Posted by tom2228 on March 31, 2014, at 14:46:23
In reply to Re: Options for ADD while on Nardil » tom2228, posted by SLS on March 31, 2014, at 0:22:42
> Hi Tom.
>
> Thanks for all of your input. Desoxyn sounds interesting. I might discontinue taking Parnate in order to try Brintellix (vortioxetine). I could add it then. I would feel more comfortable adding Desoxyn while not taking a MAOI. I am quite amazed that you were able to combine these drugs without suffering serotonin syndrome.
>
You are brave! I am currently on a washout from Marplan and starting nortriptyline tonight as my new pdoc didn't have the guts to combine to two (as well as halving Mirapex). The Abilify feels stronger (in a bad way) and the Desoxyn seems not to work as well, even a slightly higher dose. I think there is something about the mechanism of Desoxyn that becomes altered as dose increases that puts me on the other side of the inverted-U curve if the dose is too high. The MAOI seems to allow for a smaller yet a more efficacious mechanistic action to be potentiated.I believe that SS is a dose-dependent response. Remember unmethylated amphetamines also are serotonergic, too; Desoxyn is just "more" serotonergic. Likewise nortriptyline, although not as significantly as say clomipramine, has SRI properties -- I would reckon that an overdose of nortriptyline would cause SS in a patient on an MAOI. That being said I perhaps had mild symptoms of SS only when using high doses of mAMP (>500-2000mg) over days with 40mg Marplan. None at therapeutic doses; my total daily dose is 17.5mg.
If you try Brintellix, I would wait to try Desoxyn until you have a clear assessment of what Brintellix can do for you on its own. Aside from the 2-week washout, it takes a while for the effects of Parnate at the receptor level to reset, and similarly long for the Brintellix to show its true colors even if it may show efficacy earlier than other ADs.And If you do d/c Parnate, pay close attention to your judgement during the washout. I too am on many psych meds -- 7. Have you considered that although each additional medication provides greater control in specific symptom areas, being on so much medication may perhaps be adverse to your depressive condition? While I still would prefer to add nortrip rather than go off Marplan, taking MAOIs with other stimulating meds (stims, TCAs) is a heavy combination that I'm only realizing now that I am washing out. I still struggle with depression but my brain feels exhausted and partly relieved of a burden of some sorts. While considering possible withdrawal effects I am trying to listen to my heart, knowledge of psychiatry, and my symptoms to consider that I may be improving or worsening, or both, depending on the light in which I look at my condition.
I say this because, while I acknowledge that depression is the "natural" state for many with TRD, perhaps getting back to a more "natural" ebb and flow of life can help the spirit and depression from a humanist perspective. I am trying to determine whether I have assumed depression to be be my natural state, or whether this thinking as I wash out is a return to the complacency with my symptoms that I have nearly drowned over the years and which warrants further aggressive treatment. Unless the worst of discontinuing the MAOI is soon to hit me (only been 1 week).. I may be able to continue somewhat okay without even starting nortriptyline.. but it all comes down to quality of life.
> > Scott have you tried Deplin or pramipexole/ ropinirole?
>
> I tried Deplin while taking Nardil and nortriptyline. It was mildly effective at first, but it pretty much pooped-out within a month. The only DA agonist I tried was bromocriptine in combination with Parnate and desipramine. I felt somewhat better for about 3 days. Right now, I am pushing my dosage of prazosin from 25 mg/day to 30 mg/day. One can go as high as 40 mg/day, but I may have to lobby my doctor to allow me to do this.
>
>
> - Scott
What was your dose of Deplin?
I have heard often, including from the manufacturer's data, that Deplin can take up to 2 months for the proper effect.Bromocriptine is supposedly a very dirty-feeling DA agonist. How long did you give it a chance? Supposedly DA agonists may behave somewhat like an antipsychotic in that the presynaptic receptors do not downregulate fully until at least 2 weeks.
I am also curious about how high a dose you started at. That and I have noticed a substantial difference in effect from 0.375mg ER of pramipexole and 0.75mg; the higher dose is actually too intense for me. Thus I would caution against starting at the average effective dose and to "start low, go slow" in any case. I am discontinuing Mirapex, but I stayed at 0.375 for about 2 months before I went up. Otherwise I am sure I would have found the med completely intolerable if I started higher and may have missed the AD effect that I became familiar with at the lower dose before the sides took over.
poster:tom2228
thread:1063351
URL: http://www.dr-bob.org/babble/20140328/msgs/1063480.html