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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by NYCguy on February 2, 2007, at 13:09:09
Hello fellow Babblers!
Today is my ninth day taking Parnate, my fourth taking it at 30mg TID. I also take Klonopin 2-3mg per day. So far, things are going very well. I'm able to me more social and far less depressed than I had been. Parnate seems to make me a bit more tired than I had been before I began, but only in the physical labor/stamina department.
The only other MAOI I've taken before has been EMSAM and it didn't really work too well for depression. I did get a bit of a high off of it that I have yet to experience from Parnate, but that is okay in my book. Parnate seems to give me a "warm, it's going to be alright" feeling. Life seems more "real" and less overwhelming.
I know it hasn't even been two weeks. My plan for the next month or so is just to stay on this dose and see how things progress. Maybe this will be all I need and that would be super!
I hope this will be the med combo that lets me feel better and start living more: working, making new friends, maybe persuing school, all that stuff.
A question to the Parnate/MAOI vets out there... does anyone know the right time interval to dose Parnate if one is taking it three times daily? Right now I'm taking it at 9am, 1pm, and 5pm, but I don't know if this is best. Any ideas?
Thanks!
Posted by Quintal on February 2, 2007, at 13:32:03
In reply to Nine Days on Parnate!, posted by NYCguy on February 2, 2007, at 13:09:09
That's about the same dosing schedule I used myself. So long as you're having no problems it makes sense to stick to it, I just listened to what my body was telling me with Parnate and 80-120mg felt right. You'd almost certainly feel a buzz off that if you were ever to raise the dose so high. If Parnate ever seems to be pooping out would you consider adding Lamictal as an augmenter? The Lamictal, Parnate, Klonopin cocktail gave me the most robust improvement I've ever had. I highly recommend it.
Great to hear a Parnate success story.
Q
Posted by Phillipa on February 2, 2007, at 13:40:13
In reply to Re: Nine Days on Parnate! » NYCguy, posted by Quintal on February 2, 2007, at 13:32:03
Q I think there are quite a few. Love Phillipa
Posted by halcyondaze on February 2, 2007, at 14:41:29
In reply to Re: Nine Days on Parnate! » NYCguy, posted by Quintal on February 2, 2007, at 13:32:03
I try to avoid taking any Parnate after 3 or 4 pm because I find it worsens my insomnia.
Posted by UGottaHaveHope on February 2, 2007, at 15:17:28
In reply to Re: Nine Days on Parnate!, posted by halcyondaze on February 2, 2007, at 14:41:29
What is your diagnosis? Regular depression? Any anxiety? Does the Parnate help anxiety?
I am taking Emsam now. Was was your final opinion of that? Thanks Michael
Posted by Crazy Horse on February 2, 2007, at 15:46:35
In reply to Re: Q for NYCGuy, posted by UGottaHaveHope on February 2, 2007, at 15:17:28
> What is your diagnosis? Regular depression? Any anxiety? Does the Parnate help anxiety?
>
> I am taking Emsam now. Was was your final opinion of that? Thanks MichaelGreat news! Parnate is one of the best, if not the best AD in my opinion. I'll be restarting it myself on Feb. 25th. My recommendation is to stay at the lowest dose that works for you and as far as dividing the dose up, it's totally an individual thing. I prefer to take all or most of my dose all early in the morning..it helps with the insomnia to not take it in the p.m. (for me). Keep up the good work!
-Monte
Posted by Crazy Horse on February 2, 2007, at 16:08:29
In reply to Re: Q for NYCGuy » UGottaHaveHope, posted by Crazy Horse on February 2, 2007, at 15:46:35
Posted by NYCguy on February 2, 2007, at 16:37:37
In reply to Re: Q for NYCGuy, posted by UGottaHaveHope on February 2, 2007, at 15:17:28
> What is your diagnosis? Regular depression? Any anxiety? Does the Parnate help anxiety?
>
> I am taking Emsam now. Was was your final opinion of that? Thanks MichaelI have pretty bad "atypical" depression, anxiety, and some docs have speculated that I have ADD. The Parnate does help with anxiety in combination with the Klonopin I take.
I took Emsam for a couple weeks and did not really get much anti-depressant kick out of it. Some days it would work well and others it would send me into the pits of despair. I was on 6mg. I should have waited at least a month on it, but at the time I was very frustrated and it didn't seem to be helping at all.
