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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by tom2228 on May 23, 2014, at 8:52:34
Hey Scott,
I saw a new (amazing) doc yesterday who said he contacted STAHL (!!) about my case -- who said that Desoxyn + an MAOI + TCA is safe.
I am taking still taking 22.5mg Desoxyn + 40mg Marplan + now 25mg desipramine (titrating, switched from nortriptyline), + all the rest.
Hope you're well,
Tom
Posted by SLS on May 23, 2014, at 10:28:05
In reply to Desoxyn with MAOIs --) SLS, posted by tom2228 on May 23, 2014, at 8:52:34
> Hey Scott,
>
> I saw a new (amazing) doc yesterday who said he contacted STAHL (!!) about my case -- who said that Desoxyn + an MAOI + TCA is safe.
>
> I am taking still taking 22.5mg Desoxyn + 40mg Marplan + now 25mg desipramine (titrating, switched from nortriptyline), + all the rest.
>
> Hope you're well,
> Tom
OMG! Desoxyn? Isn't that a potent serotonin releaser? Perhaps a selective releaser, and not a reuptake inhibitor, allows for the combination without precipitating serotonin syndrome. I am glad that your doctor is now unafraid to add desipramine. It can be a squirrely drug at first. It will feel harsh compared to nortriptyline. You might experience a feeling of being "wired" or uncomfortably energetic. You will notice your accelerated heart rate. You might experience palpitations. Even though desipramine is devoid of anticholinergic activity, the effects of a hyperadrenergic state will mimic the more familiar anticholinergia. These things may lessen over time, but not disappear entirely. Still, the side effects are relatively minor compared to the powerful antidepressant properties desipramine can exert.I'm doing okay. I am in the midst of discontinuing nortriptyline. I have already discontinued Abilify (amotivation / laziness) and minocycline (hyperpigmentation of the feet, ankles, and shins). I experienced withdrawal phenomena for discontinuing both drugs. Discontinuing Abilify produced an brief acute depression immediately and a more extended, albeit less severe, depression a few weeks later. Discontinuing minocycline produced a profound fatigue that felt much like an amphetamine let-down. This lasted for about a week.
My doctor suggested that I may no longer need the nortriptyline since adding prazosin. It would be nice to lose weight and resolve the xerostomia that adds to tooth decay and gum disease..
Currently:
Parnate 100 mg/day
nortriptyline 100 mg/day (tapering from 150 mg/day for discontinuation)
Lamictal 200 mg/day
lithium 450 mg/day
prazosin 30 mg/day
I told my doctor that the best we have been able to do so far is to provide me with palliative treatment to reduce the severity of symptoms without producing a truly robust antidepressant response. This is inadequate. However, I am afraid of DBS, which is a treatment he feels I should investigate. There do not seem to be any convenient answers. Deep TMS? Maybe. Brintellix? I am not convinced that it has worked magic for anyone on Psycho-Babble yet. I am waiting for my doctor to develop a better feel for Brintellix in order for me to decide if it is worth discontinuing Parnate for.Good luck with your desipramine trial!
- Scott
Posted by tom2228 on May 23, 2014, at 11:14:52
In reply to Re: Desoxyn with MAOIs --) SLS » tom2228, posted by SLS on May 23, 2014, at 10:28:05
Scott, I really encourage you to try Desoxyn with Parnate, especially since you are coming off the nortriptyline -- that should lessen the serotonergic load. It is safe, coming from the man Stahl himself (I was and still am in sheer aw when my doc told me he had corresponded with him about my case!). I have been on MAOIs (including Parnate up to 60mg, Marplan up to 50mg, and Nardil up to 75mg) with up to 25mg Desoxyn for the past 4 years with no problems.
