The Medication Merry-Go-Round

I haven’t napped during the day since lowering my current anti-depressant. My mom seemed to think it made me tired, but I never noticed a correlation. I’ve been on it for 2.5 years. I guess she never said anything because it lifted the last suicidal depression and she figured napping 1 – 3 hours a day was better than suicidal ideation. However, if she was right, she could’ve mentioned it and suggested taking it at night. I think the blog helps me not nap. Usually I have something to vent about regarding my day and I do that as soon as I get home. By the time I’m done writing, it is less than an hour until my mom gets home. So it seems pointless to nap. Nonetheless, I’m done with my current medication tomorrow. Then I start Prozac. Unfortunately, that takes at least 2 – 3 weeks to kick in. So, I’m relying on my mood stabilizer and stimulant to pick up the slack.

I’ve been on the mood stabilizer since my last suicide attempt. No one before, or since, the inpatient psychiatrist agreed with his diagnosis of Bipolar Type 2, but it seems to help. I’ve been on my current stimulant since law school. In college I tried a different one and in middle school I was an a non-stimulant ADHD medication. However, after my first suicide attempt, they took me off of it because they blamed my suicide attempt on it.

Although I really want to try an MAOI because they are efficacious for atypical depression, my psychiatrist insists on trying Prozac again. He says, in some people, their brains adjust to the medication and it suddenly stops working. I think the stress from my eating disorder and especially not getting the promotion contributed to the depression relapse. I don’t think it was purely a medication issue. Part of atypical depression is that it is cognitively mediated. In other words, the thoughts in my head about external events contribute to my depression. In normal depression, people’s moods remain sad regardless of what is happening around them. I have mood reactivity,  I can feel happy  if good things occur. Malnutrition also causes depression. Therefore, I believe the eating disorder and work stress combined to cause the relapse. Last week, the Conversation caused me to spiral. I read some interesting articles about atypical depression. Part of how psychologists know it is a distinct illness from melancholic depression is that it responds differently to medication. It is less susceptible to SSRIs and SSNRIs. However, it is more susceptible to MAOIs. In my research, I found various studies that support a specific MAOI’s, Phenelzine, efficacy for Bulimia. Prozac is the only medication FDA approved to treat Bulimia, but I’ve been on Prozac a few times and it doesn’t seem to change my impulse control or bulimic symptoms. Therefore, I’m curious about Phenelzine for bulimia and depression. My psychiatrist is against MAOIs because they have potentially fatal interactions with certain foods. However, recently the FDA said those fears might be overstated. Plus, my uncle, a psychiatrist, says they now have skin patches, which are less likely to cause that problem.

I am somewhat hopeful about the Prozac, even though I’d rather try Phenelzine, Ketamine, or NSI-189 because I’ve been on all current classes of anti-depressants other than MAOIs. I remain somewhat hopeful because Prozac was the first anti-depressant I tried and I distinctly remembering catching myself whistling as I left gym class. Also, despite not remembering any effect on my Bulimia in the past, maybe it will help this time. In addition, my psychiatrist says Prozac is helpful increasing energy.

I was curious about Ketamine and NSI-189 have novel anti-depressant mechanisms of action. That is, they work differently than any FDA approved anti-depressant. They are both experimental. The first study I attempted to join was for NSI-189 and the second was for Ketamine. Wellbutrin is one FDA approved medication with a distinct mechanism of action. However, my psychiatrist will never approve it because it lowers the seizure threshold and I had seizures as a kid. Moreover, Bulimia can cause seizures. In fact, specifically bulimics on Wellbutrin had a higher incidence of seizures.

Other Studies of Phenelzine in Bulimia:

Treatment of bulimia with phenelzine. A double-blind, placebo-controlled study.

A double-blind placebo-controlled comparison of phenelzine and imipramine in the treatment of bulimia in atypical depressives.

A double-blind trial of phenelzine in bulimia.

Sadly, much of the MAOI research is old because they fell out of favor once SSRIs and SSNRIs came on the market.

 

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