Posted by Robert_Burton_1621 on August 20, 2016, at 9:50:38
In reply to Re: Ultra high dose parnate (tranylcypromine), posted by Robert_Burton_1621 on August 20, 2016, at 9:42:44
> I'm sorry to hear of your residual symptoms. Parnate is an excellent medication. I have taken it (120 - 140mg) - and wish to take it again - but also experienced residual challenges (which were essentially remedied by lamotrigine 300mg, until I confronted serious side-effects and had, alas, to withdraw it).
>
> I would echo Scott's suggestion regarding nortriptyline augmentation. Strattera is not a particularly potent NRI and is scheduled for the treatment of ADHD; I do not think it is indicated for depressive conditions, though I could be wrong.
>
> Have you trialled lithium augmentation of parnate? This can be a very effective combination. It is important to monitor your thyroid hormones while on lithium treatment.
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> There is a case report of tranylcypromine with successful bupropion augmentation, too. However, I should have thought the first augmentation strategy would involve lithium.
>
> While expert psychopharmacologists would concede - and even openly acknowledge - that the dose of tranyclypromine used in the putatively authoritative STAR*D trials was woefully inadequate, I have never come across a study which assessed the efficacy and tolerability of tranylcypromine 200mg/day. I have read a study which used 170mg. And there is a well-known study which used 120mg (and various augmentation strategies, including with nortriptyline and (when nort was less than successful, with dextroamphetamine).
>I do wonder whether increasing your dose to 200mg when 140mg itself has proven inadequate would deliver you significant clinical benefits, unless you experienced a significant benefit from progressing from 100mg to 120mg, for instance.
You mention social anxiety as one of your major symptoms. Have you considered nardil? This MAOI also operates on GABA, and is slightly more selective for MAO-A. These characteristics are hypothesised to make it indicated for major depression with social anxiety.
>
> Best of luck.
poster:Robert_Burton_1621
thread:1091116
URL: http://www.dr-bob.org/babble/20160819/msgs/1091468.html