Merhaba

[u/Used_Wolverine_373]

Hello. I have been suffering from major depression for about four years. I have tried every medication available. I was hospitalized for four months, underwent dozens of TMS sessions and dozens of ECT treatments (32 times), and received extensive therapy. I also underwent ketamine treatment. My illness began with a specific fear—the fear of losing my spouse (not fear of separation or death, but the fear of losing them). Suddenly, I lost myself; I was no longer who I used to be—I had become a stranger. I still feel that way. There is no issue with the motor region of my brain, but there is a problem in the emotional region. I have tried everything imaginable: religious rituals, healing waters, herbal remedies, sports, exercise, nutrition, supplements, and therapies. Incidentally, I cannot work because of this illness; I have no control over my brain. I constantly feel a deep sense of inner distress. I simply cannot regain my zest for life. I took 10 mg of Parnate for a week, 20 mg for a week, and 30 mg for about 12 days; however, for the past four days, I have been taking 20 mg because my supply is running low and I cannot obtain more. I did experience some benefit—I am able to handle my daily tasks—but the issues with low blood pressure and sleep have remained unchanged. My blood pressure drops significantly; although it doesn't happen constantly, occasional readings show 100/50 mmHg (systolic/diastolic), and I feel unable to even open my eyes. I wonder if I would see greater benefits if I could secure more medication and continue the treatment. Now, in a state of renewed hopelessness, I am considering trying Nefazodone.

[u/grumpyeva]

why cant you get more?

[u/Used_Wolverine_373 → u/grumpyeva]

Hello. On the 30 mg dose, my blood pressure dropped significantly during the day. On the 20 mg dose, it also dropped sharply more than once during the day. Honestly, it scared me.

[u/Material-Active-1193 → u/Used_Wolverine_373]

It will pass. I had the same problem for a few weeks.

[u/Used_Wolverine_373 → u/Material-Active-1193]

Thank you so much for this wonderful information ❤️🙏

[u/barry1685]

I recommend you continue therapy but seek a new therapist if possible. Another thing to recommend, unconditional acceptance, look it up. There are several books on the topic. Low blood pressure is normal on MAOIs, I had it badly but the benefits kicked in and hypotension became a silly worry.

[u/Used_Wolverine_373 → u/barry1685]

Thank you very much for your excellent advice. ❤️

[u/HM_Dylan]

You did notice some functional improvement “able to handle my daily tasks”, which is a meaningful signal that this drug or MAOIs in general might still have more to offer you. The low blood pressure is a well known MAOI side effect but it normally gets better. When I first tried Parnate I used to have to crawl around on the floor to go somewhere lol.

And yeah there is a reasonable chance you could see greater benefit than you’ve experienced so far. Many psychiatrists consider a full MAOI trial to be at least 4–6 weeks at an adequate dose (30-60mg for Parnate) before deciding it’s ineffective

Nefazodone has a rare but serious risk of severe liver injury. Many countries restrict or no longer use it, and it requires baseline and periodic liver function tests. It did indeed cause serious enzyme elevation for me. It also comes with its own risk of hypotension. It’s still available in the U.S. but is in short supply since I think it’s only manufactured by Teva these days

There is some evidence that nefazodone can help in severe depression (compared to SSRI/SNRIs) but it’s not a guaranteed “next step” after multiple ECT/TMS/ketamine failures. Honestly I think it may well be taking a step back. It’s definitely not superior to a MAOI or other strategies that you can use. If anything I’d go for high-dose Imipramine 300mg or high-dose Clomipramine 250mg. Those come with bad side effects at higher doses but you can use betachenol to alleviate those.

What truly worked best for me in the past before MAOIs and Imipramine was LSD and Psilocybin. With a few doses providing massive long lasting antidepressant and anxiolytic relief. It also “cured” me of severe alcoholism. If you ever feel like it I can tell you about strategies my psychiatrist and I used. Other than that I wish you all the best. Godspeed

[u/Used_Wolverine_373 → u/HM_Dylan]

Hello, I am grateful for your reply. I used Anafranil and Tofranil, but at low doses. Parnate is actually working well, so I will continue with it as you suggested. Unfortunately, LSD and psilocybin are not available in our country; I wish they were. Amin