![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 39. Go back in thread:
Posted by Sarah T. on March 3, 2005, at 20:56:24
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 1, 2005, at 7:58:33
Hi SLS. I certainly know what you mean when you describe experiences with MAOIS and TCA's as a tease. I have had that feeling about several antidepressants along the way. There were a few times when that tease or brief glimmer of hope lasted only a few days or weeks. Right now, I am very discouraged about psychopharmacology and most psychiatrists. There are so few really good, "complete" doctors around. You said that you are bipolar. Do you think you are bipolar? I ask because that seems to be a popular diagnosis these days, and I often wonder whether it is over-used by doctors who simply don't know what the heck is going on. I'm particularly wary of the "soft bipolar" diagnosis. Nearly everyone I know, including my domestic pets, has some seasonal variation in energy and mood, but is that a good reason to medicate? And one of my biggest concerns is that so many people are diagnosed based on symptoms that are side effects of the medications they are taking or from which they are withdrawing, rather than on who they are at baseline. On the other hand, once you've been on psychotropic medications for a while, how do we know what "baseline" is anymore?
You asked which stimulants I'd taken. I've been on several different forms of methylphenidate, Adderall and Dexedrine. The worse rebound was from methylphendiate, followed by Adderall. Dexedrine rebound was more tolerable, but I'm uncertain why. Adderall is supposed to have a smoother decline, but it didn't work that way for me.
When I tapered Klonopin, I did so over many weeks, even though I never took that high a dose. I had the orange tablets, which are 0.5mg, I think. I cut the pills in tinier and tinier amounts over a few months. Each time I lowered the dose, I spent at least a week on it, sometimes more. Because I was cutting the pills, and the pills don't cut that well without crumbling, my method was not very precise. I estimated by size as close as I could, and it seemed to work out. I do think that Klonopin is a good drug. In years past, I had tried other anxiolytics, such as Librium, Valium and Ativan. And, as I mentioned a few days ago, when I had those panic attacks, I took Xanax. Of all the benzos I've taken, I think Klonopin is the best and the "most benign." Unfortunately, benzos don't work well for me as sleep aids. If I take a tiny chip of Klonopin on an anxiety-ridden day, it helps. If I take Klonopin at night, I sleep very poorly, and I feel horrid the following day. I know that, like alcohol, benzodiazapines interfere with some stages of sleep and can also impair memory, so I figure that they must be interfering with a sleep stage that is particularly important to me.
I was interested to read that you had been at NIMH. Have you ever considered the Mayo Clinic? I have often wondered about getting treatment there.
I still have hope that the right medicines will be available some day. If only there were more funding and other types of support for mental health research.
Posted by SLS on March 4, 2005, at 4:15:39
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 3, 2005, at 20:56:24
Hi Sarah.
Like many people here, my disorder does not fit entirely well into the more classical categories of mental illness. I suffer from a chronic severe depression that is unremitting. I have brief responses to a few medications, but only once for longer than a week. I have also had brief, but psychotic manic reactions to medication. The depression "looks" like bipolar depression as it is anergic, anhedonic, and presents reverse vegetative symptoms similar to atypical major depression. The doctors at the NIMH felt this was sufficient to label me as bipolar. The next DSM is supposed to include my presentation as "Bipolar III".
> Right now, I am very discouraged about psychopharmacology and most psychiatrists.
Me too. :-)
> There are so few really good, "complete" doctors around.
This has been my experience as well.
Rant:I am becoming increasingsly frustrated reading the more recent posts on this board. I wonder if people don't review the whole board first before undertaking to discontinue their antidepressants and benzodiazepines "cold turkey" or using a counterproductive plan like skipping days between doses. It would be a shame if this board were to become nothing more than a gathering place for people who are currently suffering from withdrawal syndromes and whom decide to "stay the course" despite the effective alternatives that are staring them right in the face. Sorry. I guess I should realize that most sufferers arrive here only after the fact looking for support. I hope more and more people become willing to intervene on their own behalf by using a strategy to mitigate or prevent all together the withdrawal syndrome.
