# Best anti-depressant for social phobia and atypical depression?



## bmwfan07 (Jun 3, 2007)

Recently I've come down with a "case" of major depression with apparent atypical features. I haven't really exhibited increased appetite but do have increased need for sleep, near-zero energy or motivation, and a "longstanding pattern of interpersonal sensitivity," as well as mood reactivity and nocturnal diurnal variation of mood.

This episode developed after a several-month period of unemployment and related OCD worsening. I'm 21 years old and have ADHD, generalized social phobia, OCD, possibly GAD, and now this depression. I've never been clinically depressed before in my life, and the concept was foreign. I also have congenital hypothyroidism (athyreosis) and have encountered a complication with treatment recently. From what I've read, subclinical (or overt) hypothyroidism can more easily predispose one to or trigger a major depressive episode. The anergic symptoms I experience might also be somewhat attributable to that, too...

Anyway, my p-doc wants to try me on Lexapro (of course...an SSRI), but I'm not all that keen on the idea, primarily because I'm concerned a) it won't help my social phobia much, if at all, and b) I may develop a hypomanic or mixed episode or worsen the course of possible underlying bipolar disorder (fairly common in ADHD, and atypical depression more typically occurs in bipolar than unipolar depression, as well as having an earlier onset in bipolar).

So I'd like to know if my concerns are legitimate, reasonable, or overly paranoid, and, regardless, if there's a better drug out there to start with. My inclination is toward Nardil or Emsam (both MAOI, latter being a selegiline transdermal patch), but I'm hesitant to bring that up unprompted until I'm confident it will be a good solution. 

FWIW, I've also done a two-day (yes, two days...) trial of Adderall in which I either overreacted to the stimulant crash or it triggered an actual temporary mixed or depressive episode of some kind. It was not a good day. :no


----------



## rustybob (Nov 19, 2009)

You open mentioning the lack of energy and motivation, so I'm guessing those are some of the more serious problems. Wellbutrin is usually good for those problems. It's risky if you're at risk for seizures though. If you reaaly do have GAD it may make things worse. Although SSRIs usually are first-line, it's generally not a problem getting Wellbutrin.

Have you actually been diagnosed as bipolar? If not I'd go with overly paranoid. Some (maybe even most) doctors may say that an SSRI putting you into hypomania or mania instantly means you're bipolar. Both Zoloft and Effexor put me into mania. When I mentioned it to my doctor he basically said "that's just the drugs, you're not bipolar. Lower the dose and you'll be fine". I ended up dropping both due to side effects, but I haven't gone back into mania since. I have nothing but respect for my doctor for not instantly slapping the bipolar label on me.


----------



## bmwfan07 (Jun 3, 2007)

rustybob said:


> You open mentioning the lack of energy and motivation, so I'm guessing those are some of the more serious problems. Wellbutrin is usually good for those problems. It's risky if you're at risk for seizures though. If you reaaly do have GAD it may make things worse. Although SSRIs usually are first-line, it's generally not a problem getting Wellbutrin.


Indeed they are the most pressing issues right now. I just don't care about anything, really, and it feels like nothing can really penetrate the cloud I'm under. For instance, we're going on vacation next week and I'd rather just stay home. I feel completely lifeless and anhedonic at the present moment, except sporadically--the mood reactivity presents in that when something really good happens, I'm > 50% better (the criteria for "mood reactivity") for a few hours to up to several days, it seems. I'm also better during the day.

I'm really not sure if I have GAD. I don't really know if my anxiety symptoms are covered instead by SAD and OCD, since the latter can cause a lot of ruminations and obsessional doubts that seem to also plague GAD sufferers (along with, of course, the intrusive thoughts, obsessions, and compulsions). I'm sure to my p-doc (and psychologist...and ADHD coach), I do come across as quite neurotic :um, so maybe the p-doc would be reluctant to prescribe Wellbutrin out of concern for worsening my anxiety. It also has near-zero efficacy for social anxiety, right? I did find that Adderall helped me quite significantly with social anxiety, but again I was only on it for a couple of days. Still have some in the cabinet, though... 



> Have you actually been diagnosed as bipolar? If not I'd go with overly paranoid. Some (maybe even most) doctors may say that an SSRI putting you into hypomania or mania instantly means you're bipolar. Both Zoloft and Effexor put me into mania. When I mentioned it to my doctor he basically said "that's just the drugs, you're not bipolar. Lower the dose and you'll be fine". I ended up dropping both due to side effects, but I haven't gone back into mania since. I have nothing but respect for my doctor for not instantly slapping the bipolar label on me.


I haven't been diagnosed with bipolar, but I've done so much reading about this stuff in the past few months--which caused me even greater stress and OCD and, ironically, probably contributed to this major depression--that I've become convinced that I am or will be, especially given my atypical depression. It's true that the trend now seems to be a much increased bipolar diagnosis because of the new concept of the "bipolar spectrum," but when you see how many people *do* have "Prozac poop-out," increased agitation/racing thoughts/hypersexuality/other hypomanic symptoms, and worsening depression on SSRI, SNRIs, NDRIs, etc., it does make me wonder...

Just out of curiosity, are your depressive symptoms (if you have/had any) atypical (increased eating and/or sleeping, literally next to no energy, etc.) or melancholic (or neither)? Interestingly, in social phobics with AvPD having major depression, atypical depression presents in 55% of cases, versus only 31% of non-social phobic/AvPD subjects.


----------



## crayzyMed (Nov 2, 2006)

If there are concerns of SSRI's inducing hypomania those would apply to nardil as well, that said nardil is a very effective antidepressant for those with social anxiety because it also acts on dopamine.


----------



## leon21 (Nov 8, 2009)

crayzyMed said:


> If there are concerns of SSRI's inducing hypomania those would apply to nardil as well, that said nardil is a very effective antidepressant for those with social anxiety because it also acts on dopamine.


but parnate too......and it`s not as effective for SA as nardil.
Isn`t it because nardil also acts on gaba and parnate not?
Actually i`ve nerver heard of anyone having success with parnate for SA.


----------



## crayzyMed (Nov 2, 2006)

leon21 said:


> but parnate too......and it`s not as effective for SA as nardil.
> Isn`t it because nardil also acts on gaba and parnate not?
> Actually i`ve nerver heard of anyone having success with parnate for SA.


I do know of several parnate succes story's, but indeed its not as effective as nardil, its increase in gaba also plays a big role it seems, raising monoamine's by MAO inhibition is also pretty far from optimal.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> If there are concerns of SSRI's inducing hypomania those would apply to nardil as well, that said nardil is a very effective antidepressant for those with social anxiety because it also acts on dopamine.


Are the risks of inducing hypomania as great with MAOIs as they are with SSRIs?

There is an interesting school of thought currently that suggests a large subset of social phobics actually have a pattern of behavioral inhibition and a hypomanic response to anti-depressants, indicating some level of bipolarity. Particularly, those at highest retrospective risk of having this atypical bipolar syndrome are those with psychological dependence on others... that would be me. :afr http://www.ncbi.nlm.nih.gov/pubmed/9858079

What I'd most like to end is my depression right now, as it is causing me the most suffering. Given that, would you (and others) recommend starting with my p-doc's original suggestion of Lexapro or trying to get her to prescribe Nardil (might be tough; she's quite mainstream)? I've heard MAOI are also better for atypical depression.


----------



## crayzyMed (Nov 2, 2006)

I dont know how much the risk compared.

Mood stabilisers can be added to MAOI's to prevent hypomania.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> I dont know how much the risk compared.
> 
> Mood stabilisers can be added to MAOI's to prevent hypomania.


