Posted by TH on May 17, 2019, at 16:32:03
In reply to Re: Tranylcypromine - Fluctuating Effects » TH, posted by SLS on May 17, 2019, at 11:15:30
Thanks for your input, Scott.
As far as medication changes, I am hesitant to do anything dramatic as Tranylcypromine has been the only useful therapy of the handful I have trialed.
Ideally, I'm hoping that it can remain a viable monotherapy. I dread the idea of adding / changing to drugs like TCAs; my brief experience with the H1 antagonism of Quetiapine was fairly unpleasant. Tranylcypromine has felt very clean and it would be a shame to lose that, however if I do reach a point of desperation, the potential benefit may begin to outweigh the cost.
If, after several weeks / months, this cycle remains, my first action would probably be to begin increasing the dose of TCP, however I am somewhat concerned about the possibility of repeatedly increasing dose if it is not the problem. Not that there would be any real way of knowing without trying.
Failing that, Lamotrigine or Lithium augmentation does seem like a suitable next step.
One roadblock to this is that my prescription for Tranylcypromine has been granted by a supportive GP. While I am grateful he has taken the chance with me, I'm sure that there would come a day where an ever escalating series of requests for psychiatric drugs would be too much for him to tolerate. The official New Zealand guidelines suggest a dose of 20 - 30mg TCP, so even pushing far beyond that may be an unreasonable request. Before seeking any radical medication regimes it would probably be wise to seek management under a psychiatrist, ideally one with experience using MAOIs. This could prove to be quite the search.
I have never trialed Phenelzine, so this may be another option, however its sedative effects do make it seem less attractive than Tranylcypromine.
One thing that makes me strongly suspect something strange is the fact that these periods of wellness are accompanied by the now familiar side effects and sensations of the drug, where as the periods of low mood are accompanied by their complete disappearance. It is as if, overnight, I had reverted to an unmedicated state.
At this point I don't feel that any dramatic changes are justified; for the most part I am very happy with Tranylcypromine. It has been the greatest glimmer of hope since this whole mess began. I am holding onto the idea that things will continue to improve and these effects will stabilize with time, and that any remaining fluctuation / defecit may be manageable with lifestyle change, or even simply be tolerable as a best case scenario. Things would have to turn for the worse before I seriously consider further medication adjustments.
poster:TH
thread:1104415
URL: http://www.dr-bob.org/babble/20190513/msgs/1104446.html