![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 54. Go back in thread:
Posted by Elizabeth on January 3, 2000, at 9:33:11
In reply to Re: Parnate Update-Thanks!, posted by Scott L. Schofield on January 2, 2000, at 11:28:10
> > By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
>
> If it ain’t broke, don’t fix it.
> It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.Any properties I should know about?
Posted by cn. michele on January 3, 2000, at 11:41:59
In reply to Parnate "properties" :), posted by Elizabeth on January 3, 2000, at 9:33:11
> > > By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
> >
> > If it ain’t broke, don’t fix it.
> > It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.
>
> Any properties I should know about?I am thinking about Parnate for relief of GAD/depression would you mind posting any side-effects your have experienced with this drug. Thanks, Michele
Posted by Frymet on January 3, 2000, at 15:42:22
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Did your doctor check you kidney function?
Lithium can cause kidney problems and perhaps the combination may increase the possibility.
Posted by Scott L. Schofield on January 3, 2000, at 17:01:24
In reply to Parnate "properties" :), posted by Elizabeth on January 3, 2000, at 9:33:11
> > It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.
>
> Any properties I should know about?When I get a chance, I'll see if I can find some of the stuff about it. I'm sure you would be quite interested to know about them, but nothing I read indicates any kind of risk involved with these dosage-emergent pharmacodynamic effects.
- Scott
Posted by S. Suggs on January 3, 2000, at 18:55:50
In reply to Parnate Update-response to S.Snuggs, posted by Frymet on January 3, 2000, at 15:42:22
>
> Did your doctor check you kidney function?
> Lithium can cause kidney problems and perhaps the combination may increase the possibility.Just curious, what type of kidney function test are you mentioning. (I believe in leaving no stones unturned - no pun intended). Thanks and many blessings,
S. Suggs
Posted by Elizabeth on January 4, 2000, at 19:26:47
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 3, 2000, at 17:01:24
> When I get a chance, I'll see if I can find some of the stuff about it. I'm sure you would be quite interested to know about them, but nothing I read indicates any kind of risk involved with these dosage-emergent pharmacodynamic effects.
Thanks -- I'd appreciate that. I am interested to hear what you've found about high-dose Parnate. I'm thinking seriously of switching back due to weight gain on Marplan. I suggested maybe trying to figure out a way to get the Parnate dose a little higher than I did before, which my pdoc referred to -- with a smile -- as "cowboy psychopharmacology." :-)
Posted by Adam on January 4, 2000, at 22:07:09
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 4, 2000, at 19:26:47
>I suggested maybe trying to figure out a way to get the Parnate dose a little higher than I did before, which my pdoc referred to -- with a smile -- as "cowboy psychopharmacology." :-)Not trying to be a pain here...
I'd be very interested in hearing about this "cowboy psychopharm." if and when you can share such info. (I promise no more talk of selegiline, or anything else!...I'm just interested)
Thanks! :)
Posted by Michael on January 5, 2000, at 5:54:08
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
> I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
>
> S. SuggsHaving been on Parnate for many years, I also experience cold intolerance. Fortunately, there are few other side effects.
Posted by S. Suggs on January 5, 2000, at 6:15:20
In reply to Re: Parnate Update, posted by Michael on January 5, 2000, at 5:54:08
Michael, thanks for the reply. The cold intolerance is a minor side effect that I can put up with. What I've also noticed is a huge improvement in the social aspect. For ex. while at Home Depot (wood worker and tool freek) I,m talking briefly to strangers and just being plain nice. Also, when the Parnate wears off, I do crash (get sleepy), this is fine since I end up getting a full and restful nights sleep. For years I never slept well. It's good (I've tried so many AD's).
My main question to you is what is your dose of Parnate, I'm at 60?
Blessings,
S. Suggs
Posted by Elizabeth on January 5, 2000, at 19:31:05
In reply to Re: Parnate "properties" :), posted by Adam on January 4, 2000, at 22:07:09
> I'd be very interested in hearing about this "cowboy psychopharm." if and when you can share such info.
I'm sort of confused by this...can you rephrase the question please?
Posted by Phillip Marx on January 6, 2000, at 1:31:01
In reply to Re: Parnate Update-Thanks!, posted by ann faber on January 1, 2000, at 21:12:35
> >Also, I have an odd question-has anyone experienced that their urine smells like burnt rubber with use of Nardil? Kind of like after you eat asparagus. Good luck with your explorations.
