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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Ben on October 31, 2011, at 8:35:23
I`m taking parnate 100mg/d now. First we started with 10 mg/d as I was taking Doxepin 100mg/d. Then we increased the Parnate slowly and reduced the Doxepin quickly. First everything was fine, then I had to go up to 60mg/d. After some weeks I was getting more depressed again and we had to go up to. 80mg/d. Finally I had to increase the dose now to 100mg/d but I feel more depressed as before.Is this cycle a typical poop out?
I`m also more irritable, have more tremor and headaches. During the night I sleep well with vivid dreams and in the morning I have the feeling that I slept only for some hours but in fact I slept about 8 hours. Now I`m thinking that it could be a mild serotonin syndrome. Should I go back to 80mg/d? My pdoc is on holidays now.
First I had some sleep probs with Parnate so we added a small amount of Doxepin (25mg/d). Perhaps I should go up with the doxepin again because I had some positive effects of Doxepin. Once I had a good combo of Doxepine and Luvox but it didnt help for my social phobia. Then my depression was gone. The Parnate works for my social phobia but not for constantly my depression. Everything tricky. Can you help me?I`m bipolar II with social phobia and take also: Abilify, Valproate, Lamictal, Lithium and T4. Tried almost every AD.
Posted by SLS on October 31, 2011, at 9:05:48
In reply to PARNATE poop out? -Please help!, posted by Ben on October 31, 2011, at 8:35:23
> I`m taking parnate 100mg/d now. First we started with 10 mg/d as I was taking Doxepin 100mg/d. Then we increased the Parnate slowly and reduced the Doxepin quickly. First everything was fine, then I had to go up to 60mg/d. After some weeks I was getting more depressed again and we had to go up to. 80mg/d. Finally I had to increase the dose now to 100mg/d but I feel more depressed as before.Is this cycle a typical poop out?
> I`m also more irritable, have more tremor and headaches. During the night I sleep well with vivid dreams and in the morning I have the feeling that I slept only for some hours but in fact I slept about 8 hours. Now I`m thinking that it could be a mild serotonin syndrome. Should I go back to 80mg/d? My pdoc is on holidays now.
> First I had some sleep probs with Parnate so we added a small amount of Doxepin (25mg/d). Perhaps I should go up with the doxepin again because I had some positive effects of Doxepin. Once I had a good combo of Doxepine and Luvox but it didnt help for my social phobia. Then my depression was gone. The Parnate works for my social phobia but not for constantly my depression. Everything tricky. Can you help me?
>
> I`m bipolar II with social phobia and take also: Abilify, Valproate, Lamictal, Lithium and T4. Tried almost every AD.Combine Parnate with a tricyclic?
You may want to consider the possibility that the doxepin was a necessary component to your feeling better during that short interval. You should be able to add it back safely. If your doctor is unsure about doxepin, you can use desipramine or nortriptyline instead. The doxepin should be safe, though. It is important to understand that drugs that inhibit the reuptake of serotonin be avoided. This would exclude clomipramine and imipramine from consideration as adjuncts.
http://www.ncbi.nlm.nih.gov/pubmed/3406429http://www.ncbi.nlm.nih.gov/pubmed/3997787
http://www.dr-bob.org/tips/split/TCAs-+-MAOIs.html
- Scott
Posted by Phillipa on October 31, 2011, at 11:19:23
In reply to PARNATE poop out? -Please help!, posted by Ben on October 31, 2011, at 8:35:23
Ben wishing you the best and that your parnate doesn't poop out. Scott has some good recommendations for you. Phillipa
Posted by Ben on October 31, 2011, at 11:44:31
In reply to Re: PARNATE poop out? -Please help! » Ben, posted by Phillipa on October 31, 2011, at 11:19:23
Thanks for your input Scott and the wishes from Phillipa.
I dont know if I should go higher with the Parnate or following a augmentation strategy. One Problem is my awful tremor which is limited for some combos.
As I said I had a real good combo 200mg/d of Luvox and 100-150 mg of Doxepin at night. The problem was that it didn't help my social phobia and I gained weight besides the tremor which was pretty worse. But the mood was good and my sleep was also fine. No hangover!
Posted by SLS on October 31, 2011, at 11:49:32
In reply to Re: PARNATE poop out? -Please help!, posted by Ben on October 31, 2011, at 11:44:31
> Thanks for your input Scott and the wishes from Phillipa.
> I dont know if I should go higher with the Parnate or following a augmentation strategy. One Problem is my awful tremor which is limited for some combos.
> As I said I had a real good combo 200mg/d of Luvox and 100-150 mg of Doxepin at night. The problem was that it didn't help my social phobia and I gained weight besides the tremor which was pretty worse. But the mood was good and my sleep was also fine. No hangover!
If you decide to go with a tricyclic to add to Parnate, you might want to make nortriptyline your first pick. It is better for sleep than is desipramine, and probably won't put on as much weight as doxepin or amitriptyline.My best response came with a combination of Parnate and desipramine. Insomnia was a problem, though.
- Scott
Posted by Ben on October 31, 2011, at 12:08:50
In reply to Re: PARNATE poop out? -Please help! » Ben, posted by SLS on October 31, 2011, at 11:49:32
> > Thanks for your input Scott and the wishes from Phillipa.
> > I dont know if I should go higher with the Parnate or following a augmentation strategy. One Problem is my awful tremor which is limited for some combos.
