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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Geezer on December 11, 2002, at 11:31:28
Has anyone made a successful transition from Parnate to an SSRI following ECT treatments? I completed a series of 11 ECT treatments one week ago. I have been taking Parnate (currently 40mg. in divided doses) for the past six weeks. I just can't tolerate the Parnate - it makes me so tired I fall asleep in the afternoon. It is my understanding I would have to be off the Parnate completely for two weeks before starting an SSRI and continue to follow the MAOI diet for one month. Prozac is the only drug that ever gave me any relief (prior to poop-out after 18 months)......I am thinking of going back to Prozac and possibly adding pstims. I am DEFINITELY trying to live with TRD and just about at the end of my rope. The constant tired feeling is more than I can tolerate - I am not going to spend the rest of my life in bed. Any suggestions welcome. Thanks.
Posted by jay on December 11, 2002, at 20:10:53
In reply to Parnate to SSRI After ECT???, posted by Geezer on December 11, 2002, at 11:31:28
> Has anyone made a successful transition from Parnate to an SSRI following ECT treatments? I completed a series of 11 ECT treatments one week ago. I have been taking Parnate (currently 40mg. in divided doses) for the past six weeks. I just can't tolerate the Parnate - it makes me so tired I fall asleep in the afternoon. It is my understanding I would have to be off the Parnate completely for two weeks before starting an SSRI and continue to follow the MAOI diet for one month. Prozac is the only drug that ever gave me any relief (prior to poop-out after 18 months)......I am thinking of going back to Prozac and possibly adding pstims. I am DEFINITELY trying to live with TRD and just about at the end of my rope. The constant tired feeling is more than I can tolerate - I am not going to spend the rest of my life in bed. Any suggestions welcome. Thanks.
Hi:I feel in a similar boat, as my doctor, after 10 years of little good response to meds, has suggested ECT. Effexor is similar to me as Parnate is to you. I have gotten off it because of the fatigue and memory block.
If Prozac did the trick for you before, you may want to try either a higher dose or augmentation. Have you considered even augmenting with things like thryoid, and tricyclics? How about a good daily dose of a benzo? I think a med like Xanax can release enough tension so that we don't feel
so tired and overwhelmed. I'd say even try just a tricyclic with Xanax, especially the ones that act on norepinephrine, like Nortriptyline. I have also read of some excellent responses to the old 'gold' standard, Imipramine.If your doctor is willing, take advantage of it and try some very different combinations and routes. Good luck...
Jay
Posted by Geezer on December 12, 2002, at 11:53:18
In reply to Re: Parnate to SSRI After ECT??? » Geezer, posted by jay on December 11, 2002, at 20:10:53
> > Has anyone made a successful transition from Parnate to an SSRI following ECT treatments? I completed a series of 11 ECT treatments one week ago. I have been taking Parnate (currently 40mg. in divided doses) for the past six weeks. I just can't tolerate the Parnate - it makes me so tired I fall asleep in the afternoon. It is my understanding I would have to be off the Parnate completely for two weeks before starting an SSRI and continue to follow the MAOI diet for one month. Prozac is the only drug that ever gave me any relief (prior to poop-out after 18 months)......I am thinking of going back to Prozac and possibly adding pstims. I am DEFINITELY trying to live with TRD and just about at the end of my rope. The constant tired feeling is more than I can tolerate - I am not going to spend the rest of my life in bed. Any suggestions welcome. Thanks.
>
>
> Hi:
>
> I feel in a similar boat, as my doctor, after 10 years of little good response to meds, has suggested ECT. Effexor is similar to me as Parnate is to you. I have gotten off it because of the fatigue and memory block.
>
> If Prozac did the trick for you before, you may want to try either a higher dose or augmentation. Have you considered even augmenting with things like thryoid, and tricyclics? How about a good daily dose of a benzo? I think a med like Xanax can release enough tension so that we don't feel
> so tired and overwhelmed. I'd say even try just a tricyclic with Xanax, especially the ones that act on norepinephrine, like Nortriptyline. I have also read of some excellent responses to the old 'gold' standard, Imipramine.
>
> If your doctor is willing, take advantage of it and try some very different combinations and routes. Good luck...
>
> JayJay,
Thank you for your post. I think your suggestion to augment will be my first attempt. Pdocs in my part of the country are not too creative (three have given up on me as hopeless in the past 2 years....I have been fighting the battle for over 30 years) so it's a struggle.
Geezer
Posted by ItsHowdyDudyTime on December 13, 2002, at 18:03:48
In reply to Parnate to SSRI After ECT???, posted by Geezer on December 11, 2002, at 11:31:28
> Has anyone made a successful transition from Parnate to an SSRI following ECT treatments? I completed a series of 11 ECT treatments one week ago. I have been taking Parnate (currently 40mg. in divided doses) for the past six weeks. I just can't tolerate the Parnate - it makes me so tired I fall asleep in the afternoon. It is my understanding I would have to be off the Parnate completely for two weeks before starting an SSRI and continue to follow the MAOI diet for one month. Prozac is the only drug that ever gave me any relief (prior to poop-out after 18 months)......I am thinking of going back to Prozac and possibly adding pstims. I am DEFINITELY trying to live with TRD and just about at the end of my rope. The constant tired feeling is more than I can tolerate - I am not going to spend the rest of my life in bed. Any suggestions welcome. Thanks.