This is true, but most p-docs, except maybe those extremely savvy with the new concept of the bipolar spectrum, won't diagnose bipolar without a previous history of hypomania, and thus won't prescribe a mood stabilizer. I actually got my p-doc to say she'd let me try Lamictal, but I'm a little nervous about actually going through with it, particularly since I don't *know* I'm bipolar. To my knowledge, there's no bipolar in my family, although maybe my mom has one of the "spectrum" conditions (several episodes of anxiety with depression).

You mentioned in another thread you have ADHD. I do too. But you also mentioned you've never had problems with depression. Just out of curiosity, when did your social phobia start and was there some precipitating event? From what I can recall (my memory sucks), mine started at around 11 when I felt a constant stream of peer rejection and some teasing, but I don't recall a particular trigger, just a gradual worsening of the condition into adolescence.

I'm also not sure what I should do at this point, whether to take the Lexapro my p-doc originally offered (and/or Lamictal, but that's of questionable wisdom) or to try to get her to prescribe Nardil. I need to move fast, because I'd ideally like some benefit by the time we leave for vacation next week. Being depressed there would suck.


----------



## crayzyMed (Nov 2, 2006)

Ive been born with SA as far as i remember, my med experiences also confirm a neurological problem involved (i only get SA relief from amphetamine) opiates, benzo's, GBL, alcohol etc all dont work, even if they make me euphoric and not care.

I dont remember any worsening, it was allways the same.

Perhaps just start nardil on its own, and contact your pdoc in case of a hypomanic episode?


----------



## rustybob (Nov 19, 2009)

crayzyMed said:


> Ive been born with SA as far as i remember, my med experiences also confirm a neurological problem involved (i only get SA relief from amphetamine) opiates, benzo's, GBL, alcohol etc all dont work, even if they make me euphoric and not care.
> 
> I dont remember any worsening, it was allways the same.
> 
> Perhaps just start nardil on its own, and contact your pdoc in case of a hypomanic episode?


Have you been on any meds before bmwfan?

I hate riding the medication merry-go-round just as much as the next person, but I think it's pretty extreme to go from nothing to an irreversable MAOI.


----------



## rustybob (Nov 19, 2009)

bmwfan07 said:


> Just out of curiosity, are your depressive symptoms (if you have/had any) atypical (increased eating and/or sleeping, literally next to no energy, etc.) or melancholic (or neither)? Interestingly, in social phobics with AvPD having major depression, atypical depression presents in 55% of cases, versus only 31% of non-social phobic/AvPD subjects.


I'd definitely be mixed, amongst other things. I was absolutely apathetic (basically the closest thing to a single human emotion I had was annoyance) and anhedonic (didn't care if I did bad, and no matter how good I did they was no joy, just thoughts of "I could do better"), I had GAD and SAD forever, OCD, (undiagnosed) ADHD, racing thoughts, impulsiveness, chronic insomnia... and yet I've beem quite successful in spite of myself.

Wellbutrin usually isn't something used for SAD, but some people do find relief. Earlier this year I was basically cured of SAD with Wellbutrin and Remeron. I was making new friends, reconnecting with old ones, working jobs where socializing is part of the job, etc. I ended up falling into depression and haven't found my way back to that point but I'm working on it.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> Ive been born with SA as far as i remember, my med experiences also confirm a neurological problem involved (i only get SA relief from amphetamine) opiates, benzo's, GBL, alcohol etc all dont work, even if they make me euphoric and not care.
> 
> I dont remember any worsening, it was allways the same.
> 
> Perhaps just start nardil on its own, and contact your pdoc in case of a hypomanic episode?


Interesting. Actually, come to think of it, I've had some symptoms of SAD since before the age I mentioned, too. I distinctly remember feelings of extreme self-consciousness at this pool party when I was 7 or 8. I was pathologically nervous about taking off my shirt, even though I wasn't really overweight and had nothing to be ashamed of. Weird.



rustybob said:


> Have you been on any meds before bmwfan?
> 
> I hate riding the medication merry-go-round just as much as the next person, but I think it's pretty extreme to go from nothing to an irreversable MAOI.


Was on Zoloft for all of two days when I was 16, but I felt nauseous, kinda zoned out and zombie-like, and already had sexual dysfunction within the first night so I ditched it. My mom had a great response to Zoloft, so my p-doc was interested in trying that originally, but Paxil is supposedly better for social phobia, so then she moved onto that. And when I became depressed, she moved to Lexapro. I suggested Lamictal and she was somewhat amenable to the idea since I was convinced (not because of my history but because of my atypical symptoms) I had or would develop bipolar, and obviously she doesn't want me switching into (hypo)mania any more than I do.

I agree it's a bit of a stretch to go from essentially nothing to Nardil as far as mainstream psychiatry is concerned, but I don't really understand the rationale, if the patient is careful with dietary and drug interactions. If one drug is proven to work better than another, why waste time with the other one? Psychiatrists seem to be in love with SSRIs.



rustybob said:


> I'd definitely be mixed, amongst other things. I was absolutely apathetic (basically the closest thing to a single human emotion I had was annoyance) and anhedonic (didn't care if I did bad, and no matter how good I did they was no joy, just thoughts of "I could do better"), I had GAD and SAD forever, OCD, (undiagnosed) ADHD, racing thoughts, impulsiveness, chronic insomnia... and yet I've beem quite successful in spite of myself.


Could your mood change in response to positive events? For example, say you got a promotion at work or went out for a drink with some friends and had a "good" time. Would your mood temporarily lift for a few hours, even days, following? How were your energy levels--lower than normal but still able to function somewhat normally from a physical standpoint--and sleep while depressed--still insomniac?

The reason I ask these questions is because your manic response to the AD might indicate you have a more atypical depression, from what I've read, but perhaps this is not so. I'm actually curious to know whether melancholic or undifferentiated depression sometimes switches from ADs.



> Wellbutrin usually isn't something used for SAD, but some people do find relief. Earlier this year I was basically cured of SAD with Wellbutrin and Remeron. I was making new friends, reconnecting with old ones, working jobs where socializing is part of the job, etc. I ended up falling into depression and haven't found my way back to that point but I'm working on it.


Forgive me if you already stated this, but have you tried MAOIs or any mood stabilizers, including lithium?


----------



## rustybob (Nov 19, 2009)

bmwfan07 said:


> Could your mood change in response to positive events? For example, say you got a promotion at work or went out for a drink with some friends and had a "good" time. Would your mood temporarily lift for a few hours, even days, following? How were your energy levels--lower than normal but still able to function somewhat normally from a physical standpoint--and sleep while depressed--still insomniac?
> 
> The reason I ask these questions is because your manic response to the AD might indicate you have a more atypical depression, from what I've read, but perhaps this is not so. I'm actually curious to know whether melancholic or undifferentiated depression sometimes switches from ADs.
> 
> Forgive me if you already stated this, but have you tried MAOIs or any mood stabilizers, including lithium?


No my mood never changed. I was literally a zombie for 24.5 years of my life. Energy wise it was always low no matter what. Ephedrine helped slighty, but otherwise I was constantly fatigued. Sleep, the only time I could sleep for more than an hour and a half straight was when I was sick. The amount of times I slept for longer when I wasn't sick I could count on one hand, with 4 hours being the longest.

Never tried MAOIs. I still like to do some MDMA every once in a while, which is a big no-no on MAOIs. The dietary restrictions are too much for me at this point in my life as well. I've found partial to complete relief without MAOIs.

Mood stabilizers, no as well. Despite the fact that SSRIs briefly put me into mania, I don't think I'm bipolar and neither does my doctor.


