[imported_ace]

Hi Cam, thanks so much for taking the time for answering my qstn. BTW, are you still posting at p-babble? I loved your posts there. I am not happy with the admin but- I got banned for 8 weeks for saying '***' while some people are recommending very dangerous combos.

Anyhow just a couple of questions now,

1. Zyprexa + MAOI- do you think this is safe? Would the Zyprexa cancel out the MAOIs effects? I have heard that James Barbee MD (do you know of him?) says MAOI + Zyprexa is a terrible combo. Risperidone is apperently recommended instead.

2. Have you heard Of Clonidine + MAOIs?- I am thinking of trying Clonidine for my OCD. Can you see much of an interaction their ?(apart from BP issues) If it doesn't work then Amisulpride or risperidone probably.

Thanks so much Cam, and all the best to you- I have a whole stash of your posts photocopied- they help so much!

Ace

[CamW]

ace - a few questions....

1) Which MAOI would you be mixing with the Zyprexaª (olanzapine)? I have to say that I have seen only a couple of drug regimens where the combination of Zyprexa and Nardilª (phenelzine) was used. If I am not mistaken the Zyprexa doses were very low 1.25mg (half of a 2.5mg; - we had the patient break open the tablet with a pill cutter and drop into a glass of orange juice - stirred very well - ; drink half today and half tomorrow. The problem with phenelzine is that, in some people trigger manic states in those taking antipsychotics (both traditional - tAP; and newer agents - aAP).

Manerixª (moclobemide) has exacerbated (make worse) psychotic symptoms when given to those who had a schizoaffective component to their depression or a depressive component to their schizophrenia (two very different groups, with the former usually having the AP added to the AD, whereas in the later scenario the AD is usually added to the a regimen consisting of an AP already.

So, could it be that the "manic state" of phenelzine and the "increase in psychotic symptoms" of moclobemide when combined with an antipsychotic be the reason for Dr. Barbee's (don't personally know of him) loathing of this combination. I never say never to any drug combo, as it reduces the size and scope of the tools available to combat psychiatric illness ............. although ..............

2) NEVER combine Clonidine and an MAOI <lol>; the potential potentiation possibilities poses problems. The adverse effects associated with these drugs when taken individually are not for the squeamish; combine these side effects profiles into one drug regimen and Still, the monitoring of that lil ol' "BP issues" may become a full time job, as both classes of drugs directly affect the heart. Not a good combo, in my opinion.

Risperidone (Risperdalª) has little antihistaminergic action compared to that seen with Zyprexa anf Clozarilª (clozapine), so combining this with an MAOI may not be so bad.

I have seen several treatment resistant depressions and I did follow one guy with treatment resistant OCD who could not tolerate clomipramine (Anafranilª) any longer. We switched him to Zyprexa 2.5mg at bedtime; and Manerix 150mg twice daily. He lasted on the Zyprexa for about 2 days and was back in. The doc switched to Risperdal 0.25mg at bed, which was raised to 0.5mg at bedtime a week later. In two weeks his Manerix dose was titrated up to 300mg twice daily. After some initial jitteriness and nervousness, the combo began to work. This "blah" feeling, which I attributed to the medication change, did take about 2 months to go away. For the first month - to month and a half - he said he felt worse, not better (do you how hard it is to motivate someone to keep taking their medications when you yourself start doubting the treatment).

At the 2 month mark he was much improved, at 6 months he got his first job that he actually stayed at for more than a week. I don't know if he has the same job, but I talked to him while visiting Mental Health Services. He is still taking the same drug regimen for the last 5 years.

Just remember though, I have seen this combination fail in several other treatment resistant cases of OCD &/or depression.

I hope this helps - Cam
(Which of my posts do you keep?; my treatise on dating misogynistic architecture [no, not Jayne Mansfield]?)
You know, after I finally do go off the deep end in some silly but spectacular way, you could probably put together a book and make millions ..... cool!
I've never kept anything that I wrote. Can you find conflicting information, and stuff like that?

[imported_ace]

Thanks again so much Cam.

I am on Parnate now, and that's the one I'm going to mix. 2 probs however...

1. 2 weeks 2 days on Parnate- I feel apathetic, irritable, more depressed at times, and anxious. I titrated fast- 20mg first 3 days, then 30mg for 4, then 40 for 2, then 50 for one, then 60mg for 5. Yesterday I went down to 40mg as I can no longer tolerate the fatigue and weakness. I can barely study- I'm in the middle of a uni semester and I'm getting real worried! I thought Parnate kicks in quick!

2. I noticed when I was on Olanzapine + Nardil, after 3 days I had a dramatically good effect, BUT this stopped after around 25 days and depression got worse. I eventually stopped olanzapine and lowered Nardil to get out of it.
That's why I'm leaning towards Risperidone.

I feel so worried I feel like just dropping Parnate and going quickly back to Nardil. I just want the Parnate to set in!

But your right - its soooo hard to be patient - every day I'm looking at the date anxiously hoping enough time on Parnate has been served.


Apart from Risperidone can you see any other drugs that could kick-start the Parnate?

Oh- your articles. All the ones on p-babble, mostly about antipsychotics. There extremely well written and have provided me with much help. And they are consistent the way through. You were a great asset for that site.

I'm gunna look out for your dating misogynistic architecture article now!!!

Thanks so much Cam,
Ace.

Cam,
Are you the same Cam as Cam W?
Lou

[CamW]

louelsa - Before I answer, do I owe you money?

Yup, I am CamW., master faeces flinger, and hyperexcitable pharmacist.

[CamW]

How's it goin' ace? Did the Parnate kick in? - Cam

[imported_ace]

Hey Cam!,

Thanks for asking! You wouldn't believe it! 2 weeks 4 days into Parnate and I was still suffering a paradoxical depression. I quickly changed back to Nardil (50 hour washout). Within 3 days things were getting better (the anxiety, derealization, depression were horrid). Within I week I could study again. Now, 3 or so weeks later and the Nardil is working well again. What a relief!

The only beef I have is this: When the AD and anti-phobic response kicks in the OCD seems to get worse! Maybe when I'm so depressed I just can't focus on the OCD. Or maybe my OCD has something to do with high lovels of 5-ht, DA, or NE (as raised by Nardil). What do you think Cam? What woul;d you recommend as augmentation for the OCD- pindolol (although raises 5ht I believe), amisulpride?.

I must say Zyprexa worked Supremely on one of my OCD problems.

Take Care Cam, and try not to be so busy! (easier said than done!)

Ace.

[johnx76]

can anyone tell me the web address to p-babble? Thanks

[CamW]

ace - I am not a big believer in pindolol augmentation. I know people who swear that it works, but I haven't much luck with it in a clinical setting. I just say ... "wait it out, relief is on the way" and I know that two weeks seems like a long time (similar to being away from my wife for that time), it does pass fairly quickly (at least at my age times passes quickly).

I have never seen amisulpride used (it is not available in Canada), but I do think that it is a cool drug. I just wish I could see it's results without having to read between the lines of the industry drug trials.

Zyprexa™ (olanzapine) is a good powerful drug; it is just that it's side effects suck (can I say that?). If you are able to starve yourself for a year, you can avoid the large weight gain associated with the drug, as the carbohydrate cravings seem to lessen after a year. Clozaril™ (clozapine) is even a better drug than Zyprexa, but it is more toxic still. Why is it that the best neuropsychiatric drugs have to be the most dangerous (in terms of potential side effects and heath effects)? There has got to be something to this obsevation; I am just not smart enough to see it.

Good luck ace, and hang in there. You're sounding much better. - Cam