![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Malcolm64 on May 10, 2007, at 15:04:58
Well it's been close to two weeks since I started the Parnate and I'm up to 30 mgs and still...nothing. And no sleep problems either (not last night anyway).
I called my doc last night and he left me a message saying that he had actually been rather aggressive in terms of the dose I'm on, but is 30 mgs really an aggressive dose? I thought that I'd have to be in the 80-100 mg range.
Of course, I won't know what he meant until I actually talk with him, but I'm getting awfully anxious, especially since I'm job hunting right now (and that alone can shoot someone's anxiety level sky high, especially someone with SA).
Now I know that no one here knows me personally, but I'm just wondering if my frequent posts here are starting to come across as whining. Would you all let me know if does?
Malcolm
Posted by Quintal on May 10, 2007, at 17:28:00
In reply to Parnate at 30 mgs - still nothing, posted by Malcolm64 on May 10, 2007, at 15:04:58
From past experience I wouldn't expect much of a response at 30mg, but sadly many psychiatrists unfamiliar with MAOIs will heed the ultra conservative advice given in their prescribing manuals. In the UK the maximum recommended dose is 30mg, doses higher than this, it warns, must be used under close supervision only, adding; usual maintenance dose 10mg daily. I've never heard of anyone using or responding to those doses in real life (though they no doubt exist).
When starting Parnate I read here that it doesn't really begin to work until the 40mg mark, and my experiences with it would support that. I can only assume the 10mg maintenance dose is recommended on the theory that Parnate works purely through MAO inhibition and that this can be maintained with a small 10mg dose. It's a flawed hypothesis IMO.
My advice would be not to expect too much until you reach the 40mg mark, and no I don't think you're whining. It's entirely normal to feel frustrated with little progress.
Q
Posted by Quintal on May 10, 2007, at 18:08:11
In reply to Parnate at 30 mgs - still nothing, posted by Malcolm64 on May 10, 2007, at 15:04:58
Well would you credit it? As I sit here declaring that Parnate doesn't begin to work until the 40mg range, here above is a new Parnate user having exactly that experience.
http://www.dr-bob.org/babble/20070509/msgs/757322.html
Q
Posted by FredPotter on May 10, 2007, at 18:46:12
In reply to Re: Parnate at 30 mgs - still nothing » Malcolm64, posted by Quintal on May 10, 2007, at 17:28:00
Don't you have to take it for a few weeks before it works, like with Nardil? It took 6.5 weeks working up to 75 mg Nardil before there was an improvement
Posted by Quintal on May 10, 2007, at 20:11:15
In reply to Re: Parnate at 30 mgs - still nothing » Quintal, posted by FredPotter on May 10, 2007, at 18:46:12
It can take time yes, but with Parnate (when it works) people usually the effect within a few days of reaching their optimum dose. Nardil is much slower, it seems to work on a similar timescale to other antidepressants like SSRIs. I don't know why.
Q
Posted by Phillipa on May 10, 2007, at 21:28:51
In reply to Re: Parnate at 30 mgs - still nothing » FredPotter, posted by Quintal on May 10, 2007, at 20:11:15
Quintal I didn't know that thanks for the education. Love Phillipa
Posted by Jedi on May 11, 2007, at 2:34:51
In reply to Parnate at 30 mgs - still nothing, posted by Malcolm64 on May 10, 2007, at 15:04:58
> Well it's been close to two weeks since I started the Parnate and I'm up to 30 mgs and still...nothing. And no sleep problems either (not last night anyway).
Hi Malcolm,
Two weeks is a very short time and 30mg is a ridiculously small dose if a person is treatment resistant. I see no reason to be on Parnate if you are not treatment resistant.
> I called my doc last night and he left me a message saying that he had actually been rather aggressive in terms of the dose I'm on, but is 30 mgs really an aggressive dose? I thought that I'd have to be in the 80-100 mg range.Maybe your doc feels that 30mg is aggressive after only two weeks. Maybe he just plans to take you up slowly. I would ask him directly what his dosage plans are. If he is going to stop at 30mg, he is just wasting your time. I've been at 80mg for five weeks and I'm still not as well as on 90mg of Nardil. Of course, I'm in an experiment with a small sample size, n=1. My main side effect is still the daytime somnolence. I had to take a two hour nap to get through the day. If not for the weight gain side effect,I would be back on Nardil. Have you tried phenelzine? IMHO, when combined with clonazepam, it is the best for social anxiety.
