Just thought to check for any possibilities for additions to an MAOI regimen.
Currently:
40-50 mg Parnate, perhaps an increase as orthostatic pressures level out.
600 mg Lithium
Quite a lot of long stories on this forum, so I'll keep it easy. Relatively typical refractory depression case- low appetite, low sleep, low energy, not really thinking, negative outlook in frame of understanding. No real connection to interests from before depression- "intelligent person/hard-working" background. Math/science, museums, music, history, technology, movies. (Whatever that means after many years of depression.) Evaluated for personality disorders and other problems, and came out clean. Working low level job, getting through. Don't really do anything outside of work. The interests are there inside of me, but I don't seem to be able to wade through the depression.
I'm getting better, just very slowly. Disorganized. Went through the ssri loop, many augmentation routes, and periods of being on nothing at all and doing exercise and diet changes. Lot of partial or stunted responses. Got close to a break in the depression with 80mg Prozac, 300mg Wellbutrin, and 1200mg Lithium (Psych went through a Bipolar II phase with me, but has since gone away from it. Never been hypomanic, but I can be a bit anxious.)
Any ideas or experience in this area? (I don't plan to go change anything without checking with my docs. )
Things that I have tried or may try, or general comments:
Might be put on a stimulant. Seeing how this dosing goes. I am tired on Parnate, one of those types.
Evaluated for Cardiac health. Quite good. (Checked when on Desipramine and lithium.)
Thyroid a-ok. Vitamin D has been very very low before, but should be okay now.
Tried intense exercise the previous med break. Really made me feel not well. I don't seem to get the same results out of exercise as others seem to. Still planning to return to some healthy level of it though. Certainly the only way to go healthily. I tend to really feel dumb around it.
Low-carb, Paleo, or caloric restriction were terrible for my mood and affect. Just went flat and negative. I tend to seem to do best with almost too much food and big meals. I just have trouble eating that much most of the time, and likely it just is a short-term measure. Trouble eating too many rich foods.
No problems diet/tyramine-wise with Parnate. Looking right now at some leftover Thai food, some chocolate. Regular pizza seems to be fine, and fresh mozerella is great anyways. The highest reading I've had with my pressure after eating was 135/75, which is high for me, but certainly not any sort of reaction. I do have an accurate blood-pressure machine. Typically 110/65, though with the orthostatic problems it sometimes drops to 88/44 (that area). Only at the start of dose change. Did have a 150/90 during an anxious/depressive state once, but I was in a pretty bad state.
Sleep is not too bad now. Not really hit by the insomnia typical of parnate. Fairly consistent sleep regimen, if somewhat marked by early morning awakenings.
Not a drinker or a drug-user. Well, I've certainly been on a lot of drugs, but not in an abusive or illegal fashion.
Music - I play some piano. Coming back to it as I feel better with the Parnate.
Trying some more with Meditation. I have a lot of difficulty with it, and I find it very hard to stay in whatever moment that I have to stay in. Monitoring my own body doesn't seem to help much. But I am interested in incorporating some measure. It just is an interesting mental state.
Therapy- currrently in combo cbt/dbt/act sort of deal. Slow progress for me, but certainly the right course of therapy. Straight cbt didn't do anything (or at least how I approached it, it didn't help me) for severe depressive episodes, and excerbated the negative evaluation cycle that seems to be a major component of my depression.
Choline- Alpha GPC, CDP Choline, etc...well, I have a good dose of depression. Not helpful for my flat mood or negative thoughts.
Ginkgo and Ginseng - didn't react well with the lithium, although that was on a much higher dose. I probably don't want to do anything that would lower my blood pressure too much more.
I don't personally care for the Lithium in regard to cognition and memory, and maybe energy, but it is certainly the best choice for anti-depressant augmentation and for helping with suicidal ideation and processing. Lithium Orotate was certainly nowhere near the same sort of drug. I could never suggest it as an alternate, "bioavailibility" or whatever. I am a particular case though. Depakote- slow. Just slow. Lamictal- had auto-immune rash in high school, so everyone has been very wary. Topamax- dope-a-max. I was just braindead. Without migraines though. Benzos- never been on any, though I have been given a few small doses from time to time. I just sort of shut down and sleep.
I tried Piracetam and Aniracetam, but it was during an increasing depressive episode, so I really didn't notice anything at all. Not really a fair evaluation. Alcar/ALA was during the same period as well. And l-theanine. Hard to judge.
Social anxiety and Isolation- were bigger symptoms a while ago, but I seem to work okay. Missing out on friendships. Hard to not get in that "drain on the people around you" state when you are going pretty slow.
Post-SSRI effects - never really noticed all that long of a period. Cold-stopped Zoloft due to an interaction, and Cymbalta as well. Tapered off Lexapro pretty quickly. Whatever periods of dullness and mood fluctuation seem pretty small compared to the rest of the depression.
Caffeine- been off of it for many long stretches, and never noticed a benefit. I enjoy my coffee too much as a drink anyways. Not a large effect.
But now it seems like I have a new slate with the MAOI. Just looking for any suggestions. The dangers are quite high, beyond even the typical interactions. I emphasize that danger again, just to make it clear I am not acting on anything too quickly, and that I know I don't have the knowledge and experience to really make the decisions. I'm not the impulsive or dramatic type. But it is good to throw ideas around. (I apologize if I am late to respond. Really pretty slow with this.)