![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 46. Go back in thread:
Posted by jemma on June 18, 2003, at 10:33:54
In reply to Re: maoi plus wellbutrin » jemma, posted by shrimp on June 17, 2003, at 15:17:30
Have you told your pdoc about the twitches, the blurred vision, and the orthostatic hypotension? The combined action of monoamine oxidase inhibition - which raises levels of dopamine, norepinephrine, and serotonin - and wellbutrin - which inhibits reuptake of dopamine, norepinephrine, and serotonin - does seem to risk potentially dangerous levels of all three, especially serotonin. I think it would be wise to let him know you're having trouble.
- Jemma
> Jenna,
> I didn't know you could combine the two either, but i trust my p-doc, he's good. I think it is a novel combination though, and he had some reservations, because i increased the nardil very, very slowly. I was on 45mg been on 60 mg. for about 2 weeks, still waiting for it to kick in. Actually, i do feel better, but i still have lethargy, lack of motivation, and anhedonia.
> Hope that helps.
> Shrimp
Posted by Carlos on June 18, 2003, at 12:12:46
In reply to Re: maoi plus wellbutrin » shrimp, posted by jemma on June 18, 2003, at 10:33:54
> Have you told your pdoc about the twitches, the blurred vision, and the orthostatic hypotension? The combined action of monoamine oxidase inhibition - which raises levels of dopamine, norepinephrine, and serotonin - and wellbutrin - which inhibits reuptake of dopamine, norepinephrine, and serotonin - does seem to risk potentially dangerous levels of all three, especially serotonin. I think it would be wise to let him know you're having trouble.
>
> - Jemma
>
>
>
>
>
> > Jenna,
> > I didn't know you could combine the two either, but i trust my p-doc, he's good. I think it is a novel combination though, and he had some reservations, because i increased the nardil very, very slowly. I was on 45mg been on 60 mg. for about 2 weeks, still waiting for it to kick in. Actually, i do feel better, but i still have lethargy, lack of motivation, and anhedonia.
> > Hope that helps.
> > Shrimp
>
>It's all over-hyped I feel. I've used MDMA (ecstasy - no lectures, please. Just giving an example) many times while on Nardil. I can't think of any "legal" substance that raises your seritonin levels more than that. Although, I'll admit I've lowerd my dose of MDMA that I would usually take to recieve desired recreational effect. I would usually take a full dose (one pill) but can now get the same high from 1/4 pill.
I don't suggest doing this yourself, I may just be a particular case. I've even gotten away with eating anything I'd like without hypertension crisis. Although I really do think that there's been un-nessasary scare for those wanting to try MAOIs, or already on them over hypertension and 5HT syndrome.
Posted by SLS on June 18, 2003, at 13:44:05
In reply to Re: maoi plus wellbutrin, posted by Carlos on June 18, 2003, at 12:12:46
> I don't suggest doing this yourself, I may just be a particular case. I've even gotten away with eating anything I'd like without hypertension crisis. Although I really do think that there's been un-nessasary scare for those wanting to try MAOIs, or already on them over hypertension and 5HT syndrome.
Because of my personal experiences with both Parnate and Nardil, I would recommend to anyone taking these drugs to have a healthy respect for the potential for them to induce both hypertensive crises and serotonin syndrome. While taking Parnate 60mg + desipramine 150mg, I experienced the pounding occipital headache associated with a tyramine reaction after accidently eating 1 1/2 slices of thinly-cut pepperoni on a pizza. Cheese pizza without meat toppings has never been a problem for me. I experienced a serotonin syndrome delirium after taking a 37.5mg dose of Effexor that lasted for well over an hour. I experienced a serotonin syndrome dystonia while taking Nardil 60mg + imipramine 300mg. It resolved upon the discontinuation of imipramine.
- Scott
Posted by shrimp on June 18, 2003, at 17:33:49
In reply to Re: maoi plus wellbutrin » shrimp, posted by jemma on June 18, 2003, at 10:33:54
Hi Jenna,
Yes, I am one of those annoying patients who calls my doctor every other day on a side effect. I guess the blurred vision goes along with the hypotension. The twitches have gotten better since i reduced the Wellbutrin, but they are definitely still there, when i have an exciting or happy thought i twitch!! I've learned to laugh at it, but it is bizarre. My pdoc seems to think these side effects are no big deal compared with how depressed i was (suicidal), and i guess he is right, but the depression is not gone yet, it is just a little better. Oh, and i'm also constantly constipated!! I have to take this medicine called colase every single day for that. I feel like a 90 yr. old with all these side effects.
> Have you told your pdoc about the twitches, the blurred vision, and the orthostatic hypotension? The combined action of monoamine oxidase inhibition - which raises levels of dopamine, norepinephrine, and serotonin - and wellbutrin - which inhibits reuptake of dopamine, norepinephrine, and serotonin - does seem to risk potentially dangerous levels of all three, especially serotonin. I think it would be wise to let him know you're having trouble.
>
> - Jemma
>
>
>
>
>
> > Jenna,
> > I didn't know you could combine the two either, but i trust my p-doc, he's good. I think it is a novel combination though, and he had some reservations, because i increased the nardil very, very slowly. I was on 45mg been on 60 mg. for about 2 weeks, still waiting for it to kick in. Actually, i do feel better, but i still have lethargy, lack of motivation, and anhedonia.
> > Hope that helps.
> > Shrimp
>
>
Posted by shrimp on June 18, 2003, at 17:39:51
In reply to Re: maoi plus wellbutrin, posted by SLS on June 18, 2003, at 13:44:05
>
> > I don't suggest doing this yourself, I may just be a particular case. I've even gotten away with eating anything I'd like without hypertension crisis. Although I really do think that there's been un-nessasary scare for those wanting to try MAOIs, or already on them over hypertension and 5HT syndrome.
