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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by SLS on January 7, 2005, at 11:16:53
My doctor's only experience with giving a patient more than 100mg resulted in the patient complaining of a strange headache in the middle of his head. Because of this, he is reluctant to return to the high-dosage strategy with me.
I would like to see a list of people who have taken Parnate at high dosages and know what side-effects showed up. Has anyone experienced this headache? I had once been up to 150mg and never experienced this.
Thanks all for your participation.
- Scott
Posted by Dan Perkins on January 7, 2005, at 11:32:03
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
Have a look at this journal abstract about high dose Parnate treatment:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2710808&dopt=Abstract
High dose tranylcypromine therapy for refractory depression.Amsterdam JD, Berwish NJ.
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
Posted by EERRIICC on January 7, 2005, at 15:05:17
In reply to Re: How many people have taken Parnate 100mg + ?, posted by Dan Perkins on January 7, 2005, at 11:32:03
I took 150mg a day (50mg 3x per day) for two years. I had no side effects, except blood pressure problems at the start.
Scott, do you have any idea how to stop Parnate from pooping out? It is the only thing that has worked well for me. Do you think that taking a "day-off" every three days would be a good strategy?
Do you know anything about NMDA antagonists, like Memantine, preventing stimulant poop out? Maybe they could prevent Parnate poop out?
I hope you find something that helps you soon, I'm sorry you've had to go through so much pain.
Eric
Posted by ace on January 7, 2005, at 20:24:55
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
> My doctor's only experience with giving a patient more than 100mg resulted in the patient complaining of a strange headache in the middle of his head. Because of this, he is reluctant to return to the high-dosage strategy with me.
>
> I would like to see a list of people who have taken Parnate at high dosages and know what side-effects showed up. Has anyone experienced this headache? I had once been up to 150mg and never experienced this.
>
> Thanks all for your participation.
>
>
> - ScottScott,
On the whole, how did Parnate work for you?What are you on these days??
Take Care friend,
Ace (Andrew)
Posted by Maxime on January 7, 2005, at 20:37:27
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
Yes, I have. At about 130 mg. But it didn't stay forever and after that I was okay. Just like any other side effect when you increase a dosage it does go away (usually)
Max
Posted by SLS on January 8, 2005, at 17:50:45
In reply to Re: How many people have taken Parnate 100mg + ?, posted by EERRIICC on January 7, 2005, at 15:05:17
Hi Eric.
> Scott, do you have any idea how to stop Parnate from pooping out?
:-)
If I did, I wouldn't be here...
Because of my good experience with it, I would consider adding a TCA to the Parnate, either desipramine or nortripyline.
> It is the only thing that has worked well for me.The only thing that EVER worked well for me was a combination of Parnate + desipramine. Unfortunately, I no longer respond to it. The doctor at the time elected to discontinue the combination when I became manic, and refused to go back to it when I relapsed into depression. Thereafter, it was of little use.
> Do you think that taking a "day-off" every three days would be a good strategy?
No. The MAO inhibition of Parnate does not drop off so quickly as one would see with the stimulant effect of amphetamine. You would just not feel as well the day after skipping the Parnate.
As to whether or not memantine would be of utility to prevent or reverse the loss of positive effect of these drugs, I really don't know. I might give it a try now that you mention it. I have some memantine left. Of course, it would have to "reverse" something in me since there has been no antidepressant response to lose.
- Scott
Posted by Willyee on January 8, 2005, at 19:50:10
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
I think there is an obvious trend with this med,first it seems to be just about the most effective med next to nardil,if you read through here,and other groups youll notice you dont see the consistent tourment like posts from parnate as you do with most of the meds,most times you see people on various ssris in total miseray,to the point you wonder why they are taking it.
What you DO see a lot with parnate is that aside from the sucess,its poops out.This is totaly frustrating,to have a med work,get just a little taste of normality and then poof gone.Even thoug i am in a semi poop out stage,until i see any other med produce responses from the general public even close to parnate,then parnate still will be the only med i will touch,i will never go on a ssri go round again,those horrid coctails the docs beging to brew for you.
