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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 g_g_g_unit on September 15, 2009, at 19:50:58
does anyone have any links to abstracts/articles citing the doses used for Parnate in treating OCD and/or social anxiety disorder?
i would like to have them for my next appt with my pdoc in case i need to convince him that his proposed upper limit of 30mg is inadequate.
Posted by Phillipa on September 15, 2009, at 22:21:18
In reply to parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 15, 2009, at 19:50:58
Personally I'd think parnate would be horrible for OCD and anxiety. OCD is of the anxiety spectrum. Phillipa
Posted by SLS on September 16, 2009, at 6:08:58
In reply to parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 15, 2009, at 19:50:58
I didn't find much on Medline that you will be able to use. Here are a few that will help convince you, but probably not your doctor:
- Scott
Posted by g_g_g_unit on September 16, 2009, at 6:38:10
In reply to Re: parnate abstracts - OCD/sad?, posted by SLS on September 16, 2009, at 6:08:58
> I didn't find much on Medline that you will be able to use. Here are a few that will help convince you, but probably not your doctor:
>
> http://www.ncbi.nlm.nih.gov/pubmed/6833198?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> http://www.ncbi.nlm.nih.gov/pubmed/8437650?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> http://www.ncbi.nlm.nih.gov/pubmed/2335494?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
> http://www.ncbi.nlm.nih.gov/pubmed/3209719?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
>
>
> - Scottheh, all the convincing i need's right here on this board.
i'd seen all those abstracts, but unfortunately there's nothing along the lines of a stated minimum for OCD, etc.
i'm going to call my doctor tomorrow and set up an appointment to discuss enhanced leeway to experiment with the dose, and also change sleeping med. my sleep on Seroquel sucks due to the RL thing, which is partly why i'm not feeling so good, i suspect.
Posted by g_g_g_unit on September 17, 2009, at 3:03:48
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 16, 2009, at 6:38:10
my psychiatrist increased my parnate dose to 30mg, which i begin tomorrow. he also increased my seroquel dose to 50mg, because 25mg stopped working. i don't know if it's the seroquel, disturbed sleep, or parnate, but i am just feeling worse each day. i really hope 30mg has some positive effect.
Posted by desolationrower on September 17, 2009, at 10:31:50
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 17, 2009, at 3:03:48
well hope it works, but even ~15mg will pretty much saturate histamine receptors, so more mirtazapine will not affects sleep (maybe some improved quality from 5ht2 antagonism).
-d/r
Posted by bulldog2 on September 17, 2009, at 11:36:25
In reply to parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 15, 2009, at 19:50:58
> does anyone have any links to abstracts/articles citing the doses used for Parnate in treating OCD and/or social anxiety disorder?
>
> i would like to have them for my next appt with my pdoc in case i need to convince him that his proposed upper limit of 30mg is inadequate.I once saw an abstract that cited some docs used 200 mg parnate for trd.
Seriouly your doc's knowledge of parnate is totally inadequate. Some now use 40 mg as the beginning range of being therapeutic for parnate.
If they prescribe a drug isn't it part of their job to understand the limits of the medicine? Some just read the insert for their reference on a med and that isn't doing enough!
Posted by g_g_g_unit on September 17, 2009, at 16:06:37
In reply to Re: parnate abstracts - OCD/sad?, posted by desolationrower on September 17, 2009, at 10:31:50
> well hope it works, but even ~15mg will pretty much saturate histamine receptors, so more mirtazapine will not affects sleep (maybe some improved quality from 5ht2 antagonism).
>
> -d/ryou mean seroquel? i actually stuck to 25mg last night. i think the one-night "poop out" was just a coincidence
Posted by g_g_g_unit on September 17, 2009, at 16:15:20
In reply to Re: parnate abstracts - OCD/sad?, posted by bulldog2 on September 17, 2009, at 11:36:25
>
> I once saw an abstract that cited some docs used 200 mg parnate for trd.
>
> Seriouly your doc's knowledge of parnate is totally inadequate. Some now use 40 mg as the beginning range of being therapeutic for parnate.
> If they prescribe a drug isn't it part of their job to understand the limits of the medicine? Some just read the insert for their reference on a med and that isn't doing enough!i'm not sure if 30mg is some kind of legal limit in my country; i've seen reference that unless prescribed in a hospital, patients in england are also tiered to a ceiling dose of 30mg.
i looked up the prescribing information on the government's med site here and it says 30mg can "very cautiously" be superseded if there's no blood pressure issues. mine's actually dropped (it was 90/70 or something), which my pdoc was impressed with. i'm gonna see how i respond to 30mg; if there's any kind of improvement in depression, then that might help him raise it. otherwise, i may try find a research psychiatrist at the university or something who will take me above 30mg and also possibly add in a TCA for sleep. i mean, i have quite a defeatist mentality which resigns me to just accepting defeat, but if Parnate shows signs of working, i dont see why i shouldn't be allowed to fully recover.
