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Dr. Bob is Robert Hsiung, MD,
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Posted by SLS on January 5, 2012, at 15:24:35
In reply to Re: Adding Parnate and prazosin., posted by sigismund on January 5, 2012, at 15:16:44
> I don't know what the situation is here, but in some places nefazodone was discontinued because of liver toxicity?
I read that the incidence of liver toxicity was fairly low. 1 in every 250,000. You could screen for toxicity with blood tests.
A friend of mine who has N24 circadian rhythm disorder finds prazosin helpful.
- Scott
Posted by Phillipa on January 5, 2012, at 18:38:53
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 5, 2012, at 15:24:35
And to think I read on here about the liver toxicity and the banning in Canada and Europe so would not take it when the pdoc here begged me too. Others here basically said don't. As for nightmares for last two years having them frequently. Fears of death and things haven't thought about in years. I think the 40 year old female across the road from me takes it for PTSD nightmare also said it works for her. She's on other meds also antipsycotic, antidepressant? Jan/P
Posted by SLS on January 6, 2012, at 6:35:38
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 5, 2012, at 18:38:53
I am not feeling as well today as I had been feeling for the week before.
I am, of course, frightened.
Hopefully, I am not plateauing or relapsing.
I am being hypervigilant, I know.
30 years of failed treatments...
I don't want to go back there.
- Scott
Posted by Phillipa on January 6, 2012, at 19:47:18
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 6, 2012, at 6:35:38
From your current regimen or did you cut down on abilify if so quality of life first? Jan/P
Posted by SLS on January 9, 2012, at 18:53:54
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 6, 2012, at 19:47:18
Still feeling better.
- Scott
Posted by Phillipa on January 9, 2012, at 20:25:54
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 9, 2012, at 18:53:54
That is serious good mood as if can discontinue the abilify you will also lower triglycerides and weight and feel like lifting again maybe? Congrats so far. Phillipa
Posted by Beckett on January 9, 2012, at 23:56:22
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 9, 2012, at 18:53:54
> Still feeling better.
>
>
> - ScottYou are ?
:-)
Posted by SLS on January 10, 2012, at 6:11:37
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 9, 2012, at 20:25:54
> That is serious good mood
Yup. Seriously good.
> as if can discontinue the abilify
I suspect that I can. I discontinued it for a few months in 2010, and was okay. I went back to it when I had a few bad days. Perhaps I was premature in restarting it. We'll see. If I must take Abilify, I will. I would rather live a few less years than to live out the rest of my days depressed.
> feel like lifting again maybe?
I really hope so. Exercise is something that I would like to add back in my life.
> Congrats so far.
Thanks. My doctor deserves the congratulations. His choice of prazosin was brilliant.
- Scott
Posted by SLS on January 10, 2012, at 6:15:10
In reply to Re: Adding Parnate and prazosin., posted by Beckett on January 9, 2012, at 23:56:22
> > Still feeling better.
> >
> >
> > - Scott> You are ?
I know. What a weird concept. It is too good to be true. I have a long way to go in terms of magnitude of improvement, but I remain optimistic. If I can get 50% better, I think I can return to employment.
> :-)
:-)
- Scott
Posted by Bob on January 10, 2012, at 14:17:38
In reply to Re: Adding Parnate and prazosin. » Beckett, posted by SLS on January 10, 2012, at 6:15:10
> > > Still feeling better.
> > >
> > >
> > > - Scott
>
> > You are ?
>
> I know. What a weird concept. It is too good to be true. I have a long way to go in terms of magnitude of improvement, but I remain optimistic. If I can get 50% better, I think I can return to employment.
>
> > :-)
>
> :-)
>
>
> - Scott
I'm still a little confused. You started the Parnate at the same time as the Prazosin, right? How do you know you're positive response is not due to a combination of Parnate + Prazosin, or Prazosin + one of the other drugs in your cocktail (e.g. Abilify), or Parnate + Abilify, etc...?Bob
Posted by SLS on January 10, 2012, at 14:42:42
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on January 10, 2012, at 14:17:38
Hi Bob.
> > > > Still feeling better.
> > > >
> > > >
> > > > - Scott
> >
> > > You are ?
> >
> > I know. What a weird concept. It is too good to be true. I have a long way to go in terms of magnitude of improvement, but I remain optimistic. If I can get 50% better, I think I can return to employment.
