Posted by SLS on October 2, 2013, at 7:44:50
In reply to My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 1, 2013, at 22:11:59
> Hi everyone,
>
> My name is Rahilka and I have tried many different SSRIs/SNRIs/AAPs etc. for my Major Depression, Generalized Anxiety Disorder, Body Dysmorphic Disorder, and Obsessive Compulsive Disorder. Some I have had a partial response to, but most were unsuccessful, so my doctor has finally put me on an MAOI, Parnate.What other drugs are you currently taking?
What is your doctor's rationale for titrating so slowly?
Why was Parnate chosen instead of Nardil?
> This concerns me because from what I have read, the lowest effective dose of Parnate is 30 milligrams.
Historically, I have needed a minimum dosage of 40 mg/day.
> If I go from 10 to 20 milligrams the third week, and then from 20 to 30 milligrams the fourth week, then that means it will have taken me an entire month JUST to get to the lowest effective dose - not to mention that I will have to be at 30 milligrams for at least two or three weeks to see if there is going to be any benefit.
Yup. However, it has been my experience that taking lower dosages of Parnate "set up" for a quicker response once the minimum effective dosage is reached. You might not have to wait a full 3 weeks at 30 mg/day for it to work.
> I am also very concerned, worried, scared, anxious, apprehensive, etc. because I suffer from severe GAD in addition to my depression and after reading many, many first-hand accounts of Parnate experiences online it seems that Parnate is not good for anxiety disorders and actually makes them worse.
Perhaps it depends on which anxiety disorder is being treated.
http://www.ncbi.nlm.nih.gov/pubmed/20036427
Notice how 30 mg/day of Parnate was ineffective while 60 mg/day produced a clinical improvements.
> PLEASE tell me this is not always the case!
I can't speak from experience regarding Parnate in the treatment of GAD. However, I have seen Nardil bring about a remission in a woman who suffered from depression, GAD, and panic disorder. When I take Nardil, I find that it produces an anxiolytic effect early in treatment, often before the antidepressant effects emerge.
> I absolutely do not want to have to augment it with a benzodiazopene (sorry for bad spelling...) because benzos and I don't really get along. They cause a lot of depression.
Can you describe this depression?
Which benzodiazepines cause depression for you?
> I am so frightened about this drug.
The breathing thing may be temporary and is sometimes referred to "air hunger". It can appear as a side effect of drug treatment and even as a symptom of the depression itself. Air hunger appeared in me before I was ever treated.
> For the past two days I have been having some shortness of breath; it feels like someone is sitting on my chest and it is very difficult for me to breathe deeply and fully which of course is making me freak out more. Is this a possible side effect of Parnate, even at a low dose of 5 milligrams? So far I have also experienced more mental clarity (which only lasted for two or three days, now I'm back to fogginess,) a definite increase in anxiety, dizziness, seeing 'floaters' in my vision when I move my head around, and lightheadedness. I have been able to coast just above deep depression for the past few weeks somehow but now that this Parnate is increasing my anxiety I can feel my mood drop and I am becoming irritable, hostile, snappy, and withdrawn. Some days I even feel more agoraphobic and paranoid, and everyone gets on my nerves even if they're not doing anything wrong.
Parnate is stimulating and can display amphetamine-like effects. You might be experiencing autonomic dysregulation - even at 5.0 mg/day - as a side effect. This is usually not dangerous. However, I would ask your doctor about it. With me, these things eventually disappear with continued treatment.
For now, there might be a synergism between a Parnate-induced dysautonomia and your anxiety. This will be uncomfortable, but you might be able to minimize the severity of this anxiety psychologically knowing that you are safe and that others have experienced side effects similar to yours. I have. I would say that there is a chance that Parnate can work in your case, but you are going to need to be patient and titrate the dosage at a rate that avoids the exacerbation of your anxiety.
> Did my doctor and I pick the wrong medication?
Perhaps.
It does happen that someone will respond to one MAOI and not another.
I am still curious as to why Parnate was chosen in place of Nardil.
- 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:1051551
URL: http://www.dr-bob.org/babble/20130930/msgs/1051572.html