----------



## jim_morrison (Aug 17, 2008)

rustybob said:


> I'd definitely be mixed, amongst other things. I was absolutely apathetic (basically the closest thing to a single human emotion I had was annoyance) and anhedonic (didn't care if I did bad, and no matter how good I did they was no joy, just thoughts of "I could do better"), I had GAD and SAD forever, OCD, (undiagnosed) ADHD, racing thoughts, impulsiveness, chronic insomnia... and yet I've beem quite successful in spite of myself.


Sounds almost as if you would have faired much better on stimulants than antidepressants.


----------



## rustybob (Nov 19, 2009)

jim_morrison said:


> Sounds almost as if you would have faired much better on stimulants than antidepressants.


In hindsight, absolutely. Thinking back to how me, my brother, and my sister were, all of us would've benefitted from stimulants. But all of our tendencies always got chalked up to "that's just them being kids". I would've benefitted the most. My brother and sister got subsets of all those disorders, I was the unlucky one who got all of them.

And the thing was, I always knew something was wrong with me, it just took me 24.5 years to figure it out what. The apathy part especially I always figured wasn't normal, but I really never knew that what was wrong had a name, let alone that something could be done about it.

I also never knew that crappy feeling I felt 24/7 was anxiety. It was only after starting meds when it went away that I realized what it was. Since it wasn't something that just popped up I figured it was just the way I was born.

The sleep issues, that's been going on for at least 4 generations of family. Others actually tried meds, I think only SSRIs though. I was the one who figured out what drugs were beneficial for us, and we're all sleeping much better now.


----------



## jim_morrison (Aug 17, 2008)

rustybob said:


> The sleep issues, that's been going on for at least 4 generations of family. Others actually tried meds, I think only SSRIs though. I was the one who figured out what drugs were beneficial for us, and we're all sleeping much better now.


What do you all take for sleep issues now, Remeron?


----------



## rustybob (Nov 19, 2009)

jim_morrison said:


> What do you all take for sleep issues now, Remeron?


I was on Remeron for over a year but I've since changed over to trazodone. The fatigue and apathy Remeron was causing became too much.

Trazodone I started about 3 weeks ago. There is some level of next-day fatigue but it's not even close to Remeron. The sleep is more variable than Remeron. Some nights I sleep 8 straight hours, some I'll wake up once, and others, like last night, I wake up repeatedly. There hasn't been any apathy, which was my main issue with Remeron. The only other side effects have been the hungover feeling when waking up, and sexual problems seems to come and go.


----------



## bmwfan07 (Jun 3, 2007)

I've called a different p-doc's office to schedule a first-time appointment. I'd really like a second opinion and one from someone who specializes in adult ADHD, anxiety, and mood disorders--exactly my issues! This one does, but it'll be close to a month before I can get an appointment. I'm not sure what to do in the meantime.



rustybob said:


> No my mood never changed. I was literally a zombie for 24.5 years of my life. Energy wise it was always low no matter what. Ephedrine helped slighty, but otherwise I was constantly fatigued. Sleep, the only time I could sleep for more than an hour and a half straight was when I was sick. The amount of times I slept for longer when I wasn't sick I could count on one hand, with 4 hours being the longest.
> 
> Never tried MAOIs. I still like to do some MDMA every once in a while, which is a big no-no on MAOIs. The dietary restrictions are too much for me at this point in my life as well. I've found partial to complete relief without MAOIs.
> 
> Mood stabilizers, no as well. Despite the fact that SSRIs briefly put me into mania, I don't think I'm bipolar and neither does my doctor.


Did you ever feel suicidal? I'm impressed you managed, and presumably functioned, that long without descending into a deep and possibly suicidal despair. I often feel suicidally depressed these days at night and I can't imagine feeling that bad for 25 years.



rustybob said:


> In hindsight, absolutely. Thinking back to how me, my brother, and my sister were, all of us would've benefitted from stimulants. But all of our tendencies always got chalked up to "that's just them being kids". I would've benefitted the most. My brother and sister got subsets of all those disorders, I was the unlucky one who got all of them.
> 
> And the thing was, I always knew something was wrong with me, it just took me 24.5 years to figure it out what. The apathy part especially I always figured wasn't normal, but I really never knew that what was wrong had a name, let alone that something could be done about it.
> 
> ...


I wasn't clinically depressed until just recently, although you could say I was somewhat apathetic, unmotivated, and generally out-of-sync with my peers (which led to occasional feelings of depression) for most of my life. The most frustrating thing is that I was never treated for ADHD in childhood, because my parents didn't want to put me on stimulants. I understand the concern there, but I think I would have benefited enormously from it at an early age. I was just all over the place--physically and mentally--since I can remember, and I've never had any direction or focus in life. It's been a constant, tangential journey to seeming nowhere. And now, with this depression, I feel even more hopeless and pessimistic about my future.


----------



## rustybob (Nov 19, 2009)

bmwfan07 said:


> I've called a different p-doc's office to schedule a first-time appointment. I'd really like a second opinion and one from someone who specializes in adult ADHD, anxiety, and mood disorders--exactly my issues! This one does, but it'll be close to a month before I can get an appointment. I'm not sure what to do in the meantime.
> 
> Did you ever feel suicidal? I'm impressed you managed, and presumably functioned, that long without descending into a deep and possibly suicidal despair. I often feel suicidally depressed these days at night and I can't imagine feeling that bad for 25 years.
> 
> I wasn't clinically depressed until just recently, although you could say I was somewhat apathetic, unmotivated, and generally out-of-sync with my peers (which led to occasional feelings of depression) for most of my life. The most frustrating thing is that I was never treated for ADHD in childhood, because my parents didn't want to put me on stimulants. I understand the concern there, but I think I would have benefited enormously from it at an early age. I was just all over the place--physically and mentally--since I can remember, and I've never had any direction or focus in life. It's been a constant, tangential journey to seeming nowhere. And now, with this depression, I feel even more hopeless and pessimistic about my future.


Suicidal, no The thought briefly crossed my mind for about 5 seconds when I was young. But to me suicide is the most selfish act a person can commit. I'm sure the apathy and anhedonia are part of the reason why, but one thing you really can't call me is selfish. And yeah, I functioned quite well despite my problems. I had friends, I worked, I was an athlete, I did well in school. But lack of focus and direction really has held me back in life. I always have ideas on what I want to do and never follow through on them.

There's only been 3 times in my life that I'd say I was truly depressed, with two of them pre-meds. When you're a zombie already it's pretty hard to get any lower. ADHD still isn't something that's been diagnosed, but I absolutely meet the criteria. ADHD does seem to have at least somewhat of a genetic component, and some family a generation below have been diagnosed with it. I've considered going for a diagnosis, but I've taken Ritalin and Adderall before. Both definitely allowed me to focus, but they also left me incredibly fatigued. It's pretty paradoxial for me. Most people feel fatigued during/after the crash, me, I feel awake again.


----------



## bmwfan07 (Jun 3, 2007)

rustybob said:


> Suicidal, no The thought briefly crossed my mind for about 5 seconds when I was young. But to me suicide is the most selfish act a person can commit. I'm sure the apathy and anhedonia are part of the reason why, but one thing you really can't call me is selfish. And yeah, I functioned quite well despite my problems. I had friends, I worked, I was an athlete, I did well in school. But lack of focus and direction really has held me back in life. I always have ideas on what I want to do and never follow through on them.
> 
> There's only been 3 times in my life that I'd say I was truly depressed, with two of them pre-meds. When you're a zombie already it's pretty hard to get any lower. ADHD still isn't something that's been diagnosed, but I absolutely meet the criteria. ADHD does seem to have at least somewhat of a genetic component, and some family a generation below have been diagnosed with it. I've considered going for a diagnosis, but I've taken Ritalin and Adderall before. Both definitely allowed me to focus, but they also left me incredibly fatigued. It's pretty paradoxial for me. Most people feel fatigued during/after the crash, me, I feel awake again.