I wish more people would do the following:
> When I tapered Klonopin, I did so over many weeks, even though I never took that high a dose. I had the orange tablets, which are 0.5mg, I think. I cut the pills in tinier and tinier amounts over a few months. Each time I lowered the dose, I spent at least a week on it, sometimes more. Because I was cutting the pills, and the pills don't cut that well without crumbling, my method was not very precise. I estimated by size as close as I could, and it seemed to work out.
> I do think that Klonopin is a good drug. In years past, I had tried other anxiolytics, such as Librium, Valium and Ativan. And, as I mentioned a few days ago, when I had those panic attacks, I took Xanax. Of all the benzos I've taken, I think Klonopin is the best and the "most benign." Unfortunately, benzos don't work well for me as sleep aids. If I take a tiny chip of Klonopin on an anxiety-ridden day, it helps. If I take Klonopin at night, I sleep very poorly, and I feel horrid the following day. I know that, like alcohol, benzodiazapines interfere with some stages of sleep and can also impair memory, so I figure that they must be interfering with a sleep stage that is particularly important to me.
Hmm. What alternatives have you considered? Remeron might be helpful as a hypnotic with the benefit of improving sleep architecture.
> I was interested to read that you had been at NIMH. Have you ever considered the Mayo Clinic?
I really haven't developed an interest in the Mayo Clinic, primarily because I haven't seen described any success stories, although there may be many.
> I have often wondered about getting treatment there.
Have you come across anything that you find compelling to try it?
> I still have hope that the right medicines will be available some day.
Me too, but I think I was born about 50 years too early. 50 years from now, I doubt someone like me will have to remain severely afflicted for 25 years without remedy.
> If only there were more funding and other types of support for mental health research.
Don't get me started. Until recently, the federal government granted the NIMH less than 700 million dollars annually to study mental illness. They now get 1.3 billion. Unfortunately, a smaller and smaller percentage of the budget is directed towards clinical research instead of general neuroscience. Depression is the single most pervasive disability and the largest drain on the economy. It is cost effective to spend larger amounts of money to find effective treatments. Somehow, I think this idea remains lost in the government bureaucracy.
- Scott
Posted by Sarah T. on March 6, 2005, at 1:33:22
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 4, 2005, at 4:15:39
Hi Scott,
You mentioned that you had brief, psychotic, manic reactions to some antidepressants. May I ask which AD's caused this reaction? The one antidepressant that caused a psychotic reaction for me was Parnate. I'm uncertain whether my reaction was caused by the fact that Parnate is one of the most dopaminergic medications, or by the fact that it caused severe disruption of sleep and circadian rhythms, or something else altogether. Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared, and my circadian rhythms improved. Dexedrine was the most stabilizing medicine I've ever been on, something I would have never expected after my initial reaction to Parnate. Oh, one other point about Parnate-induced psychosis. I read that Parnate suppresses REM sleep more than just about any other AD, and while some doctors believe that REM suppression leads to antidepressant activity, it did not have that effect on me.
Is diagnosis very important to you and/or your doctor? Diagnosis serves a function, but I think too much importance is placed on it, and it can detract from understanding and treating the patient as a person. A relative of mine who is a physician knows one of the doctors who co-wrote one of the DSMs. My relative said that "Dr. DSM" was one of the most boring people he'd ever met. Reducing psychiatry to diagnostic labels is sort of like saying that biology should be reduced to taxonomy. Classifying organisms into genus and species serves a purpose, but if that's all there were to biology, the study of it would have died off long ago. And one of my biggest gripes is the fabrication of diagnostic labels for the purpose of marketing a drug. For example, as a female, I am all-too-well acquainted with "PMS," but "PMS" wasn't good enough for drug companies. I heard that the diagnostic label "PMDD" (pre-menstrual dysphoric disorder) was coined for the purpose of marketing Sarafem, which is just Prozac, re-packaged and re-named.