>
>
> Because of my personal experiences with both Parnate and Nardil, I would recommend to anyone taking these drugs to have a healthy respect for the potential for them to induce both hypertensive crises and serotonin syndrome. While taking Parnate 60mg + desipramine 150mg, I experienced the pounding occipital headache associated with a tyramine reaction after accidently eating 1 1/2 slices of thinly-cut pepperoni on a pizza. Cheese pizza without meat toppings has never been a problem for me. I experienced a serotonin syndrome delirium after taking a 37.5mg dose of Effexor that lasted for well over an hour. I experienced a serotonin syndrome dystonia while taking Nardil 60mg + imipramine 300mg. It resolved upon the discontinuation of imipramine.
>
>
> - Scott
>
> Scott, what is dystonia and delirium, I have had some very, very bizarre feelings and sensations on this combo. They never seem to last, and i can't really describe them, but i might recognize it if i see it described by someone else.
Posted by shrimp on June 18, 2003, at 17:46:06
In reply to Re: nardil fainting wellbutrin, posted by indivmed on June 15, 2003, at 1:41:55
> > Rick,
> > I have taken Parnate, and it made me that tired as well, but at the same time i was shaky. I would crash particularly hard around 4 pm. I've always had the sleepy lethargic depression, so my p-doc kept me on 400mg of W and added the Nardil. I was at 45, last week upped to 60mg.
> > I became very agitated and anxious about a week later, so we have decided to lower the W to 300mg., as i felt like i was twitching uncontrollably and having mini seizures at night, which hopefully will slow down as the W leaves my system. I did try Provigil, didn't do anything. I can say that since i've been on the Nardil for about 5 weeks, the sleepiness has remissed somewhat, and that may be due to the wellbutrin i am taking with it. I had bad hypotension on Parnate, it's bad on the Nardil as well. If i were you, i would try adding a low dose of W to the Parnate, if your p-doc will let you. I was not getting results from anything, zoloft, parnate, paxil, etc. and this combination, after going through about a month of miserable side effects, finally seems to be working, outside of the speedy felling on 300mg. In my experience, dopaminergic agents have been key to clearing up some of my mental fog, so i think that the Wellbutrin is a good addition. Have you tried Nardil? Don't know if you can augment Parnate with it. Also on the Parnate, extreme cold sensitivity, bloating, fainting, insomnia. May i ask how many mg. of W and Parnate are you on, and how long you have been taking them? Then i can give you some more information on what to expect not expect. I am atypical, and you are bipolar, so take that into account when comparing our experiences. If you have any questions, please let me know.
> > Shrimp
> >
> Shrimp--
>
> Thank you so much for the input--I tend to hate the "build-up" to a therapeutic dose and will pretty much get there as quick as possible regardless of the side effects. I started on 30 mg Parnate two weeks ago with no Wellbutrin, then went up to 60 mg Parnate and added 300 mg Wellbutrin. I like the fact that I can sit down and do a lot of work and am very concentrated, but I do have significant anxiety and feel somewhat sketchy at times. Sometimes the speedy feeling can be overwhelming but part of me is like, "just stay with it, side effects will disappear." I thought I was starting to get manic so I decided to go back on my Depakote--was already taking Neurontin--which probably has an effect on the lethargy.
>
> The Parnate (alone) side effects were awful--I would get out of bed just to walk to the couch and go back to sleep. I didn't go to the university (I'm a grad student in chemistry) and do work...just watched TV and napped. I usually did make it to the gym just because it's such an integral part of my day (unlike work :))--but come to think of it, that happens around 6:30 PM so I think the last dose was wearing off (or the blood levels were dropping--I read the half-life is very short)--hence, a little more energetic at 6:30 (my last dose was at 3:00 PM).
>
> My depressions are very lethargic--I lay around and have hypersomnia--and because I miss appointments, don't go to work, miss the gym, I start hating myself and then I want to lay around and sleep more. So I needed to be on something that was slightly stimulating--the problem is that I used to be a substance abuser so I can't really take anything other than Wellbutrin--and it wasn't working as monotherapy.
>
> With the Parnate, I feel that I have more clarity--I feel like I have a better grasp on what is going on in my life, what I need to do, and I am able to sort out the reality of who I am versus the negative/depressive idea of who I am (I hope that made sense). Adding the wellbutrin gave me the motivation to go from thinking it to doing it--they gave each other a significant boost.
>
> Okay, so my problem is that Parnate causes spontaneous hypertension (which is actually NOT exacerbated by the Wellbutrin) and I'm thinking it is just because I went to 60 mg/day so fast...I'm thinking it will go back down after a few weeks or so. I may be wrong...high BP is an issue in my family. Do you know of anyone that takes BP medication with Parnate?
>
> So that is my experience so far--two weeks on Parnate, with the 2nd week augmenting with Wellbutrin. It's a huge jolt to the system but taking the Depakote takes some of the edge off (which I should be taking anyway since I'm bipolar and am on the Parnate and Wellbutrin) and the Neurontin helps with anxiety also, but I will have to drop that as my insurance won't kick in for a while and I have no money.
>
> Any suggestions on any of this? I'm pretty bad at rambling after drinking Red Bull!
>
> Thanks!
> Rick
>
Rick, how are you doing on the Parnate? I am finally starting to improve on the nardil, which i started (30mg) in late April, so try to hang in there. I'm not okay yet my any means, and i am dealing with all kinds of bizarre side effects, but there has been improvement. My weakness has pretty much gone away, so don't worry about that. I would forget exercising until the weakness fades, it just made me feel like s**t. Did you find a new doctor yet? Let me know how it goes.
>
>
>
>
>
Posted by SLS on June 18, 2003, at 18:32:46
In reply to Re: maoi plus wellbutrin » SLS, posted by shrimp on June 18, 2003, at 17:39:51
> > Scott, what is dystonia and delirium, I have had some very, very bizarre feelings and sensations on this combo. They never seem to last, and i can't really describe them, but i might recognize it if i see it described by someone else.