Interesting. So your "depression" manifested mostly in apathy and somewhat in anhedonia, but not as much in _feeling_ awful. That is, from my understanding, not a typical presentation, but probably more characteristic of dysthymia or feelings of frustration as a result of your undiagnosed and untreated ADHD (but those symptoms usually aren't a diagnosis in and of themselves).

Suicide is indeed a selfish act, but when the pain gets unbearable, some people literally see no other way out. Depression often comes with delusional feelings of hopelessness, worthlessness, guilt, self-reproach, ruminations on past mistakes and failures, etc. It literally transforms your mind into a factory of negativity.

I have a feeling (and many statistics confirm this) that the suicide rate, attempted and completed, is higher in atypical and/or bipolar depression, because the absolute apathy, feeling of total numbness and disconnection from the world, lethargy, fatigue, and having no social utility because of the seeming inevitable tendency toward dysfunction in oversleeping, binge-eating, and inactivity probably leaves these people even more hopeless and perpetuates the negative downward spiral. I believe, by contrast, most "typical" or melancholic depressives are somewhat on auto-pilot but don't have the same severity or extent of apathy, fatigue, lethargy, or dysfunction. There are biochemical differences between the two types of depression: melancholic is typically characterized as a "hyper-aroused" state, versus atypical depression as "hypo-arousal." Melancholic depression also often includes higher levels of anxiety as a result. I know that my social phobia, per se, is lessened currently while I'm depressed, which I guess is in some perverted way, a "benefit."

Anyway, I'm glad you're presumably feeling a lot better and that you got the treatment you needed! I hope the same comes true for me soon, because this is getting really awful.


----------



## bmwfan07 (Jun 3, 2007)

Also, any more suggestions or experiences with meds for atypical depression? I get the feeling this is a tough nut to crack.


----------



## ambidexter (Jul 17, 2010)

bmwfan07 said:


> I'm also not sure what I should do at this point, whether to take the Lexapro my p-doc originally offered (and/or Lamictal, but that's of questionable wisdom) or to try to get her to prescribe Nardil. I need to move fast, because I'd ideally like some benefit by the time we leave for vacation next week. Being depressed there would suck.


It's unlikely that you'll see much in the way of benefits from most antidepressants within a week.

Nardil, especially, is probably not something you want to start on expecting to feel good on vacation next week.

It can be really rough going in the beginning. Maybe it would be okay if you started it now and you just stayed at 15 mg a day until you got back -- that might be a good approach, actually, 'cause slow titration is good, I think, and you might feel fairly good on that at first. But you also might not...

Nardil pretty much requires a lifestyle change, if you want to make it work. You need to do some research and get your supplies together before starting on it.

And it helps to be in a situation where you can ride out the side effects for a while. Most of them do go away or lessen significantly with time for a lot of people -- definitely for me, anyway.

Also just for me, in case it turns out to be relevant for you -- the right SSRI can kick me out of a depression. I wouldn't want to be on one forever; they get deadening and blech after a while, but six months on an SSRI can be helpful. Doesn't do anything for my SA, which is the really debilitating issue for me, but still sometimes when you're really depressed it's like you need to climb up out of that hole before you can work on anything else.

So if that's true for you too, maybe Lexapro could be a good option for the moment.


----------



## bmwfan07 (Jun 3, 2007)

ambidexter said:


> It's unlikely that you'll see much in the way of benefits from most antidepressants within a week.
> 
> Nardil, especially, is probably not something you want to start on expecting to feel good on vacation next week.
> 
> ...


Thanks for all the info!

What supplies does one need in preparation for taking Nardil? Are there supplements that are recommended to take with it? I know there are some pretty significant dietary restrictions, but I've also heard that some people are far more sensitive than others to it, and just to stay on the safe side, the FDA has issued a blanket warning. Could I, for instance, introduce small amounts of cheese, avocado, etc. to see if they affect me in any way?

Was your depression atypical (increased appetite and/or increased sleep, very low motivation and energy, mood reactivity, and/or worsening at night)? I've yet to read about anyone with atypical depression who's been significantly helped by SSRIs. It doesn't mean it doesn't happen, but it isn't as convincing to me yet. If you had atypical features, though, and had success with it, I might feel more confident.


----------



## crayzyMed (Nov 2, 2006)

bmwfan07 said:


> Also, any more suggestions or experiences with meds for atypical depression? I get the feeling this is a tough nut to crack.


Well are you interested in my experience with AMT (alpha methyl tryptamine) its a serotonine, dopamine and NE releasing agent and strong 5HT2A agonist, its quite off label tough and only available as a research chemical, but IME it blows amphetamine away.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> Well are you interested in my experience with AMT (alpha methyl tryptamine) its a serotonine, dopamine and NE releasing agent and strong 5HT2A agonist, its quite off label tough and only available as a research chemical, but IME it blows amphetamine away.


Sure, I'd love to hear about your experiences with it! I've never heard of that compound, but it definitely sounds intriguing from my reading.


----------



## Canadian4Life (Sep 27, 2010)

I have been on Alot of antidepressants and zoloft worked for my atypical depression. Also try adding methylcobalamin (b12) to your antidepressant..it makes my zoloft work alot better


----------



## bmwfan07 (Jun 3, 2007)

Canadian4Life said:


> I have been on Alot of antidepressants and zoloft worked for my atypical depression. Also try adding methylcobalamin (b12) to your antidepressant..it makes my zoloft work alot better


How long have you been on the Zoloft? I've heard about B12's benefits, and I currently take some, but how much is optimal?


----------



## Canadian4Life (Sep 27, 2010)

bmwfan07 said:


> How long have you been on the Zoloft? I've heard about B12's benefits, and I currently take some, but how much is optimal?


Been on zoloft 10 weeks now. Working great for me..really good! The methylcobalamin in addition is a major help too. I take 10-20mg a day depending on how I feel. That's a very high dose but it works amazing. I get the 5mg tablets so I don't need to take alot of tablets. 10-20mg of methylcobalamin a day will give you potent anti-anxiety and antidepressant effects on or off an antidepressant. Give it a week or so you will feel alot better..more like amazing


----------



## crayzyMed (Nov 2, 2006)

bmwfan07 said:


> Sure, I'd love to hear about your experiences with it! I've never heard of that compound, but it definitely sounds intriguing from my reading.


In low doses it acts as releasing agent of the 3 monoamine's and a 5HT2A agonist and in high doses its a psychedelic, i personally dont like psychedelics due to a severe bad trip in the past on LSD so i have never chosen to try AMT that way, ive only used it therapeutically.

Its the single most effective med i ever tried, it abolishes my ADHD, it completely vanishes my very severe OCD and it reduces my social anxiety better then therapeutic doses of amphetamine i also normally dont suffer from depression but i got a few very severe depressive episodes of a few weeks this year and while even the combination of amphetamine and GHB didnt help (they made the depression more easily to tolerate but i was still badly depressed) just one dose COMPLETELY kicked me out of, like it just pulls you out with a grip and it didnt return afterwards, my depression was mostly caused by irrelevant OCD toughts and AMT normalized my thinking wich lasted after i stopped taking it.

There 's no comedown in my experience, it lasts untill i go to sleep, even if i take it 6 o clock in the morning and go sleep 4 at night also tolerance doesnt appear to be much of an issue. It has allways worked great for me without side effects, altough i did induce tolerance sometimes tough, caused by cross tolerance due to my MDMA use, a 2 day break allways reversed it tough.

The downside? It has been in clinical use for 20 years in russia and research papers didnt report any major side effects also someone i know checked the russion toxicology database, and he said no toxicology issues with AMT came up, but its still a research chemical, only researched in a communistic state so caution is a good idea, i do beleive severe treatment resistant patients can truly benefit from this substance.

