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Re: Parnate insomnia: please help. » Axmann

Posted by SLS on January 31, 2016, at 7:40:28

In reply to Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 5:46:37

Hi.

Welcome. Thanks for stopping in. I hope you decide to stick around for awhile. We can use some new faces. Try to ignore the troll (Please see below). Most forums seem to attract at least one.

> History: 24-year-old male with severe ADD-PI, extremely treatment-resistant depression, and lifelong insomnia.

What does the "PI" stand for in ADD-PI?

1. What happens when you go up to 15 mg of mirtazapine (Remeron)?

2. Quetiapine (Seroquel) at relatively low dosages (25-100mg) can help. Even low-dose risperidone (Risperdal) is worthy of consideration.

3. How do you respond to zolpidem (Ambien)?

4. It might be time for a high-potency benzodiazepine (BZD). Triazolam (Halcion) has the best chance of putting you to sleep (initiation). However, it has a very short half-life, and often doesn't keep you asleep (maintenance) for the whole night. You would need something with a longer half-life to combine it with. You can either experiment with the drugs you already take, or add a second BZD. I like lorazepam (Ativan) and temazepam (Restoril). They have an intermediate half-life, and do not tend to produce a hangover the next morning. Both are very clean drugs and don't make you feel sedated. Halcion really is the most potent hypnotic BZD, and should help more than Ambien or Lunesta. At some point in the future, Parnate might not cause as much insomnia such that you can perhaps remove the BZDs gradually, although I don't think it is necessary. Regarding BZDs, memory, and Alzheimer's Dementia, I would need to see more convincing evidence that there is a significant problem. If it does raise the risk, it can't be by that much. Untreated depression represents a greater risk. People take BZDs their whole lives without a problem. Anyway, you can use them as a temporary bridge until something better comes along.

5. Wait for the Parnate to settle-in. The first time I tried it, I could not sleep a single minute for the first three weeks. Then, I used the Halcion-Ativan strategy and slept very well. Now that I've been on Parnate 80-120 mg/day for an extended period of time, I sleep without needing sleep-aids.

6. You can give up on Parnate and go to Nardil, but there is no guarantee that it will not interfere with your sleep. Some people get insomnia with Nardil, although the incidence is less than Parnate. I should mention another MAOI called isocarboxazid (Marplan). My guess is that it would affect your sleep the least among the non-selective MAOIs, which tend to work best.

7. With Parnate on board, you might be able to reduce your dosage of amphetamine. Parnate was used for ADD many years ago. Parnate has amphetamine-like properties. It may be that the combination of Parnate and amphetamine works synergistically in producing insomnia.

If I were you, I would not let the insomnia be an obstacle until you try a few more things to treat it aggressively. However, I would not head in the direction of using barbiturates. They are way too dangerous. Alcohol is counterproductive.

* One last note. Most people end up needing 40-80 mg/day of Parnate for maximum benefit. If you begin to lose the therapeutic effect or plateau, don't worry about it too much. You should be able to recapture the antidepressant response at higher dosages.

My vote is to first add Halcion to what you are already taking. It would be the simplest thing to try first. If you find that it puts you to sleep, but you find yourself waking up 3 hours later, despite your taking other drugs, you might then drop the Lunesta and replace it with either Ativan or Restoril.

I'm sure other people here will be able to come up with other ideas for you. These are the strategies I am most familiar with.

Good luck.


- Scott

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Internet troll:

"In Internet slang, a troll (/ˈtroʊl/, /ˈtrɒl/) is a person who sows discord on the Internet by starting arguments or upsetting people, by posting inflammatory,[1] extraneous, or off-topic messages in an online community (such as a newsgroup, forum, chat room, or blog) with the deliberate intent of provoking readers into an emotional response[2] or of otherwise disrupting normal on-topic discussion,[3] often for their own amusement."

-Wikipedia


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