When I added Effexor to Parnate, I was disoriented and didn't know where I was (delirium). This occurred within 15 or 20 minutes of taking a small dose. I couldn't get myself up and out of bed. I babbled nonsense for at least a half hour. It was like being very, very drunk. With the addition of Nardil to imipramine, the muscles of my torso became very stiff and achy (dystonia). My biceps were in a constant state of contracture. I became very dizzy, and needed to crawl on the floor to get around my apartment or else I would faint.
Not that you should rely on one person's reported experiences with drug treatment, but the combination of Parnate + Wellbutrin gave me no problems. However, I don't think Nardil is as forgiving when it comes to side effects or interactions with other drugs.
- Scott
Posted by SLS on June 18, 2003, at 19:15:11
In reply to Re: maoi plus wellbutrin » SLS, posted by shrimp on June 18, 2003, at 17:39:51
Here's an abstract that was sent to me by a friend:
------------------------------------
Bupropion-Tranylcypromine Combination for Treatment-Refractory DepressionSir: We report the safe and successful use of combined bupropion and tranylcypromine in a case of treatment-refractory depression.
Case report. Ms. A, a 27-year-old woman with chronic major depression (DSM-III-R criteria), was treated in 1990 at age 17 with imipramine up to 150 mg/day. In March 1994, after a suicide attempt by imipramine overdose, paroxetine, 20 mg/day, replaced imipramine. On paroxetine, 30 mg/day, and amitriptyline, 50 mg q.h.s., she experienced only mild improvement at 6 months. By 1995, Ms. A was taking paroxetine, 30 mg/day; nortriptyline, 35 mg/day; and temazepam, 15 mg q.h.s. (with a plasma nortriptyline level of 71 ng/mL). Despite the addition of brief trials of methylphenidate, 5 mg b.i.d., her mood remained depressed.
In August 1995, bupropion was initiated with the gradual withdrawal of nortriptyline and paroxetine. Trazodone, 25 mg q.h.s., replaced temazepam. By October 1995, Ms. A was taking bupropion, 150 mg b.i.d.; trazodone, 100 mg q.h.s.; and lorazepam, 0.5 mg t.i.d., with only a partial response. A trial of adjunctive liothyronine (T3), 25-75 microg/day, failed to yield sustained improvement, and her dysphoria, fatigue, and insomnia instead worsened. Tranylcypromine was added and upon titration to 50 mg/day, Ms. A reported a gradual return to euthymia with resolution of her long-standing depressive symptoms.
Bupropion was tapered and discontinued in March 1996, but within 2 weeks, Ms. A noted a return of depressive symptoms. Bupropion was therefore restarted with good results. On one occasion, Ms. A developed symptomatic hypertension after eating cheese, but it was managed with nifedipine at home. Other than this episode, she was normotensive at all checkups. By the summer of 1996, T3, trazodone, and lorazepam were withdrawn. She remained on a regimen of tranylcypromine, 60 mg/day (40 mg in the morning and 20 mg at noon), and bupropion sustained release (SR), 150 mg b.i.d., with sustained euthymia. Transient and mild periods of stress-related dysphoria or insomnia were manageable with low-dose lorazepam. In November 1997, tranylcypromine was withdrawn in order for Ms. A to undergo a surgical procedure. During the 2 weeks off tranylcypromine treatment, she experienced an acute worsening of mood symptoms that quickly resolved with its reintroduction. Two years later, she remains on tranylcypromine, 60 mg/day, and bupropion SR, 150 mg b.i.d., without relapse of depression. She continues to keep nifedipine in the event of a hypertensive crisis, but aside from her 1 episode associated with ingestion of cheese 3 years ago, she has had no further blood pressure elevations over the course of her treatment.
Ms. A's case is remarkable for chronic depression unresponsive to treatment with a selective serotonin reuptake inhibitor and tricyclic antidepressants, as well as adjunctive methylphenidate and T3. The addition of tranylcypromine to bupropion finally resulted in a sustained remission of her depression. Depressive symptoms returned whenever either antidepressant was withdrawn over the course of treatment, thereby emphasizing the apparent necessity of both antidepressants for treatment response. Ms. A's poor response to multiple antidepressant trials, including both a tricyclic and tranylcypromine alone, classifies her depression at Stage IV resistance as defined by Thase and Rush.1 The treatment of choice for Stage IV resistant depression is electroconvulsive therapy (ECT). 1 ECT was not administered to Ms. A, owing to her desire to continue employment and outpatient management of her depression.
While no controlled double-blind studies support the use of combination antidepressant therapy in treatment-resistant depression,2 this practice is supported by anecdotal evidence and general clinical opinion. Ms. A's case adds to this body of evidence and suggests that combination antidepressant therapy deserves greater study in refractory depression. Although the combination of bupropion and a monoamine oxidase inhibitor is not usually recommended due to the risk of hypertensive crisis,3 the cautious administration of tranylcypromine and bupropion together may be a safe and effective strategy in some cases of treatment-resistant depression.
References
1. Thase ME, Rush AJ. When at first you don't succeed: sequential strategies for antidepressant nonresponders. J Clin Psychiatry 1997;58(suppl 13):23-29
2. Nelson JC. Overcoming treatment resistance in depression. J Clin Psychiatry 1998;59(suppl 16):13-19
3. Kaplan HI, Sadock BJ, eds. Comprehensive Textbook of Psychiatry. 6th ed. Baltimore, Md: Lippincott, Williams & Wilkins; 1995
Joseph M. Pierre, M.D.
Michael J. Gitlin, M.D.
