Posted by SLS on July 30, 2008, at 4:21:15
In reply to Re: MAOI-TCA combos » SLS, posted by Crotale on July 29, 2008, at 18:03:21
> > The answer is both...
>
> Oh dear....
>
> > The acronymn, "SNRI", was originally used to denote a selective norepinephrine reuptake inhibitor. I believe it came into use around the time viloxazine, reboxetine and atomoxetine were first referred to as such. Later, "SNRI" came to mean serotonin/norepinephrine reuptake inhibitor of which there are three representatives: Effexor, Pristiq, and Cymbalta.
> So, on this board, "SNRI" could mean either?
> > "NARI" has since come to mean noradrenergic reuptake inhibitor.
> >
> > "SRI" = serotonin reuptake inhibitor (in addition to other properties).
> Well, yeah, I was thinking of the "selective" ones.I guess what I wrote was misleading. SSRI is still the prefered acronym for Prozac, Zoloft, Luvox, Paxil, Celexa, and Lexapro, even though these drugs have other properties that have not, up until now, figured in to theories of how these drugs work.
> > Yes. My condition was extremely resistent to monotherapy. It only took doctors and me 26 years to find a treatment that produced a robust antidepressant response.
> Glad to hear you did find one eventually (err). How long has it been working?Partial response for 1 1/2 years. It has been more robust since adding Deplin. I am making slow, but steady gains.
>
> > I was desperate. I even took a single dose of Effexor while taking Parnate to see for myself if a SRI would cause SS when combined with a MAOI.
>
> "Just curious," huh?
>
> > The answer is yes. It only took 45 minutes to emerge.
>
> Yeah, I know. I did the same thing, only with Nardil, but for different reasons (was suicidal).
> > I was completely incoherent and couldn't stand up. My muscles tensed up and made it impossible to get out of bed. Luckily, the reaction lasted for only an hour or so. Parnate + imipramine was without ill effect, whereas Nardil + imipramine produced moderate SS.
> Do you think it's liable to be worse if you add the MAOI to the SRI or vice versa? (just curious this time, not planning on trying it)
> > > (I got CSS just from taking Cymbalta. No risky mixtures required.)
> >
> > You'll here of this occasionally, where SS will be produced by SRI monotherapy.
> It was pretty freaky. The muscular rigidity wasn't as bad as with the Effexor/Nardil combo, but my BP was all over the place, I felt like I was burning up, and I was delirious.
> > One day, medical science will provide us with ways to choose certain drugs and reject others based upon gene activity and PET scans.
> (Or something of the sort...)
> > Until then, don't give up on using clinical trial-and-error algorithms. I don't expect you will need to wait 26 years to achieve remission.> Well, it's only been 18 for me so far, with a couple of temporary successes.
That might as well be 26 years. The problems with these two numbers is that they are so large. The longer one remains depressed, the worse is the damage to the brain that is produced.
ECT has actually gone pretty well, but it hasn't been long enough for me to count it a success yet.
>
> I won't say I've exactly given up on trial-and-error, but the prevalence of "me-too drugs" these days is discouraging.
>
> > By the way, my current treatment consists of:
> >
> > nortriptyline 150mg
> > Nardil 90mg
> > Lamictal 200mg
> > Abilify 20mg
> > Deplin 7.5mg
> > N-acetylcysteine 1800mg
>
> I had problems with TCA metabolism although I never did determine whether it was an interaction with something else I was on or an individual thing like a mutation in one of the cytochrome P450 genes (AFAIK 2D6 seems to be the one responsible for a lot of the interindividual variability in TCA metabolism). I tried Abilify recently; it made me jittery at much lower doses than you're on (and I already have problems with sleep). Never tried any form of folate...maybe I should.
> Incidentally: what's the NAC for? Liver issues? I've only ever heard of that being used to prevent hepatotoxicity reactions.Like acetaminophen poisoning.
It also acts as an antioxidant and a reactant in the production of glutathione, which is lower in people with mood disorders. It is a neuroprotectant of brain tissue from a loss of neurons due to the presence of chronic stress. It seems to prevent the acceleration of apoptosis.
>
> -Crotale
- Scott
poster:SLS
thread:829828
URL: http://www.dr-bob.org/babble/neuro/20080706/msgs/843007.html