![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by itsme2003 on August 25, 2006, at 14:40:41
In the past I've tried over 20 anti-depressants or anti-depressant combinations but not had much luck treating my treatment resistant atypical depression. I am finally trying parnate, which I know often has good results for this type of depression.
I am self-medicating with parnate. I have been taking this for three weeks and have just moved my dosage to 30 mg / day taking 20mg in the morning and 10 mg mid-afternoon. I am very carefully following the dietary restrictions. I am currently taking no other meds. I am also on the Atkins diet (six years). I am a diabetic and my blood sugar is in great control. I weigh 280 lbs. and I have lost 10 pounds since starting parnate. I usually spend three hours per week working out in a gym.
Hypotension or postural hypotension is a know effect from parnate. My blood pressure has dropped considerably since starting parnate, which is no surprise to me. My heart rate has also dropped quite a bit since starting parnate, which is a surprise to me.
Prior to starting parnate my blood pressure was normally in the range of 130-140/85 and my resting heart rate was 85. Now my blood pressure ranges around 110/70 to sometimes as low as 100/62. My resting heart rate is now around 68. One time earlier this week my heart rate was 61. I don't feel light-headed when standing up, but I'm being cautious because I feel that at this BP I could easily be light-headed on standing.
I am using one of the electronic blood pressure cuffs and I know from previous comparisons that it correlates well to blood pressure readings that I have gotten from my doctor's office. I noticed a drop in my BP and heart rate when I first started with 10 mg of parnate and the drop has increased as I have increased my dosage. In addition I am very lethargic (my normal state is lethargic, but I'm even more so now). I believe that the lethargy is also an expected side effect of parnate.
Quite a few years ago I was very fit and my resting pulse rate was around 65 which I was not concerned about (and in fact I was pleased to be fit enough to get my resting pulse down that far). I'm not terribly worried about my heart rate now, but I am concerned a little. I am concerned that if my dosage needs to go higher (which I think will be likely) that my heart rate will fall even further. If I do increase my dosage and my resting pulse rate should fall below 60 I will immediately cut my dosage back.
I've read research about combining a very low dose amphetamine (5 mg / day) with parnate to help boost low BP. I currently have a prescription for adderall (which I'm not currently taking). I could divide one of the adderall into 5 mg doses to help boost my BP and heart rate.
Does anyone have any thoughts about my heart rate or about adding the low dose amphetamine to the mix? Should I cut back my dosage now to get my heart rate back up? Does this reaction reveal any interesting uderlying biochemistry?
Posted by silvercoin on August 25, 2006, at 16:19:45
In reply to Parnate and slow heartbeat, posted by itsme2003 on August 25, 2006, at 14:40:41
I've experienced lowered blood pressure and heart rate on all the MAOIs I've taken, including Parnate. Typically, my heart rate has declined into the 50's and has gotten down into the 40's. The lowered BP and heart rate were a severe problem the first time I was on Nardil, but in subsequent MAOI trials, they have only been a nuisance. It is not an especially large concern unless you suffer from heart failure or find yourself frequently on the verge of fainting. I have also noticed fatigue-like symptoms on these various MAOIs and would tend to ascribe this to the lowered BP and heart rate as well. Low dose stimulants are sometimes used to ameliorate these effects seen with MAOIs, but they need to be added slowly and cautiously in dosages very much as you are suggesting. I believe what you are suggesting is relatively safe and might be worth a try. However, it might be good to have some nifedipine around just in case; I might want to have some for peace of mind, but it is probably not absolutely necessary.
Todd
Posted by willyee on August 25, 2006, at 16:25:36
In reply to Parnate and slow heartbeat, posted by itsme2003 on August 25, 2006, at 14:40:41
> In the past I've tried over 20 anti-depressants or anti-depressant combinations but not had much luck treating my treatment resistant atypical depression. I am finally trying parnate, which I know often has good results for this type of depression.
>
> I am self-medicating with parnate. I have been taking this for three weeks and have just moved my dosage to 30 mg / day taking 20mg in the morning and 10 mg mid-afternoon. I am very carefully following the dietary restrictions. I am currently taking no other meds. I am also on the Atkins diet (six years). I am a diabetic and my blood sugar is in great control. I weigh 280 lbs. and I have lost 10 pounds since starting parnate. I usually spend three hours per week working out in a gym.
>
> Hypotension or postural hypotension is a know effect from parnate. My blood pressure has dropped considerably since starting parnate, which is no surprise to me. My heart rate has also dropped quite a bit since starting parnate, which is a surprise to me.
>
> Prior to starting parnate my blood pressure was normally in the range of 130-140/85 and my resting heart rate was 85. Now my blood pressure ranges around 110/70 to sometimes as low as 100/62. My resting heart rate is now around 68. One time earlier this week my heart rate was 61. I don't feel light-headed when standing up, but I'm being cautious because I feel that at this BP I could easily be light-headed on standing.