Perhaps I shouldn't have posted that I stopped stimulants abruptly. It seemed to be the right thing for me at the time, but it is probably not the best way to go about withdrawal, and I don't encourage others to stop "cold turkey."
The reason that I mentioned the Mayo Clinic is that a couple of doctors have suggested it to me. I have another medical condition that contributes to my depression, and my doctors thought it might be helpful for me to be evaluated and treated by a team of doctors from different specialties. I don't know. I'm so discouraged and fed up with most doctors. I think I'd just be used by the team for teaching purposes, and then, thousands and thousands of dollars later, I'd leave, no better off than when I arrived. I have nothing against teaching hospitals, but I'm tired of paying others so that they can learn from me without giving anything in return. After nearly every medical appointment, I am further depleted of energy and money, and yet, the help I need is not forthcoming. Do you think you got anything out of your stay at NIMH?
Regarding mental health funding, I will discuss that at another time. I am usually not one to avoid controversial topics and conflict, but it's late now, and I think it's nearly impossible to get into a discussion about funding for mental health research without also discussing politics and all sorts of other topics that will make me angry and further exacerbate my delayed sleep phase syndrome. To be continued. . .
Sarah
Posted by SLS on March 6, 2005, at 7:13:01
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 6, 2005, at 1:33:22
Hi Sarah.
> You mentioned that you had brief, psychotic, manic reactions to some antidepressants. May I ask which AD's caused this reaction?
Parnate + desipramine
Parnate after pretreatment with Paxil and desipramine
Nardil discontinuation rebound maniaThe one antidepressant that caused a psychotic reaction for me was Parnate. I'm uncertain whether my reaction was caused by the fact that Parnate is one of the most dopaminergic medications, or by the fact that it caused severe disruption of sleep and circadian rhythms, or something else altogether.
Good thinking. All three, probably.
> Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared,
An infrequently embraced observation is that amphetamine can act as an antimanic agent. I didn't know that Ritalin could do the same thing.
> and my circadian rhythms improved.
How so?
> Dexedrine was the most stabilizing medicine I've ever been on,
Case in point. (I hadn't read down this far yet) :-)
> something I would have never expected after my initial reaction to Parnate.
Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
> Oh, one other point about Parnate-induced psychosis. I read that Parnate suppresses REM sleep more than just about any other AD, and while some doctors believe that REM suppression leads to antidepressant activity, it did not have that effect on me.
Did you glean any antidepressant effect from Parnate at all?
The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
> Is diagnosis very important to you and/or your doctor?
Yes and no. He first described what I experienced as a deficit syndrome, much like that encountered with the negative symptoms of schizophrenia. That I am bipolar probably rests on the observations that I became manic on medication, had been an ultra-rapid cycler, and display reverse vegetative symptoms like an atypical depressive. However, I am not mood-reactive. The diagnosis was first placed on me by William Z. Potter, MD at the NIMH.
> Diagnosis serves a function, but I think too much importance is placed on it,
On the contrary, I think it is showing itself to be increasingly important as it seems the diathesis seen in the bipolar spectrum disorders is different from that of true unipolar depression. The differences in neurobiology between the two is indicated by the pattern of response to antidepressants and mood stabilizers.
> and it can detract from understanding and treating the patient as a person.
I'm sure this is true of a great many doctors. With affective-disorders, sometimes treating individual symptoms is the best you can do as a palliative measure in the absence of true remission.
> A relative of mine who is a physician knows one of the doctors who co-wrote one of the DSMs. My relative said that "Dr. DSM" was one of the most boring people he'd ever met.
What would you expect? They are basically statisticians. :-)
> Reducing psychiatry to diagnostic labels is sort of like saying that biology should be reduced to taxonomy.
The beauty of the DSM is that it does NOT associate symptom clusters as discreet biological entities. They are merely describing what is observed empirically.
