Posted by jujube on February 2, 2005, at 19:38:48
In reply to HELP ME - Augment the effect of Parnate, posted by Maxime on February 2, 2005, at 12:11:47
Maxime,
Just thought I would share the following with you FWIW. There are a number of options that you may wish to discuss with your pdoc. I'm so sorry you are suffering so, and hope that you and your pdoc can identify new treatment or augmenting options which will provide you with a least some measure of relief.
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http://www.aafp.org/afp/981200ap/cadieux.html
http://www.mddaboston.org/lect032200.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11448087&dopt=Abstract
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Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been
suggested for the treatment of bipolar depression, not only because of its
efficacy, but also because of a probably lower risk of inducing switches to
hypomania or mania. Most studies on bupropion treatment in bipolar patients have
been performed in moderately ill out-patients. In contrast, we report on a
sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic
or therapy-refractory bipolar depressive in-patients. In this open and
prospective study, 13 patients were treated with bupropion as an add-on strategy
mainly to other antidepressants and to various mood stabilizers. Our data
support the idea that bupropion is a first-line antidepressant in the treatment
of severe bipolar depression. Eight of 13 patients showed a >50% reduction of
Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with
drugs commonly used in treatment-resistant bipolar disorder including
venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our
small sample. While adhering to the suggestion of Goren and Levin not to exceed
a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we
did not observe any switch from depression to hypomania or mania. Copyright 2002
S. Karger AG, BaselPublication Types:
Review
Review, TutorialPMID: 11893875 [PubMed - indexed for MEDLINE]
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TCA + MAOI + CNS StimulantsIn an uncontrolled case series, Feighner et al (1985) reported the successful treatment of "treatment resistant" depression with the addition of a CNS stimulant (i.e., d-amphetamine, methylphenidate) to a MAOI or to a combination of TCA and MAOI. The literature on combination of CNS stimulants and MAOIs indicates that hypertensive and hyperthermic crises may occur when high doses are given. The author's state, "Our clinical experience is that these hypertensive crises are, at most, infrequent, and that this combination is often effective." It would appear that with many pharmacologic and non-pharmacologic treatment options available, this combination would be infrequently and carefully considered.
Methylphenidate in doses ranging from 10 to 40 mg/day was used to augment SSRI treatment in a case series of five patients. Self-reported symptom reduction was achieved rapidly in all cases (Stoll et al 1996).
Tamara
poster:jujube
thread:451719
URL: http://www.dr-bob.org/babble/20050202/msgs/451984.html