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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 TylerJ on March 6, 2006, at 13:14:43
I'm relatively new to Psycho-Babble, but I can certainly tell one thing, you are very knowledgable, humble and on top of that, you have good common sense...something I think perhaps others that have the Knowledge are lacking. When I read your posts I seem to agree with all of them. I have some med. knowledge but definitley not even close to what you know.
Anyway, since I respect you, and I believe that you really know your stuff-you're not just trying to impress others with your intellect, that's where I see you're humble, and you really try to help others here, and you do that very well! If you could give me some augmentation strategies for Parnate I would greatly appreciate it. What I'm am doing is trying to be prepared ahead of time in case the time comes when I need to utilize other meds to keep Parnate working ...I don't need anything now and hopefully never will, but just in case I want as much ammunition as possible-right now parnate is working beautifully for me without any augmentation agents. So, if you could Scott, the more the better, the only thing my pdoc will not use are stimulants. Thanks Scott.Tyler
Posted by SLS on March 7, 2006, at 7:24:47
In reply to Scott, advice please., posted by TylerJ on March 6, 2006, at 13:14:43
Hi Tyler.
Gosh, with all of the flattering comments you've squeezed in this post, my head is about ready to explode.
I know how important it is to have in place a list of alternative treatments just in case the current one proves inadequate.
To augment Parnate:
I guess the first thing to try would be an old strategy of adding a moderate amount of lithium (300-600mg). This works even when one is unipolar. Lamictal might be another consideration. 200mg seems to be the dosage most often targeted with this drug.
I once had success mixing Parnate 60mg with desipramine (a tricyclic; TCA) 150mg. Parnate is safe to mix with certain TCAs. Desipramine and nortriptyline are the two I would most recommend. They are less likely to produce serotonin syndrome and are milder than the others with respect to side effects. Some people profit from the addition of Dexedrine. Many doctors will contend that these combinations are absolutely contraindicated and lethal, but they have been used often enough in the past to conclude that they are safe. Traditionally, it has been thought that the best way to mix Parnate + TCA is to start the TCA first. However, I have not had any problems doing the reverse. More recently, I added nortriptyline to Parnate. It would be prudent to monitor your blood pressure when first starting.
Don't forget about thyroid hormone. I prefer how T4 (Synthroid) treats me. T3 (Cytomel) makes me feel much worse. Personally, I feel that T4 has been much overlooked in treating depression.
Parnate + Wellbutrin is safe. I've done that one too. Unfortunately, every time I have taken Wellbutrin, it has made me feel worse.
I was once on a combination of Parnate 120mg + desipramine 200mg + Dexedine 20mg + thyroid. It helped for awhile, but ultimately proved to be a dead end for me.
Sometimes, adding one of the atypical antipsychotics is helpful. Zyprexa and Abilify are the two that occur to me as having the best chances of helping. Perhaps Seroquel.
I don't know about Remeron. One person here added it successfully to Nardil. I have no personal experience with this combination and have never discussed it with a doctor.
I get the feeling that Provigil is worth looking into.
I guess I would go with the lithium or Lamictal first and the TCA second.
- Scott
Posted by TylerJ on March 7, 2006, at 9:49:24
In reply to Re: Scott, advice please. » TylerJ, posted by SLS on March 7, 2006, at 7:24:47
> Hi Tyler.
>
> Gosh, with all of the flattering comments you've squeezed in this post, my head is about ready to explode.
>
> I know how important it is to have in place a list of alternative treatments just in case the current one proves inadequate.
>
> To augment Parnate:
>
> I guess the first thing to try would be an old strategy of adding a moderate amount of lithium (300-600mg). This works even when one is unipolar. Lamictal might be another consideration. 200mg seems to be the dosage most often targeted with this drug.
>
> I once had success mixing Parnate 60mg with desipramine (a tricyclic; TCA) 150mg. Parnate is safe to mix with certain TCAs. Desipramine and nortriptyline are the two I would most recommend. They are less likely to produce serotonin syndrome and are milder than the others with respect to side effects. Some people profit from the addition of Dexedrine. Many doctors will contend that these combinations are absolutely contraindicated and lethal, but they have been used often enough in the past to conclude that they are safe. Traditionally, it has been thought that the best way to mix Parnate + TCA is to start the TCA first. However, I have not had any problems doing the reverse. More recently, I added nortriptyline to Parnate. It would be prudent to monitor your blood pressure when first starting.
>
> Don't forget about thyroid hormone. I prefer how T4 (Synthroid) treats me. T3 (Cytomel) makes me feel much worse. Personally, I feel that T4 has been much overlooked in treating depression.
>
> Parnate + Wellbutrin is safe. I've done that one too. Unfortunately, every time I have taken Wellbutrin, it has made me feel worse.
>
> I was once on a combination of Parnate 120mg + desipramine 200mg + Dexedine 20mg + thyroid. It helped for awhile, but ultimately proved to be a dead end for me.
>
> Sometimes, adding one of the atypical antipsychotics is helpful. Zyprexa and Abilify are the two that occur to me as having the best chances of helping. Perhaps Seroquel.
>
> I don't know about Remeron. One person here added it successfully to Nardil. I have no personal experience with this combination and have never discussed it with a doctor.
>
> I get the feeling that Provigil is worth looking into.
>
> I guess I would go with the lithium or Lamictal first and the TCA second.
>
>
> - ScottThanks Scott-good stuff!
I've read before that Lamictal works really well w/ Parnate and lithium. I've read it's very activating and has low incidence of side-effects as well, supposed to be more effective in depression than other mood stabilizers-prompting us in treatment-resistant unipolar depression. I'm kinda chicken to take Antipsycotics due to possibility of of Tardive dyskinesia...I certainly don't need anymore probs.:) Thanks again Scott.Tyler
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