Unpredictable

sadness(Sung to the tune of “Unforgettable” with apologies to Irving Gordon, and apologies to my readers for being unable to rhyme)

Unpredictable
Bipolar is,
Unpredictable
Tho’ low or high.

Like a song about a rollercoaster,
How the thought of you does things to me.
Never before
Has something been more…

Unpredictable
In every way,
And forever more
That’s how I’ll stay.

Finally, after one of the worst and longest bouts of depression I’ve had in years, the good old standard MAOI, but in a different form, has started working again. It appears I had built up a tolerance to my “miracle drug” I started taking a few years ago when I had become SSRI-resistant. Taking into consideration the length of time I’d been away from SSRIs, my psych was hoping that a new class of drugs would work. But alas, some made me worse, some made me manic, and then of course some had those frightening side effects that we all know and love. As explained in the article by Natasha Tracy in her Breaking Bipolar Blog, building a tolerance to psych meds (or just about anything) is quite common. It’s actually called the poop-out effect, as shown in this article from the Mayo Clinic:

….in some people, a particular antidepressant may simply stop working over time. Doctors don’t fully understand what causes the so-called “poop-out” effect or antidepressant tolerance — known as tachyphylaxis — or why it occurs in some people and not in others.

MAOIs have been around a long time, since the early 1950s-originally a tuberculosis medication, but since they don’t play well with others (including a long list of foods as well as medications), they really aren’t prescribed much anymore. But when all else had failed (even a horrific attempt at ECT) the first one I tried in 2011, Nardil, worked like a charm. So as I sat in my psych’s office with no affect, unable to stop crying, and a thwarted suicide attempt, he suggested I try an MAOI again, this time Parnate.

The waiting game for this type of drug is pretty much like floating on a piece of flotsam in the middle of the ocean, waiting for seemingly eons for someone to come to one’s rescue. First, it usually takes a few weeks to taper off whatever psych med is currently inhabiting one’s body, then wait another four weeks to make sure there’s no trace of the original med, then wait another four to six weeks for the new one to start working. Let me tell you, it’s damn scary. If it weren’t for my loving, supportive husband there’s no doubt in my mind I would have given up.

But I made it through…for now. While being grateful for emerging from the darkness, I can’t help but wonder how long it will last this time. This is not a defeatist attitude, it’s reality.

No more banana peels

Nardil has been both a blessing and a bane to my existence. I had treatment-resistant depression for longer than I care to remember, and it was the only drug that worked. But being an MAOI, it doesn’t play well with others. In addition to the foods listed below (chocolate! cofee! sourdough bread!), “a total of 924 drugs are known to interact with Nardil (phenelzine).” (from Drugs.com) Every time I’ve had a surgery, an illness, or pain (it interacts with many pain meds), I have to warn the prescribing physician that I take phenelzine. They always look at me oddly and question why I’m taking such an antiquated medication.

This drug may rarely cause an attack of extremely high blood pressure (hypertensive crisis), which may be fatal. Avoid drinking large amounts of beverages containing caffeine (coffee, tea, colas) or eating large amounts of chocolate. Foods and beverages high in tyramine should be avoided while you are taking this medication.

Foods include: aged cheeses, aged/dried/fermented/salted/smoked/ pickled/processed meats and fish (includes bacon), banana peel (is this even necessary to say?), bouillon cubes, commercial gravies, concentrated yeast extracts, fava beans, Italian green beans, broad beans, fermented bean curd, homemade yeast-leavened bread, kim chee (Korean fermented cabbage), orange pulp, overripe or spoiled fruits (again, really…is this a problem?), packaged soups, red wine, sauerkraut, sherry, snow pea pods, sourdough bread, soy sauce, soybeans, soybean paste/miso, tofu, tap beer (but canned beer is ok?) and ale, vermouth.

Moderate-to-low tyramine content foods include: alcohol-free beer, avocados, bananas, bottled beer and ale, chocolate and products made with chocolate, coffee, cola, cultured dairy products (e.g. buttermilk, yogurt, sour cream), distilled spirits, eggplant, canned figs, fish roe (caviar), green bean pods, pate, peanuts, port wine, raisins, raspberries, red plums, spinach, tomatoes, white wine.

Add to this the fact that even though it’s available as a generic, I still have to pay the full price because the insurance company doesn’t like that it’s rarely used anymore. And this year the price went up. So it’s time to play drug roulette once again. Even though I greatly fear the though of finding an alternative, I don’t see how I can continue to take this drug.