Posted by jemma on May 30, 2003, at 11:51:26
In reply to Re: Running out of med options... » jemma, posted by SLS on May 28, 2003, at 22:49:34
Hi Scott -Thanks for the suggestion of parnate. If I run out of options, I'll certainly try it, though my pdoc is very resistant to MAOIs. He did suggest desipramine, however, and I may well go there, though the possibility of weight gain worries me.
I'm glad you're getting at least some benefit from the meds you're on. I tried lamictal for several months - I titrated all the way up to 350 mg. Unfortunately, it started making me stupid, and my vocabulary shrank to half its normal size. It might have been the mild seratonin effect. After 10 years on zoloft, I've developed an intolerance to drugs that increase seratonin levels - they make me very foggy, as though my head is full of cotton batten. Effexor was like that for me, so I didn't last long on it.
Of course, the lamictal might have made me so dumb and unmotivated because it was blocking glutamate. Certainly, glutamate release seems to be one of the main factors in modafinil's action. Too much glutamate isn't good, but modafinil seems to have an inbuilt ablity to protect neurons against glutamate-induced excitotoxicity. And the energy and motivation is wonderful - I marvel several times every day at how alert and awake I feel, and I've been taking it for months!
Good luck finding the meds that work best for you. I'm sorry about the parnate - I know what it's like to feel really well, then have that snatched away from you.
- Jemma
> > For the moment, I'm back on a modafinil ritalin sr cocktail. I hate the rebound off the ritalin, though, and I get bruxism and muscle tightness. When I see my pdoc in a week, I'm going to suggest trying wellbutrin again along with 200 mg modafinil. I tried wellbutrin before - all the way up to 450 for eight weeks - and felt nothing, no side effects, just a bit of sleepiness. I'm wondering if modafinil might work synergistically with it, as it seems to do with almost everything.
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> Have you tried Parnate? It doesn't usually produce edema, and there is no reason why you couldn't combine it with Provigil. You can even combine it with amphetamine, Ritalin, or a tricyclic. Parnate is usually chosen over Nardil for bipolar depression.
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> > What meds are you on these days? If I recall, don't you also suffer from anergic bipolar depression?
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> My depression is indeed anergic. There are times when the psychomotor retardation leaves me motionless in a chair. Fortunately, I am gleaning a mild benefit from combining Lamictal 250mg + imipramine 300mg. I am just beginning to take trimipramine (Surmontil). It occasionally works when other tricyclics fail. The only time I ever sustained a remission beyond a week was during a trial of Parnate 60mg + desipramine 150mg. I felt alive (normal) for at least 6 months. Unfortunately, my doctor at the time had me discontinue the combination due to the precipitation of mania. He should have continued it and simply added antimanic agents. I am now resistant to that combination. 20-20 hindsight.
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> I am looking forward to the FDA approval of duloxetine (Cymbalta). Hopefully, it will pack a more potent punch than Effexor. I found Effexor somewhat helpful when combined with imipramine.
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> - Scott
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poster:jemma
thread:550
URL: http://www.dr-bob.org/babble/20030530/msgs/230216.html