> >
> > > :-)
> >
> > :-)
> >
> >
> > - Scott
>
>
> I'm still a little confused. You started the Parnate at the same time as the Prazosin, right? How do you know you're positive response is not due to a combination of Parnate + Prazosin, or Prazosin + one of the other drugs in your cocktail (e.g. Abilify), or Parnate + Abilify, etc...?
>
> Bob
I began prazosin 2 weeks before I began taking Parnate. I felt somewhat improved during this time, although the improvement was subtle. I responded significantly well to the addition of Parnate within 10 days of starting it at a dosage of 60 mg. I then discontinued the prazosin for 36 hours as an experiment. I relapsed, and then added it back.I am hoping that I can discontinue Abilify without relapsing. I am down to 5.0 mg. The next step is to take 5.0 mg every other day. So far, I have not observed any deterioration in my condition.
- Scott
Posted by Bob on January 10, 2012, at 14:46:53
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on January 10, 2012, at 14:42:42
> Hi Bob.
>
> > > > > Still feeling better.
> > > > >
> > > > >
> > > > > - Scott
> > >
> > > > You are ?
> > >
> > > I know. What a weird concept. It is too good to be true. I have a long way to go in terms of magnitude of improvement, but I remain optimistic. If I can get 50% better, I think I can return to employment.
> > >
> > > > :-)
> > >
> > > :-)
> > >
> > >
> > > - Scott
> >
> >
> > I'm still a little confused. You started the Parnate at the same time as the Prazosin, right? How do you know you're positive response is not due to a combination of Parnate + Prazosin, or Prazosin + one of the other drugs in your cocktail (e.g. Abilify), or Parnate + Abilify, etc...?
> >
> > Bob
>
>
> I began prazosin 2 weeks before I began taking Parnate. I felt somewhat improved during this time, although the improvement was subtle. I responded significantly well to the addition of Parnate within 10 days of starting it at a dosage of 60 mg. I then discontinued the prazosin for 36 hours as an experiment. I relapsed, and then added it back.
>
> I am hoping that I can discontinue Abilify without relapsing. I am down to 5.0 mg. The next step is to take 5.0 mg every other day. So far, I have not observed any deterioration in my condition.
>
>
> - Scott
So it sounds like having the Parnate on board helped at least a little?
Posted by SLS on January 10, 2012, at 15:09:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on January 10, 2012, at 14:46:53
> > I began prazosin 2 weeks before I began taking Parnate. I felt somewhat improved during this time, although the improvement was subtle. I responded significantly well to the addition of Parnate within 10 days of starting it at a dosage of 60 mg. I then discontinued the prazosin for 36 hours as an experiment. I relapsed, and then added it back.
> >
> > I am hoping that I can discontinue Abilify without relapsing. I am down to 5.0 mg. The next step is to take 5.0 mg every other day. So far, I have not observed any deterioration in my condition.> So it sounds like having the Parnate on board
helped at least a little?I would say that the Parnate is an important component to my treatment. I seem to need a MAOI and TCA in combination. This is what I had success with in the past.
- Scott
Posted by Phillipa on January 10, 2012, at 18:38:25
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on January 10, 2012, at 15:09:29
Scott just what if you only needed the prazosin? And not a technical depression med? Is it possible that after all this time you have been taking meds that have hampered your recovery instead of helping. Just a wild thought out of nowhere. And it was your doc's suggestion? Your doc is great!!!! Phillipa
Posted by SLS on January 13, 2012, at 5:28:24
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 10, 2012, at 18:38:25
Hi All.
Well, I am still improved, but I am impatient to feel MUCH better. I worry that this will be only a partial response or a fading response. It is not happening fast enough for me to feel confident that this will be the end to my suffering.
My advice to myself is to take it week by week or month by month, but not day by day. That's what I tell other people. It is so hard, though.
I want a guarantee.
- Scott
Posted by Phillipa on January 13, 2012, at 18:41:14
In reply to Re: Adding Parnate and prazosin., posted by SLS on January 13, 2012, at 5:28:24
Scott I know I issue a guarantee. But what is wrong with day to day as it's AA's motto one Day at a Time. Great news!!!! So what are you now doing different with your days than before? Phillipa
Posted by SLS on January 13, 2012, at 21:13:25
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on January 13, 2012, at 18:41:14
Hi Phillipa
> Scott I know I issue a guarantee. But what is wrong with day to day as it's AA's motto one Day at a Time. Great news!!!! So what are you now doing different with your days than before? Phillipa
What I meant is that I am looking at my antidepressant response with a microscope, hoping to see significant gains each day. I probably expect too much. The first time I got well, it took about three months to get there. I am somewhere in the middle. I now have a tendency to get bored, but I still don't feel like doing anything. Usually, I am too vegetative to be bored, so this is a good sign.
