Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Roslynn on March 12, 2013, at 15:41:31
Hi all,
I have now failed trials of EMSAM, Nardil and Parnate, in that order, due to intolerable, and one dangerous, side effect. Am I the only one here unable to take an MAOI? I feel very alone and these were my last hopes.
Thank you, for any input,
Roslynn
Posted by Tomatheus on March 12, 2013, at 16:48:03
In reply to Anyone else fail trials of the MAOIs?, posted by Roslynn on March 12, 2013, at 15:41:31
Roslynn,
Ultimately, none of the MAOIs worked out for me in the long run. Nardil is really the only antidepressant that ever put a significant dent in my chronic fatigue, or vegetative depression, for more than a few days at a time. However, both Pfizer's American Nardil and the Australian Nardil eventually became ineffective for me, for reasons that I suspect had more to do with changes in the medication itself than anything else, although I'm far from 100 percent certain about that. Goldshield's version of tranylcypromine (generic Parnate), isocarboxazid (generic Marplan -- a version I obtained from the U.K.), oral selegiline, and moclobemide all produced significant benefits for no more than three days at a time.
My condition is more complicated than it used to be, because about three months into a trial with a combination of Goldshield's tranylcypromine and SAM-e (a combination that's not recommended to be taken), I started experiencing cognitive problems and psychotic symptoms that I have yet to recover from six years later. Strangely enough, my chronic fatigue, or vegetative depression, is not nearly as debilitating as it used to be, but it may still be manifesting itself as mostly problems with concentration. So, basically, my depressive symptoms, though less severe than they were in the past, have become even more difficult to treat than they were in the past because of the cognitive problems and psychosis. I should probably also add that in the past, I attributed my cognitive problems and psychosis to a medication that I tried called aminoguanidine, but after I read some old e-mails that I had written, I found out that I took aminoguanidine about a month before I thought I had taken it and changed my mind about my cognitive problems and psychosis being related to my aminoguanidine use.
Anyway, I would encourage you to continue to look for any treatment options that might be available, even if you feel as if you've exhausted everything. I personally think that alternative medicine has a lot to offer to individuals with mental illnesses, as far as treatments are concerned, but like conventional psychiatry, trying to find an alternative treatment that works usually involves a lot of trial and error. Because I was frustrated with the whole trial-and-error process and felt like taking shots in the dark, so to speak, was basically getting me nowhere, I recently was evaluated at an orthomolecular treatment center. They basically just found my vitamin D level to be low and my white blood cells to be elevated (the second finding being something that I had known about because my white blood cells had kept coming back elevated when I was hospitalized), but at least the low vitamin D finding is something about my biochemistry that I know is off. So, now I'm supplementing with vitamin D, and although it's far too early to tell how I'll respond to the vitamin in the long run, I seem to be experiencing positive results from it early on.
I know that it can be discouraging when treatments don't seem to help and sometimes may even create new problems, but I somehow always end up finding something else to try even after reaching a point of thinking that I had already tried everything that was worth trying. So, I would recommend that you keep your eyes open to anything that might even potentially benefit you. And I think it would also be worthwhile to get some tests done (if you haven't already), be it with an orthomolecular doctor, a naturopathic doctor, or some other health professional, to help equip you with some information about yourself that might guide your treatment.
I don't know if anything I've said will help, but I did want to respond to your thread to let you know that you're not alone as far as being unresponsive to MAOIs (at least in the long run) is concerned and that you may still have some options, even though they may be difficult to find.
Take care,
Tomatheus
Posted by Phillipa on March 12, 2013, at 18:50:33
In reply to Re: Anyone else fail trials of the MAOIs?, posted by Tomatheus on March 12, 2013, at 16:48:03
I had no idea this happened to you. I'm so sorry. I know a poster that broke her back when on nardil and then went on become addicted to pain meds. So their seems to be a price to pay for some. Phillipa
Posted by Justherself54 on March 12, 2013, at 23:14:03
In reply to Anyone else fail trials of the MAOIs?, posted by Roslynn on March 12, 2013, at 15:41:31
I'm sorry you're feeling so alone. I tried two trials with Parnate and one with Nardil. It's frustrating and scary to feel you are at the end of the med trail. I ended up retrying meds and finally have found some degree of stability with a cocktail of a SSRI that had pooped out on me a couple of times before, but at a smaller dose, seems to be hanging in there.
