Reducing number of meds by introducing a MAOI

[Alpam]

My Pdoc has said to me that he wants to cut down on my medication and simplify things which I think is a good idea. Currently I am taking:

1. Benztropine (for Akathesia)

2. Citalopram (Depression)

3. Clonazepam (Anxiety)

4. Dexamphetamine (Fatigue / ADD)

5. Seroquel (occasional PRN sleep med)

6. Zyprexa (Mood Stabiliser)

I have not had a straight diagnosis on my brain cooties but have been told I have Atypical Depression, Insomnia and possibly Borderline Personality Disorder, ADD and GAD with panic disorder.

I have just upped my dose of Citalopram from 40mg to 60mg and my pdoc and I decided that if this does not work to try a MAOI either Parnate or Nardil. If I do go along that path I want to take as little else as possible. What I was thinking was:

1. Parnate / Nardil

2. Dexamphetamine (keep using on a smaller dose)

If the MAOI Works I would like to cut out the Clonazepam, and possibly the Seroquel, Zyprexa and Benztropine.

What I really want is something that will elevate my mood (nothing has really worked so far), reduce anxiety (I had to take 2 days off this week due to anxiety) and allow me to sleep at night and concentrate during the day.

Is this achievable? and which of the two should I be going with if I end up down this path. I know about all the diet restrictions and it's something I am willing to endure.

[Cuttlefish]

My Pdoc has said to me that he wants to cut down on my medication and simplify things which I think is a good idea. Currently I am taking:

1. Benztropine (for Akathesia)

2. Citalopram (Depression)

3. Clonazepam (Anxiety)

4. Dexamphetamine (Fatigue / ADD)

5. Seroquel (occasional PRN sleep med)

6. Zyprexa (Mood Stabiliser)

I have not had a straight diagnosis on my brain cooties but have been told I have Atypical Depression, Insomnia and possibly Borderline Personality Disorder, ADD and GAD with panic disorder.

I have just upped my dose of Citalopram from 40mg to 60mg and my pdoc and I decided that if this does not work to try a MAOI either Parnate or Nardil. If I do go along that path I want to take as little else as possible. What I was thinking was:

1. Parnate / Nardil

2. Dexamphetamine (keep using on a smaller dose)

If the MAOI Works I would like to cut out the Clonazepam, and possibly the Seroquel, Zyprexa and Benztropine.

What I really want is something that will elevate my mood (nothing has really worked so far), reduce anxiety (I had to take 2 days off this week due to anxiety) and allow me to sleep at night and concentrate during the day.

Is this achievable? and which of the two should I be going with if I end up down this path. I know about all the diet restrictions and it's something I am willing to endure.

Why not Emsam? It's also an MAOI, but it has a little more wiggle room in terms of diet than the other MAOI's when taken transdermally. Also, why not try a tricyclic antidepressant first? With depression that doesn't respond to medication so easily, it usually goes SSRI's, then tricyclic antidepressants, and then MAOI's. Tricyclics don't carry dietary restrictions like MAOI's do, however, they were replaced by SSRI's because they cause a lot of annoying side effects.

Many side effects may be related to the antimuscarinic properties of the TCAs. Such side effects are relatively common and may include dry mouth, dry nose, blurry vision, lowered gastrointestinal motility or constipation, urinary retention, cognitive and/or memory impairment, and increased body temperature.

Other side effects may include drowsiness, anxiety, emotional blunting (apathy/anhedonia), confusion, restlessness, dizziness, akathisia, hypersensitivity, changes in appetite and weight, sweating, sexual dysfunction, muscle twitches, weakness, nausea and vomiting, hypotension, tachycardia, and rarely, irregular heart rhythms. Rhabdomyolysis or muscle breakdown has been rarely reported with this class of drugs as well.

I know personally from taking Nortriptyline that I had dry mouth, constipation, and increased body temperature (it caused me to sweat profusely with even the slightest of demanding activities). However, above you mention that a problem of yours is insomnia. Tricyclics are known to cause sedation (some more than others).

Your goal of having just two medications may be a bit too optimistic. If you have GAD with panic disorder, and neither the MAOI or the tricyclic that you are given is enough to reduce it to a level that you are comfortable with, you may need to stay on a benzo, or, perhaps take it PRN. Some of us take them every day, but many of us take them as needed. Either approach, as long as it makes you more functional when you need to be, is fine.

Good luck!