>
> ann.Burning rubber smell (urine?)
http://www.childrenwithdiabetes.com/dteam/1999-06/d_0d_3wu.htm
http://www.med.harvard.edu/AANLIB/cases/case25/mr1/013.html
http://williamcalvin.com/bk7/bk7ch5.htm
http://www.google.com/search?q=burning+rubber+smell+urine&num=10&sa=Google+Search
I’m going to be asleep in a few minutes so I can’t say more.
Lucky us.
pm
Posted by Noa on January 6, 2000, at 6:17:11
In reply to --burnt rubber - urine--, posted by Phillip Marx on January 6, 2000, at 1:31:01
> I’m going to be asleep in a few minutes so I can’t say more.
>
> Lucky us.
>
> pmPhillip, LOL. I am glad to see you have a good sense of humor.
Posted by Adam on January 6, 2000, at 12:38:04
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 5, 2000, at 19:31:05
> > I'd be very interested in hearing about this "cowboy psychopharm." if and when you can share such info.
>
> I'm sort of confused by this...can you rephrase the question please?Sure. If I remember correctly, one of the difficultites you had with Parnate was recurrent spontaneous hypertensive crisis at a relatively low (but promisingly therapeutic)dose. I assume "cowboy psychopharmacology" might refer to creative, perhaps unorthodox, strategies to increase Parnate dosage while minimizing or eliminating ill effects. If the above is true and you are comfortable discussing, I would be interested in hearing what you are trying and how it is working.
Thanks again!
Posted by Phillip Marx on January 6, 2000, at 14:04:08
In reply to Phillip has a sense of humor!, posted by Noa on January 6, 2000, at 6:17:11
How could I have been more to the point and still had my point missed? Re-synchronize target points. Target below: Center dot first. First concentric ring second. Second concentric ring third. Fourth: bales of hay backguard. Fifth: contest arena. Sixth: prizes for all participants.
Ann, There are some internet hints at what you are asking. The first one is almost congruent, had only a "not here" for an answer, but shows you aren't alone.
The second specifically identifies which part of the brain is damaged by an encephalitis (brain infection) that could be caused by a Herpes virus. These can be fatal if not treated with acyclovir. The danger stage is apparently synchronous with a hallucinatory or distorted, off-true, olfactory sense. Be prepared. A preserved sample specimen could uncapsize a diagnostic drift towards that direction. Presentation of such a sample to an actual urologist might be the smartest place to start next, since neuropsychiatrists are preoccupied with neuropsychiatric faults matched to symptoms.
Another related to actual hallucinations of smells, which ref I lost, too much of a stretch to apply to you, since yours seemed annoyingly persistent and oriented as to time and place, which isn't always a hallucination disqualifier. For thouroughness though, it should be in your information collection so that you can have your diagnosis re-centering rebuttals in place for oddball pitches and games. The faster that trash gets identified as trash, the faster it gets thrown out. If it's not true and they won't give it up, then bail out, find a plane with a better pilot.
The fourth is a localized brain seizure/false activation disorder they may very evasively try to rule-out. Patient worry avoidance tactics can result in patient sensitivity testing for a given subject that skirt the subject from such a distance you will never know what it is you might have had. Prep-up. Fix-up fears should be far less that never-fixed-up fears.
I'd draw the 3-D diagnostic tree-molecule-cloud, with the cloud envelope, the fog-globs and all, but my data bank is too empty from insufficient deposit. I'd be critically afraid to post it.
Hmmm. I'm not so sure what was funny. I try to put a little anti-depressant (humor) spin in nearly everything I write, maybe if I didn't spread it out so much I would do better. All this perception from the inside out stuff is interesting to me since I come from the world that looks at the inside from the outside. This is sure harder than fixing mere computers.
> >Also, I have an odd question-has anyone experienced that their urine smells like burnt rubber with use of Nardil? Kind of like after you eat asparagus. Good luck with your explorations.
>
> ann.
Burning rubber smell (urine?)A nearly identical question from elsewhere.
I might add, is it a sulphurous burning rubber?
Any sulphates from foods or pills being excreted? Any nervous eraser chewing? Any unstable enemies near your food? Twinkies?
