Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Kathy on March 7, 2000, at 11:51:33
Has anyone had experience using an Mao med to treat bipolar ll and dysthymia. I am considering starting on it since I have not had really good results with a combination of celexa,neurontin and ritalin. I have tried the SSRI's and years ago the trycyclics. I just dont seem to be able to get rid of the depression and fatigue. I could easily sleep the day away without any problem.
Posted by Dennis on March 7, 2000, at 14:00:24
In reply to MAO med for atypical bipolar and dysthymia, posted by Kathy on March 7, 2000, at 11:51:33
> Has anyone had experience using an Mao med to treat bipolar ll and dysthymia. I am considering starting on it since I have not had really good results with a combination of celexa,neurontin and ritalin. I have tried the SSRI's and years ago the trycyclics. I just dont seem to be able to get rid of the depression and fatigue. I could easily sleep the day away without any problem.
Kathy, Unfortunately I've never tried an MAOI, as my GP is uncomfortable prescribing one to me. Since meds are largely trial-n-error, and appointments with a psychopharmacologist are considerably more expensive, I'm reluctant to go back to one. However, I too am running out of options with SSRI's for a type of depression similar to yours (atypical bipolar II). I too experience significant fatigue and apathy while on medications and when off of them, experience significant depression and anxiety. I'm currently taking Celexa along with Ritalin and although my depression has been reduced, I do feel apathetic, tired and my libido and function are hampered considerably. Although I'm interested in trying an MAOI to see if they would be more effective in treating my depression without the negative side effects I'm currently experiencing, I'm reluctant for reasons concerning dietary restrictions assoicated with their use. As I've read that protein type foods containing significant levels of an amino acid tyramine can negatively interact with MAOI's and cause dangerously high levels in blood pressure. Although I can't really help you with your query, I wish you much luck in your search. Dennis
Posted by Chris A. on March 7, 2000, at 21:30:55
In reply to MAO med for atypical bipolar and dysthymia, posted by Kathy on March 7, 2000, at 11:51:33
I found Parnate quite activating (too much so for me). I don't recall what mood stabilizers I took concurrently. My pDoc would never prescribe any AD to a bipolar patient without first having mood stabilizers on board. More recently I tried Selegiline and found it less activating. If I return to an AD I will use it again. I didn't find the diet at all dificult. I used a modified version that some researchers in Toronto had investigated throughly. Every once in a while I use decongestants, so had to be careful about that. Hope you find something that works.
Chris A.
Posted by S. Suggs on March 10, 2000, at 5:34:30
In reply to MAO med for atypical bipolar and dysthymia, posted by Kathy on March 7, 2000, at 11:51:33
Kathy, I am dysthymic with add-h. Currently take parnate 80 mg with great success. Also take Lithium 900 and T3 25 mcg. Seems to be a good mix so far. Dr's are by nature leary of maoi's, probably due to liability issues. Wishing you the best in your search for the right mix! Blessings,
S. Suggs
Posted by Anna P. on March 24, 2000, at 12:17:22
In reply to Re: MAO med for atypical bipolar and dysthymia, posted by S. Suggs on March 10, 2000, at 5:34:30
>
Can anyone please explain to me that issue?
I would like to consider Parnate as my last resort, but I've experienced alreadty the heart pain on Moclobemide, and stimulants.
I know, it wasn't anxiety symptoms. My EKG was fine , but the cardiologist has said
all these meds are stimulating for the heart.
I take already different medicines for 5 years.
what are my chances for Parnate?
I was always helped by the stimulating medications.
Parnate could help, as I'm bipolar II, and nothing helps so far.Anna P.
Posted by Scott L. Schofield on March 25, 2000, at 13:18:33
In reply to Re: Parnate and cardiac toxicity? Dr. Bob?, posted by Anna P. on March 24, 2000, at 12:17:22
> Can anyone please explain to me that issue? I would like to consider Parnate as my last resort, but I've experienced alreadty the heart pain on Moclobemide, and stimulants. I know, it wasn't anxiety symptoms. My EKG was fine , but the cardiologist has said all these meds are stimulating for the heart. I take already different medicines for 5 years. what are my chances for Parnate? I was always helped by the stimulating medications. Parnate could help, as I'm bipolar II, and nothing helps so far.
Hi Anna.Parnate (tranylcypromine) is a good choice for depression in bipolar disorder.
Is the "heart pain" you experience the same as heart-palpitations? With heart-palpitations, you can feel your heart beat, but it should not be painful. If your doctor thinks that the "heart pain" is a normal side effect, I would not worry too much. I have heart palpitations sometimes when I start a new drug. Usually, it goes away.
Parnate is not supposed to be cardiotoxic. It does not hurt the heart. It can increase heart rate. For some people, it can raise blood pressure. This is not common. However, it can be dangerous. It usually happens at the beginning. Sometimes it gets better, sometimes not. It is a good idea to check your blood pressure when you start treatment. Usually, Parnate lowers blood pressure. It can make you dizzy when you first stand up, but then it goes away. Usually, the dizziness gets better with time, but doesn't always go away completely.
