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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 282 to 306 of 317. Go back in thread:
Posted by SLS on April 20, 2012, at 7:22:30
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Alexei on April 19, 2012, at 14:46:50
> Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.
>
> May I ask your opinion on Parnate?I like Parnate more than Nardil because it has milder side effects. In addition, I find that Nardil produces a euphoric effect that I would prefer to do without. Everyone reacts to these two drugs differently. Some people do not respond to Parnate who do respond to Nardil. In my experience as a TRD patient, I have found it necessary to take a MAOI in order to respond well to treatment. I have always had to combine a MAOI with a tricyclic in order to glean a lasting improvement in depression.
> How would you rate its efficacy compared with ssri & snri meds?
MAOI > SNRI > SSRI
> Does it have any merit for OCD?
There are several anecdotal reports for success in treating OCD using either Parnate or Nardil. These drugs have not been the focus of study in this disorder. One study of Nardil (phenelzine) reported negative results, but its design had some significant flaws.
Study:
http://www.ncbi.nlm.nih.gov/pubmed/9286186Rebuttal:
http://ajp.psychiatryonline.org/article.aspx?Volume=156&page=159&journalID=13Do you have any other types of anxiety disorder?
> I'm finding venlafaxine to be merely average.
There are plenty of studies demonstrating the efficacy of clomipramine, fluoxetine, and fluvoxamine. Only a few studies exist using venlafaxine or paroxetine.
> Do you prefer nortriptyline to desipramine? If so, why?
I have used both drugs, and while I find them both effective in my case, nortriptyline produces better results. The autonomic side effects tend to be milder with nortriptyline. I experience a greater elevation of heart rate and palpitations with desipramine. I also get more dry mouth and blurred vision with desipramine. Sometimes you don't have a choice between the two. There are people who respond only to desipramine just as there are people who respond only to nortriptyine.
> Also, you've spoken of some type of synergy between abilify and lamictal.
I do better when I take both drugs together than when I take either one alone. I also know someone with depression who takes only these two drugs. She does not take any of the standard antidepressants, although she has tried most of them. Her system needs both drugs for her to feel well.
> Could you elaborate a bit on this?
I am going to have to disappoint you on demonstrating an explanation for the mechanics of interaction of the two drugs to produce a synergy. I don't know of any scientific studies investigating this. I have proposed my own pet theory which might explain a dopaminergic synergy between of these two drugs. Abilify seems to increase DA tone in neurons that are hypoactive in the nucleus accumbens via D2/D3 partial agonism. I think that Abilify is more of a modulator than it is a stimulant. Lamictal might produce an increase in DA activity in the nucleus accumbens via disinhibition. Lamictal reduces glutamate release in the thalamus. These glutamate circuits normally travel to the nucleus accumbens whereupon they act to reduce DA activity when activated. Lamictal reduces GLU activity in the thalamus and thus allows for increased DA activity in the the nucleus accumbens.
> I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.
These things are very ofen startup side effects that disappear within a week or two. However, there are enough people who continue to react badly to Abilify that aborting a trial is necessary.
What dosage of Ability did you start at?
It may be that people with unipolar depression are more sensitive to Abilify than those with bipolar disorder. I had no problem treating my bipolar depression with a starting dosage of 20 mg. People with unipolar depression often respond to dosages of 5 mg and lower. Some respond well at 2.5 mg, but suffer intolerable side effects at 5 mg.
So, what's your plan?
- Scott
Posted by uncouth on April 20, 2012, at 8:07:50
In reply to Re: Adding Parnate and prazosin. » Alexei, posted by SLS on April 20, 2012, at 7:22:30
Scott, quick question...have you ever tried much higher dose lamictal? Or memantine added on, at like 40mg? I know you're seeing great results with prazosin now and don't need/want to screw with anything, but i'm just curious...namenda is seeming to become really popular in a lot of treatment resistant mental health cases...may require higher dosages than the 20mg used in studies though. Same deal with lamictal, i think i posted to you a few months ago that in the rehab i went to two years ago, they said thy were seeing really great things happen with lamictal at 400-600-even 800 mg. I think going up on lamictal is probably a really easy thing to try and one can just back off if cognitive issues arise. Seems like there is definitely some magic pushing up dosages.