>
> I am using one of the electronic blood pressure cuffs and I know from previous comparisons that it correlates well to blood pressure readings that I have gotten from my doctor's office. I noticed a drop in my BP and heart rate when I first started with 10 mg of parnate and the drop has increased as I have increased my dosage. In addition I am very lethargic (my normal state is lethargic, but I'm even more so now). I believe that the lethargy is also an expected side effect of parnate.
>
> Quite a few years ago I was very fit and my resting pulse rate was around 65 which I was not concerned about (and in fact I was pleased to be fit enough to get my resting pulse down that far). I'm not terribly worried about my heart rate now, but I am concerned a little. I am concerned that if my dosage needs to go higher (which I think will be likely) that my heart rate will fall even further. If I do increase my dosage and my resting pulse rate should fall below 60 I will immediately cut my dosage back.
>
> I've read research about combining a very low dose amphetamine (5 mg / day) with parnate to help boost low BP. I currently have a prescription for adderall (which I'm not currently taking). I could divide one of the adderall into 5 mg doses to help boost my BP and heart rate.
>
> Does anyone have any thoughts about my heart rate or about adding the low dose amphetamine to the mix? Should I cut back my dosage now to get my heart rate back up? Does this reaction reveal any interesting uderlying biochemistry?
>Im surprised the depression itself dident have an impact on your energy levels and working out.I know prior to being sick i spent hours lifting,since getting sick that dwindled and dwindled,i have combine dex and ritalin with parnate,and it appeared to be more of a brain motor energy feel opposed to a physical energy.
Of course everyone is different,be cautious,and if you have any ocd tendcies really avoid this combo.Just my two cents.
Posted by itsme2003 on August 27, 2006, at 11:13:23
In reply to Re: Parnate and slow heartbeat, posted by willyee on August 25, 2006, at 16:25:36
Thanks for the replies.
I actually have some Nifedipine 10 mg on hand to use for altitude sickness. I get altitiude sickness above 7000 feet and on the rare occasion that I go to that elevation I want to be prepared.
What is the treatment protocol for using Nifedipine with a hypertensive reaction from MAOIs?
The point about the exercise is very valid. In my case it's not so much about the energy that I put into my workouts as it is the difficulty that I have in getting myself to the gym in the first place. I would say that my workouts are not quite as intense as they used to be, but while I'm at the gym I can really put forth the effort. I would say that in a 90 minute workout I do about 80% as much exercise as I did years ago, and I would say that I put 90% as much energy into any individual exercise as I used to.
On the other hand getting to the gym is entirely different. I used to work out 6 - 8 hours per week (3 - 4 x 2 hours). Now it takes everything that I can do to get myself to the gym for 3 hours per week (2 x 1.5 hours). It's only because I truly understand the benefits of exercise as regards both my health and my mental health that I'm even able to make it to the gym at all.
Posted by Jost on August 27, 2006, at 23:22:15
In reply to Re: Parnate and slow heartbeat, posted by itsme2003 on August 27, 2006, at 11:13:23
Unless you have special expertise, self-medicating with Parnate doesn't sound like a completely safe idea.
Moreover, I wouldn't try adding adderall or anything else that's contraindicated--or problematic--until I had reached the dose I was stabilized on.
And then I'd only do it after a time, so as to be sure that I'd accommodated, and things had leveled out.
But once things get complicated--which they seem to have-- you really are playing with fire, IMHO, to add to an already-somewhat-edgy drug.
Be careful.
Jost
Posted by willyee on August 28, 2006, at 11:01:00
In reply to Re: Parnate and slow heartbeat » itsme2003, posted by Jost on August 27, 2006, at 23:22:15
> Unless you have special expertise, self-medicating with Parnate doesn't sound like a completely safe idea.
>
> Moreover, I wouldn't try adding adderall or anything else that's contraindicated--or problematic--until I had reached the dose I was stabilized on.
>
> And then I'd only do it after a time, so as to be sure that I'd accommodated, and things had leveled out.
>
> But once things get complicated--which they seem to have-- you really are playing with fire, IMHO, to add to an already-somewhat-edgy drug.
>
> Be careful.
>
> Jost
>
>I agree self medicating with contradictory medications should be reserved for a MUST and specific reason,and avoided at all possable.
Unfortunatly i dont agree self medicating with parnate is such a bad idea,ive contacted glaxco a number of times,and broken down to the pharmacy level where they still stumbled over there own words,and basicaly read from sites i was reading from word by word.
Docs used the paragraph or so in the PDR to work with it.Which is very little.
Uusaly a doc will have so much everyay experiance with a drug theyll learn the most that way,parnate being a drug usualy uncommon,its NOT uncommon i believe for a doc to not use it correctly,or at least most benificiacly,i think my last doc preferred i suggested to her dose ranges,as she seemed not to remember much of it except it helped a great deal of patients before she stopped using maois period.
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.