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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by MRM1666 on June 4, 2011, at 0:16:23
Hello.
I have have suffered from major depression my entire adult life (I'm now 49) with my primary symptom being a kind of tiredeness. The current medications I'm on are the following:
100 mg of Parnate
250 mg of Nuvigil
100 mg of Lamictal
10mg of Abilify
the Abilify (the Abilify and Lamictal have been added as an attempt to boost the efffectiveness of the Parnate)
3 mg of Lunesta for sleepI've now been on this combination for a few months and I'm not sure that it is accurate to speak of a "poop-out" factor but I will say that I'm not feeling anywhere near the same positive effect compared to when I started.
This round of psychiatric meds was stated with a psychiatric I statarted working with about 3years ago. In fact, the 100mg dose of parnate was fine until I started to complian to him about about 5 months or or so again that my primary symptom of fatigue had settled back in again (which is when he started to add the "booster").I've tried virtually every SSDI and none seem to do have done much form for me. Can anyone make recommendations for other medications I could relate to my psychiatrist (again, focusing on giving an energizing effect...(And, I'm wary of starting on any stimulants.
Note: Interesting, that at some point a few years ago that a high dose of Strattera did for me then what Parnate was doing for me just a few months ago (I was wrongly diagnosed by the MD who prescribed the Strattera).
Again any suggestions and or/options would be appreciated.
Thank you.
Posted by SLS on June 4, 2011, at 5:38:49
In reply to Alternative(s) to Parnate, posted by MRM1666 on June 4, 2011, at 0:16:23
> Hello.
>
> I have have suffered from major depression my entire adult life (I'm now 49) with my primary symptom being a kind of tiredeness. The current medications I'm on are the following:
>
> 100 mg of Parnate
> 250 mg of Nuvigil
> 100 mg of Lamictal
> 10mg of Abilify
> the Abilify (the Abilify and Lamictal have been added as an attempt to boost the efffectiveness of the Parnate)
> 3 mg of Lunesta for sleep
>
> I've now been on this combination for a few months and I'm not sure that it is accurate to speak of a "poop-out" factor but I will say that I'm not feeling anywhere near the same positive effect compared to when I started.
>
>
> This round of psychiatric meds was stated with a psychiatric I statarted working with about 3years ago. In fact, the 100mg dose of parnate was fine until I started to complian to him about about 5 months or or so again that my primary symptom of fatigue had settled back in again (which is when he started to add the "booster").
>
> I've tried virtually every SSDI and none seem to do have done much form for me. Can anyone make recommendations for other medications I could relate to my psychiatrist (again, focusing on giving an energizing effect...(And, I'm wary of starting on any stimulants.
>
> Note: Interesting, that at some point a few years ago that a high dose of Strattera did for me then what Parnate was doing for me just a few months ago (I was wrongly diagnosed by the MD who prescribed the Strattera).
>
> Again any suggestions and or/options would be appreciated.
>
> Thank you.
I have had luck combining Parnate with desipramine. I am currently taking Nardil and nortriptyline. Fatigue and tiredness are symptoms of depression, and not usually the type of daytime sleepiness that Nuvigil can address fully, even as an augmenter. Continue to treat the depression. You might want to start a new thread asking for people's experiences with Provigil and Nuvigil. Perhaps I underestimate these two drugs.Augmenters: Buspar? Lithium? Amphetamine? Ritalin? Wellbutrin? Thyroxine (T4)?
Currently, I am taking:
Nardil 90mg
nortriptyline 150mg
Lamictal 200mg
Abilify 10mg
lithium 300mgAdding lithium really helped "nourish" the growing antidepressant response and reduced mood lability. Low dosages of lithium are roughly 300-600mg. You would know within two weeks whether or not lithium will help. It often starts working within a few days. If you feel no better by the end of two weeks at 600mg, you can scrap it.
Good luck.
- Scott
Posted by MRM1666 on June 4, 2011, at 8:41:22
In reply to Re: Alternative(s) to Parnate » MRM1666, posted by SLS on June 4, 2011, at 5:38:49
Thank you Scott, for your reply. Yes, I've spoken with my psychiatrist about adding desipramine or nortriptyline or Ritalin but he's wary of doing so because he's afraid of possible consequences (which I understand).
I've read on Psycho-Babble that some people experience a "poop-out" factor with Parnate. Was this your case.
Thanks very much.
I have had luck combining Parnate with desipramine. I am currently taking Nardil and nortriptyline. Fatigue and tiredness are symptoms of depression, and not usually the type of daytime sleepiness that Nuvigil can address fully, even as an augmenter. Continue to treat the depression. You might want to start a new thread asking for people's experiences with Provigil and Nuvigil. Perhaps I underestimate these two drugs.
>
> Augmenters: Buspar? Lithium? Amphetamine? Ritalin? Wellbutrin? Thyroxine (T4)?
>
> Currently, I am taking:
>
> Nardil 90mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 10mg
> lithium 300mg
>
> Adding lithium really helped "nourish" the growing antidepressant response and reduced mood lability. Low dosages of lithium are roughly 300-600mg. You would know within two weeks whether or not lithium will help. It often starts working within a few days. If you feel no better by the end of two weeks at 600mg, you can scrap it.
>
> Good luck.
>
>
> - Scott> > Hello.
