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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 MRM on January 27, 2011, at 14:18:00
I have suffered from major depression my entire adult life and I've been on most antidepressants. My primary symptom is tiredness, lethargy. I'm on the following medications:
Parnate: 100mg/daily
Nuvigil: 250 mg/daily
Lamictal: 200 mg/daily (used to boost the effectiveness of the Parnate)
Abilify: 10mg/daily (used to boost the effectiveness of the Parnate)
Lunesta: 3mg/nightA few observations:
1. I started on Parnate about a year ago and I notice that it doesn't have the same positive effect on me now as it does then. I've read on this list of "Parnate Poop Out" but when I mentioned it to my psychiatrist he dismissed it.
2. I'm a fast metabolizer. So the Nuvigil, which has been helpful is no longer so (and I don't think I've built up a tolerance to it, but I could be wrong).
3. My psychiatrist has increased the Lamictal and the Abilify as I have told him of the "loss of oomph!" But he refuses to increase either the Parnate or the Nuvigil.
4. When I told him I have read (within psychobabble) of the augmentation of Parnate with one of the TCAs or with Thyroid hormone, etc. he dismissed the ideas as being to dangerous (and I understand and respect his point of view on this).
Has anyone been on the Parnate/Nuvigil combination withOUT developing a tolerance?
Has anyone, or is anyone, on more than 100mg of Parnate daily?
I appreciate any and all responses. Thanks very much.
Posted by Sailboat77 on January 27, 2011, at 17:40:00
In reply to Parnate Augmentation With Nuvigil???, posted by MRM on January 27, 2011, at 14:18:00
I've been on Parnate 40mg for 5 weeks and just started at 60mg about a week ago. I went up and down on dosage because of side effects (dizzy/fainting), but now I'm doing fine at the higher dose.
Parnate has been the only thing to help my treatment resistant depression, but it only gets me so far. I still have a lack of interest in fun activities and friends. Like you, my metabolism is very fast and my doctor seems to think so to, which means that my liver might be processing medicine faster than the average person, therefore needing a boost.
In about 3 weeks, my doctor and I have agreed to try small amounts of Adderall with the 60mg of Parnate. In the past, stimulants like Vyvanse or Adderall have pretty much "eliminated" my depression, but I emotionally crash afterwards and feel more depressed. The difference now is that the Parnate seems to stop my crash -- (without my doctor's permission, at 40mg of Parnate, I tried some Adderall on my own and seemed to feel better without crashing afterwards. I did this twice and don't advise it because of the health risks).
For many people, Parnate or Nardil alone work fine, though some people need doses higher than recommended or additional antidepressant medicines. Doctors can be hesitant or unwilling to do this because of the risks involved. But as I explained to my doctor, it's much riskier for me to continue on this path of depression/suicidal thoughts without taking some serious chances. There are tons of warning against using a stimulant with Parnate, but for me, it seems to be safe and beneficial.
Posted by MRM on January 28, 2011, at 6:41:04
In reply to Re: Parnate augmentation with Adderall, posted by Sailboat77 on January 27, 2011, at 17:40:00
Yes, I understand Sailboat. Over the years I also have been prescribed small amounts of stimulants with always the same result: I quickly became tolerated to the dose and the psychiatrist had to decide whether to raise it or cut me off of it.
I know that some people can develop a tolerance to Provigil/Nuvigil while others never have such a problem.
Posted by creepy on January 28, 2011, at 15:04:28
In reply to Re: Parnate augmentation with Adderall, posted by Sailboat77 on January 27, 2011, at 17:40:00
I know provigil induces its own metabolism and needs to be raised after some time. Im guessing nuvigil may be similar.
As far as parnate poop-out, have you tried other MAOIs or a TCA or stimulant to augment?
Posted by Chairman_MAO on February 2, 2011, at 8:30:02
In reply to Re: Parnate augmentation with Adderall, posted by Sailboat77 on January 27, 2011, at 17:40:00
I've used 60mg/day of immediate-release Dexedrine along with up to 120mg/day of Nardil. I never had an untoward interaction between the two.
Parnate may be somewhat riskier because it and its metabolites have stimulant properties themselves, but in practice it'll probably be fine.
You may wish to ask for an emergency medication such as clonidine, nifedipine, or chlorpromazine to take in case of hypertension, etc.
Posted by shalhevet on February 9, 2011, at 22:08:00
In reply to Parnate Augmentation With Nuvigil???, posted by MRM on January 27, 2011, at 14:18:00
I've taken 100mg Parnate with 20mg Dexedrine (5mg IR tablets), spaced carefully throughout the day. I haven't developed a tolerance, but I can't say I'm thrilled with the constant jaw clenching and huge pupils. I'm also now taking Atenolol, since my heartrate wouldn't go under 130bpm. And my sleep cycle is totally jacked. Of course, those are far less horrifying issues than depression.
I've had poop-outs twice, unfortunately. I had an incredible response at 50mg only to be suicidal five weeks later. At 90mg, I felt normal and incredible but "meh" after awhile. At 100mg I experienced a total absence of leaden paralysis (how amazing for my *body* to stop feeling depressed), but the side-effects were truly unmanageable: constant, freaky choreoathetoid movements. Long-term I've done well at 80mg but I do take 100mg when I feel a slump coming on, and for a year now I've staved off a major episode. That's huge and totally life-changing.
My psychiatrist is wary of extended-release formulations of stimulants. If some bad interaction happened (extreme tachycardia, anxiety, urinary retention, whatever), I'd just be stuck with it all day. That said, I did try Provigil+Parnate for a few weeks, but I didn't get past 50mg - too small a dose to make an impact on fatigue. (I stopped because the impact on my mental state was weird and alarming. Dexedrine has been fine - sometimes I just get really into making lists)
This is the end of the thread.
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