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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Seamus2 on November 6, 2000, at 21:02:48
History of unipolar major depression for twenty years. Stable for the past 10 using MAOI's, the last 7 on Parnate 10 mg BID or TID during winter months (Oct - Feb).
"Drug vacations" lead to another episode sooner or later, so I've been pretty cautious and taken my maintenance doses regularly. I discontinued the Parnate end of July and was okay until beginning of October (start of the SAD season, always predisposing) at which time I started Amisulpride 50 mg/day because I was starting to slip. I got an immediate "lift" out of it; or rather, it lifted me. The effect was subtle, but my mood and affect seemed to have more bouyancy. No side effects except for slighly limper erections.
Added Adrafanil 100 mg BID two weeks ago to combat anhedonia and improve motivation, and except for some mild psychmotor activation (nervous tics, pacing) I'm starting to slip again. So far I haven't noticed it does much.
Question for the gallery: Do I increase the Amisulpride to 100mg/day or do I decrease it to 25/day? Should I give the Adrafanil another few weeks, or should I push the dose to 200 mg BID. Or both?
Thanks,
Seamus
Posted by SLS on November 6, 2000, at 22:05:37
In reply to Amisulpride: Adjust Dose Up or Down?, posted by Seamus2 on November 6, 2000, at 21:02:48
Dear Seamus,
I think you might be better served by taking your vacations in Jamaica and bringing your Parnate along with you.
:-)
Seriously.
If I were you, I would take whatever works indefinitely without disruption. Your history indicates that this is probably in your best interests. There is a tendency for someone to become more and more difficult to treat with subsequent depressive episodes (relapses). To discontinue a drug and restart it often results in its diminished effectiveness.
Unless there are significant adverse effects when you take 30mg of Parnate, I don't see any advantage to reducing the dosage to 20mg. Keep the system stable (homeostasis).
If you cannot find an alternate treatment to Parnate, I would suggest that you carefully consider taking Parnate 30mg or more for the rest of your life. You don't want to endanger your responsiveness to the only drug that works for you.
It is not such a big deal once you accept it.
Really.
Sincerely,
Scott
> History of unipolar major depression for twenty years. Stable for the past 10 using MAOI's, the last 7 on Parnate 10 mg BID or TID during winter months (Oct - Feb).
>
> "Drug vacations" lead to another episode sooner or later, so I've been pretty cautious and taken my maintenance doses regularly. I discontinued the Parnate end of July and was okay until beginning of October (start of the SAD season, always predisposing) at which time I started Amisulpride 50 mg/day because I was starting to slip. I got an immediate "lift" out of it; or rather, it lifted me. The effect was subtle, but my mood and affect seemed to have more bouyancy. No side effects except for slighly limper erections.
>
> Added Adrafanil 100 mg BID two weeks ago to combat anhedonia and improve motivation, and except for some mild psychmotor activation (nervous tics, pacing) I'm starting to slip again. So far I haven't noticed it does much.
>
> Question for the gallery: Do I increase the Amisulpride to 100mg/day or do I decrease it to 25/day? Should I give the Adrafanil another few weeks, or should I push the dose to 200 mg BID. Or both?
>
> Thanks,
>
> Seamus
Posted by JohnL on November 7, 2000, at 4:04:18
In reply to Amisulpride: Adjust Dose Up or Down?, posted by Seamus2 on November 6, 2000, at 21:02:48
If Parnate worked for you, then as SLS said you might have to consider going back to it. That is, if it worked. I know you were on it a long time, but no mention of how well it actually worked or not during that time.
But since you are already into treatment with other drugs, I personally would want to exhaust all options with those first before throwing in the towel. But that's just me. I think every option you mentioned could be tried. Often just a little tweeking one way or the other can make all the difference. With Amisulpride you could try going up to 100mg, then after that change has been in place a week, double the Adrafinil dose too. Just don't do both at the same time like I did, because then it becomes impossible to tell which change made the difference.
I found 25mg Amisulpride+ 200mg Adrafinil to be pretty good. I found 50mg Amisulpride + 200mg Adrafinil better. I found 100mg Amisulpride + 200mg Adrafinil better still. I found 100mg Amisulpride + 400mg Adrafinil the best of all.
You've noticed limper erections though? Damn. Me too. That's the one and only side effect that has me really bothered.
John
Posted by Seamus2 on November 7, 2000, at 9:47:19
In reply to Re: Amisulpride: Adjust Dose Up or Down? » Seamus2, posted by SLS on November 6, 2000, at 22:05:37
> Dear Seamus,
>
> I think you might be better served by taking your vacations in Jamaica and bringing your Parnate along with you.Would you settle for India for three weeks in January? < g >
>
> It is not such a big deal once you accept it.
>
> Really.Took a good number of years before I finally did accept that I need to take it just as a diabetic needs to take insulin, but Parnate does have side effects I could do without. I've started and stopped numerous times and it's always worked quickly and effectively when I reinstate it, so if the trial of Amisulpride doesn't work I'll switch back without hesistation.
But I want to give Amisulpride a fair trial and am wondering which way to adjust the dosage. I believe SLS (whose reply I haven't read yet) takes just 25 mg/day.
Thanks for the reply.
Seamus
Posted by Seamus2 on November 7, 2000, at 10:03:44
In reply to Re: Amisulpride: Adjust Dose Up or Down?, posted by JohnL on November 7, 2000, at 4:04:18
> I found 25mg Amisulpride+ 200mg Adrafinil to be pretty good. I found 50mg Amisulpride + 200mg Adrafinil better. I found 100mg Amisulpride + 200mg Adrafinil better still. I found 100mg Amisulpride + 400mg Adrafinil the best of all.
Ah, that's what I was looking for! I had you and SLS mixed up in my reply to him. I think he takes 25 mg/day. I'll bump the Amisulpride to 100 mg/day and hold the Andrafanil steady for two weeks so not to confound the results. Thanks for the feedback.
>
> You've noticed limper erections though? Damn. Me too. That's the one and only side effect that has me really bothered.My guess is hyperprolactinemia. My very first AD was amoxapine, distant cousin to the thorazine family if I recall correctly. Did the same thing, only worse. Incidently, I tried bromocriptine to augment DA when I was on Nardil a zillion years ago and is made me spacey and light-headed, so beware if you try this intervention.
I had my GP run a testosterone check because frankly my libido has been borderline for years and replacement therapy has been shown to improve mood. Results aren't back yet, but I'll be mighty curious if she starts me on the shots.
Thanks for the reply. Now to hear from Andrew...
Seamus
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