> Of course, I won't know what he meant until I actually talk with him, but I'm getting awfully anxious, especially since I'm job hunting right now (and that alone can shoot someone's anxiety level sky high, especially someone with SA).
>
> Now I know that no one here knows me personally, but I'm just wondering if my frequent posts here are starting to come across as whining. Would you all let me know if does?
>
> MalcolmSeems to me that you are just someone doing their best to find help. I don't think that anyone in this group would call that whining.
Good Luck,
Jedi
Posted by malcolm64 on May 11, 2007, at 18:46:04
In reply to Re: Parnate at 30 mgs - still nothing » Malcolm64, posted by Jedi on May 11, 2007, at 2:34:51
> > Well it's been close to two weeks since I started the Parnate and I'm up to 30 mgs and still...nothing. And no sleep problems either (not last night anyway).
>
> Hi Malcolm,
> Two weeks is a very short time and 30mg is a ridiculously small dose if a person is treatment resistant. I see no reason to be on Parnate if you are not treatment resistant.
>
> > I called my doc last night and he left me a message saying that he had actually been rather aggressive in terms of the dose I'm on, but is 30 mgs really an aggressive dose? I thought that I'd have to be in the 80-100 mg range.
>
> Maybe your doc feels that 30mg is aggressive after only two weeks. Maybe he just plans to take you up slowly. I would ask him directly what his dosage plans are. If he is going to stop at 30mg, he is just wasting your time. I've been at 80mg for five weeks and I'm still not as well as on 90mg of Nardil. Of course, I'm in an experiment with a small sample size, n=1. My main side effect is still the daytime somnolence. I had to take a two hour nap to get through the day. If not for the weight gain side effect,I would be back on Nardil. Have you tried phenelzine? IMHO, when combined with clonazepam, it is the best for social anxiety.
>
> > Of course, I won't know what he meant until I actually talk with him, but I'm getting awfully anxious, especially since I'm job hunting right now (and that alone can shoot someone's anxiety level sky high, especially someone with SA).
> >
> > Now I know that no one here knows me personally, but I'm just wondering if my frequent posts here are starting to come across as whining. Would you all let me know if does?
> >
> > Malcolm
>
> Seems to me that you are just someone doing their best to find help. I don't think that anyone in this group would call that whining.
> Good Luck,
> JediJedi: thanks for that reassurance, sometimes it's hard to know. All I know is that ever since I started the Parnate I've lost interest in working out, which is one of the primary indicators of my mental health. I've always been addicted to fitness, so when I lose interest in working out, it's never a good sign.
Of course, as I mentioned in an earlier post, I'm job hunting and that's always a stressful situation, b/c employers make decisions on their own schedule, not on yours.
Plus I continue to do badly in job interviews (it's almost as if what's on my resume doesn't really reflect what I've done - like I'm making it all up). But that's b/c I can't F*CKING remember anything I've done and make it relevant to an employer. So why would anyone want to hire me when there are tons more qualified, competent people out there?
This situation causes me more grief than almost everything else combined. Given that you spend the majority of your day at work, what you do for a living matters a LOT in status-conscious Washington, DC (as it does in most major cities).
And it embarrasses me tremendously that I'm STILL on disability five years after my near-fatal suicide attempt. In a way, I feel like it's being on welfare.
So that's more background than I really feel comfortable sharing, but I figure no one can offer any meaningful advice without knowing all of the facts. So there they are.
Malcolm
Posted by malcolm64 on May 11, 2007, at 19:12:14
In reply to Re: Parnate at 30 mgs - still nothing » Malcolm64, posted by Jedi on May 11, 2007, at 2:34:51
> > Well it's been close to two weeks since I started the Parnate and I'm up to 30 mgs and still...nothing. And no sleep problems either (not last night anyway).