The dosage for Parnate that I recommend is 40mg - 80mg. You must start at a lower dose. Follow your doctor's directions. It usually takes two to three weeks to work, if the dosage is right. It will take longer if you must adjust the dosage higher.
With bipolar II, you must be careful of mania. Any antidepressant drug can cause this. It might be a good idea to take a mood-stabilizer drug like Depakote (valproate, valproic acid) or lithium. Lamictal (lamotrigine) is another mood-stabilizer drug that can also add to the antidepressant effect of Parnate. It can prevent mania, but sometimes not. Depakote is better for mania.
I put an article at the bottom about Parnate and the heart. It compares Parnate to amitriptyline. Amitriptyline is a tricyclic antidepressant (TCA). TCAs can be cardiotoxic, usually at high dosages.
Good luck.
- Scott
--------------------------------------------------------
Int Clin Psychopharmacol 1991 Spring;6(1):11-7 Related Articles, Books
A comparative study of the electrocardiographic effects of tranylcypromine and amitriptyline when prescribed singly and in combination.O'Brien S, McKeon P, O'Regan M
Student Health Centre, Trinity College, Dublin, Eire.
The authors treated 53 in-patients aged between 18 and 65 years who were suffering from major depression with either tranylcypromine, amitriptyline or a combination of tranylcypromine and amitriptyline. Electrocardiograms taken before and after treatment were compared. In clinically effective doses amitriptyline gave rise to a significant increase in heart rate when prescribed alone and in combination with tranylcypromine. Single tranylcypromine treatment had little effect on heart rate and gave rise to no change in cardiac conduction as measured by the electrocardiogram. Amitriptyline when prescribed in combination with tranylcypromine was associated with significant lengthening of the PR interval. None of the patients developed pathological changes in their electrocardiograms under the carefully monitored treatment conditions of the study.
Posted by Anna P. on March 28, 2000, at 11:25:12
In reply to Re: Parnate and cardiac toxicity? Dr. Bob?, posted by Scott L. Schofield on March 25, 2000, at 13:18:33
> > Can anyone please explain to me that issue? I would like to consider Parnate as my last resort, but I've experienced alreadty the heart pain on Moclobemide, and stimulants. I know, it wasn't anxiety symptoms. My EKG was fine , but the cardiologist has said all these meds are stimulating for the heart. I take already different medicines for 5 years. what are my chances for Parnate? I was always helped by the stimulating medications. Parnate could help, as I'm bipolar II, and nothing helps so far.
>
>
> Hi Anna.
>
> Parnate (tranylcypromine) is a good choice for depression in bipolar disorder.
>
> Is the "heart pain" you experience the same as heart-palpitations? With heart-palpitations, you can feel your heart beat, but it should not be painful. If your doctor thinks that the "heart pain" is a normal side effect, I would not worry too much. I have heart palpitations sometimes when I start a new drug. Usually, it goes away.
>
> Parnate is not supposed to be cardiotoxic. It does not hurt the heart. It can increase heart rate. For some people, it can raise blood pressure. This is not common. However, it can be dangerous. It usually happens at the beginning. Sometimes it gets better, sometimes not. It is a good idea to check your blood pressure when you start treatment. Usually, Parnate lowers blood pressure. It can make you dizzy when you first stand up, but then it goes away. Usually, the dizziness gets better with time, but doesn't always go away completely.
Hi Scott!I don't know what type of a bipolar I have, it must be atypical, as I don't experience mania or hypomania. My problem is that any medication I try, works couple weeks, then stops.
I've experienced strong heart pain with Moclobemide, which I took for six months maximum dozes, and then in combinations with Revia, Cytomel and stimulants. It was happening, when I was breathing, but later on I was waking up hot on my face, with REALLY intense heart beat. It didn't happen at the beginning of thre therapy, though.
But I'm willing to try Parnate. All I know, I never can go on stimulants again.
What about the augmentation of Parnate besides Lithium, Depakote, Lamictal
Cytomel, stimulants, and Wellbutrin?
Some of the above I've already tried.
Any input I appreciate.
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> Anna P.
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Posted by Scott L. Schofield on March 30, 2000, at 10:32:17
In reply to Re: Parnate and cardiac toxicity? Scott!, posted by Anna P. on March 28, 2000, at 11:25:12
Hi Anna.
> > > Can anyone please explain to me that issue? I would like to consider Parnate as my last resort, but I've experienced alreadty the heart pain on Moclobemide, and stimulants. I know, it wasn't anxiety symptoms. My EKG was fine , but the cardiologist has said all these meds are stimulating for the heart. I take already different medicines for 5 years. what are my chances for Parnate? I was always helped by the stimulating medications. Parnate could help, as I'm bipolar II, and nothing helps so far.
