![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 44 to 68 of 106. Go back in thread:
Posted by SLS on December 17, 2008, at 5:29:10
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 16, 2008, at 20:39:02
I would like to add that a treatment strategy that can be very effective is to add an atypical neuroleptic, of which Abilify and Geodon are emerging as the most effective.
- Scott
Posted by SLS on December 17, 2008, at 5:43:01
In reply to Re: Treatment Resistant (Refractory) Depression, posted by desolationrower on December 16, 2008, at 21:56:34
I understand that lithium is thought to directly inhibit the reuptake of glutamate, but I am still unclear as to how it can stabilize and limit glutamatergic excitation. I recall something involving NMDA receptors, but I don't know if lithium acts directly to change the conformation of the transporter molecule. What else does lithium do to influence glutamate activity? How might protein kinase-C inhibition affect glutamate?
Thanks.
- Scott
Posted by CaptainAmerica1967 on December 17, 2008, at 10:05:57
In reply to Re: Treatment Resistant (Refractory) Depression, posted by desolationrower on December 16, 2008, at 21:56:34
Thanks for your response.
"acetyl cysteine or aniracetam"- yes I tried both of these; I've been into holistic health for years (Life Extension Foundation) and have taken acetyl cysteine before.
I've tried aniracetam and some other "smart drugs" after reading the book "Smart Drugs & Nutrients years ago by Ward Dean, M.D..I've been very interested in NMDA receptor antagonists after the news of ketamine having such a profound and lasting effect on TRD and looked into going to the NIMH in Bethesda, MD, for a ketamine study on treatment resistant depression but it would have meant having to go off the antidepressant I was taking at the time or any antidepressant for that matter for a washout time and I get severely non functional just after being off them for two days. I've tried memantine without any benefit and have thought about trying the med for ALS(Lou Gehrig's Disease) called Riluzole which is also a potent glutamate blocker or NMDA receptor antagonist (clinicaltrials.gov), but the cost is phenomenol at $10-$20 per pill and the dose of at least two per day.
I thought about trancranial magnetic stimulation (TMS), but since I failed a course of 70 ECT treatments, the TMS wouldn't likely to anything.
I'm also interested in cortisol blockers being studied.
Jeff
Posted by SLS on December 17, 2008, at 10:18:43
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 17, 2008, at 10:05:57
I suffered a negative reaction from taking Provigil. Nevertheless, I am suspicious that it might make a good adjunct to MAOIs.
By the way, what treatments are you aware of that you have not yet tried?
- Scott
Posted by CaptainAmerica1967 on December 17, 2008, at 20:18:14
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 17, 2008, at 10:18:43
"By the way, what treatments are you aware of that you have not yet tried?"
Deep brain stimulation-hopefully it will continue to show promise in treating severe treatment resistant depression and will be approved even though I don't like surgery as there's always a risk.
Other than that, there's not much I haven't tried except some drugs going through clinical trials.
http://neurotransmitter.net/newdrugs.html
or www.clinicaltrials.gov
-CRF antagonistsI'm still really interest in ketamine (NMDA antagonsit), but cannot or will not get off my current meds (was out) in order to be able to participate in the study. http://clinicaltrials.gov/ct2/show/NCT00088699?cond=%22Depression%22&rank=35
Riluzole(an inhibitor of glutamate release)-indicated for ALS, but studies on going like ketamine.
Also meds that increase brain-derived neurotrophic factor (BDNF) as antidepressants and physical exercise increase levels in the brain and those with depression have reduced levels.
Cysteamine bitartrate (Cystagon), an FDA approved med for the treatment nephropathic cystinosis, has been shown to increase BNDF in neuronal tissue, and to stimulate cell growth.
Posted by SLS on December 17, 2008, at 20:55:15
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 17, 2008, at 20:18:14
I did not respond to riluzole. Nothing good - nothing bad.
I also tried mifepristone. I did not like it. I felt very washed-out at the end of the week, and less well overall.
Did you ever combine Provigil with an MAOI?
- Scott
Posted by CaptainAmerica1967 on December 17, 2008, at 21:11:43
In reply to Re: Treatment Resistant (Refractory) Depression, posted by SLS on December 17, 2008, at 20:55:15
No, I haven't used Provigil with an MAOI. I used Provigil with other meds such as Cymbalta but I still felt sleeply most of the time, however, I was taking so many other meds at the time too such as pindolol, thyroid, various amphetamines, Lamictal.
Currently I'm taking Parnate, Nortriptyline, Lithium Orotate and amineptine.
Vigorous physical exercise can make feel completely normal for temporary afterwards as can total sleep deprivation.
