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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by River1924 on May 1, 2007, at 12:36:17
Is anyone on Parnate? Has your motivation improved? Has it helped you make changes in your life?
Any side-effects- sleeplessness?
I feed better but sleep is difficult.
Roger.
Posted by Honore on May 1, 2007, at 17:30:36
In reply to 90 mg Parnate, posted by River1924 on May 1, 2007, at 12:36:17
I found that I slept very lightly, or only half-slept. I also had extremely persistent and odd, repetitive dreams that lasted seemingly for hours.
I think this was a very atypical response-- but it was quite notable the entire time I used Parnate.
Have you tried seroquel, or, if sleep is less problematic, ambien?
I've used both of those. Small doses of seroquel are quite effective for insomnia. I never tried it while on the Parnate, but use it now.
Honore
Posted by malcolm64 on May 1, 2007, at 19:20:21
In reply to 90 mg Parnate, posted by River1924 on May 1, 2007, at 12:36:17
> Is anyone on Parnate? Has your motivation improved? Has it helped you make changes in your life?
>
> Any side-effects- sleeplessness?
>
> I feed better but sleep is difficult.
>
>
> Roger.I just started Parnate a few days ago and am still only on 20 mgs. I go up to 30 mgs this Friday. So far, I'm sleeping really well, but that's probably b/c of the low dose I'm on. What I notice is fatigue (although strangely today, it seemed a bit less).
I'm just curious, 90 mgs is a very high dose of this med. When you say that you feel better, can you describe how so? And how long have you been on it?
thanks-
Malcolm
Posted by Jedi on May 2, 2007, at 3:50:17
In reply to 90 mg Parnate, posted by River1924 on May 1, 2007, at 12:36:17
> Is anyone on Parnate? Has your motivation improved? Has it helped you make changes in your life?
Hi Roger,
I've been on 80mg of Parnate for a month after being between 75mg and 105mg of Nardil for years. I think it is starting to kick in. No major depression at this point. Maybe some dysthymia. I believe my motivation has improved some. I had one failed trial on Parnate about seven years ago. I don't think we pushed the dosage enough or tried augmentation with lithium or stimulants. This time, I'm going to do whatever it takes to make this med work.> Any side-effects- sleeplessness?
My main side effect is afternoon somnolence. After work, it is very hard to get by without a nap. Of course, this adds to nightime insomnia which I am treating with 25 to 50mg of Seroquel.
> I feed better but sleep is difficult.Again,I find Seroquel is the best for my insomnia.
Hope it works for you,
Jedi
Posted by Girlnterrupted on May 2, 2007, at 7:55:29
In reply to Re: 90 mg Parnate » River1924, posted by Jedi on May 2, 2007, at 3:50:17
Hey Jedi,
I have a question: You say you were on Nardil for years. How many years? How effective was it, and for how long?
Did it poop-out? If so, how soon did that happen?
Thnx for any info =)
Posted by Jedi on May 2, 2007, at 12:09:01
In reply to Re: 90 mg Parnate » Jedi, posted by Girlnterrupted on May 2, 2007, at 7:55:29
> I have a question: You say you were on Nardil for years. How many years? How effective was it, and for how long?
Hi,
I just posted to you in another thread about my opinion of Nardil. I took Nardil for most of the past ten years. It saved my life.
>Did it poop-out? If so, how soon did that happen?If you get hypomanic on this med, do not misinterpret the loss of that effect for poop out. You have to compare how you feel without the med to how feel with the med. I quit Nardil four times over that ten year period, mostly to try newer meds with less side effects. None of them worked. All of the SSRIs, SNRIs and tricyclics failed. I could get into an exhaustive list, but it is 40+ combinations.
I am currently trying Parnate for the 2nd time. So far so good, but it is no better than Nardil for me, except for the loss of the severe sweet carbohydrate cravings. This is what I am after, as that was my worst side effect on Nardil. It doesn't hit everyone, but it did me.