Its likely neurotoxic (AET has been found too) however as with amphetamine neurotoxiticy of dual releasers like MDMA is caused by a combination of hyperthermia and excess oxidative stress caused by excessive dopamine metabolism, likely not an issue in therapeutically relevant doses.


----------



## crayzyMed (Nov 2, 2006)

I second the addition of vitamin B12, ive noticed a defiency can severely manipulate my response to the substances i take, it definatly makes antidepressants work better.

I allways get sloppy with supplementing tough, when i notice my substances start acting weird (negative reaction, inhibition of positive effects) i get the IM injections at the pharmacy, wich basicly work right away, after a few days my B12 levels are back optimal, after that i'm gonna switch to the sublingual form tough.


----------



## Canadian4Life (Sep 27, 2010)

crayzyMed said:


> In low doses it acts as releasing agent of the 3 monoamine's and a 5HT2A agonist and in high doses its a psychedelic, i personally dont like psychedelics due to a severe bad trip in the past on LSD so i have never chosen to try AMT that way, ive only used it therapeutically.
> 
> Its the single most effective med i ever tried, it abolishes my ADHD, it completely vanishes my very severe OCD and it reduces my social anxiety better then therapeutic doses of amphetamine i also normally dont suffer from depression but i got a few very severe depressive episodes of a few weeks this year and while even the combination of amphetamine and GHB didnt help (they made the depression more easily to tolerate but i was still badly depressed) just one dose COMPLETELY kicked me out of, like it just pulls you out with a grip and it didnt return afterwards, my depression was mostly caused by irrelevant OCD toughts and AMT normalized my thinking wich lasted after i stopped taking it.
> 
> ...


Wish I could try this stuff! not a chance in canada


----------



## Canadian4Life (Sep 27, 2010)

crayzyMed said:


> I second the addition of vitamin B12, ive noticed a defiency can severely manipulate my response to the substances i take, it definatly makes antidepressants work better.
> 
> I allways get sloppy with supplementing tough, when i notice my substances start acting weird (negative reaction, inhibition of positive effects) i get the IM injections at the pharmacy, wich basicly work right away, after a few days my B12 levels are back optimal, after that i'm gonna switch to the sublingual form tough.


Weirdness is exactly the word I feel when my B12 is low and I stop supplementing. I take 10-20mg of it a day, I don't know why my body needs so much but everytime I take it I feel myself feeling satisfied. They say b12 levels stay in the body a long time. But not in my case If I go 3 days without supplementing I get very nervous and feel "out of it" and get very shakey.


----------



## crayzyMed (Nov 2, 2006)

Yeah i get defiency's after a few days without supplementing too, i also noticed the shaking, especially when i take AMT i get a cracked out response, hands shaking, severe RLS and a wierd unpleasant stimulation instead of the potent antidepressant effects, also amphetamine induces severe anxiety when my B12 levels arent optimal.

I also notice it makes me feel better and more satisfied.


----------



## bmwfan07 (Jun 3, 2007)

Canadian4Life said:


> Been on zoloft 10 weeks now. Working great for me..really good! The methylcobalamin in addition is a major help too. I take 10-20mg a day depending on how I feel. That's a very high dose but it works amazing. I get the 5mg tablets so I don't need to take alot of tablets. 10-20mg of methylcobalamin a day will give you potent anti-anxiety and antidepressant effects on or off an antidepressant. Give it a week or so you will feel alot better..more like amazing


I'm glad it's working so well for you! That said, I was hoping you'd been on it longer to determine whether it pooped out. :b That's my main concern with SSRIs in treating atypical depression, which I believe acts more like--or is, in fact--bipolar depression. Has Zoloft increased your energy levels, motivation, and eliminated your anhedonia as well as extreme interpersonal sensitivity? Or did you not have most of these symptoms to begin with?



crayzyMed said:


> In low doses it acts as releasing agent of the 3 monoamine's and a 5HT2A agonist and in high doses its a psychedelic, i personally dont like psychedelics due to a severe bad trip in the past on LSD so i have never chosen to try AMT that way, ive only used it therapeutically.
> 
> Its the single most effective med i ever tried, it abolishes my ADHD, it completely vanishes my very severe OCD and it reduces my social anxiety better then therapeutic doses of amphetamine i also normally dont suffer from depression but i got a few very severe depressive episodes of a few weeks this year and while even the combination of amphetamine and GHB didnt help (they made the depression more easily to tolerate but i was still badly depressed) just one dose COMPLETELY kicked me out of, like it just pulls you out with a grip and it didnt return afterwards, my depression was mostly caused by irrelevant OCD toughts and AMT normalized my thinking wich lasted after i stopped taking it.
> 
> ...


That's an awesome anecdote; thanks! I too have fairly severe (at times... it seems to vary with stress) pure-O as well as regular OCD, but the pure-O is far more disturbing (aggressive, intrusive thoughts). The pure-O has subsided significantly in the past couple of months and I guess since I've had the "regular" OCD with neutralizing compulsions my whole life, I'm used to it and it doesn't bother me that much (rituals like tapping, touching, counting, symmetry, etc.--no extreme hand-washing or checking).

Were your depressions more atypical or melancholic (I believe this is key in distinguishing treatment efficacy)? Based on your comorbidity, I'd guess atypical, but maybe they wouldn't qualify for major depression at all, if they were indeed OCD-induced as you say. I too have wondered about the connection between OCD and depression, as I believe OCD can legitimately affect mood, but it isn't in the same way that major depression does. That is, the mood change seems easily reversible with the fading or expulsion of the obsession. For instance, I was literally convinced I was a psychopath for a month or so when I first got pure-O symptoms (till that time I'd only had the "regular" form of OCD) after a particularly stressful life event. My psychiatrist gave me a mood questionnaire and I'm sure I would have qualified for a MDD diagnosis then--because my appetite, sleep, energy, pleasure-seeking behavior, mood, ruminations, etc. were all severely affected by my OCD. This current depression, however, is distinctly different, in that I cannot identify any relation to any event.

So do you take AMT every day? How do you procure it, and how much do you take? Have there been any studies of its efficacy or safety in anything psychiatric?

Sorry for all the questions, but you've really piqued my interest!


----------



## Canadian4Life (Sep 27, 2010)

bmwfan07 said:


> I'm glad it's working so well for you! That said, I was hoping you'd been on it longer to determine whether it pooped out. :b That's my main concern with SSRIs in treating atypical depression, which I believe acts more like--or is, in fact--bipolar depression. Has Zoloft increased your energy levels, motivation, and eliminated your anhedonia as well as extreme interpersonal sensitivity? Or did you not have most of these symptoms to begin with?
> 
> That's an awesome anecdote; thanks! I too have fairly severe (at times... it seems to vary with stress) pure-O as well as regular OCD, but the pure-O is far more disturbing (aggressive, intrusive thoughts). The pure-O has subsided significantly in the past couple of months and I guess since I've had the "regular" OCD with neutralizing compulsions my whole life, I'm used to it and it doesn't bother me that much (rituals like tapping, touching, counting, symmetry, etc.--no extreme hand-washing or checking).
> 
> ...


I don't have problems with energy i'm wired without drugs. But it has helped my motivation and definetly my anhedonia.


----------



## Canadian4Life (Sep 27, 2010)

crayzyMed said:


> Yeah i get defiency's after a few days without supplementing too, i also noticed the shaking, especially when i take AMT i get a cracked out response, hands shaking, severe RLS and a wierd unpleasant stimulation instead of the potent antidepressant effects, also amphetamine induces severe anxiety when my B12 levels arent optimal.
> 
> I also notice it makes me feel better and more satisfied.