Posted by NYCguy on February 2, 2007, at 16:42:58
In reply to Re: Q for NYCGuy » UGottaHaveHope, posted by Crazy Horse on February 2, 2007, at 15:46:35
Monte,
Thanks for the encouragment, so far I like it a lot. How does one know if they are on the right dose? I mean, I do feel better, but I do still get spells of depression from time to time, and my energy is still low. How long does it take to kick in and is this effect noticiably different from the initial stimulating properties of the med?
How much works for you and do you think it depends on a person's weight?
-D
>
> Great news! Parnate is one of the best, if not the best AD in my opinion. I'll be restarting it myself on Feb. 25th. My recommendation is to stay at the lowest dose that works for you and as far as dividing the dose up, it's totally an individual thing. I prefer to take all or most of my dose all early in the morning..it helps with the insomnia to not take it in the p.m. (for me). Keep up the good work!
>
> -Monte
Posted by NYCguy on February 2, 2007, at 16:52:37
In reply to Re: Nine Days on Parnate! » NYCguy, posted by Quintal on February 2, 2007, at 13:32:03
Oh, yeah. I've taken Lamictal before and I did get a response at about 25mg. A tiny dose, but anything more and I got very d.u.m.b.! I still don't really know what to expect as to this dose. I've heard a lot of folks say that when it kicks in that there will be no question if it's working or not. Well, even though I feel a lot better, I still have that doubt. I wonder "is this really working, or is it just the stimulating properties and placebo?" sometimes.
BTW, Quintal, do you know if it hurts the effect of the Parnate by dosing it all at once? (I was thinking that maybe some of the MAOI genesis will not be inhibited in the later hours if the dosing was not spread out.)
Hey, thanks. I hope I am a Parnate success story. Things look promising right now, but only time will tell!
-D
Posted by NYCguy on February 2, 2007, at 16:55:59
In reply to Re: Nine Days on Parnate!, posted by halcyondaze on February 2, 2007, at 14:41:29
halcyondaze,
Are you still taking 80mg per day? Do you find that Parnate has you sleeping the same ammount of hours as before or more or less? Also, how do you dose it, all at once or spread out over the day?
Thanks!
> I try to avoid taking any Parnate after 3 or 4 pm because I find it worsens my insomnia.
Posted by Crazy Horse on February 2, 2007, at 17:04:50
In reply to Re: Q for NYCGuy » Crazy Horse, posted by NYCguy on February 2, 2007, at 16:42:58
> Monte,
>
> Thanks for the encouragment, so far I like it a lot. How does one know if they are on the right dose? I mean, I do feel better, but I do still get spells of depression from time to time, and my energy is still low. How long does it take to kick in and is this effect noticiably different from the initial stimulating properties of the med?
>
> How much works for you and do you think it depends on a person's weight?
>
> -D
Well, for me 50 mgs. is required to get an initial response. Try to take just enough to make you feel not depressed and not anxious, i have in the past taken more, just to see if 80mgs. would make me feel even better than 70 mgs..this can get a person into trouble because i believe higher dose = a higher/worse side effect profile. I'd stay at your current dose about 5-7 days and if you are still somewhat depressed/anxious then increase to 40 mgs.(which is still a pretty low dose for most people). Most people (not all) get an initial stimulaing effect that is more speeded up than the AD effect. But even the AD effect is very activating. I think either time or increasing the dose will eliminate the low energy you are experiencing.Is response related to weight? I think so, some may disagree, but i think higher weight = higher dose and vice versa (In the majority of cases).
Feel free to ask any questions.
-Monte
Posted by halcyondaze on February 2, 2007, at 17:06:20
In reply to Re: Nine Days on Parnate! » halcyondaze, posted by NYCguy on February 2, 2007, at 16:55:59
> halcyondaze,
>
> Are you still taking 80mg per day? Do you find that Parnate has you sleeping the same ammount of hours as before or more or less? Also, how do you dose it, all at once or spread out over the day?
>
> Thanks!
>
> > I try to avoid taking any Parnate after 3 or 4 pm because I find it worsens my insomnia.
>I'm one of those people who finds Parnate abusable so, though I am Rx'ed 80 mg/day, I often take up to 140 mg/day. However, I did tell my doctor about this and she will now be giving me a weekly supply of pills.
When I do take the 80 I am Rx'ed, I take: 20 mg at 8:00 a.m., and then 20 mg every 2 hours after that. I find that every two hours is a good way to keep the drug stable in my system - it just sucks because I can "feel" it leaving my system later at night. When I wake up late (like 10:00 a.m.), I take 30 mg at 10 am, then 20 mg at 12 pm, then 30 mg at 2 pm.
