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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 Snell on October 6, 2013, at 14:17:34
Hello everyone. I have been having a disagreement with my pdoc over the appropriate dose of Parnate--yes, it's an MAOI--for me. (I began it textbook style, with a washout period--that was awful--I stay away from tyramine, etc.)
On 20mg/d, I have had some remission of symptoms. I still feel, however, social isolation, anergia, low mood, and sleep disturbances. (The sleep disturbances may be a result of the Parnate.) My blood pressure is normal. My health, otherwise, is good.
I have been taking the Parnate since September 1. I would like to try a higher dose. My pdoc is *strongly* opposed to this. The literature that supports a 20 mg/d dose all comes from the manufacturers or sites such as RxList and Drugs.com. The research literature, however, supports raising the Parnate to sixty (60) to eighty (80) mg/day. Several articles have recommended a dose of 1 mg/kg. I weigh 102 kg, so obviously that's a dose of 100mg/day.
Some pdocs raise the Parnate to 150 to 200 mg/day in nonresponders. I am not asking for this. I am concerned that I am taking a subtherapeutic dose. Any advice or reactions?
Posted by Christ_empowered on October 6, 2013, at 20:40:46
In reply to Parnate (tranylcypromine) dose, posted by Snell on October 6, 2013, at 14:17:34
Since your doc isn't down with upping the Parnate, could try adding something? Provigil, Ritalin, some sort of Amphetamine (Adderall, vyvanse, Dexedrine, desoxyn), maybe a low-ish dose of a carefully selected TCA?
Posted by europerep on October 7, 2013, at 14:53:00
In reply to Parnate (tranylcypromine) dose, posted by Snell on October 6, 2013, at 14:17:34
Hi,
Pretty much all you said in your post is correct. I haven't met anyone who experienced remission on 20mg/d of tranylcypromine.
Your response is a great sign, and it would make much more sense to raise the dose of tranylcypromine than to add in another drug.
If you aren't experiencing significant side effects, the standard procedure would be to go higher on tranylcypromine. I'm not saying you should do this on your own, but trying to convince your psychiatrist would be a good idea. Bring the papers you have already discovered.
Good luck!
ER
Posted by baseball55 on October 7, 2013, at 19:29:43
In reply to Re: Parnate (tranylcypromine) dose » Snell, posted by europerep on October 7, 2013, at 14:53:00
When I started on parnate, the dose was 30mg. My docs regarded this as a safe and therapeutic dose. My own p-doc said he would not prescribe more than 40mg, since this was the highest dose he was comfortable with.
I have read posts on this board of much higher doses.
But 20mg is low. Could you try to convince her to go up to 30, which is a standard dose (10mg, 3x day), rather than talk about very, very high dosages?
Posted by ed_uk2010 on October 12, 2013, at 16:06:49
In reply to Parnate (tranylcypromine) dose, posted by Snell on October 6, 2013, at 14:17:34
I wouldn't discuss very high doses with your pdoc yet, he needs to be comfortable with lower doses first.
In the US, the maximum dose recommended by the manufacturer is 60mg per day. Your doctor can read this on the manufacturer's data sheet.
The manufacturer considers 30mg to be a 'standard dose', so I'm not sure why your doctor doesn't want to increase.
What country are you in?
Posted by Snell on October 12, 2013, at 17:49:50
In reply to Re: Parnate (tranylcypromine) dose, posted by ed_uk2010 on October 12, 2013, at 16:06:49
Thank you all for your considered replies. I had some relief, and then when my pdoc insisted that I reduce to 30mg, I began slipping, slipping, slipping. Now I'm fully and completely depressed, with all the symptoms except suicidality. I told my pdoc that I thought his experiment was a failure, and that either (a) I must require a higher dose or (b) some augmentation strategy. I can't tell you how disappointing this is to me. I feel that I worked really hard to get here. The only other psych med that I'm on, now, is Lamictal 100mg. I feel that so many people's response to this medicine is that they're riding the tail of a comet, and yet here I am in my crypt again. I am very dispirited.
I'm in the United States, and here the "standard" dose is not 30mg but 20mg. But honestly, after 10 days at 30mg and watching my mood collapse, I can only come to the conclusion that some other modality, or approach, must be called for. I've come across several academic papers that advocate 1mg/kg. I weigh 100 kg, so you do the math. I'm not trying to die, Lord knows; I just want relief of this horrible pain.
