Psycho-Babble Medication Thread 1016518

Shown: posts 1 to 13 of 13. This is the beginning of the thread.

 

feel foggy/stoned on Parnate

Posted by g_g_g_unit on April 26, 2012, at 22:07:50

So I had actually been doing reasonably well on 30mg of Parnate. I found that each 10mg dose had a beneficial effect on my attention (more so than Dexedrine), but that there was a lot of background anxiety and OCD, and trying to ameliorate it with Valium only left me feeling stuporous.

However, I hadn't noted any changes in blood pressure (which Dr Gilman suggests is one of the indications of having reached a therapeutic dose).

So, based on the fact that people report higher doses being more anxiolytic, I prematurely (i.e. without my doctor's permission) increased to 40mg. It's been 3 or 4 days and, instead of the alertness I experienced on 30mg, I find myself feeling out-of-it. There are also occasional moments of lightheadedness when I stand up, particularly when a dose is wearing off. So I'm wondering if, despite the frustration caused by the fogginess, this is all in fact a good sign?

Also as usual, for some reason, my mood is really good at night, i.e. I feel almost euthymic, compared to the flatness I experience during the day.

 

Re: feel foggy/stoned on Parnate » g_g_g_unit

Posted by SLS on April 27, 2012, at 6:40:49

In reply to feel foggy/stoned on Parnate, posted by g_g_g_unit on April 26, 2012, at 22:07:50

Hi.

I often feel foggy and somehow weird upon increasing dosages of MAOIs. I always thought that this was a good sign. It is for me, anyway. So, too, is insomnia. The fogginess clears up withing a week for me.

I never thought you would get up to 40 mg of Parnate. I doubt that I would have had the resolve to tolerate the side effects you did at the beginning of treatment. You deserve to get well on this stuff. You worked hard to get there.


- Scott

 

Re: feel foggy/stoned on Parnate » SLS

Posted by g_g_g_unit on April 28, 2012, at 8:31:48

In reply to Re: feel foggy/stoned on Parnate » g_g_g_unit, posted by SLS on April 27, 2012, at 6:40:49

Wow, thanks Scott. That is high praise coming from someone who's been through as many trials as you have. I think I'm just stubborn, and dread the idea of returning to SSRIs, so have vowed to make Parnate work for me :)

What's interesting is I recall feeling very depressed on it last time, but am not experiencing the same phenomena this time. The only explanation I can offer is that I am not using any short-acting benzos or z-drugs, which produce rebound depression in me. I recall being in tears most nights during my first trial (I was regularly using Zopiclone), whereas now, like I say, I tend to feel happy and euthymic at night, which seems like a good sign, because in my unmedicated state, that's typically when my depression is at its worst. The only annoying thing is I'll tend to feel very spacey during these periods.

Yes, I remember you commenting about feeling foggy and weird on Nardil prior to it kicking in, which is why I haven't been particularly concerned about it. My main concern re: ADHD is the stimulant effect 'pooping out'. I e-mailed one of the few experts in TRD here and asked if he combines MAOIs with stimulants and he said no, he considers it far too dangerous.

> Hi.
>
> I often feel foggy and somehow weird upon increasing dosages of MAOIs. I always thought that this was a good sign. It is for me, anyway. So, too, is insomnia. The fogginess clears up withing a week for me.
>
> I never thought you would get up to 40 mg of Parnate. I doubt that I would have had the resolve to tolerate the side effects you did at the beginning of treatment. You deserve to get well on this stuff. You worked hard to get there.
>
>
> - Scott

 

Re: feel foggy/stoned on Parnate » g_g_g_unit

Posted by SLS on April 28, 2012, at 9:21:36

In reply to Re: feel foggy/stoned on Parnate » SLS, posted by g_g_g_unit on April 28, 2012, at 8:31:48

Hi GGG.

> I e-mailed one of the few experts in TRD here and asked if he combines MAOIs with stimulants and he said no, he considers it far too dangerous.

