Super trough

For the past 10 days or so I've been in and out of a horrid state of atypical depression. I say atypical because, again, you would probably not realize that I was depressed unless you spent a lot of time observing me. It did make working difficult, and my motivation and cognitive capabilities were definitely a lot lower. For two of the days I did something different. Rather than ride my bike I came home and sat on the couch and watched TV. It was actually a pleasant change. I watched Friends for the first time in years. I forgot how funny Joey Tribiani is. But having suicidal feelings wasn't a very pleasant change. A few days ago I saw my psychiatrists who increased the Nardil to 60mg. I pray that this helps alleviate this atypical depression. So far the side effects have pummeled me. From about 1pm to 5pm at work I am a ZOMBIE. I am falling asleep. I can barely think. I walk like I'm drunk. I drink coffee and tea all day, to no avail. I may need to get an IV to feed me caffeine directly. Maybe that might help. This is an expected side effect of the Nardil that I pray passes soon. I have never felt this level of sedation. Granted, it's quite possibly the combination of depression and medication that is making me feel this way.

The joy (or pain) of hypomania

I do believe that my recent euphoric episode was sort of a Nardil-induced hypomania (Or was it? Read on). I am not bipolar, and no doctor has ever suspected so. I talked to a friend yesterday who said she had a two-week hypomania episode. For her it manifests itself as becoming super productive, but forgetting about the rest of the world. My "hypomania," or whatever you want to call it, left me feeling exhuberant and giddy. I was super funny, super productive, super confident, and super friendly. So what's so wrong with all of this? As "good" as it felt, there was no peace inside all of this good feeling. Something was driving me, and it wasn't me.

...Or was it really medication-induced? I also had a lot of reason to be giddy. One of my core longings is love. There is a long story behind this, but it's not right for this blog. So just before my "hypomania" I had three potential dates. One came through and it was a fun time. Imagine someone walking around in the desert for a decade thirsty and finally he finds water. Well that's an exaggerated way to compare how I felt. I was so happy to finally feel like I'm getting somewhere in this area of my life which has been largely non-existent. That's sure to make me happy, right? How about hypomanic? If my theory were correct, then I guess I would have been hypomanic during the dating period. Well, turns out I was depressed the week I went out on the date. Even the day of the date I was depressed, but I managed to pull myself up and have a decent time. Perhaps along with the wonderful feelings of dating there are also real feelings of fear and distress that come along with it. Thus the fluctuation between depressed and giddy. Who knows.

The trough

I have hit my first trough since being on Nardil. The last two days I have been a damn zombie. My face feels heavy, I have very little motivation, I just want to be by myself, I don't laugh at anyone's jokes. I guess even the most "powerful" of medications can't necessarily remove these troughs. They might tame them a little bit. I mean, life is full of troughs. But when I talk about troughs here, I mean real serious depression troughs.

Since I didn't have the oomph to continue with the previous blog I saved it as a draft. I'm revisiting this post now (July 19) after several days. I have come out of the euphoria and the subsequent trough. Now I'm just feeling dysphoric and that something is just not right. Fortunately, other people have had similar experiences when initiating Nardil. I've learned this by reading messages from this forum. I'm realizing, too, that I'm probably not at a therapeutic dose of Nardil yet. I'm taking 45mg, and for my weight (150 lbs) I need to be taking at least 60mg. The rule-of-thumb is 1mg/kg, which is 1mg of Nardil per every 2.2 lbs of body weight. So, for me, that would be 68 mg of Nardil. So I'm on 45 right now. And that could be why I go through horrible depressive spells at points throughout the day.

Delicious water

Water is water, right? Certainly cold water tastes better or more refreshing than lukewarm water. Well, the latest side effect from the Nardil is that cold water tastes absolutely delicious. It's like I'm eating ice cream. But it's water!

Loops and bounds

Social situations seem to bring to light the side effects of the 45mg of Nardil more. I have noticed that I feel very loopy and lethargic in social situations, which is not a normal thing for me. In fact, whereas I used to crave social contact, at times, in the middle of, say, the happy hour I convened last Friday, I just want to escape, go home, and go to sleep. This is a problem.

A good resource

I've finally found a good, well-rounded resource to learn about MAOIs. You don't often read a journalistic view of MAOIs. Rather, you read soulless language churned out by what seems to be a robot. This description of MAOIs from HealthyPlace.com is excellent. It is thorough, yet interesting. And it includes accounts from patients and doctors.

Here's a line from this site that stood out, for me at least: "If you're very vulnerable to depression but don't suffer from the classic symptoms of major depression, MAOIs could be for you. They are especially good if you seem mildly depressed, if you become depressed more gradually, or if your primary complaints are boredom and apathy."

It has been established that MAOIs are good for atypical depression. But this is the first time that I've heard MAOIs being good for being "mildly" depressed. Well, my depression could be considered atypical and certainly mild. Other accounts of MAOIs make it seem as if it is meant for only the most "severely" depressed patients. DO NOT be thrown off by the term "mild" depression. I would argue that mild depression can be almost as debilitating, destructive, and painful as "severe" depression.

Drunk, and no wine needed

So I do believe it is the Nardil that is making feel drunk. Now, this isn't necessarily a bad feeling. It is better than feeling depressed. However, at times I feel inappropriately happy or giddy, and when I talk to people I have to control myself. Now, I am taking Lithium as well, which I imagine would quell these inappropriately "high" feelings. Let's see how these feelings progress. Like I said, it's not necessarily a bad feeling. It can feel uncomfortable at times.

So I guess I don't need Pinor Noir to get a buzz.