The potency of NE:5-HT is about 1:44 in terms of neurotransmitter release. Bear in mind that (meth)amphetamine-mediated neurotransmitter efflux inherently is accompanied by reputake inhibition as the efflux occurs through the transporter itself in the reverse direction, independently of cellular stimulation. But recall that nortriptyline and desipramine are also SRIs; while this is comparatively less with respect to their noradrenergic activities, it is still clinically relevant, but somehow safe. Sometimes we must simply trust our doctors as experience may speak louder than pharmacodynamics. Desoxyn can help with depression and anxiety more so than the other stimulants, in my opinion and experience.
Yes, I experienced the uncomfortably energetic/ stuttering while speaking experience that I refer to as "tweaky" when adjusting to the first few days of nortriptyline at 75mg. I took the first desipramine dose last night and don't feel too many sides since we're starting low. These two are much nicer to me than Wellbutrin, which I just tried with my previous doc the past week in place of nortriptyline.
Yeah, I understand things like dry mouth can be just as bad as on nortriptyline, but the main benefit is that the pseudoanticholinergia lacks the cognitive impairment of the true version produced by nortrip, which was causing me problems in school along with the sedation. Am looking froward to the thermogenic properties of desipramine as I gained 15lbs on Abilify + nortrip in 2 months.
I think you are brave for coming off much of your medication and am rooting for you. I am likely starting rTMS (Neurostar machine) in a few weeks if we can convince insurance to cover it for *bipolar* depression.
In the mean time I will likely be coming off of Abilify for the same reasons you state along wtih apathy, disinterest in things/ people, and trialing Invega. My doctor seems just as interested in trying out Namenda XR as I am to replace Mirapex and augment cognition and mood. Have you tried memantine?
That is interesting about prazosin replacing nortriptyline because nortriptyline has effects on the same site, a1 antagonism. My thinking is that this aspect of the drug's profile tempers the NRI effect to make it less harsh, less anxiogenic/ tweaky/ physically uncomfortable. I hope the Prazosin works out well for you.
I can't say much about the Brintellix but I imagine it would be no better than an SSRI augmented with an AAP to get the serotonin antagonism that Brintellix has. I would suspect that an MAOI + AAP would get the job done even better, but everyone is different.
Posted by Phillipa on May 23, 2014, at 12:04:42
In reply to Re: Desoxyn with MAOIs --) SLS » tom2228, posted by SLS on May 23, 2014, at 10:28:05
Scott the hyperpigmentation that I read of should take less than a year to disappear. You didn't get the lupus like syndrome with the mino though? Mino is very strong. I knew on day l that I couldn't take it. Lots of med changes. Will give the doc also a chance to see what closer to baseline is. Phillipa
Posted by SLS on May 23, 2014, at 19:22:08
In reply to Re: Desoxyn with MAOIs --) SLS » SLS, posted by Phillipa on May 23, 2014, at 12:04:42
> Scott the hyperpigmentation that I read of should take less than a year to disappear. You didn't get the lupus like syndrome with the mino though? Mino is very strong. I knew on day l that I couldn't take it. Lots of med changes. Will give the doc also a chance to see what closer to baseline is. Phillipa
I think I caught it early enough. Minocycline-induced hyperpigmentation is often irreversible. From what I understand, large doses of vitamin C can prevent it from emerging. I started taking 1000 mg/day, hoping that it would stop the process and allow for fading.
Thanks for the information.
- Scott
Posted by Phillipa on May 23, 2014, at 21:14:09
In reply to Re: Desoxyn with MAOIs --) SLS » Phillipa, posted by SLS on May 23, 2014, at 19:22:08
Scott I normally take 2000mg of time release C a day. You can take more than this as water soluable. You will pee out what your body doesn't use. Phillipa
Posted by SLS on May 23, 2014, at 21:50:23
In reply to Re: Desoxyn with MAOIs --) SLS » SLS, posted by Phillipa on May 23, 2014, at 21:14:09
> Scott I normally take 2000mg of time release C a day. You can take more than this as water soluable. You will pee out what your body doesn't use. Phillipa
Okay. I'll start taking 2000 mg/day tomorrow. Thanks.
