Posted by Adam on May 23, 2000, at 19:19:10
In reply to Re: ECT, bob, posted by Elizabeth on May 22, 2000, at 3:29:44
> > I suppose it could even be that nearly a year of intense,
> > sometimes mind-numbing depression terminating in a period of quivering
> > frenzy did its own damage.
>
> Don't scoff so readily at this possibility! I've wondered about that myself.Actually, I was kind of serious about that. Cortisol, etc. Not a pleasant
thought.I think it's wrong to jump to too many conclusions about ECT, as tempting as
it is. However, I used to be rather convinced that nefazodone may have had
something to do with some of that "mind numbing frenzy", which, no matter how
bad my depression or obsessions got, was something quite beyond my experience.
The idea was repeatedly discounted by all my doctors.But I read, and read, and found some references, to mCPP, a major metabolite
of nefazodone. I first came across that chemical in my reading about OCD
and the serotonin receptors implicated in that disease, and mCPP is used quite
a lot to probe receptor binding, relieve OCD-like symptoms with chronic use
(at least, in animals), and acutely as an anxiogenic. The connnection to
nefazodone I stumbled on quite by accident.As it turns out, in some instances, prescribing nefazodone can be problematic
for some patients, because it can precipitate intense anxiety, as well as some
other distressing, almost hallucinogenic symptoms. Primarily this occurs when
those either genetically deficient in CYP450-2D6, or those who have recently or
are being prescribed a drug that inhibits 2D6, also take nefazodone, since 2D6
is the primary metabolizer of mCPP.As it turns out, I was also being prescribed clozapine, which is well known to
have a host of potential drug interactions, including and especially those drugs
which interact with 2D6. This may have been a particularly ill-concieved combo.,
since clozapine has never been convincingly shown to have any special benefits
for OCD sufferers (the reason I was told to take it). Meanwhile risperidone, which
has far lower potential for drug interactions, had been shown to be helpful for
some OCD patients at low doses, with statistical significance, in open-label
trials as early as 1995. What I describe above took place in late 1998, early
1999.
Anyway, I was at first suspicious, came to doubt myself after professional
reassurances, and now not only suspect nefazodone again, I have some real evidence
supporting that suspicion, with other cases of adverse reactions to such a combo.
documented, and a sound mechanistic explanation.My confidence has been shaken again and again by professional reassurances. I do
appreciate the fact that while the potential mCPP connection is well-documented,
any such claims about ECT and permanent damage are far less so. But when I have
doubts or suspicions, it's not so easy to brush them off as it used to be. I was
once dold Zoloft wasn't causing my weight gain, but when I took it I gained 30
pounds, and when I stopped taking it, I lost weight. What should one think under
such circumstances? I could only advise others to read. A lot.
poster:Adam
thread:33082
URL: http://www.dr-bob.org/babble/20000517/msgs/34448.html