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from Abilify straight to MAOIs


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Normally, I think my pdoc is great and totally trust his judgement. However, at my last appointment he started me on Abilify and said if it didn't work, he wanted me on a MAOI. I think this is incredibly drastic.

Just for some background - I have recurrent, refractory depression. I've gone through just about every SSRI on the market in previous episodes and have gone through nearly all the modern non-SSRIs with no effect in this episode. But isn't there a whole lot else out there? Lamictal? Lithium? Thyroid hormone? I find it hard to believe that your response to one AAP predicts if you'll have a response to other mood stabilizers.

But maybe he has a point. Running around suicidal is probably not safe while spending two months titrating onto Lamictal, which may or may not work. Hospitalization is not an option - not only am I not insured, I was hospitalized twice as a teenager and both times were horrible and traumatic.

Does anybody have any advice? Should I just go on a MAOI (abilify isn't doing jack)? Should I insist on a trial of lamictal or lithium first? Not only are MAOIs a pain in the ass, but the only thing left after that is ECT. Thanks guys - I know no one IRL who has been on half as many meds as I have.

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(Mods, please feel free to delete the similar topic in Misc. Meds. I am hoping to get some responses by posting here).

Has anybody with MDD not had Abilify work but then had a good response to either lithium or lamictal? After failing a bunch of AD trials, my pdoc prescribed Abilify. He said if it doesn't work (and it isn't), he wanted me on a MAOI.

I think this is drastic. Should I insist on a trial of lithium or lamictal first? Or does your response to Abilify predict your response to other mood stabilizers?

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Persephone,

Well which meds have you actually tried? There are more AD's out there then are listed in your signature so I'm a little confused there. I don't see any tricyclics, which is a whole class of drugs in itself.

If there are other AD's out there that you want to try, you should certainly tell your pdoc about it.

Having been on an MAOI, they aren't as big of a deal as they are made out to be. You have to be careful of drug reactions (as you have to do with all psych meds). The diet restrictions have been updated and aren't as strict as they were when the tyramine connection was first discovered. I ate what I wanted to eat (in moderation) and took my blood pressure with different foods for the first few weeks. Outside of that it was like any other AD.

What actually pissed me off the most - was that I couldn't take sudafed anymore and had to go get some zyrtec instead.

Not only are MAOIs a pain in the ass

This might be true in some respects, but so is this

Running around suicidal is probably not safe

~ May

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Have you tried various ADs in combination or used them mostly in monotherapy? A lot of them are more powerful when combined than when used alone.

If you've done all that, MAO-Is don't seem unreasonable.

Considering the next step is ECT, I'd give the MAO-Is a nice long trial, the standard ones and not just Emsam.

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Hopefully the Abilify will work and you won't even have to worry about any of this!

My depression is also treatment-resistant. I considered MAOIs but decided to ask pdoc for Lamictal because I was also hesitant to try them. Lamictal has been bringing me back to life and exceeded any expectations I had for my mood. That being said, MAOIs have a long history and they tend to work very well. I am glad I tried Lamictal and would recommend it to anybody. (I actually have 2 other close friends using Lamictal to treat MDD, and they share the same opinions as I do.)

If you really don't want to take MAOIs, ask your pdoc if you can try it. But maybe you shouldn't rule out MAOIs just yet. While I completely understand why you're hesitant, I have to admit that they seem to be miracle meds for a lot of people. Plus, if you're severely depressed, Lamictal isn't going to provide relief very quickly. It takes a while to titrate up and there are a lot of unpleasant side effects. It's just something to consider. However, Lamictal has changed my life, so I can't say many negative things about it. I'm kind of biased.

I hope the Abilify helps you. Good luck with everything.

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Thanks for the replies everyone.

Just to clarify I have taken all of these meds as monotherapy:

Prozac, Zoloft, Paxil, Serzone, Lexapro, Effexor

I have taken these combinations:

Lexapro/Wellbutrin, Effexor/Remeron, Effexor/Abilify

I don't why the pdoc hasn't suggested TCAs. Maybe because of risk of weight gain (I have a history of a serious ED)? In the meantime, I called him and got him to order a blood test. I don't want to go through all of this just to find out my problem is low thyroid levels.

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  • 3 weeks later...

Good news everyone! Even though only 2 mg of Abilify made me incredibly activated and there is probably no way I could tolerate a higher dose, there was a slight effect on my mood. My pdoc thought that trying out Lamictal was worth a shot now, since I responded a little bit.

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Good news everyone! Even though only 2 mg of Abilify made me incredibly activated and there is probably no way I could tolerate a higher dose, there was a slight effect on my mood. My pdoc thought that trying out Lamictal was worth a shot now, since I responded a little bit.

It's so good to hear you're doing a little bit better! I hope that slight effect gets even bigger.

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