![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Caedmon on April 21, 2006, at 21:23:41
Here's my Parnate thread.
Background
23-year-old male in Salt Lake City, UT. One (1) friend and a 30 hour per week job, and I'm afraid of losing both. I'm a speech therapy assistant. Going to grad school this Fall.
Dx: Bipolar II w/ Tx-resistant atypical depression, social phobia (also Tx-resistant but I think that's normal for SP). *Probably* some subsyndromal inattentive ADD stuff, some vocal and motor tics (e.g. dermatotillomania, plus I like to say "kuh" and "guh"), subsyndromal OCD stuff (ESPECIALLY compulsive overeating). There's some other health stuff too like asthma and acne.
Sx: Feeling like @#$%, of course. Getting totally sick of apathy, lack of motivation and energy, hyperphagia, hypersomnia, SSRIs/SNRIs are sucking, and eerie anhedonia. Physical Sx of anxiety are controlled by Valium (diazepam), but I'm very avoidant and lacking in self-confidence. Desperately want to feel better in time for graduate school (starts in September).
Current Rx: Topamax 100mg, Valium (diazepam) 10mg, and now... Parnate.
Other Tx: In therapy (CBT emphasis), trying to get a jogging program going, yoga, journaling like a madman, fish oil 3 g epa/dha. Does laying in bed wishing the world didn't exist count as therapy?
Right now listening to: Nada Surf
_____________My scheduled titration is/was 2 days at 10mg, 7 days at 20mg, and then the remainder of the month at 30mg. I'm at 30mg today, my first day of it.
I'm excited about it, although some of my initial excitement has waned because it's not doing anything yet, not really. No significant effects or side effects. It initially raised my blood pressure by about 15 mm Hg but that's back to normal. The diet's really not hard.
I keep taking naps and I'm still all tired and 'blah'. I'm waiting for those "amphetamine-like properties" to kick in, because they sure haven't yet!
Thanks for reading.
- Chris
Posted by willyee on April 21, 2006, at 21:39:18
In reply to Babbler Takes Parnate, Turns Into Yeti, posted by Caedmon on April 21, 2006, at 21:23:41
My understanding is both Topamax and Valium
are king size sedatives.In fact i remember reading a lot on jokes about Topamax being dubbed Dopamax due to the sedation.
Not saying both dont have value,as i myself have wanted to try topamax,anyway u MIGHT MIGHT not get that initial beginners rush being on those two meds.
That rush however is short lived and long term anti depressant effects are what u really want and r waiting for.
Also another thing is Parnate EHANCES the effects of other drugs,which means parnate can actualy be making the other two meds a lil more POTENT,so u MIGHT want to talk to ur doc about lowering the others to see if u can get a response from parnate,im right there with u parnate for me is just not doing it im about to post my on post in a second,good luck to us both im sure without knowing u personaly i can say for sure like myself u deserve a break from hell.
Posted by SLS on April 21, 2006, at 22:03:17
In reply to Babbler Takes Parnate, Turns Into Yeti, posted by Caedmon on April 21, 2006, at 21:23:41
You might not see any benefit from Parnate until you are at 40mg for two weeks. I know it is hard to be patient. That you don't feel anything yet is normal. Try not to allow your outlook to become pessimistic. These drugs seem to work by forcing the brain to compensate and adjust itself in response to antidepressants. It takes approximately two weeks to see changes occur in receptor numbers. The range of therapeutic dosages normally seen lies between 40mg and 80mg.
It is too early to pass judgment. I hope you get lucky.
- Scott
Posted by Glydin on April 21, 2006, at 22:40:15
In reply to Re: Babbler Takes Parnate, Turns Into Yeti, posted by SLS on April 21, 2006, at 22:03:17
At least you're not a Florida Skunk Ape.
Seriously, good luck to you.
Posted by Phillipa on April 21, 2006, at 22:45:53
In reply to Yetis - I KNEW they were still around, posted by Glydin on April 21, 2006, at 22:40:15
Glydin's reunion night!!!!!!Love Phillipa
Posted by Crazy Horse on April 22, 2006, at 11:28:27
In reply to Babbler Takes Parnate, Turns Into Yeti, posted by Caedmon on April 21, 2006, at 21:23:41
> Here's my Parnate thread.
>
> Background
>
> 23-year-old male in Salt Lake City, UT. One (1) friend and a 30 hour per week job, and I'm afraid of losing both. I'm a speech therapy assistant. Going to grad school this Fall.