Geeezer, this is just a guestimation or speculation, so take it with a grain of salt. But your problem with Parnate might have to do with the fact that you are trying it right at the end of an ECT trial. Keep in mind ECT increases dopamine a lot all by itself. Throwing in a potent dopaminergic antidepressant like Parnate right at the end or in the middle of a session of ECT might amount to a simple surplus of dopamine, with resulting psychosis or "flattening" affect and catatonic feelings as you have been describing in your posts.In Max Fink's book "Electroshock: Restoring the Mind" Dr. Fink mentions this. He discusses using ECT for treatment of parkinsons disease. He talks about how people with parkinsons who take dopamine agonists like leva dopa usually have to sharply reduce their dopamine agonists during and after the ECT sessions. IF they dont, oftentimes they will become frankly psychotic or catatonic. Get the book and read it for yourself if you want.
I read your posts and this crossed my mind. ECT plus Parnate might equal TOO MUCH dopamine in your brain. On the other hand, if you stop the ECT and wait six months to a year, you might be able to handle 30 to 40 mg parnate just fine. Or possibly another MAOI such as Nardil. Some can tolerate Nardil or Marplan just fine but just cant hack Parnate.
Howdy Doody
Posted by Geezer on December 14, 2002, at 10:52:48
In reply to Re: Parnate to SSRI After ECT???, posted by ItsHowdyDudyTime on December 13, 2002, at 18:03:48
> > Has anyone made a successful transition from Parnate to an SSRI following ECT treatments? I completed a series of 11 ECT treatments one week ago. I have been taking Parnate (currently 40mg. in divided doses) for the past six weeks. I just can't tolerate the Parnate - it makes me so tired I fall asleep in the afternoon. It is my understanding I would have to be off the Parnate completely for two weeks before starting an SSRI and continue to follow the MAOI diet for one month. Prozac is the only drug that ever gave me any relief (prior to poop-out after 18 months)......I am thinking of going back to Prozac and possibly adding pstims. I am DEFINITELY trying to live with TRD and just about at the end of my rope. The constant tired feeling is more than I can tolerate - I am not going to spend the rest of my life in bed. Any suggestions welcome. Thanks.
>
>
> Geeezer, this is just a guestimation or speculation, so take it with a grain of salt. But your problem with Parnate might have to do with the fact that you are trying it right at the end of an ECT trial. Keep in mind ECT increases dopamine a lot all by itself. Throwing in a potent dopaminergic antidepressant like Parnate right at the end or in the middle of a session of ECT might amount to a simple surplus of dopamine, with resulting psychosis or "flattening" affect and catatonic feelings as you have been describing in your posts.
>
> In Max Fink's book "Electroshock: Restoring the Mind" Dr. Fink mentions this. He discusses using ECT for treatment of parkinsons disease. He talks about how people with parkinsons who take dopamine agonists like leva dopa usually have to sharply reduce their dopamine agonists during and after the ECT sessions. IF they dont, oftentimes they will become frankly psychotic or catatonic. Get the book and read it for yourself if you want.
>
> I read your posts and this crossed my mind. ECT plus Parnate might equal TOO MUCH dopamine in your brain. On the other hand, if you stop the ECT and wait six months to a year, you might be able to handle 30 to 40 mg parnate just fine. Or possibly another MAOI such as Nardil. Some can tolerate Nardil or Marplan just fine but just cant hack Parnate.
>
> Howdy DoodyHey Howdy,
Welcome back. That is a good possibility re: the dopamine effect from Parnate following ECT. The last ECT treatment was 9 days ago so we will see if that has any effect. I do have Max Fink's book here and will go back and read it again. At this point I would have to say Parnate is the most unpredictable AD I have ever taken, it might wake you up.....put you to sleep.....leave you with fits of anger - right now I am fighting sever insomnia at night. This all changes from day to day so each day holds a nasty surprise. Went through the futile effort of calling the pdoc-he doesn't return calls (the two before him just gave up on me and told me to find another pdoc...thinking of changing over to plumbers or electricians for better results).
I would love to get back to an SSRI even if it did last for only a year. The best effect from an SSRI (actually everyone here complains about it) is "emotional blunting" or that "who gives a d***" attitude. Until someone comes up with an AD that works better I'll opt for the "who cares zone".
Let me know how you are doing.
Geezer
>
>
Posted by Dr. Bob on December 14, 2002, at 12:22:05
In reply to Re: Parnate to SSRI After ECT???, posted by ItsHowdyDudyTime on December 13, 2002, at 18:03:48
> In Max Fink's book "Electroshock: Restoring the Mind" Dr. Fink mentions this.
