Posted by Vincent_QC on January 20, 2009, at 8:46:41
In reply to My MAOI stack, posted by Medline on January 16, 2009, at 2:03:13
> I suffer from therapy-resistant Social Phobia and chronic atypical depression with anhedonia + alcohol dependence. My treatments included most SSRIs/SNRIs/2 TCAs, Bupropion, Moclobemide... none really worked. I started Parnate today (10mg). I plan to increase the dosage over the next weeks to 30-40mg. I will add 2mg Clonezepam bid for 4 weeks, 1 week break and then again 4 weeks Klonopin to avoid physical addiction. I take 25mg Baclofen tid for it's alcohol anti-craving and light anxiolytic effects. 50-100mg Naltrexone as needed. I think about carefully adding low dose Reboxetine (a NARI) so that the Norepinephrine Transporter is blocked and tyramine can not or to a lesser degree act on the cardiovascular system (cheese effect).
>
> My emergency meds are 10mg Nifedipine, 4mg Cyproheptadine and 2mg Clonazepam.
>
> What do you think?
Hi ;-)
I think the people on this board are very busy with the Obama inauguration...So don't hope for a fast answer ;-) lolWell...you're the second person I see on this board with a SIMILAR problem then mine...resistant social phobia as a primary problem with comorbidities is quite rare here...
I also suffer from social phobia + atypical depression with anhedonia (no energy, no motivation, no interrest) + past alcohol abuse problem and drugs addiction as well and as a dependence to benzodiazepine that I still use a lot today...(20mg/day of Valium...) but i'm free of the alcohol since june 2006 and I never toutch a "street" drug since 2005...Anyway I always have panic attacks on them, the same apply with alcohol, I do a major panic attack the last time I drink too much and after I was not able to tolerate the alcohol and I had several smaller panic attacks...So I just stop drinking, since I was not able to find the initial pleasure I had without the "freaking" part of the panic attack and the sense of depersonalisation...
I never had any improve with therapies...I'm doing another therapy for anxious troubles right now...I have to work on my anxiety level in anxious situations...I have to do a lot of exposure time and things like that...and I know that trying to change thoughts and mental speechs after 32 years is very hard...anyway I never improve a lot on therapy...and I never improve on all the newer drugs like all the SSRI'S and the SNRI'S, including the Wellbutrin-XR and the unfamous Ritalin who never give me any energy at all...coffee is more helping than the Ritalin ...anyway... and even with the Nardil at 90mg/day (another MAOI)... I try mostly all the others drugs used in an "off-label"...Topamax, Gabapentin, Lyrica, name them...
The only one thing who work for me was the Rivotril but it work only 1 month...afetr I had to double the dosage, to end up at 8mg/day with a high dependancy problem on the benzo drugs...I'm lucky that I founded the energy and the power inside me to be able to decrease my benzo intake to a little 20mg/day of Valium...The Valium don'T have any effect on my social anxiety and my general anxiety but I need it because if I don't take it my brains goes just crazy...I feel weird inside my head...like someone tighten my brain with his two hands and I fear a lot seizures if I stop it cold turkey...and trust me, I try often to stop it...but I don'T know why...it's so hard...I stop a lot of more potent "street" drugs, I stop them cold turkey and I never had any problem at all...Maybe it's because I read too much things about the dangers of withdraw benzo drugs...
For what I read about you're problems and the drugs you take now, I think you are in the good track...I had a bad experience with the Parnate but I have an appointment with my PDoc today, I will see what is my next option.
You are in the States no? Because here in the Canada, we don't have the Naltrexone and we don't have also the Reboxetine....
For you're emergency meds...that's perfect...Nifedipine help with the rare but happening hypertensives crisis ( I had a couple of them without food interraction) and the Nifedipine help to decrease the blood pressure, just be carefull and try to monitor your BP when you take the Nifedipine (in case your BP goes too low)... I don't know the Cyproheptadine, I guess we don't have this in the Canada...and for the Clonazepam (Rivotril), if you can avoid it, that's a good thing...the less you will take, and the less you will became addicted on it...Maybe ask for Valium (Diazepam) instead of the Rivotril...it is less incisive and cause less addiction and it stay more longer in the blood stream...It's more sedating than the Clonazepam...but the sedation fade away with time...Also, on the Parnate or on the Nardil...(MAOI's), I always had a natural decrease of my benzo drugs intake...it's a sign that it's helping a lot in the anxiety field...I think...i'm not a doctor or a Pdoc...that just my experience...On most of the new drugs like Effexor-XR, Wellbutrin or even on more old like the Proxac, Zoloft, Paxil or anything else that was new in the 80 and 90"s....I always had an increase of my benzo drugs on them...so I guess they was not helping me at all...
I stop the Parnate 1 week ago, I was on 40mg/day for 1 month...Well 1 week at 10-20mg..increase fast to 30mg and 40mg...return to 30mg day and stop it...and I decrease my Valium intake by half in that month...Since I stop the Parnate, I return to the 20mg/day of Valium...and I have to take more Seroquel at bedtime because I do more insomnia...but at the same time, I had a lot more sedation at daytime on the Parnate, a lot more PHYSICAL fatigue, not just MENTAL like the one I have most of the time...it's suppose to be a stimulant drug but I always feel it was more sedating...(if you don't count the 2 or 3 days of speedy action on the brains when you up the dosage)...
For the Parnate, go slow...that's just my advise...a lot of hypotension orthostatic problem...(on me), it was hard on my blood pressure....more than the Nardil...The Nardil have a more neutral side-effects profile than the Parnate and is more stable in his action I think...I mean that on the Parnate, I had a lot of roller coaster days... At the same time, the parnate and the Nardil, even at a low dose, seem to have a good effect on the anxiety...I was just not able to live with the side-effects on my heart (On the Parnate). With the Nardil, I never had any high blood pressure problems...my BP was always low on it...it's why I stop it, I had too much orthostatic hypotension at 90mg/day...
So that's it...I hope you will find some relief and improve on the Parnate !!!! ;-) I wish you good luck!!!
BTW...you mention Manerix...I never try it but I know my Pdoc will propose it to me today...I have to say no...that's not good for me...It's acting more on the serotonin (Type-A of the MAO...) than the NE or DA (type-B of the MAO). Since all the SSRI decrease my state...I will never take the chance to try it...I don't have more time to loose...
You mention TCA's also...I plan to ask my Pdoc about trying one of them for my social anxiety and depression with the lack of energy and motivation and interrest... You write that it was innefective...I never try them , exception of the Elavil at a low dose for my migraines...and another one...but it was not helping...I need one TCA that will give me a lot of energy...and the one who will not cause gain weight!!! Since my condition always decrease on drugs who acts on the serotonin...maybe one with no effect on the SE but only on the NE will help me a little bit no??? Witch ones you tries??? Can you give me some advise on TCA's...?
Well thanks for your help... ;-)
I know, I don't help you a lot...but all I hope is that the Parnate will be THE good drug for you!!!
Take care!
Vincent ;-)
poster:Vincent_QC
thread:874277
URL: http://www.dr-bob.org/babble/20090104/msgs/875113.html