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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by tensor on October 18, 2013, at 9:16:36
Almost three weeks on 40mg, nine weeks in total on Parnate. I take it for TRD and anxiety. While it works ok for anxiety I'm still anhedonic and anergic. Initially I had some troublesome side effects like nausea, chills, very low bp, sexual dysfunction and constipation. Most of these passed and appr. two weeks after a dose increase the sexual dysfunction and other s/e diminish and libido is increased over baseline.
I still have some orthostatic hypotension and delayed orgasm, I sleep okay though, much I believe thanks to melatonin, it really made a huge difference. I read that 95% of those who respond, respond to 30-50mg (Dr. Ken Gillman), so I'm not sure if I should just increase to 50mg or if I should augment with e.g. Lamictal. Although my pdoc has done his homework, he has no experience of this medication, it's not available here without a license. Ideas greatly appreciated.
/tensor
Posted by Christ_empowered on October 18, 2013, at 12:30:19
In reply to Parnate - raise or augment?, posted by tensor on October 18, 2013, at 9:16:36
I don't know much about MAOIs...would it be safer to raise or augment? Besides lamictal, what drugs were you thinking of?
Posted by LouisianaSportsman on October 18, 2013, at 13:43:52
In reply to Parnate - raise or augment?, posted by tensor on October 18, 2013, at 9:16:36
I'd love to analyze this for you. I spend a lot of time doing this kind of thing, but I need to know what you're currently taking and what medications were not efficacious for you in the past.
I'd suggest, based on my limited understanding, that augmenting with Lamictal would be a good idea. At 50mg. of Parnate, you're more likely to develop more side effects than therapeutic benefits. Lamotrigine is a great medicine to augment with tranylcypromine. Still, I'd try 60mg. of the tranylcypromine and begin a slow titration with lamotrigine.
What condition are you trying to treat? This would help us betting pinpoint augmentation agents.
Thanks!
Posted by tensor on October 18, 2013, at 15:26:31
In reply to Re: Parnate - raise or augment?, posted by Christ_empowered on October 18, 2013, at 12:30:19
>
> I don't know much about MAOIs...would it be safer to raise or augment? Besides lamictal, what drugs were you thinking of?Possibly AAPs or nortrip.
/tensor
Posted by tensor on October 18, 2013, at 16:08:02
In reply to Re: Parnate - raise or augment?, posted by LouisianaSportsman on October 18, 2013, at 13:43:52
> I'd love to analyze this for you. I spend a lot of time doing this kind of thing, but I need to know what you're currently taking and what medications were not efficacious for you in the past.
>
> I'd suggest, based on my limited understanding, that augmenting with Lamictal would be a good idea. At 50mg. of Parnate, you're more likely to develop more side effects than therapeutic benefits. Lamotrigine is a great medicine to augment with tranylcypromine. Still, I'd try 60mg. of the tranylcypromine and begin a slow titration with lamotrigine.
>
> What condition are you trying to treat? This would help us betting pinpoint augmentation agents.
>
> Thanks!Hi!
I'm trying to treat recurring unipolar depression without melancholia and also anxiety. Tranylcypromine seems to work pretty well for anxiety although it's not 100% effective, I guess it has todo with my unresolved depression. I currently take 40mg of tranylcypromine and 2mg of clonazepam.
I have tried 30+ medications and many combinations, as a matter of fact always at least two medications except when I started medicating many years ago. It's easier to list some of the combinations that have worked as I can't remember them all. Nearly all of them have been in combinations with Remeron and clonazepam.
The following have worked with Remeron and clonazepam in the past (up to a year):
fluoxetine (for anxiety only)
clomipramine
sertraline
sertraline + bupropion (only 7 weeks)
nortriptyline
escitalopram + modafinil
Other combinations:
Seroquel + Lamictal + clonazepam
Seroquel + Lamictal + clonazepam + modafinilI'm fairly certain Seroquel messes with my cholesterol as it's normal now after I quit it. So I'm not so keen about restarting it. One thing though, Week 2 on tranylcypromine I was still on Seroquel and that week I felt much better, had a lot of energy several hours everyday. This may have been an initial transient response to tranyl or it was this combination with Seroquel. The thing is I decided to stop Seroquel because it caused a massive drop in blood pressure each time I took it that lasted a few hours, which in turn raised my pulse to 120, making it impossible to sleep.
