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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by EERRIICC on August 16, 2005, at 23:35:27
Can I take amaneptine with an MAOI? I was doing it and it was working well and I added an insuffleated buprenorphine 2mg which landed me in the ICU with seratonin syndrome. Was it the buprenorphine or a coulple days of 200-300mg amaneptine with my 150mg parnate?
What is it whe you you can't stop twisting and flexing your muscles but it doesn't feel bad?
Wackey sh*t eh,
Eric
Posted by ed_uk on August 17, 2005, at 6:20:57
In reply to Help Ed, Linkage, Scott, or another med jedi., posted by EERRIICC on August 16, 2005, at 23:35:27
Hi Eric,
>150mg parnate....
It's a hefty dose - you'll have to be very careful what you combine with it!
>amineptine
I can't find any data RE to what extent amineptine inhibits the reuptake of serotonin.
~ed
Posted by linkadge on August 17, 2005, at 16:26:03
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » EERRIICC, posted by ed_uk on August 17, 2005, at 6:20:57
I would suspect buprenorphine, but personally I wouldn't combine parnate with anything esp 150mg. If that dose of that med isn't working then maybe it would be safer to try another drug combination.
Effexor and amineptine might be better.
Linkadge
Posted by SLS on August 17, 2005, at 18:54:00
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by linkadge on August 17, 2005, at 16:26:03
I know of someone whom had great success combining amineptine and sulpiride.
I have been on Parnate 150mg in combination with Lamictal. I found that the drug takes on a different personality at the higher dosages that helps to enhance cognition and mood. If you are tolerating the dosage well, you might consider trying a series of augmentation strategies like adding lithium.
I agree that it was the buprenorphine that produced the adverse event.
- Scott
Posted by Declan on August 17, 2005, at 19:09:51
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by SLS on August 17, 2005, at 18:54:00
Hi Scott
Did you discontinue/reduce Parnate 150mg/d because of something to do with the effects of Parnate at this doseage? It sounds as if you liked something about it.
And how do you find sleep on any (reasonable) dose of Parnate?
Declan
Posted by EERRIICC on August 18, 2005, at 2:09:25
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by SLS on August 17, 2005, at 18:54:00
Thanks Scott
Posted by EERRIICC on August 18, 2005, at 2:12:53
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » SLS, posted by Declan on August 17, 2005, at 19:09:51
On this dose of Parnate, the only one that really works for awhile, I'm usually up every other night and then I sleep ten hours the next and feel really sluggish in the morning. No mania though. I tried Strattera(18mg) and it did nothing except normalise my sleeping patterns, maybe I should add it, what do you think?
Posted by EERRIICC on August 18, 2005, at 2:20:15
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by SLS on August 17, 2005, at 18:54:00
What do you think could stop this parnate poop-out (three months every time)
Naltrexone, DA's, Memantine, Ritalin, bloodletting, appeasement of angry gods?
Posted by Declan on August 18, 2005, at 2:37:58
In reply to Help Ed, Linkage, Scott, or another med jedi., posted by EERRIICC on August 16, 2005, at 23:35:27
I'm curious Eric, what's the difference between no Parnate and 150mg/d for you?
Is it a huge difference?
When the Parnate stops working, do you feel greatly different when you stop it?
Do you think that this is tolerance, as in (what I'm familiar with) tolerance to benzos, opiates, amphetamines?
Or something else?Declan
Posted by Declan on August 18, 2005, at 2:43:27
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » Declan, posted by EERRIICC on August 18, 2005, at 2:12:53
Hey again, what do you mean by Straterra normalising your sleeping patterns?
That you sleep normally every night? That sounds extraordinary. (But I know nothing about Strattera. It's not a NARI?)Sleep is important to me, especially deep sleep.
Declan
Posted by SLS on August 18, 2005, at 6:55:21
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » SLS, posted by EERRIICC on August 18, 2005, at 2:20:15
> What do you think could stop this parnate poop-out (three months every time)
I don't know, but if you figure it out, I want to be amongst the first to know!
> Naltrexone, DA's, Memantine, Ritalin, bloodletting, appeasement of angry gods?
All good ideas...
:-)
Naltrexone is interesting. However, I know of only one person on PB who reported its successful use as an augmentor of Prozac (20mg Prozac and 25mg Naltrexone).
Memantine is theoretically interesting. Unfortunately, I haven't seen a preponderance of people report having success with it as an agent to prevent tolerance to stimulants. I experienced a brief antidepressant response to it last year. Perhaps the manipulation of NMDA glutamatergic neurotransmission by memantine and other drugs has some utility in treating depression, but there is a paucity of even anecdotal data to support this. The NIMH has been conducting trials of memantine to treat major depression. I don't know what have been their results.