> > I’m going to be asleep in a few minutes so I can’t say more.
> >
> > Lucky us.
> >
> > pm
>
> Phillip, LOL. I am glad to see you have a good sense of humor.Though I'm glad to have something that gets me to sleep real fast if I run around my block, sometimes I'd like to learn to stretch it a few minutes more easily.
pm p.s. Fun sites showing the perceptions of those with "outside-in" perspective:http://www.crd.ge.com/esl/cgsp/projects/medical/
http://www.williamcalvin.com/
http://www.med.harvard.edu/AANLIB/home.html
http://www.indiana.edu/~primate/
http://www.cs.utexas.edu/users/nn/web-pubs/htmlbook96/
http://www.nlm.nih.gov/research/visible/
http://metalab.unc.edu/jstrout/uploading/MUHomePage.html
http://www-hbp.scripps.edu/HBP_html/HBPsites.html
http://sulcus.berkeley.edu/
http://www.wjh.harvard.edu/~kwn/kosslab.html
http://www.bic.mni.mcgill.ca/
http://hebb.uoregon.edu/brainlab/belHome.html
http://www.wlu.edu/~web/bp/brainpk.html
http://faculty.washington.edu/chudler/ehc.html
http://www.neuropsychologycentral.com/index.html
http://www.neuroscience.cnter.com/
http://www.neuroguide.com/
http://neuro-www2.mgh.harvard.edu/MIND/Poetry/submit.html
http://neuro.med.cornell.edu/VL/
I can't get a couple of others to still work, later maybe. A few of these are really different from when I last looked. Endless mindfullness.
pm
Posted by Elizabeth on January 7, 2000, at 8:54:00
In reply to Re: Parnate "properties" :), E, posted by Adam on January 6, 2000, at 12:38:04
> Sure. If I remember correctly, one of the difficultites you had with Parnate was recurrent spontaneous hypertensive crisis at a relatively low (but promisingly therapeutic) dose. I assume "cowboy psychopharmacology" might refer to creative, perhaps unorthodox, strategies to increase Parnate dosage while minimizing or eliminating ill effects. If the above is true and you are comfortable discussing, I would be interested in hearing what you are trying and how it is working.
Aha. Okay. I'm still on Marplan right now, but considering returning to good ol' Parnate because of that insidious weight gain.
One thing my therapist suggested when I mentioned this to him was to try adding verapamil or some other Ca++ antagonist to the Parnate to keep my BP stable.
I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)
Posted by Adam on January 7, 2000, at 9:51:32
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 7, 2000, at 8:54:00
>
> Aha. Okay. I'm still on Marplan right now, but considering returning to good ol' Parnate because of that insidious weight gain.
>I HATE that.
> One thing my therapist suggested when I mentioned this to him was to try adding verapamil or some other Ca++ antagonist to the Parnate to keep my BP stable.
>
Thanks for sharing!> I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)
Best of luck to you!
Posted by Scott L. Schofield on January 8, 2000, at 20:35:29
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 7, 2000, at 8:54:00
> Aha. Okay. I'm still on Marplan right now, but considering returning to good ol' Parnate because of that insidious weight gain.
>
> One thing my therapist suggested when I mentioned this to him was to try adding verapamil or some other Ca++ antagonist to the Parnate to keep my BP stable.
>
> I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)
Do you discontinue MAOIs all at once or do you gradually taper off of them? I know it would protract the time necessary to wait before starting Parnate, but might not weaning prevent any disturbances that would otherwise affect function? I have discontinued MAOIs abruptly many times. Unfortunately, the withdrawal syndrome seems to be less severe now than it was early on. I’m not sure I like the idea of a drug leaving less of an “impression” on the system as to allow for reduced side-effects or a milder withdrawal. Anyway, I am curious as to which withdrawal phenomena bother you most. I no longer seem to experience either the REM suppression during treatment or the REM rebound of withdrawal. I do continue to have the “lightening bolt” type thing going on, though.The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties. There was some thought initially that the L-type calcium-channel blockers, such as nimodipine, might be more effective at regulating mood. The more recent stuff I have come across does not support this contention. What’s more, nimodipine is prohibitively expensive to use on a regular basis. (I believe its primary use is to mitigate the damage that immediately follows a CVA). You may want to look into how ACE-inhibitors compare to CA++ channel blockers regarding their efficacy in counteracting sympathomimetics in general and amphetamines in particular.