> Classifying organisms into genus and species serves a purpose, but if that's all there were to biology, the study of it would have died off long ago. And one of my biggest gripes is the fabrication of diagnostic labels for the purpose of marketing a drug. For example, as a female, I am all-too-well acquainted with "PMS," but "PMS" wasn't good enough for drug companies. I heard that the diagnostic label "PMDD" (pre-menstrual dysphoric disorder) was coined for the purpose of marketing Sarafem, which is just Prozac, re-packaged and re-named.
As far as PMS versus PMDD, I am mostly ignorant of their study. I don't know if they represent varying expressions of the same phenomenon along a continuum of magnitude or are actually discreet biological phenomenon. Do women taking Prozac still get PMS? That would be an interesting place to start.
> Perhaps I shouldn't have posted that I stopped stimulants abruptly. It seemed to be the right thing for me at the time, but it is probably not the best way to go about withdrawal, and I don't encourage others to stop "cold turkey."
As you had indicated previously, different drugs might require or allow for different discontinuation strategies. I was not on methylphenidate nor amphetamine long enough to assume that my system had developed a biological state to produce withdrawal syndrome. I do know that whenever I discontinue Parnate quickly, I experience profound fatigue.
> The reason that I mentioned the Mayo Clinic is that a couple of doctors have suggested it to me. I have another medical condition that contributes to my depression, and my doctors thought it might be helpful for me to be evaluated and treated by a team of doctors from different specialties. I don't know. I'm so discouraged and fed up with most doctors. I think I'd just be used by the team for teaching purposes, and then, thousands and thousands of dollars later, I'd leave, no better off than when I arrived.
I know the feeling.
> I have nothing against teaching hospitals, but I'm tired of paying others so that they can learn from me without giving anything in return.
With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures. In return, I left there taking an MAOI named clorgyline that could not be appropriated anywhere else in the world. Unfortunately, I responded to it episodically at first and only partially thereafter. I stopped taking it after I had been home for a few months for lack of efficacy.
After nearly every medical appointment, I am further depleted of energy and money, and yet, the help I need is not forthcoming. Do you think you got anything out of your stay at NIMH?
In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well. As far as the other subgroup is concerned, they seemed to be much more dedicated to sending their patients home healthy. Unfortunately, their approaches were not at all novel. I felt they were actually several years behind the state of the art.
In 1992, while I was there, the entire budget of the NIMH was only about 6 hundred million dollars. There were less than 20 beds devoted to the study of affective disorders. It was pitiful. Over the last 3 years, the budget has increased to 1.3 billion. However, the dollar is worth quite a bit less now. Considering that depression alone costs the American workplace more lost productivity than any other illness, this remains a nonsensical number.
- Scott
Posted by ed_uk on March 6, 2005, at 10:31:54
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 6, 2005, at 7:13:01
Hi Scott,
>You mentioned that you had brief, psychotic, manic reactions to some antidepressants.
What were you main symptoms when you were manic? I hope you don't mind me asking.
Ed.
Posted by SLS on March 6, 2005, at 16:46:09
In reply to Re: Mania » SLS, posted by ed_uk on March 6, 2005, at 10:31:54
> Hi Scott,
>
> >You mentioned that you had brief, psychotic, manic reactions to some antidepressants.
>
> What were you main symptoms when you were manic? I hope you don't mind me asking.
>
> Ed.
I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.That was a rather sane episode as psychotic episodes go.
(Don't tell anyone that I got the job).
- Scott
Posted by Sarah T. on March 7, 2005, at 23:58:25
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 6, 2005, at 7:13:01
> > > > Oddly enough, when a small dose of Ritalin was added to the Parnate, the psychosis disappeared,
>
> An infrequently embraced observation is that amphetamine can act as an antimanic agent.That's fascinating. I'd like to understand how that is possible. I'd also like to know how some antidepressants induce mania in susceptible individuals. By the way, did Parnate alone cause problems for you, or was it only when it was combined with the other medications? Have you ever taken dexedrine as monotherapy?
> > > and my circadian rhythms improved.
