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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 katamnesis on September 2, 2009, at 8:31:02
Hi everyone. I used to post under the usernames tygereyes83 and halcyondaze. If any of you recall, I had a phenomenal response to high-dose (120 mg/day) Parnate - two trials and both resulted in complete remissions of major depressive disorder, body dysmorphic disorder, and Interstitial Cystitis.
Instead of writing all of the details of why I was in the position of needing to add a MAOI to a psychostimulant and how it transpired, I'll link you to a post I made in a LiveJournal community for MAOI users that I also moderate (WARNING: POSSIBLE TRIGGER FOR TALK OF SUICIDAL IDEATION/PLANNING): http://community.livejournal.com/maoi_users/14017.html
I'm currently taking 30 mg Parnate (brand-name GSK) [and yes, much lower than my previous trials!] with 15 mg Dexedrine Spansules (brand-name GSK) + 10-20 mg immediate-release dextroamphetamine (generic awful Teva mess).
I actually have a question related to that. I want to increase the Parnate but not until the stimulant is slightly reduced. I'm already down from my baseline doses of 40 mg Adderall XR + 40 mg dextroamphetamine (which I'd been taking for about 2 years prior to MAOI initiation) and my CNS hypersomnia is barely controlled right now.
Partially, I attribute this to the fact that Teva Pharmaceuticals has utterly ruined every generic amphetamine they've put their corrupt hands on - and I had SERIOUS complaints about Barr dextroamphetamine and basically went insane when Shire, Ethex, and Mallinckrodt all removed their generic formulations of dextroamphetamine from the market around December 2008 - but the quality of this medication has diminished even further since Teva took over. It is barely more effective than a placebo.
Unfortunately, while GSK Spansules do keep me awake during the day, the slow sustained-release mechanism of the medication is insufficient for waking me up in the morning, which has always been the most difficult part of my sleep disorder anyway. Since the only dextroamphetamine available is Teva and no brand-name version exists, I was wondering what everyone thought about the different Adderall generics (CorePharma vs. Eon). So here are my questions:
1) I'm under the impression that Eon (subsidiary of Sandoz) makes the superior immediate-release Adderall generic, as compared to CorePharma (subsidiary of Ranbaxy) and Barr/Teva - and that it's even superior to the "brand name" immediate release Adderall made by Duramed (subsidiary of Barr/Teva). Anyone have any experiences to share to maybe back this up?
2) Is Adderall (with it's mixture of levoamphetamine and dextroamphetamine and sulfate and saccharate and aspartate) more dangerous to combine with MAOIs than Dexedrine? I feel "safer" with regular dextroamphetamine sulfate and have always felt like levoamphetamine put my autonomic nervous system on high alert even without being on Parnate, so I suppose I'm wondering if taking Adderall may just result in a plethora of adverse events that I simply do not need without exhibiting any discernible benefit over Dexedrine? Is there any pharmacological evidence to back this up? [Sadly, the paucity of research on levoamphetamine rivals that of the paucity of research on tranylcypromine!]
3) Everything I have read states that 10 mg Adderall = 5 mg - 7.5 mg Dexedrine. As related to MAOIs, does anyone know if this still holds true? Or should Adderall and Dexedrine be considered on an equivalent milligram-by-milligram basis because levoamphetamine and dextroamphetamine, while not equipotent, are equivalent in their ability to facilitate NE/DA release and inhibit MAO? I want to be safe, obviously, in doing this. But I also want to be awake or there's no point in doing it.
4) For those who have taken stimulants with MAOIs, how did you proceed in increasing the dose(s) of either drug if you needed to? I want to increase the dose of Parnate by 10 mg, which is how I've done it thus far, but it does make me nervous to be playing around with doses of stimulants and MAOIs at the same time.
Thanks to anyone who can help. Good to see some familiar names here! :)
Posted by maxime on September 2, 2009, at 11:45:30
In reply to Adding MAOIs to stimulants - it can be done!, posted by katamnesis on September 2, 2009, at 8:31:02
I was on 80mg of Parnate when I added 30mg of Adderall XR. I had no problems with this combo. I was just lucky to have a pdoc who would let me do it. I don't have ADD. We added the adderall because my depression was coming back on the Parnate.