Take care,
Jedi
Posted by stevezen on May 5, 2007, at 10:22:55
In reply to Re: 90 mg Parnate » Girlnterrupted, posted by Jedi on May 2, 2007, at 12:09:01
just to add, I'm nearing the end of my 7th week on parnate. I've managed to get the dose up to 60mg's, not without the difficulty of daytime solmnolence. it makes me wonder if in the opening stages of taking this med, we should be incouraged to take it before bed.
I've not seen it mentioned anywhere, but I do think about it when I'm dizzy, freezing cold, tired beyond belief!
maybe once our bodies have adapted, we can enjoy the pro-stimulating qualities it's supposed to have but I've not yet come accross.
I'm shooting for 70mg's today, had 40 this morning and seem to still be up and about. I know for sure though the following 30mg's is gonna knock me for six!
I have had one pro-social day so far, by my standards anyway, small talk isn't usually my forte, but I found myself at least saying something instead of yer or no!
feeling pretty depressed and introvered today though :(
go go parnate!
Posted by River1924 on May 5, 2007, at 10:40:26
In reply to Re: 90 mg Parnate, posted by stevezen on May 5, 2007, at 10:22:55
I'm not expecting any miracles.
I started at 30 mg and quickly raised it to over 90 mg over two weeks.
I follwed these instructions----
Early Phase Treatment:
Dosage should be increased to at least 60 mg/day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to 90 mg/day to obtain sufficient MAO inhibition. Many patients do not show a clinical response until treatment at 60 mg has been continued for at least 4 weeks.Maintenance Dose:
After maximum benefit from phenelzine (Nardil, Parnate) is achieved, dosage should be reduced slowly over several weeks. Maintenance dose may be as low as 1 tablet, 15 mg/day or every other day, and should be continued for as long as is required.--------
So far I've learned not to take any pills after mid-afternoon. I tend to have hypersomnia but with this dose of Parnate, I can not sleep at all if I take it too late in the day.
Each time I take a handful of Parnate, I get a headache but that goes away within an hour.
I began April 13 2007 so it has only been three week so far.
Later. Roger.
Posted by Honore on May 5, 2007, at 10:54:44
In reply to Re: 90 mg Parnate, posted by River1924 on May 5, 2007, at 10:40:26
Was there some reason you didn't stay at 60 mg for a while to see if that was a therapeutic dose, and also to adjust to the drug?
Honore
Posted by Malcolm64 on May 5, 2007, at 11:29:05
In reply to Re: 90 mg Parnate, posted by River1924 on May 5, 2007, at 10:40:26
> I'm not expecting any miracles.
>
> I started at 30 mg and quickly raised it to over 90 mg over two weeks.
>
> I follwed these instructions----
>
> Early Phase Treatment:
> Dosage should be increased to at least 60 mg/day at a fairly rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to 90 mg/day to obtain sufficient MAO inhibition. Many patients do not show a clinical response until treatment at 60 mg has been continued for at least 4 weeks.
>
> Maintenance Dose:
> After maximum benefit from phenelzine (Nardil, Parnate) is achieved, dosage should be reduced slowly over several weeks. Maintenance dose may be as low as 1 tablet, 15 mg/day or every other day, and should be continued for as long as is required.
>
> --------
>
> So far I've learned not to take any pills after mid-afternoon. I tend to have hypersomnia but with this dose of Parnate, I can not sleep at all if I take it too late in the day.
>
> Each time I take a handful of Parnate, I get a headache but that goes away within an hour.
>
> I began April 13 2007 so it has only been three week so far.
>
> Later. Roger.
>
>
>
I wanted to ask something that I don't believe has been discussed before: what about taking Parnate and Nardil at the same time? Obviously, the doses would need to be adjusted to safe levels, but I'm just wondering if these two meds can be combined safely to get more "bang for the buck" if you will. That way the strengths of each drug would be combined to deliver maximum effectiveness.Has anyone ever tried this before and has it helped?
I realize I may be grasping at straws here, but I thought I'd ask.
Malcolm
Posted by Jedi on May 5, 2007, at 14:17:16
In reply to Re: 90 mg Parnate, posted by stevezen on May 5, 2007, at 10:22:55
> just to add, I'm nearing the end of my 7th week on parnate. I've managed to get the dose up to 60mg's, not without the difficulty of daytime solmnolence. it makes me wonder if in the opening stages of taking this med, we should be incouraged to take it before bed.