>
> How so?When I was on Parnate alone, I had "attacks" of severe daytime somnolence, almost like narcolepsy. When the urge to sleep hit, I HAD to sleep. This was most inconvenient, not to mention dangerous. I'd sleep whenever the urge hit, which was usually during the day, and then I couldn't sleep at night. I'd go to bed around the time that most people wake up. I went to a new doctor who was familiar with this problem. He prescribed a small amount of Ritalin, which I took in the morning and at noon. I think it was either 2.5 or 5mg, twice a day. That stopped me from sleeping during the day, and I was better able to sleep at night. My circadian rhythms were still out of phase, but not nearly as bad as they had been. I have been interested in trying Selegiline if it ever comes out in the patch, but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well. You are probably aware of this, but just in case you haven't heard, several of the newer dopamine agonists that are prescribed to patients with Parkinson's Disease also cause those uncontrollable daytime sleep attacks. As I mentioned in the previous post, Parnate is considered to be one of the most dopaminergic AD's. I wonder what it is about dopamine that causes "narcolepsy."
> Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
What are its metabolites? Selegiline is converted to several amphetamines, but I think they are the "nasty" ones, the l-isomers, which cause the unpleasant/intolerable peripheral effects, like tremor, palpitations, etc.
> Did you glean any antidepressant effect from Parnate at all?When I took Parnate, I thought it had an antidepressant effect, but that was probably because I was so glad to be off of the "dumb drugs," like Elavil and imipramine. In retrospect, I think that Parnate functioned primarily as a stimulant for me, and that is most definitely not the same as an antidepressant. When I wasn't having the sleep attacks, I was pretty active physically and I lost the TCA-induced weight gain and edema, but my mood was pretty negative. I also had tremendous difficulty reading on Parnate. I'm not dyslexic. I love to read and usually don't have problems with it. I still don't know why I couldn't read well. When I was able to read, I had a lot of difficulty retaining what I read or learning. Perhaps that was caused by the sleep disruption. Aren't memories consolidated during certain stages of sleep?
> > The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
Just recently I read that REM sleep and dreaming occur in different parts of the brain. I will try to find the reference.
> With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures.
It sounds like a nightmare. That would have made me so depressed, I would have walked out. Did you actually stay at NIMH for nine months? My insurance company wouldn't pay for nine days, or nine hours for that matter. I have another medical condition that requires follow-up CT scans and MRIs at regular intervals. The last time my doctor ordered a CT and MRI, my insurance company refused to pay for both. They said that they would pay for one or the other, but not both, as if they were interchangeable! Oh-oh, this is another one of those "Don't get me started" topics.
> In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well.What was their priority?
As far as the other subgroup is concerned, they seemed to be much more dedicated to sending their patients home healthy. Unfortunately, their approaches were not at all novel. I felt they were actually several years behind the state of the art.
>
That's disappointing and disturbing to hear that NIMH, of all places, was behind the state of the art. Was/is there any place that is state of the art?Is there a seasonal variation to your depression? Do you feel better during the spring and summer? Do you have seasonal affective disorder? As I mentioned above, I was interested to know whether you've ever tried Dexedrine as monotherapy, or has it been prescribed only as an augmentor to another AD? I thought Dexedrine was a much better antidepressant for me than Parnate. Unfortunately, most people find that frequent "drug holidays" are necessary to stave off tolerance.
Posted by Sarah T. on March 8, 2005, at 0:04:03
In reply to Re: Mania » ed_uk, posted by SLS on March 6, 2005, at 16:46:09
> > > > > > I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so.> - Scott
>
>OK, this is far-fetched for real life, but it would make a great movie plot.
Posted by SLS on March 8, 2005, at 8:33:43
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 7, 2005, at 23:58:25
> By the way, did Parnate alone cause problems for you, or was it only when it was combined with the other medications?
For me, Parnate alone has not precipatated a manic reaction. It seems that it will if a TCA enters the picture.
