TCA's? Love Phillipa
Posted by Quintal on June 17, 2007, at 12:01:40
In reply to Going Off Parnate, next drug - your insight?, posted by sophia04 on June 17, 2007, at 2:00:38
Yup, we'll make a great psychopharmacologist out of you yet Phillipa. Your best results seem to have been with TCAs sophia, so it would be logical to go back to either Nortriptyline or another in that class. I had a similar experience myself filling in a spreadsheet of all the meds I've taken (I can't even post it here because it's wider than the screen), Dothiepin was the only one I could give 10/10 on efficacy.
So which TCA? You could go back to Norty and see if it worked as well as it did last time. Clomipramine (Anafranil) is a very effective TCA that has strong serotonin reuptake effects along with the typical TCA profile. Desipramine is another option to consider, as is Lofepramine (Gamanil) (depending which country you're in) as it has fewer side effects and is safer in overdose than the other TCAs. It is metabolized into Desipramine. Some of the other TCAs like Amitriptyline might be too sedating for regular use as antidepressants.
Q
Posted by Jesus is Savior on June 17, 2007, at 12:42:24
In reply to Going Off Parnate, next drug - your insight?, posted by sophia04 on June 17, 2007, at 2:00:38
> Hello,
> I feel as though I've given all my drug trials fair shakes - most recently 11 exceedingly difficult weeks on Parnate. I'm looking for a new drug and your advice. The following is a list of all the antidepressant meds I've tried in the last 11 years (not in chronological order) and a number ranking their effectiveness + tolerability. I have had relatively bad luck. My symptoms are depression, obsessive thinking, and anxiety.
>
> Nortriptyline 7 - pooped out after 1 yr.
> Lexapro 0 - no impact / + side effects
> Imipramine 8 - pooped out after 3+ yrs.
> Wellbutrin 0 - no impact / + side effects
> lithium 0 - no impact / side effects
> Buspar 0 - no impact/ no side effects
> Remeron 0 - no impact/ side effects
> Effexor 0 - no impact / ++ side effects
> Paxil 0 - no impact / + side effects
> Celexa 4 - some impact / few side effects
> Luvox 1 - some impact / few side effects
> Prozac 0 - no impact / few side effects
> Zoloft 0 - no impact / + side effects
> lamictal 0 - no impact / few side effects
> Parnate 0 - no impact / ++++ side effects
>
> Yikes! That's a lot.
>
> Sophia
Maybe try imipramine again?-MJ
Posted by Phillipa on June 17, 2007, at 20:31:41
In reply to Re: Going Off Parnate, next drug - your insight? » sophia04, posted by Quintal on June 17, 2007, at 12:01:40
Thanks Quintal. Love Phillipa
Posted by Maxime on June 17, 2007, at 20:50:54
In reply to Going Off Parnate, next drug - your insight?, posted by sophia04 on June 17, 2007, at 2:00:38
How about Nardil?
Maxime
Posted by sophia04 on June 17, 2007, at 20:59:39
In reply to Re: Going Off Parnate, next drug - your insight? » sophia04, posted by clarence on June 17, 2007, at 4:18:07
> Sophia, I am sorry you have had such a hard time in getting an agent to suit you or work for long term. I do have to ask, however, how long and at were the dosages of the said meds at the maximum tolerable dosages and lengths of time to determine thier effectiveness. Just curious.
> SnapperThank you all for your feedback. The SSRIs were prescribed first and not under a psychiatrists supervision, but I do believe I stayed on them long enough to decipher their (lack of) effectiveness. However, it's hard to say - imipramine was the first drug to really *blow* a 5-year treatment-resistent depression away, but this was at a dose of 275mg (which I understand is relatively high). When Nortriptyline (175 mg) started to loose its effectiveness (after about 1 year) i briefly went back to imipramine, but found that I did not respond to it in the same way, and so went back to Nortriptyline. After a short stint back on Nor.. I decided to give Parnate a try, and have found it the most difficult drug to tolerate thus far. I will discuss other TCA options with my doc tomorrow. Thanks so much! You are all so helpful.
Sophia
Posted by Jedi on June 19, 2007, at 21:50:45
In reply to Re: Going Off Parnate, next drug - your insight?, posted by sophia04 on June 17, 2007, at 20:59:39
Hi Sophia,
Is your depression atypical? If so a combination of the nortriptyline, which worked for a while for you, and phenelzine(Nardil) might be a working combination. They are officially contraindicated but sometimes used in TRD. I know you had a lot of problems with Parnate, but Nardil is a completely different medication and works very well with atypical depression and social anxiety. It is not without side effects but I haven't found an AD that is. Just a thought.
Take care,
JediReferences:
A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=7560546&ordinalpos=38&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumTreatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8071301&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumCombined MAO-inhibitor and tri- (tetra) cyclic antidepressant treatment in therapy resistant depression.
