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Second post on crazy boards. In short I have tried many different classes of Ad's with little help. I am copying my maoi proposal to my pdoc below. I apologize for length, this proposal should cover everything. --------------------------------------------------------------------------------- I have been on Zoloft, Cymbalta, Strattera, Wellbutrin, remeron, fetzima, viibryd, deplin, Lamictal, Abilify, and Nuvigil with moderate to little help. Some boosts and stabilization here and there I will give credit for. Particularly Zoloft for anxiety, Cymbalta for uplifting feeling, Strattera short term for depression, Abilify possibly for irritation, and Nuvigil as a sort of stimulant with little to no crash. This being said my depression just feels very weighted, and dark. I can say for certain my depression has gotten much heavier and darker from 14 to 22. Both in a physical sense and in a mental sense. Suicidal ideations (not induced by medications.) have unfortunately become almost daily recently, now the act of suicide I would definitely be too scared to act out, but it's the thought process that scares me. Doing anything ranging from brushing my teeth to getting to work is more than just a chore, it's painful. My depression feels like a constant itch you cannot scratch, and over the years the itch has grown. My anxiety though not as severe as my Lethargy or depression is still very bad. My motivation is also very lacking in my life which is probably due to my depression. I find myself wanting to cry to get some relief but often cannot. I am getting increasingly tired of trying new meds without the benefit I need. I truly believe atleast 65% of my depression is biological and out of my control which is why I'm searching for a medicine that can allow me to more easily fulfill the other 35% or so treatable with cbt. Why I'm suggesting an irreversible maoi is for the following reasons. I believe have atypical depression sleepiness or excessive sleep, marked fatigue or weakness, moods that are strongly reactive to environmental circumstances, and feeling extremely sensitive to rejection. I have tried various classes of antidepressants and augmentations with little benefit My depression is extremely Lethargic/low energy. The maoi scare was overhyped I can follow dietary restrictions I could care less about sexual side effects or weight gain by this point in my life. Maoi’s are a powerful and underutilized tool in the psychiatric world. I understand the 2 week grace period that's required. Psychiatric times states that TCAs were found to be most effective in severe depression, especially with melancholic features. MAOIs, on the other hand, were more effective in less severe, chronic depression with prominent anxiety, without melancholic features, and often in the presence of reversed vegetative symptoms.35,36 *nardil had a change In formulation in 2003 so maybe parnate might be a better fit. User reports also show parnate might be more energizing than nardil. *Emsam might be good as is a topical patch with less diet complications. Would reboxetine be useful to take with an maoi? Can I still take abilify with an maoi? --------------------------------------------------------------------------------- I have ruled out thyroid issues and sleep apnea with my internal medicine doctor. I am seeing him again August 6 2018 to see if there are any other reasons besides a biochemical deficit that can be causing my extreme fatigue and oversleeping. My question to you guys is if you have had success with maoi's where as other antidepressants have failed? Thank you in advance for taking the time to read my post.
Though I came up surrounded by close family members who struggled with various mental illnesses, I wouldn't say I had an especially traumatic or even a really remarkable childhood, apart from the sporadic, sometimes episodic fireworks Crazy can bring. On the whole I had a pretty typical middle class upbringing, for which I am grateful. My older sister served as my introduction to the mysteries and miseries of mental illness. She suffered from Bipolar Disorder, and it was clear my parents despaired at her condition. There was much acting out, at least one suicide attempt that I am aware of, multiple stays at inpatient facilities, and an ever-changing cocktail of medications throughout her teens. She tapered off meds when she planned to start a family, and has done amazingly well without them. My younger sister struggles with panic disorder and more physical ailments than anyone her young age ought to be saddled with. My mother was a survivor of child abuse, and subsequent to the passing of her father when I was about 12, she suffered a series of psychotic breaks that led to the first of several inpatient hospitalizations, and a lifetime of profound treatment resistant MDD that continues to this day. Not only did she not perpetuate the cycle of abuse she suffered but I never even knew what she'd been through until I was much older. My father never (to my knowledge) sought treatment for any mental illness, and tended towards stoicism and emotional opaqueness. I suspect however that he suffered (or even suffers still) from depression -- at the very least. HIs siblings suffered from myriad mental maladies. His upbringing was somewhat of a mystery to me, as what remained of his immediate family were separated by geography. I believe he too was a survivor of child abuse, based on what I've gleaned from anecdotes. My older brother was a bit of a black sheep, and when youthful indiscretions of the self-medicating type became too much for my well-meaning folks to handle he was given an ultimatum and joined the armed services. He was stationed in South Korea, and I gather his self-medicating ways came along for the ride. Upon returning stateside he had a hard time reintegrating, finding stable work, and had to rely on the support of his family more than I think he would have liked. He was a very emotional person, and felt things very deeply. I imagine if I would have asked him for one word to describe himself he might have chosen "failure". That's certainly not how I would have described him, but he was the type of person for whom every setback might have seemed like the universe pointing a spindly celestial finger at the tip of his nose and proclaiming FUCK. YOU. By the time my brother killed himself with the sputtering exhaust of the sparkly brown hatchback my mother had given him, I was living my own kind of Crazy. Today, I find myself at a strange cross roads. I am happily married. Successful, especially considering I never finished college. I have more than my fair share of material possessions. I have family and friends whom I love, and who love me. As much as I curse those who use the phrase, I'm Blessed. And yet, I can't recall a time I felt more lost. You see, growing up as an insatiably curious child in a household surrounded by Crazy, and where both parents worked in the medical field. So I didn't just *live* with Crazy, I, in a sense, *studied* it. Psychology. Anatomy. Psychiatry. Biology. Pharmacology. And most especially *Psychopharmacology*. I was never under the illusion that reading medical texts would make me a doctor any more than reading cookbooks would make me a chef. But I found, and still find the subject phenomenally interesting. In the late 80's and early 90's before webforums, TV drug adverts, wikipedia, etc., it seemed physicians expected laypeople to know almost nothing about medicine, so much so, that if you knew even a little, and went in with talking points memorized, you were going to leave with whatever it was you came for (within reason). Maybe it's always been that way. But I certainly felt clever, and in retrospect maybe a part of the burgeoning vanguard that changed how pharmaceuticals are consumed. Modern medicine is so unabashedly, brazenly consumer driven, I doubt any clinician bats an eye when patients come in and know exactly what their diagnosis is, the name brand and dosage of the drug they want, and oh by the way I've already printed off my own coupon that makes my copay 3 dollars until the drug goes off patent in 2030. But back to my personal tale of medico-consumerism. 22 years ago, at about 14 years of age, I self-diagnosed myself with depression. PART II To Follow Later