Posted by Ame Sans Vie on September 15, 2003, at 12:48:10
In reply to What can they use to augment Nardil?, posted by jerrympls on September 12, 2003, at 23:04:28
Go for the Provigil, I say. That is, if you still find yourself unable to knock some sense into your pdoc's head and get her to allow a trial of a real stimulant. :-)
Really though, it is a good thing she's being prudent about this issue... perhaps she would value the opinions of her fellow psychiatrists more than some facts and figures pulled off the 'net? Just a thought. Ask her if she might consult with her colleagues on the idea. Of course, starting off at a low dose (1.125mg-2.5mg) and keeping nifedipine/chlorpromazine on hand should also ease her mind.
Anyways, if you end up having to try something else, I would suggest trying the Provigil, increasing the dose once or twice a week until benefit is obtained -- it takes three days after initiation of modafinil or raising the dosage for it to reach maximum effect. While Provigil is most often perfectly safe taken with MAOIs, doses starting around 800mg have been shown to cause mild hypertension, so doses exceeding 600mg would probably be risky territory. Perhaps, if you gain a partial response from Provigil, a low-normal dose of Mirapex, Requip, Parlodel, Dostinex, Symmetrel, or even Sinemet-CR as an augmentor would provide additional help with motivational difficulties and anhedonia.
The Parnate idea is a good one also, though I assume you'd rather find a quick fix than switch meds entirely. Was your depression characterized by hypersomnolence, lack of motivation and/or overeating *before* it was treated? If so, then Parnate may have been the better choice for you from the start.
Unless the Effexor has worked for you in the past to some degree, I might be inclined to just scratch that option off the list for now. Even if it were somewhat helpful, the washout period would sure be a b*tch. :-\
On a more personal note, I'm also a musician, and I can completely sympathize with you that the passion just seems conspicuously absent. Just very recently I finally bought a new guitar and began to write again... it's better than sex, lol. Very sickening though... I used to own several $100,000 worth of gear -- custom guitars, basses, amps, drums, synths, recording equipment, live sound equipment, etc, etc, etc. But I pawned every last bit of it in favor of self-medication early last year. Well, not all of it... I still have a worn-out MXR Disortion + stomp box that the pawnbrokers wouldn't take. But I think I got somewhere in the realm of 15 grand for all of it... if only you knew how many beautiful musical accoutrements and apparatus I threw away for a three-month relief from my depression/anxiety. When I think about all the stuff I hocked, I really do get physically ill. I figured at the time that I'd never use them again -- that the passion was gone, I was too jaded, whatever. So now I'm starting over with nothing but a Harmony acoustic I bought from a friend for 40 bucks.
Moral of the story: that sonic bliss *will* come back to you one day, so whatever you do, don't be a complete moron like me and get rid of all your sh*t! lol
poster:Ame Sans Vie
thread:259528
URL: http://www.dr-bob.org/babble/20030912/msgs/260257.html