Posted by desolationrower on December 17, 2008, at 23:01:12
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 17, 2008, at 21:11:43
If you haven't tried buprenorphine or lowdose naltrexone, i think that would be the obvious thing. I think they either could be taken with current regimine.
Dextromethorphan has some similarities to ketamine. It has strong affinity for the SERT (i think, info is hard to come by) so definatly not something you can take with parnate. I think it has some specific dopaminergic activity as well, and sigma. Of course, i have no idea if this would be benefical long-term, but it is another easily avilible uncompetitive NMDA antagonist
Did you try the memantine with the current drugs, and did you take at least 40mg? It seems to be more effective at higher doses. I'm asking again as some of the studies show subtherapeutic mem+tca or other AD results in full antidepressant effect.
Also, have you tried adding NAC to your current drugs.
Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason? I haven't noticed any strong effect from adrafinil with parnate and my other stuff, n=1. Oh and wherever it was mentioned, i don't know about specific Li/Glu interaction or PCK. I believe it increases glu uptake chronically. Given Mgs role in the NMDA receptor, i'd think it interacts in some fashion.
-d/r
Posted by CaptainAmerica1967 on December 18, 2008, at 4:06:01
In reply to TRD --SLS, CPTAmerica, posted by desolationrower on December 17, 2008, at 23:01:12
Thanks for your feedback.
I haven't tried buprenorphine, but have been interested in it as I'm interested in almost anything that could bring about a better life. I'm not sure about the drug interaction with Parnate and would have to do some more research on it. I have a gut feeling my depression could be related to some sort of malfuncition with the hypothalamus-pituitary-adrenal axis (hot flashes or feeling warm all the time)-cortisol, endorphins, neurotransmitters. Obviously exercise affects mood as a result from many different physiological mechanisms, but it's only the intense physical exercise that produces the slight euphoria and antidepressant effect I feel which could be attributed to endorphins hence buprenorphine or naltrexone might help. Also, my father got "hooked" on heroin the first time he tried it in 1972 and died from an accidental overdose (sad to know that the following day he was suppose to go in for treatment, but never made it) so this could point to my depression as having some type of opioid dysfunction. Dextromethorphan would be interesting to try too if I weren't on an MAOI.
I cannot recall the dose of memantine (10mgs twice day or whatever the dose was BID). NAC is in my life extension multivitamin mix and I've used it for years.
Regards,
Jeff
Posted by SLS on December 18, 2008, at 6:37:51
In reply to TRD --SLS, CPTAmerica, posted by desolationrower on December 17, 2008, at 23:01:12
> Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason?
Not really. I just remember that, during the first few days of modafinil treatment (added to imipramine and Lamictal), I felt some pretty good stuff, and just wondered if it might not be a great augmenter of an MAOI. Unfortunately, toward the end of the first week, I deteriorated; an increase in the severity of my depression that lasted for weeks after the discontinuation of modafinil. Was there a glutamatergic antagonism by modafinil of Lamictal that caused this? I can't be sure.
If one really thought they could hand-pick drugs based on their properties, I guess there would be no concrete rationale that I am aware for why there might be a synergistic effect between the two drugs. I am still not convinced that modafinil is fully understood, and that dopamine reuptake inhibition explains its wake-promoting effect. If anything, it might help with vigilance. Wake promotion seems to be the result of orexin (hypocretin) interactions in the hypothalamus and reticular formation. One wouldn't necessarily think of this as being important in the etiology of depression. I have yet to read about just where and how dopaminergic flow is enhanced by modafinil.
- Scott
Posted by desolationrower on December 18, 2008, at 12:01:10
In reply to Re: TRD --SLS, CPTAmerica » desolationrower, posted by SLS on December 18, 2008, at 6:37:51
> > Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason?
>
> Not really. I just remember that, during the first few days of modafinil treatment (added to imipramine and Lamictal), I felt some pretty good stuff, and just wondered if it might not be a great augmenter of an MAOI. Unfortunately, toward the end of the first week, I deteriorated; an increase in the severity of my depression that lasted for weeks after the discontinuation of modafinil. Was there a glutamatergic antagonism by modafinil of Lamictal that caused this? I can't be sure.
>
> If one really thought they could hand-pick drugs based on their properties, I guess there would be no concrete rationale that I am aware for why there might be a synergistic effect between the two drugs. I am still not convinced that modafinil is fully understood, and that dopamine reuptake inhibition explains its wake-promoting effect. If anything, it might help with vigilance. Wake promotion seems to be the result of orexin (hypocretin) interactions in the hypothalamus and reticular formation. One wouldn't necessarily think of this as being important in the etiology of depression. I have yet to read about just where and how dopaminergic flow is enhanced by modafinil.