> >
> > I have have suffered from major depression my entire adult life (I'm now 49) with my primary symptom being a kind of tiredeness. The current medications I'm on are the following:
> >
> > 100 mg of Parnate
> > 250 mg of Nuvigil
> > 100 mg of Lamictal
> > 10mg of Abilify
> > the Abilify (the Abilify and Lamictal have been added as an attempt to boost the efffectiveness of the Parnate)
> > 3 mg of Lunesta for sleep
> >
> > I've now been on this combination for a few months and I'm not sure that it is accurate to speak of a "poop-out" factor but I will say that I'm not feeling anywhere near the same positive effect compared to when I started.
> >
> >
> > This round of psychiatric meds was stated with a psychiatric I statarted working with about 3years ago. In fact, the 100mg dose of parnate was fine until I started to complian to him about about 5 months or or so again that my primary symptom of fatigue had settled back in again (which is when he started to add the "booster").
> >
> > I've tried virtually every SSDI and none seem to do have done much form for me. Can anyone make recommendations for other medications I could relate to my psychiatrist (again, focusing on giving an energizing effect...(And, I'm wary of starting on any stimulants.
> >
> > Note: Interesting, that at some point a few years ago that a high dose of Strattera did for me then what Parnate was doing for me just a few months ago (I was wrongly diagnosed by the MD who prescribed the Strattera).
> >
> > Again any suggestions and or/options would be appreciated.
> >
> > Thank you.
Posted by bleauberry on June 4, 2011, at 19:02:57
In reply to Alternative(s) to Parnate, posted by MRM1666 on June 4, 2011, at 0:16:23
Just my opinion, but I think you are seeing the wrong specialist for the complaint of chronic fatigue. That is a whole different issue that is either related to infection or glandulars, not psychiatric. An integrative or alternative doc who is comfortable with treating adrenal and thyroid issues is what you need, one who is comfortable basing decisions on clinical presentation/history even when labs "appear" ok, as well as one who recognizes mystery diseases are not uncommonly improved with antibiotics or antimicrobial herbal strategies. If your clinician does not have that kind of open mindedness I don't think you are going to find a psychiatric medication to do the job. And even if you did, it would predictably (my opinion) make the underlying chronic fatigue worse in the long run, better in the short run, but overall a worse picture than it is now.
I am assuming here that the general consensus is..."depression = fatigue....so fix the depression and the fatigue will go away with it". I disagree with that. They are two separate issues, but easily and accidentally intertwined as if the same.
Posted by SLS on June 4, 2011, at 20:28:03
In reply to Re: Alternative(s) to Parnate, posted by bleauberry on June 4, 2011, at 19:02:57
"Fatigue and tiredness are symptoms of depression"
You disagree with this?
Fact 1: Fatigue and tiredness are symptoms of depression.
Fact 2: Fatigue and tiredness are also symptoms of many other illnesses.
Fact 2 does not preclude Fact 1.
People know this.
Pretty simple.
- Scott
Posted by jono_in_adelaide on June 5, 2011, at 18:21:10
In reply to Re: Alternative(s) to Parnate » bleauberry, posted by SLS on June 4, 2011, at 20:28:03
Have you tried Welbutrin?
Another one that might be worth a try is protriptyline (Vivactil), either with the Parnate, or by it self.
Stimulant meds like dexamptetamine etc can give you a short term boost, but it quickly wears off in the majority of cases - it might be that you could ask your doctor for a few dexamphetamine tablets, and use them occasioaly, for example when you have a big event on, or have some other need for an extra boost. Amphetamines generaly arnt effective in major depression.
Posted by bleauberry on June 7, 2011, at 5:19:11
In reply to Re: Alternative(s) to Parnate » bleauberry, posted by SLS on June 4, 2011, at 20:28:03
Scott maybe it's the way I phrase things, the inability to experience a face to face conversation, or just misinterpretation for whatever reason on the reader's part, but I think you misunderstood me. I am saying exactly what you said in your reply below. However, and this is important....people almost universally and totally ignore your point #2.
And keep in mind that both the depression and the fatigue have a decent probability of being expressions of a different illness. In other words, the disease is something else, the depression and fatigue are symptoms of it. We can spend our lives trying to treat the depression and the fatigue and yet never even touch the diseases itself. And thus we scratch our heads and wonder why things don't work.
Pretty simple.
> "Fatigue and tiredness are symptoms of depression"
>
> You disagree with this?
>
> Fact 1: Fatigue and tiredness are symptoms of depression.
>
> Fact 2: Fatigue and tiredness are also symptoms of many other illnesses.
>
> Fact 2 does not preclude Fact 1.
>
> People know this.
>
> Pretty simple.
>
>
> - Scott
Posted by desolationrower on June 11, 2011, at 13:36:13
In reply to Re: Alternative(s) to Parnate, posted by jono_in_adelaide on June 5, 2011, at 18:21:10
Have you had a sleep test on your regimine to see if you are getting restful sleep?
I might think about adding a drug to improve sleep quality if that is the case.
O just now am wondering about how MAOI and their increasing melatonin might cause fatigue. I'd be double sure to have bright light (should have significant blue spectrum, so probably a flouresecent, not incandescent/halogen), especially if you spend your days in an office. and vitamin D3/k2 while i'm thinking about it.-d/r
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