>
> Dx: Bipolar II w/ Tx-resistant atypical depression, social phobia (also Tx-resistant but I think that's normal for SP). *Probably* some subsyndromal inattentive ADD stuff, some vocal and motor tics (e.g. dermatotillomania, plus I like to say "kuh" and "guh"), subsyndromal OCD stuff (ESPECIALLY compulsive overeating). There's some other health stuff too like asthma and acne.
>
> Sx: Feeling like @#$%, of course. Getting totally sick of apathy, lack of motivation and energy, hyperphagia, hypersomnia, SSRIs/SNRIs are sucking, and eerie anhedonia. Physical Sx of anxiety are controlled by Valium (diazepam), but I'm very avoidant and lacking in self-confidence. Desperately want to feel better in time for graduate school (starts in September).
>
> Current Rx: Topamax 100mg, Valium (diazepam) 10mg, and now... Parnate.
>
> Other Tx: In therapy (CBT emphasis), trying to get a jogging program going, yoga, journaling like a madman, fish oil 3 g epa/dha. Does laying in bed wishing the world didn't exist count as therapy?
>
> Right now listening to: Nada Surf
> _____________
>
> My scheduled titration is/was 2 days at 10mg, 7 days at 20mg, and then the remainder of the month at 30mg. I'm at 30mg today, my first day of it.
>
> I'm excited about it, although some of my initial excitement has waned because it's not doing anything yet, not really. No significant effects or side effects. It initially raised my blood pressure by about 15 mm Hg but that's back to normal. The diet's really not hard.
>
> I keep taking naps and I'm still all tired and 'blah'. I'm waiting for those "amphetamine-like properties" to kick in, because they sure haven't yet!
>
> Thanks for reading.
>
> - ChrisHi Chris,
Yea, when it does kick in you won't be taking anymore naps. I've been on Parnate for over 2.5 mos. and still can't take a nap, i can lay down and rest comfortably, but never fall asleep. This is fine with me, naps would effect my nighttime sleep.Man, i hope Parnate works as well for you as it has for me. I also have social phobia and some ocd, both are well under control with the Parnate. I'm like the person now that i always wanted to be, my thoughts are clear and concise, and communication with others is fun and effertless. People,i.e., my brother, my sister, my wife, are always commenting on the huge positive change in me.
I've told you before i responded on day 10 at 60 mgs. Your response may take longer, and 40 mgs. might be efficient for you, but if no response at 40 for 1 week, i would recommend upping to 50, each week if no response up it. This however is only my personal opinion.
Anyway welcome to Parnateville Chris. I think and hope good things are in store for you! :)
Parnately yours, :^)
Monte
Posted by Caedmon on April 22, 2006, at 11:54:48
In reply to Re: Babbler Takes Parnate, Turns Into Yeti, posted by SLS on April 21, 2006, at 22:03:17
*sigh* You're right of course. Patience isn't one of my better qualities.
>> It is too early to pass judgment. I hope you get lucky.>>
Thanks for your support Scott :-)
- Chris
Posted by Caedmon on April 22, 2006, at 14:39:22
In reply to Re: Babbler Takes Parnate, Turns Into Yeti, posted by willyee on April 21, 2006, at 21:39:18
>> Also another thing is Parnate EHANCES the effects of other drugs,which means parnate can actualy be making the other two meds a lil more POTENT,so u MIGHT want to talk to ur doc about lowering the others>>
I hadn't heard this before, thanks! I think Parnate is metabolized by multiple liver enzymes, and I have heard that long-term users should have periodic liver panels. So, that makes sense.
- Chris
Posted by Caedmon on April 22, 2006, at 14:41:30
In reply to Yetis - I KNEW they were still around, posted by Glydin on April 21, 2006, at 22:40:15
> At least you're not a Florida Skunk Ape.
>
> Seriously, good luck to you.I'm so bummed out this morning, but you made me smile. :) Thanks.
- Chris
Posted by Caedmon on April 24, 2006, at 18:54:10
In reply to Re: Yetis - I KNEW they were still around » Glydin, posted by Caedmon on April 22, 2006, at 14:41:30
I've been on 30 mg of tranylcypromine for three days now and I'm finally noticing some small changes.
1) I'm a bit less anxious around other people. It's a different quality from benzos, which sort of sedate me but don't make me want to socialize. It's more of a pro-social, "I'm happy to talk to you now" sort of thing.
2) I feel like I can think better. Not so much cloudy thinking as I've had in the past. I have some definite (subsyndromal?) ADD tendencies and these are clearing up. I can follow conversations somewhat better.