>
>
> - ScottYeah, it seems to be one of the least understood meds. I think it also increase 5ht efflux in pfc, so that would make it one of the few meds with 5htergic properties that can be taken with an MAoi, although i guess a number have similar downstream effects. Also interesting the 'hibernation' theory of depression vs. antiD effects of sleep deprivation, hypocretin activation.
-d/r
Posted by desolationrower on December 18, 2008, at 12:26:42
In reply to Re: TRD --SLS, CPTAmerica, posted by CaptainAmerica1967 on December 18, 2008, at 4:06:01
> Thanks for your feedback.
>
> I haven't tried buprenorphine, but have been interested in it as I'm interested in almost anything that could bring about a better life. I'm not sure about the drug interaction with Parnate and would have to do some more research on it. I have a gut feeling my depression could be related to some sort of malfuncition with the hypothalamus-pituitary-adrenal axis (hot flashes or feeling warm all the time)-cortisol, endorphins, neurotransmitters. Obviously exercise affects mood as a result from many different physiological mechanisms, but it's only the intense physical exercise that produces the slight euphoria and antidepressant effect I feel which could be attributed to endorphins hence buprenorphine or naltrexone might help. Also, my father got "hooked" on heroin the first time he tried it in 1972 and died from an accidental overdose (sad to know that the following day he was suppose to go in for treatment, but never made it) so this could point to my depression as having some type of opioid dysfunction. Dextromethorphan would be interesting to try too if I weren't on an MAOI.Hm, given the relationship of opiods and your family tradegies i can see it being a complicated subject for you.
One more idea i thought of last night, stimulant-type drugs seem to help, have you ever gotten ahold of an H3 antagonist? Betahistine is the only one i think that is easily availible, its also a H1 agonist i think. Its used for some sort of ear dysfunction i think, but H3 antagonists are being tested for ADHD. Given its rather broad effects (h3 antongoism on heteroreceptors disinhibits a number of neurotransmitters) slow titration since you're on an MAOI would probably be wise although no reactions have been reported. Additionally, betahistine may be metabolised by MAO so much lower doses might be needed. -> THE METABOLISM OF BETAHISTINE IN THE RAT
L. A. STERNSON 1, A. J. TOBIA 1, G. M. WALSH 1, and A. W. STERNSON 1
ABSTRACT
The metabolism of betahistine, 2-(2-methylaminoethyl)pyridine, a bio-isostere of histamine, was studied in the rat. 2-Pyridylacetic acid, which had been previously isolated as a metabolite of betahistine from dog and rabbit urine, was isolated from rat urine as well as from rat liver homogenates. In addition, trace amounts of the N-demethylated product, 2-(2-aminoethyl)pyridine, was isolated from liver homogenates. In vitro studies revealed that the preponderance of betahistine oxidase activity originated in liver mitochondria and was attributable to monoamine oxidase (MAO). The participation of mitochondrial MAO in metabolism was corroborated by inhibiting betahistine oxidation with specific MAO inhibitors. Additional experiments ruled out the involvement of diamine oxidase in betahistine metabolism. The kinetics for the MAO-catalyzed oxidation of betahistine was studied and revealed that betahistine had a greater affinity for mitochondrial MAO (KM = 3.3 x 10-5 M) than did tyramine, serotonin, or benzylamine.Also, read this patent application for betahistine use-> http://www.wipo.int/pctdb/en/wo.jsp?wo=2007076140&IA=US2006049321&DISPLAY=DESC
Lots of stuff in there, they think it normalises HPA same as MAOIs.
Hm, someone else had the same idea, i found this now: ongoing study -> http://clinicaltrials.gov/ct2/show/NCT00585585Quite promising.
-d/r
Posted by JadeKelly on December 18, 2008, at 18:04:23
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 17, 2008, at 21:11:43
Hi Jeff,
This is too long but IM DESPERATE!! I developed a tr/mdd about 3 years ago after a cluster of family tragedies struck in a very short time. It developed into apathy/numbness/not leaving my room/bed. I can't tolerate most a/d's, especially ssri's. I've been on Parnate for ten weeks and have been at 60mg for 3 days, wieght 125lbs. How high should I go? I got a week long reprieve/high following initial dose of 30mg, then 2-3 days of this when I increase dose. I honestly can't tell how well the A/d effect is because I am SO lethargic. It should be working by now, right? Whats the longest Parnate should take to work? I do think my mood is better. If I wasnt lethargic, I think the rest would fall into place. Was this your experience at all?
