Posted by sfy on November 8, 2004, at 17:49:41
In reply to Re: What To Do Now? (anhedonia/dysthymia) » SFY, posted by King Vultan on November 5, 2004, at 13:03:21
> For insomnia, it's hard to go wrong at least trying Ambien if it's affordable on your insurance (it really isn't on my mine). There are a number of other possibilities, but I think they generally have more drawbacks and side effects than does Ambien, which many doctors will let you use every night. Risperdal at a very low dosage might not be such a bad alternative, though, as it is so selective for the 5-HT2A receptors that there may be very little blockade of the dopamine D2 receptor. I feel that blockading that particular dopamine receptor is not a great thing to be doing for someone with anhedonia.
I tried Ambien a few years ago for my endogenous (i.e., non-drug related) insomnia and it had absolutely no effect. When I took Prozac years ago, a nightly dose of trazodone helped me sleep. But the one thing that has consistently worked for my endogenous, early-awakening insomnia is a small (7.5 mg) dose of mirtazapine. Even a sleep doc recommended it after they could find no organic cause for my insomnia (it's most likely related to my constant low-level depression). Unfortunately, as far as I know, mirtazapine is contraindicated when taking MAOI's (and I don't think I want to experiment). On selegiline, I took diphenhydramine (Benadryl) but that's proved only partly effective.
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> I don't know if the super-doc you talked to had any thoughts on your paradoxical reaction to selegiline, but reactions opposite to what generally happens suggests to me that you may have hypersensitive autoreceptors in one of your major neurotransmitter systems. That is, you may have too many inhibitory receptors, which react to the release of the neurotransmitter by inappropriately slowing or shutting down the firing rate of the neuron. Selegiline is extremely dopaminergic, and your paradoxical reaction suggests a possible problem in your dopamine system, as does your anhedonia and lack of motivation.I saw the super-doc months ago before trying selegiline (been putting off the Parnate decision for awhile) so I don't know what he would think about my reaction to it (and I'm not paying $$$ again to find out). I'll ask my regular pdoc if he has any thoughts about but I'm not sure how well-versed he is on the subject. (Though he was more than happy to let me try selegiline just on my say-so.)
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> Parnate is also dopaminergic, but less so than selegiline. If you are able to work up to a high enough dosage, which might be anywhere between 40-80 mg/day for solid therapeutic effects, I think you might find it be a very effective drug, and one that I would hope and think would induce less sexual effects than the selegiline. If you try it, I would give it time to work also. In my case, it induced periods of outright depression after some of my dosage increases, but these subsided after several days to a week. The insomnia I've suffered on it remains by far my biggest problem, but I will eventually find a med or a combo of meds that are affordable and work.
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> ToddI'm still struggling with the Parnate decision (esp. now that my mood seems to have brightened somewhat since I stopped the selegiline but that could just be cyclical). I was trying to see if there was one last non-MAOI option to try before taking the Parnate plunge. Or at least hoping the Emsam patch might be an option by now (though consideration my reaction to selegiline I'm not sure how worthwhile that would be).
poster:sfy
thread:411757
URL: http://www.dr-bob.org/babble/20041108/msgs/413434.html