Posted by Bob on March 1, 2016, at 0:42:58
In reply to Re: Parnate » Bob, posted by SLS on February 29, 2016, at 16:58:39
> > My current regimen is getting slowly more complex. I currently take the following:
>
> > Nortriptyline 200mg (75mg 2x per day and 50mg at bedtime)
>
> For most people, this is too much. If you haven't already checked your blood level, you can do that and get a good idea if a dosage adjustment is necessary. The reason I mention this is because nortriptyline has a very real therapeutic window. More is not better. If the dosage of nortriptyline is too high, it stops working.
>Yes, I've had my blood levels taken many times. The recent few times have been between 130 and 147 mcg/L. I'm not sure where the level would be the best for me but these values are within the accepted therapeutic range of 50-150 mcg/L.
> Have you ever tried desipramine? I am doing better on desipramine than I had been doing on nortriptyline. I find that it gives me more mental energy. I get more things done. I take 300 mg/day. I am optimistic that I will respond more robustly to desipramine than to nortriptyline. Stay tuned...
>I have not tried desipramine and would not rule it out. My doctor seems to think it is a harsher med in his experience. Still, I'd consider it in place of nortriptyline.
> > Brintellix 10mg (5mg 2x per day)
>
> I have no personal experience with this drug, and have not seen enough anecdotes to have an opinion. I have had experience with Viibryd, and have a doctor who has used it quite a bit. I would recommend talking to your doctor about it. Compared to Britellix, Viibryd is a more potent serotonin reuptake inhibitor. Viibryd is also a 5-HT1a partial agonist (like aripiprazole and buspirone), while Brintellix is a full agonist. I don't know for sure what the significance of this is, but my guess is that a partial agonist would act more like a stabilizer of serotonin activity.
>Yes, it's difficult to say exactly what the advantages of partial over full agonists may be. I wasn't really aware Viibryd was a potent partial agonist. Seems worth considering for sure. When you say you have experience with it does that mean you've taken it yourself or is it second-hand experience?
> > Aripiprazole 4mg (2mg 2x per day)
>
> I would explore higher dosages. For me, the sweet-spot is 10 mg/day. I lose the antdepressant effect at 5 mg/day. However, my depression is of an unusual type of bipolar disorder.
>God knows my depression is of an unusual type. How did you arrive at 10mg being your sweet spot? Did you ever take it at higher levels?
> > Lithium 112.5mg at bedtime
>
> Why not 300 mg/day (150 mg x 2)?I'm taking the Eskalith CR 450mg pill. I could divide that in half for 225mg however it seems to slow me down at higher doses. I just take a quarter so that I have "trace" amounts of lithium present. Probably not doing much buy I'm taking it nonetheless.
>
> > Lithothyronine T3 25mcg in the morning
>
> Does it help depression? What about thyroxine T4?Like anything else I've taken I got a real nice boost as an adjunct to my ADs and then that eventually faded somewhat -- still the T3 seems to help a little. My doctor and the literature seem to concentrate on T3 more than T4.
>
> > Pramipexole .375mg (.125mg 3x per day)
>
> I'm not a big fan of full agonists of dopamine receptors. They usually don't help that much or for that long. I have seen two exceptions, though.I realize that pramipexole might not be the best approach but I'm running out of options and suffer with significant anhedonia even on all these meds. There aren't a lot of drugs out there addressing this for me. Pramipexole tends to be a little edgy and may poop out completely on me but for now I'm sticking with it.
>
> > I assumed that Parnate might have to be taken multiple times per day to stabilize blood levels.
>
> I don't think there are any blood levels to stabilize. Parnate is more of a hit-and-run drug. Still, I make it a habit of dosing three times a day. I would be just as comfortable dosing twice a day.
>
> > Seems like the levels would get pretty low with a once per day dosing and a 2-hr half-life. I've found for some reason that for me it seems even for meds with a relatively long half-life it helps to dose more than once per day. This is especially true when starting a new medicine.
>
> The first time I tried Parnate, I needed to take it 3 or 4 times a day to help reduce postural hypotension.
>
> > I'm not getting a super-robust response from what I'm now taking and everything I take eventually fades in effectiveness. I recently added small amounts of pramipexole which is actually helping somewhat. MAOIs are the only class of drug I haven't tried to date and there is suggestions that they are more suited to atypical depression (which I seem to have) and are less prone to losing effectiveness over time. Then again I've seen people on this very forum who claim to have lost effect with MAOIs.
>
> It is my impression that Nardil is more likely to poop-out than Parnate. It happens, though, that someone will respond well to Nardil for many years and be completely unresponsive to Parnate.
>
> > I think I saw recently where you said if you don't achieve remission with your current regime you may try an SNRI?
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> I have never combined Effexor or Cymbalta with a therapeutic dosage of nortriptyline or desipramine.
>
> > Is the Parnate + nortriptyline not helping enough?
>
> I have switched from nortriptyline to desipramine because I felt that I was stuck with an unacceptable improvement. Things get a little complicated because I only recently discontinued prazosin, which apparently was "polluting" my response to desipramine. Perhaps the prazosin was limiting my response to nortriptyline as well. If I get stuck again, I would opt for doing a very quick switch back to nortriptyline as an experiment.
>
> I try not to leave any stone unturned.I too would like to leave no stone unturned but it is quite difficult to transition on and off medicines.
>
>
> - Scott
>
poster:Bob
thread:1086592
URL: http://www.dr-bob.org/babble/20160131/msgs/1086618.html