Yes my ritalin causes me insane anxiety without supplementing my b12 and the same with antidepressants. They give me an effect but not an antidepressant effect (like you said unpleasant stimulation) unless I supplement methylcobalamin. I don't think any med would work period if I didn't supplement my B12..sounds far fetched but it's actually true


----------



## crayzyMed (Nov 2, 2006)

My depressive symptons where definatly atypical, not really major depression but i'm sure that i wouldnt have been able to get out of it for pretty long with AMT, it was also a very severe episode, feeling completely hopeless and only wanting to sleep.

Oh man i understand completely my OCD used to be extremely severe in the past, i did find memantine to reduce it a TON, however where AMT realy shine's is that it makes it completely vanish, like it just isnt there anymore.

I think AMT has major potential for atypical depression due to its dopaminergic effects and its 5HT2A agonism.

Yes i do take AMT daily at 7,5mg a day, took it consistently for 2 months before i temporary stopped it because i got sick and then even got sicker afterwards due to the antibiotic they gave me.. also currently i ran out of memantine and stopped taking most of my regime to avoid excessive dopamine downregulation, i also take dexedrine, because AMT didnt fully fix up my social anxiety, it did greatly tough but after some experimentation i concluded i needed the addition of amphetamine, from there on it takes chronic exposure wich is essential to induce wanting to be social, meds alone cant do that trick, except make you talkative on MSN.

I order it online from a research chemical vandor, vendors that sell recreational research chemicals, AMT is pretty popular as a psychedelic drug.

There are study's but i need someone that can acces a library in a university to acces them:
Here is an overview of the most interesting abstracts:

Title: [APROPOS OF THE USE OF INDOPAN IN CLINICAL PSYCHIATRY.]
Author: LEVIT, V G
Add.Author / Editor: MOROZOVA, T N
POPOVA, A N
Citation: Zh Nevropatol Psikhiatr Im S S Korsakova
Volume: 64, Date: 1964 , Pages: 768-70 
http://www.labmeetin...ical-psychiatry

Title: [Pharmacological properties of indopane (alpha-methyltryptamine HCl).]
Author: MASHKOVSKII, M D
Add.Author / Editor: TRUBITSYNA, T K 
http://www.labmeetin...yptamine-hcl)

Title: [On the mechanism of action of indopan]
Author: Popova, E N
Citation: Zh Nevropatol Psikhiatr Im S S Korsakova
Volume: 67, Issue: 1, Date: 1967 , Pages: 125-31 
http://www.labmeetin...tion-of-indopan

Title: [Effect of indopan on cerebral circulation]
Author: Mashkovskiĭ, M D
Add.Author / Editor: Lanskiĭ, V P
Citation: Farmakol Toksikol
Volume: 31, Issue: 5, Pages: 587-90 
http://www.labmeetin...ral-circulation

Title: [EFFECT OF INDOPAN ON THE BIO-ELECTRIC ACTIVITY OF THE BRAIN.]
Author: ROSHCHINA, L F
Add.Author / Editor: MASHKOVSKII, M D
Citation: Zh Nevropatol Psikhiatr Im S S Korsakova
Volume: 63, Date: 1963 , Pages: 1679-87 
http://www.labmeetin...ty-of-the-brain

Title: [Morphophysiologic studies of the effect of indopan on the process of higher nervous activity]
Author: Krivitskaia, G N
Add.Author / Editor: Mering, T A
Citation: Zh Vyssh Nerv Deiat Im I P Pavlova
Volume: 16, Issue: 4, Pages: 648-54 
http://www.labmeetin...ervous-activity

Title: [Group toxicity of indopan and its reaction to various neurotropic drugs]
Author: Trubitsyna, T K
Add.Author / Editor: Mashkovskiĭ, M D
Citation: Farmakol Toksikol
Volume: 28, Issue: 1, Pages: 23-7 
http://www.labmeetin...urotropic-drugs

Title: Activation of brain 5-HT neurons by two alpha-methylated tryptamine derivatives.
Author: Arai, Y
Add.Author / Editor: Tadano, T
Yonezawa, A
Fujita, T
Kinemuchi, H
Kisara, K 
http://www.labmeetin...ine-derivatives

Title: Involvement of 5-hydroxytryptamine and dopamine neurones in the behavioural effects of alpha-methylytryptamine.
Author: Marsden, C A
Citation: Neuropharmacology
Volume: 19, Issue: 8, Date: 1980 Aug , Pages: 691-8 
http://www.labmeetin...thylytryptamine



> Toxicopathologic studies of α-methyl- and α-ethyltryptamine acetates (Monase) *1: I. Acute, subacute, and miscellaneous studies
> 
> Toxicopathologic characterizations of two recently reported monamine oxidase inhibitors, α-methyl- and α-ethyltryptamine, were presented; the data included acute (mouse, rat) and subacute (rat, dog) toxicity evaluations.
> In the 28-day rat studies, α-methyltryptamine and α-ethyltryptamine were well tolerated at levels of 3 and 10 mg/kg, respectively. At higher doses, increasing retardation of body weight gains and signs of CNS stimulation occurred.
> ...





> Studies on the toxicology of α-methyl- and α-ethyltryptamine acetates (Monase) *1: II. Chronic studies
> 
> The rat data obtained after one-year oral administration indicated that MT and ET were well tolerated at levels of 3.0 and 10 mg/kg/day. Drug effects, such as excessive salivation, slight erythema, hypersensitivity, and muscle tenseness, were observed in some rats of these groups during the study. The appearance and behavior of the rats on a dosage of 30 mg/kg/day were altered, more severe manifestations of the clinical signs being observed in the two lower dosage groups. Increasing retardation of body weight gains and food consumption occurred at the higher dosage levels. The survival rate for the rats at the 30 mg/kg/day level of MT was significantly lower than for the controls. Bimonthly hematologic values of all dosed groups were comparable with those of the controls.
> In the dog, dosages of 3.0 and 10 mg/kg/day of MT and ET were well tolerated during a 6-month study. The pharmacologic effects observed in these groups were occasional episodes of lacrimation, pupillary dilatation, and slight mydriasis. At 30 mg/kg/day a more exaggerated and wider range of drug-induced signs (hyper-activity and slight ataxia) was observed. The body weights of the dogs of all groups were maintained. Hematologic, biochemical, and urine values for the test dogs remained within normal limits.
> ...





> [Acute and latent influenzal infection in mice with altered endogenous serotonin metabolism]
> http://www.ncbi.nlm....v/pubmed/919502
> QUOTE
> A steady and long-term increase of the endogenous serotonine concentration in the lungs, spleen, and brain achieved by administration of nontoxic doses of indopan, an inhibitor of monoamineoxidase, caused a significant decrease of resistance of animals to influenza virus in acute infection. After natural route of inoculation with 20 LD50 of the allantoic influenza A3/WSN (HON1) virus strain in the animals treated with indopan the area of lung affection with specific influenza pneumonia increased, the virus concentration in the lungs and spleen rose sharply, the titre of IgM antibody in the blood decreased; the animal mortality in this group also increased. The level of serotonin in the blood and organs of latently infected animals became normal 6 weeks after virus inoculation. In some of these animals, however, indopan caused a greater increase of serotonin level in the lungs than in intact mice of the same weight and age. Without changing the amine levels in the spleen and the brain, indopan caused 4-16-fold increase in the titer of specific antihemagglutinins in the blood, mostly of IgM fraction, as compared with the controls. In latent influenza infection the balance of serotonin metabolism in the lungs in unstable.


http://resources.metapress.com/pdf-preview.axd?code=t78048858nt60n72&size=largest


----------



## crayzyMed (Nov 2, 2006)

Canadian4Life said:


> Yes my ritalin causes me insane anxiety without supplementing my b12 and the same with antidepressants. They give me an effect but not an antidepressant effect (like you said unpleasant stimulation) unless I supplement methylcobalamin. I don't think any med would work period if I didn't supplement my B12..sounds far fetched but it's actually true


Yeah i agree 100% same for me.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> Yeah i get defiency's after a few days without supplementing too, i also noticed the shaking, especially when i take AMT i get a cracked out response, hands shaking, severe RLS and a wierd unpleasant stimulation instead of the potent antidepressant effects, also amphetamine induces severe anxiety when my B12 levels arent optimal.
> 
> I also notice it makes me feel better and more satisfied.