There is a story behind this

These days, if someone says they are taking an MAOI, then there's got to be a story behind it. I mean a long, painful story. MAOIs are considered a "last resort" medication, when nothing else has budged the depression. This may give the impression, though, that getting to the point where one has to take an MAOI means that he is at his wits end and at the bottom of the bottom of his depression. No other medication has worked, and he is bedridden. In my case, this is absolutely not true. Remember, if you met me you wouldn't know I am (or rather was depressed). What is the long, painful story part? The psychological story is for another posting. The brief psychiatric story, since for some reason this morning I am feeling semi-loquiacous, is that I have tried about 16 medications plus ECT over the past 12 years. To varying degrees of success. Some haven't worked at all, and others have been wonder drugs. Even the wonder drugs, though, sometimes end up not working any more. I think after all my readings about MAOIs I might be getting tired of people calling MAOIs a "drug of last resort." That's a very negative way to paint a picture of what seems to be a highly effective medication. I'm sure the hypertensive crisis risk is very real. That's why I got a Medic Alert necklace. And that's why I am choosing my foods carefully. But Pinor Noir is so delicious.

Pinot Noir #2

This bottle is not nearly as good as the one last night. But this time I had about two glasses.

I love Pinot Noir

Pinot Noir is so delicious. I am sipping it right now. Just a little bit. Half a glass. Red wine is supposed to be contraindicated, according to some sources that you might read on MAOI diet.

New side effects plus that which does not kill you Pt. 2

Lightheadedness and a small bit of dizziness. So far I think I might be experiencing these side effects from the Nardil (phenelzine). They aren't troublesome by any means, though. This afternoon these symptoms were a bit more pronounced and noticeable.

About this afternoon. I was ravenously hungry, so I went to the local Indian buffet and piled on the food. Upon returning to the office, I inhaled said food. Later, when I started feeling more lightheaded and dizzy, I thought to myself, "well shit, I wonder if I ate something I shouldn't have." The only thing I could think of was some tofu in the vegetable korma. I freaked out momentarily. I went to the friendly-neighborhood Rite-Aid and checked my blood pressure. It was not any higher than usual. To celebrate I bought some batteries and pain relievers for the office.

Since I'm feeling good and want to keep on living, I bought a Medic Alert necklace. The necklace has a number on it that emergency personnel can call to find out that I am taking an MAOI, so they need to be careful what they put into me.

Day 9

Day 9 of being on Nardil has passed. I am up to 45mg, which is starting to reach the effective dose. I feel great. No ill effects from the medication. I was having a horrid week when I started the medication, and now I feel great. Is it placebo effect? Maybe. Is it the medication? Maybe. I noticed I don't have this horrible morning dysphoria anymore. I just wake up and go about my day. I'm jolly, talkative, and energetic. I'm posting blogs at 9:30am when I should be at work. My depression has always been atypical, and they say MAOIs are excellent for atyical depressions. Mine has been atypical in that you wouldn't know that I was depressed unless I told you. Even then, you wouldn't believe me. Even when I was in the damn hospital, people would tell me, "you seem fine." Well, trust me, I was not fine. I am fine right now, though. After taking all of those reuptake inhibitor medications, I think it was time to try something different. MAOIs work different than SSRIs or TCAs. MAOIs don't do reuptake. They go deeper to inhibit the activity of the enzyme monoamine oxidase, thus preventing the breakdown of serotonin, norepinephrine, and dopamine, thereby increasing their availability. Now this seems more effective than inhibiting reuptake, and of just one neurotransmitter at that.

That which does not kill you

Will probably not kill you in the future. My Cosi Margherita Flatbread Pizza that I had for lunch today had parmesan cheese on it. Parmesan cheese is an aged cheese, and aged cheeses are a "no no" when it comes to MAOIs. I only noticed the sprinkles of parmesan cheese after eating several slices. Whoops. If Cosi were to use REAL Parmesan cheese, it would have been aged for a long time (which means more tyramine?), and cost me about $16 for the pizza, as opposed to $8. However, I'm sure this was American parmesan cheese, which apparently isn't aged for as long. So, anyway, I survived eating the entire pizza. No ill effects whatsoever. I tell you the truth because here I am typing this blog.

What you can and can't eat

Every list of the "MAOI Diet" is different. Some lists make it seem like you can eat only bread and water. You mean I can't eat raisins, avocados, chocolate, yogurt etc.? (I'm vegetarian, so things like dried fermented sausage and shit aren't part of my life). Other lists make it seem like it's no big deal to take an MAOI. Only things like pickled herring and aged cheeses are off limits. Who eats these every day? Surprisingly, the medication guide from Pfizer hardly spends half a page on diet. Having viewed many different lists, including the handout provided by Penn's Treatment Resistant Depression Clinic, I feel like the most carefully considered and helpful list is that provided by the University of Pittsburgh Medical Center. It separates foods into "allowed," "limit," and "avoid." Still there are conflicts. Penn's list says a limited amount of bottled beer is OK. UPMC's list puts beer into the "avoid" column. Shit. Penn says a glass of wine is OK. UPMC says white wine is OK, in limitation, but red wine is not. Shit So what do I do?

What makes a drug "powerful?"

My doctor called the MAOI "powerful." What makes a drug powerful? Is it the number of side effects? That really would be a bad indicator if its potency; but a good indicator of its, well, side effect profile. What makes one drug, say, Effexor, more or less powerful than, say, Elavil? MAOIs are often called powerful. Is it because they often work when nothing else works? Is it because they have a very high percentage of success in relieving symptoms (not taking into account side effects). Is it because it affects three neurotransmitters, as opposed to just one or two?