Aswad
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Joined: 4/4/2007
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ORIGINAL: deliciousmorsel
SSRIs are pretty useless.
Close to it, but not entirely.
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Nobody wants to hear it- but Valium is absolutely the best treatment.
I would posit that sublingual buprenorphine is another candidate for that position.
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I use the MAOI Parnate, which every one is told is extremely dangerous.
Been on 200mg/day of it myself for refractory depression, along with other stuff.
It is dangerous, but so is anxiety, depression and driving a car; treated with respect, it's not a big deal.
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Do not settle for Nardil, the other MAOI. It will make you fat and diabetic.
It may well do that in some cases, but there's a reason it's still in production for only 15.000 users:
For anxiety, Nardil has a leg up on Parnate, presumably due to inhibiiting GABA-T.
And it's not the only other MAOI. Among the irreversibles, there is Marplan (isocarbaxozid), Emsam/Selegeline/Eldepryl (l-deprenyl) and various others that are less readily available. Among the reversibles, only Manerix (moclobemide) is approved for this indication, if memory serves. These all have different primary uses, and slightly different side effects. As a rule of thunb, Nardil is used when nothing else will stop anxiety, while Parnate is used when nothing else will stop depression. For dysthymia and avolition, Emsam seeems good.
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Parnate is a rough ride on while it shakes up your brain and rewires it, but it's worth it. Even if you need to go off it someday you will be better, because you will have learned how to be well. Do not under estimate the cognitive therepuetic powers of the experience of well.
Parnate is indeed a rough ride for some, particularly with anxiety disorders, to the point where the Jatrosom brand is made with an antipsychotic (trifluoperazine) added to it in order to calm down people that find the ride too rough and get neurotic throughout it.
Then there's the bit about making sure there's nothing wrong with your heart, that your body can handle the blood pressure rise right after taking a dose, and that the drop in baseline blood pressure won't make you faint. Let's not forget that people with migraines may not be able to tell if they have a hypertensive crisis. Also, it's got a fairly significant number of interactions, and the dietary restrictions aren't for everyone.
Some people can't afford to lose that much weight, either.
Going off it again can be a frustrating experience, as well. People often call brain shivers "Efexor shocks." That's a misnomer, as they should clearly be called "Parnate shocks," given that the latter produces stronger shocks. Nightmares while tapering isn't uncommon, either. And of course all the usual effects of tapering anything that works on all the monoamines and some of the diamines at the same time.
Don't get me wrong... I think Parnate is a wonderful and underused drug.
But you're painting a rather rosy picture here; at USD 200 for 5 grams, and 10-200mg/day, people deserve a more nuanced one.
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look at <www.psychotropical.com> The site owner is retired, bored, and one of the best neuropsychopharmacologists in the world today. You can write him.
Much appreciated. Sounds like someone I want to talk to until his ears fall off. 
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I beleive in talk therapy, but you can't talk away anatomical variances that aren't going back to normal.
Agreed. But using CBT (specifically; other therapies weren't equally effective, last I checked) can go a long way, even in those cases.
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And talk with proper medication works better.
Unless the medication is serotonergic, in which case it reduces the long-term success rate.
Edit: Almost forgot to mention. For goodness sake, do not combine Parnate (or any other MAOI) with 5-HTP, SSRIs, TCAs, opioids or St. John's Wort. The ER docs will be very stern witth you about that, if you wake up again afterwards
Health,
al-Aswad.
< Message edited by Aswad -- 2/8/2008 2:00:09 PM >
_____________________________
"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do." -- Rorschack, Watchmen.
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RE: Generalised anxiety disorder - 
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