>
> Hi Malcolm,
> Two weeks is a very short time and 30mg is a ridiculously small dose if a person is treatment resistant. I see no reason to be on Parnate if you are not treatment resistant.
>
> > I called my doc last night and he left me a message saying that he had actually been rather aggressive in terms of the dose I'm on, but is 30 mgs really an aggressive dose? I thought that I'd have to be in the 80-100 mg range.
>
> Maybe your doc feels that 30mg is aggressive after only two weeks. Maybe he just plans to take you up slowly. I would ask him directly what his dosage plans are. If he is going to stop at 30mg, he is just wasting your time. I've been at 80mg for five weeks and I'm still not as well as on 90mg of Nardil. Of course, I'm in an experiment with a small sample size, n=1. My main side effect is still the daytime somnolence. I had to take a two hour nap to get through the day. If not for the weight gain side effect,I would be back on Nardil. Have you tried phenelzine? IMHO, when combined with clonazepam, it is the best for social anxiety.Yes, I was on Phenelzine (Nardil) about a year ago, had a fantastic reaction to it, but it pooped out after just 3 weeks. I don't remember augmenting it with Clonazepam (except possibly at night to help me sleep). The fantastic thing about Nardil when it first worked was that I could have cared less whether someone was friendly to me or blew me off - I was happy regardless. But now the slightlest rejection is painful.
I still don't understand how a mere medication could so completely wipe away feelings of shame and angst. Hell, when the Nardil first worked, I actually enrolled in a bartending class as a way to make some fast cash. Imagine me, as a bartender!!? I never would have thought in a million years that that was something I could actually do, but the Nardil caused such a miraculous transformation of my personality it was unbelieveable. Needless to say, I dropped out of the class when it became clear that the Nardil effects wouldn't last. And that ended my flirtation with bartending. Never again.
The one thing that continues to piss me off about my doc is that he NEVER told me that the euphoria wouldn't last. I'm still seeing him, b/c he and I have an established, caring relationship for many years, but it still pisses me off that he never told me. Which leads me to believe that he had no real experience with MAOI's to begin with.
And if he did, why the hell did he wait until I nearly died after OD'ing on 40 tricyclic tabs when there was a med (MAOI's) that had been available for decades before trying it with me. And I was the one who suggested it to him, not the other way around.
It's a still a sore subject with me.
Malcolm
>
> > Of course, I won't know what he meant until I actually talk with him, but I'm getting awfully anxious, especially since I'm job hunting right now (and that alone can shoot someone's anxiety level sky high, especially someone with SA).
> >
> > Now I know that no one here knows me personally, but I'm just wondering if my frequent posts here are starting to come across as whining. Would you all let me know if does?
> >
> > Malcolm
>
> Seems to me that you are just someone doing their best to find help. I don't think that anyone in this group would call that whining.
> Good Luck,
> Jedi
>
Posted by Jedi on May 11, 2007, at 21:05:58
In reply to Re: Parnate at 30 mgs - still nothing, posted by malcolm64 on May 11, 2007, at 19:12:14
> Yes, I was on Phenelzine (Nardil) about a year ago, had a fantastic reaction to it, but it pooped out after just 3 weeks. I don't remember augmenting it with Clonazepam (except possibly at night to help me sleep). The fantastic thing about Nardil when it first worked was that I could have cared less whether someone was friendly to me or blew me off - I was happy regardless. But now the slightlest rejection is painful.
Malcolm,
Forgive me for my less than acute memory. I now recall that you had posted about your Nardil experience. Ten years of fighting major atypical depression and social anxiety with 40+ combinations of meds has left my mind just a little mushy.One of the symptoms of atypical depression is rejection sensitivity. Before MAOIs and clonazepam the slightest critisism would wipe me out. I say major depression for ten years, but I fought dysthymia with the social anxiety for another twenty-five years before that. It seems to have started about the time I started high school. When greeting someone my hands would be so sweaty, I would have to wipe them on my pants before shaking hands.