:-)
- Scott
Posted by Christ_empowered on May 25, 2014, at 9:24:13
In reply to Re: Desoxyn with MAOIs --) SLS » Phillipa, posted by SLS on May 23, 2014, at 19:22:08
I'm a big high dose C fan. I take 12 grams/day, in 2 divided doses (I use time release).
High dose vitamin C is supposed to have a calming effect for mentally ill people. I read a PubMed abstract where high doses of C were used with some unnamed atypical, and the atypical worked better.
Just throwing that out there.
Posted by tom2228 on May 25, 2014, at 9:42:07
In reply to vitamin c, posted by Christ_empowered on May 25, 2014, at 9:24:13
> I'm a big high dose C fan. I take 12 grams/day, in 2 divided doses (I use time release).
>
> High dose vitamin C is supposed to have a calming effect for mentally ill people. I read a PubMed abstract where high doses of C were used with some unnamed atypical, and the atypical worked better.
>
> Just throwing that out there.Yeah, I've always thought that's why the psych hospitals keep the fridge well-stocked with juice and the patients are sipping it like nobody's business.
Vitamin C is involved in the conversion of dopamine to norepineprhine,
Posted by Phillipa on May 25, 2014, at 19:56:58
In reply to Re: vitamin c, posted by tom2228 on May 25, 2014, at 9:42:07
It is? How? Phillipa
Posted by tom2228 on May 25, 2014, at 20:37:43
In reply to Re: vitamin c » tom2228, posted by Phillipa on May 25, 2014, at 19:56:58
> It is? How? Phillipa
Ascorbic acid a cofactor (helps out) in the synthesis of norepinephrine from dopamine via the enzyme dopamine beta hydroxylase. In other words, Vitamin C facilitates the conversion of DA to NE.
It is also involved in the synthesis and catabolism (breakdown) of tyrosine, a precursor to dopamine and noreprineprhine. For one, it plays a role in the breakdown of tyrosine by helping out the enzyme 4-hydroxyphenylpyruvate dioxygenase.
etc.
Posted by phidippus on May 25, 2014, at 21:50:55
In reply to Re: Desoxyn with MAOIs --) SLS » tom2228, posted by SLS on May 23, 2014, at 10:28:05
Glad to see you're cutting back on your drug regimine.
Try Brintellix. It had a strong antideprssant effect for me-in fact it made me manic.
Eric
Posted by Phillipa on May 25, 2014, at 21:51:28
In reply to Re: vitamin c » Phillipa, posted by tom2228 on May 25, 2014, at 20:37:43
How did you learn this? Phillipa
Posted by Phillipa on May 25, 2014, at 21:57:53
In reply to Re: vitamin c » tom2228, posted by Phillipa on May 25, 2014, at 21:51:28
Tom doesn't this negate it?
Posted by tom2228 on May 25, 2014, at 22:48:38
In reply to Re: vitamin c » tom2228, posted by Phillipa on May 25, 2014, at 21:51:28
> How did you learn this? Phillipa
Lots of online reading. I have some background in biology and chemistry from school, and a personal passion for psychopharm -- I am going to school to become a psychiatrist, specifically a psychopharmacologist.
> Tom doesn't this negate it?
>
> http://www.ncbi.nlm.nih.gov/pubmed/3171470Very interesting find, and no, no negation, but rather a different topic -- the antioxidant properties of Vitamin C apart from its role as an enzymatic cofactor that I talked about before. The answer is in the first two sentences of the abstract:
"The chemical structure of dopamine includes an ortho-catechol group which is labile to oxidizing agents. Ascorbic acid, a reducing agent, has in the past been added to the incubation medium in order to protect dopamine against oxidation."
What this is saying is that Vitamin C helps prevent dopamine from being broken down, which it does by "neutralizing" other molecules that might otherwise break down the dopamine. Because the dopamine resists being deactivated for a longer period of time, it is functional for longer and thus less is necessary to inhibit prolactin.
Vitamin C has a variety of different functions and mechanisms of action in the body.
This is the end of the thread.
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