![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by bulldog2 on August 10, 2009, at 11:10:37
I know you have been having a hard time lately so maybe this may be of some help. I also read that another p-doc is using higher maoi doses than what is normally recommended.
Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: MAOIs in high doses and with stimulantsThere are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.
Posted by CaptainAmerica1967 on August 11, 2009, at 17:02:55
In reply to To Scott - Things Ivan Goldberg Has Tried, posted by bulldog2 on August 10, 2009, at 11:10:37
Consulted with Dr. Goldberg via email for TRD then read and posted study supporting High Dose Parnate for severe and TRD by Jay Amersterdam, MD (PSYCHIATRIC ANNALS 36:9 | SEPTEMBER 2006, http://www.psychiatricannalsonline.com/showPdf.asp?rID=20772; never felt better in my life on Parnate @ 110mgs by my FP after showing study (forget about all the poly pharm as they made me feel worse, ex, adding Lithium, and Nortrip. Add exercise as Parnate motivates you to exercise), but now am getting some alopecia (hair loss) and had to reduce Parnate dosage. I've had severe and TRD since the age of 15y/o and currently 42y/o with every med tried (unfortunately not high enough dose of MAOIs in past as even psychiatrists are inexperienced or know about high dose MAOIs) including 70 plus ECTS wihtout relief. Parnate High dose is the best in my opinion. Forced sleep deprivation is also good as mao neurons don't get to rest like they would in normal sleep and puts them on overdrive hence more mao. Cold showers to sitmulate endorphins and norepinephrine is also good. Strong feeling that Brain Stimulation Implant-Broadmanns area (Dr. Helen Nyberg) would cure most with depression. I even take 5mgs of selegiline which augments Parnate and helps with libido and sex drive.
Just starting taking Boswella (herb) for joints as I've lifted heavy weights for years and possibly feeling an antidepressant effect from it. Article on frankicense or Boswellia in ScienceDaily here..works different mechanism than monamines; http://www.sciencedaily.com/releases/2008/05/080520110415.htm
Posted by zatar on August 17, 2009, at 10:40:40
In reply to To Scott - Things Ivan Goldberg Has Tried, posted by bulldog2 on August 10, 2009, at 11:10:37
The thing that comes to mind is that most drug studies didn't, and still don't, take into account the differences in drug metabolism of patients. Slow metabolizers and fast metabolizers, not to mention the effect that other medications have, are all lumped together. Then there's the differences in receptor sensitivity.
I used low dose doxepin (10mg) for sleep for years and it worked like a charm, yet a blood level at that dose was "zero". Lately, the same 10mg didn't keep me asleep, so I raised the dose to 40mg to get the same effect. Admittedly these are low doses and most docs wouldn't even think twice about it, but my point is that some may need MORE than typical doses to see an effect, while some may need LESS.
-zatar
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.