Ritalin is a drug that I have tried in combination with Parnate. It did nothing for me. I think it might make a good augmentor when there is residual low energy, but probably does not confer a robust antidepressant effect when placed in this role.
In the past, bloodletting and appeasement of angry gods have demonstrated too high a placebo effect to yield meaningful results. People often claimed remission even before the first blade was unsheathed.
- Scott
Posted by Jedi on August 19, 2005, at 1:21:53
In reply to Help Ed, Linkage, Scott, or another med jedi., posted by EERRIICC on August 16, 2005, at 23:35:27
EERRIICC,
Sorry, I haven't been able to keep up on all of the posts. What is your diagnosis and what other medications have you tried? Did an MD put you on the 150mg of Parnate? I would do a whole lot of research before adding ANYTHING to that. I've used 100mg nortriptyline with 90mg of Nardil, but the tricyclic dose was estabished first, then the MAOI was added. I think Scott said he had gone the other way, but be careful. Again, if you are augmenting such a large dose of Parnate, I wouldn't even take an MD's word on it. Research, Research, Research.
Jedi
Posted by Jedi on August 19, 2005, at 1:44:42
In reply to Help Ed, Linkage, Scott, or another med jedi., posted by EERRIICC on August 16, 2005, at 23:35:27
EERRIICC,
The last sentence of this abstract suggests that it may not have been the buprenorphine that caused your serotonin syndrome. But again, at that dosage of Parnate, who knows?
JediBr J Anaesth. 2005 Jul 28; [Epub ahead of print] Related Articles, Links
Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.
Gillman PK.
Pioneer Valley Private Hospital, Mackay, Queensland 4740, Australia.
Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by clonus, hyper-reflexia, hyperthermia and agitation. Serotonergic side-effects occur with serotonergic drugs, and overdoses of serotonin re-uptake inhibitors (SRIs) frequently produce marked serotonergic side-effects, and in 15% of cases, moderate serotonergic toxicity, but not to a severe degree, which produces hyperthermia and risk of death. It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI. There are a number of lesser-known drugs that are MAOIs, such as linezolid and moclobemide; and some opioid analgesics have serotonergic activity. These properties when combined can precipitate life threatening serotonin toxicity. Possibly preventable deaths are still occurring. Knowledge of the properties of these drugs will therefore help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT2A antagonists for severe cases) if they occur. The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
Posted by SLS on August 19, 2005, at 9:05:23
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » EERRIICC, posted by Jedi on August 19, 2005, at 1:44:42
Hi Jedi.
That's a great article you pulled up. I don't know why I was under the impression that buprenorphine possessed pro-serotonergic properties. Thanks for the correction.
Yes. It is preferable to add the MAOI to the TCA already started or start them at the same time. I have no idea why this tradition has become so imbedded in clinical practice, though. Is it a matter of theory or observation? I guess it is a lot quicker to stop the TCA or fine-tune it than to reduce MAO inhibition by stopping the MAOI. Reducing the MAO activity would take too long in an emergency. However, I don't know if either order of administration is more apt to actually provoke an adverse reaction. So far, it hasn't made a difference for me. Perhaps I've been lucky. I think there might be an advantage to starting them at the same time as there might be a temporal synergy in the brain's compensitory processes to the explosure of both drugs. The only time a treatment worked for me is when I began taking Parnate and desipramine simultaneously and worked the dosages of both up quickly. I don't think I have tried the same strategy since with Parnate. I have with Nardil + desipramine, though. No go.
- Scott
> EERRIICC,
> The last sentence of this abstract suggests that it may not have been the buprenorphine that caused your serotonin syndrome. But again, at that dosage of Parnate, who knows?
> Jedi
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16051647&query_hl=12
>
> Br J Anaesth. 2005 Jul 28; [Epub ahead of print] Related Articles, Links
>
> Monoamine oxidase inhibitors, opioid analgesics and serotonin toxicity.
>
> Gillman PK.
>
> Pioneer Valley Private Hospital, Mackay, Queensland 4740, Australia.