- Scott
Posted by sigismund on January 14, 2012, at 1:39:48
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 13, 2012, at 21:13:25
Scott, can you write more about what you think the effect of the prazosin on the way you feel is?
Posted by SLS on January 14, 2012, at 7:20:25
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 14, 2012, at 1:39:48
> Scott, can you write more about what you think the effect of the prazosin on the way you feel is?
To me, the addition of prazosin felt like a powerful and clean antidepressant. I gained mental energy and clarity. I was smarter. I enjoyed things more and was more social. My self-confidence increased. I was less apt to sigh or become breathless. Music sounds better. Food tastes better.Right now, I seem to be in a lull. The antidepressant response has faded somewhat. It is still early in treatment, though. I began responding only two weeks ago. For me, two weeks is a long time.
What exactly are the features or symptoms of your condition that you would like to see successfully treated?
- Scott
Posted by Phillipa on January 14, 2012, at 19:47:46
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on January 13, 2012, at 21:13:25
Scott I can join you in being bored. So I'm doing well? Phillipa
Posted by sigismund on January 15, 2012, at 1:50:47
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 14, 2012, at 7:20:25
>prazosin felt like a powerful and clean antidepressant. I gained mental energy and clarity. I was smarter. I enjoyed things more and was more social. My self-confidence increased. I was less apt to sigh or become breathless. Music sounds better. Food tastes better.
That would be unexpected for me. Very interesting.
>What exactly are the features or symptoms of your condition that you would like to see successfully treated?
I would like deeper sleep and more of it. I have been thinking of trimipramine, guanfacine, nefazodone and prazosin (possibly acamprosate as well) as things which may be useful. If they make me feel better in the day, that would be a bonus
Posted by SLS on January 15, 2012, at 7:50:41
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 15, 2012, at 1:50:47
> I would like deeper sleep and more of it. I have been thinking of trimipramine, guanfacine, nefazodone and prazosin (possibly acamprosate as well) as things which may be useful.
Those are all some pretty brainy choices. I'm sure you'll find something that is a good match for you.
> If they make me feel better in the day, that would be a bonus.
Trimipramine would be a logical choice if depression is mixed-up in your condition somehow. Prazosin might smooth out disturbed sleep, but I don't know if it helps to sleep deeper. If PTSD is in there somewhere, it might be a good choice. Nefazodone is a worthy choice for improving sleep architecture. My concern with nefazodone is that this effect cannot be sustained beyond a few weeks as reported by the second study appearing below. They might be wrong, though. I found another study that made no mention of diminishing effect after 8 weeks.
- Scott-----------------------------------------
Neuropsychopharmacology. 1994 Apr;10(2):123-7.
The effects of nefazodone on sleep architecture in depression.Armitage R, Rush AJ, Trivedi M, Cain J, Roffwarg HP.
University of Texas Southwestern Medical Center, Dallas 75235-9070.
AbstractA polysomnographic study was conducted on 10 outpatients with major depression at baseline and during 4 to 8 weeks of open-trial treatment with nefazodone (400 to 600 mg/day). All 10 patients were treatment responders as evidenced by at least 50% reduction from baseline scores on the Hamilton Depression Rating Scale. Nefazodone was associated with significantly decreased wake and movement time and increased minutes and percentage of stage 2 sleep at the expense of light stage 1 sleep. Nefazodone did not increase rapid-eye-movement (REM) latency and it did not suppress REM sleep. In fact, a trend toward increased REM in the second REM period was observed, although decreased REM in the third REM period was also noted. In summary, nefazodone, an effective antidepressant, decreases arousals and wakefulness during sleep and reduces light non-REM sleep. This agent does not appear to suppress REM sleep or prolong REM latency in patients who respond to treatment.
PMID:
8024673
[PubMed - indexed for MEDLINE]
-----------------------------------------------------Br J Psychiatry. 2002 Jun;180:528-35.
Randomised controlled study of sleep after nefazodone or paroxetine treatment in out-patients with depression.
