Posted by Bob on January 13, 2016, at 14:36:32
In reply to Re: Parnate shame » Bob, posted by SLS on January 12, 2016, at 14:38:36
> > > > > Luckily it seems most stimulants do help some. Adderall seems to be the best however, with my doc unwilling to rx that, I ended up with the milder Ritalin; for which I had to nearly beg. I'd prefer the dose be larger (10 mg twice a day). For the record, the hard to get scripted, but easily obtainable Modafinil, and its pro-drug adrafinil seem to work well also.
>
> > > > I'm assuming that your doctor was reluctant to Rx Adderall because he was worried about a MAOI reaction?
>
> > > Parnate and Adderall go well together. Focalin is another drug that can be added to Parnate. I prefer Focalin to Ritalin in that it seems to me to be smoother with less of a let down when it wears off.
> > >
> > > Any drug that inhibits the reuptake of serotonin (SSRI, SNRI, others) is strictly prohibited.
>
> > Is it only serotonin reuptake that is prohibited? My doctor won't mix a MAOI with nortriptyline and some other meds that modify dopamine/norepinephrine. He claims that serotonin is not the only danger.
>
> In deference to your doctor, I believe that he is under the wrong impression.
>
> Serotonin might not be the only danger, but one can safely add the secondary amine TCAs (desipramine, nortriptyline), methylphenidate, amphetamine, and dopamine receptor agonists (pramepexole, ropinerole).
>
> I have been on Parnate 120 mg/day in combination with one or more of the following: desipramine, nortriptyline, amphetamine, methylphenidate, bromocriptine (DA agonist), and Wellbutrin.
>
> Try adding lithium (300-600 mg/day) for depression. For me, 300 mg/day is the sweet-spot.
>
>
> - Scott
>Found this in Stahl's "Essential Pyschopharmacology of Depression and Bipolar Disorder":
"One old-fashioned augmentation strategy that has fallen out of favor in recent years is to combine with great caution a TCA and an MAO inhibitor. Given its potential dangers (e.g., sudden hypertensive episodes, orthostatic hypotension, drug and dietary interactions, obesity), as well as the wide variety of other antidepressant combinations available today, this combination is rarely necessary or justified."
The date of last printing on the book is 2001 and I'm not sure if this has been updated. I wonder if his opinion has changed any?
When he says with great caution, what exactly does that mean in a practical real-world application?
Bob
poster:Bob
thread:1085235
URL: http://www.dr-bob.org/babble/20151225/msgs/1085362.html