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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by morganator on August 14, 2009, at 18:04:50
I am currently severely depressed with on and off severe anxiety. I just started Zoloft 2 weeks ago. I am also taking Depakote 1500mg and Zyprexa 10mg. I have some physical issues that are definitely contributing to my depression and anxiety. When I finally wake up in the afternoon, my body aches and my mind simply does not feel like it is operating properly. I often wake up feeling like I have a hang over. I swear I notice differences in muscle function when an antidepressant is working and when it is not.
I guess I am wondering if Parnate, or Nardil, would make the kind of impact on my brain that I am looking for without making me too anxious or stimulated. I know that Depakote and Zyprexa should help to keep me in the safety zone while trying a new AD. And, I understand everyone is different, but since you are also BP, I was interested in what your experience has been with Parnate or Nardil. I know I could go through the archives but I just don't have the mind power or concentration to make to effort right now. It has been difficult enough to write this message.
I think zoloft will do something, I just fear it will not be enough. I wish I had discussed Parnate and Nardil with my doctor a few weeks ago. I guess I was playing it safe. I will discuss these MOAIs with him when I seem him next.
Another thing I will be asking him about is rTMS.
Posted by SLS on August 14, 2009, at 19:24:46
In reply to To SLS, Parnate Question, posted by morganator on August 14, 2009, at 18:04:50
> I am currently severely depressed with on and off severe anxiety.
That stinks.
> I just started Zoloft 2 weeks ago.
How high are you planning to go with Zoloft?
> I am also taking Depakote 1500mg and Zyprexa 10mg.
That's a great antimanic combination.
> I swear I notice differences in muscle function when an antidepressant is working and when it is not.
Very much so. Depression can weaken muscles and cause them to fatigue more easily.
> I guess I am wondering if Parnate, or Nardil, would make the kind of impact on my brain that I am looking for without making me too anxious or stimulated.
Parnate might be stimulating in the beginning. However, this doesn't necessarily indicate that it will produce an increase in anxiety. If Parnate works the way it is supposed to, ideally, it will reduce the anxiety along with the depression.
Nardil probably reduces anxiety more quickly than Parnate. This is often attributed to its effects on GABA, something that Parnate lacks.
Both drugs can produce insomnia. Perhaps the Zyprexa will help prevent that. If it doesn't, don't be bashful about treating it.
I hope that answered your questions. I'll be happy to answer more.
- Scott
Posted by morganator on August 15, 2009, at 0:28:11
In reply to Re: To SLS, Parnate Question » morganator, posted by SLS on August 14, 2009, at 19:24:46
Thanks man...I am just looking for something to jump start me I guess. I have already started Zoloft and I have mixed feelings about it.
>Both drugs can produce insomnia. Perhaps the Zyprexa will help prevent that. If it doesn't, don't be bashful about treating it.
I don't know if I will have the protection I zyprexa for very long. My doctor doesn't want to keep me on it and I have no problem with that. But, I will be on Depakote for a long time so that may help if I choose to try Parnate.
>Very much so. Depression can weaken muscles and cause them to fatigue more easily.
Yeah I have stiff weak muscles. I have a difficult time contracting them. Being that medications and depression effect neurotransmitters that play roles in muscle function, I would not be surprised if muscle function was impaired for some people that may be temporarily damaged by medication trials and severe depression/anxiety.
What are your thoughts about rTMS? And Agomelatine? I would love to try both. I feel like Agomelatine would be a nice compliment to Zoloft, maybe not. rTMS could get me to that place I need to get to faster than just using medication alone. Neither treatments appear to be very invasive. If ECT was not so potentially invasive, I would have had it done by now.
Morgan
Posted by morganator on August 15, 2009, at 0:29:23
In reply to Re: To SLS, Parnate Question, posted by morganator on August 15, 2009, at 0:28:11
Thanks Scott
Posted by morganator on August 15, 2009, at 0:30:40
In reply to Re: To SLS, Parnate Question, posted by morganator on August 15, 2009, at 0:29:23
> Thanks Scott
I'm losing it..I don't know why I did that
Posted by bulldog2 on August 15, 2009, at 13:12:54
In reply to To SLS, Parnate Question, posted by morganator on August 14, 2009, at 18:04:50
> I am currently severely depressed with on and off severe anxiety. I just started Zoloft 2 weeks ago. I am also taking Depakote 1500mg and Zyprexa 10mg. I have some physical issues that are definitely contributing to my depression and anxiety. When I finally wake up in the afternoon, my body aches and my mind simply does not feel like it is operating properly. I often wake up feeling like I have a hang over. I swear I notice differences in muscle function when an antidepressant is working and when it is not.