My gut feeling is that it might be wise to continue the semester without making any major changes, the results of which, for you, are unpredictable. When I was younger, and a bit more handsome, I was confronted with a similar situation. I began seeing a new doctor about a month before I was to be married. After a battery of psychometric exams (pretty cool stuff) and a detailed review of my history, he wanted to try a combination of Parnate and Norpramin. I was not receiving any treatment at the time. However, I knew that I could count on what little I had to work with to remain available and stable. The wedding went great (unfortunately, the marriage did not), and I waited until I felt the time was right to take the risk of losing some degree of function. I believe it was the right decision for me.
If Marplan has helped you, I imagine you feel smarter because of it. It might be a good idea to use the extra smartness to ace your courses, then wait until summer to lose the extra weight. I dunno. I sure wish I had some extra smartness to work with.
Good Luck !!!
Get Well.
- Scott
Posted by Elizabeth on January 9, 2000, at 5:25:13
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 8, 2000, at 20:35:29
> Do you discontinue MAOIs all at once or do you gradually taper off of them? I know it would protract the time necessary to wait before starting Parnate, but might not weaning prevent any disturbances that would otherwise affect function?
I try to compromise between the above-mentioned rock and hard place by tapering off but not too extremely slowly. (Quitting all at once would just be *bad*.) I've had nasty withdrawal symptoms each time I d/c'd MAOIs nonetheless.
Also, I'm under some time pressure to switch, since the new semester begins in just a few weeks.
> Anyway, I am curious as to which withdrawal phenomena bother you most. I no longer seem to experience either the REM suppression during treatment or the REM rebound of withdrawal. I do continue to have the “lightening bolt” type thing going on, though.
I never got the "lightening bolts." For me it's REM rebound (especially bad because of my sleep disorder), hypersomnia, agitation, panic attacks, and moodiness.
> The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
(Note: I'm not bipolar.)
> You may want to look into how ACE-inhibitors compare to CA++ channel blockers regarding their efficacy in counteracting sympathomimetics in general and amphetamines in particular.
Good plan; the ACE inhibitors also are thought not to cause depression, whereas it is believed that other antihypertensives may.
> My gut feeling is that it might be wise to continue the semester without making any major changes, the results of which, for you, are unpredictable.
They're pretty predictable, both for better and for worse. I really wonder what all this weight yo-yo-ing is doing to me.
When I was younger, and a bit more handsome, I was confronted with a similar situation. I began seeing a new doctor about a month before I was to be married. After a battery of psychometric exams (pretty cool stuff) and a detailed review of my history, he wanted to try a combination of Parnate and Norpramin. I was not receiving any treatment at the time. However, I knew that I could count on what little I had to work with to remain available and stable. The wedding went great (unfortunately, the marriage did not), and I waited until I felt the time was right to take the risk of losing some degree of function. I believe it was the right decision for me.
> If Marplan has helped you, I imagine you feel smarter because of it. It might be a good idea to use the extra smartness to ace your courses, then wait until summer to lose the extra weight.
Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)
> I dunno. I sure wish I had some extra smartness to work with.
Me too.
> Good Luck !!!
> Get Well.:) Thanks!
Posted by Seamus on January 9, 2000, at 10:39:16
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Suggs,
On Parnate many years at 30 mg/day.
The cold feet and hands finally bothered me so much that I insisted on adding thyroid to me regime, despite "normal" TSH levels.STarted w/ .5 grain Armour, it helped. Upped it to 1 gr. and am happy as a clam. No gross adverse effects -- dropped a few pounds, but no palps, temp still 97.5.
I would definitely give it a try, the risk/reward ratio is pretty low.
Seamus
Posted by Scott L. Schofield on January 9, 2000, at 10:54:46
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 5:25:13
> > The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
> (Note: I'm not bipolar.)
> Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all. I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy. If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
Sorry, gotta go…
- Scott
Posted by S. Suggs on January 9, 2000, at 19:32:09
In reply to Re: Parnate Update, posted by Seamus on January 9, 2000, at 10:39:16
Hello Seamus: I'll mention this to my doc on my next visit. Thanks and Blessings,
S. Suggs
Posted by Scott L. Schofield on January 9, 2000, at 20:08:55
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 10:54:46
> > > The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
>
> > (Note: I'm not bipolar.)