> I've not seen it mentioned anywhere, but I do think about it when I'm dizzy, freezing cold, tired beyond belief!
> maybe once our bodies have adapted, we can enjoy the pro-stimulating qualities it's supposed to have but I've not yet come accross.
> I'm shooting for 70mg's today, had 40 this morning and seem to still be up and about. I know for sure though the following 30mg's is gonna knock me for six!
> I have had one pro-social day so far, by my standards anyway, small talk isn't usually my forte, but I found myself at least saying something instead of yer or no!
> feeling pretty depressed and introvered today though :(
> go go parnate!Hi stevezen,
I've been at 80mg of Parnate for over a month now. I'm not great, but I haven't fallen back into major depression. I'm going to ask my doctor to either go to 100mg or add a small dosage of a stimulant to get over the daytime somnolence. I would like to try adding modafinil(Provigil), but because of the cost I may have to try a tiny dose of methylphenidate(Ritilan). I really thought the daytime tiredness would be gone by now, but it is nap time about 5pm every day! I am just exhausted, even though I'm getting good sleep at night with 25mg of Seroquel. So far, Parnate isn't working as well as Nardil for my social anxiety. I expected that because of it's lack of effect on Gaba. I'm not giving up on this med. I still have things to try: higher dosage, lithium, stimulants, drop Seroquel, increase clonazepam.
Good Luck,
Jedi
Posted by Jedi on May 5, 2007, at 14:27:27
In reply to Re: 90 mg Parnate, posted by River1924 on May 5, 2007, at 10:40:26
> Each time I take a handful of Parnate, I get a headache but that goes away within an hour.
>
Hi Roger,
I would recommend taking your blood pressure if you are getting headaches after each dose of Parnate. Though it is rare, some people do get spontaneous increases in BP from Parnate. I almost never get headaches, so if I get one I'm racking my brain to determine if I ate anything wrong.
Take care,
Jedi
Posted by Jedi on May 5, 2007, at 15:07:30
In reply to Can you take Parnate and Nardil at the same time?, posted by Malcolm64 on May 5, 2007, at 11:29:05
> I wanted to ask something that I don't believe has been discussed before: what about taking Parnate and Nardil at the same time? Obviously, the doses would need to be adjusted to safe levels, but I'm just wondering if these two meds can be combined safely to get more "bang for the buck" if you will. That way the strengths of each drug would be combined to deliver maximum effectiveness.
> Has anyone ever tried this before and has it helped?
> I realize I may be grasping at straws here, but I thought I'd ask.
> MalcolmMalcom,
I'll take a look for the research but combining Nardil & Parnate would be a very dangerous combination. I remember someone on the board a year or two ago was going to try it. Since both medications affect serotonin, Serotonin Syndrome would be a possible outcome. Any medication that increases serotonin when combined with a MAOI is the most frequent cause of Serotonin Syndrome. Usually the articles talk about increasing serotonin by different methods, which is the reason all SSRIs are a NO-NO with MAOIs. I'll research further, but DON'T DO IT.
Jedi
Posted by Jedi on May 5, 2007, at 15:40:47
In reply to Can you take Parnate and Nardil at the same time?, posted by Malcolm64 on May 5, 2007, at 11:29:05
> I wanted to ask something that I don't believe has been discussed before: what about taking Parnate and Nardil at the same time? Obviously, the doses would need to be adjusted to safe levels, but I'm just wondering if these two meds can be combined safely to get more "bang for the buck" if you will. That way the strengths of each drug would be combined to deliver maximum effectiveness.
> Has anyone ever tried this before and has it helped?
> I realize I may be grasping at straws here, but I thought I'd ask.
> MalcolmMalcom,
Here is some of the research:Ann Pharmacother. 1992 Mar;26(3):337-8.
Central nervous system toxicity after abrupt monoamine oxidase inhibitor switch: a case report. Safferman AZ, Masiar SJ.