I'd just like to plug the double double quotes feature here:
http://www.dr-bob.org/babble/faq.html#amazon
But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at Psycho-Babble Administration:
http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
Thanks!
Bob
Posted by ItsHowdyDudyTime on December 14, 2002, at 15:19:32
In reply to Re: double double quotes » ItsHowdyDudyTime, posted by Dr. Bob on December 14, 2002, at 12:22:05
> > In Max Fink's book "Electroshock: Restoring the Mind" Dr. Fink mentions this.
>
> I'd just like to plug the double double quotes feature here:
>
> http://www.dr-bob.org/babble/faq.html#amazon
>
> But I don't mean to be pushy. Did you deliberately not use it to link to Amazon? If so, I'd be interested in why, over at Psycho-Babble Administration:
>
> http://www.dr-bob.org/babble/admin/20020918/msgs/7717.html
>
> Thanks!
>
> Bob
Uh...no I didnt do anything deliberately. I was merely quoting the book in the standard MLA style I learned in English 101 in College years ago. You know, when you quote a specific book you are supposed to put the title in quotes. Thats what I did. As far as putting it in "double double quotes" I didnt even know that option was available here. I dont read most of the stuff on this website and havent read the FAQ. Im also cognitively impaired from severe mental illness, so that might have something to do with it. Its like a head injury. I just tell people offline I was kicked in the head by a mule and have neurological damage. Plus I have a bad head cold right now.If you can do that and link books directly like that, thats pretty neat and I just didnt know about that option. Normally the way I link books to Amazon.com is to just copy and paste the direct link in my post. If there is an easier way, thats good.
Howdy Doody
Posted by ItsHowdyDudyTime on December 14, 2002, at 15:42:51
In reply to Re: Parnate to SSRI After ECT??? » ItsHowdyDudyTime, posted by Geezer on December 14, 2002, at 10:52:48
Im doing OK, going back to work soon to make some money. Im going to get retrained I think. Im also getting ready to have full battery neuropsychological testing in January, Im really looking forward to that. My Pdoc doesnt want me to have ECT anymore and he wont let me take anymore anti-psychotics, not even this new Abilify. All he wants me on is MAOIs. MAOIs is all I hear about. They are good drugs, the best Ive tried so far, at least for me. Im off them right now, I had a mild reaction a while back but Im going right back on them soon.Im thinking of forming a lobbying organisation in the future, which will be dedicated towards trying to formally merge psychiatry into Neurology. I have looked it up and there is no organisation dedicated specifically to that objective. I think its something thats long overdue myself. The Stanley foundation while a good organisation, is mostly technically nuts and bolts research oriented and is focused more on schizophrenia and bipolar and not on severe depression or anxiety disorders I have gotten the impression. NAMI is a joke and doesnt have enough political power to get anything substantial done. Most of the other "mental health" lobby groups are more interested in patients rights and things like that. There is no organisation dedicated towards trying to get severe mental illness totally and formally redefined as Neurological diseases and getting them removed from the category of psychiatric illnesses.
We need to totally bypass psychiatry, go around them, dont waste our time with them and rebuild a better, more science based foundation for diagnosing and treating severe mental illness IMO. In other words, the wheel needs to be reinvented, chiefly by forcing Neurology to take over severe mental illness.
Another goal of this organisation would be to try to get the mentally ill to vote more, so politicians would pay more attention to us. And get more real medical research into severe mental illness going. Politicians only pay attention to two groups of people. People who vote and people who have money and are politically organized.
Ive given the thought of going back to school too. Im thinking of becoming a lobbyist. If I create an organisation such as this at some point in the future, would you be interested in becoming involved possibly?
Are you aware of the most powerful lobby groups? The NRA is number one, another lobby group I support totally. Gun owners tend to vote. After that its the AARP, all the senior citizens vote. then the American trial lawyers association lobby. Then a lobby called AIPAC, which is a quiet lobby that is behind a large portion of the American government's support for Israel.
Id like to see a grass roots lobby that represented the severely mentally ill someday in the top ten most powerful lobby groups someday. I know most would say thats a pipe dream and maybe they are right. But I think it could be done, somehow. NAMI certainly wont ever cut it, maybe I can create an organisation that will do it. Even if it took me the rest of my life to build and I made absolutely no money at it, Id do it anyway.
A big part of our problem is that the mentally ill do not vote on a regular basis, as a block. If this could be changed somehow, I believe we could have real progress in the war on mental illness.
later,
Howdy Doody
Posted by Dr. Bob on December 15, 2002, at 20:27:59
In reply to Re: Parnate to SSRI After ECT???, posted by ItsHowdyDudyTime on December 14, 2002, at 15:42:51
> Im thinking of forming a lobbying organisation in the future, which will be dedicated towards trying to formally merge psychiatry into Neurology...
As discussed before, I'd like posts about psychiatry vs. neurology to be redirected to Psycho-Social-Babble; otherwise, they will (continue to) be deleted.
Bob
PS: And follow-ups regarding posting policies should of course be redirected to Psycho-Babble Administration, thanks.
This is the end of the thread.
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