Posted by jd on February 1, 2000, at 0:38:27
In reply to Re: MAOIs c/ other antidepressants, posted by Cam W. on January 31, 2000, at 22:12:19
Mark,
I can understand your frustration--it seems like some people ONLY respond to an MAOI, and if the response is partial, it's natural to want to augment it in some way.You're also absolutely right that, under proper supervision, certain meds can be mixed with MAOIs--it must be doubly frustrating to have a doctor who refuses to acknowledge this. Especially with TCAs, however, I do believe it's easier and safer to add an MAOI to an existing regimen than the other way around.... Provided you can find a doctor who's willing to actually work with you, you might also want to look into augmentation strategies that are a little less orthodox. (This is also suggested by the fact that most other ADs you've tried haven't helped, though I'm unsure if you've tried mood-stabilizers too.) For example, I've seen one person on this board mention successfully augmenting an MAOI with the beta-blocker pindolol. Going yet farther afield, on the "tips" part of this site, Dr. Lee Dante mentions that he has at least once tried the opioid-blocker naltrexone as an augmentation strategy with Nardil. While he says the results were rather mixed for this particular person, naltrexone seems to have a good track record as an augmentation strategy in refractory, chronic depression, especially when presenting with apahthy and anhedonia. (The best results seem to be as an add-on to SSRIs.) So this is something you might look into as well, though I suppose one might want a little more assurance that naltrexone is safe with MAOIs in the first place.
Good luck to you, whatever your decisions. May you find a doctor who's keeping up with the literature!
best,
jd> > > Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
> >
> > Mark - Thanks for the info. Work closely with your doctor and share your research with him/her. If you are willing (and it sounds like you are) your doctor should be open to trying a polypharm approach. Sorry to hear about your ECT experience. Good luck and keep us posted on your progress, we would all be interested. - Cam W.
> Mark - One more thing, if your doctor still refuses to do the polypharm after you show him the research, ask him why he/she is reluctant and tell him you will sign a waiver absolving him in case of any serious event. If you and your doc work together there should be little chance of a problem. - Cam W.
poster:jd
thread:20219
URL: http://www.dr-bob.org/babble/20000128/msgs/20282.html