Posted by Sunbath on September 28, 2009, at 8:55:11
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 17, 2009, at 16:15:20
Hi,
are you feeling any better? Did you change the Seroquel to something else? How's your sleep?
It's not very good to not know how those different drugs effect you when you take them altogether and haven't taken them seperately before I guess.. I for myself didn't like Seroquel (got very irritable and moody) and I got tolerant to the sedative effect after 10days. After that I tried nortriptyline, which was way better, but I didn't like the feel of it either :(
Although not a good antidepressant I like trazodone MUCH more for sleep and it's enough for me (20mg Parnate) for now to let me sleep normally.. in fact I seem to be sleeping better than before when I was on ssris when I had to take >150mg trazodone in order to sleep..Just wanted to let you know how it's working out for me. Maybe the seroquel isn't doing you any good either.
GOOD LUCK!!!
Posted by g_g_g_unit on September 29, 2009, at 7:25:54
In reply to Re: parnate abstracts - OCD/sad? » g_g_g_unit, posted by Sunbath on September 28, 2009, at 8:55:11
> Hi,
>
> are you feeling any better? Did you change the Seroquel to something else? How's your sleep?
> It's not very good to not know how those different drugs effect you when you take them altogether and haven't taken them seperately before I guess.. I for myself didn't like Seroquel (got very irritable and moody) and I got tolerant to the sedative effect after 10days. After that I tried nortriptyline, which was way better, but I didn't like the feel of it either :(
> Although not a good antidepressant I like trazodone MUCH more for sleep and it's enough for me (20mg Parnate) for now to let me sleep normally.. in fact I seem to be sleeping better than before when I was on ssris when I had to take >150mg trazodone in order to sleep..
>
> Just wanted to let you know how it's working out for me. Maybe the seroquel isn't doing you any good either.
>
> GOOD LUCK!!!hey thanks for your concern. Seroquel was a bust - if i used it for more than 3 days in a row, i'd get the worse sinus-like headaches that lasted all day. i also think it makes me more irritable, and stopped working as a sleep aid anyway. right now i'm using temazepam and zopiclone but growing tolerant to those as well.
i've seen no improvements on Parnate and am going to stop. nortriptyline has never helped me sleep in the past, so i don't see it breaking through the insomnia of Parnate; i also get 'dumb drug' effects on it. unfortunately, trazodone is not available in my country, so i can't use that. i just don't see myself ever sleeping on Parnate. if there were some positive effects, i might try think my way around it, but i feel way more aggressive and depressed. i'm thinking of switching back to Nardil.
sorry, don't mean to be a downer. hope your trial's going well :)
Posted by Sunbath on September 29, 2009, at 9:21:27
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 29, 2009, at 7:25:54
Oh that's bad :(
Are you sure the Parnate is the reason for your increased aggressiveness/depression and not the sleep deprivation or Seroquel? A pity that you can't try trazodone.. did you ever think of trying some low-dose amitriptyline to help you sleep?as to how my trial goes: not that good.. I can sleep, but I get sooo tired -2-4h after taking my doses- that I'm unable to do anything for the next 5hours at least.. I really really hope this is going to attenuate after a few days, otherwise I'll have to stop..
Have a nice evening!
Posted by ColoradoSnowflake on September 29, 2009, at 13:55:32
In reply to Re: parnate abstracts - OCD/sad? » g_g_g_unit, posted by Sunbath on September 29, 2009, at 9:21:27
Hi Guys:
I'm going into my 6th month of Parnate. I promised my pdoc at least that much time. I had a few weeks of excellent response. I think it's really hard to find the right amount and the timing and the augmentation.
It's such a pain to get off everything else, the washout etc. that I'm going to continue trying to tweak it.
I was tired during the day. The Provigil worked really well but I didn't have much of it. I have just now found a source, so I'm going to do the recommended amount now.
Also, my pdoc recommended I take the Parnate divided, afternoon and evening. That is working MUCH better. But I do get really tired in the late afternoon-evening. I'm going to ask him if I can take all 70mg at night. The nortriptyline still helps me sleep at night, so that's ok. GGG I think Sunbath's idea of taking amytriptyline at night is really good. I slept like a log on it, but it tired me out during the day. I'm really sensitive to "downers" of any sort.
I have been cranky and irritable, too, and that's usually not me. I think it's the other drugs getting out of my system and some feeling coming up. All that seems to be going away now.