UCLA Neuropsychiatric Institute
Los Angeles, California
Posted by indivmed on June 18, 2003, at 20:01:20
In reply to Re: nardil fainting wellbutrin » indivmed, posted by shrimp on June 18, 2003, at 17:46:06
> Rick, how are you doing on the Parnate? I am finally starting to improve on the nardil, which i started (30mg) in late April, so try to hang in there. I'm not okay yet my any means, and i am dealing with all kinds of bizarre side effects, but there has been improvement. My weakness has pretty much gone away, so don't worry about that. I would forget exercising until the weakness fades, it just made me feel like s**t. Did you find a new doctor yet? Let me know how it goes.
>
>
Actually, I'm not doing so well on the Parnate anymore...I'm going to ask to switch over to Nardil tomorrow--it was awesome for a week, but the past couple of days I have wanted to isolate, not get out of bed, argue with my friend and parents (well, that's not THAT new), etc. Didn't you say you used to take Parnate? What are the differences that you can tell so far between taking the Parnate and then the Nardil? Have you ever added Provigil instead of Wellbutrin or a dopamine agonist (I'm totally new to these dopamine agnoists)? Please keep me posted...and thank you for your help so far...you've been awesome shrimp!Rick
Posted by SLS on June 19, 2003, at 8:01:57
In reply to Re: nardil fainting wellbutrin, posted by indivmed on June 18, 2003, at 20:01:20
> Actually, I'm not doing so well on the Parnate anymore...I'm going to ask to switch over to Nardil tomorrow--it was awesome for a week, but the past couple of days I have wanted to isolate, not get out of bed, argue with my friend and parents (well, that's not THAT new), etc.
Hi Rick.How long have you been taking Parnate? What dosage are you at and how long have you been there?
I would not dare to give you any guarantees, but the ascent from depression is often not a steady climb. For many people, the improvement over time includes some setbacks or "retreats". One of my doctors called it a sort of brain "reset". Robert Post, M.D. of the NIMH describes this course of remission as a saw-tooth pattern. Each improvement tends to reach a higher point than the one previous. Likewise, the following retreat is less low. Even over the long-haul, some people experience brief dips. It is scary as hell, but it might be worth riding this one out to see if you follow this pattern. It would be a shame to overlook an effective treatment. Nardil will always be there.
Get well.
- Scott
Posted by indivmed on June 19, 2003, at 23:28:00
In reply to Re: nardil fainting wellbutrin » indivmed, posted by SLS on June 19, 2003, at 8:01:57
> > Actually, I'm not doing so well on the Parnate anymore...I'm going to ask to switch over to Nardil tomorrow--it was awesome for a week, but the past couple of days I have wanted to isolate, not get out of bed, argue with my friend and parents (well, that's not THAT new), etc.
>
>
> Hi Rick.
>
> How long have you been taking Parnate? What dosage are you at and how long have you been there?
>
> I would not dare to give you any guarantees, but the ascent from depression is often not a steady climb. For many people, the improvement over time includes some setbacks or "retreats". One of my doctors called it a sort of brain "reset". Robert Post, M.D. of the NIMH describes this course of remission as a saw-tooth pattern. Each improvement tends to reach a higher point than the one previous. Likewise, the following retreat is less low. Even over the long-haul, some people experience brief dips. It is scary as hell, but it might be worth riding this one out to see if you follow this pattern. It would be a shame to overlook an effective treatment. Nardil will always be there.
>
> Get well.
>
>
> - Scott
>Thank you very much Scott--I have had an AWFUL day today. I ran out of meds and can't afford to get them until tomorrow. I didn't realize how accustomed I was to already taking the Parnate daily.
I'm on week three of taking the parnate and it was just odd to be doing REALLY well that first week and then it all kind of spiraled back down into depression--I'm probably just really bitter and hypervigilant about seeing these things--my brain is notorious for things working in the beginning and then me taking a major turn for the worse (usually with subsequent hospitalization). I think it is that expectation, the subsequent let-down that make people believe that there is indeed no hope. But like my friends have always said, I am a fighter and am not going to let this beat me.
I saw my pdoc today and he suggested I take Parnate (60 mg/day)--which I'm taking now, STOP the Wellbutrin (it might be making me irritable and anxious, and to add Provigil (400 mg) and Mirapex (3 mg) to counteract some of the more heinous Parnate side effects. Being the saint that he is, he also gave me a few Xanax to get through those moments when I'm completely distraught and am in pure panic mode. I'm assuming these will dissipate as the other meds kick in.
Does anyone have any info on this combo? From other listings, this is not that normal and I'm going to have to be monitored quite closely.
I will say that your theory concerning the recovering from depression is what I needed to hear...I'm just so deathly afraid of visiting "that place." It is just so incredibly intense and awful
Finally, this is somewhat off the subject, but my first depressive episode was in college and it was SO intense, that the thoughts of EVER experiencing that pain, despondence, or morbidity ever again, scares the hell out of me. It's almost like I have PTSD concerning this first episode and it has played itself out over and over because it's my worst fear being realized on a continual (bi annual basis).
Any thoughts? Again, Thank you Scott!
RickMost importantly:
1) When have you seen Parnate used (what types of depression?
2) When have you seen Mirapex used and at what dosages (after initial nausa)
3) Is Provigil and issue to use with the Parnate since it really doesn't affect any of the main three neuros?
Posted by shrimp on June 20, 2003, at 18:35:21
In reply to Re: nardil fainting wellbutrin, posted by indivmed on June 18, 2003, at 20:01:20
> > Rick, how are you doing on the Parnate? I am finally starting to improve on the nardil, which i started (30mg) in late April, so try to hang in there. I'm not okay yet my any means, and i am dealing with all kinds of bizarre side effects, but there has been improvement. My weakness has pretty much gone away, so don't worry about that. I would forget exercising until the weakness fades, it just made me feel like s**t. Did you find a new doctor yet? Let me know how it goes.