[pinkiemarie]

Just to let you know, as cuttlefish said, tricyclics are often used for insomnia. In fact, they have me taking one (trazodone) which has worked wonders on my insomnia. Just a thought, because MAOIs can be so dangerous if not used with extreme caution. Not trying to discourage you though, just help you look at other possible options.

[gizmo]

I don't know your med history, but I find it really hard to believe that you can cram 5 meds of treatment into one MAOI. Granted, I'm not an MAOI expert, but I think that medication result overexpectation can lead to really disappointed patients.

I notice that you take two meds with some slight counterpurposes - the dex for fatigue/add and the seroquel for sleep. Are you taking the seroquel to sleep, and then having such a hard time waking up that you need a dose of dex to wake you up for the day? If so, as other posters have suggested, tricyclics are often really good meds for sleep and don't knock you on your ass like seroquel can.

I wish you the best with your choice. As I said, I'm not a AD expert, so I only have the suggestion above.

[Mayteana]

Did you and your pdoc discuss doing dex with an MAOI?

MAOI's & stims are a (potentially) major drug interaction.

~ May

[Alpam]

Thanks for your replies guys much appreciated.

Why not Emsam? It's also an MAOI, but it has a little more wiggle room in terms of diet than the other MAOI's when taken transdermally. Also, why not try a tricyclic antidepressant first? With depression that doesn't respond to medication so easily, it usually goes SSRI's, then tricyclic antidepressants, and then MAOI's. Tricyclics don't carry dietary restrictions like MAOI's do, however, they were replaced by SSRI's because they cause a lot of annoying side effects.

I know personally from taking Nortriptyline that I had dry mouth, constipation, and increased body temperature (it caused me to sweat profusely with even the slightest of demanding activities). However, above you mention that a problem of yours is insomnia. Tricyclics are known to cause sedation (some more than others).

Your goal of having just two medications may be a bit too optimistic. If you have GAD with panic disorder, and neither the MAOI or the tricyclic that you are given is enough to reduce it to a level that you are comfortable with, you may need to stay on a benzo, or, perhaps take it PRN. Some of us take them every day, but many of us take them as needed. Either approach, as long as it makes you more functional when you need to be, is fine.

Good luck!

Emsam is not available in Australia, we do have the Selegiline tablets though. It would be great to get down to two meds I think maybe my opinion of MAIO's are too high.

Just to let you know, as cuttlefish said, tricyclics are often used for insomnia. In fact, they have me taking one (trazodone) which has worked wonders on my insomnia. Just a thought, because MAOIs can be so dangerous if not used with extreme caution. Not trying to discourage you though, just help you look at other possible options.

We don't have Trazodone here either, I have tried Dothiepin which is a TCA, helped the first time I was on it for insomnia, but not the second.

I don't know your med history, but I find it really hard to believe that you can cram 5 meds of treatment into one MAOI. Granted, I'm not an MAOI expert, but I think that medication result overexpectation can lead to really disappointed patients.

I notice that you take two meds with some slight counterpurposes - the dex for fatigue/add and the seroquel for sleep. Are you taking the seroquel to sleep, and then having such a hard time waking up that you need a dose of dex to wake you up for the day? If so, as other posters have suggested, tricyclics are often really good meds for sleep and don't knock you on your ass like seroquel can.

I wish you the best with your choice. As I said, I'm not a AD expert, so I only have the suggestion above.

I have had sleeping problems since I was a little kid, my first ever medication was Dex, with the Seroquel added in some time later. Even before starting meds I had trouble getting to sleep and waking up in the mornings, that's one of the reasons I saw my Pdoc. Also I have pretty much stopped the Seroquel, I take on average 50mg once a week.

Did you and your pdoc discuss doing dex with an MAOI?

MAOI's & stims are a (potentially) major drug interaction.

~ May

I haven't discusses stims with a MAOI yet, but from the research journals I have seen, with close observation they can be a very good augmenting med.

I have developed a tolerance to Benzo's and Dexamphetamine, it would be good if I could spend a couple of months off them to gain some of the tolerance back. Also the Benztropine (Cogentin) that I am taking is giving me blurred vision, makes work almost impossible.

After a recent suicide attempt, I just want something that will work, every AD I have been on has improved my mood for a week, before they stop working.

[dancesintherain]

not to push TCAs...but amitryptaline is another good one i've heard for both depression and sedation. i'm afraid that i don't know if that's the same as one of the ones in your signature, so apologies if it's one you've already tried.