Posted by tom2228 on July 5, 2010, at 23:23:18
In reply to Re: Eh, contraindication not totally structure-related » tom2228, posted by SLS on July 3, 2010, at 13:27:47
> Without more information, it is difficult to judge risk. What is the mechanism by which these changes in neurotransmitter concentrations occur? Is there an increase in neuronal receptor or transporter tone, or is there an increase in afferent input from other structures?
>
> There is that one report from 1993. What will you be basing your decision on?
>
>
> - Scott
> > Without more information, it is difficult to judge risk.
>
> I agree. There are a small number of reports of safe concomitant use of carbamazepine with phenelzine, tranylcypromine and moclobemide in the medical literature. As far as I can see, there are no reports of serious interactions such as serotonin syndrome.
>
> My overall impression is that it's vital to be cautious when adding most other psych meds to MAOIs. Provided that there is a clear clinical justification for prescribing it, I don't think there is any reason to believe that carbamazepine should be contraindicated . Initial doses should obviously be low and careful monitoring should take place. The main problem with the carbamazepine + MAOI combination is probably medico-legal, due to the warning on the package insert. In my opinion, an initial test dose of 50mg carbamazepine would be prudent.
>
> EdScott and Ed, I agree with both of you. I tried my best to search for more information and at least there seems to be no liver enzyme issues between the two.. so nothing pharmacological to worry about. Any pharmacodynamic problems I'd be able to tell (like SS or something).
All I know is that OXC and the active metabolite are serotonin (and DA) releasing agents.. but not sure if that SRA properly involves blocking the 5-HT transporter like MDMA.. which would not be too good. Also I believe the SRA properties are exclusive to the reward center but not sure. Is is possible to get SS from too much 5-HT action in the reward center or does SS result from other brain structures?
A big part of my decision is my doc's confidence. He knows I know a lot about this stuff so he said it's fine as long as I monitor myself, how I'm feeling ya know. His tone and everything gave me the impression that there's nothing to worry about. Also knowing that others have been on the combo with no issues, and that my doses are relatively low.
That's all on paper, ok now to my experience. I haven't noticed anything remotely dangerous. But today I felt the dopamine effect from the 2nd dose of OXC was too strong.. felt like Ritalin which I don't like.
My appointment is actually later today (tuesday) and I'm going to be begging my doc to get back on Vyvanse. Thats if I need to beg lol, I really doubt it, we already touched on it briefly and I really am buggin' out. The stimulating nature of parnate is definitely is not cuttin' it for my ADHD. But the issue is vyvanse also hits the dopamine so I'm afraid that with the trileptal it'll just be too much. And I REALLY need to get back on a stimulant for my sanity so I'm thinking maybe the trileptal just isn't the best idea..
Thinking about depakote or possibly using klonopin as a mood stabilizer, I heard somewhere that it can be. Question about depakote. Being a gaba transaminase inhibitor, is it calming? How does it feel compared to alcohol or benzos? What about cognition, does it f that up?
And what's your take on the klonopin for mood stabilization? It's not so much episode prevention that I need a stabilizer for, it's mostly that naturally my mood through the day is shaky and it feels like something is "not okay" .. mood stabilizers level that out where I'm not thinking about my mood and can simply function. Also stimulants and antidepressants make this unstable mood issue worse// I get overstimulated on stimulants. So I need a stabilizer to benefit from both of those. So might klonopin help?
Thanks for the help guys I could really use it. Finally nearing the end of my meds journey. At this point I understand that I need Vyvanse (my fave stim), a mood stabilizer, and an AD. Just a matter of doses and narrowing down the choices. Maybe a benzo too but too early to tell. But at least I know what's wrong and what needs fixin now!
poster:tom2228
thread:951790
URL: http://www.dr-bob.org/babble/20100628/msgs/953456.html