Hicks JA, Argyropoulos SV, Rich AS, Nash JR, Bell CJ, Edwards C, Nutt DJ, Wilson SJ.
SourcePsychopharmacology Unit, University of Bristol, UK.
Abstract
BACKGROUND:Sleep effects of antidepressants are important clinically and for elucidating mechanism of action: selective serotonin reuptake inhibitors disturb sleep and 5-HT(2) receptor-blocking compounds may enhance sleep quality.
AIMS:To compare the objective and subjective effects on sleep of paroxetine and nefazodone in patients with moderate to severe depression.
METHOD:Forty patients with depression were randomised to take paroxetine 20-40 mg/day or nefazodone 400-600 mg/day for 8 weeks. Objective and subjective quality of sleep and depression measures were assessed throughout.
RESULTS:Nefazodone significantly increased objective sleep efficiency and total sleep time, and improved subjective sleep on days 3 and 10. Paroxetine decreased sleep efficiency early in treatment and some sleep disruption remained at week 8. Paroxetine but not nefazodone produced marked suppression of rapid eye movement (REM) sleep.
CONCLUSIONS:Nefazodone improves sleep in early treatment compared with paroxetine in patients with moderate to severe depression. These effects are seen within the first 2 weeks of treatment and diminish thereafter.
PMID:
12042232
[PubMed - indexed for MEDLINE]Free full text
--------------------------------------------------
J Clin Psychopharmacol. 1997 Jun;17(3):161-8.
A multicenter, double-blind comparison of the effects of nefazodone and fluoxetine on sleep architecture and quality of sleep in depressed outpatients.
Armitage R, Yonkers K, Cole D, Rush AJ.
SourceUniversity of Texas Southwestern Medical Center, Depart. of Psychiatry 75235-9070, USA. armitage@utsw.swmed.edu
AbstractThis study was an 8-week, randomized, double-blind, parallel-group investigation that compared the effects of nefazodone and fluoxetine on sleep architecture and on clinician- and patient-rated sleep measures in 43 outpatients with moderate to severe, nonpsychotic major depressive disorder and insomnia. Twenty-two patients received nefazodone 200 mg daily for 1 week, followed by 400 mg daily for 7 weeks. Twenty-one patients received fluoxetine 20 mg daily. Dosage increases (to 500 mg/day for nefazodone and 40 mg/day for fluoxetine) were available after day 29, depending on clinician judgement. Sleep parameters were measured during baseline phase, while patients were unmeasured and symptomatic, and at weeks 2, 4, and 8 of treatment. Nefazodone and fluoxetine were equally effective as antidepressants. However, compared with baseline, nefazodone increased sleep efficiency and reduced the number of awakenings and percent awake and movement time, whereas fluoxetine increased the number of awakenings and did not significantly alter sleep efficiency or percent awake and movement time. Although fluoxetine increased stage 1 sleep and rapid eye movement (REM) latency and reduced total percent REM sleep, nefazodone increased REM sleep, decreased REM latency, and did not alter stage 1 sleep. Differences between treatment groups, based on change from baseline, revealed greater sleep efficiency, fewer awakenings, less percent awake and movement time, less percent stage 1 and more REM sleep, and shorter REM latency for nefazodone compared with fluoxetine. Significantly greater improvement in clinician- and patient-rated sleep disturbance was found with nefazodone compared with fluoxetine. Nefazodone was associated with better sleep quality.
PMID:
9169959
[PubMed - indexed for MEDLINE]
Posted by sigismund on January 15, 2012, at 11:57:22
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on January 15, 2012, at 7:50:41
Thanks Scott for the references.
Whatever I get I will be using the lowest possible dose
Posted by SLS on January 16, 2012, at 6:35:40
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on January 15, 2012, at 11:57:22
> Thanks Scott for the references.
>
> Whatever I get I will be using the lowest possible dose
Good luck.If you are chronically sleep-deprived, you might be very surprised by how differently you will feel once you make up the sleep-debt.
- Scott
Posted by SLS on January 16, 2012, at 6:44:52
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
I experienced a lull in my response to treatment. It lasted for about a week. I had been greatly disappointed by this. I came to believe that my improvement had plateaued and was fading.
I am doing significantly better today. Something must still be working. I am more hopeful that my progress will continue and result in a robust antidepressant response. I guess I should expect that the course of improvement will not be linear, and that I should expect occasional lulls.
- Scott
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