> I still don't understand how a mere medication could so completely wipe away feelings of shame and angst. Hell, when the Nardil first worked, I actually enrolled in a bartending class as a way to make some fast cash. Imagine me, as a bartender!!? I never would have thought in a million years that that was something I could actually do, but the Nardil caused such a miraculous transformation of my personality it was unbelieveable. Needless to say, I dropped out of the class when it became clear that the Nardil effects wouldn't last. And that ended my flirtation with bartending. Never again.Nardil did exactly the same thing for me. The lifting of the depression and anxiety was indeed euphoric. I think your mistake was believing that this touch of hypomania was going to last forever. When the mania went away, you interpreted that as a loss in efficacy of the Nardil. I wish I could have kept that feeling also, but that was not the true antidepressant effect. For me also, augmenting with clonazepam increased the affect on GABA and really helped with the social anxiety. IMHO if you would of stayed on the Nardil things would have been much better for you. I'm one to talk though, this is my fourth time off Nardil in ten years. The other three times the major depression returned withing several months. Something about how my body reacts with Nardil causes the intense sweet carbohydrate cravings. At one point I was 110 pounds above my normal weight. Parnate doesn't do this to me. I just hope it will hold off the major depression.
> The one thing that continues to piss me off about my doc is that he NEVER told me that the euphoria wouldn't last. I'm still seeing him, b/c he and I have an established, caring relationship for many years, but it still pisses me off that he never told me. Which leads me to believe that he had no real experience with MAOI's to begin with.
> And if he did, why the hell did he wait until I nearly died after OD'ing on 40 tricyclic tabs when there was a med (MAOI's) that had been available for decades before trying it with me. And I was the one who suggested it to him, not the other way around.
> It's a still a sore subject with me.
> MalcolmThe euphoria side effect(hypomania) is supposed to be quite rare with Nardil. From the postings on this board, which really represent more treatment resistant patients, it seems to be quite common. |I don't know if there is any kind of connection.
Many PDOCS really fight the use of MAOIs. They will do several trials of SSRIs, SNRIs, tricyclics, some even ECT before a trial of MAOIs. Again, IMHO MAOIs should be a 2nd tier treatment for atypical depression; not a last resort.
Get Well Soon,
Jedi
Posted by malcolm64 on May 11, 2007, at 21:57:29
In reply to Re: Parnate at 30 mgs - still nothing » malcolm64, posted by Jedi on May 11, 2007, at 21:05:58
> > Yes, I was on Phenelzine (Nardil) about a year ago, had a fantastic reaction to it, but it pooped out after just 3 weeks. I don't remember augmenting it with Clonazepam (except possibly at night to help me sleep). The fantastic thing about Nardil when it first worked was that I could have cared less whether someone was friendly to me or blew me off - I was happy regardless. But now the slightlest rejection is painful.
>
> Malcolm,
> Forgive me for my less than acute memory. I now recall that you had posted about your Nardil experience. Ten years of fighting major atypical depression and social anxiety with 40+ combinations of meds has left my mind just a little mushy.
>
> One of the symptoms of atypical depression is rejection sensitivity. Before MAOIs and clonazepam the slightest critisism would wipe me out. I say major depression for ten years, but I fought dysthymia with the social anxiety for another twenty-five years before that. It seems to have started about the time I started high school. When greeting someone my hands would be so sweaty, I would have to wipe them on my pants before shaking hands.
>
> > I still don't understand how a mere medication could so completely wipe away feelings of shame and angst. Hell, when the Nardil first worked, I actually enrolled in a bartending class as a way to make some fast cash. Imagine me, as a bartender!!? I never would have thought in a million years that that was something I could actually do, but the Nardil caused such a miraculous transformation of my personality it was unbelieveable. Needless to say, I dropped out of the class when it became clear that the Nardil effects wouldn't last. And that ended my flirtation with bartending. Never again.
>
> Nardil did exactly the same thing for me. The lifting of the depression and anxiety was indeed euphoric. I think your mistake was believing that this touch of hypomania was going to last forever. When the mania went away, you interpreted that as a loss in efficacy of the Nardil. I wish I could have kept that feeling also, but that was not the true antidepressant effect. For me also, augmenting with clonazepam increased the affect on GABA and really helped with the social anxiety. IMHO if you would of stayed on the Nardil things would have been much better for you. I'm one to talk though, this is my fourth time off Nardil in ten years. The other three times the major depression returned withing several months. Something about how my body reacts with Nardil causes the intense sweet carbohydrate cravings. At one point I was 110 pounds above my normal weight. Parnate doesn't do this to me. I just hope it will hold off the major depression.