Have you and your doctor considered retrying meds that worked in the past but pooped out?
Posted by SLS on March 13, 2013, at 7:00:43
In reply to Anyone else fail trials of the MAOIs?, posted by Roslynn on March 12, 2013, at 15:41:31
> Hi all,
>
> I have now failed trials of EMSAM, Nardil and Parnate, in that order, due to intolerable, and one dangerous, side effect. Am I the only one here unable to take an MAOI? I feel very alone and these were my last hopes.
>
> Thank you, for any input,
> RoslynnI am sure that you will get a bunch of ideas from the people here.
How do you react to lithium?
If you haven't tried combining drugs, it might be time to consider some aggressive polypharmacy. It is not rare that someone will need 4 - 5 drugs to obtain a robust therapeutic effect. I have my own favorites based upon my personal experience and what I have observed in others. When a MAOI is contraindicated, I think the following combinations are worth considering.
(Effexor or Pristiq) + Wellbutrin + Lamictal + Abilify
(Effexor or Pristiq) + nortriptyline + Lamictal + Abilify
(Effexor or Pristiq) + nortriptyline + Remeron
If it is determined that Lamictal is helpful, but not sufficient, adding minocycline may produce a more robust response. There is very little overlap in the actions between these drugs. If Remeron makes you feel worse, substituting it with prazosin might be worth a try.
I am under the impression that Pristiq has some clinical advantages over Effexor. Side effects of Pristiq might be more moderate, and its therapeutic effects occurring more frequently.
I hope Linkadge offers some input. His experience has been different from mine, and he might offer some very different ideas.
What other medical conditions have been screened for to explain your depression? Thyroid? Cortisol? Prolactin? Lyme? PCOS? Food sensitivities? CFS? Lupus? Diabetes? Kidneys? Estrogen? Progesterone? B12? Beta-blockers? Cortisone? Calcium?
- Scott
Posted by Roslynn on March 13, 2013, at 15:11:14
In reply to Re: Anyone else fail trials of the MAOIs?, posted by Tomatheus on March 12, 2013, at 16:48:03
Dear Tomatheus,
Thank you for your words of encouragement. I appreciate your ideas.
I'm sorry about your situation. Best to you also regarding your treatment.
Roslynn
Posted by Roslynn on March 13, 2013, at 15:15:16
In reply to Re: Anyone else fail trials of the MAOIs?, posted by Justherself54 on March 12, 2013, at 23:14:03
Dear Justherself,
Thank you for your encouragement and ideas. It helps to know I am not the only one who failed the "gold standard" of antidepressants.
What your described (retrying meds) is probably something I'll end up doing also. How long have you been on the SSRI cocktail?Thank you,
Roslynn
Posted by Roslynn on March 13, 2013, at 15:33:20
In reply to Re: Anyone else fail trials of the MAOIs? » Roslynn, posted by SLS on March 13, 2013, at 7:00:43
Dear Scott,
Thank you for your response. I'm going to put my answers below your questions...
>
> How do you react to lithium?I'm on 675mg and not seeing any benefit but have never been able to go higher due to side effects.
>
> If you haven't tried combining drugs, it might be time to consider some aggressive polypharmacy. It is not rare that someone will need 4 - 5 drugs to obtain a robust therapeutic effect. I have my own favorites based upon my personal experience and what I have observed in others. When a MAOI is contraindicated, I think the following combinations are worth considering.I'm also on Seroquel (which just puts me to sleep) and ativan. My most recent med prior to trying the MAOIs was clomipramine which lost effectiveness. Best response within the last few years was to a combo of Prozac and clomipramine which eventually pooped out.
>
> (Effexor or Pristiq) + Wellbutrin + Lamictal + Abilify
>
> (Effexor or Pristiq) + nortriptyline + Lamictal + Abilify
>
> (Effexor or Pristiq) + nortriptyline + Remeron
>
> If it is determined that Lamictal is helpful, but not sufficient, adding minocycline may produce a more robust response. There is very little overlap in the actions between these drugs. If Remeron makes you feel worse, substituting it with prazosin might be worth a try.