Posted by Girlnterrupted78 on September 2, 2009, at 16:11:03
In reply to Adding MAOIs to stimulants - it can be done!, posted by katamnesis on September 2, 2009, at 8:31:02
Hi katamnesis,
I apologize that I won't be able to answer your question. I have only been on 40mgs of Parnate for a couple of weeks, and coincidentally, just *today* my pdoc added 5mgs of Adderall. So I will probably have some info for you in a few days/weeks.
I really just wanted to ask you why did you go down on Parnate from 120mg to 30mg, even though you experienced full remission on the higher dose?
I have all my hopes set on Parnate, so I'm very curious about what happened to you.
Anyway, we're on the same boat, it seems, so if I find anything about this subject, I will definitely come and share with you.
Hopefully, one of the more experienced posters here will be able to help you with that info.
I wish you the best of luck!
GI
> If any of you recall, I had a phenomenal response to high-dose (120 mg/day) Parnate - two trials and both resulted in complete remissions of major depressive disorder.> I'm currently taking 30 mg Parnate (brand-name GSK) [and yes, much lower than my previous trials!]
Posted by katamnesis on September 2, 2009, at 16:21:58
In reply to Re: Adding MAOIs to stimulants - it can be done! » katamnesis, posted by Girlnterrupted78 on September 2, 2009, at 16:11:03
You can find the whole story at the link I posted. Basically, in short: I overdosed on heroin in December 2006. I didn't know it at the time but the anoxic brain injury caused CNS hypersomnia. At the time, though, I was on sleeping meds for Parnate and I didn't know what was causing it - I thought maybe the Parnate itself. So when I almost got fired for not showing up, I thought stimulants would be a short term solution to a med-related side effect and stopped everything. Oops. Apparently not. And since I literally sleep constantly and am totally sleep drunk when not taking stimulants, I couldn't take enough time off of work to titrate onto high dose Parnate and then add stimulants to that. Eventually I'd like to be on higher doses - not as high as before, since stimulants and Parnate work synergistically and I have experienced a partial remission even at this low dose - but I need to accommodate my sleep disorder first or I won't be able to afford meds anyway bc I won't be employed!
> Hi katamnesis,
>
> I apologize that I won't be able to answer your question. I have only been on 40mgs of Parnate for a couple of weeks, and coincidentally, just *today* my pdoc added 5mgs of Adderall. So I will probably have some info for you in a few days/weeks.
>
> I really just wanted to ask you why did you go down on Parnate from 120mg to 30mg, even though you experienced full remission on the higher dose?
>
> I have all my hopes set on Parnate, so I'm very curious about what happened to you.
>
> Anyway, we're on the same boat, it seems, so if I find anything about this subject, I will definitely come and share with you.
>
> Hopefully, one of the more experienced posters here will be able to help you with that info.
>
> I wish you the best of luck!
> GI
>
>
> > If any of you recall, I had a phenomenal response to high-dose (120 mg/day) Parnate - two trials and both resulted in complete remissions of major depressive disorder.
>
> > I'm currently taking 30 mg Parnate (brand-name GSK) [and yes, much lower than my previous trials!]
>
Posted by rjlockhart04-08 on September 5, 2009, at 11:58:53
In reply to Adding MAOIs to stimulants - it can be done!, posted by katamnesis on September 2, 2009, at 8:31:02
Are MAOI's that good?
I've taken Prozac for a while, it's been the best. One thing, just don't take Strattera with it, causes agitated depression (state) (too much reptake of norepinephreine).
Posted by alexb123 on September 16, 2009, at 15:35:52
In reply to Adding MAOIs to stimulants - it can be done!, posted by katamnesis on September 2, 2009, at 8:31:02
Katamnesis -
I am reading what you wrote and I must chat with you. How can I reach you? I feel as though that was me writign what you wrote. would you like to email me or call me? Or I can maybe email you or call you.Please let me know
my email is
alex.bollettino@gmail.com
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