> >
> >
> Actually, I'm not doing so well on the Parnate anymore...I'm going to ask to switch over to Nardil tomorrow--it was awesome for a week, but the past couple of days I have wanted to isolate, not get out of bed, argue with my friend and parents (well, that's not THAT new), etc. Didn't you say you used to take Parnate? What are the differences that you can tell so far between taking the Parnate and then the Nardil? Have you ever added Provigil instead of Wellbutrin or a dopamine agonist (I'm totally new to these dopamine agnoists)? Please keep me posted...and thank you for your help so far...you've been awesome shrimp!
>
> Rick
>
Rick, how long have you given the parnate to work? you should give it at least a month. The nardil gave me horrible side effects at first, but it finally started working. it didn't hit me on one day, it was gradual. Side effects are orthostatic hypotension, extreme sleepiness around 4 pm. but that has subsided, really weak, tired muscles, but that also went away. I felt like i had the flu for a week, and horribly deppresed, i definitely got worse before i got better. so many times i wanted to drop it but my doc said to stick it out and i'm glad i did. did make me extrememly sensitive to the cold, so the side effects are the same as the parnate, maybe a bit worse, but they do go away. You may need a higher dose of parnate. I was eventually at 90, and it wasn't working, so i stopped. I've taken Provigil with zoloft, didn't really notice much. Did you find a good doctor? You need one with the nardil, because there are olny certain things you can augment with, but some docs don't even know that you can take anything with it. Overall, the nardil makes me feel somewhat normal,my depression always got much worse as the day went on, i literally could not read a book at night, and now i can. It feels more level and steady than the parnate, i would recommend it, but remember i am also on 300mg.Wellbutrin. I would also take a good 2 weeks off of anything while dealing with side effects, just know that they will pass while you are having them. My doc said that these meds can take up to 6 weeks to reach full effect, and most depressed people don't have that kind of patience. So let me know how it goes when you start the nardil. My doc increased mine very slowly, since i am so sensitive to side effects. hope this helps let me know how it goes.> Wait, you've only been on the Parnate for a week??? You need to give it more time.
>
Posted by shrimp on June 20, 2003, at 18:51:03
In reply to Re: stayed at parnate, added Mirapex/Provigil » SLS, posted by indivmed on June 19, 2003, at 23:28:00
> > > Actually, I'm not doing so well on the Parnate anymore...I'm going to ask to switch over to Nardil tomorrow--it was awesome for a week, but the past couple of days I have wanted to isolate, not get out of bed, argue with my friend and parents (well, that's not THAT new), etc.
> >
> >
> > Hi Rick.
> >
> > How long have you been taking Parnate? What dosage are you at and how long have you been there?
> >
> > I would not dare to give you any guarantees, but the ascent from depression is often not a steady climb. For many people, the improvement over time includes some setbacks or "retreats". One of my doctors called it a sort of brain "reset". Robert Post, M.D. of the NIMH describes this course of remission as a saw-tooth pattern. Each improvement tends to reach a higher point than the one previous. Likewise, the following retreat is less low. Even over the long-haul, some people experience brief dips. It is scary as hell, but it might be worth riding this one out to see if you follow this pattern. It would be a shame to overlook an effective treatment. Nardil will always be there.
> >
> > Get well.
> >
> >
> > - Scott
> >
>
> Thank you very much Scott--I have had an AWFUL day today. I ran out of meds and can't afford to get them until tomorrow. I didn't realize how accustomed I was to already taking the Parnate daily.
>
> I'm on week three of taking the parnate and it was just odd to be doing REALLY well that first week and then it all kind of spiraled back down into depression--I'm probably just really bitter and hypervigilant about seeing these things--my brain is notorious for things working in the beginning and then me taking a major turn for the worse (usually with subsequent hospitalization). I think it is that expectation, the subsequent let-down that make people believe that there is indeed no hope. But like my friends have always said, I am a fighter and am not going to let this beat me.
>
> I saw my pdoc today and he suggested I take Parnate (60 mg/day)--which I'm taking now, STOP the Wellbutrin (it might be making me irritable and anxious, and to add Provigil (400 mg) and Mirapex (3 mg) to counteract some of the more heinous Parnate side effects. Being the saint that he is, he also gave me a few Xanax to get through those moments when I'm completely distraught and am in pure panic mode. I'm assuming these will dissipate as the other meds kick in.
>
> Does anyone have any info on this combo? From other listings, this is not that normal and I'm going to have to be monitored quite closely.
>
> I will say that your theory concerning the recovering from depression is what I needed to hear...I'm just so deathly afraid of visiting "that place." It is just so incredibly intense and awful
>
> Finally, this is somewhat off the subject, but my first depressive episode was in college and it was SO intense, that the thoughts of EVER experiencing that pain, despondence, or morbidity ever again, scares the hell out of me. It's almost like I have PTSD concerning this first episode and it has played itself out over and over because it's my worst fear being realized on a continual (bi annual basis).
>
> Any thoughts? Again, Thank you Scott!
> Rick
>
> Most importantly:
>
> 1) When have you seen Parnate used (what types of depression?
> 2) When have you seen Mirapex used and at what dosages (after initial nausa)
> 3) Is Provigil and issue to use with the Parnate since it really doesn't affect any of the main three neuros?Rick, Scott explained it better than i did, i felt amazing on Parnate for a few days, but like he said it is a gradual process, which i myself need to remember, because i had a bad day yesterday and started totally panicking because i thought that i was going to have to start a new med, and of course that none could really work, and i would be some zombie imcompetent depressive forever. I'm also really impulsive, and like a true depressive, i only see negative horrible repurcussions, i didn't even consider that it was part of the getting better process. Thanks Scott, that will be helpful when i have some bad days.I think the W with the P could be too much, the P is more activating than N. I'm am not familiar with Mirapex, and all i know about Provigil is that it is a stimulant, i don't believe with any addictive properties, that is used to treat narcolepsy. so i am assuming you have a new doctor.
