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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by Jedi on August 3, 2005, at 3:51:43
Scott,
I’ve been following your posts for many years and I was wondering about your current thoughts on nortriptyline augmented with Parnate?I have extended periods of treatment resistant, atypical depression with social anxiety. This is interspersed with dysthymia, when I am in partial recovery. I am currently on 75mg of Nardil with 1mg of clonazepam. Nardil is the only medication that has brought me out of the major depressions. The main side effects I’ve had are the extreme carb cravings with associated weight gain and delayed ejaculation. I have had no noticeable orthostatic hypertension
I have been on nortriptyline combined with Nardil, which brought me out of one major depression. I later dropped the nortriptyline because it did not seem to be doing any better than the Nardil with clonazepam. I’ve also taken Parnate, combined with seroquel and clonazepam with no noticeable effect on the major depression. I had to switch back to Nardil to knock it out. I’ve also been on desipramine with clonazepam as a separate trial. The desipramine seemed to buzz me out, even though the blood level was below optimal. One short trial with Abilify gave me my only taste of akathisia, what a nasty feeling. I won’t get into the SSRI and SNRI trials; they just did not work or caused such amotivational syndrome, that I couldn’t do anything. My garage has yet to recover from these trials. A three car garage and I haven’t had a car parked in it for four years.
Anyway, it seems from your posts that you are doing much better with the nortriptyline combined with Parnate as part of your cocktail. I realize, of course, that we are all different, and react to drugs differently. What is your current diagnosis? The nortriptyline combined with Parnate sounds like a way to eliminate my side effects. If it would just work for my atypical depression, I would take the risk of coming off the Nardil. And make the switch. My doctor is pretty good about letting me try things, as long as I do the legwork. I search through babble for ideas and then print him out the actual studies that show efficacy and lack of danger.
I’m with you on the placebo-controlled studies. I’ve read some research where they did eliminate the obvious placebo responders. If a subject responds in a day or two to a medication that should take three to four weeks to show a real response, this is a placebo response. These subjects were eliminated and the rest randomized again. I can’t remember if they did anything with experienced subjects that could tell by the side effects if they were getting the actual medication.
Sorry about running on, it’s 1:30AM on the west coast and I’m getting kind of rummy.
Wishing you Well,
Jedi
Posted by SLS on August 3, 2005, at 7:33:47
In reply to Question for SLS: Nortriptyline with Parnate?, posted by Jedi on August 3, 2005, at 3:51:43
Hi Jedi.
> I’ve been following your posts for many years and I was wondering about your current thoughts on nortriptyline augmented with Parnate?
I'm getting some mild relief from the following combination:
Parnate 80mg
nortriptyline 100mg
Lamictal 150mg
Abilify 10mg
Trileptal 900mgI really thought the Trileptal was going to work indefinitely. After a few weeks of a moderate response, it plateaued and all but disappeared. This has been a constant theme for me. Currently, I am diagnosed as bipolar depression with occasional dysphoric manias induced by medication.
I think using Parnate with nortriptyline is something that makes sense to explore, simply because you have not tried it before. I don't think you should become hugely optimistic, though. You didn't seem to be affected in any way by either of these drugs when taken independently. I would approach the combination with cautious optimism.
I have never had a problem combining desipramine with either Parnate or Nardil. Parnate + desipramine is the only thing that ever worked for me. Traditionally it was considered prudent to add the MAOI while the TCA was already on board or start the two together. I found that for me, it doesn't matter which order I take them in.
What dosage of nortriptyline have you used in the past? Did you get blood-levels?
One thing that you may want to consider is the addition of small dosages of lithium if you get "stuck". Lithium at dosages of 300-600mg can act to make Parnate work better. It is being reported by some doctors that the addition of Lamictal is producing similar results.
I wish you luck in your pursuit of health.
- Scott
Posted by Jedi on August 3, 2005, at 13:05:03
In reply to Re: Question for SLS: Nortriptyline with Parnate?, posted by SLS on August 3, 2005, at 7:33:47
> I'm getting some mild relief from the following combination:Parnate 80mg
nortriptyline 100mg
Lamictal 150mg
Abilify 10mg
Trileptal 900mg
-----------------------------------------------
Thanks Scott,Another thought I had was augmenting the Nardil with desipramine. I believe I read in one of your posts that this should not be a problem because of the low serotonic effect of desipramine. Since Nardil is the only med that has ever worked for my severe atypical depression, maybe adding a more energizing drug to the mix would help with the side effects.
I've augmented in the past with lithium, but not while taking Nardil or Parnate. This would be a fairly easy trial, since I wouldn't have to taper off Nardil to try it.
The only newer anti-seizure medication I've used is gabapentin. I had a good response with this while augmenting several other meds. I'm fairly certain that my social anxiety is related to gaba. All of the medications that I have taken which affect gaba (phenelzine, clonazepam, & gabapentin) have helped with the social anxiety. What side effects do you get from the Trileptal?
Another option for the weight gain side effect of Nardil would be the addition of a stimulant. This would be a hard sell to my doctor, but is not without precedent. Have you had any experience with modafinil?
Thanks for any additional thoughts you may have on these augmentation stategies. I want to keep the cocktail as simple as I can, but this is not always possible with treatment resistant depression.
Jedi
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