> Have you ever taken dexedrine as monotherapy?
Yes. I received some mild benefit from it for about 3 days.
> > > and my circadian rhythms improved.
> but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.I don't think that is accurate. It seems to be pretty specific to Parnate.
> > Parnate is NOT converted to amphetamine in the body, much to the disappointment of some folks.
> What are its metabolites?
I don't know. I don't think that Parnate has been studies well enough to have elucidated this. It seems to be a mystery. You know, Parnate has a 1/2 life of about 1-2 hours. Perhaps much of it is excreted unchanged.
> > The first few times I took Parnate, I did not dream at all. I imagine this was the result of REM suppression. Unfortunately, I no longer experience this. I wish I did. In my mind, it is just one more reason to believe that my depression is pharmacologically intractable. My brain is far from being a naive virgin.
> Just recently I read that REM sleep and dreaming occur in different parts of the brain. I will try to find the reference.
That's interesting.
> > With the NIMH, I paid with 9 months of inpatient care leading to mild to moderate instutionalization, the endurance of a protracted exacerbation of my depression, many liters of blood and urine, PET scans, and several lumbar punctures.
> It sounds like a nightmare. That would have made me so depressed, I would have walked out. Did you actually stay at NIMH for nine months? My insurance company wouldn't pay for nine days, or nine hours for that matter.
It was "free". Again, they seemed to get more out of it than I did.
> > In the subgroup of investigators to whom I was assigned, my remission was not their priority. They were not committed to developing a multimodal treatment to get me well.
> What was their priority?
Obtaining P.E.T. scan images of me while taking various drugs.
> That's disappointing and disturbing to hear that NIMH, of all places, was behind the state of the art. Was/is there any place that is state of the art?
I think Harvard / Massachusetts General is high up on the list.
> Is there a seasonal variation to your depression?
No.
> I was interested to know whether you've ever tried Dexedrine as monotherapy, or has it been prescribed only as an augmentor to another AD?
I have used it both ways. Once, I was taking a combination of Parnate + desipramine + amphetamine + T4 thyroid.
How demoralizing.
- Scott
Posted by Sarah T. on March 8, 2005, at 23:54:32
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 8, 2005, at 8:33:43
> > > > but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.
>
> I don't think that is accurate. It seems to be pretty specific to Parnate. >
> > > > > > - ScottIt occurs with Parnate and Nardil. This has been documented in various journal articles over the years. Most of the references I'm aware of were published before selegiline was used, and I haven't checked to see whether there is anything in the literature about selegiline causing the same problem. One reference I'm aware of regarding Nardil and Parnate is the following:
Teicher MH, Cohen BM, Baldessarini RJ, Cole JO. "Severe Daytime Somnolence in patients treated with an MAOI." AMERICAN JOURNAL OF PSYCHIATRY. 1988 Dec; 145(12): 1552-6.
When I had this problem, one of my doctors called Dr. Teicher at McClean Hospital. I spoke with Dr. Teicher, also, and I must say that he was very helpful and very kind to me.
Posted by SLS on March 9, 2005, at 7:48:06
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 8, 2005, at 23:54:32
Hi Sarah.
> > > > > but one of my doctors told me that most patients who experience daytime sleep attacks on one MAOI will experience them on the others as well.
> >
> > I don't think that is accurate. It seems to be pretty specific to Parnate. >
> > > > > > > - Scott
>
> It occurs with Parnate and Nardil. This has been documented in various journal articles over the years. Most of the references I'm aware of were published before selegiline was used, and I haven't checked to see whether there is anything in the literature about selegiline causing the same problem. One reference I'm aware of regarding Nardil and Parnate is the following:
>
> Teicher MH, Cohen BM, Baldessarini RJ, Cole JO. "Severe Daytime Somnolence in patients treated with an MAOI." AMERICAN JOURNAL OF PSYCHIATRY. 1988 Dec; 145(12): 1552-6.