Our depresions sound similar, except I have never suffered from anxiety but am starting to as I lose hope with this catch 22 I seem to be in. I, too, get pretty intense high when I do a difficult workout. Don't know if thats everyone, or just some. Haven't done it for a while due to fatigue and fear of BP irregularities. I forgot to mention, BP always on the low side, but even when I can get it up to 120/80, I'm still lethargic. I need ritalin for a while as I'm very familiar with it and I can switch or add nortriptyline when fatigue/lethargy wears off.
Right now the only drug I take is 3mg klonopin, been taking it for years for a nerve injury in my neck. REALLY want to stop taking it and see if I still need it. Have no psychological dependence on it but don't want w/d's to interfere with Parnate benefit. Do you think I should taper off now? Or wait?
It makes sense to me, due to my ignorance in this subject, to copy your regimen (one that I was headed towards! I wanted ritalin or nortriptyline) and that advised to you by one of the leading tr/dep PDoc's, Dr. Gordon I think it is, in New york. I took Ritalin for 12 years for ADD, as diagnosed by only PDoc, and I responded to it beautifully. I don't have an addictive personality at all so I was able to go from original dose of 5mg 3x day to 5mg 5xday during those 12 years. (I often wonder if it wasn't working as a mild A/D also) Pdoc made me d/c with MAOI, will not talk about augment to get me up and moving. But no risk to bedridden 24/7??
My current problem, I have lost faith in my PDoc, he is not at all creative with despensing of meds, and I realize that he doesn't seem to care much that I've became deeply depressed, then onto apathetic and numb, in front of his very eyes. The only reason I'm on an MAOI is that I was following a poster (before I joined), RobertDavid, who was trying the patch. I took that and had the same immediate reaction (great). When I had to go up to 9mg patch it made sense to switch to Parnate.
So, I need Doc to prescribe first choice, low dose Ritalin (5mg 3-5x day), to get me up and moving, then maybe 2nd choice, nortriptyline or amitriptyline, and I noticed a 3rd you take Li??, would you recommend? It sounds like you are not in full remission, in what way: depression, fatigue, apathy, etc?
Finally, and most importantly, how does one go about getting much needed medication from a PDoc who is experienced enough to not be overly conservative, like the one you consulted with ? This is getting to be an emergency for me as I have to go back to work (not to mention the time of year) Do Docs scribe with phone consult? I've only had the one. ANY help appreciated.
Posted by JadeKelly on December 18, 2008, at 18:23:36
In reply to Re: TRD --SLS, CPTAmerica » desolationrower, posted by SLS on December 18, 2008, at 6:37:51
Hi Scott, Hi d/r,
I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
Thanks for any help with this-Jade
Posted by CaptainAmerica1967 on December 18, 2008, at 19:30:21
In reply to Re: TRD --SLS, CPTAmerica » CaptainAmerica1967, posted by desolationrower on December 18, 2008, at 12:26:42
Wow, interesting...learn something new everyday.
I'm familiar with vertigo and Meniere's Disease, but had never heard of Betahistine. I guess it's not available in the USA, but available mainly in the UK and maybe Canada.
I have to read over the information again, but it sounds like a good med to try. Doesn't specify if there's any drug interaction with an MAOI, but I'll search for some more information on it.
Wikipedia states that "The H3 receptor has also been shown to presynaptically inhibit the release of a number of other neurotransmitters (i.e. it acts as an inhibitory heteroreceptor) including, but probably not limited to dopamine, GABA, acetylcholine, noradrenaline, and serotonin" so betahistine as an H3 receptor antagonist would increase these neurotransmitters.
Thanks for the info...interesting to see that a study is being done on betahistine in relation to atypical depression.
Jeff
Posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by JadeKelly on December 18, 2008, at 18:04:23
Hi,
Sorry to hear you'r not feeling better.
I think dosage is an individual thing. The PI states the normal dose of Parnate is from 20mg-80mg, but I know it can be dosed higher. Dr. Ivan Goldberg, a psychiatrist in the New York City area says that's just an average range and one could go higher. He see severe TRD and has good luck giving an; MAOI+TCA(orpsychostimulant)+Lithium.
If you current psychiatrist isn't willing to work with you (show him some evidence that other psychiatrists use the above combination), fire him and find someone new. If all else fails, order via a mail order pharmacy not requiring a doctor's RX.
A night of sleep deprivation can boost me out of the fatigue and excessive sleepiness I experiencemuch of the time.
Posted by Phillipa on December 18, 2008, at 21:09:30
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
Captain have heard his name come up frequently how would someone contact him? Thanks isn't there a site with send e-mail? Phillipa
Posted by desolationrower on December 18, 2008, at 21:14:30
In reply to TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by JadeKelly on December 18, 2008, at 18:23:36
> Hi Scott, Hi d/r,
>
> I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
>
> Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
>
> Thanks for any help with this-JadeWell, mine said i haven't tried enough things yet for a drastic treatemtn like tca+maoi or stim+maoi.