I imagine your doctor and I could have an animated discussion over this. There are plenty of TRD doctors who would disagree with him. I would be curious to know upon what he bases his opinion.

I wrote a little bit about this in the following thread:

http://www.dr-bob.org/babble/20120425/msgs/1016596.html

For you specifically, such combinations might not be a good idea. It would depend upon your initial reaction to Parnate. I forget - how did Parnate affect your blood pressure when you first started taking it? How is it now?


- Scott

 

Re: feel foggy/stoned on Parnate » SLS

Posted by g_g_g_unit on April 29, 2012, at 1:49:10

In reply to Re: feel foggy/stoned on Parnate » g_g_g_unit, posted by SLS on April 28, 2012, at 9:21:36

> Hi GGG.
>
> > I e-mailed one of the few experts in TRD here and asked if he combines MAOIs with stimulants and he said no, he considers it far too dangerous.
>
> I imagine your doctor and I could have an animated discussion over this. There are plenty of TRD doctors who would disagree with him. I would be curious to know upon what he bases his opinion.

I'm not sure, though I wasn't too surprised. I did say 'stimulants' in my e-mail, though he singled out dexamphetamine in his reply. I've spoken to Dr Gilman about this, and while he's comfortable using Methylphenidate, he likewise says that he would fear using dexamphetamine due to the potential for serotonin syndrome.
>
> I wrote a little bit about this in the following thread:
>
> http://www.dr-bob.org/babble/20120425/msgs/1016596.html
>
> For you specifically, such combinations might not be a good idea. It would depend upon your initial reaction to Parnate. I forget - how did Parnate affect your blood pressure when you first started taking it? How is it now?

I noticed no subjective effect on blood pressure between 10-30mg (I haven't formally been measuring it), but I do notice more dizziness upon standing now at 40mg .. however, these 'attacks' are mild and intermittent.

Do you have any explanation for the 'fogginess' on MAOIs? Do you think it might involve auto-receptors?

 

Re: feel foggy/stoned on Parnate » g_g_g_unit

Posted by SLS on April 29, 2012, at 2:26:47

In reply to Re: feel foggy/stoned on Parnate » SLS, posted by g_g_g_unit on April 29, 2012, at 1:49:10

I happened to be awake early this morning - too early. I spent entirely too much time composing a post along the "more harm than good" thread. If I had seen your post first, I would have invested the time into replying to it instead. I may not have time to get to it tomorrow. I'm off to bed to try to get more sleep.

I will need to look into the Dexedrine thing more closely.

Have a good day.


- Scott


> > Hi GGG.
> >
> > > I e-mailed one of the few experts in TRD here and asked if he combines MAOIs with stimulants and he said no, he considers it far too dangerous.
> >
> > I imagine your doctor and I could have an animated discussion over this. There are plenty of TRD doctors who would disagree with him. I would be curious to know upon what he bases his opinion.
>
> I'm not sure, though I wasn't too surprised. I did say 'stimulants' in my e-mail, though he singled out dexamphetamine in his reply. I've spoken to Dr Gilman about this, and while he's comfortable using Methylphenidate, he likewise says that he would fear using dexamphetamine due to the potential for serotonin syndrome.
> >
> > I wrote a little bit about this in the following thread:
> >
> > http://www.dr-bob.org/babble/20120425/msgs/1016596.html
> >
> > For you specifically, such combinations might not be a good idea. It would depend upon your initial reaction to Parnate. I forget - how did Parnate affect your blood pressure when you first started taking it? How is it now?
>
> I noticed no subjective effect on blood pressure between 10-30mg (I haven't formally been measuring it), but I do notice more dizziness upon standing now at 40mg .. however, these 'attacks' are mild and intermittent.
>
> Do you have any explanation for the 'fogginess' on MAOIs? Do you think it might involve auto-receptors?
>
>

 

Re: feel foggy/stoned on Parnate » g_g_g_unit

Posted by SLS on April 29, 2012, at 5:59:34

In reply to Re: feel foggy/stoned on Parnate » SLS, posted by g_g_g_unit on April 28, 2012, at 8:31:48

> I will need to look into the Dexedrine thing more closely.

