Posted by Ezrahite on September 7, 2009, at 19:38:46
I've been on generic tranylcypromine for about a month, I'm up to 40 mg/day. There may have been a brief period where there was some benefit, but that seems to have been from the stimulating side effect; for a while I was able to push myself into activity, especially when I was going up in dose. But the effects that are persistent are that I feel more depressed, angry, frustrated, hopeless, and now I can't even think as well - I already have a lot of trouble with that, and I can't deal with more.
I know that if there's a dose that would help me with TRD it's likely to be higher - 60-80 at least, possibly much higher. Unfortunately Parnate is raising my blood pressure consistently, and when I take three pills at a time, or doses too close to each other, it gets higher than I can accept long-term. My blood pressure medication doesn't feel like it's helping, and I don't like the idea of raising the dose anyway. I think I could get up to 60 mg, but doubt I could take it higher. The other limit is what my doctor is willing to do, even if I could go up over 100 safely I doubt she would agree. And with my treatment resistance and from what I've read, I would probably need to.
I only decided to try a psychiatrist again because I got my hopes up about Parnate - such a potent and thorough action on neurotransmitters must surely help if anything will. Now I'm not so sure that's the approach that I need. It's just that nothing much else ever helped either. Only twice did I get results beyond a day or two. When I was four, I was given imipramine, and my Mother says it really improved my mood and focus. Later in my twenties I tried that again for ADD, and desipramine, with no result. But I also tried dexedrine and that really seemed to work, at 20 mg/dose. But I didn't get the chance to continue that, and years later when I tried it again there were no results.
Other things I tried in my thirties: Effexor improved my mood, fatigue, maybe a few other things - but only for a day, and by the next week I couldn't even tell I was taking it. SSRIs didn't seem to do anything. Wellbutrin didn't work. I tried various supplements. Bitter melon definitely elevated my mood and relieved my fatigue, but only for a day, then came the awful crash; by the third day I could get no benefit from it at all. When I started on T4 and T3 for a slight thyroid deficiency, the first day again I had great relief, but the effect never reappeared. I never felt any better with thyroid replacement, only worse for a while if I discontinued it.
Anyway, back to Parnate. I feel like I may be giving up on it without giving it shot. I tend to go in with high hopes and then give up when things take too long. I get anxious about the passage of time. Maybe some of the worsening symptoms are from increased sleep difficulties, or some coincidental factor. Maybe augmentation would work, I had intended it; but the doctor said we had to get to the right dose of Parnate first, and I foresee that being a matter of going as high as I can tolerate and then parking there indefinitely until somehow the parnate starts working. From what I've read, it's good to start the augmentation at the same time as the Parnate, or even add the Parnate later (especially if used with a stimulant).
So the best I could come up with is switch to something else closer to what has worked in the past, and then if needed I can add an MAOI to augment that. That most likely means tricyclics, though I fear the side effects will not be as hard to reach as the desired effects. And I can't really accept more constipation, brain fog, or fatigue. What I'd really like to try is dexedrine spansules from Mallinckrodt, but I have little hope in getting anyone to work with stimulants.
When I first saw this doctor and mentioned MAOIs, she was kind of enthusiastic about Emsam, and still is if I mention selegiline. I can't afford Emsam, and it's not covered by my insurance. Maybe she has a point in a way though, it has (mediocre) stimulant metabolites. I think her concerns are dietary restrictions, plus not wanting to prescribe selegiline off-label. Maybe I should see if there's a way I can afford to give it a shot?
Okay, sorry for rambling... My choices seem to be to continue with Parnate for months and see if it can be made to work, or to drop parnate and try a tricyclic (but which one?), or if somehow it were possible try Emsam instead. Can anyone advise?
poster:Ezrahite
thread:916036
URL: http://www.dr-bob.org/babble/20090902/msgs/916036.html