I have had some hives (or whatever it is) from tranyl, in the beginning I could have three or four at the same time, although I get one now and then sporadically, they seem to appear less frequently. They are easily treated with some eczema cream and disappear after an hour or so, but it raises some concerns about starting Lamictal. I'm not sure how this affects the risk of getting the rash and I have started Lamictal twice before without a problem.Thanks,
tensor
Posted by bk2va32 on October 18, 2013, at 17:27:01
In reply to Parnate - raise or augment?, posted by tensor on October 18, 2013, at 9:16:36
I want to write a article for this , im a ten year user of Parnate ,and one thing i notice is this ,parnate has a extremly swift onset of action which makes it good for the SEVERLY depressed ,now HOWEVER
i noticed myself and from a lot of users that soon after it looses its PEP.Some just go off ,but you have the right idea ,the two ways to make parnate more effective are 1.Slowly raise the dose ,there is a excellent article you can find on the success of high dose parnate 2. Augment it ,i take it you want to augment to kick start it ,well just recently and i read an article that a excellent augment to parnate per trial was the mild stimulant modfanil.I can attest as i use this myself.Of course if its too strong augmenting with klonopin for example would be the opposite.Google the terms high dose parante treatment , and parnate stimulant treatment and bring em to your doc.P.S ADHD sronger stimulants can also be used with CARE in small doses they can make parnate ignite in a way.Good luck
Posted by Phillipa on October 18, 2013, at 18:07:39
In reply to Re: Parnate - raise or augment?, posted by bk2va32 on October 18, 2013, at 17:27:01
Tensor could you be allergic to the parnate hence the hives? Phillipa
Posted by tensor on October 19, 2013, at 2:42:35
In reply to Re: Parnate - raise or augment?, posted by bk2va32 on October 18, 2013, at 17:27:01
> I want to write a article for this , im a ten year user of Parnate ,and one thing i notice is this ,parnate has a extremly swift onset of action which makes it good for the SEVERLY depressed ,now HOWEVER
> i noticed myself and from a lot of users that soon after it looses its PEP.Some just go off ,but you have the right idea ,the two ways to make parnate more effective are 1.Slowly raise the dose ,there is a excellent article you can find on the success of high dose parnate 2. Augment it ,i take it you want to augment to kick start it ,well just recently and i read an article that a excellent augment to parnate per trial was the mild stimulant modfanil.I can attest as i use this myself.Of course if its too strong augmenting with klonopin for example would be the opposite.Google the terms high dose parante treatment , and parnate stimulant treatment and bring em to your doc.
>
> P.S ADHD sronger stimulants can also be used with CARE in small doses they can make parnate ignite in a way.Good luckThanks for your reply, I have used modafinil a lot in the past but it just doesn't do anything anymore. I think it's a wacky medication that you can never trust, but I'm speaking from my own experience. Stimulants make me tired, I get nothing from Concerta and the stimulant effect from tranylcypromine just causes fatigue, interestingly I still get that crash 6-8 hours after the dosing.
I'm losing a little faith in this medication as monotherapy, but I'm going to try 50mg I think if my bp recovers a little. I do take clonazepam 2mg regularly./tensor
Posted by tensor on October 19, 2013, at 2:49:55
In reply to Re: Parnate - raise or augment?, posted by Phillipa on October 18, 2013, at 18:07:39
> Tensor could you be allergic to the parnate hence the hives? Phillipa
It could be an allergic reaction, I don't know really. Being off antihistamines (as in Remeron or Seroquel) for the first time in over a decade could play a part of this. If tranylcypromine increases histamine it could be this additive effect that causes it.
/tensor
Posted by bk2va32 on October 19, 2013, at 15:25:31
In reply to Re: Parnate - raise or augment? » bk2va32, posted by tensor on October 19, 2013, at 2:42:35
Bro i feel you compltly the parnate fatique syndrome
is horror,nothing seems to help,but there is,look into the semi new adhd med called and i dont know the spelling right VYNAESE this bad boy will keep you awake alive without any stimulant ruch youll be a new person promise.
