Posted by david maclean on February 16, 2003, at 17:42:25
This is a long email. Please be patient and please take time to read through. Thank you.
I feel I am coming to the end of all my efforts to sort my head out. The end is approaching because (1) my medical insurance has almost run out and (2) I am weary from the journey.
I am 47 and have had dysthymia for most of my adult life. In addition I have Obsessive Compulsive Personality Disorder (OCPD and not OCD). I have been in good therapy (mainly for the OCPD rattehr than the low mood but the two are interlocked) for 16 months but that finished when the money ran out about 10 months ago. SInce then I have had a relapse.
I am now looking for a few last meds to help out. I have found that using the MAOI moclobemide (not available in the US) really and truly helps with my mood. I noticed that it produced a CLARITY of thought and ENERGY and WAKEFULNESS and lack of low MOOD which I very much welcome. These effects come on quickly within days when I get to a dose of about 450 mg and do not take weeks like SSRIs might. But the last time I tried moclobemide I could not get much above 450 to 600 due to side effects (constricted feeling inside my guts) even though many people feel that high doses of 600 to 1,200 mg are better.
Well, at only 450 to 600 I found the moclobemide lost its efficacy after a several months. Sad. So I feel there is not much left for me to try as I have already tried clompramine and various other tricyclics. I have tried all the SSRIs except for the new escitalopram and had poor results on all of them. Only the SNRI reboxetine also gave me a good effect but its side effects were quite severe (Reynaulds syndrome strangely enough) and really I had to stop.
So what should I take?
I gently starting to try moclobemide once again but the interesting thing is that I very recently read that some MAOIs have amphetamine derivatives. Now holy shit!!! I used to describe moclobemide to my psychiatrists as almost a drug of abuse where I pooped a pill and a day or two later I was feeling energised and good. I never got a glimmer of response. But now I see that I was probably experiencing the stimulant effect..
Can someone help me with 2 questions ... (1) Where can I find out more about MAOIs and their amphetamine like effects as there is little on Google? and (2) is it worth trying a pure stimulant like Ritalin perhaps with or without moclobemide? The effect I got was very worth while and did not remind me of the sort of drug relationship which amphetamine addicts probably have. BTW does ritalin like compunds demonstarte a “poop out” simialr to that which I experienced after a few minths or do they tend to be effective for a long while?
If not a low level amphetamine like Ritalin then would you suggest one of the newer neuroleptics like Clozapine (Clozaril), risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), sertindole (Serlect) or ziprasidone (Zeldox)?
It is clear than increasing serotonin does not seem to help me. Would buproprion be useful for me?
As I said I am getting desperate. I am running out of time. I have personal crises which need me to address then as soon as possible so I can't wait around for 12 week trials on meds and all that sort of thing.
The only other thing is that I find I am highly functional on benzodiazepine sleeping tablets. I never take a BDZ for more than 3 or 4 nights in a row to avoid addiction. They really do make me very effective the following morning. Maybe anxierty is a major part of my make up and maybe I should address it more directly. I have started taking 1mg Clonazepam but it does not work as well my my old 5mg nitrazepam. Would it be worth looking at an anti-anxierty med like Buspirone which has far less of the addictive and habituation potential?
I am sorry this has been so very long. Thank you for kindly reading this. I look forward to any constructive answers.
poster:david maclean
thread:200976
URL: http://www.dr-bob.org/babble/20030214/msgs/200976.html