I am baffled by what Dr. Gillman told you.

I can't find any reason why Dexedrine cannot be combined with Parnate for most people. I have been reading about amphetamines since 1983, and never came across anything that suggests that it releases serotonin or otherwise produces serotonin syndrome when combined with an MAOI. Hypertension is a concern for some people, but this is a catecholamine thing. The thing is, new properties are discovered in old drugs quite frequently, so there there must be literature that I have not seen yet.

Here is an excerpt of what Dr. Gillman writes on the subject:

"Amphetamine and MAOIs have also been in use together for 40 years and there are few deaths from apparent serotonin toxicity reported with amphetamine. Amphetamine has weak serotonergic effects; and there seems little risk of precipitating serotonin toxicity if combined with MAOIs."

One must read the whole article. He apparently contradicts himself. The doctor certainly seems ambivalent.

http://www.psychotropical.com/CNS_stimulants_with_MAOIs.shtml

Medline (Pubmed) is a reasonably comprehensive repository of medical literature. So far, I have not seen anything describing amphetamine in such a way.

I guess it makes sense to accept your doctor's assessment of amphetamine at this point. I would like to see more proof, though.


- Scott

 

Re: feel foggy/stoned on Parnate » g_g_g_unit

Posted by Alexei on April 29, 2012, at 14:35:17

In reply to Re: feel foggy/stoned on Parnate » SLS, posted by g_g_g_unit on April 28, 2012, at 8:31:48

> I think I'm just stubborn, and dread the idea of returning to SSRIs, so have vowed to make Parnate work for me :)


I've taken plenty of ssri and snri but never an MAOI. Is the difference in efficacy and potency that drastic?

 

Re: feel foggy/stoned on Parnate » SLS

Posted by g_g_g_unit on April 30, 2012, at 9:48:43

In reply to Re: feel foggy/stoned on Parnate » g_g_g_unit, posted by SLS on April 29, 2012, at 5:59:34


> I guess it makes sense to accept your doctor's assessment of amphetamine at this point. I would like to see more proof, though.
>
>
> - Scott

Just to clear things up: He isn't my current treating doctor - just a self-assigned expert on TRD who I've been in e-mail contact with.

There's something of a blanket conservatism at work in Australia (and the UK, plus certain other parts of Europe from what I understand). There probably isn't much point in trying to challenge it - either with logic or scientific evidence.

 

Re: feel foggy/stoned on Parnate » Alexei

Posted by g_g_g_unit on April 30, 2012, at 10:00:32

In reply to Re: feel foggy/stoned on Parnate » g_g_g_unit, posted by Alexei on April 29, 2012, at 14:35:17

> I've taken plenty of ssri and snri but never an MAOI. Is the difference in efficacy and potency that drastic?
>

To be honest, I can't really say yet. Nardil made me hypomanic, which was fun, but the insomnia was relentless and I've since been diagnosed with ADHD; from my research, Nardil doesn't show much efficacy in that area.

Parnate is far more 'cleaner' than any SSRI I've been on, and has a stimulating effect at lower doses which came in handy (i.e. it actively improved attention, rather than simply energizing me). Since hitting 40mg, I've lost the stimulating benefits, but am wondering if this may involve DA autoreceptors. Anyway, I'm curious to see how higher doses affect me with regards to motivation etc.

 

*still* feel foggy/stoned on Parnate

Posted by g_g_g_unit on May 2, 2012, at 22:49:42

In reply to Re: feel foggy/stoned on Parnate » Alexei, posted by g_g_g_unit on April 30, 2012, at 10:00:32

Ugh, it's been over a week on 40mg and I still feel spacey. This is so frustrating, especially after the ADD benefits I was seeing on 30mg (which was also, unfortunately, exacerbating my anxiety).