>
> > The one thing that continues to piss me off about my doc is that he NEVER told me that the euphoria wouldn't last. I'm still seeing him, b/c he and I have an established, caring relationship for many years, but it still pisses me off that he never told me. Which leads me to believe that he had no real experience with MAOI's to begin with.
>
> > And if he did, why the hell did he wait until I nearly died after OD'ing on 40 tricyclic tabs when there was a med (MAOI's) that had been available for decades before trying it with me. And I was the one who suggested it to him, not the other way around.
>
> > It's a still a sore subject with me.
> > Malcolm
>
> The euphoria side effect(hypomania) is supposed to be quite rare with Nardil. From the postings on this board, which really represent more treatment resistant patients, it seems to be quite common. |I don't know if there is any kind of connection.
>
> Many PDOCS really fight the use of MAOIs. They will do several trials of SSRIs, SNRIs, tricyclics, some even ECT before a trial of MAOIs. Again, IMHO MAOIs should be a 2nd tier treatment for atypical depression; not a last resort.
> Get Well Soon,
> Jedi
>
>Well, again I don't think the term "MAOI inhibitor" was on his radar screen as far as meds go; again, I had to suggest it to him. I sent him a rather blunt e-mail a couple of days ago and his response was that "I doubt that five years ago I, or anybody else, could have done anything different to prevent the suicide attempt. Given that many times I have gone beyond the call of duty with you, insinuating that another medication might have made a difference is pretty nasty."
He's certainly right about him going well beyond the call of duty with me (being receptive to phone calls, charging me 1/2 of his regular fee, etc), and he admits later in the same e-mail that "I have never billed myself as an expert on medications. Although I have a reasonable good knowledge, and more than anything else, a lot of experience in handling medications, my strongest competencies are as a psychotherapist."
I don't mean to sound ungrateful (and I sent him an email response apologizing if it came across that way), but there's also this sense that if meds weren't his competency, why the hell didn't he refer me to someone who had more experience in that area YEARS ago? I've felt that we've spent week after week rehashing the same issues over and over again, and nothing changes! Since I can't change my personality through sheer force of will power (and lord knows I've tried), it will take the right combo of meds and psychotheraphy for things to change.
As I see it meds don't do the work for you, you still have to do the work on changing yourself, but they make it possible for you to attempt the change. It's like the short-lived experience with the Nardil. It didn't create my sunny disposition, but allowed it to come forth from behind the clouds. If I had had been a nasty person, I would probably have remained nasty even while Nardil was at its peak.
So I'm not expecting any med to all of a sudden change my personality. What I'm hoping for is that it will allow the Malcolm that's been hidden for most of my life to finally shine.
Isn't that all any of us can really expect any of these meds to do?
Malcolm
Posted by Jedi on May 12, 2007, at 0:48:51
In reply to Re: Parnate at 30 mgs - still nothing, posted by malcolm64 on May 11, 2007, at 21:57:29
Malcolm,
I was really lucky that ten years ago there was a PDOC in our little community that knew something about MAOIs and atypical depression. I believe that I would be 10 years into the long nap if this man had not shown up when he did. Shortly after I got on Nardil he moved across the country.This is my life, I have a disease; I do everything that I am capable of to make my life better. Honestly, I know more about MAOIs than any MD or PDOC in our small town. I study them almost every night(OCD). It is not their life at stake. With MAOIs you have to take your level of responsibility up a level. So many in the profession know nothing about MAOIs. (Isn't Parnate for athlete's foot or something?)
It seems to me that the best psychopharmacologists gather together in the larger markets. For one, there are more patients there that can use their services(more money). For two, there are more people like them that they can communicate with and bounce ideas off of. That puts us in the boondocks on the Internet trying to glean any information we can.
Take care,
Jedi
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.