Posted by Amelia_in_StPaul on April 12, 2009, at 11:54:09
In reply to Re: Meds aren't working; doc is frustrating » Amelia_in_StPaul, posted by bleauberry on April 12, 2009, at 8:44:00
bleauberry, thank you. I'm at my wit's end, truly, and welcome all thoughts. I appreciate the time you took to think this one through. Since my doctor is so stubborn about staying on this regiment, I think I will ask to have the brand Prozac and not the generic. I remember that I was first on Prozac when there was no generic, and it felt differently than it did subsequently.
May I ask what the Abilify would be for? I think to activate the Prozac, right? I think though that both Abilify and Prozac use the cytochrome P540 2D6, as does Trazodone, a little. So would that be too hard on my body? Side effects too harsh?
Do people tend not to be sleepy on Nardil and Parnate?
And one final question: do you know anything about bipolar II. I'm starting to question whether that's the problem. Usually my mood swings are tied to my sleeping and fatigue (too much fatigue = depression; waking up = happiness) but I do match some of the "soft bipolar" signs. On the other hand, I do truly have BPD (emptiness; fear of abandonment), and according to some, that rules out bipolar II.
Thanks in advance for any additional thoughts. And thanks so much for your thoughtfulness about my situation.
> This is a tough situation, but sadly, a common one. There is however always strong hope and plenty of options. These options immediately came to mind:
>
> 1. Switch to brand Prozac. I assume you are probably on generic. This is no joke. There is often a huge difference between the two, even though they are supposedly the same (long story, take my word for it). My doctor sees such a big difference between brand Lilly Prozac and generics that he never prescribes the generic version any more. We've seen this phenomenon here at pbabble for years by countless people with a number of different meds. It doesn't mean that all generics are bad or that generics won't work, because they work just fine for some people. It means that there is enough of a difference with enough people that it has to be considered as an easy and potentially effective strategy to do before adding another med or switching meds.
>
> 2. Add Abilify to the prozac, beginning at 1mg per day. Go slow. Common final doses in clinical trials range from 2.5mg to 15mg, though some people take 20mg to 30mg. Since you are so sensitive, as am I, start very low, go very slow, and find your magic window in an unhurried manner.
>
> 3. This would be hard since it would involve weaning off Prozac and being without any meds for an entire month. But, after that month, start either Parnate or Nardil. Since they were invented 50 years ago, there are still none that beat their performance when so many other meds have already been tried. Other doctors who commonly use Nardil or Parnate (those doctors are few) would have already had you on one of them by now. You've had enough failures and trials to justify it. Though they have a reputation of more side effects and dangerous food interactions, many people find the side effects easier than SSRIs, and the food interactions are dramatically overblown. In recent years studies have been done to re-evaluate the foods-to-avoid list and it is actually quite a short list, mostly things you probably never even eat anyway. When the reuptake inhibition drugs produce problems or limited results, the MAOIs (Nardil, Parnate) often prove to be powerful weapons in the psychiatric arsenal. For any doctor hesitant to try one, just remind them they were part of the large STAR*D study, and that you are enough far along in the treatment protocol to have arrived at the place where the MAOIs are tried.
poster:Amelia_in_StPaul
thread:890010
URL: http://www.dr-bob.org/babble/20090408/msgs/890118.html