>
> I guess I am wondering if Parnate, or Nardil, would make the kind of impact on my brain that I am looking for without making me too anxious or stimulated. I know that Depakote and Zyprexa should help to keep me in the safety zone while trying a new AD. And, I understand everyone is different, but since you are also BP, I was interested in what your experience has been with Parnate or Nardil. I know I could go through the archives but I just don't have the mind power or concentration to make to effort right now. It has been difficult enough to write this message.
>
> I think zoloft will do something, I just fear it will not be enough. I wish I had discussed Parnate and Nardil with my doctor a few weeks ago. I guess I was playing it safe. I will discuss these MOAIs with him when I seem him next.
>
> Another thing I will be asking him about is rTMS.
>
>Parnate is a uniquie drug. After each dose there was a ritalin like effect for me for a couple dose. Seriously there are some amphetamine metabolite in this drug. But after that wears off I found it calming. For some tge stimulating effect goes away.
Posted by shasling on August 15, 2009, at 13:51:05
In reply to Re: To SLS, Parnate Question » morganator, posted by SLS on August 14, 2009, at 19:24:46
Nardil probably reduces anxiety more quickly than Parnate. This is often attributed to its effects on GABA, something that Parnate lacks.
Both drugs can produce insomnia. Perhaps the Zyprexa will help prevent that. If it doesn't, don't be bashful about treating it.
I hope that answered your questions. I'll be happy to answer more.
Hey scott did you read the latetest on parnate stating it has gaba B properties?
Posted by SLS on August 15, 2009, at 14:43:03
In reply to Re: To SLS, Parnate Question, posted by shasling on August 15, 2009, at 13:51:05
> Hey scott did you read the latetest on parnate stating it has gaba B properties?
Really? No, I hadn't read that. How does this affect someone?
- Scott
Posted by shasling on August 15, 2009, at 15:05:41
In reply to Re: To SLS, Parnate Question » shasling, posted by SLS on August 15, 2009, at 14:43:03
Heres the link,at least its a reputable one,
http://74.125.155.132/search?q=cache:ENhlwhJ3wewJ:www.biopsychiatry.com/tranylcypromine-parnate.htm+parnate+gaba+b&cd=1&hl=en&ct=clnk&gl=usLinkadge said something to the affect this doesent mean anything,however to my knowledge
substances affecting gaba b areAlcholol
GHB
Phenibut
BacoflenAlso gaba b is usualy the one that unlike benzos and gaba A which work on anxiety,gaba B is more like a social effect and less anti anxiety.
Perhaps this contributes to parnates pro social effect.
Posted by SLS on August 15, 2009, at 17:43:05
In reply to Re: To SLS, Parnate Question, posted by shasling on August 15, 2009, at 15:05:41
> Heres the link,at least its a reputable one,
> http://74.125.155.132/search?q=cache:ENhlwhJ3wewJ:www.biopsychiatry.com/tranylcypromine-parnate.htm+parnate+gaba+b&cd=1&hl=en&ct=clnk&gl=us
>
> Linkadge said something to the affect this doesent mean anything,however to my knowledge
> substances affecting gaba b are
>
> Alcholol
> GHB
> Phenibut
> Bacoflen> Also gaba b is usualy the one that unlike benzos and gaba A which work on anxiety,gaba B is more like a social effect and less anti anxiety.
I didn't realize that. Thanks for the explanation.
> Perhaps this contributes to parnates pro social effect.
You might be right. I would like to know through what mechanism GABA-B receptors become upregulated.
I'm thinking that there might also be an increase in phenethylamine in the brain that would lead to an inhibition of the GABA-B receptor, thus disinhibiting (increasing) dopaminergic neurotransmission. I don't know. There has long been a "rumor" that Parnate is metabolized into amphetamine or amphetamine-like substances. I don't think any have been isolated, though. It seems more likely that the parent molecule has amphetamine-like actions of its own.
- Scott
Posted by morganator on August 15, 2009, at 18:15:00
In reply to Re: To SLS, Parnate Question, posted by bulldog2 on August 15, 2009, at 13:12:54
Bulldog2, how did you dose Parnate? Did you take it twice a day like Scott and others do?