3) Enjoying things I used to enjoy. This is a nice change. I'm actually engaging in certain activities, and wanting to, because they are FUN. I've been so apathetic towards everything that this is a nice change for me.
It's not a tremendous, "boom!" type of change, but it is noticeable. I like it.
Side effects: none. :) My sleep was just plain irregular for a few days but now it's normalized. No insomnia, no shorter length of sleep. I've seen no effect (no increase/decrease) in my appetite.
No blood pressure weirdness. It did raise my BP the first few days but now it's back to normal. (I naturally have a bit of hypotension anyway. My pre-Parnate BP average was 106/67.) It's probably a good thing that I started slow, I might be getting syncope feeling tremendous dizziness.
So, I am taking these as good signs anyway. :)
- C
Posted by Crazy Horse on April 24, 2006, at 19:19:11
In reply to My latest Parnate and cryptozoology updates, posted by Caedmon on April 24, 2006, at 18:54:10
Congratulations! I'm very happy for you. My recommendation is if you're doing well on 30 mgs. with NO INSOMNIA...stay there as long as possible. Parnate without insomnia is rare, consider yourself lucky. Insomnia is my biggest complaint about the "Big P", i have at least one night a week where i can't sleep at all...it sucks. Again congrats, doesn't it feel good to finally feel good? :)
Monte
Posted by Caedmon on April 24, 2006, at 23:28:08
In reply to Re: My latest Parnate and cryptozoology updates » Caedmon, posted by Crazy Horse on April 24, 2006, at 19:19:11
> Congratulations! I'm very happy for you. My recommendation is if you're doing well on 30 mgs. with NO INSOMNIA...stay there as long as possible. Parnate without insomnia is rare, consider yourself lucky. Insomnia is my biggest complaint about the "Big P", i have at least one night a week where i can't sleep at all...it sucks. Again congrats, doesn't it feel good to finally feel good? :)
>
> MonteLet's cross our fingers! Oh and to think, Monte, that I had begun to *doubt* Parnate! :p I'm crazy enough these days to think that these little red pills might work...
- C
Posted by Caedmon on May 2, 2006, at 16:52:42
In reply to Re: My latest Parnate and cryptozoology updates » Crazy Horse, posted by Caedmon on April 24, 2006, at 23:28:08
30mg for about 9(?) days. It might be helping, but I can't tell. I've gotten depressed again. It's sort of unimpressive so far. Maybe it needs more time.
I still get naps from it. I think this is a side effect I'm going to have to deal with, at least at this dosage. Otherwise no side effects.
Well... okay then.
- C
Posted by Caedmon on May 2, 2006, at 16:56:10
In reply to Re: My latest Parnate and cryptozoology updates, posted by Caedmon on May 2, 2006, at 16:52:42
Ideas?
I have heard of people taking buspirone or pindolol to help SSRIs work faster. (I don't know how often it really works, but...) Anything that might work for something like Parnate? Obviously those first two are contraindicated.
- C
Posted by ed_uk on May 2, 2006, at 17:24:48
In reply to Re: My latest Parnate and cryptozoology updates, posted by Caedmon on May 2, 2006, at 16:52:42
It's early days C, very early. There's a good chance that Parnate will work well for you :)
Ed
Posted by Crazy Horse on May 2, 2006, at 18:38:58
In reply to Re: My latest Parnate and cryptozoology updates, posted by Caedmon on May 2, 2006, at 16:52:42
> 30mg for about 9(?) days. It might be helping, but I can't tell. I've gotten depressed again. It's sort of unimpressive so far. Maybe it needs more time.
>
> I still get naps from it. I think this is a side effect I'm going to have to deal with, at least at this dosage. Otherwise no side effects.
>
> Well... okay then.
>
> - CMy opinion from personal experience is you need a dose increase...30 mgs. at 9 days and depressed again, bump it up to 40 (of course with pdocs permission). You are still early in the game, however the #1 reason maoi's fail is due to insufficient doses. Remember even 60 mgs. most people agree is based on Litigation fears. I think it'll work for you C, but you need to be more agressive with the dosing. I'm not a good example because i need high dose everything, my pdoc says i'm a poor absorber of meds, anyway by day 9 on was on 60 mgs. and it "kicked in" on day 10 for me, you will definitely know it when it kicks in...unlike other non maoi AD's you can feel a difference. I would say right now at 30 mgs. if you haven't felt a difference in 9 days...trust me with the right dose and adequate time you will "feel it", it's time to increase the dose. As always this is only my opinion...one i feel very strongly about :). Keep us posted, and don't give up. Best wishes.