Posted by SLS on April 20, 2012, at 14:10:55
In reply to Re: Adding Parnate and prazosin. » SLS, posted by uncouth on April 20, 2012, at 8:07:50
> Scott, quick question...have you ever tried much higher dose lamictal?
I went up to 450 mg once. I couldn't remember my own name. I spent several years at 300 mg. I had constant brain-fog along with profound impairments in short-term memory. It wasn't until I tried reducing the dosage as an experiment that I discovered that 200 mg was the highest dosage I could take without cognitive side effects.
> Or memantine added on,
I tried adding 20 mg to Lamictal. Nothing. When I increased the dosage of memantine to 40 mg, I felt drunk and got scared. I stopped taking it. Perhaps the drunkeness would have disappeared if I stuck with it.
I came upon this not too long ago:
Original listing:
http://clinicaltrials.gov/ct2/show/NCT00305578
Results:
http://www.ncbi.nlm.nih.gov/pubmed/22329473
I'll keep memantine on hand, just in case.
Thanks for the suggestion.
- Scott
Posted by uncouth on April 20, 2012, at 16:52:29
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 20, 2012, at 14:10:55
Yes that is typical memantine reaction, and does go away. If your depression gets bad again, try 40mg on top of your lamictal. High dose namenda is going to change psychiatry.
Posted by g_g_g_unit on April 21, 2012, at 10:27:51
In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 20, 2012, at 16:52:29
are you on Namenda at the moment uncouth? I wanna add it to Parnate for OCD, ADHD, impulse control issues ..
any problems with insomnia, dissociation etc.?
Posted by SLS on April 24, 2012, at 18:51:05
In reply to Re: Adding Parnate and prazosin. » uncouth, posted by g_g_g_unit on April 21, 2012, at 10:27:51
Best day yet!
Woohoo!
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg
- Scott
Posted by Phillipa on April 24, 2012, at 21:30:59
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 24, 2012, at 18:51:05
Congrats sounds excellent. That's 12mg of prazosin now right? Phillipa
Posted by Twinleaf on April 25, 2012, at 5:58:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on April 24, 2012, at 21:30:59
This is the best news ever. It seems as though right from the beginning there has been something about Prazosin's effect on you which made you very hopeful about it. Do you think it's the effect it may be having on the traumatic component of your depression? Or is it more its synergy with the other medications? In any event, it's wonderful to hear.
Posted by SLS on April 25, 2012, at 21:43:34
In reply to Re: Adding Parnate and prazosin., posted by Twinleaf on April 25, 2012, at 5:58:29
> This is the best news ever. It seems as though right from the beginning there has been something about Prazosin's effect on you which made you very hopeful about it. Do you think it's the effect it may be having on the traumatic component of your depression? Or is it more its synergy with the other medications? In any event, it's wonderful to hear.
Thanks, Twinleaf!
I'll give your excellent questions some more time to consider.
I have a few ideas, but nothing definite. I think the mind/brain gets into the habit of dissociating in response to trauma, both external and internal. Once established, the dissociative processes in the brain might remain active, even after the traumas are resolved. The brain gets "stuck" in a dissociative, vegetative depressive state.
The addition of prazosin felt like I had added a robustly effective antidepressant that produced greater clarity of thought. It is very "clean" cognitively. The only two side effects I have is mild orthostatic hypotension and a loss of libido.
- Scott
Posted by Ron Hill on April 27, 2012, at 3:56:59
In reply to Re: Adding Parnate and prazosin. » Twinleaf, posted by SLS on April 25, 2012, at 21:43:34
> and a loss of libido.
-----------
Scott,Loss of sexual desire only, or ED plus lack of sexual desire?
-- Ron
Posted by SLS on April 27, 2012, at 13:44:37
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Ron Hill on April 27, 2012, at 3:56:59
> > and a loss of libido.