>
> Toxicity resulting from excessive intra-synaptic serotonin, historically referred to as serotonin syndrome, is now understood to be an intra-synaptic serotonin concentration-related phenomenon. Recent research more clearly delineates serotonin toxicity as a discreet toxidrome characterized by clonus, hyper-reflexia, hyperthermia and agitation. Serotonergic side-effects occur with serotonergic drugs, and overdoses of serotonin re-uptake inhibitors (SRIs) frequently produce marked serotonergic side-effects, and in 15% of cases, moderate serotonergic toxicity, but not to a severe degree, which produces hyperthermia and risk of death. It is only combinations of serotonergic drugs acting by different mechanisms that are capable of raising intra-synaptic serotonin to a level that is life threatening. The combination that most commonly does this is a monoamine oxidase inhibitor (MAOI) drug combined with any SRI. There are a number of lesser-known drugs that are MAOIs, such as linezolid and moclobemide; and some opioid analgesics have serotonergic activity. These properties when combined can precipitate life threatening serotonin toxicity. Possibly preventable deaths are still occurring. Knowledge of the properties of these drugs will therefore help to ensure that problems can be avoided in most clinical situations, and treated appropriately (with 5-HT2A antagonists for severe cases) if they occur. The phenylpiperidine series opioids, pethidine (meperidine), tramadol, methadone and dextromethorphan and propoxyphene, appear to be weak serotonin re-uptake inhibitors and have all been involved in serotonin toxicity reactions with MAOIs (including some fatalities). Morphine, codeine, oxycodone and buprenorphine are known not to be SRIs, and do not precipitate serotonin toxicity with MAOIs.
>
>
Posted by Jedi on August 19, 2005, at 10:54:20
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » Jedi, posted by SLS on August 19, 2005, at 9:05:23
Thanks for all of your knowledge Scott. There are many times I have wanted to add back some nortriptyline to my Nardil. This little thing in the back of my mind has kept me from doing it. I imagine if I started at really small doses of the tricyclic it would be ok and work it up slowly. I'm still getting a good partial response from the Nardil. The last thing I want to do is wean off that to start the nortriptyline. Both times I've quit Nardil in the past few years, it's been back to the black hole. I'll look up some more info on it.
Thanks again,
Jedi
Posted by EERRIICC on August 20, 2005, at 6:55:29
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by Declan on August 18, 2005, at 2:43:27
At 150mg of parnate I can think, feel function and live/work without it I cannot do any of those things.
Although I've heard only one other person report this phenomena, 18mg of sttratera made me tired at regular times (10-12), wake up refreshed at regular times (7-9) and sleep well in general.
Posted by EERRIICC on August 20, 2005, at 7:08:05
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » EERRIICC, posted by Jedi on August 19, 2005, at 1:44:42
I was taking DLPA (3000mg/day) and the rare rench drug amantadine (100-200mg/day), could it have been one of those characters.
Posted by EERRIICC on August 20, 2005, at 7:20:32
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by SLS on August 18, 2005, at 6:55:21
I'm thinking of taking one or two days off a week. No real logic behind this, but the blood levels should recover quickly and maybe its effectiveness is amphetamine-like; you know something that would respond to these kind of holidays. The main problem now is sleep, without any mania I'm always up for 48hrs and than I crash for 16, it's always been this way with parnate (a lower dose doesn't matter) and it's so counter-productive to its effects. Should I get the new melatonin agonist drug or re-implement strattera at 18mg which for reasons beyond the ken of mortal souls totally normalised my sleep patterns? Maybe low dose Ami. Problem is I'm so preoccupied with the impending poop-out that I'll opt for ritalin/naltrexone/memantine before any attempt to resolve the sleep issues which ironically might be the problem. Amineptine works really well with parnate even with my 4 day trial, but I wound up in the ICU with a catheter and devilishly mean nurse; was it because I idiotically snorted the buprenorphine? Are you interested in trying amineptine?
Posted by EERRIICC on August 20, 2005, at 7:21:47
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by SLS on August 18, 2005, at 6:55:21
I'm thinking of taking one or two days off a week. No real logic behind this, but the blood levels should recover quickly and maybe its effectiveness is amphetamine-like; you know something that would respond to these kind of holidays. The main problem now is sleep, without any mania I'm always up for 48hrs and than I crash for 16, it's always been this way with parnate (a lower dose doesn't matter) and it's so counter-productive to its effects. Should I get the new melatonin agonist drug or re-implement strattera at 18mg which for reasons beyond the ken of mortal souls totally normalised my sleep patterns? Maybe low dose Ami. Problem is I'm so preoccupied with the impending poop-out that I'll opt for ritalin/naltrexone/memantine before any attempt to resolve the sleep issues which ironically might be the problem. Amineptine works really well with parnate even with my 4 day trial, but I wound up in the ICU with a catheter and devilishly mean nurse; was it because I idiotically snorted the buprenorphine? Are you interested in trying amineptine
Posted by ed_uk on August 20, 2005, at 10:57:31
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » Declan, posted by EERRIICC on August 20, 2005, at 6:55:29
>Although I've heard only one other person report this phenomena, 18mg of sttratera made me tired at regular times (10-12), wake up refreshed at regular times (7-9) and sleep well in general.