Monte
Posted by Caedmon on May 5, 2006, at 13:40:54
In reply to Re: My latest Parnate and cryptozoology updates » Caedmon, posted by Crazy Horse on May 2, 2006, at 18:38:58
I'm sleeeeepy on Parnate.
I read that the standard time to onset is usually a few weeks for tranylcypromine despite "clinical lore" (lol, nice term) of being faster than the hydrazines. Also, I guess sedation is not uncommon with it. I'm taking 10 mg in the a.m., at noon, and in the evening, so it's all very spread out. It has a short half-life so this makes sense to me.
Still waiting for it to really kick in. I figure if I have to ask, "is it working yet?", then it probably isn't. I'll likely need a dose increase at my followup, and by then I think we'll have given the receptors a chance to change at the lower dose.
Naps! I'm a good nap-taker now. It's like clockwork, one or two naps every day. I used up my leftover modafinil, which was helping that, but now it's all gone. I have to get this weird pseudo-narcolepsy thing figured out. I don't know if I want to add a C2 stimulant if I don't need to, and modafinil is too expensive.
Hah, that could be fun to ask for, "can I have some amphetamine so that I don't fall asleep all the freakin' time?"
- C
Posted by ed_uk on May 6, 2006, at 12:21:38
In reply to Parnate turned me into a cat., posted by Caedmon on May 5, 2006, at 13:40:54
Hi sleepy
Quite a few people have reported that they need to take naps on Parnate, especially in the afternoon. I hope it gets better for you.
Ed
Posted by Jost on May 8, 2006, at 21:06:09
In reply to Parnate turned me into a cat., posted by Caedmon on May 5, 2006, at 13:40:54
> I'm sleeeeepy on Parnate.
>
> I read that the standard time to onset is usually a few weeks for tranylcypromine despite "clinical lore" (lol, nice term) of being faster than the hydrazines. Also, I guess sedation is not uncommon with it. I'm taking 10 mg in the a.m., at noon, and in the evening, so it's all very spread out. It has a short half-life so this makes sense to me.>
> - CI've read about the afternoon let-down/nap phenomenon, so maybe it's that.
I had a constant overwhelming fatigue reaction to parnate-- esp. at lower doses. It got better at higher doses-- although I was always very very weary on it.
I used both modafinil and adderal with it, but, although they helped, neither cut through the fatigue that much. I don't know about your insurance (if you have it), but mine stopped covering modafinil, except for narcolepsy-- and it is expensive.
If you're only taking naps and feeling okay between them, it might really work for you at higher levels. 30 mg. is a fairly low dose, so I would definitely not give up.
I hope it does work out for you. I thought the feel of it as a drug was pretty natural, and good,
Jost
Posted by Caedmon on June 2, 2006, at 11:31:53
In reply to Re: Parnate turned me into a cat., posted by Jost on May 8, 2006, at 21:06:09
I've been on 40mg of tranylcypromine for a couple weeks now and I would have to give it a BIG thumbs up for both depression and social anxiety! I am not in remission on either end, but I am much improved. It feels very natural, not apathy-inducing like SSRIs. I have energy and motivation now to do a lot of things - for example, I've taken up jogging, which used to be a hobby of mine. :-)
Side effects have been afternoon sedation - which, sometimes, is intense, although it is less intense now than it was at the start of treatment - and I had a period during which I experienced very mild heart palpitations while laying down. (The heart palpitations are gone now that I've reduced my caffeine.) It has dropped my blood pressure to an average of 107/60.
I'm debating three options in my head. I really think I could get at least the depression into remission (the social anxiety I have had for years, and I think that's just gonna take time and "exposure", yuk). I thought I could try:
(1) Adding a stimulant (methylphenidate, d-amphetamine)
+ Help w/ inattentiveness and sociability (still fairly low areas for me)
+ Compensate for Parnate side effects (tiredness, hypotension)
+ Evidence-based
- Increased physical anxiety, insomnia(2) Adding lithium
+ Decrease depression
+ “Bridging” antidepressant in case I ever need to switch ADs
+ Neurotrophic effects
+ Evidence-based
- New/ more side effects(3) Adding gabapentin
+ Decrease anxiety, depression
+ Hypnotic (cheaper than Ambien!)
+ Few side effects
- Lacks evidence of efficacy(4) Increase dosage of Parnate (60mg?)
+ Theoretical advantage of MAO inhibition approaching 80%+
+ Further decrease anxiety, depression
- Increase tiredness, arrhythmias(?)What do you think is a good option? Any other ideas? Comments? Questions? Thanks,
- Chris
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.