I am a 52-year-old female who has suffered from a mood disorder (major depressive disorder and possibly BPII) since the age of 12, although I was not treated until a major episode of depression that was triggered by Aldomet at the age of 17. I have been on every antidepressant and some mood stabilizers with varying success. Some medications helped a lot until "poop out". Despite numerous hospitalizations, I was able to pursue a career in IT until 2002. At that time I developed cognitive difficulties and neurological symptoms (including episodic ataxia and other stroke-like symptoms) that were attributed to complicated migraines and/or TIAs. Hormonal issues, anemia and mild hypothyroidism probably contributed to a return of depressive symptoms (alternating with short episodes of hypomania) once my neurological symptoms finally abated on a gluten-free diet that I've been on since 2004.

I have had several courses of ECT which probably saved my life because I was acutely suicidal. My last treatment was in April 2005 when an episode of atrial fibrillation failed to resolve itself (as it had done once before) following my treatment. Two medications were administered and I was told that a cardiology consult would be required before any further ECT could be administered. After a year of asking about the cardiology consult, I gave up and decided that ECT was no longer an option for me. Since that time, I was prescribed Parnate which helped me a lot despite frequent adjustments to my dosage (up to 60 mg) because I felt "hyper" at times or could feel my mood slipping . I tapered down very gradually in preparation for rTMS which requires that patients be Parnate-free for a minimum of 3 weeks. Unfortunately there was a major delay in starting rTMS and my depressive symptoms returned. I was prescribed Manerix, which could be stopped abruptly for rTMS, but discontinued that medication because of side effects. Parnate was restarted but I remained suicidal and had to be hospitalized. An accelerated tapering off of Parnate in preparation for ECT was carried out, but I opted for a trial of Effexor and Lithium instead, and the cardiology consult was once again a non-issue.

After developing a host of physical symptoms, I eventually discontinued both Lithium and Effexor. Thankfully, gynecological surgery this February determined there was no malignancy in my endometrium or ovaries, but I was reluctant to take any medication at this point. It can be very difficult to differentiate between side effects of medication and new physical symptoms that require investigation. Balancing medications for hypothyroidism, migraines and a mood disorder is difficult enough! Not surprisingly, I experienced a return of psychiatric symptoms this June and actually requested that Parnate be tried again. I noticed an improvement (diminished suicidal ideation) soon after starting, but when I increased my dosage of Parnate from 20 to 30 mg, I experienced a pounding heartbeat that started about 30 minutes after taking the medication, and lasted for about two hours. I would need to lie down because I felt lightheaded, and actually napped after the episode because I felt like I had just run a marathon. Hoping that my body would eventually adapt to the medication, I waited 5 days before calling my psychiatrist. He advised me to divide the doses, not to increase to 40 mg as planned, and to see my family physician for an ECG. Although my ECG results were normal, my family physician ordered a 24-hour Holter. I should have the results within the next two weeks, and I'm not overly concerned because the heart palpitations have lessened in intensity and frequency since dividing my doses of Parnate. However, I do find myself short of breath and lightheaded at times and have to rest after most activities (shopping, cooking, cleaning and even showering). I realize this may be partly attributable to depression, but this level of fatigue is new to me (even worse than when I was both anemic and hypothyroid at the same time).

So, my real question is whether or not I should continue with Parnate or reconsider the possibility of ECT if I become more depressed. I was hoping to keep this post concise but include enough information to convey my dilemma. I'm not sure if I succeeded at either but I thank you for reading it.