Posted by SLS on October 12, 2013, at 18:33:16
In reply to Re: Parnate (tranylcypromine) failure?, posted by Snell on October 12, 2013, at 17:49:50
> Thank you all for your considered replies. I had some relief, and then when my pdoc insisted that I reduce to 30mg, I began slipping, slipping, slipping. Now I'm fully and completely depressed, with all the symptoms except suicidality. I told my pdoc that I thought his experiment was a failure, and that either (a) I must require a higher dose or (b) some augmentation strategy. I can't tell you how disappointing this is to me. I feel that I worked really hard to get here. The only other psych med that I'm on, now, is Lamictal 100mg. I feel that so many people's response to this medicine is that they're riding the tail of a comet, and yet here I am in my crypt again. I am very dispirited.
>
> I'm in the United States, and here the "standard" dose is not 30mg but 20mg. But honestly, after 10 days at 30mg and watching my mood collapse, I can only come to the conclusion that some other modality, or approach, must be called for. I've come across several academic papers that advocate 1mg/kg. I weigh 100 kg, so you do the math. I'm not trying to die, Lord knows; I just want relief of this horrible pain.It is my observation that, with Parnate, the effective dosage range is 40 - 80 mg/day. The high-dosage strategy employs dosages of 120 mg/day and higher.
I was not aware of a 1 mg/kg formula for Parnate. I have seen it for Nardil, though.
- Scott
Posted by babbler20 on October 14, 2013, at 21:23:28
In reply to Parnate (tranylcypromine) dose, posted by Snell on October 6, 2013, at 14:17:34
Hi, when I was on Parnate it didn't start working until 90 mg. I ended up taking 100 mg, but I didn't sleep for more than 5.5 hrs in a year and a half and I eventually ran out of steam. I tried taking up to 120 mg, but I didn't see any additional benefit.
Posted by SLS on October 14, 2013, at 22:20:57
In reply to Re: Parnate (tranylcypromine) dose, posted by babbler20 on October 14, 2013, at 21:23:28
> Hi, when I was on Parnate it didn't start working until 90 mg. I ended up taking 100 mg, but I didn't sleep for more than 5.5 hrs in a year and a half and I eventually ran out of steam. I tried taking up to 120 mg, but I didn't see any additional benefit.
I just wanted to thank you for describing your experience with Parnate. It gives me more motivation to ask my doctor tomorrow to raise my Parnate to 100 mg/day.
:-)
- Scott
Posted by Snell on October 15, 2013, at 6:11:46
In reply to Re: Parnate (tranylcypromine) dose » babbler20, posted by SLS on October 14, 2013, at 22:20:57
Yes, I agree. During a time when my pdoc has mostly obscure and obstructive, this thread has been informative and kind.
Posted by Snell on October 21, 2013, at 11:03:07
In reply to Parnate (tranylcypromine) dose, posted by Snell on October 6, 2013, at 14:17:34
Again, thank you everyone. On October 16, at 40mg/d, I started feeling a response. For one thing, my dreams started being very vivid, and I would wake up after each one (it was like going to a quadruple feature). Then during the day I noticed I felt more positive and had more energy.
That stayed like that for a couple of days--no "recovery," just feeling slightly less bad--and I increased the dose to 60 mg/day on Saturday. Now I can say I've recovered--I'm able to work a full day, the paralysis is gone, my anxiety is much lower, I'm able to "approach, not avoid." Don't worry, if it switches into mania I'll back off on the dose and I have plenty of Seroquel and Depakote.
I know that this pattern is what's supposed to happen--you start the drug and get an immediate reaction that fades after a couple of days, then there's several weeks of nothing, then the drug starts to "really" work if it's going to work. I've just never had that experience with any other antidepressants. With everything else, if it was going to work, it started working almost immediately--I've never had this classic six-week waiting period. I think that's why I started the thread with "... failure?"
I have heard, not only from the gentleman here, but elsewhere, that this drug likes to poop out between 6 and 18 months after it starts. Well, I'll take all the functioning I can fit in.
I certainly don't think I'll need to go above 60mg/d.
Posted by Snell on October 21, 2013, at 11:06:20
In reply to Re: Parnate (tranylcypromine) ... starting to work, posted by Snell on October 21, 2013, at 11:03:07
... and the pills no longer put me to sleep for 90 minutes.
This is the end of the thread.
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