> -----------
> Scott,
>
> Loss of sexual desire only, or ED plus lack of sexual desire?
>
> -- Ron
Prazosin has reduced my sexual desire. This is not an uncommon side effect with this drug. I have no problems with erection and orgasm. The hardware works just fine.
- Scott
Posted by SLS on May 3, 2012, at 7:30:34
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 24, 2012, at 18:51:05
> Best day yet!
>
> Woohoo!Not the best day yet.
Woohoo?
:-(
- Scott
Posted by Phillipa on May 3, 2012, at 20:38:01
In reply to Re: Adding Parnate and prazosin., posted by SLS on May 3, 2012, at 7:30:34
I don't like the sad face? What's going on? Phillipa
Posted by SLS on May 11, 2012, at 16:31:46
In reply to Re: Adding Parnate and prazosin., posted by SLS on May 3, 2012, at 7:30:34
> > Best day yet!
> >
> > Woohoo!
> Not the best day yet.
>
> Woohoo?
>
> :-(
Better days are here.:-)
I reduced my dosage of prazosin from 12 mg to 8 mg. I found that the higher dosage produced some lethargy, fatigue, and tremulousness. I thought the tremulousness would abate, but it hasn't. The lethargy and fatigue have disappeared. I now take prazosin 4 mg b.i.d. This seems to be adequate so far. I don't think once-a-day dosing would work. The half-life of prazosin is just a few hours.
I am gaining more confidence in my treatment regime. The periodic dips in mood are disconcerting, but not at all hellish. They can last from a few minutes to a few days. There is no obvious cycle.
I am still hopeful that I will eventually achieve remission. It won't happen overnight, though. It will probably take another year. I can be patient if I am convinced that the process continues in a positive direction. My goal is to go to work and meet people. I won't have to wait another year to do these things, though.
- Scott
Posted by Phillipa on May 11, 2012, at 20:40:44
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on May 11, 2012, at 16:31:46
Why a year? Don't feel could be sooner? Phillipa
Posted by SLS on May 12, 2012, at 0:54:49
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on May 11, 2012, at 20:40:44
> Why a year? Don't feel could be sooner? Phillipa
Things seem to move very slowly for me. Whenever I experience an acute, robust antidepressant response to treatment, it never lasts. I'm lucky to be responding at all. I'll take what I can get, even if that means my CNS takes a few years to find a functional equilibrium. It can take an athlete a year or more to recover from a major injury. MDD and BD represent major assaults on the brain.
- Scott
Posted by Phillipa on May 12, 2012, at 19:44:52
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on May 12, 2012, at 0:54:49
True. Have you thought of testing yourself with an online course of some interest to you? Phillipa
Posted by SLS on June 21, 2012, at 15:52:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by SLS on May 11, 2012, at 16:31:46
> I am still hopeful that I will eventually achieve remission. It won't happen overnight, though. It will probably take another year. I can be patient if I am convinced that the process continues in a positive direction.
I added Topamax in an effort to accelerate my response to treatment. It would be nice to achieve remission within a month or two rather than within a year or two. I am following the titration schedule recommended for the treatment of migraine to minimize cognitive side effects. I am planning on taking 100 mg/day.
- Scott
Posted by uncouth on June 21, 2012, at 16:06:17
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on June 21, 2012, at 15:52:33
what is logic behind topamax?
Posted by Tomatheus on June 21, 2012, at 16:57:30
In reply to Re: Adding Parnate and prazosin + Topamax, posted by SLS on June 21, 2012, at 15:52:33
Good luck, Scott, and feel free to keep us updated on how you've been doing.
Tomatheus
Posted by SLS on June 21, 2012, at 19:16:23
In reply to Re: Adding Parnate and prazosin + Topamax, posted by uncouth on June 21, 2012, at 16:06:17
> what is logic behind topamax?