Zeugma? He reported something similar.
~Ed
Posted by Declan on August 20, 2005, at 13:28:26
In reply to Re: Help Ed, Linkage, Scott, or another med jedi. » EERRIICC, posted by ed_uk on August 20, 2005, at 10:57:31
Why should Strattera do this? Anyone know?
Declan
Posted by Jedi on August 21, 2005, at 11:59:33
In reply to Re: Help Ed, Linkage, Scott, or another med jedi., posted by EERRIICC on August 20, 2005, at 7:20:32
> I'm thinking of taking one or two days off a week.
Eric,
I am a bit worried about all of the dopamine agonists and other dopaminergic medications you are taking. Although rare, Neuroleptic Malignant Syndrome or "dopaminergic malignant syndrome" can result from the sudden withdrawal of dopaminergic drugs. This condition is fatal about 11% of the time. Some studies say 20% but with better recognition today, it is lower. When you start talking about two day drug holidays, it makes me think of some possible, very negative, consequences.What did they treat you with in the ICU. NMS is often mistaken for serotonin syndrome because it is so rare. Most cases are caused by people taking the antipsychotic drugs and dopamine agonists are then often used as a treatment. But some cases of NMS or "dopaminergic malignant syndrome" are caused by the abrupt withdrawal of the dopaminergic drugs, mostly in Parkinson's patients.
PLEASE BE CAREFUL
I Care,
Jedi“…NMS occurs from prolonged exposure to neuroleptic agents or withdrawal of dopamine agonists, and there is lead-pipe rigidity with NMS, in contrast to myoclonus or hyperreflexia seen in persons with serotonin syndrome.”
1: Singapore Med J. 2001 Feb;42(2):85-8.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11358199&query_hl=6
Neuroleptic malignant syndrome without neuroleptics.
Ong KC, Chew EL, Ong YY.
Department of Respiratory & Critical Care Medicine, Singapore General Hospital.
Neuroleptic malignant syndrome is an uncommon condition characterised by hyperthermia, rigidity, altered mentation and autonomic instability. Recognition of this condition is essential because its complications are potentially lethal, leading to death in 20% of patients. Not all cases of this syndrome are associated with the use of neuroleptics and there is an increasing number of reports of this condition occurring after withdrawal of therapy with dopaminergic drugs, typically in patients with Parkinsonism. In this setting, there is tremendous potential for misdiagnosis and delay in institution of treatment because of the traditional and common association of the syndrome with the use of neuroleptics only. We report a case of neuroleptic malignant syndrome in a patient with Parkinsonism subsequent to the withdrawal of levodopa and bromocriptine.
1: J Neurosci Nurs. 2005 Jun;37(3):160-2.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16001822&query_hl=4
Neuroleptic malignant syndrome in a patient with Parkinson's disease: a case study.
Ward C.Parkinsonism Relat Disord. 2003 Jan;9(3):175-8.
Link:
/entrez/utils/lofref.fcgi?PrId=3048&uid=12573874&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S135380200200035
Neuroleptic malignant syndrome-like, or--dopaminergic malignant syndrome--due to levodopa therapy withdrawal. Clinical features in 11 patients.Neurology Care Line-127PD 2002 Holcombe Blvd., Houston, TX 77030, USA. constance.ward@med.va.gov
Neuroleptic malignant syndrome (NMS) is a potentially lethal condition that has been described in patients with idiopathic Parkinson's disease (PD) after long-term dopaminergic medications are suddenly stopped or moderately decreased …
Posted by EERRIICC on August 22, 2005, at 1:04:48
In reply to I am a bit worried-Neuroleptic Malignant Syndrome » EERRIICC, posted by Jedi on August 21, 2005, at 11:59:33
Thanks you for your concern, I feel I am gambling sometimes against the dark black god of pyschic pain, and if I don't take extreme chances he'll gladly harvest his daily dose of extreme pain.
Posted by Jedi on August 22, 2005, at 1:27:39
In reply to Thanks » Jedi, posted by EERRIICC on August 22, 2005, at 1:04:48
Posted by Jedi on August 22, 2005, at 2:08:44
In reply to I am a bit worried-Neuroleptic Malignant Syndrome » EERRIICC, posted by Jedi on August 21, 2005, at 11:59:33
Sorry, I messed up the link to this abstract. I'll try again. Look at the related articles also.
Jedi1: Parkinsonism Relat Disord. 2003 Jan;9(3):175-8.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12573874&query_hl=10
Neuroleptic malignant syndrome-like, or--dopaminergic malignant syndrome--due to levodopa therapy withdrawal. Clinical features in 11 patients.Serrano-Duenas M.
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