Posted by Triss on January 5, 2002, at 4:38:44
First of all, let me make it clear that I am fully
aware of the dire risk of producing serotonin syndrome
(which, of course, can turn fatal) by combining an SSRI
with an MAO inhibitor (and thus why professional
references strenuously forbid against attempting such
a cocktail).Now, my situation... I'm attempting to transition away
from an SSRI (fluvoxamine) to an MAOI (phenelzine).
However, the last time I attempted this (following my
doc's conservative -we must go it very slow- directions) during the lag time
between transitioning from the old drug to the new drug,
I had a devastatingly rapid relapse which sent me to hospital, where
I required ECT treatments just to get me partially out of what to
me was the most hopessly desolate and urgently horrible bout of
depression I have ever fallen into in so short a time.
I had tried to discontinue fluvoxamine many times before,
only to quickly return to it when depressive symptoms started
to become too much for me to be able to handle while waiting for
the extended process (i.e. for old drug to eventually leave my system
-plus a few days medication free for even more safety-
and then (to ward against nasty surprises) begin the
MAOI at subclinical dosages and then in the weeks ahead
gradually work dosages up ever so slowly until (someday)
reaching the usual effective starting dose.Therefore, (and this is where my upcoming query stems from),
I am without my doc's knowledge currently in the process
of transitioning from fluvoxamine to phenelzine by my own
desperate method of choice, by overlapping the dosage-with
drawal process of the former with the commencement and
dosage-build up process of the latter. So far I've
reduced the fluvoxamine dosage from it's previous
200mg/d to 112.5mg/d; and I've managed to (slowly;
by increments of 7.5mg/d) increase the phenelzine up
to 30mg/d. (Usual effective starting dose for phenelzine
is 45mg/d.)
So far, I've experienced no signs or hints (both subjective
and objective) suggestive of any degree of serotonin syndrome.
However, considering that my knowledge and medical skills
in this enterprize are not in any way sophisticated, I
realize I have only been very lucky, so far. But my
aim still exists to keep increasing the phenelzine,
whilst decreasing the fluvoxamine, in tandem, trying
to maintain "complementary homeostasis", as it were,
(i.e. decreasing fluvoxamine while taking enough phenelzine
to prevent a serotonergic-withdrawal syndrome and/or
depressive relapse), until I can comfortably stop the
fluvoxamine altogether and be stable on the phenelzine instead.Now, I guess my query is then for any information (preferable
from a professional with experience specific to this)
which can be offered me to help me complete this
SSRI to MAOI transition -whilst overlapping the two- as
safely and successfully as possible; an attempt to change
antidepressants _without_ having to experience a painfully
dangerous relapse while escaping the odds of development
of a life threatening serotonin syndrome. Thank you,Triss
poster:Triss
thread:88818
URL: http://www.dr-bob.org/babble/20020103/msgs/88818.html