Getting to your point,i have gone above 100 mg,it helped the poop out at first,only to fall victim again.I stated this before but some things to consider on such a high dose are....
*** Unlike lower doses,i did begin to notice more of a need for the med,almost a craving,so i do think it begins to have a addiction potential at such a high dose.
**** If you take such a high dose,and miss a nights sleep,you might want to consider taking your next at a much lower dose,a 100 mg dose of parnate on a person going with no sleep for 24 hrs can make you semi manaic.This also was a problem for me
**** Last at such a dose you will always have to have that many tabs on hand,that can be a frustatrating task.Also the mention of the patient of ur docs,i doubt everyone can go that high,i think depending on your body you have a limit,there will almost definatly be discomfort for almost everyone the first time to begin to go higher,but it should subside,if however it doesent,then youll know its too high of a dose,the tingling in the head,the edginess,the feeling that you cant sit still keep getting up etc.....i would not try to push what my body is alowing me to take.
I had an immesnly horrendous witdrawal recently due to not having acess to the med for a few days,never in four years of taking it did this happen,so i contribute it to the high dosing.
I since have lowered the dose,and i find it much easier on my system,i also feel more normal.I will post in a seperate thread exactly how im taking it.
> My doctor's only experience with giving a patient more than 100mg resulted in the patient complaining of a strange headache in the middle of his head. Because of this, he is reluctant to return to the high-dosage strategy with me.
>
> I would like to see a list of people who have taken Parnate at high dosages and know what side-effects showed up. Has anyone experienced this headache? I had once been up to 150mg and never experienced this.
>
> Thanks all for your participation.
>
>
> - Scott
Posted by Dan Perkins on January 8, 2005, at 20:46:16
In reply to Re: How many people have taken Parnate 100mg + ?, posted by Willyee on January 8, 2005, at 19:50:10
It is pretty interesting that despite having some unpleasant side effects (like raging insomnia, blood pressure fluctuations, fatigue), you very rarely (almost never) hear people who have taken Parnate disparage it. Even when it poops out, people don't seem to really resent the drug like they do the SSRIs and SNRIs, they are mostly just bummed out that it isn't working for them anymore.
I have been on 15-20 differnet meds for depression, anxiety and ADD, and looking back I pretty much hate every one of those drugs, am bitter about having to take them and resent the doctors who prescribed them. Yet even though Parnate gave me insomnia, played games with my blood pressure, zonked me out in the afternoon, pooped out on me eventually and was a pain to withdraw from, I really still like the drug, would recommend it to others (to the extent that I recommend any drug), am happy that my pdoc prescribed and would be willing to give it another try.
My only theory for this (other than the possibility that it really is a better, more effective drug - at least for me) is that all of the bad stuff about MAOIs are pretty much known and any pdoc you go to will run down a list of side effects and warn you about how dangerous the drug can be and many times will flat out refuse to prescribe the drugs. On the other hand, SSRIs and SNRIs are touted as these miracle drugs that pdocs seem over eager to prescribe and you are lucky if they even mention the possible side effects (and when they do mention them they tell you that they occur very rarely and are no problem to deal with). And when you do report side effects from SSRIs or SNRIs your pdoc will often deny that they are even attributable to these drugs. So, months down the line, when you realize how potent the SSRIs and SNRIs really are, you can really resent that you weren't given a more accurate picture of these drugs before you started out.
I am speaking in general terms, but this is all directly from personal experiences that have happened to me time and again (for example, last 2 pdocs I have seen have recommended Effexor as a great drug with no noticable side effects). I also remember a pdoc I met with a few years ago reacting with disbelief that Zoloft pooped out on me. He told me that that was not a normal thing to happen and he was very shocked (pissed off AT ME more acurately).
> if you read through here,and other groups youll notice you dont see the consistent tourment like posts from parnate as you do with most of the meds,most times you see people on various ssris in total miseray,to the point you wonder why they are taking it.