>
Lamictal drastically dimishes my cognitive abilities. Wellbutrin gave me facial tics. No real history on Effexor or Pristiq. With Remeron I would be very concerned about the possibility of gaining weight....Abilify made me feel agitated. Nortrip I tried on its on with no luck but it might work in combo..
>>
> What other medical conditions have been screened for to explain your depression? Thyroid? Cortisol? Prolactin? Lyme? PCOS? Food sensitivities? CFS? Lupus? Diabetes? Kidneys? Estrogen? Progesterone? B12? Beta-blockers? Cortisone? Calcium?
>
These are all good questions. Thyroid, diabetes, kidneys ok for now. Am not on beta-blockers. The rest of these questions probably need to be examined. Thank you for bringing them up and for your med suggestions!-Roslynn
Posted by SLS on March 13, 2013, at 16:57:29
In reply to Re: Anyone else fail trials of the MAOIs? » SLS, posted by Roslynn on March 13, 2013, at 15:33:20
> Wellbutrin gave me facial tics
Has ADD / ADHD been considered?
Have you tried desipramine?
- Scott
Posted by Justherself54 on March 15, 2013, at 0:03:39
In reply to Re: Anyone else fail trials of the MAOIs?, posted by Roslynn on March 13, 2013, at 15:15:16
> Dear Justherself,
>
> Thank you for your encouragement and ideas. It helps to know I am not the only one who failed the "gold standard" of antidepressants.
>
>
> What your described (retrying meds) is probably something I'll end up doing also. How long have you been on the SSRI cocktail?> Thank you,
> Roslynn
>
>
Hi!I was able to be SSRI free for a couple of months, but I then had a hard time with anger flare-ups..nothing scary..just not normally like me..so we added 50 mg. of Zoloft back with my modafinil and that seemed to settle that down and then I still take night meds for sleep.
I've tried a lot of different meds and always seem to get something (sometimes not much) out of Zoloft.
I hope you and your doctor can find a combo that can help.
I like to think now that I don't fail med trials, as it always sounds to me like I didn't try hard enough and found myself blaming myself for not being tougher. I say now that (insert med) wasn't a good fit for my brain. I don't blame myself and I don't blame the drug.
Peace..Justy
Posted by Roslynn on March 15, 2013, at 14:17:19
In reply to Re: Anyone else fail trials of the MAOIs?, posted by SLS on March 13, 2013, at 16:57:29
> > Wellbutrin gave me facial tics
>
> Has ADD / ADHD been considered?
>
> Have you tried desipramine?
>
>
> - ScottHi Scott,
I think ADD/ADHD has been ruled out. Stimulants make me tired, of all things.
I have had short-lived success with desipramine in the past.
Roslynn
Posted by SLS on March 15, 2013, at 15:12:30
In reply to Re: Anyone else fail trials of the MAOIs? » SLS, posted by Roslynn on March 15, 2013, at 14:17:19
> > > Wellbutrin gave me facial tics
> >
> > Has ADD / ADHD been considered?
> >
> > Have you tried desipramine?
> >
> >
> > - Scott
>
> Hi Scott,
>
> I think ADD/ADHD has been ruled out. Stimulants make me tired, of all things.
>
> I have had short-lived success with desipramine in the past.
>
> Roslynn
Gosh. What haven't you tried?I see that you've been around the block a few times.
Keep trying. I feel that the odds are in your favor that something will work, especially in light of your positive responses to treatment in the past.
I mentioned ADD because of the tics you described.
Have you tried memantine (Namenda)?
I wonder if D-cycloserine, currently marketed as an antibiotic anti-tuberculin, might be a substance worth adding. Like ketamine, it works on the NMDA receptor complex to reduce currents. Unlike ketamine, it acts as a partial agonist of the glycine subunit, and does not produce the adverse cognitive effects of ketamine. There are several other orally-administered compounds in development as antidepressants that work this way, but they might be a few years away from reaching market.
http://www.ncbi.nlm.nih.gov/pubmed/23174090
http://clinicaltrials.gov/show/NCT00408031
I guess you need to develop a core antidepressant treatment around which to build and add other types of drugs as adjuncts. What would be your guesses as to which antidepressants have the most potential to produce any kind of improvement?
