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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by mrm1036 on March 14, 2010, at 14:09:49
My diagnosis has always been major depression and the primary symptom has been tiredness, a kind of lethargy.
I'm on:
100mg of Parnate
300mg of Nuvigil
5 mg of Abilify,
3 mg of Lunesta, and
200 mg of LamictalThe combination works for me but I still feel terribly tired around 2 or 3 pm and it stays with me till I go to sleep.
Has anyone ever been on more than 300 Mg of Provigil or Nuvigil? I'm going to ask my psychiatrist to raise the dose of Nuvigil by 50 mg.
Posted by delna on March 14, 2010, at 14:49:33
In reply to Anyone on More than 300 MG of Nuvigil?, posted by mrm1036 on March 14, 2010, at 14:09:49
> My diagnosis has always been major depression and the primary symptom has been tiredness, a kind of lethargy.
>
> I'm on:
>
> 100mg of Parnate
> 300mg of Nuvigil
> 5 mg of Abilify,
> 3 mg of Lunesta, and
> 200 mg of Lamictal
>
> The combination works for me but I still feel terribly tired around 2 or 3 pm and it stays with me till I go to sleep.
>
> Has anyone ever been on more than 300 Mg of Provigil or Nuvigil? I'm going to ask my psychiatrist to raise the dose of Nuvigil by 50 mg.You sound like me!!
Yes, i am on 400mg Provigil and have been on it for a while. I consulted a specialist who said that I could go up to 600mg. Maybe the parnate is making doctors hesitate in raising the dose.
I've recently discovered that Ritalin is much more effective that Provigil for wakefulness (for me anyway). I take 40mg Ritalin and 400mg provigil. Also Ritalin is commonly prescribed with Parnate (by an expert only)
When do you take the abilify? Does it activate you? I found that I needed to take it at night as it was somewhat sedating.
TC
D
Posted by rjlockhart04-08 on March 14, 2010, at 18:22:32
In reply to Re: Anyone on More than 300 MG of Nuvigil? » mrm1036, posted by delna on March 14, 2010, at 14:49:33
I've taken 500mg of Nuvigel before and all it does is increases the flow of awakeness and get's the mood going on the peak effect, but not like a traditional stimulant that produces coffee-enthusiasm euphoria like adderall....
hope you get better
and 100mg of parnate is really .. good aloto of people here take it.
M
Posted by Phillipa on March 14, 2010, at 19:33:52
In reply to Re: Anyone on More than 300 MG of Nuvigil?, posted by rjlockhart04-08 on March 14, 2010, at 18:22:32
Isn't that a high dose of parnate? Phillipa
Posted by mrm1036 on March 15, 2010, at 6:15:43
In reply to Re: Anyone on More than 300 MG of Nuvigil? » mrm1036, posted by delna on March 14, 2010, at 14:49:33
Thanks you for all of your responses.
I acknowledge that my dose of Parnate (100 mg) is a relatively high dose but it is the only antidepressant that has ever helped me (after being on who knows how many different combinations of antidepresssants over the past 28 years). I was worried about tolerance re: Nuvigil so I asked my wife to hide it from me and she doles it out to me in the morning. I've read that some members of Psycho Babble on even higher doses of Parnate.
The Nuvigil does promote wakefulness in me and I'll be seeing my psychiatrist later today. I'll also ask him if there's a chance that the Abilify is causing drowsiness (he added it to boost the effectiveness of the Parnate).
Thanks again.
Posted by delna on March 15, 2010, at 10:21:52
In reply to Re: Parnate and Provigil/NUVIGIL?, posted by mrm1036 on March 15, 2010, at 6:15:43
-I was worried about tolerance re: Nuvigil so I asked my wife to hide it from me and she doles it out to me in the morning.
In my experience of 3 years with Provigil I have not noticed any tolerance build up whatsoever. I hope the Nuvigil continues to work for you too.
I'm really not too sure about this but I think I read somewhere that, although they are practically the same molecule, Provigil can be more effective in some patients than Nuvigil. Maybe worth thinking about.
Good luck
TC
D
Posted by delna on March 15, 2010, at 10:37:26
In reply to Re: Parnate and Provigil/NUVIGIL?, posted by mrm1036 on March 15, 2010, at 6:15:43
> I acknowledge that my dose of Parnate (100 mg) is a relatively high dose but it is the only antidepressant that has ever helped me (after being on who knows how many different combinations of antidepresssants over the past 28 years).Hi,
Regarding your dose of Parnate, yes it is so true that many people need higher doses .
Just for your general interest, you may be interested in these 2 tips by Dr Ivan Goldberg (who has been prescribing Parnate forever) that also speak positively of high doses for resistant cases (plus augmentation with stimulants).
Date: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.
Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: MAOIs in high doses and with stimulantsThere are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.
Posted by mrm1036 on March 15, 2010, at 19:36:57
In reply to Re: Parnate and Provigil/NUVIGIL? » mrm1036, posted by delna on March 15, 2010, at 10:37:26
Thank you so much Delna. I've just printed out your post re: relatively high doses of Parnate to show my psychiatrist.
Posted by qbsbrown on March 21, 2010, at 20:43:59
In reply to Re: Parnate and Provigil/NUVIGIL?, posted by mrm1036 on March 15, 2010, at 19:36:57
For what it's worth, and granted we are all individuals with totally different reactions to meds, but I did find that abilify did induce a couple of hours of depression per day, although it is now commonly used to add to ADs. Go figure.
Brian
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