Posted by Rahilka on October 3, 2013, at 10:07:20
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by SLS on October 2, 2013, at 7:44:50
> >
>
> What other drugs are you currently taking?Hi Scott! Thanks for taking the time to read my thread and help me with my dilemma. I am currently only taking the Parnate and Klonopin when I am feeling extremely anxious, have to go out to a friends house (very bad social anxiety,) or have to go to work (which is not often; I only go once or twice a week so I can have some money to pay hospital bills.)
> What is your doctor's rationale for titrating so slowly?
I don't really know what his rationale was; I believe he just wanted to see if I would have any adverse reactions to the medication. He knows from my past AD trials that I am very sensitive to medications and how much they increase my anxiety (whether this is real or just imagined anxiety) so I am sure that was a big part of his decision too.
> Why was Parnate chosen instead of Nardil?
We decided on Parnate because I suffer from a very bad energy deficit and have for years. I lack a lot of motivation and initiative, although this could also be due to anxiety. I'm assuming that if it is my GAD/OCD making me exhausted, then we might have chosen the wrong medication. But it's so hard to tell because I have a lot of trouble thinking straight (like right now.)
>
> Historically, I have needed a minimum dosage of 40 mg/day.This relieves me because going any higher would be extremely expensive for me. I always assumed in general that most people needed to take much more. I've also heard that how much you need to take is sometimes dependent on your body weight - .8 mg/kg. In this case I would only need a small dose (around 40 mg I believe) because I am 110 pounds. Have you heard this theory?
> 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.
Thanks Scott!! Reading this ^^ in particular has brought me a lot of relief! I would have to agree with you, now that I think about it, because the same thing happened when I titrated up on Effexor, although it was a much quicker titration.
> >
>
> 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.Thanks for the study information, Scott. I do suffer from the occasional panic attack and pretty major social anxiety. I am good at "casual conversation" but talking about myself or things happening in my life (AKA nothing) causes me to go blank and my thoughts to race. Hopefully if I can stay on the Parnate it will address this.
It would be very beneficial, though, if it could treat Generalized Anxiety Disorder. I feel like I am in a rush all the time and get nervous and scared about EVERYTHING. I am scared of life in general. Every day feels like impending doom.
It's hard to separate out my symptoms into the different diagnoses because I have been to so many doctors and they all had different ideas of what "affliction" I have (for lack of a better term.)
>
> 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 thought Nardil sounded like a promising drug, too, but have read online how much sedation and lethargy it has the potential of causing, how people have had to stop exercising due to the hypotension, etc. I know it's unfair to judge a drug without trying it but the side effects of Nardil sound horrendous! Or, rather, the severity of the SEs.
Have you run into trouble with the SEs of Nardil?
>
> Can you describe this depression?Well, when I take my Klonopin now, the next day after waking up I just feel even more tired, foggy, lethargic, and just in general very low mood. It doesn't happen all the time but it does happen most of the time.
>
> Which benzodiazepines cause depression for you?I have tried Klonopin, Xanax, and Valium. The only one I have taken for over a year (now PRN,) is Klonopin. Xanax knocks me OUT and would be completely useless to me in social situations. Valium hardly touches my social anxiety. Klonopin seems "sharp" enough to address the SA but not so much that it makes me dysfunctional.
>
> 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.This is really good to know, thanks Scott. I really hope it is temporary because I had high hopes for Parnate. Today will be the 3rd day in a row where the breathing has been an issue, whether I am actively anxious or not. Yesterday at a friend's house I was standing outside and it was MILDLY hot outside and I felt like I was going to stop breathing. My friend who is a pharmacist told me to have my blood pressure checked today due to difficulty breathing being a symptom of hypertension and call my doctor.
>
> 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.Good to know. I will ask him today. I have heard the amphetamine-like effects wear off once the body becomes adjusted. Has this been the case for you? Amphetamines make my focus amazing and give me more energy but they also make me more irritable and want to be alone. Some people are helped by amphetamines for social anxiety and I am absolutely NOT one of those people! I hope since Parnate is an analog of amphetamine that it will not cause me to have the same side effects of the stimulants I have tried.
>
> 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.That does make me feel better to know that I am not the only one who has had these SEs before - I hope they go away! I do also think that titrating this slowly is causing me to have more anxiety - I will ask my doctor today if we can pick up the pace. I don't want to insult him as I think he is a very brilliant doctor and I know he just wants me to be safe but the waiting game is just driving me crazy. I haven't had an HC and it's been 6 doses so come on! LOL.
>
> I am still curious as to why Parnate was chosen in place of Nardil.
Constant fatigue and exhaustion, cognitive dysfunction/"brain fog", lethargy. Also, according to studies and anecdotes, fewer side effects/less intense side effects (other than higher chance of HC.)
>Thanks again, Scott! Nice to meet you :)
poster:Rahilka
thread:1051551
URL: http://www.dr-bob.org/babble/20130930/msgs/1051617.html