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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Deahoidar on June 14, 2011, at 5:25:29
After being on parnate for over 12 years, and having tried augmentations with a variety of meds (lithium, modafinil, emsam, wellbutrin, etc) None made a notable improvement.
Finally, the EDS side affects became untolerable and my mood was sliding quickly toward a dark, deep, place.
So, I'm tapering off Parnate (from 30mg to zero, over several weeks.) So far so good. Until sleep weirdness breaks loose. Hot and cold flashes, sweating, chills, rampants REM sleep, and episodes of 10-20 hours of sleep at one time. Not good.
Hoping to make it past this difficult stage and begin Emsam and GHB.
Right now, it's looking pretty sketchy and I'd like to find the exit door.
Any suggestions would be appreciated. I'm just trying to hang in there, day by day.
Thanks.
Posted by floatingbridge on June 14, 2011, at 11:27:10
In reply to Parnate (tranylcipramine) discontinuation =) weird, posted by Deahoidar on June 14, 2011, at 5:25:29
Well, good luck to you. I haven't gone through that before.
I am on emsam and trying to work the insomnia. Why GHB may I ask? That's xyrem, isn't it?
I've asked about it below.
Sorry not to be much help here. An maoi veteran should be by soon.
fb
Posted by phillipa on June 14, 2011, at 11:31:32
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird » Deahoidar, posted by floatingbridge on June 14, 2011, at 11:27:10
Do you have a doc? I feel you need really expert advise. Long time on parnate for sure. Phillipa
Posted by Deahoidar on June 15, 2011, at 12:21:55
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird » Deahoidar, posted by floatingbridge on June 14, 2011, at 11:27:10
> Well, good luck to you. I haven't gone through that before.
>
> I am on emsam and trying to work the insomnia. Why GHB may I ask? That's xyrem, isn't it?
>
> I've asked about it below.
>
> Sorry not to be much help here. An maoi veteran should be by soon.
>
> fbYes, Xyrem is GHB (sodium oxybate). Considering giving it a trial. I appear to be one of the "fortunate" few for whom Parnate destroys REM sleep and causes extreme daytime somnolence. In many ways similar to narcolepsy.
Xyrem apparently promotes REM sleep and we're hoping it will relieve this problematic side effect. It has gotten so bad that I can no longer tolerate Parnate at a therapeutic dose.
I'll be sure to report back.
Cuba
Posted by Deahoidar on June 15, 2011, at 12:28:07
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird, posted by phillipa on June 14, 2011, at 11:31:32
> Do you have a doc? I feel you need really expert advise. Long time on parnate for sure. Phillipa
Phillipa, absolutely! I feel very fortunate to a pdoc that I believe is one of the best. Been with them for well over 15 years. I know how difficult it can be to find a good doc who knows how (and cares) to work on treatment resistant depressives.
The discontinuation symptoms have improved. I halted the taper and let things find a steady state. Wasn't much fun. Can't remember the last time I slept more than 20 hours of a day for several days. Literally too tired to eat. Weird. Began to kinda wonder if I could die. Not too concerned about it. That's how things are.
Posted by floatingbridge on June 15, 2011, at 12:57:56
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird » floatingbridge, posted by Deahoidar on June 15, 2011, at 12:21:55
Cuba, I would very much like to hear back. Vitally so.
Here's wishing you luck!
fb
Posted by Deahoidar on June 22, 2011, at 17:21:05
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird » Deahoidar, posted by floatingbridge on June 15, 2011, at 12:57:56
I stopped tapering down on parnate and leveled off at 10mg. Many of the unpleasant symptoms have eased up, but I'm still having trouble sleeping and concentrating. It makes work very challenging.
With my pdoc, I'm evaluating a couple of options for treatment. (no one dare speak of ECT. Not again)
On one hand, there's xyrem (GHB) to improve sleep.
On the other, there's selegiline. MAOIs have worked well with me before, and there's hope that oral selegiline could work. The transdermal patch didn't work so well, so we're looking at oral.
I'd appreciate anyone's experiences with xyrem, as it sounds promising. And I like the prospect of getting quality sleep. Haven't had that in years.
Thanks for your support and concern.
Cuba
Posted by floatingbridge on June 22, 2011, at 19:53:44
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird, posted by Deahoidar on June 22, 2011, at 17:21:05
Hey, good to hear from you, and glad you're hanging in there looking at options, and you have finally stabilized. And that ect is off the table.
I just asked my gp about xyrem. I still don't have anything more to add than that.
Have you searched the archives here? Not many posters seem to be talking about xyrem lately.
Will you be able to transition from parnate to segeline at your low dose, or will you need to further wash out.
I hope things move quickly for you.
fb
Posted by Deahoidar on June 23, 2011, at 16:12:21
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird » Deahoidar, posted by floatingbridge on June 22, 2011, at 19:53:44
Am waiting to talk with my pdoc next week to decide whether to try the Xyrem or the selegiline. In anecdotal reports, xyrem appears to sometimes have antidepressant effects. (I would welcome that!) It also appears to be a challenging med to take regularly.
I don't know if selegiline would be a better option. Surely it would take longer to find out if it's working.
I'm getting really tired of all this. Exhausted from the years and years of countless efforts. Struggling to find something that helps, and even then, the improved periods are much shorter than the depressed ones. For now, every day is a struggle. Going outside is an effort. Getting dressed and eating are major accomplishments. Just trying to hold it together. As are all of us.
Posted by floatingbridge on June 23, 2011, at 18:02:46
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird, posted by Deahoidar on June 23, 2011, at 16:12:21
I have heard on health boards that xyrem can have antidepressant properties for some. It is used off label for chronic fatigue and other syndromes where sleep and exhaustion are issues. I do know someone who has maintained five years on it.
Do you need to choose between the two? I suppose that's wise to observe the effects. Segeline would probably induce sleep disturbance--I'm just assuming.
You pdoc has said or you understand the payoff of xyrem use to be less immediate?
I deal with fatigue myself, so, yeah, I know it's tough.
fb
Frankly the idea of xyrem scares me, but that is in large part because I don't understand it and a doctor has not really explained it to me. Apparently it is really difficult to dose, it needs to be taken lying down (?), and nothing can rouse the sleeper. That about taps my knowledge.
Posted by floatingbridge on June 23, 2011, at 18:49:50
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird, posted by Deahoidar on June 23, 2011, at 16:12:21
Hey, I just did some more concentrated reading on xyrem. I don't think I could risk a trial of it myself, but if you do decide to try it, I would be interested in hearing how it goes for you.
Whatever you decide, I'd be interested in an update. I also want to wish you the very best for your visit next week and going forward.
fb
Posted by floatingbridge on June 23, 2011, at 19:45:27
In reply to Re: Parnate (tranylcipramine) discontinuation =) weird, posted by Deahoidar on June 23, 2011, at 16:12:21
Hey, I just did some more concentrated reading on xyrem. I don't think I could risk a trial of it myself, but if you do decide to try it, I would be interested in hearing how it goes for you.
Whatever you decide, I'd be interested in an update. I also want to wish you the very best for your visit next week and going forward.
fb
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