I have found no differences in efficacy or side effects with either dosing regimen. Lately I've been abusing it, and taking it as late as 6 pm but the Halcion knocks me out regardless of what dose I take and when so I suppose I'm lucky to have that med.
Posted by Crazy Horse on February 2, 2007, at 17:14:08
In reply to Re: Nine Days on Parnate!, posted by halcyondaze on February 2, 2007, at 17:06:20
>
> I'm one of those people who finds Parnate abusable so, though I am Rx'ed 80 mg/day, I often take up to 140 mg/day. However, I did tell my doctor about this and she will now be giving me a weekly supply of pills.
>
> When I do take the 80 I am Rx'ed, I take: 20 mg at 8:00 a.m., and then 20 mg every 2 hours after that. I find that every two hours is a good way to keep the drug stable in my system - it just sucks because I can "feel" it leaving my system later at night. When I wake up late (like 10:00 a.m.), I take 30 mg at 10 am, then 20 mg at 12 pm, then 30 mg at 2 pm.
>
> I have found no differences in efficacy or side effects with either dosing regimen. Lately I've been abusing it, and taking it as late as 6 pm but the Halcion knocks me out regardless of what dose I take and when so I suppose I'm lucky to have that med.
>
>
I'm glad i'm not alone..i find it abusable also. Last time i got up to 160mgs., which ruined my trial on Parnate, because the insomnia and afternoon fatigue got so bad. It's abusable because it feels so damn good. This time i won't make the same mistake, if i have to, i'll have my wife hold and dispense it to me.-Monte
Posted by halcyondaze on February 2, 2007, at 17:27:29
In reply to Re: Nine Days on Parnate! » halcyondaze, posted by Crazy Horse on February 2, 2007, at 17:14:08
It's always nice to hear that I'm not alone in my Parnate abuse. Oftentimes I feel stupid because I am abusing an antidepressant but I find it SO amphetamine-like that I want to keep that "speed" feeling going so I take more.
I used to lie to my doctor and say it wasn't working for my depression just so I could take more, so she was Rx'ing 120 mg/day. This time, I became very aware of how bad it would be for me if the drug stopped working for depression so I did not lie to her to get her to write for more pills per day.
Everything I've read on Parnate warns about how it may induce drug-seeking behaviors and dose escalations characteristic of addiction, especially in substance abusers but there are so many people who swear up and down that it is not euphoric for them that I often wonder if there is something seriously wrong with me.
I don't know if it's physically addicting - it causes withdrawal when stopping, like any antidepressant does, but this doesn't mean it's "addicting" - but I find it profoundly psychologically addicting, and sometimes feel like my Parnate/Halcion combo is really just a "lite" version of my previous methamphetamine/heroin cocktail. I'm off illegal drugs but I'm still behaving in the same way. :( (though, actually, I do not abuse the Halcion)
Posted by lcat10 on February 2, 2007, at 19:55:21
In reply to Nine Days on Parnate!, posted by NYCguy on February 2, 2007, at 13:09:09
>> A question to the Parnate/MAOI vets out there... does anyone know the right time interval to dose Parnate if one is taking it three times daily? Right now I'm taking it at 9am, 1pm, and 5pm, but I don't know if this is best. Any ideas?
>
> Thanks!I used to take 30 mg. of Parnate in the a.m. This was over 20 years ago. It worked really well for me. I had lots more energy and no sleepiness in the afternoon. More recently when again becoming depressed, I tried Parnate, 30 mg. in the a.m. again. Worked marginally; raised to 40 mg. in the a.m., and I started to get the jitters from it--kind of a high strung feeling. So went to Lamictal, was on 100mg. for a time, then added Emsam. On 12 mg. Emsam patch. Doesn't seem to do anything for me. I have tried other stuff too. Going off Lamictal now as it doesn't do anything. I suspect Parnate might work again for me. It is the only antidepressant I could tolerate at a therapeutic level (other than Emsam) without developing adverse reactions or allergic reactions before I could get to a therapeutic dose level. So, now time to try something different. I don't think I could tolerate Parnate above lets say 50 or 60 mgs.
lcat10
Posted by Phillipa on February 2, 2007, at 21:08:00
In reply to Re: Nine Days on Parnate! » NYCguy, posted by lcat10 on February 2, 2007, at 19:55:21
You're going to try parnate again? Love Phillipa
Posted by NYCguy on February 2, 2007, at 21:39:35
In reply to Parnate and abuse, posted by halcyondaze on February 2, 2007, at 17:27:29
This is very interesting. I've taken all the pstims for my ADD-i tendancies and so I know what that feels like. Are you guys saying that there isn't any other effect of Parnate other than the one you'd feel with amphetimine? It feels like it is working, but not fully. I'm waiting for it to "kick in" take the most of the blues away. If there is to be no more improvment except that of it being more stimulating the way taking more stims would be... man that stinks.
