Posted by SLS on January 14, 2016, at 5:25:55
In reply to Re: Parnate shame » SLS, posted by Bob on January 13, 2016, at 22:55:18
> > I read that a long time ago...
> >
> > I was forced to consider the possibility that Dr. Stahl might not be right about everything. It was very traumatic. :-)
> >
> > I guess the key words are "rarely necessary or justified". This is a judgement call, not an absolute contraindication. Of the things he listed, only one is a matter of safety - sudden hypertensive events - something to be considered seriously. However, even Parnate by itself is capable of doing this. I can only describe what has worked for me in the past and the combinations I have taken since. Most of the doctors who have experience with such things are now 75-85 years old. My current doctor sort of inherited my treatment regime. I just want to emphasize that the only two tricyclic antidepressants that I would consider adding to MAOI are desipramine and nortriptyline.> Did your current doctor have anything at all to say about the MAOI + TCA combo you were on?
You know, I don't remember whether he remarked on it or not. Like I said, he inherited my regime from my previous doctors.
The only time my doctor expressed concern was when I asked to be switched from nortriptyline to desipramine. I never asked him why. He allowed me to switch, but his titration schedule was more gradual than I would have liked. My guess is that he was a little spooked by the potency of desipramine as a norepinephrine reuptake inhibitor. He had also been spooked to go over 80 mg/day of Parnate. He had his only patient on high-dosage Parnate report having a headache. I managed to squeeze 100 mg/day out of him. I ultimately had another doctor bring me up to 120 mg/day when I went to see her temporarily for an intranasal ketamine trial. I subsequently discovered by trial and error that 80 mg/day was enough to maintain a therapeutic effect, while 60 mg/day was not.
I can say that for me, desipramine genuinely feels harsher and more energizing than nortiptyline. Be aware, though, that both drugs can produce sedation or somnolence during the first week or so. Unlike amitriptyline, these effects usually disappear entirely. I had this happen with nortriptyline but not with imipramine nor desipramine.
- Scott
Some 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:1085235
URL: http://www.dr-bob.org/babble/20151225/msgs/1085381.html