> > As I said I had a real good combo 200mg/d of Luvox and 100-150 mg of Doxepin at night. The problem was that it didn't help my social phobia and I gained weight besides the tremor which was pretty worse. But the mood was good and my sleep was also fine. No hangover!
>
>
> If you decide to go with a tricyclic to add to Parnate, you might want to make nortriptyline your first pick. It is better for sleep than is desipramine, and probably won't put on as much weight as doxepin or amitriptyline.
>
> My best response came with a combination of Parnate and desipramine. Insomnia was a problem, though.
>
>
> - ScottScott, I`m on Doxepin (25mg at night) again since I had some sleep problems with Parnate. Now I don`t know if I should choose another TCA besides my pdoc is on holidays now. Probably its better to go up with the Doxepin at the moment?!
Posted by SLS on October 31, 2011, at 13:44:44
In reply to Re: PARNATE poop out? -Please help! » SLS, posted by Ben on October 31, 2011, at 12:08:50
> > If you decide to go with a tricyclic to add to Parnate, you might want to make nortriptyline your first pick. It is better for sleep than is desipramine, and probably won't put on as much weight as doxepin or amitriptyline.
> >
> > My best response came with a combination of Parnate and desipramine. Insomnia was a problem, though.> Scott, I`m on Doxepin (25mg at night) again since I had some sleep problems with Parnate. Now I don`t know if I should choose another TCA besides my pdoc is on holidays now. Probably its better to go up with the Doxepin at the moment?!
That's a tough call. I think that you ought to consult with your doctor on this one. You might compromise his trust in you otherwise. I do know one woman who responded pretty well to a combination of Nardil and doxepin.
- Scott
Posted by Ben on October 31, 2011, at 14:41:58
In reply to Re: PARNATE poop out? -Please help! » Ben, posted by SLS on October 31, 2011, at 13:44:44
Hi Scott, dont worry, I have the agreement of my pdoc to go up with the Doxepin or the Parnate. I wanted to know what you all think about here which way to go.
Posted by SLS on October 31, 2011, at 14:57:08
In reply to Re: PARNATE poop out? -Please help! » SLS, posted by Ben on October 31, 2011, at 14:41:58
> Hi Scott, dont worry, I have the agreement of my pdoc to go up with the Doxepin or the Parnate.
Okay.
> I wanted to know what you all think about here which way to go.
I would increase the doxepin slowly and look to reach a target dosage range of 75-150 mg. You could go higher if necessary, but I think it would be prudent to give 150 mg a few weeks to work. In my experience, the co-administration of Parnate with a TCA does not allow for lower dosages of the TCA to be used in order to produce results.
- Scott
Posted by jono_in_adelaide on October 31, 2011, at 17:30:27
In reply to PARNATE poop out? -Please help!, posted by Ben on October 31, 2011, at 8:35:23
My first instincy would be to say drop the Parnate back to say 60mg per day, and add back some or all of the doxepin, as that combo seemed to work.
If that doesnt cut it, drop the parnate and try somthing else, a different combo (for example an SSRI plus bupropion plus doxepin for sleep)
Posted by Phillipa on October 31, 2011, at 19:30:15
In reply to Re: PARNATE poop out? -Please help!, posted by jono_in_adelaide on October 31, 2011, at 17:30:27
If luvox worked other than social phobia could you go back on that with a low dose of benzo for the social anxiety. Also did you taper off the luvox slowly as find it's the one med I can't get off. Also good for OCD and anxiety. Phillipa
Posted by Ben on November 4, 2011, at 8:52:16
In reply to Re: PARNATE poop out? -Please help!, posted by Phillipa on October 31, 2011, at 19:30:15
Luvox wasn't a problem to me to get off like Doxepin as well. The worst med was Paroxetine.
Posted by Ben on November 4, 2011, at 8:54:45
In reply to Re: PARNATE poop out? -Please help!, posted by jono_in_adelaide on October 31, 2011, at 17:30:27
That is a good idea but I worry about the weight gain from Doxepin I had before I went to Parnate.
Posted by Ben on November 4, 2011, at 9:00:05
In reply to Re: PARNATE poop out? -Please help! » Ben, posted by SLS on October 31, 2011, at 14:57:08
Thats a good idea but I worry about the weight gain of Doxepine. Should I switch to Amitryptyline?
I notice when I forget a dose of Parnate. I`m getting more depressed. Is that possible or only a psychological idea?
Posted by Ben on November 4, 2011, at 9:07:05
In reply to Re: PARNATE poop out? -Please help! » SLS, posted by Ben on November 4, 2011, at 9:00:05
I`m thinking to get rid of the Parnate to switch to Wellbutrin. Can you do that overlapping?
But as I have also social phobia I don`t think that Wellbutrin alone would do the trick (for depression and Social phobia). What about a combo with an SSRI for example Luvox which helped me (with Doxepine together) for depression but not for social phobia.
Posted by Phillipa on November 4, 2011, at 20:37:27
In reply to Re: PARNATE Wellbutrin combo?!, posted by Ben on November 4, 2011, at 9:07:05
You may have mentioned how high your dose of paxil was but I didn't reread the thread. Strange how meds effect us all so differently as paxil two weeks and off. Maybe the luvox is psycological as don't trust any other meds but the benzos and now no relief from them? Stange well if the luvox and doxepin worked before what about adding benzos if you haven't been on them before? Phillipa
This is the end of the thread.
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