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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by g_g_g_unit on August 30, 2009, at 1:32:15
sorry, i realise Parnate is the topic du jour lately, but i have one more question about the drug before i commit to making a case for it - namely, is there a chance i would be required to remain on a sleep med indefinitely while taking it, or do higher doses permit uninhibited restful sleep? i have tremendous difficulty with sleeping - ever since messing with meds, truth be told - and am worried about putting my body through a state of reduced sleep once again. these days, i simply would not fall sleep at a normal hour without melatonin.
on nardil, i grew tolerant to benzo's within 3-4 days, and, refusing to raise the doses, was left in a sleep-deprived state for 17 weeks which was far more psychologically taxing than being off the drug. i did not want to take Seroquel - i refuse to be on AP's unnecessarily - so had to come off the drug.
if there's a chance the insomnia would abate, then im willing to try push through and remain on it. but im a lil scared
Posted by SLS on August 30, 2009, at 7:26:43
In reply to *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 1:32:15
> if there's a chance the insomnia would abate, then im willing to try push through and remain on it. but im a lil scared
I am not a good example of Parnate-induced insomnia because when given as monotherapy, I never had a problem with it. I think Nardil is worse. However, the first time a TCA was added to Parnate, I went almost 2 weeks without sleep. (I wish this treatment would still affect me that way). I needed TWO benzodiazepines to remedy the insomnia. I was prescribed Halcion and Ativan. The combination worked perfectly. Since your doctor will probably be resistant to prescribe Halcion, you might be able to combine Ambien and either Ativan or Restoril instead. Some people have success with Lunesta monotherapy. Did you ever try it?
- Scott
Posted by g_g_g_unit on August 30, 2009, at 8:49:56
In reply to Re: *one* more Parnate question b4 appt tomorrow » g_g_g_unit, posted by SLS on August 30, 2009, at 7:26:43
> I am not a good example of Parnate-induced insomnia because when given as monotherapy, I never had a problem with it. I think Nardil is worse. However, the first time a TCA was added to Parnate, I went almost 2 weeks without sleep. (I wish this treatment would still affect me that way). I needed TWO benzodiazepines to remedy the insomnia. I was prescribed Halcion and Ativan. The combination worked perfectly. Since your doctor will probably be resistant to prescribe Halcion, you might be able to combine Ambien and either Ativan or Restoril instead. Some people have success with Lunesta monotherapy. Did you ever try it?
>
>
> - Scottit doesn't appear that Lunesta is available where i live. i tried Temazepam, Clonazepam and Zopiclone while on Parnate, and like i say, was growing tolerant to each within days (i was advised not to combine benzos). i would happily go on Seroquel or a similar agent temporarily, as long as there is some likelihood the insomnia will pass. on Nardil it did seem to eventually - i was sleeping six hours a night w/out aid of medication towards the point where i discontinued it .. so as long as the side-effect is similarly transient with Parnate ...
Posted by SLS on August 30, 2009, at 9:07:00
In reply to Re: *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 8:49:56
> i would happily go on Seroquel or a similar agent temporarily,
I was going to suggest that, but you seemed very much against the idea. I think your plan makes sense. If you can establish that the Parnate works for you, then you can go ahead and treat the insomnia more aggressively with other agents.
Restoril is not potent enough to initiate sleep, although it can help maintain it. If you are going to use a single benzodiazepine, I would give Ativan a try.
I hope you get more feedback regarding the potential for the insomnia to resolve spontaneously during Parnate therapy.
Good luck.
- Scott
Posted by Phillipa on August 30, 2009, at 10:56:30
In reply to Re: *one* more Parnate question b4 appt tomorrow » g_g_g_unit, posted by SLS on August 30, 2009, at 9:07:00
Just let me add my good luck. Phillipa
Posted by Maxime on August 30, 2009, at 17:54:56
In reply to *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 1:32:15
Let us know how the appt. goes. I wish you the best of luck!
Posted by desolationrower on August 30, 2009, at 18:06:51
In reply to Re: *one* more Parnate question b4 appt tomorrow » g_g_g_unit, posted by Maxime on August 30, 2009, at 17:54:56
there are non-benzo options for sleep, and i think that for something like an MAOI, where the insomnia is probably due more to excess stimulation of receptors like alpha1/5ht2, blocking those receptors should be the primary approach
trazadone is a pretty good monotherapy here
-d/r
Posted by bulldog2 on August 31, 2009, at 14:00:34
In reply to *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 1:32:15
> sorry, i realise Parnate is the topic du jour lately, but i have one more question about the drug before i commit to making a case for it - namely, is there a chance i would be required to remain on a sleep med indefinitely while taking it, or do higher doses permit uninhibited restful sleep? i have tremendous difficulty with sleeping - ever since messing with meds, truth be told - and am worried about putting my body through a state of reduced sleep once again. these days, i simply would not fall sleep at a normal hour without melatonin.
>
> on nardil, i grew tolerant to benzo's within 3-4 days, and, refusing to raise the doses, was left in a sleep-deprived state for 17 weeks which was far more psychologically taxing than being off the drug. i did not want to take Seroquel - i refuse to be on AP's unnecessarily - so had to come off the drug.