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3406429&ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
> Thank you all for your feedback. The SSRIs were prescribed first and not under a psychiatrists supervision, but I do believe I stayed on them long enough to decipher their (lack of) effectiveness. However, it's hard to say - imipramine was the first drug to really *blow* a 5-year treatment-resistent depression away, but this was at a dose of 275mg (which I understand is relatively high). When Nortriptyline (175 mg) started to loose its effectiveness (after about 1 year) i briefly went back to imipramine, but found that I did not respond to it in the same way, and so went back to Nortriptyline. After a short stint back on Nor.. I decided to give Parnate a try, and have found it the most difficult drug to tolerate thus far. I will discuss other TCA options with my doc tomorrow. Thanks so much! You are all so helpful.
>
> Sophia
>
Posted by sophia04 on June 20, 2007, at 0:29:37
In reply to Re: Going Off Parnate, next drug - your insight? » sophia04, posted by Jedi on June 19, 2007, at 21:50:45
Thank you Jedi for all these wonderful references. What a wealth of knowledge you all are! I'm not sure if my depression is considered atypical. I will have to do a bit of research. I seem to have pretty classic syptoms, just resistent to treatment. I will discuss the nardil/tca options w/ my doc. I know she's typically against the combo, but perhaps isn't aware of these studies. I'll keep you posted.
I've been weaning myself off parnate (down to 30 mg from 60mg) and with every little pink pill I don't take I feel less poisoned and able to actually sleep more! Which was the intolerable side effect for me. No nastly withdrawal effects yet.
Thanks again!Holly
> Hi Sophia,
> Is your depression atypical? If so a combination of the nortriptyline, which worked for a while for you, and phenelzine(Nardil) might be a working combination. They are officially contraindicated but sometimes used in TRD. I know you had a lot of problems with Parnate, but Nardil is a completely different medication and works very well with atypical depression and social anxiety. It is not without side effects but I haven't found an AD that is. Just a thought.
> Take care,
> Jedi
>
> References:
> A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=7560546&ordinalpos=38&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
>
> Treatment response of depressed outpatients unresponsive to both a tricyclic and a monoamine oxidase inhibitor antidepressant.
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8071301&ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
>
> Combined MAO-inhibitor and tri- (tetra) cyclic antidepressant treatment in therapy resistant depression.
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=3406429&ordinalpos=16&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
>
>
>
>
> > Thank you all for your feedback. The SSRIs were prescribed first and not under a psychiatrists supervision, but I do believe I stayed on them long enough to decipher their (lack of) effectiveness. However, it's hard to say - imipramine was the first drug to really *blow* a 5-year treatment-resistent depression away, but this was at a dose of 275mg (which I understand is relatively high). When Nortriptyline (175 mg) started to loose its effectiveness (after about 1 year) i briefly went back to imipramine, but found that I did not respond to it in the same way, and so went back to Nortriptyline. After a short stint back on Nor.. I decided to give Parnate a try, and have found it the most difficult drug to tolerate thus far. I will discuss other TCA options with my doc tomorrow. Thanks so much! You are all so helpful.
> >
> > Sophia
> >
>
>
Posted by Jedi on June 20, 2007, at 2:11:57
In reply to Re: Going Off Parnate, next drug - your insight?, posted by sophia04 on June 20, 2007, at 0:29:37
Holly,
I think most everyone who takes a MAOI ends up taking another med for the associated insomnia. I started with trazodone, have used diphenhydramine, and found Seroquel in doses of 12.5 to 25mg the best for me.Atypical depression is actually more common than the name implies. Symptoms include reactive mood, overeating, oversleeping, and rejection sensitivity, among others. There is some debate over the actual defining symptoms.
Also, there has been some research done which suggests that by combining a TCA with a MAOI, there is actually less chance of a hypertensive tyramine reaction. I never tested this personally.
Best of luck,
Jedi
References:
Columbia atypical depression. A subgroup of depressives with better response to MAOI than to tricyclic antidepressants or placebo.Quitkin FM, Stewart JW, McGrath PJ, Tricamo E, Rabkin JG, Ocepek-Welikson K, Nunes E, Harrison W, Klein DF.
New York State Psychiatric Institute, NY.We summarise a series of studies using a MAOI to help establish the validity of a subgroup of depressives referred to as atypical depressives. Patients with reactive mood meeting DSM-III criteria for depressive illness who had associated atypical features (which include hyperphagia, hypersomnolence, leaden paralysis, and rejection sensitivity) were randomised to imipramine, phenelzine and placebo. Non-responders were crossed over, and in all there were over 400 patient trials. Phenelzine consistently was found to be superior to imipramine. Only in trials which included patients lacking atypical, vegetative symptoms was imipramine found to equal phenelzine. We conclude that the researcher and the clinician should consider the relevance of the atypical depressive syndrome.
PMID: 8217065 [PubMed - indexed for MEDLINE]
Atypical Depression - What's in a name?
http://pn.psychiatryonline.org/cgi/content/full/38/20/20
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