nom deplume

This pulls together a couple of posts I made recently in the medicine
newsgroup. I thought some folks here might find it of interest.
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A while ago, I passed the 20th drug mark, meaning I've tried more than
20 medications for depression by now. The good news is that I've found
tremendous benefit from medication. The bad news is that I had to try
so #&%^@!() many different ones to get to that point. Oh, well; the
good news far outweighs the bad, and I'm living testimony to the
virtues of perserverance. I'd be dead now without perserverance, and
if by some miracle I'd survived, the condition I'd be in doesn't bear
thinking about.

That said, I thought I'd share with the group some of the medications
I've tried in the last year. Here they are, along with the results.

Moclobemide (Reversible MAO inhibitor): Boosts serotonin,
norepinephrine, and dopamine concentrations.This is the weakest MAOI,
and has no effect on me at all.

Selegiline (MAO-B inhibitor): Boosts dopamine concentration directly,
norepinephrine indirectly.Wow! What a boost! Energy, libido, and
generally good feelings. Some problems with insomnia at the higher
doses, but no problems with diet. I can eat anything I like.

L-Tryptophan. Non-prescription serotonin precursor: No effect.

Parnate (The classic nonselective MAO inhibitor): Boosts serotonin,
norepinephrine, and dopamine concentrations. No beneficial effect.
Makes me very tired, and completely eliminates any trace of libido.
Cannot eat cheese.

Strattera (norepinephrine reuptake inhibitor): Big energy boost. Feels
good, but no libido enhancement. I need my dopamine.

Toprolol (beta blocker): Feel tired. No benefit.

Klonopin (benzodiazepine): Boosts GABA concentration. Feeling sleepy.
Verry sleepy. Bzzzz.....

Gabitril (GABA reuptake inhibitor). Boosts GABA concentration. Feeling
sleepy. Verry sleepy. Also headachy and generally sick.

I'm now taking selegiline and cabergoline (a dopamine agonist). This
seems a pretty good combination for me.

To summarize:
==========
Anything that boosts serotonin is bad for me. It suppresses libido,
and does nothing good. My serotonin concentration seems to be just
fine, thank you. My problems are elsewhere.

Meds that boost GABA may be OK for an occasional sleeping pill, but
not for anything else.

Meds that boost norepinephrine and dopamine, or substitute for
dopamine (e.g. dopamine agonists) are good for me. I need them to feel
(and very likely stay) alive.

Finally, I seem to have a mild case of hypothyroidism, which I'm
treating with Synthroid. I had been taking Synthroid for years with no
obvious benefit, and stopped for a year. My energy slowly declined, as
did my blood levels of thyroid hormones, so apparently I do need it.
However, neither thyroid hormones nor the psychotropics alone suffice.
I need the combination.

Closing thoughts:
===========
MAO inhibitors are the boogey-men of psychotropics. They shouldn't be.
They aren't difficult to take, and dietary restrictions are not
draconian. Also, dietary restrictions don't apply at all with
moclobemide (of course, it is a pretty weak drug), and apply to
varying degrees with selegiline, depending on individual sensitivity,
but aren't nearly as stringent as they are for Parnate, Nardil, and
Marplan. These drugs are worth considering if reuptake inhibitors
aren't doing the job. There is no need to exhaust all possible
alternatives first.

Finally, I really like selegiline. Now *there* is a drug with lots of
potential, that almost no one knows about.
---


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I've tried the range from 10 - 40 mg per day. At 10 mg per day, I saw
a noticeable improvement in mood and energy. I found modest
improvement up through 30 mg, but had problems with insomnia. At 40
mg, I began to feel sick: Headaches, fatigue, mild nausea.

I measured my blood pressure before and after eating my standard
tyramine benchmark (known as a small cheese pizza from a local
restaurant). At 30 mg, there was a 6-point rise in blood pressure
within an hour following the meal. This was statistically significant,
but less than the daily fluctuations of my blood pressure, and so I
concluded it was not medically significant. At 40 mg, which I couldn't
tolerate anyway, the blood-pressure rise was more like 20 points,
which is too high. So the bottom line for me was that I could eat as
much cheese as I felt like while taking higher doses of Selegiline
than were optimum.

This does not qualify as a recommendation that you take the same dose
and eat the same foods as I did. My recommendation is that you buy a
blood pressure gage and measure your blood pressure routinely, as I
did, before and after meals that might affect it, and determine your
own sensitivity to tyramine in your diet. Individual sensitivity can
vary widely, and it is much better to measure your own, than to wing
it.

I concluded that I needed a lower ratio of stimulant to dopaminergic
effects than I could get with Selegiline alone. So now I'm taking 10
mg Selegiline daily, which provides a good level of stimulant effect
without causing insomnia, and a noticeable dopaminergic effect,
combined with 2 mg Cabergoline weekly, which provides additional
dopaminergic effect without a stimulant contribution. I may tweak the
doses a bit over time, but right now this seems like a pretty good
combination.

The benefits of Selegiline do not last for me after I stop the dose.
They fade away about as fast as they appear in the first place, over
3-5 days. As for long-term benefits distinct from what I've already
described, I can't say at this point. I can say that I haven't noticed
any diminution of its effectiveness.


--
Nom dePlume, Ph.D

Why, yes, in fact, I am a rocket scientist.

Guide to Medications for Mental Illness:
http://www.geocities.com/nomdeplume1000
=====

doug laidlaw

Wow, NDP, 20 tries!! I thought that I had tried a few. I am currently
doing quite well on Efexor. I started in the 1970's on Stelazine (an
anti-anxiety drug, with artane, an anti-Parkinsonism drug, for the side
effects). Then amitriptyline/nortriptyline (tricyclics) then Celexa then
Efexor (both SRIs). I also tried Parnate at one stage, and lithium. I
tried Prozac (SRI), but it did nothing for me. Before settling on Efexor,
I briefly tried Avanza (mirtazapine) and another one I just can't remember
the name of at present. Everyone is unique, and the best combination is
found by trial and error. The fact that you have settled on a MAO
inhibitor and I on a SSRI, underlines this. A relative did well on Prozac.
I note that MAO inhibitors still have the tyramine problem. I haven't used
benzos for depression, but in general, they don't agree with me. I don't
seek to interfere directly in the choice of medication or its dosage, just
to co-operate and report as fully as possible. All the above were
suggested by my doctor at the time. That is one culture difference between
the U.S. and Australia. The patient is definitely not encouraged here (or
qualified) to enter the debate about these issues. As the cost of our
pharmaceutical benefits scheme continues to rise, attempts are being made
to reduce drug usage, but they involve pharmacists and doctors as
intermediaries.

Doug.
--
ICQ Number 178748389. Registered Linux User No. 277548.
Remember when life's path is steep to keep your mind even.
- Horace (65-8 B.C.)