Posted by Crotale on August 3, 2008, at 18:50:53
In reply to Re: MAOI-TCA combos, posted by SLS on July 30, 2008, at 4:21:15
> I guess what I wrote was misleading. SSRI is still the prefered acronym for Prozac, Zoloft, Luvox, Paxil, Celexa, and Lexapro, even though these drugs have other properties that have not, up until now, figured in to theories of how these drugs work.
True, aside from secondary and tertiary effects related to the SRI thing. One that comes to mind is fluoxetine's active metabolite norfluoxetine (like the TCAs fluoxetine undergoes N-demethylation), which, at steady state, occurs in quite high concentrations and inhibits both 5-HT and NE transporters. Some recent research has suggested that S/NRIs may be more effective than SSRIs, so perhaps fluoxetine is actually more effective than the more "selective" SRIs.
I've become terribly confused about all the new pharmaceutical products lately, to the point where I've given up trying to learn the brand names of most of them. Partly it's this anomia thing from the ECT - I used to be a lot better at remembering drug names, among other things. (BTW do you have any suggestions for how I might deal with that? Unless much worse cognitive effects emerge, I really don't want to quit since it seems to be working so well, but I would like to try to find a way to eliminate or reduce this side effect.) Partly it's all these (pretty gratuitous, IMO, although I guess some of them do have fewer side effects) "new" drugs that are really just enantiomers or other minor variants of existing drugs, so that there are twice as many brand names to remember, but very few actual new medications. It was bad enough when all these drugs with virtually identical mechanisms (although, as you point out, there are differences; not only are there other pharmacodynamic effects besides "SSRI," and whatnot, but pharmacokinetic distinctions can also be important in choosing an AD), but now it feels like the industry has given up on finding new mechanisms and is just trying to make more money by getting "new" drugs approved with minimal effort.
> Partial response for 1 1/2 years. It has been more robust since adding Deplin. I am making slow, but steady gains.
Good for you. I admire your persistence.
> > Well, it's only been 18 for me so far, with a couple of temporary successes.
>
> That might as well be 26 years. The problems with these two numbers is that they are so large. The longer one remains depressed, the worse is the damage to the brain that is produced.Tell me about it. Sometimes I can't believe it's been so long. It's not entirely chronic for me, but the degree to which I recover between episodes is getting less and less over time.
That reminds me of something that's been frustrating me for a long time. Do you have any idea what mental disorder, or neurological impairment, or whatever, might be associated with difficulty driving? It's not exactly that I haven't been able to *learn* to drive, just that I'm bad at it. So bad that I've never been able to get a license. A lot of people (including driving instructors) insist that I'm intelligent and that I therefore ought to be able to get a driver's license, but it really isn't about that. I haven't been able to figure out what it *is* about. (It doesn't seem to be caused by my mood state, although I would guess I drive worse when I'm depressed. I don't think it's anxiety either.)
> > Incidentally: what's the NAC for? Liver issues? I've only ever heard of that being used to prevent hepatotoxicity reactions.
>
> Like acetaminophen poisoning.Precisely. Once someone I knew said, in reference to those opioid-APAP combos (and the fact that they're less controlled than pure opioids): "They add *poison* to it to make it 'safer?'" (He wasn't exactly a fan of the drug war.)
> It also acts as an antioxidant and a reactant in the production of glutathione, which is lower in people with mood disorders. It is a neuroprotectant of brain tissue from a loss of neurons due to the presence of chronic stress. It seems to prevent the acceleration of apoptosis.
That's interesting. I'm afraid I'm rather ignorant when it comes to "food supplements" (NAC is one I'm a bit more familiar with because of its use as a treatment for APAP overdose). I tried to learn about them at one point but so many of them were apparently worthless that it drove me nuts and I eventually gave up. It'd be nice if someone were to publish a book of those that are genuinely useful and discussions of their pharmacology - I'd buy that.
Best wishes and good luck in all your pursuits,
-Crotale
poster:Crotale
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/843965.html