10mg does nothing for attention now. Taking 20mg used to be highly activating, but I just tried taking 30mg to aid concentration and it's only making me teary and sleepy.

 

Re: *still* feel foggy/stoned on Parnate » g_g_g_unit

Posted by SLS on May 3, 2012, at 6:05:07

In reply to *still* feel foggy/stoned on Parnate, posted by g_g_g_unit on May 2, 2012, at 22:49:42

> Ugh, it's been over a week on 40mg and I still feel spacey. This is so frustrating, especially after the ADD benefits I was seeing on 30mg (which was also, unfortunately, exacerbating my anxiety).
>
> 10mg does nothing for attention now. Taking 20mg used to be highly activating, but I just tried taking 30mg to aid concentration and it's only making me teary and sleepy.

I'm sorry to hear that.

:-(

You try so hard.

I am unsure as to how you are taking Parnate. How do you know that 10 mg does nothing for attention; that 20 mg is no longer activating; and that 30 mg is making you sleepy? Are you changing your total daily dosage each day, or are you describing what happens after each sequential dose during the course of the same day? Is there any positive effect on depression yet?

With Nardil, I felt weird for over a week once I reached 60 mg. I eventually gleaned a partial response at 90 mg.

Did you try Emsam? It can be somewhat energizing and often reduces anxiety. There are some reports that it helps treat ADHD. Perhaps you would tolerate it better.

We are fine. Drugs are weird.


- Scott

 

Re: *still* feel foggy/stoned on Parnate » SLS

Posted by g_g_g_unit on May 3, 2012, at 8:05:21

In reply to Re: *still* feel foggy/stoned on Parnate » g_g_g_unit, posted by SLS on May 3, 2012, at 6:05:07

Thanks Scott. I hope you understand your concern means a lot to me. Sometimes I don't feel like I try hard enough, though that's mainly because I'm not doing very much to work on my OCD right now (which is just too severe for therapy alone). I spend a lot of the day engaged in avoidance behaviors.

When I went to 40mg, I took 15mg + 15mg + 10mg, 2.5-3 hours apart. After a week, I thought the fog should have dissipated, but it hadn't. I know there is no real beneficial effect on attention because I will often attempt to read something after dosing as a test. There is also none of the alertness/clearheadednss I initially experienced, which I can just detect by self-observation.

So today, out of frustration, I took 20mg. After an hour, nothing happened, so I took a further 10mg and just felt sleepy. Maybe not the most scientific approach ..

As for effects on depression, I notice an absence of leaden paralysis and a positive mood at night. I had less suicidal thoughts when my ADHD was improved, but now that I'm feeling foggy, I feel hopeless again.

I wonder if maybe a) I just need to spend more time at this dose, b) poor sleep (from benzos) is negatively impacting the ADD effects, or c) the drug is hitting the dopamine auto-receptors at this dose, which might explain the sleepiness etc. King Vultan has written about downregulating dopamine auto-receptors with Parnate in the archives. Maybe a higher dose would be necessary to achieve this.

> I'm sorry to hear that.
>
> :-(
>
> You try so hard.
>
> I am unsure as to how you are taking Parnate. How do you know that 10 mg does nothing for attention; that 20 mg is no longer activating; and that 30 mg is making you sleepy? Are you changing your total daily dosage each day, or are you describing what happens after each sequential dose during the course of the same day? Is there any positive effect on depression yet?
>
> With Nardil, I felt weird for over a week once I reached 60 mg. I eventually gleaned a partial response at 90 mg.
>
> Did you try Emsam? It can be somewhat energizing and often reduces anxiety. There are some reports that it helps treat ADHD. Perhaps you would tolerate it better.
>
> We are fine. Drugs are weird.
>
>
> - Scott
>


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