I am really going to try to make Parnate work. I still think that it's possible.
I hope you both find it better and better!Best,
Gayle
Posted by g_g_g_unit on September 29, 2009, at 19:15:00
In reply to Re: parnate abstracts - OCD/sad? » g_g_g_unit, posted by Sunbath on September 29, 2009, at 9:21:27
> Oh that's bad :(
> Are you sure the Parnate is the reason for your increased aggressiveness/depression and not the sleep deprivation or Seroquel? A pity that you can't try trazodone.. did you ever think of trying some low-dose amitriptyline to help you sleep?
>
> as to how my trial goes: not that good.. I can sleep, but I get sooo tired -2-4h after taking my doses- that I'm unable to do anything for the next 5hours at least.. I really really hope this is going to attenuate after a few days, otherwise I'll have to stop..
>i know this sounds hypocritical of me, but as far as fatigue, you really should give it more than a few days. it seems like one of the most common complaints while on Parnate, but usually seems to be pass as far as i'm aware. it could just take a couple of weeeks unfortunately. most Nardil side-effects did for me. is it really having an unmanageable impact on your life?
i think Seroquel is partly the reason behind the aggressiveness, but even when i don't take it i feel very flat and anxious.
i'm seeing my pdoc tomorrow. maybe i will ask to try amitriptyline.
Posted by desolationrower on September 30, 2009, at 0:57:44
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 29, 2009, at 19:15:00
the parnate SA study i remember was a longish one with rather high doses. i didn't ahve fulltext, it didn't seem particularly interesting, just parnate>placebo or something
-d/r
Posted by Sunbath on September 30, 2009, at 10:07:57
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 29, 2009, at 19:15:00
thank you g_g_g_unit and you are right of course.. I'm too impatient. But I really feared this was some kind of adverse reaction indicating Parnate would be the wrong med for me..
You, GirInterrupted and Gayle encouraged me :) thank you!
BTW: do you also take a stimulant to fight the fatigue like Gayle or has it worn off by itself?How long did that take and was it dose depenend for you?Curious what your pdoc said and if you are going to give amitriptyline a try! Tomorrow I've an appointment myself :)
Posted by Sunbath on September 30, 2009, at 10:17:29
In reply to Re: parnate abstracts - ggg and Sunbath, posted by ColoradoSnowflake on September 29, 2009, at 13:55:32
Hi Gayle,
thanks a lot! I really hope Parnate will work for you again and that it will last this time! Your idea with taking all the Parnate at night sounds very good since insomnia is not a problem for both of us (for me at least not *yet*). I'll ask my pdoc tomorrow what she thinks about that.. maybe it would help.
Good to hear that you got another Provigil source!
BTW: What about other stimulants?Also I think it's bad that the older pro drug adrafinil is only available in france.. as it would be much cheaper and maybe work the same I guess.. maybe it could be importet?I'll also ask my pdoc about stimulants tomorrow but I don't think she would even consider it as my country is much more restrictive in prescribing and using stimulants!
Good luck to you!!
Posted by g_g_g_unit on September 30, 2009, at 20:08:16
In reply to Re: parnate abstracts - OCD/sad? » g_g_g_unit, posted by Sunbath on September 30, 2009, at 10:07:57
> thank you g_g_g_unit and you are right of course.. I'm too impatient. But I really feared this was some kind of adverse reaction indicating Parnate would be the wrong med for me..
> You, GirInterrupted and Gayle encouraged me :) thank you!
> BTW: do you also take a stimulant to fight the fatigue like Gayle or has it worn off by itself?How long did that take and was it dose depenend for you?
>
> Curious what your pdoc said and if you are going to give amitriptyline a try! Tomorrow I've an appointment myself :)
mine wasn't too bad actually. on the first day or two i barely felt like moving, but that felt more like a psychomotor thing than fatigue, and cleared up pretty quickly. i still get tired and nap often, which i can afford to do because i only work part-time, but i've actually decided to come off the drug since i won't be able to pass 30mg, and have no clean long-term sleep aids i can use. it's been helping my depression on one level, but making my anxiety/agitation worse, so i don't feel like it's a huge loss.
Posted by Sunbath on October 1, 2009, at 9:16:32
In reply to Re: parnate abstracts - OCD/sad?, posted by g_g_g_unit on September 30, 2009, at 20:08:16
that's sad.. don't give up too soon, maybe there's still a chance for you to convince any of your doctors!
Even when I wanted to try parnate I brought articles with me since my pdoc had never ever prescribed any MAOI.. thanks to Scott and others I found enough ressources!Good luck!
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