>
Posted by ed_uk on January 8, 2005, at 21:08:55
In reply to Re: How many people have taken Parnate 100mg + ?, posted by Dan Perkins on January 8, 2005, at 20:46:16
Hi Dan!!
>My only theory for this (other than the possibility that it really is a better, more effective drug - at least for me) is that all of the bad stuff about MAOIs are pretty much known and any pdoc you go to will run down a list of side effects and warn you about how dangerous the drug can be and many times will flat out refuse to prescribe the drugs. On the other hand, SSRIs and SNRIs are touted as these miracle drugs that pdocs seem over eager to prescribe and you are lucky if they even mention the possible side effects (and when they do mention them they tell you that they occur very rarely and are no problem to deal with). And when you do report side effects from SSRIs or SNRIs your pdoc will often deny that they are even attributable to these drugs. So, months down the line, when you realize how potent the SSRIs and SNRIs really are, you can really resent that you weren't given a more accurate picture of these drugs before you started out.
This is so true. It's sad how most doctors only truly accept the side effects of the drugs that they don't prescribe anymore. They are delusional.
Regards,
Ed.
Posted by johnnystats on January 9, 2005, at 13:35:41
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
> My doctor's only experience with giving a patient more than 100mg resulted in the patient complaining of a strange headache in the middle of his head. Because of this, he is reluctant to return to the high-dosage strategy with me.
>
> I would like to see a list of people who have taken Parnate at high dosages and know what side-effects showed up. Has anyone experienced this headache? I had once been up to 150mg and never experienced this.
>
> Thanks all for your participation.
>
>
> - Scott
>I have social phobia w/depression, and I've taken both parnate and nardil at very high doses and i believe that parnate is more effective when experiencing lethargy and depression than for anxiety. The amphetimine effect of parnate gave me more energy, but i had to seriously increase my dose of xanax xr to counteract anxiety from it. I think that if you can tolerate it, nardil's best at high doses because it doesn't light you up and works well for both depression and anxiety.
Posted by Don_Bristol on January 10, 2005, at 14:52:44
In reply to Re: How many people have taken Parnate 100mg + ?, posted by Willyee on January 8, 2005, at 19:50:10
> I think there is an obvious trend with this med,first it seems to
> be just about the most effective med next to nardil,if you read
> through here,and other groups youll notice you dont see the
> consistent tourment like posts from parnate as you do with
> most of the meds,most times you see people on various ssris
> in total miseray,to the point you wonder why they are taking it.Willyee, that is a good observation. And like many good observations, it is obvious but only after it has been pointed out. I hadn't really thought about it that way until you mentioned it.
> What you DO see a lot with parnate is that aside from the
> sucess,its poops out.This is totaly frustrating,to have a med
> work,get just a little taste of normality and then poof gone.
> Even thoug i am in a semi poop out stage, [snip]I have not noticed people mention Parnate poop-out but I must confess that I too am starting to experience it. Do you know if the poop-out is typically after a few weeks, a few months or a few years? In my case it is after a three or four months.
Thanks for any info.
Posted by Willyee on January 11, 2005, at 0:40:04
In reply to Do MAOIs make normal people high? » Willyee, posted by Don_Bristol on January 10, 2005, at 14:52:44
> > I think there is an obvious trend with this med,first it seems to
> > be just about the most effective med next to nardil,if you read
> > through here,and other groups youll notice you dont see the
> > consistent tourment like posts from parnate as you do with
> > most of the meds,most times you see people on various ssris
> > in total miseray,to the point you wonder why they are taking it.
>
> Willyee, that is a good observation. And like many good observations, it is obvious but only after it has been pointed out. I hadn't really thought about it that way until you mentioned it.
>
> > What you DO see a lot with parnate is that aside from the
> > sucess,its poops out.This is totaly frustrating,to have a med
> > work,get just a little taste of normality and then poof gone.
> > Even thoug i am in a semi poop out stage, [snip]
>
> I have not noticed people mention Parnate poop-out but I must confess that I too am starting to experience it. Do you know if the poop-out is typically after a few weeks, a few months or a few years? In my case it is after a three or four months.
