Posted by SLS on November 6, 2000, at 17:42:29
In reply to Re: Parnate and Caffeine - restricted? FATIGUE! » SLS, posted by Tori on November 5, 2000, at 9:45:05
> I have been on Parnate now for almost two months; augmented with Lamictal 150 mg bid (thavee been taking since late February).450mg of Lamictal for the treatment of bipolar depression is very high. I am not familiar enough with its use in unipolar depression or other psychiatric illnesses. I can't imagine that the dosage range of Lamictal should be any greater than that used for bipolar disorder. The average dosage for Lamictal in bipolar disorder is 200mg. I need 300mg. When I try to reduce the dosage from there, I begin to lose the small improvement that it gives me. Have you tried to reduce the dosage of Lamictal methodically to find the lowest effective dosage? When I was taking 120mg of Parnate, I found that 200mg of Lamictal reacted with it to produce a great deal of sleepiness early the next day. Reducing either the Parnate or the Lamictal reduced the sleepiness. If you are taking 150mg more than you really need, it might be contributing to what you are experiencing. However, I think it more likely that your lack of good sleep hygiene is more responsible.
Lamictal for epilepsy = 300-600mg
Lamictal for bipolar = 100-300mg> The Parnate causes massive insomnia and finaly I am am taking 20 mg bid at 7 and 11 a.m. which helps but I have to fight, fight like hell, to stay awake after work until at least 10:00 PM and be up at 6. I went to bed at 5 this morning; woke up at 6:30 a.m. (hence my surfing on psychobabble). I had fallen asleep on the couch earlier for an hour and a half, that's how badly my sleep schedule gets screwed if I fall asleep during the day.
I think it is critical that you take medication to get some sleep, even if you don't use it every day. I would first look into trying trazodone (Desyrel). I think the dosage used for sleep is about 75mg. If you take too much, you might tend to be lethargic early the next day - a sort of hangover. I would have no qualms about taking this drug every day. It is used very often with Parnate. Although theoretical, and rare at most, I would just be aware that serotonin syndrome is a possibility. I would be remiss not to have mentioned that - no need to be alarmed. Trazodone is probably the drug of choice to add to Parnate for sleep.
I would also not hesitate to use a benzodiazepine (Halcion, Ativan, Restoril) or one of the newer drugs (Ambien, Sonata). I have used the strategy of taking both Halcion and Ativan before bed. You may need the strength of the Halcion to put you to sleep and the longer-action of Ativan (or Restoril) to keep you asleep. Hopefully, only one drug will be sufficient. I would not choose Halcion to be used alone. Benzodiazepine is not a four-letter word. You need to do what you need to do. Not sleeping is unacceptable.
> Does the _hypo_tension cause the incredible lethargy and sleepiness?I don't know about incredible, but it can.
> ....and an increased in inerests in life, hobbies,
I wish the SOB (Parnate) would do this for me. I am without interest or motivation or enjoyment. It gives me more mental energy. That's about it.
> plus it keeps me from getting suicidal
Me too.
> which is good as the holidays are coming and being three years without mom (background: she died in 1997 from pancreatic cancer at the age of 40) has been horrific around christmas; I hope this year is different.
Me too. I'll say a little prayer for you.
> I have been DYING for a cup of coffee; I am extremely fatigued during the day, I mean I'm atually nodding off during the morning.My guess is that this is the result of sleep deprivation. Your sleep-cycle has become
> Even when I work out at 7 am. doing cardio the energy boost lasts an hour but that's that. I nod off at my desk and when I get home I'm ndding off on the couch and will fall asleep immediately should I close my eyes.
I think it would be better for your sleep hygeine if you were to work-out in the evening. It will help you sleep better.
> QUESTION- > Caffeine is on the food restrictions list for Parnate.
Caffeine is one of those foods that is of questionable significance. The NIH let me drink regular coffee while I was taking an MAOI that is much more potent than Parnate. However, Parnate is somewhat amphetamine-like. You may find that caffeine makes you feel nervous and otherwise uncomfortable. It doesn't for me.
> I frequently (well, for me every ttwo weeks is enough for me) go hypertensive out of the blue - 170/110, etc, after usualy being HYPO at 80/60 - not because of something I ate or meds I took, just out of the blue (smoking?).
Parnate is known to be capable of this. I don't know if smoking would trigger the event. How do you know when you are hypertensive for you to take your blood pressure?
I think you would be better off taking 20mg in the morning, 10mg at noon, and 10mg at 3:00pm.
> Anybody else out there able to take caffeine? Should I slowly start with a small cup to see what it causes, then if all hell breaks loose take my Adalat to reduce the BP?
What is Adalat?
Many people carry around a Procardia (nifedipine) gel-tab capsule in case of a hypertensive crisis. One can bite into the capsule and release the liquid, and then swirl it under their tongue (sublingually).
Please wait to get more feedback.
- Scott
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Coffee is O.K.
Excerpt from the MAO Diet link that can be found on Dr. Bob's Main Page:-=Foods with Insufficient Evidence for Restriction=-
More than 200 foods contain tyramine in small quantities and have been implicated in reactions with MAOI therapy. However, the majority of the previous reactions were due to the consumption of spoiled food. Evidence does not support the restriction of the following foods listed if the food is fresh (McCabe, 1986).
+ Anchovies
+ Beetroot
+ Chips with vinegar
+ Coca Cola(r)
+ Cockles+ Coffee
+ Corn, sweet
+ Cottage cheese
+ Cream cheese
+ Cucumbers
+ Egg, boiled
+ Figs, canned
+ Fish, canned
+ Junket
+ Mushrooms
+ Pineapple, fresh
+ Raisins
+ Salad dressings
+ Snails
+ Tomato juice
+ Wild game
+ Worcestershire sauce-----------------------------------------------------------
poster:SLS
thread:48056
URL: http://www.dr-bob.org/babble/20001102/msgs/48289.html