>
> > Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)
>
> I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all. I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy. If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
>
> Sorry, gotta go…
>
>
> - Scott
To continue…I imagine if you were bipolar, mania would probably have made an appearance by now. You seem to have challenged the system with enough antidepressants and med-changes to trigger it were you to have that potential. Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin. I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria. I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
I think I mentioned in an earlier post that I came across something on one of the newsgroups that purported to list bipolar subtypes being considered for adding to a future DSM. I think there were five total. One of them described a presentation in which any manias that occur are due to some drug intervention. I think I qualify for that one. The last on the list really surprised me. It described a bipolar subtype in which mania *never* occurs. This actually makes sense to me. Additionally, I think it makes sense to consider some cases as being “soft-bipolar”, a term that I came across recently. Without going back to find the literature, I think I remember cyclothymia as being an example of this. Treating these presentations as if they were bipolar was advocated, as well as the notion that these may represent precursor conditions to “hard” bipolar illness.
I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic. Have you ever been successfully treated? I think that if I were in your position, should I find a treatment that works, I would stick with it indefinitely. Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant. A patient is best maintained at the dosages that got them well in the first place. Dr. Kupfer is one of the few investigators who have studied the course of treatment of his patients longitudinally.
- Scott
Posted by Elizabeth on January 9, 2000, at 20:41:36
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 20:08:55
> > I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all.
I started it to augment Parnate. I'm pretty sure I've discussed this here before: I was nondepressed but still had anhedonia on Parnate, added 600mg of lithium and suddenly I was enjoying going out, eating, sex, music, etc. again. Now I'm trying tapering off the lithium to see if I can manage without, because of the attention side effect.
There's no evidence that verapamil augments ADs in unipolar depression, some evidence that it doesn't, and I think there have even been reports of it triggering or exacerbating depression. See why I'm a tad concerned?
> I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy.
I'm a walking testament to this!
> If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
Nope. Depakote didn't do a thing when I took it with Parnate. They're not all identical, and lithium is by far the best-studied.
> I imagine if you were bipolar, mania would probably have made an appearance by now.
It did, when I was taking Effexor, but it was in the context of serotonin syndrome. I think I may have been a tad hypomanic (mixed) on Paxil.
> Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
What is the "typical bipolar profile?"
> Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin.
How was that combination for you? Any side effects? Do you recall what doses you were on?
> I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria.
Ow. Mixed mania is the most horrible mood state, I think.
> I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
Manic episodes that happen when you're taking antidepressants aren't supposed to count towards a diagnosis of bipolar disorder, no. But some people who don't have spontaneous manic episodes nevertheless become manic on ADs...in these cases ("bipolar III" is a term I've heard used by researchers and clinicians -- I've never heard the list you mention except posted on the internet), a mood stabilizer seems indicated.
> I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic.
Yes, it is.
> Have you ever been successfully treated?
Sure. MAOIs work well for my depression, but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble. I also have some irritating problems with MAOI side effects: Parnate causes spontaneous hypertensive episodes while Nardil and Marplan cause sugar cravings and weight gain!
> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!)
Posted by Seamus on January 10, 2000, at 19:37:32
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 20:41:36
>> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
>Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!) <<
I agree w/ that "old idea". W/ MAOI's, it's been my experience you have to go "up and over" -- _then_ back down to achieve a steady state of "euthymia."
I also think that there's no such thing as a maintenace dose. From Oct. 1st to Feb 1st, I need to up my Parnate dose else I'm susceptible to the weepies. If you're fond of labels, perhaps you might say I have a SADD syndrome. No matter, what I do works, and keeps me working and loving.
The point is, listen to the patient. Balance the risk/reward ratio. Who knows better about my inner state: me or my doctor?
Seamus
Posted by Mrs. G on January 10, 2000, at 21:02:09
In reply to Phillip has a sense of humor!, posted by Noa on January 6, 2000, at 6:17:11
Phillip is truly fascinating. Hey, aren't we all reading and replying to this wonderful site because of our own "psych problems?" I think maybe Phillip is WAY smart. Wish I were so articulate. Tell us a little about yourself. So interesting. To those who can't "take it", don't read it. Simple solution.
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