Do you like her? Are you comfortable with her? Do you trust her? Wait, now i'm confused, if each hich is higher than the previous high, why do most people feel so euphoric for a few days, or even a week at the beginning of therapy? That has always happened to me, with every med, and it happened to you with the parnate. Does that mean your next parnate high will be even better?
Posted by indivmed on June 24, 2003, at 0:29:17
In reply to Re: maoi plus wellbutrin » shrimp, posted by SLS on June 18, 2003, at 18:32:46
Hey Guys--Okay, the Parnate seems to be less tiring that originally three weeks ago (I'm at 60 mg/day and might jump to 90 mg/day in two weeks or so). Of course, it could not be as tiring since I still take a small dose of Wellbutrin (I figure I would soon drop the dose of W.B. since I was working with someting that was a more potent dopamine agonist--Mirapex--not to mention that Provigil is potent in it's own ways. I take a Klonopin at night because I have always had severe nighttime anxiety (starting around 8 pm and going til the morning).
Does anyone know of people on this combination? Or parts of it? It must not be THAT crazy because my pdoc was fine with it and my vitals are fine...no real major side effects except some fatigue after my Mirapex dose--does the Mirapex (like the Parnate) become more stimulating over time?????
Right now, Mirapex puts my ass OUT!!! But I think it is helping my mood--I might start taking the full dose at night...do you have to take it in divided doses? What is the half-life...does it become more stimulating over time (such as Wellbutrin)? Provigil helps immensely to wake me up and get me motivated to start the day--I haven't gotten up this early in YEARS! I walked the dog in the park at 8:30 AM, did some research at the univ., got some sun, trained for a biathlon, made plans to be social with others, etc...this has NOT been me lately!!!!!!!!!!1
What I would like to do is stay on Parnate, Provigil, and Mirapex...wean off the Klonopin (which is temporary anyway). But if I continue to feel the lethargy I get from the Parnate and Mirapex (well, probably just the Mirapex now), I'm going to have to continue to augment with Wellbutrin.
Any doctors or psychopharmacologists (or pyshicatric laymen out there that see any overt major problems with this (other than a pretty large amount of dopamine that is not beng metabolized...then again, maybe that's been the problem the whole time!) I feel awkward having these meds approved to take so if you post, please me as constructive as possible--destructive criticism is something I'm not very good at handling (sorry, I'm sure most of you know what I mean).
PLEASE HELP AS I HAVE ASKED FOR INFORMATION ON THIS IN AT LEAST 28,000 DIFFERENT POSTS AND NO ONE ANSWERS AND I FEEL LIKE AN IDIOT, OR STUPID, OR THAT NO ONE LIKES ME (Hey, I never said I wasn't somewhat depressed still!).Hope everyone is well,
Rick
Posted by Questionmark on June 24, 2003, at 1:39:48
In reply to PLEASE HELP ME...NEED MAOI/Mirapex suggestions, posted by indivmed on June 24, 2003, at 0:29:17
>
> Hey Guys--
>
> Okay, the Parnate seems to be less tiring that originally three weeks ago (I'm at 60 mg/day and might jump to 90 mg/day in two weeks or so). Of course, it could not be as tiring since I still take a small dose of Wellbutrin (I figure I would soon drop the dose of W.B. since I was working with someting that was a more potent dopamine agonist--Mirapex--not to mention that Provigil is potent in it's own ways. I take a Klonopin at night because I have always had severe nighttime anxiety (starting around 8 pm and going til the morning).
>
> Does anyone know of people on this combination? Or parts of it? It must not be THAT crazy because my pdoc was fine with it and my vitals are fine...no real major side effects except some fatigue after my Mirapex dose--does the Mirapex (like the Parnate) become more stimulating over time?????
>
> Right now, Mirapex puts my ass OUT!!! But I think it is helping my mood--I might start taking the full dose at night...do you have to take it in divided doses? What is the half-life...does it become more stimulating over time (such as Wellbutrin)? Provigil helps immensely to wake me up and get me motivated to start the day--I haven't gotten up this early in YEARS! I walked the dog in the park at 8:30 AM, did some research at the univ., got some sun, trained for a biathlon, made plans to be social with others, etc...this has NOT been me lately!!!!!!!!!!1
>
> What I would like to do is stay on Parnate, Provigil, and Mirapex...wean off the Klonopin (which is temporary anyway). But if I continue to feel the lethargy I get from the Parnate and Mirapex (well, probably just the Mirapex now), I'm going to have to continue to augment with Wellbutrin.
>
> Any doctors or psychopharmacologists (or pyshicatric laymen out there that see any overt major problems with this (other than a pretty large amount of dopamine that is not beng metabolized...then again, maybe that's been the problem the whole time!) I feel awkward having these meds approved to take so if you post, please me as constructive as possible--destructive criticism is something I'm not very good at handling (sorry, I'm sure most of you know what I mean).
>
> PLEASE HELP AS I HAVE ASKED FOR INFORMATION ON THIS IN AT LEAST 28,000 DIFFERENT POSTS AND NO ONE ANSWERS AND I FEEL LIKE AN IDIOT, OR STUPID, OR THAT NO ONE LIKES ME (Hey, I never said I wasn't somewhat depressed still!).
>
> Hope everyone is well,
> Rick
Sorry i havent commented earlier. i don't really know what to tell you.
But mAN are you getting a heck of a lot of dopamine stimulation, and general CNS stimulation. It's weird that your bothersome side effect is still fatigue and not horrendous anxiety. It's possible that since you raised your Parnate dose so fast you are still getting fatigue from that-- but if so i'm pretty sure that subsides with time. i have also heard of Mirapex being fatiguing at first as well (but only temporarily), though i am not sure. So that should get better with time also.
i know you like to increase your med dose really fast, but i would really suggest trying not to do that. Your brain (& body) needs time to adjust to the drug, and too much too fast is much more likely to cause problems i believe. It might even be not-quite-good for your brain. It's sensitive as heck. But i can understand wanting stuff to kick in faster and not wanting to wait what seems like eternities. But even in the long run (and certainly in the short-- dealing w/ side effects & what not) i think it's more counterproductive. i wish i could give you more specific advice, but i don't identify with your brain (or whatever)-- on 60mg Parnate PLUS Wellbutrin would be wayy too much for me, let alone the added Mirapex AND Provigil. Damn.
i might drop the Well. altogether-- it's too unpredictable and complex, at least for me.