>
> Thanks for any info.From what im gathering it varies a lot.I for instane had a whole year of effectiveness,whereas i read some have only weeks at times.
I am not surprised,my exper is everything plays a role,any other meds being taken,a persons position in life,how bad they are at the start of therapy,smoking,drinking general health,weight etc
I gather from my OWN views its a person to person thing.As to any answer,my friend if u find one let me know,i think we have an army out already searching,im jus glad there are some resources that u can go to,i personaly encourage anyone who found any succesful way to ehance their Maoi usuage to share,even if it ends up pooping out again.I have had a lot of success,just nothing lasted yet.
Posted by Chairman_MAO on January 11, 2005, at 16:16:58
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
I take 200mg/day (100mg AM, 50mg mid-day, 50mg early evening). Side effects--including, strangely enough, insomnia, are less at this dosage. It also is hardly ever agitating the way the lower doses used to be, and works sublimely on social phobia.
I've been at this dosage since October with no signs of poop-out.
Posted by mogger on January 12, 2005, at 21:43:11
In reply to How many people have taken Parnate 100mg + ?, posted by SLS on January 7, 2005, at 11:16:53
Hello,
My sister was on Nardil 45 mg, stopped taking it because she had such bad side effects, then her doctor said she could start parnate exactly one week after her last dose of Nardil. When she started Parnate she took 10 mg the 1st day, 20 mg the 2nd, and 30 mg the third day. She then had a hypertensive reaction (swelling of the eyes, headache and high blood pressure, we took her to the emergency room) after taking the 30 mg and had to come off parnate. Has that happened to anyone? She didn't eat anything that tipped it off? Just curious for anyones opinion. Many thanks,
Joseph
Posted by ace on January 12, 2005, at 22:58:54
In reply to How long does 1 wait between Nardil and Parnate?, posted by mogger on January 12, 2005, at 21:43:11
> Hello,
> My sister was on Nardil 45 mg, stopped taking it because she had such bad side effects, then her doctor said she could start parnate exactly one week after her last dose of Nardil. When she started Parnate she took 10 mg the 1st day, 20 mg the 2nd, and 30 mg the third day. She then had a hypertensive reaction (swelling of the eyes, headache and high blood pressure, we took her to the emergency room) after taking the 30 mg and had to come off parnate. Has that happened to anyone? She didn't eat anything that tipped it off? Just curious for anyones opinion. Many thanks,
> JosephHi mate,
I can only relay to you my own experience. I switched to Parnate from Nardil 90mg in one day! Then I switched back the next day from 10mg Parnate to 90mg Nardil!!! I had no ill effects.
I have heard of people who combine the two....and many have NO washout period between them
In case of a hypertensive crises: use ADALAT (NIFEDIPINE)
In case of a serotonin syndrome: Use PERIACTIN
But, this is only my advice and experience...the Doctor should have the final say....except in my case where I have the final say!! ha ha!
Posted by mogger on January 12, 2005, at 23:53:07
In reply to Re: How long does 1 wait between Nardil and Parnate? » mogger, posted by ace on January 12, 2005, at 22:58:54
Thanks for the information dude!, take care from Los Angeles,
Joseph
Posted by SLS on January 13, 2005, at 9:12:50
In reply to How long does 1 wait between Nardil and Parnate?, posted by mogger on January 12, 2005, at 21:43:11
> Hello,
> My sister was on Nardil 45 mg, stopped taking it because she had such bad side effects, then her doctor said she could start parnate exactly one week after her last dose of Nardil. When she started Parnate she took 10 mg the 1st day, 20 mg the 2nd, and 30 mg the third day. She then had a hypertensive reaction (swelling of the eyes, headache and high blood pressure, we took her to the emergency room) after taking the 30 mg and had to come off parnate. Has that happened to anyone? She didn't eat anything that tipped it off? Just curious for anyones opinion. Many thanks,
> Joseph
Hi Joseph.The prudent doctor will require a total of 14 days between the last dose of one MAOI and the first dose of the next. I believe this is more important when switching from Nardil to Parnate than the reverse. I guess there is no way to know for sure if the reaction you describes was due to an interaction between the effects of the two drugs or if it would have happened with Parnate anyway. If the Nardil showed some positive effects, I think an argument can be made that it is worth re-introducing the Parnate after two weeks using a more gradual titration. There simply is not enough data regarding the concomitant administration of Nardil + Parnate to be able to guarantee its safety. I doubt I would try it unless my doctor had already employed such a strategy in multiple cases successfully. I haven't encountered any such doctors yet.