I hate having to remember to dose something again at a certain time. I do not live a structured 9 to 5 life style.
Also, if it worked for you, why did you stop? Did it stop working?
Posted by bulldog2 on August 15, 2009, at 19:26:39
In reply to Re: To SLS, Parnate Question » bulldog2, posted by morganator on August 15, 2009, at 18:15:00
> Bulldog2, how did you dose Parnate? Did you take it twice a day like Scott and others do?
>
> I hate having to remember to dose something again at a certain time. I do not live a structured 9 to 5 life style.
>
> Also, if it worked for you, why did you stop? Did it stop working?Up to 30 mg took it in one dose but once I reached 40 I divided it in two doses. The reason for that is 40 at once was to intense with the amphetamine release.
I took it up to 60 and stopped after two weeks. I would get a boost in ad effect after each dose increase and than it would subside.
I stopped because I think I expected more. May have been a bad decision as I went back into depression after I stopped. I should Have given it more time.
Will talk to my p-doc about restarting. This time I would like to run nortriptyline with it.Others have said the addition of nortriptyline seemed to really boost the ad effect.
Posted by morganator on August 15, 2009, at 19:36:32
In reply to Re: To SLS, Parnate Question, posted by bulldog2 on August 15, 2009, at 19:26:39
Thanks for getting back... appreciated it.
Posted by g_g_g_unit on August 15, 2009, at 19:54:07
In reply to Re: To SLS, Parnate Question, posted by bulldog2 on August 15, 2009, at 19:26:39
> Up to 30 mg took it in one dose but once I reached 40 I divided it in two doses. The reason for that is 40 at once was to intense with the amphetamine release.
> I took it up to 60 and stopped after two weeks. I would get a boost in ad effect after each dose increase and than it would subside.
> I stopped because I think I expected more. May have been a bad decision as I went back into depression after I stopped. I should Have given it more time.
> Will talk to my p-doc about restarting. This time I would like to run nortriptyline with it.Others have said the addition of nortriptyline seemed to really boost the ad effect.is the amphetamine effect pretty noticeable? i understand that anything that relieves depression will probably increase mental stimulation on some level, but i suffer from anhedonia and a general flatness which responds well to straight stimulants (nicotine, ritalin, etc.).
nardil did help my mood, but i didn't find it particularly useful for attention issues. do you think Parnate might be more potent in this respect?
thanks
Posted by SLS on August 15, 2009, at 21:19:29
In reply to Re: To SLS, Parnate Question, posted by g_g_g_unit on August 15, 2009, at 19:54:07
Parnate is somewhat selective for MAO-B, which is responsible for deaminating (splitting up) dopamine. The effect of Parnate, then, is to allow for a build up and subsequent release of dopamine. It also works to increase levels of phenethylamine (PEA), a neuromodulator, as well. PEA can increase the levels of dopamine in frontal regions of the brain. Parnate itself acts as an amphetamine, but only at 10% the potency of d-amphetamine. There are some old studies reporting the efficacy of Parnate in treating ADD. There is no reason why one could not combine Parnate with amphetamine or methylphenidate to treat depression comorbid with ADD.
- Scott
Posted by morganator on August 15, 2009, at 21:31:47
In reply to Re: To SLS, Parnate Question, posted by SLS on August 15, 2009, at 21:19:29
Thanks again Scott for the useful information.
Posted by g_g_g_unit on August 15, 2009, at 22:07:44
In reply to Re: To SLS, Parnate Question, posted by SLS on August 15, 2009, at 21:19:29
> Parnate is somewhat selective for MAO-B, which is responsible for deaminating (splitting up) dopamine. The effect of Parnate, then, is to allow for a build up and subsequent release of dopamine. It also works to increase levels of phenethylamine (PEA), a neuromodulator, as well. PEA can increase the levels of dopamine in frontal regions of the brain. Parnate itself acts as an amphetamine, but only at 10% the potency of d-amphetamine. There are some old studies reporting the efficacy of Parnate in treating ADD. There is no reason why one could not combine Parnate with amphetamine or methylphenidate to treat depression comorbid with ADD.