Okay, well i hope you feel better for a lifetime. Take care and be kind.
Posted by shrimp on June 24, 2003, at 16:39:09
In reply to Re: » indivmed, posted by Questionmark on June 24, 2003, at 1:39:48
Rick,
I know how hard it is to be patient, but i have taken Parnate, and am now on Nardil, as you know, w/ Wellbutrin. Wellbutrin made me super anxious at first, so i lowered it with no problems. I agree with indvd, you need to give it time. My side effects from Nardil didn't remiss for 6 weeks. I do have to question why your doctor has you on so many meds at once. How can she tell which one is doing what? It sounds like it certainly has confused you, which is probably making you more anxious. I need dopamine!!How come nobody has ever told me about Mirapex? If you do have insomnia, mine was bad on the Parnate, try trazadone. I have been taking it on and off for years when i can't sleep, and it doesn't give me a hangover, it's safe and effective, no crazy dreams, nice benevolent sleep aid with no bizarre dreams or side effects. I don't know much about Klonopin, but ask your doc about the trazadone. Provigil didn't do much for me. I had the Parnate fatigue, and i had it with Nardil, i was falling asleep at my desk, literally, 2 weeks ago, and that side effect has disappeared. I hope that helps, still, try and hang in there, the side effects will get better, and then you'll be able to see what the Parnate is really doing. I personally think going up to 90 mg. of Parnate right now is drastic, and your side effects will be worse. However, now i'm thinking of starting the Provigil, i never want to get out of bed. You have to remember that you are getting better, it's so hard to remember that because it is never faster, and depressed people can never see anything good, but the fact that you can get out of bed and do things in the morning is huge. I've been trying to get that for years. And it does take time for your brain to adjust, i would give it more time, i know how hard it is, i had to do the same thing. Do you have a supportive pdoc? You had lots of questions about mirapex that she should have answered, or should answer if you call her. That's her job. Okay so keep me updated, i'm glad you are feeling better, even if marginally. sometimes it's not some huge wake up call, it's more gradual.
Hang in there!!! Shrimp> >
> > Hey Guys--
> >
> > Okay, the Parnate seems to be less tiring that originally three weeks ago (I'm at 60 mg/day and might jump to 90 mg/day in two weeks or so). Of course, it could not be as tiring since I still take a small dose of Wellbutrin (I figure I would soon drop the dose of W.B. since I was working with someting that was a more potent dopamine agonist--Mirapex--not to mention that Provigil is potent in it's own ways. I take a Klonopin at night because I have always had severe nighttime anxiety (starting around 8 pm and going til the morning).
> >
> > Does anyone know of people on this combination? Or parts of it? It must not be THAT crazy because my pdoc was fine with it and my vitals are fine...no real major side effects except some fatigue after my Mirapex dose--does the Mirapex (like the Parnate) become more stimulating over time?????
> >
> > Right now, Mirapex puts my ass OUT!!! But I think it is helping my mood--I might start taking the full dose at night...do you have to take it in divided doses? What is the half-life...does it become more stimulating over time (such as Wellbutrin)? Provigil helps immensely to wake me up and get me motivated to start the day--I haven't gotten up this early in YEARS! I walked the dog in the park at 8:30 AM, did some research at the univ., got some sun, trained for a biathlon, made plans to be social with others, etc...this has NOT been me lately!!!!!!!!!!1
> >
> > What I would like to do is stay on Parnate, Provigil, and Mirapex...wean off the Klonopin (which is temporary anyway). But if I continue to feel the lethargy I get from the Parnate and Mirapex (well, probably just the Mirapex now), I'm going to have to continue to augment with Wellbutrin.
> >
> > Any doctors or psychopharmacologists (or pyshicatric laymen out there that see any overt major problems with this (other than a pretty large amount of dopamine that is not beng metabolized...then again, maybe that's been the problem the whole time!) I feel awkward having these meds approved to take so if you post, please me as constructive as possible--destructive criticism is something I'm not very good at handling (sorry, I'm sure most of you know what I mean).
> >
> > PLEASE HELP AS I HAVE ASKED FOR INFORMATION ON THIS IN AT LEAST 28,000 DIFFERENT POSTS AND NO ONE ANSWERS AND I FEEL LIKE AN IDIOT, OR STUPID, OR THAT NO ONE LIKES ME (Hey, I never said I wasn't somewhat depressed still!).
> >
> > Hope everyone is well,
> > Rick
>
>
> Sorry i havent commented earlier. i don't really know what to tell you.
> But mAN are you getting a heck of a lot of dopamine stimulation, and general CNS stimulation. It's weird that your bothersome side effect is still fatigue and not horrendous anxiety. It's possible that since you raised your Parnate dose so fast you are still getting fatigue from that-- but if so i'm pretty sure that subsides with time. i have also heard of Mirapex being fatiguing at first as well (but only temporarily), though i am not sure. So that should get better with time also.
> i know you like to increase your med dose really fast, but i would really suggest trying not to do that. Your brain (& body) needs time to adjust to the drug, and too much too fast is much more likely to cause problems i believe. It might even be not-quite-good for your brain. It's sensitive as heck. But i can understand wanting stuff to kick in faster and not wanting to wait what seems like eternities. But even in the long run (and certainly in the short-- dealing w/ side effects & what not) i think it's more counterproductive. i wish i could give you more specific advice, but i don't identify with your brain (or whatever)-- on 60mg Parnate PLUS Wellbutrin would be wayy too much for me, let alone the added Mirapex AND Provigil. Damn.