> > Parnate (tranylcypromine) is a good choice for depression in bipolar disorder.
> > Is the "heart pain" you experience the same as heart-palpitations? With heart-palpitations, you can feel your heart beat, but it should not be painful. If your doctor thinks that the "heart pain" is a normal side effect, I would not worry too much. I have heart palpitations sometimes when I start a new drug. Usually, it goes away.
> > Parnate is not supposed to be cardiotoxic. It does not hurt the heart. It can increase heart rate. For some people, it can raise blood pressure. This is not common. However, it can be dangerous. It usually happens at the beginning. Sometimes it gets better, sometimes not. It is a good idea to check your blood pressure when you start treatment. Usually, Parnate lowers blood pressure. It can make you dizzy when you first stand up, but then it goes away. Usually, the dizziness gets better with time, but doesn't always go away completely.> I don't know what type of a bipolar I have, it must be atypical, as I don't experience mania or hypomania.
How old are you? (Be honest) :-)
You may not be bipolar type-I. Bipolar type-I must have mania. You are depressed only. If you are young, maybe you have bipolar type-I or bipolar type-II, but the mania will happen later. Infrequently, someone can have bipolar depression only. You might not have bipolar disorder.
Does lithium help? Does Depakote help? Does Lamictal help? Lamictal sometimes works very well for bipolar depression.
Do you have dysthymia or double-depression?
It sounds like you have unipolar depression. You might have the atypical-type. You have taken many antidepressants without mood-stabilizers, correct? None produced mania when you started them or stopped them.
Are you tired all of the time?
Do you sleep too much?
Do you move or speak very slow?
Do you eat too much?
Are you too skinny?
Are you nervous around other people?
Do you wake up early in the morning?
When is the depression worse - morning or evening?
> My problem is that any medication I try, works couple weeks, then stops.What drugs?
Have you tried a tricyclic drug? - imipramine, desipramine, amitriptyline, nortriptyline?
My problem is almost the same. I take a drug for two weeks. Then it starts to work. It works for only three days, and doesn't work any more. I can increase the dosage, and it still does not work. Parnate and Nardil (both MAO-inhibitors) work better for me than other drugs.
> I've experienced strong heart pain with Moclobemide, which I took for six months maximum dozes, and then in combinations with Revia, Cytomel and stimulants. It didn't happen at the beginning of thre therapy, though.
Did the heart-pain start when you were taking moclobemide by itself? What dosage? Did it get better or go away?Was Cytomel the worst for making the heart-pain? Do you lose hair?
> It was happening, when I was breathing, but later on I was waking up hot on my face, with REALLY intense heart beat.
This sounds bad. Your sympathetic nervous system (adrenalin, norepinephrine) was working too much.
> But I'm willing to try Parnate. All I know, I never can go on stimulants again.
Parnate works better than moclobemide (usually). It sometimes acts like a mild stimulant, though. You have to try it to find out. 40 - 80 mg. Sometimes adding lithium helps for unipolar depression using dosages of 300 - 600 mg.
Maybe Nardil is better. It does not have as much stimulant effect as Parnate. There is really no way to predict which will work. Trial and error. :-( Sometimes Parnate is better for bipolar depression or very anergic depression. Sometimes Nardil is better for atypical unipolar depression and for anxiety or social phobia.
> What about the augmentation of Parnate besides Lithium, Depakote, Lamictal
> Cytomel, stimulants, and Wellbutrin?Have you tried Wellbutrin by itself? Combining Parnate and Wellbutrin is generally safe and sometimes works when nothing else does.
* Very important. Because you may have too much sympathetic nervous system activity, you should be careful of high blood pressure when you first start Parnate. This does not happen often. It probably will not happen to you. But you must take your blood pressure to be sure.
It sounds like there are many things for you to try.
- Scott
Posted by Anna P. on March 31, 2000, at 15:44:06
In reply to Re: Parnate and cardiac toxicity? Scott!, posted by Scott L. Schofield on March 30, 2000, at 10:32:17
> Thanks Scott. What does it mean sympathetic nervous system activity?
The psychiatrist in Europe thought the same that this sounds bad.I remember your post about the ketoconazole.
I had the career that I loved, and here is what I did trying to save it.
Moclobemide, Dexedrine, Ketoconazole combo. The help was only temporary, I had to give up the job
- psychomotor slow down was the main reason.
But since that I get that heart pain.
What could happen?
I've read something about cytozome P-450, but I don't understand it much.
Basically, the heart pain started since Moclobemide Dexedrine combo, then I stopped Moclobemide for a few days to find out that Dexedrine by itself causes it.One more thing, my physician freaked out, as he gave me the ketoconazole for my infection without warning me about possible drug interactions.
Anyway, he is not friendly towards me anymore, as he is more affraid about loosing his licence, than
about his patient's life. He considers me as " a trouble making patient." Of course, there is my fault as well, as I should have asked him that.Anna P.
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