>
>
> - Scottunfortunately, since i do not have ADD (only depression-related symptoms), stimulants are strictly prohibited from being prescribed where i live. i've only managed to try ritalin through a friend.. hence my interest in parnate, since it may be the closest thing to a stimulant i can presently get my hands on, bar wellbutrin, which just increases my anxiety
Posted by morganator on August 15, 2009, at 22:13:21
In reply to Re: To SLS, Parnate Question, posted by g_g_g_unit on August 15, 2009, at 22:07:44
I would be interested in hearing your experience when you or if you try Parnate.
Posted by bulldog2 on August 16, 2009, at 12:32:17
In reply to Re: To SLS, Parnate Question, posted by g_g_g_unit on August 15, 2009, at 19:54:07
> > Up to 30 mg took it in one dose but once I reached 40 I divided it in two doses. The reason for that is 40 at once was to intense with the amphetamine release.
> > I took it up to 60 and stopped after two weeks. I would get a boost in ad effect after each dose increase and than it would subside.
> > I stopped because I think I expected more. May have been a bad decision as I went back into depression after I stopped. I should Have given it more time.
> > Will talk to my p-doc about restarting. This time I would like to run nortriptyline with it.Others have said the addition of nortriptyline seemed to really boost the ad effect.
>
> is the amphetamine effect pretty noticeable? i understand that anything that relieves depression will probably increase mental stimulation on some level, but i suffer from anhedonia and a general flatness which responds well to straight stimulants (nicotine, ritalin, etc.).
>
> nardil did help my mood, but i didn't find it particularly useful for attention issues. do you think Parnate might be more potent in this respect?
>
> thanksYes for me the amphetamine effect was pretty noticeable. Read somewhere that every 10 mg of parnate is equal to 1 mg of amphetamine.
Now you hav to understand the amphetamine effect is separate from the ad effect.
When I took 30 mg of parnate at one time I would say that it felt like 15-20 mg of ritalin.
I enjoy the stimulant effect but at 40 mg was to much and was no longer pleasant. I would say the effect was a couple hours max for me. So dividing it into two doses gave me two nice stim during the day.
Posted by bulldog2 on August 16, 2009, at 12:42:49
In reply to Re: To SLS, Parnate Question, posted by g_g_g_unit on August 15, 2009, at 22:07:44
> > Parnate is somewhat selective for MAO-B, which is responsible for deaminating (splitting up) dopamine. The effect of Parnate, then, is to allow for a build up and subsequent release of dopamine. It also works to increase levels of phenethylamine (PEA), a neuromodulator, as well. PEA can increase the levels of dopamine in frontal regions of the brain. Parnate itself acts as an amphetamine, but only at 10% the potency of d-amphetamine. There are some old studies reporting the efficacy of Parnate in treating ADD. There is no reason why one could not combine Parnate with amphetamine or methylphenidate to treat depression comorbid with ADD.
> >
> >
> > - Scott
>
> unfortunately, since i do not have ADD (only depression-related symptoms), stimulants are strictly prohibited from being prescribed where i live. i've only managed to try ritalin through a friend.. hence my interest in parnate, since it may be the closest thing to a stimulant i can presently get my hands on, bar wellbutrin, which just increases my anxietyyou have to understand the stimulant effect only lasts about two hours max or at least only for me.After that felt pretty calm or at times a bit sleepy.
I think my disappointment with parnate was I thought I was going to be activated most of the time which for me wasn't the case.Now drugs that strictly block the reuptake of norepinephrine should be safe with parnate such as nortriptyline and possibly ritalin.
On the other hand amphetamines that release norepinephrine should be used with caution as that could trigger a hypertensive crisis.
Posted by SLS on August 16, 2009, at 13:44:55
In reply to Re: To SLS, Parnate Question, posted by bulldog2 on August 16, 2009, at 12:42:49
> Now drugs that strictly block the reuptake of norepinephrine should be safe with parnate such as nortriptyline and possibly ritalin.
> On the other hand amphetamines that release norepinephrine should be used with caution as that could trigger a hypertensive crisis.I don't know how apt this combination is to produce a hypertensive reaction. However, as you say, caution should be exercised just in case.
Adding d-amphetamine to Parnate is probably more common than adding Ritalin. I took Dexedrine 20mg along with 120mg Parnate and 200mg desipramine. It is probably best to start the Parnate first to screen for spontaneous hypertensive reaction. When adding the Dexedrine, I had my blood pressure tested in the doctor's office upon the first dose. While I understand that my history should not be generalized, I have come across a few doctors and medical literature that advocate using the combination.
For me, the addition of amphetamine to Parnate gave me only three days of relief.
- Scott
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