I'm being silly here I think, I haven't even been on this for 2 weeks and I'm getting all discouraged because I got down in the dumps this afternoon.
Here's another question: (I know... I'm just full of 'em!)You know how SSRIs work and then once they're in your system you just need to dose once a day and you feel pretty consistant effects? Well, does Parnate ever work like that, or is every day when you wake up going to feel like you are very depressed until you take your morning dose?
The way people explain how it works through MAO inhibition, you would think that this would be the primary mechanisim, not the stimulation effect.
> It's always nice to hear that I'm not alone in my Parnate abuse. Oftentimes I feel stupid because I am abusing an antidepressant but I find it SO amphetamine-like that I want to keep that "speed" feeling going so I take more.
>
> I used to lie to my doctor and say it wasn't working for my depression just so I could take more, so she was Rx'ing 120 mg/day. This time, I became very aware of how bad it would be for me if the drug stopped working for depression so I did not lie to her to get her to write for more pills per day.
>
> Everything I've read on Parnate warns about how it may induce drug-seeking behaviors and dose escalations characteristic of addiction, especially in substance abusers but there are so many people who swear up and down that it is not euphoric for them that I often wonder if there is something seriously wrong with me.
>
> I don't know if it's physically addicting - it causes withdrawal when stopping, like any antidepressant does, but this doesn't mean it's "addicting" - but I find it profoundly psychologically addicting, and sometimes feel like my Parnate/Halcion combo is really just a "lite" version of my previous methamphetamine/heroin cocktail. I'm off illegal drugs but I'm still behaving in the same way. :( (though, actually, I do not abuse the Halcion)
Posted by lcat10 on February 2, 2007, at 23:00:50
In reply to Re: Parnate and abuse, posted by NYCguy on February 2, 2007, at 21:39:35
Parnate worked for me as an antidepressant and as a "stimulant" of sorts. Since I have tended to have a more endogenous depression, the antidepressant plus stimulant quality worked well for me.
Posted by Quintal on February 2, 2007, at 23:23:51
In reply to Re: Parnate and abuse, posted by NYCguy on February 2, 2007, at 21:39:35
I abused Parnate too. My pdoc only prescribed 30mg a day and wanted me to reduce it to 10mg a day as a maintenance dose after a month. I was already taking about 80mg a day by that point. Like hal I took it every few hours, like a short acting amphetamine, to keep me energized and motivated throughout the day. The Klonopin acted to make the cocktail like an upper/downer combo and the Lamictal prevented mania and tolerance to the stims I think.
As far as I'm aware the stimulant effect of Parnate isn't mediated by MAO inhibition (it wouldn't matter if you took Parnate as a single morning dose in terms of MAO inhibition since tranylcypromine binds irreversibly to the MAO enzyme for about 30 days - there just isn't enough new MAO produced by the body to influence the antidepressant effect). My own pet theory is that the MAO inhibition potentates the small amount of amphetamine metabolites (methamphetamine and PEA) which are responsible for the euphoric stimulant effects at high doses. It might be nonsense of course, but that's what I suspect might be happening in Parnate abuse.
It would seem likely that there would be such a thing as 'Parnate Psychosis' or something of the like if people were to abuse it in the same way as coke or crystal meth. Is there a ceiling on Parnate euphoria? Do people need to increase the dose indefinitely or does the MAO inhibition help prevent tolerance? Interesting. I should really go back on Parnate...............
Q
Posted by naughtypuppy on February 3, 2007, at 10:07:35
In reply to Re: Parnate and abuse, posted by Quintal on February 2, 2007, at 23:23:51
> I abused Parnate too. My pdoc only prescribed 30mg a day and wanted me to reduce it to 10mg a day as a maintenance dose after a month. I was already taking about 80mg a day by that point. Like hal I took it every few hours, like a short acting amphetamine, to keep me energized and motivated throughout the day. The Klonopin acted to make the cocktail like an upper/downer combo and the Lamictal prevented mania and tolerance to the stims I think.