Does the possibility exist that the B12 deficiency is somehow being caused or affected by the interactions of the medication(s) you're on? I.e. most people do not have those overt symptoms of B12 deficiency that you and Canadian4Life describe, and they're also not taking psychotropics (although it's probably not uncommon, from my reading, to have B12 deficiencies).

I also have a congenital thyroidism--specifically, no thyroid. Obviously, this has significant implications for mental illness, particularly with regard to depression and/or bipolar--connections, most of which modern science has probably yet to discover and establish (one thing is for sure: hypothyroidism predisposes bipolar-disordered people to a rapid-cycling course--not good!). I was taking Armour thyroid for a year and a half but recently switched back to the synthetic T4 after I was getting some weirdness in my lab results--for anyone who's savvy with the thyroid and cares, T4 was highish (3.5), free T3 was _above_ range, and free T4 was _below_ range. Now, I've read that in atypical depression serum TSH is often about .4 higher than normal, but even a TSH of 3.1 in euthymic state could not really explain the combination of high T3 and low T4. The only explanation I've discovered is a possible hypocortisolism, which is contraindicated in melancholic depression but possibly tied into atypical depression. This is obviously where it could get interesting. I have sitting here a saliva cortisol testing kit that I have yet to complete, ironically because of my depression and my tendency to oversleep past the point in the morning when I can do it. But I'm definitely curious to see if my cortisol levels are low, which might explain both some of my anergic/atypical symptoms and my T3 pooling in the blood (cortisol facilitates cell uptake of T3). Either way, I've been back on Synthroid for a couple of weeks with no improvement, so I'm not optimistic.


----------



## crayzyMed (Nov 2, 2006)

I used to have really cracked out responses to stuff years ago before i tried any medication, also extreme anxiety on amphetamine when i tried it and the simular cracked out response to amp i get now, its only after i got on meds i figured it out tough.


----------



## bmwfan07 (Jun 3, 2007)

Canadian4Life said:


> I don't have problems with energy i'm wired without drugs. But it has helped my motivation and definetly my anhedonia.


Huh. It doesn't sound like you had the hallmark atypical syndrome. Perhaps you simply had acute melancholic depression--feelings of sadness, worthlessness, guilt over past failures/mistakes/wrongdoings, reduced appetite, insomnia, etc. Or maybe dysthymia? Or perhaps you're just a very hyperactive ADHDer --did you mention you had ADHD (I know you were taking stimulants)? Also, how old are you? Sorry if you already mentioned both; my brain's totally fried right now.

The distinction between atypical and melancholic depression is critical, in my view.



Canadian4Life said:


> Yes my ritalin causes me insane anxiety without supplementing my b12 and the same with antidepressants. They give me an effect but not an antidepressant effect (like you said unpleasant stimulation) unless I supplement methylcobalamin. I don't think any med would work period if I didn't supplement my B12..sounds far fetched but it's actually true


Interesting. I noticed myself that Adderall actually _lessened_ my anxiety to an extent, particularly my social phobia. But I know Adderall and MPH are different drugs.



crayzyMed said:


> My depressive symptons where definatly atypical, not really major depression but i'm sure that i wouldnt have been able to get out of it for pretty long with AMT, it was also a very severe episode, feeling completely hopeless and only wanting to sleep.
> 
> Oh man i understand completely my OCD used to be extremely severe in the past, i did find memantine to reduce it a TON, however where AMT realy shine's is that it makes it completely vanish, like it just isnt there anymore.


Amazing that it worked so quickly and effectively. Man, I'm kinda wishing I had that AMT right now! I could definitely use a pick-me-up-and-get-me-the-hell-out-of-this-funk. I haven't felt suicidal for a couple of days, but I dread when it gets that bad (usually when I'm alone and idle, so I try to avoid both). Interestingly, although atypical depression is associated with less constant "mood" impairment and negative rumination, it's associated with greater suicidality. I'm not really sure why in terms of symptomatology. Perhaps one theory is that melancholics spend their time brooding and ruminating about the past, never really changing, mood-wise, in either direction, and are somewhat on auto-pilot with anhedonia and low-ish energy, but nonetheless unless severe, they aren't left with feelings of total incapacitation, isolation, and disconnection.



> I think AMT has major potential for atypical depression due to its dopaminergic effects and its 5HT2A agonism.
> 
> Yes i do take AMT daily at 7,5mg a day, took it consistently for 2 months before i temporary stopped it because i got sick and then even got sicker afterwards due to the antibiotic they gave me.. also currently i ran out of memantine and stopped taking most of my regime to avoid excessive dopamine downregulation, i also take dexedrine, because AMT didnt fully fix up my social anxiety, it did greatly tough but after some experimentation i concluded i needed the addition of amphetamine, from there on it takes chronic exposure wich is essential to induce wanting to be social, meds alone cant do that trick, except make you talkative on MSN.
> 
> ...


Wow, lots of studies, cool--wish I had access to those publications. The community college I'm technically still enrolled in probably does; I should investigate whether they do--if I can get enough energy and motivation... :roll

Also, is AMT illegal to import and consume in the U.S.? I would suspect yes...


----------



## crayzyMed (Nov 2, 2006)

Yes its illegal in the states, like pretty much everything...

Yeah the effectiveness of AMT and quite a bit of study's make it look very interesting.


----------



## bent (Aug 4, 2005)

I know it's not an anti depressant but after being on effexor for a long time i recently added seroquel and it's pretty good. the only bad part is that i think it weakens your energy...waddayagonnado.

anyway, seroquel is goodtimes. i'm on a really low dose but it makes things better...takes the edge off.


----------



## bmwfan07 (Jun 3, 2007)

crayzyMed said:


> Yes its illegal in the states, like pretty much everything...
> 
> Yeah the effectiveness of AMT and quite a bit of study's make it look very interesting.


I hate this country more and more every day. :mum (Pretty soon, saying that will be illegal. :roll)



bent said:


> I know it's not an anti depressant but after being on effexor for a long time i recently added seroquel and it's pretty good. the only bad part is that i think it weakens your energy...waddayagonnado.
> 
> anyway, seroquel is goodtimes. i'm on a really low dose but it makes things better...takes the edge off.


What prompted you to add Seroquel? I've heard the same thing about it being sedating/causing low energy.


----------



## bent (Aug 4, 2005)

My physician suggested it because I also have sleep difficulties and apparently it is used for that and can then additionally help with anxiety and depression. Of course, they might just be saying that while secretly thinking "This guy's nucking futs...time for the anti-psychotics."


----------



## robtyl (Sep 2, 2010)

crayzymed - i have access to university databases in australia and the uk. i will look all those up for you later tonight 

you seriously sound frighteningly crazy with all your experimentation - but i like reading your posts!


x


----------



## crayzyMed (Nov 2, 2006)

robtyl said:


> crayzymed - i have access to university databases in australia and the uk. i will look all those up for you later tonight
> 
> you seriously sound frighteningly crazy with all your experimentation - but i like reading your posts!
> 
> x


Cheers, that gives us some more safety data on this one, the question is how much we can trust sovjet russia tough, but i consider it well worth the risk in my case due to the complete lack of side effects and incredible effiacy.