>
> When I had this problem, one of my doctors called Dr. Teicher at McClean Hospital. I spoke with Dr. Teicher, also, and I must say that he was very helpful and very kind to me.My experience is anecdotal, of course, but I found that the initial daytime sedation associated with Nardil disappeared and was replaced by a pleasant stimulation. I hope this can be generalized to the majority of people. The paper you cited described 8 people out of the 100s that McClean had treated. In addition, they didn't enumerate how many of the 8 had been on Nardil. I still think the profound daytime sleepiness is more common with Parnate and perhaps even specific to that drug based on the number of people reporting it on PB.
Have you tried Nardil and Parnate? I found them to be very different drugs in many respects.
- Scott
Posted by ed_uk on March 9, 2005, at 8:52:18
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 8, 2005, at 23:54:32
Hello,
>Dr. Teicher
Isn't that the guy who wrote some of the first reports of intense suicidal ideation due to fluoxetine (Prozac)?
Ed.
Posted by ed_uk on March 9, 2005, at 8:54:48
In reply to Re: Mania » ed_uk, posted by SLS on March 6, 2005, at 16:46:09
Hi Scott,
>I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.
Wow, that's interesting! How was this episode resolved?
Ed.
Posted by Sarah T. on March 9, 2005, at 22:24:52
In reply to Re: Sometimes there's no choice, posted by SLS on March 9, 2005, at 7:48:06
Hi Scott. I've tried both Parnate and Nardil, but I was on Nardil for a very short period. I was on Parnate several times, for at least 6 months each time. Can you tell me a bit about Nardil? I wasn't on it very long, so I never bothered to learn much about it. Prior to the availability of the dopamine agonists that are used primarily in Parkinson't Disease, Parnate was considered to be one of the most dopaminergic medicines. Both the dopamine agonists and Parnate can cause daytime sleep attacks. I wonder what it is about all that excess dopamine that causes this problem is susceptible people.
Posted by Sarah T. on March 9, 2005, at 22:27:13
In reply to Re: Sometimes there's no choice » Sarah T., posted by ed_uk on March 9, 2005, at 8:52:18
Hi Ed. I think you are right about Dr. Teicher. He's very prolific. If you look him up on PubMed, there must be a zillion citations with his name.
Posted by SLS on March 10, 2005, at 10:07:04
In reply to Re: Mania » SLS, posted by ed_uk on March 9, 2005, at 8:54:48
> Hi Scott,
>
> >I drove down to the Goddard Space Flight Center to sell myself a job as a brilliant college drop-out rocket scientist. I parked the car in a lot across the street from the center. I thought by then that the giant cataclysmic earthquake I had predicted for Manhattan as the epicenter had occurred, so I decided to drive back home, now that it was safe to do so. I still thought that I might have a need for the shovel and pick axe I packed up in the car to cut through the debris of my house when I got back.
>
> Wow, that's interesting! How was this episode resolved?
>
> Ed.
Forcibly. I was committed. This was in 1990. It was actually a manic rebound from discontinuing Nardil while already in a hypomanic state.lithium + Thorazine if I remember correctly.
- Scott
Posted by ed_uk on March 10, 2005, at 11:00:02
In reply to Re: Mania » ed_uk, posted by SLS on March 10, 2005, at 10:07:04
Hi Scott,
I think I read somewhere that you find Li makes your depression a bit worse. Will you tell me a bit more about what effect it had on you while depressed?
Regards,
Ed.
Posted by SLS on March 10, 2005, at 11:09:09
In reply to Re: Sometimes there's no choice » SLS, posted by Sarah T. on March 9, 2005, at 22:24:52
> Hi Scott. I've tried both Parnate and Nardil, but I was on Nardil for a very short period. I was on Parnate several times, for at least 6 months each time. Can you tell me a bit about Nardil?