>
> As far as I'm aware the stimulant effect of Parnate isn't mediated by MAO inhibition (it wouldn't matter if you took Parnate as a single morning dose in terms of MAO inhibition since tranylcypromine binds irreversibly to the MAO enzyme for about 30 days - there just isn't enough new MAO produced by the body to influence the antidepressant effect). My own pet theory is that the MAO inhibition potentates the small amount of amphetamine metabolites (methamphetamine and PEA) which are responsible for the euphoric stimulant effects at high doses. It might be nonsense of course, but that's what I suspect might be happening in Parnate abuse.
>
> It would seem likely that there would be such a thing as 'Parnate Psychosis' or something of the like if people were to abuse it in the same way as coke or crystal meth. Is there a ceiling on Parnate euphoria? Do people need to increase the dose indefinitely or does the MAO inhibition help prevent tolerance? Interesting. I should really go back on Parnate...............
>
> QThat's really interesting. The only time that I had a euphoric feeling was the first 3 weeks at 20mg. after that period and increasing the dosage, I lost a lot of that feeling. It was like a peaceful calm without anxiety that I have only felt a few times in my life.
Posted by Crazy Horse on February 3, 2007, at 11:30:33
In reply to Re: Parnate and abuse, posted by NYCguy on February 2, 2007, at 21:39:35
You've only been on it for 10 days now, and your dose is on the low end, this is why you are still getting some break through depression.
For me when the dose is right and i've been on it for about 1 month i have 0 depression, 0 anxiety, and 0 social anxiety. Be patient bud, you are way early in the game, and your dose is low.
-Monte
Posted by NYCguy on February 3, 2007, at 13:53:18
In reply to Re: Parnate and abuse » NYCguy, posted by Crazy Horse on February 3, 2007, at 11:30:33
Thanks, Monte.
I hear what you're saying. In fact, this morning I got up and felt pretty darn good. My dream is to be like one of the people on askapatient.com that has been on the med 10- 30 years. The med merry-go-round isn't so merry sometimes!
When you start, will you just go on 80 the first day, or will you build up slowly?
> You've only been on it for 10 days now, and your dose is on the low end, this is why you are still getting some break through depression.
>
> For me when the dose is right and i've been on it for about 1 month i have 0 depression, 0 anxiety, and 0 social anxiety. Be patient bud, you are way early in the game, and your dose is low.
>
> -Monte
Posted by Crazy Horse on February 3, 2007, at 14:01:20
In reply to Re: Parnate » Crazy Horse, posted by NYCguy on February 3, 2007, at 13:53:18
> Thanks, Monte.
>
> I hear what you're saying. In fact, this morning I got up and felt pretty darn good. My dream is to be like one of the people on askapatient.com that has been on the med 10- 30 years. The med merry-go-round isn't so merry sometimes!
>
> When you start, will you just go on 80 the first day, or will you build up slowly?
>
No, i will build slowly, and i may not even need 80mgs. Hey, if 40mgs. works well i'll stay there as long as possible. I don't want to make the mistake i made the last time i was on Parnate of going to high. The least amount that you need to feel well, the better.-Monte
Posted by psychobot5000 on February 4, 2007, at 1:38:53
In reply to Re: Parnate and abuse, posted by NYCguy on February 2, 2007, at 21:39:35
> This is very interesting. I've taken all the pstims for my ADD-i tendancies and so I know what that feels like. Are you guys saying that there isn't any other effect of Parnate other than the one you'd feel with amphetimine? It feels like it is working, but not fully. I'm waiting for it to "kick in" take the most of the blues away. If there is to be no more improvment except that of it being more stimulating the way taking more stims would be... man that stinks.
>My personal experience with Parnate (I also just started) is that there's definitely an independent antidepressant effect, besides the stimulant one. The evidence (and conventional opinion among psychiatrists) seems to back that up. I wouldn't get disheartened--maybe you just haven't had enough weeks on it to get that full AD effect, yet.
I do believe that you get better MAO inhibition by spreading the doses out over the day, though. That way your blood-levels of the drug are high, and constantly snapping up MAO. Since that's the presumed mechanism behind the AD effect, it seems the best dosing strategy--assuming you don't get insomnia. It's one of the best! Don't lose hope after just a couple of weeks! But as for me, I say don't sell parnate's stimulant effect short--no doubt here that it's helping me.
Best wishes!
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