Posted by SLS on December 30, 2012, at 6:33:58
In reply to Re: question for SLS » SLS, posted by metamorphosis on December 29, 2012, at 23:04:36
> Thanks Scott, I am pretty new to reading and posting on this site, but there are a lot of people with MAOI experience on here. And you have been very helpful to all. Just from reading your posts, you are very knowledgeable. are you currently in university or work in the mental health field? I am intrigued as to how you have gained so much knowledge? :)
I am a car salesman by trade. I was a biology major in college, but I had to drop out after my sophomore year when my cognitive impairments made it impossible for me to read, learn, and remember. I lament not being able to continue my education.
Much of what I know (as little as that is) I learned during two brief (2-weeks) periods of relative remission that occurred after discontinuing a trial of antidepressant treatment involving a combination of MAOI + TCA. This phenomenon is known as a "withdrawal rebound improvement". I did quite a bit of work in a medical school library during these times. Not bad for 4 weeks. I have been forced to skim rather than read word for word. This has allowed me to keep up with things to some extent, but details escape me, and I forget easily. Right now, my ability to read has improved such that I can get through whole paragraphs.
> My pdoc is very open to adding medications cautiously to the Parnate.
This is *extrememly* good.
> I have only been on the Parnate for a week but my depression seems to have worsened. I can almost directly pinpoint this to my stoping modafinil before I started the Parnate. The same situation has happened in the past with my stopping modafinil. It works amzingly well for my depression.
Why did you stop the modafinil? You can add it to Parnate.
> So, before I babble on for to long let me list what I am on.
> I see my pdoc in a week. He is open to listening to my ideas. I have been seeing him for over 2 yrs. He is willing to add the modafinil back after he sees how I react to the Parnate.
Smart doctor.
With Parnate, I would not give up on it until you reach a dosage of 80 mg/day. You can divided into two dosages if you want. You can take 40 mg upon awakening and 40 mg in the afternon before 3:00pm. This might help reduce insomnia.
Do not let insomnia be the reason you stop taking Parnate. Be aggressive with its management. Take low-dose (25 - 100 mg/day) Seroquel if you have to. There are other things you can try, of course. Seroquel might serve two purposes. It can treat insomnia and anxiety.
> What are some of your recommendations for sleep. It seems like nortriptyline would be the first choice?
Amitriptyline is better for sleep than is nortriptyline. However, some people find it too sedating. I would try it first, though. You can go up to 150 - 200 mg/day so that you augment the Parnate for treating the depression. Of course, you would want to titrate the amitriptyline to find the lowest effective dosage. You could possibly respond to 50 - 100 mg/day. You can take your whole dose at night to help you sleep.
> I have always had insomnia and have used trazadone in the past. I have read of some people on here using it for sleep with an MAOI. Isn't that dangerous due to it's 5HT properties?
Trazodone had been very popular as a sleep-aid for treating insomnia with Parnate. Yes, serotonin syndrome is a possibility, but I have never seen anyone have a problem with it. If it does happen, it is likely that it would be relatively mild, in which case you can discontinue it.
I know one woman who combined Nardil + doxepin (at therapeutic antidepressant dosages) It seemed safe enough. However, you probably wouldn't want to take two TCA. Just don't use imipramine or clomipramine because of their potential to produce serotonin syndrome when combined with a MAOI.
> Last questions-
I'll need to give them some thought. In the meantime, I am sure other people will have some feedback for you.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1034189
URL: http://www.dr-bob.org/babble/20121217/msgs/1034196.html