- Scott
Posted by ravenstorm on January 13, 2005, at 13:59:48
In reply to Re: How long does 1 wait between Nardil and Parnate? » mogger, posted by SLS on January 13, 2005, at 9:12:50
What bad side effects did your sister have on nardil and how slowly did she taper up to the 45mg dosage?
Posted by mogger on January 13, 2005, at 16:22:57
In reply to Re: How long does 1 wait between Nardil and Parnate?, posted by ravenstorm on January 13, 2005, at 13:59:48
She stopped Nardil cold turkey one day (Doctor's orders), then started Parnate exactly one week later.
Posted by mogger on January 13, 2005, at 16:27:40
In reply to Re: How long does 1 wait between Nardil and Parnate? » mogger, posted by SLS on January 13, 2005, at 9:12:50
Thanks Scott,
I was hoping he would try it again but he seems to have gone off the MAOI thing. Does Selegiline or Marplan have the same significant warnings? I am not sure if Marplan is sold in the US.
Posted by SLS on January 13, 2005, at 20:50:49
In reply to Re: How long does 1 wait between Nardil and Parnate?, posted by mogger on January 13, 2005, at 16:27:40
> Thanks Scott,
> I was hoping he would try it again but he seems to have gone off the MAOI thing. Does Selegiline or Marplan have the same significant warnings? I am not sure if Marplan is sold in the US.Marplan is still sold in the US. There were a few years in the mid 1990s when it wasn't. I'm not sure how much of a market share it has, but I hope the drug company is making enough off of it to continue manufacturing it. It's not a bad drug. Some doctors characterize it as being sort of a cross between Nardil and Parnate, but weaker. All the precautions when taking Marplan are the same as when taking the other two.
Selegiline is a much different drug at the dosages it is used to treat Parkinsons Disease: 5-10mg. It generally affects only one of the two types of MAO enzyme: MAO-B. However, oral dosages above 10mg can leave one vulnerable to the same food-tyramine reaction as the other MAOIs as it begins to inhibit MAO-A. Dosages used for depression are generally higher than 10mg.
A new selegiline patch (transdermal delivery - through the skin) is close to being approved by the FDA, and is intended to treat depression. I don't know what the daily dosage will equate to, but the transdermal delivery system is not supposed to cause a food-tyramine reaction, as it bypasses the digestive system. I remain cautious, however, as significant MAOI effects still reach the intestines, albeit to a much lesser extent.
- Scott
Posted by mogger on January 14, 2005, at 0:16:20
In reply to Re: How long does 1 wait between Nardil and Parnate?, posted by SLS on January 13, 2005, at 20:50:49
Thanks for the information Scott, I appreciate it,
Joseph
Posted by solarice on February 2, 2015, at 19:49:05
In reply to Re: How many people have taken Parnate 100mg + ?, posted by Chairman_MAO on January 11, 2005, at 16:16:58
> I take 200mg/day (100mg AM, 50mg mid-day, 50mg early evening). Side effects--including, strangely enough, insomnia, are less at this dosage. It also is hardly ever agitating the way the lower doses used to be, and works sublimely on social phobia.
>
> I've been at this dosage since October with no signs of poop-out.Hi Chairman_MAO,
I'm interested in whether you are still taking 200mg parnate, have changed medications, or augmented it to continue the desired effect?
I'm currently on 90mg parnate and find it is helping more so than any SSRI / TCA and nardil for depression. However, I'm prepared to move up if need be.
Regards,solarice
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