For now, I am going along with my doctor's hunch that my illness is, in part, being driven by "developmental PTSD". This is why prazosin was chosen. More recently, Topamax has been reported to be helpful in PTSD. I tried Topamax without prazosin several years ago. Much to my surprise, I felt somewhat better on it. However, my response to it was deemed inadequate and it was discontinued. I agreed with my doctor that Topamax was worth another look, now that I am taking a different combination of drugs. If Topamax does not accelerate my rate of recovery, I am considering memantine, ketamine, and rTMS as treatment adjuncts.
I once saw Topamax 100 mg/day successfully treat a nasty case of mixed-state hypomania. I think Topamax might be overlooked for the treatment of certain cases of bipolar disorder.
- Scott
Posted by SLS on June 21, 2012, at 19:17:37
In reply to Re: Adding Parnate and prazosin + Topamax, posted by Tomatheus on June 21, 2012, at 16:57:30
> Good luck, Scott, and feel free to keep us updated on how you've been doing.
>
> Tomatheus
Thanks. Your support is important to me.
- Scott
Posted by creepy on June 25, 2012, at 8:30:37
In reply to Re: Adding Parnate and prazosin + Topamax » uncouth, posted by SLS on June 21, 2012, at 19:16:23
I rapid cycled on 50mg topamax.. might be a little rough titrating up to 100.
I was a hyper-responder when I took it though. at 50mg I had some really intense side effects most dont get until higher doses. Maybe something else I was taking at the time raised my levels? Dunno.
Its supposedly good at taming angry outbursts in PTSD. But whether thats due to calming a mixed state or something else like slowing the amygdala I have no idea. I get the feeling the docs dont either! =(
Zoloft has been good on my PTSD, but my body seems to respond by 'somatizing' the depression so now I have pain and fatigue.
What symptoms make your doc think you have PTSD?
Andrenergic drugs will of course make you jumpy and hyperaroused.
Posted by SLS on June 25, 2012, at 16:44:53
In reply to Re: Adding Parnate and prazosin + Topamax, posted by creepy on June 25, 2012, at 8:30:37
Hi Creepy.
> I rapid cycled on 50mg topamax.. might be a little rough titrating up to 100.
Were you steadily depressed prior to beginning Topamax?
> I was a hyper-responder when I took it though. at 50mg I had some really intense side effects most dont get until higher doses. Maybe something else I was taking at the time raised my levels? Dunno.
What sorts of effects did you experience?
> Its supposedly good at taming angry outbursts in PTSD.
I didn't know that. I have seen it do this for bipolar disorder, mixed-state.
> But whether thats due to calming a mixed state or something else like slowing the amygdala I have no idea.
That's an interesting thought.
> I get the feeling the docs dont either! =(
I know.
> Zoloft has been good on my PTSD, but my body seems to respond by 'somatizing' the depression so now I have pain and fatigue.
Experiencing the somatic symptoms of depression or drug side effects is not the same thing as "somatization".
> What symptoms make your doc think you have PTSD?
Childhood history of physical abuse and neglect.
He thinks that I might have "developmental PTSD", and that this, in part, is driving the depression and creating a biological substrate for my presentation of rapid relapse upon response to antidepressant treatment.
http://www.positivehumandevelopment.com/developmental-ptsd.html
- Scott
Posted by SLS on July 4, 2012, at 5:39:00
In reply to Re: Adding Parnate and prazosin + Topamax » creepy, posted by SLS on June 25, 2012, at 16:44:53
So far, so good.
I raised the dosage of Topamax to 75 mg yesterday (25 mg t.i.d.). I will remain there for a week before increasing to the target dosage of 100 mg. It doesn't appear that I am having any cognitive or memory impairments that are in addition to those that are integral to the depression itself. I cannot be sure that the Topamax is helping, though. Of course, it is early. Unless there is true magic in these pills, I will not continue taking them.
I remain partially improved since adding the prazosin. However, I would like to accelerate my rate of recovery and help to attain full remission. If Topamax is not effective in filling this role, I am thinking about trying either ketamine or rTMS.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
Topamax 75 mg
- Scott
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