Expert: Ivan Goldberg, M.D. - 1/26/2011

Question
Hi Dr Goldberg,

I apologize in advance - my question is not technically about Bipolar Disorder, but instead concerns severe anergic atypical depression.

I have tried Parnate once before, roughly a year ago: I initially experienced a positive effect at 10mg (which I assumed was the stimulant effect people report), which evolved into increased anxiety at 20mg, and then a perturbing sense of 'flatness'/inhibition at higher doses which resembled the neg. sx of schizophrenia. My mood was also much darker on the drug. I continued to increase my dose to 50mg and stayed there for two weeks, but saw no letting up of the side-effects or any sign of a positive response. I would estimate my total time spent on the drug was 8 weeks (including dose increases).

As my options are beginning to run out, I have contemplated revisiting Parnate (I have comorbid ADD and noticed it improved my attention, which no other anti-depressant has done).

I suppose what I have been wondering is whether you tend to see some 'non-responders' to the drug and if the symptoms I describe sound familiar at all? Or would you wager that perhaps I did not give the drug enough time?

One more thing - what is the best way of tracking down doctors familiar with MAOIs? I have recently immigrated to Melbourne, AUstralia and am a little lost.

Thank you for your time,
David

Answer
David . . .

here is a brief answer to your off-topic question.

Parnate + amphetamines; and
Parnate + lithium are often useful treatments for people with symptoms similar to yours.

You should do searches in the "Pubmed" data base.

The best way to find someone familiar with the use of MAOIs is to seek help in the psychiatric department of a medical school. Another technique is to use the Pubmed system to see who has published on the topic who is located in a city close to yours.

Best regards . . .

Ivan
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