The first time I took Nardil, I experienced a sort of sedation and fatigue during the first few weeks, whereupon it became activating. I could actually catch a bit of an energy boost within minutes of dosing. When it worked, I liked it much better than Parnate. Parnate leaves me with residual anhedonia. Nardil was definitely more of a "mood-brightener" than Parnate for me. I believe that Nardil is somewhat more pro-serotonergic than Parnate. I am susceptible to serotonin syndrome when combining imipramine with Nardil, but not with Parnate. Perhaps it is the pro-serotinergic effects of Nardil that account for the mood-brightening I experience with it. That's nothing more than a silly guess.
I believe most of, although not all of, the weight gain with Nardil is the result of increased carbohydrate intake resulting from cravings. The rest might be metabolic. Nardil might mess around with glucose/insulin dynamics. Another silly guess.
> Both the dopamine agonists and Parnate can cause daytime sleep attacks.
I never made this connection. You are right.
> I wonder what it is about all that excess dopamine that causes this problem is susceptible people.
Hmm. Interesting.
With DA receptor agonists, I think it might have something to do with pre-synaptic receptor downregulation. One last silly guess.
:-)
- Scott
Posted by ed_uk on March 10, 2005, at 12:49:55
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 10, 2005, at 11:09:09
Hi,
>Nardil was definitely more of a "mood-brightener" than Parnate for me.
Perhaps you got a greater % MAO inhibition from the dose of Nardil that you were taking. Maybe Parnate would have been just as good if the dose was higher.
Ed.
Posted by SLS on March 10, 2005, at 21:36:39
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 10, 2005, at 12:49:55
> Hi,
>
> >Nardil was definitely more of a "mood-brightener" than Parnate for me.
>
> Perhaps you got a greater % MAO inhibition from the dose of Nardil that you were taking. Maybe Parnate would have been just as good if the dose was higher.
>
> Ed.How's 150mg?
:-)
- Scott
Posted by Sarah T. on March 11, 2005, at 23:59:24
In reply to Re: Sometimes there's no choice » Sarah T., posted by SLS on March 10, 2005, at 11:09:09
Hi Scott. None of those were silly guesses! You have very interesting ideas.
I'm just very discouraged right now about psychopharmacology and psychopharmacologists. I really wish I'd never taken any of these medications. I think they've made me worse than I was when I started.
Posted by ed_uk on March 15, 2005, at 10:24:57
In reply to Re: Sometimes there's no choice » ed_uk, posted by SLS on March 10, 2005, at 21:36:39
Hi Scott!
>How's 150mg?
Did you ever combine 150mg Parnate with any other ADs?
Ed.
Posted by SLS on March 15, 2005, at 13:43:30
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 15, 2005, at 10:24:57
> Hi Scott!
>
> >How's 150mg?
>
> Did you ever combine 150mg Parnate with any other ADs?
>
> Ed.
You're really testing my poor memory now! :-)I combined Parnate 120mg + desipramine 200-300mg + Dexedrine 20mg + T4 thyroid ?mcg
I really like that you brainstorm ideas for other people. That is very compassionate of you.
- Scott
Posted by ed_uk on March 16, 2005, at 10:19:12
In reply to Re: Sometimes there's no choice » ed_uk, posted by SLS on March 15, 2005, at 13:43:30
Hi Scott!
>I combined Parnate 120mg + desipramine 200-300mg + Dexedrine 20mg + T4 thyroid ?mcg
I wondered whether you ever took 150mg Parnate with imipramine. I thought that *if* you were able to take so much Parnate with imipramine w/o developing the serotonin syndrome, the % MAO inhibition might not have been as high as expected. Based on that theory you might benefit from an even higher dose.
Did you ever take imipramine with a high dose of Parnate?
>I really like that you brainstorm ideas for other people. That is very compassionate of you.
Thanks, that's a really nice thing to say :-)
Best regards,
Ed.
Posted by ed_uk on March 16, 2005, at 10:52:31
In reply to Re: Sometimes there's no choice » SLS, posted by ed_uk on March 16, 2005, at 10:19:12
>Based on that theory you might benefit from an even higher dose.
Not so much that you'd develop the SS though!
Ed.
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