Posted by TH on May 15, 2019, at 3:40:28
Last month I wrote a post asking for opinions on how to deal with Tranylcypromine Tachyphylaxis. At the time I was taking a dose of 30mg and had been for ~5 months. Having suddenly dropped back into a depressed state, I was concerned that the medication had permanently lost effectiveness.
I arranged to see my doctor to increase the dose to 40mg daily, however even before I could attend the appointment, my mood began to improve again. Nevertheless, I followed through with the new dose of 40mg, and have been at this dose now for 3 weeks.
While it is still too soon for me to say that the new dose has taken full effect, ever since that first dip in mood I have found myself trapped in a cycle of oscillating moods. These fluctuations seem to have a period of 3 - 7 days.
The low periods are marked by tiredness, apathy, boredom, return of food cravings, and (to a lesser degree) the agitation that I felt before I started tranylcypromine.
The high(er) periods seem to be a return to a more peaceful state. If that initial 5 month honeymoon period could be described as 80% recovery, these higher periods feel maybe 60%. Compared to the initial effect, I feel less driven to complete tasks, and take less pleasure in doing them. It is as if the symptoms are beginning to remit and I am feeling "okayish", but before this happens it seems to drop away again.Possible scenarios I can imagine that *might* cause this sort of thing include:
- a latent bipolar disorder
- an initial placebo effect having worn off
- the improvement having come from tranylcypromine's dopamine releasing properties, and having developed a level of tolerance
- some sort of self-perpetuating cycle to do with tranylcypromine being metabolised by MAO
Against the possible bipolar scenario:
I would not have described the "higher" point of the cycle as a hypomania. It does not meat the diagnostic criteria, and is really more of a "lessening of negative symptoms" than a swing into the positive. The periods also seem to be suspiciously short for a bonafide bipolar disorder. In addition to this, there is no history of bipolar in my family.Nonetheless, it warrants consideration. The only mention of this "fluctuating effect" has been in the following pamphlet:
http://cdn.neiglobal.com/content/pg/live/tranylcypromine.pdf
>Some patients may experience apparent
lack of consistent efficacy due to activation
of latent or underlying bipolar disorder, and
require antidepressant discontinuation and
a switch to a mood stabilizerAnother curious detail is that the periods of low mood are accompanied by a total disappearance of side effects, and the higher mood periods begin a day or two after the side effects resume.
It is worth noting that while I did have mood-swings before tranylcypromine, they have never resembled this before, in dichotomous nature, or in time scale. It *is* possible that this type of mood fluctuation has been happening for some time, but on such a large time scale that it has gone unnoticed (> 6 months).
I have done my best to keep any external circumstances constant over this period. Sleep schedule has remained constant, doses taken at the same time, on an empty stomach.
I'd greatly appreciate any opinions on the situation. In any case, I don't intend to take any action to try correct this situation for, at minimum, several more weeks, to give the new dose a fair chance to stabilise.
poster:TH
thread:1104415
URL: http://www.dr-bob.org/babble/20190513/msgs/1104415.html