----------



## crayzyMed (Nov 2, 2006)

bent said:


> My physician suggested it because I also have sleep difficulties and apparently it is used for that and can then additionally help with anxiety and depression. Of course, they might just be saying that while secretly thinking "This guy's nucking futs...time for the anti-psychotics."


Antipsychotic use is irresponsible tough in depressive and anxioust patients, because 1) the evidence comes from small pilot study's wich have never been replicated in bigger study's, as an example:


> J Clin Psychiatry. 2005 Oct;66(10):1289-97.
> Olanzapine/fluoxetine combination for treatment-resistant depression: a controlled study of SSRI and nortriptyline resistance.
> Shelton RC, Williamson DJ, Corya SA, Sanger TM, Van Campen LE, Case M, Briggs SD, Tollefson GD.
> 
> ...


Only a faster onset but no better endresponse does NOT justify the use of medication with diabeti's and tardive dyskinesia as possible long term side effects, those are well documented in people with shizophrenia (the risk is pretty significant.)

2) Possibly of additional risks in patients with depression and anxiety, the following abstracts goes in debt about that but doesnt provide any results in the abstract, if anyone can get the full paper of this one too id appreciate it:


> Curr Drug Saf. 2010 Jul 2;5(3):263-6.
> Safety considerations of the use of second generation antipsychotics in the treatment of major depression: extrapyramidal and metabolic side effects.
> DeBattista C, DeBattista K.
> 
> ...


----------



## kratos (Nov 16, 2010)

robtyl said:


> crayzymed - i have access to university databases in australia and the uk. i will look all those up for you later tonight
> 
> you seriously sound frighteningly crazy with all your experimentation - but i like reading your posts!
> 
> x


 How do you get hold of them? I'm at university in the UK but can only request inter-lending for books related to my course. It seems like I can request any book from the city library though, although I'm not sure whether they only inter-lend with libraries in the area,I will have to find out. Please let me know if there are easier ways.


----------



## ambidexter (Jul 17, 2010)

bmwfan07 said:


> Thanks for all the info!
> 
> What supplies does one need in preparation for taking Nardil? Are there supplements that are recommended to take with it? I know there are some pretty significant dietary restrictions, but I've also heard that some people are far more sensitive than others to it, and just to stay on the safe side, the FDA has issued a blanket warning. Could I, for instance, introduce small amounts of cheese, avocado, etc. to see if they affect me in any way?
> 
> Was your depression atypical (increased appetite and/or increased sleep, very low motivation and energy, mood reactivity, and/or worsening at night)? I've yet to read about anyone with atypical depression who's been significantly helped by SSRIs. It doesn't mean it doesn't happen, but it isn't as convincing to me yet. If you had atypical features, though, and had success with it, I might feel more confident.


Hmm, will try to write a longer post on this next week -- am at the end of a semester right now trying to get everything done. But short version: a medical alert bracelet, high protein food that will work for you and with the dietary restrictions, a blood pressure monitor you can carry around with you but that doesn't suck too much (like an Omron wrist monitor), salt packets to bring everywhere, vitamins including B6, something very high fiber that you can eat every day like a super high fiber cereal, caffeine tablets, doxylamine succinate (if that's an option for you with other meds and stuff -- it's okay with Nardil though), lemon balm.

Yeah, my depression was atypical.


----------



## crayzyMed (Nov 2, 2006)

robtyl said:


> crayzymed - i have access to university databases in australia and the uk. i will look all those up for you later tonight
> 
> you seriously sound frighteningly crazy with all your experimentation - but i like reading your posts!
> 
> x


Hey,

Did you ever end up trying to get those? Np if you didnt, but it would be awesome


----------



## bmwfan07 (Jun 3, 2007)

ambidexter said:


> Hmm, will try to write a longer post on this next week -- am at the end of a semester right now trying to get everything done. But short version: a medical alert bracelet, high protein food that will work for you and with the dietary restrictions, a blood pressure monitor you can carry around with you but that doesn't suck too much (like an Omron wrist monitor), salt packets to bring everywhere, vitamins including B6, something very high fiber that you can eat every day like a super high fiber cereal, caffeine tablets, doxylamine succinate (if that's an option for you with other meds and stuff -- it's okay with Nardil though), lemon balm.
> 
> Yeah, my depression was atypical.


Huh. You don't think that's a bit excessive? I was under the impression that as a practical measure, one need only avoid foods with significant amounts of tyramine. I suppose the medical alert bracelet would be a good idea, too.


----------



## crayzyMed (Nov 2, 2006)

Those damn SSRI's company's need to design nardil and parnate patches instead of developping novel isomers of their own old junk the whole time! And bring AMT back in clinical trials, oh wait thats what i'm gonna do!


----------



## roscopeeco (Dec 28, 2010)

So true. Bipolar is the new MDD recurrent. If they can slap you with bipolar they can adjunct the heck out of your medications. More medications equals more kickbacks for some Doctors. This is not to say that some people do need polypharmacy.


----------



## bmwfan07 (Jun 3, 2007)

roscopeeco said:


> So true. Bipolar is the new MDD recurrent. If they can slap you with bipolar they can adjunct the heck out of your medications. More medications equals more kickbacks for some Doctors. This is not to say that some people do need polypharmacy.


I think that viewpoint is overly cynical and dismisses the fact that a certain protocol (whether it's flawed or not is a different story) is followed in treating major depression, usually starting with SSRIs. Now, I'm not a big fan of SSRIs, especially for people like those on this forum who usually have more complicated clinical pictures and atypical depression for which SSRIs often suck. But, if several SSRIs (and/or tricyclics and/or MAOIs and/or standardized SJW formulations) don't work, or they induce hypomania, that's a pretty good indicator that a refractory depression--and, often, bipolar spectrum disorder--is present. What you call it, if the term bipolar bothers you, is irrelevant if treatment with "bipolar" medications helps. Lithium is pretty routinely administered to supposedly--and diagnosed--"major depressives" with no [clinically obvious] hint of bipolarity, and for many it makes a world of difference. Does the diagnosis at that point matter?

In fact, the trend toward a greater prevalence of bipolar is one that is likely well-informed, based on the numerous studies indicating that a very high number--up to 50%--of major depressives have had sub-threshold (i.e. less than the 4 days required by the notably outdated DSM-IV) hypomania before. Among this number is presumably the greater proportion of "treatment-refractory" patients who do require polypharmacy, often with mood stabilizers, even anti-psychotics.

But, what perturbs me most about all of this is that our understanding of mood disorders--and neuroscience, in general--is so deceptively small that it's almost embarrassing. We've only scratched the surface of exactly how (and why) mood disorders manifest in different people, let alone their causes and neurobiological underpinnings. It's just kind of pathetic, and the fact that doctors are relegated to throwing medications that they don't even understand (it's not their fault: the people who made them don't even understand them) at patients is great cause for concern. I think, for starters, the medical community, clinical and research alike, could do a better job at communicating with each other about both anecdotal and research findings and updates so that we can start making some better progress on these conditions. And more clinical practitioners need to do a better job at keeping informed and assimilating new research into their practice to perform more holistically, rather than routinely (and somewhat brainlessly). So many of the p-docs that I've talked to or observed (or heard through others) are dangerously inept because of their lack of understanding of contemporary methods and trends. This field literally requires daily and thorough reading and active consideration, and I don't think many practitioners actually do anything close to that.


----------



## crayzyMed (Nov 2, 2006)

I would like some selective 5HT2A agonists, have major potential for atypical depression and SA imo.


----------