> i might drop the Well. altogether-- it's too unpredictable and complex, at least for me.
> Okay, well i hope you feel better for a lifetime. Take care and be kind.
Posted by indivmed on June 24, 2003, at 21:52:29
In reply to Re: » Questionmark, posted by shrimp on June 24, 2003, at 16:39:09
Hey Guys--Thank you so far for the posts--they have helped immensely. I have cut out Wellbutrin entirely as it is pointless (and has other pharmacoaction) and will keep the Parnate at 60 mg /day for a while. The Mirapex does give me horrible headaches and tends to make me really nauseous, and makes me tired but not able to sleep. My pdoc added 1 mg Klonopin (which will work *somewhat* as a mood stabilizer--I'm so far from mood stabilizers right now it isan't even funny--but will help me sleep). I took it years ago and it helped. It is unreal how well the Provigil is working. I was able to work all day today for the first time in years.
I'm in the process of working on my PhD and that is why it is absolutely crucial that I NOT slip/get depressed anymore--I did while in undergrad and it almost cost me my future (it did to a degree). Because I want to be a professor/lecturer, I can't let this rule my life like it has for years now. And I've been on so many freakin' meds that haven't worked that my pdoc has decided to be quite aggressive with me...which is fine...i told him just to get me to a point where I can study, start training for triathlons again, and make plans with friends and KEEP them. I just want my life back.
So if you readers are getting a major sense of urgency and desperation out of my posts, that is probably why. Honestly, if these meds don't work, I'm pretty much out of options. Again, thank you for your input...once again, some science/facts/research on these meds would be awesome!
Posted by shrimp on June 25, 2003, at 0:12:46
In reply to Re:, posted by indivmed on June 24, 2003, at 21:52:29
Posted by indivmed on June 25, 2003, at 2:27:25
In reply to Re: shrimp to rick (nm) » indivmed, posted by shrimp on June 25, 2003, at 0:12:46
What does (nm) mean? Does it mean anything or am I being all paranoid? Actually, I'm sad because I was looking forward to reading something that you posted.Have a good night,
Rick
Posted by shrimp on June 25, 2003, at 10:01:22
In reply to Re: shrimp to rick, posted by indivmed on June 25, 2003, at 2:27:25
Posted by jch on October 14, 2011, at 14:15:40
In reply to Re: maoi plus wellbutrin, posted by Carlos on June 18, 2003, at 12:12:46
I have been taking 45-60 mgs of Nardil plus a low dose of various stimulants for over 12 years. First 9 years mostly good, then anhedony and leaden legs. Spent last three years in bed, watching TV.
Added Aplenzin, 172mgs week one, 358mgs thereafter. Life is improving daily w/ few minor side effects.
Will report if anything changes.
Posted by SLS on October 14, 2011, at 19:23:41
In reply to Re: maoi plus wellbutrin, posted by jch on October 14, 2011, at 14:15:40
> I have been taking 45-60 mgs of Nardil plus a low dose of various stimulants for over 12 years. First 9 years mostly good, then anhedony and leaden legs. Spent last three years in bed, watching TV.
>
> Added Aplenzin, 172mgs week one, 358mgs thereafter. Life is improving daily w/ few minor side effects.
>
> Will report if anything changes.
Thanks.I hope you continue to improve. If you get "stuck", you might try increasing the dosage of Nardil to 75-90mg. One guideline often followed is to administer 1 mg of Nardil per 1 kg of body weight. If you weigh 165 pounds or greater, you should probably be taking 75mg.
Good luck.
- Scott
Posted by jch on October 15, 2011, at 10:28:00
In reply to Re: maoi plus wellbutrin » jch, posted by SLS on October 14, 2011, at 19:23:41
Thanks, but I am 5'8" and weigh 130-35 lbs. If I run into trouble I'll go up and just squat wherever I am when I feel a faint coming on. F.Y.I. I have tried higher doses in the past three years, my legs wouldn't hold me up for more than a few minutes. Really not good.
Posted by SLS on October 15, 2011, at 12:36:12
In reply to Re: maoi plus wellbutrin, posted by jch on October 15, 2011, at 10:28:00
> Thanks, but I am 5'8" and weigh 130-35 lbs. If I run into trouble I'll go up and just squat wherever I am when I feel a faint coming on. F.Y.I. I have tried higher doses in the past three years, my legs wouldn't hold me up for more than a few minutes. Really not good.
I guess the obvious question is whether or not you have tried Parnate. If leg weakness is due to hypotension, perhaps using Florinef would help. If leg weakness is a more direct effect of the drug, I doubt you will be able to do much about it. My legs get very weak on Nardil, even in the absence of hypotension. I don't know, perhaps a stimulant would help.
- Scott
Posted by jch on October 15, 2011, at 14:21:17
In reply to Re: maoi plus wellbutrin » jch, posted by SLS on October 15, 2011, at 12:36:12
When I took Parnate I had bouts of limbs shaking uncontrollable. I would sit on the floor and it would pass, Id get up,go 4/5 more steps and be hit with another bout. One time I fell off the toilet.
Stayed on it for five days, thinking it might pass, but it only got worse.I've had fainting episodes during the day in the grocery. If I squat down and hold onto something, it passes in a minute or two, and I'm fine. It was scary at the beginning, when I had no idea of what was happening and didn't know to get something to hold onto. I would end up falling face first. Not a lot of fun; I had never fainted before in my life. I only faint when I go up to 60, but w/ the Aplenzin it might be different.
If this combination poops out at least I have room to increase both drugs. Now I'm happy and if I have problems in the future, I'll deal with them then.
I don't know the other medication, I'll check it out.
This is the end of the thread.
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