Posted by Questionmark on January 30, 2004, at 15:05:16
In reply to NO! you need to taper and washout!, posted by missliz on January 29, 2004, at 2:17:03
> A lot of people need more than 60 mg- which blows my mind, because I was booming on 30 mg. Parnate doesn't "poop out". The stuff is basicly methamphetamine, with a few other choice metabolites.
It is NOT basically methamphetamine. It IS often quite stimulating, but it is NOT an amphetamine nor have its metabolite(s) been found to be (an) amphetamine(s).
> It works- you just need enough of it. There's a bonafide problem of undermedication of deppressive illness in this country- it's 'cause the PDR is written by company lawyers. What people on this board call poop out is usually just time to titrate the dose up again but the bottom of the class people who get shunted into psych won't do it. May I suggest a second opinion? Or a new doctor?
"Poop-out" as i'm aware of the slang, is just a layman's term for "tolerance." Therefore even if it's just time to titrate the dose up again it is *still* poop-out. One has built up a tolerance to the present dose and needs to either increase the dose or swich meds. However, increases the dosage of a drug too often and/or too much can just create a cyclical problem of dependence. So it's not always just an obvious smart move to increase one's dose of something when s/he has built a tolerance to it. It depends on a variety of factors.
> If he switches, he needs to taper the dose down for a few weeks and then do the two weeks. The chemistry is too tedious to write out- but there is any ruler of the MAOI it's me. The washout is very important. Gruesome, but better than stroking out.
That is what is typically maintained. But depending on the time on and the dosage, i believe it's much safer to go from Parnate to Nardil than vice versa, and therefore not always necessary to wait 2 weeks before doing so. A smart dr. should know a reasonable timeline for this. From my own experience, Parnate is MUCH more likely to cause a hypertensive reaction than Nardil is. So, yeah. But then again it's better safe than sorry. It just depends. i almost never like these "carved in stone" type of psychiatric standards.
> Parnate is manufactured from amphetamine; Nardil is made from antibiotics, which were the original MAOIs. It's gentler, causes weight gain in some people, I LOVED it. So good to be normal! Drank gallons of coffee on it, but I was in grad school a lot of that time. The lifestyle.
i'm sorry, but do you have any proof to back up that first sentence of this paragraph? (i do agree with that rest of the paragraph though-- in most cases). i've never heard that Parnate was manufactured from amphetamine or Nardil from an antibiotic. i guess it's possible. But if you're referring to the first MAOI that was being used for something other than depression and was later found that it was alleviating many of the patients' depressions, that was specifically tuberculosis it was being used for (i'm pretty sure). But that doesn't mean that the subsequent hydrazine MAOIs (e.g. Nardil) are synthesized from that original MAOI or any other antibiotic. Sorry to be a technical a-hole, just wanted to clear that up.
> I think a higher dose deserves a chance- or, here's a cool trick, you can goose an MAOI with lithium and see if that gets it moving. I reccomend Lithobid over the generic, a small dose should do it. Do not under any circumstanses take a diuretic with this combo- Parnate and thiazide diuretics are potentially lethal. Bet nobody knew that, did you? ;D Neither does your shrink- it isn't in the PDR, but it's in the formularies of every other nation in the first world.
Thats interesting. i wonder why that is. i didnt know about that.
> If the shrink doesn't know any of this, he's in over his head and you need a real psychopharmacologist. MAOIs are the big leagues of treatment, and depression that severe needs a doc who knows what he's doing.
Pdocs need to freaking educate themselves about MAOIs to an adequate level and stop relying on the g.d. pharmaeutical companies to supply them with most of their new freaking information!! AH it drives me NUTS how incompetent psychiatrists are, espECially with MAOIs! A:Lhf!! (anger not toward you. just brought it up in me).
> Is he on anything else?
> This is all meant to be tried under the supervision of a pdoc who knows what they're doing, of course, but there are more things to try with the Parnate. Good luck.
>
> Lizzy
poster:Questionmark
thread:305978
URL: http://www.dr-bob.org/babble/20040127/msgs/307376.html