You just havent earned it yet, baby
You just havent earned it, son
You just havent earned it yet, baby
You must suffer and cry for a longer time
You just havent earned it yet, babyAnyway, if you had read the post i wrote specifically for you in the SAMe thread, i had a suggestion for your fatigue. But you love chatting so i'll tell you again. Go buy some creatine, i think it might help with MAOI induced fatigue independent of hypotension. Also, acetyl l carnitine might help, although i don't think MAOIs create a unique need for it so it'll have hte same effect as if you weren't on one. But it helps some fatigue conditions.
-d/r
Posted by CaptainAmerica1967 on December 18, 2008, at 21:28:01
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by Phillipa on December 18, 2008, at 21:09:30
Do you mean Ivan Goldberg, M.D.?
Posted by CaptainAmerica1967 on December 18, 2008, at 21:31:44
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by JadeKelly on December 18, 2008, at 18:04:23
You might also try cold showers. Takes a little bit of getting used to but it's stimulating (enhances endorphins and norepinephrine) and helps with fatigue.
Posted by JadeKelly on December 18, 2008, at 21:41:19
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
Posted by JadeKelly on December 18, 2008, at 21:47:02
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » JadeKelly, posted by desolationrower on December 18, 2008, at 21:14:30
Posted by CaptainAmerica1967 on December 18, 2008, at 22:10:55
In reply to TRD/PARNATE LETHARGY Thanks d/r, Jade (nm) » desolationrower, posted by JadeKelly on December 18, 2008, at 21:47:02
From PubMed Adpated cold shower for treatment of depression
Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of "thermal exercise" may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people. To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 degrees C, 2-3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months. The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.
PMID: 17993252 [PubMed - indexed for MEDLINE]
Posted by SLS on December 18, 2008, at 23:50:46
In reply to TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by JadeKelly on December 18, 2008, at 18:23:36
> I'm at 10 weeks of Parnate, 3 days at 60mg.
Try to stick with it. Caffeine helps. Eventually, this side effect will pass. I used caffeine pills just like any other drug. Use as little as will produce the desired effect so as not to grow tolerant of stimulation. 100-200mg taken in late morning is all I usually need to get a kick that lasts the whole day.
See if Robert Post, MD still has a private practice in Chevy Chase. Also, I would highly recommend Kay Redfield Jameson, MD, PhD. at Johns Hopkins University. Even if these people are unable to take you on as a patient, I am sure they will direct you to ones that will. Impress upon them your desire to combine Parnate with nortriptyline or desipramine. That should be the "litmus test" for finding a doctor.
- Scott
Posted by JadeKelly on December 19, 2008, at 21:49:14
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » JadeKelly, posted by desolationrower on December 18, 2008, at 21:14:30
> > Hi Scott, Hi d/r,
> >
> > I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
> >
> > Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
> >
> > Thanks for any help with this-Jade
>
> Well, mine said i haven't tried enough things yet for a drastic treatemtn like tca+maoi or stim+maoi.
>
> You just havent earned it yet, baby
> You just havent earned it, son
> You just havent earned it yet, baby
> You must suffer and cry for a longer time
> You just havent earned it yet, baby
>
> Anyway, if you had read the post i wrote specifically for you in the SAMe thread, i had a suggestion for your fatigue. But you love chatting so i'll tell you again. Go buy some creatine, i think it might help with MAOI induced fatigue independent of hypotension. Also, acetyl l carnitine might help, although i don't think MAOIs create a unique need for it so it'll have hte same effect as if you weren't on one. But it helps some fatigue conditions.
>
> -d/rI've suffered plenty thank you and I've earned some normalcy as well IMHO. I'm not cognitively functioning as it is d/r, how am I supposed to find a post "specifically for me" if you don't put my name on it? Please stay out of that "box" under the sink. I know you like to play under there (oops, sorry, chatting again). Well, geuss what I got in one day? 120 5mg Ritalin. I'll give you a moment to be jealous........OK, took one didn't feel it at all???? Why?? Also, I've probably asked this a hundred times but if Parnate is going to work for me, how much longer for significant improvement?? Isn't 10 weeks long enough for ANYONE???? I hate to even ask this, but when do ya call it a day? When is Parnate screaming I WILL NEVER HELP YOU!!!
Thanks, I'll keep ya posted on the ritalin.
~Jade-day 4 on 60mg Parnate/over 10 wks...ugghh
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