Hillside Hospital, Division of Long Island Jewish Medical Center, Glen Oaks, NY.DESCRIPTION: There have been numerous case reports of adverse reactions involving monoamine oxidase inhibitors (MAOIs), including reactions that developed when one MAOI was substituted for another. Although most reports have usually described a switch from isocarboxazid or phenelzine to tranylcypromine, we report a case of acute central nervous system toxicity possibly associated with a switch from phenelzine to isocarboxazid. SYMPTOMATOLGY: Predominant symptoms included stuporous sensorium, hypertension, tachycardia, tremor, and urinary retention. Onset of symptoms began within 48 hours after the abrupt MAOI switch. CONCLUSIONS: Clinicians must allow a sufficient washout period before adding any agent that has a known potential to interact adversely with MAOIs. In addition, patients who are unusually sensitive to one type of MAOI may also be at increased risk for developing problems with a different MAOI secondary to unforeseen pharmacokinetic or pharmacodynamic effects, even at doses that are usually considered subtherapeutic.
PMID: 1554951 [PubMed - indexed for MEDLINE]
J Clin Psychiatry. 1998 Jul;59(7):382.
Stroke resulting from a rapid switch from phenelzine to tranylcypromine. Mattes JA.
PMID: 9714269 [PubMed - indexed for MEDLINE]
Posted by Joe44 on May 9, 2007, at 23:13:53
In reply to Re: Can you take Parnate and Nardil at the same time? » Malcolm64, posted by Jedi on May 5, 2007, at 15:40:47
I've been on parnate for just four days...how long would I need to wait before I try sertraline?
Posted by Joe44 on May 9, 2007, at 23:16:23
In reply to Re: Can you take Parnate and Nardil at the same ti, posted by Joe44 on May 9, 2007, at 23:13:53
I forget to mention...How long would I have to wait if I stopped parnate now and went onto an ssri (sertraline). Would only having been on parnate for a few days mean I don't have to wait as long?
The side effects of parnate are just too strong for me (low bp, fast and hard pulse etc).
Posted by Jedi on May 10, 2007, at 1:50:42
In reply to Re: Can you take Parnate and Nardil at the same ti, posted by Joe44 on May 9, 2007, at 23:16:23
> I forget to mention...How long would I have to wait if I stopped parnate now and went onto an ssri (sertraline). Would only having been on parnate for a few days mean I don't have to wait as long?
>
> The side effects of parnate are just too strong for me (low bp, fast and hard pulse etc).
Hi Joe,
I wish I had a direct response to your question. Parnate can be a very fast acting med compared to some of the other MAOIs. You did not indicate the dosage you were on, that could make a big difference. Differrent people metabolize medications at different rates. The normal wait is 14 days; I'm sure your wait can be less than that. But, you are playing with fire. The most common cause of Serotonin Syndrome is combining a MAOI with a medication that increases serotonin by another means(sertraline and other SSRIs are common offenders). You really need to ask an expert psychopharmacologist who is familar with MAOIs and has ALL of the relevant information on this one. Sorry I could not be more help, but better safe than sorry. Serotonin Syndrome is nasty and can be fatal.
Jedi
Posted by joe44 on May 10, 2007, at 2:00:51
In reply to Parnate washout » Joe44, posted by Jedi on May 10, 2007, at 1:50:42
Thanks for the reply Jedi.
I started on 20mg am + 20mg midday for the first three days, then upped to 30mg + 20mg.
I have read that perhaps I should wait and see if the effects subside in a week or two, so I may stick it out. Perhaps I have started at too high doses and not given my body time to adjust. Nevertheless the AD properties are great, especially the anxiety and negative self talk.
I actually started another thread about my predicament with more info on the side-effects I've encountered; http://www.dr-bob.org/babble/20070509/msgs/757322.html
Thanks again for the advice :)
Posted by kaleidoscope on May 10, 2007, at 13:49:40
In reply to Re: Parnate washout, posted by joe44 on May 10, 2007, at 2:00:51
>I started on 20mg am + 20mg midday for the first three days, then upped to 30mg + 20mg.
10mg once or twice a day would be a normal starting dose.
Ed
This is the end of the thread.
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