>
> if there's a chance the insomnia would abate, then im willing to try push through and remain on it. but im a lil scaredI was on parnate 60 mg and the insomnia eventually went away. Actually anxiety lessned and cut down my klonopin usage. This was my experience.
Posted by bulldog2 on August 31, 2009, at 16:39:37
In reply to *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 1:32:15
> sorry, i realise Parnate is the topic du jour lately, but i have one more question about the drug before i commit to making a case for it - namely, is there a chance i would be required to remain on a sleep med indefinitely while taking it, or do higher doses permit uninhibited restful sleep? i have tremendous difficulty with sleeping - ever since messing with meds, truth be told - and am worried about putting my body through a state of reduced sleep once again. these days, i simply would not fall sleep at a normal hour without melatonin.
>
> on nardil, i grew tolerant to benzo's within 3-4 days, and, refusing to raise the doses, was left in a sleep-deprived state for 17 weeks which was far more psychologically taxing than being off the drug. i did not want to take Seroquel - i refuse to be on AP's unnecessarily - so had to come off the drug.
>
> if there's a chance the insomnia would abate, then im willing to try push through and remain on it. but im a lil scaredGive parnate a chance. The potential bliss of remission may await you. Remember you can always stop a drug if sides are bad.
Posted by Maxime on August 31, 2009, at 20:26:09
In reply to *one* more Parnate question b4 appt tomorrow, posted by g_g_g_unit on August 30, 2009, at 1:32:15
Posted by g_g_g_unit on September 1, 2009, at 0:10:07
In reply to How did the appt. go? (nm), posted by Maxime on August 31, 2009, at 20:26:09
i made a mistake with the day. it was actually today. in fact, i just got back from seeing him.
he was really nice :)
after explaining my situation, he basically asked me how i wanted to proceed with treatment. i requested Parnate, which he was hesitant about, because i said the Nardil gave me horrendous insomnia, but I agreed to use Seroquel as a temporary bandaid to get me through the first few weeks. he even offered to let me go for a CT scan at some point if i was genuinely concerned about my cognitive issues. most doctors just brush them off, given my age!
i am curious about the conservative dosing regime: 20mg at first, and then 30mg if that proves insufficient. most people here are on 50-80mg? is there even much MAO inhibition at 20mg?
Posted by g_g_g_unit on September 1, 2009, at 4:31:34
In reply to Re: How did the appt. go?, posted by g_g_g_unit on September 1, 2009, at 0:10:07
also hope i didn't make the wrong decision going w/ Parnate for OCD. i guess that's the OCD talking, but still . . .
Posted by SLS on September 1, 2009, at 5:45:12
In reply to Re: How did the appt. go?, posted by g_g_g_unit on September 1, 2009, at 0:10:07
> i am curious about the conservative dosing regime: 20mg at first, and then 30mg if that proves insufficient.
It is conservative. For most moderate to severe cases of MDD or BD, 40mg seems to be the minimum dosage that one will respond to. How long is it until you see the doctor next?
> is there even much MAO inhibition at 20mg?
Not enough to be consequential.
I had to suffer through a protracted trial of desipramine because my doctor was unfamiliar with adding it to Parnate, and he was still afraid of Parnate and its potential to produce spontaneous hypertensive events. I could have arrived at my therapeutic dose (300mg) within two weeks. It took over two months to get to where I needed to be under his supervision. I can't blame him though. Were I in his position, I probably would have been conservative, too.
Perhaps you can use a negotiating tool. Show him stuff regarding the safe and effective use of Parnate at dosages of 120mg and higher. Maybe he'll meet you half-way. :-)
- Scott
************************************************************************
1: Pharmacopsychiatry. 1989 Jan;22(1):21-5.Links
High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
**********************************************************************
Posted by g_g_g_unit on September 1, 2009, at 5:52:55
In reply to Re: How did the appt. go? » g_g_g_unit, posted by SLS on September 1, 2009, at 5:45:12
> > i am curious about the conservative dosing regime: 20mg at first, and then 30mg if that proves insufficient.
>
> It is conservative. For most moderate to severe cases of MDD or BD, 40mg seems to be the minimum dosage that one will respond to. How long is it until you see the doctor next?one month until our next appointment. what would 30mg be the equivalent to with Nardil in terms of effectiveness(roughly)? 45mg?
>
> > is there even much MAO inhibition at 20mg?
>
> Not enough to be consequential.
>
> I had to suffer through a protracted trial of desipramine because my doctor was unfamiliar with adding it to Parnate, and he was still afraid of Parnate and its potential to produce spontaneous hypertensive events. I could have arrived at my therapeutic dose (300mg) within two weeks. It took over two months to get to where I needed to be under his supervision. I can't blame him though. Were I in his position, I probably would have been conservative, too.
>
> Perhaps you can use a negotiating tool. Show him stuff regarding the safe and effective use of Parnate at dosages of 120mg and higher. Maybe he'll meet you half-way. :-)thanks for the citation. i'll see how i go on 20mg/30mg anyhow. even a little push for now would be really wecome.
Posted by SLS on September 1, 2009, at 8:47:49
In reply to Re: How did the appt. go?, posted by g_g_g_unit on September 1, 2009, at 5:52:55
> one month until our next appointment. what would 30mg be the equivalent to with Nardil in terms of effectiveness(roughly)? 45mg?
That sounds about right.
- Scott
This is the end of the thread.
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