- Scott
Posted by Roslynn on March 17, 2013, at 14:25:23
In reply to Re: Anyone else fail trials of the MAOIs? » Roslynn, posted by SLS on March 15, 2013, at 15:12:30
Hi Scott,
Thanks for your message.
My doc has been trying to get me off the seroquel and lithium for quite a while but it creates severe panic. So those are still stuck in my cocktail.
Thank you for your mention of different agents such as memantine but I am nowhere near being sophisticated when it comes to investigating or proposing new/different agents to my pdoc. I don't live anywhere like NYC where you might find the cutting-edge doctors. I am too tired to research much on my own other than coming to this board.
My best guess as to a future med would be either something from the TCA class, perhaps in combination. This because I did respond very briefly to desipramine and I got a longer response to the combo of clomipramine and prozac (probably contraindicated but my doc let me stay on it.) It was due to an overlap while I was trying to transition.
Other than that, possible Effexor (yikes) or Pristiq. I may have tried Effexor very briefly, and Pristiq I think I could have done a longer trial.Thank you for listening!
Roslynn
>
> Gosh. What haven't you tried?
>
> I see that you've been around the block a few times.
>
> Keep trying. I feel that the odds are in your favor that something will work, especially in light of your positive responses to treatment in the past.
>
> I mentioned ADD because of the tics you described.
>
> Have you tried memantine (Namenda)?
>
> I wonder if D-cycloserine, currently marketed as an antibiotic anti-tuberculin, might be a substance worth adding. Like ketamine, it works on the NMDA receptor complex to reduce currents. Unlike ketamine, it acts as a partial agonist of the glycine subunit, and does not produce the adverse cognitive effects of ketamine. There are several other orally-administered compounds in development as antidepressants that work this way, but they might be a few years away from reaching market.
>
> http://www.ncbi.nlm.nih.gov/pubmed/23174090
>
> http://clinicaltrials.gov/show/NCT00408031
>
> I guess you need to develop a core antidepressant treatment around which to build and add other types of drugs as adjuncts. What would be your guesses as to which antidepressants have the most potential to produce any kind of improvement?
>
>
> - Scott
Posted by ChicagoKat on March 18, 2013, at 19:03:54
In reply to Anyone else fail trials of the MAOIs?, posted by Roslynn on March 12, 2013, at 15:41:31
> Hi all,
>
> I have now failed trials of EMSAM, Nardil and Parnate, in that order, due to intolerable, and one dangerous, side effect. Am I the only one here unable to take an MAOI? I feel very alone and these were my last hopes.
>
> Thank you, for any input,
> RoslynnHi Roslynn,
Please don't feel alone. I have failed Nardil - it worked, but I had falls - and I have failed Parnate - had Rhabdomyolysis with that one, was in a coma in the ICU. So no more MAOIs for me, that's for sure. And like you, they were one of my last hopes. Hang in there. Hopefully there will be a solution for both of us.
Kat
Posted by Roslynn on March 19, 2013, at 15:24:29
In reply to Re: Anyone else fail trials of the MAOIs? » Roslynn, posted by ChicagoKat on March 18, 2013, at 19:03:54
Hi ChicagoKat,
It's nice to hear from you! Thank you for answering. I hope you are doing ok. I hope that we both can find something that works.
Roslynn
>
> Hi Roslynn,
> Please don't feel alone. I have failed Nardil - it worked, but I had falls - and I have failed Parnate - had Rhabdomyolysis with that one, was in a coma in the ICU. So no more MAOIs for me, that's for sure. And like you, they were one of my last hopes. Hang in there. Hopefully there will be a solution for both of us.
> Kat
>
>
Posted by ChicagoKat on March 20, 2013, at 15:05:35
In reply to Re: Anyone else fail trials of the MAOIs? » ChicagoKat, posted by Roslynn on March 19, 2013, at 15:24:29
Hi Roslynn good to meet a fellow maoi failure :)
i wish you luck, i agree that i hope we can both find a solution!
take care,
Kat
This is the end of the thread.
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