Posted by jono_in_adelaide on October 20, 2013, at 21:40:23
In reply to Parnate - raise or augment?, posted by tensor on October 18, 2013, at 9:16:36
You could push the dose (to 60mg say) or you could augment with say Nortriptyline 75mg at bedtime, or you could even do both if needed
Nortriptyline helps depression, anxiety, and sleep
Posted by tensor on October 21, 2013, at 5:27:02
In reply to Re: Parnate - raise or augment?, posted by jono_in_adelaide on October 20, 2013, at 21:40:23
> You could push the dose (to 60mg say) or you could augment with say Nortriptyline 75mg at bedtime, or you could even do both if needed
>
> Nortriptyline helps depression, anxiety, and sleepYes, it's just that it's making me too tired at 40mg, raising it further would only make me more tired, it feels like 30mg was a better dosage (not just s/e-wise). Haven't noticed any benefits from increasing to 40mg. I also have some issues with my BP. No more tricyclics, I'm done with them. After nine weeks I should feel something, right? Some features have improved, I'm more social for example, but the core symptoms of my depression have not. Anhedonia and lack of energy.
/tensor.
Posted by ed_uk2010 on October 22, 2013, at 16:28:24
In reply to Re: Parnate - raise or augment? » jono_in_adelaide, posted by tensor on October 21, 2013, at 5:27:02
Hi M,
I believe you're taking 20mg of tranyl twice a day, is that right? Since you appear to be experiencing 'ups' and 'downs' during the day as your Parnate blood level rises and falls, I'd be very tempted to spread your total daily dose out into a greater number of divided doses - this could be inconvenient but possibly very worthwhile. For example, you could increase to 50mg by taking 20mg in the morning then 10mg three times a day. This could lead to greater stability, with the melatonin continuing to improve your insomnia. I do think augmentation is a definite possibility, but it might be worth experimenting with Parnate alone for a couple more weeks first.
The hives are too mild and intermittent to represent a true allergy, but cetirizine 10mg/day could be a good choice to deal with this. I expect you can buy it from a pharmacy - certainly, you can in most countries, and it's a very safe and well tolerated drug. I do not believe that you're any more likely to experience the dreaded rash with Lamictal because of this reaction, but you could be misled into thinking you're developing a serious Lamictal rash when you're actually experiencing something much more minor. Confusing :(
If you're considering adding back a bit of quetiapine, start really low and increase very gradually. The risk of hypotension seems to be much reduced by this method. For example, try 12.5mg at night to start with.
Best regards,
Ed :)
PS. And finally, don't forget that some people get a much better AD effect from Nardil than Parnate. If Parnate doesn't work out, Nardil could be a fantastic choice.
Posted by tensor on October 23, 2013, at 0:59:03
In reply to Re: Parnate - raise or augment?, posted by ed_uk2010 on October 22, 2013, at 16:28:24
> Hi M,
>
> I believe you're taking 20mg of tranyl twice a day, is that right? Since you appear to be experiencing 'ups' and 'downs' during the day as your Parnate blood level rises and falls, I'd be very tempted to spread your total daily dose out into a greater number of divided doses - this could be inconvenient but possibly very worthwhile. For example, you could increase to 50mg by taking 20mg in the morning then 10mg three times a day. This could lead to greater stability, with the melatonin continuing to improve your insomnia. I do think augmentation is a definite possibility, but it might be worth experimenting with Parnate alone for a couple more weeks first.
>
> The hives are too mild and intermittent to represent a true allergy, but cetirizine 10mg/day could be a good choice to deal with this. I expect you can buy it from a pharmacy - certainly, you can in most countries, and it's a very safe and well tolerated drug. I do not believe that you're any more likely to experience the dreaded rash with Lamictal because of this reaction, but you could be misled into thinking you're developing a serious Lamictal rash when you're actually experiencing something much more minor. Confusing :(
>
> If you're considering adding back a bit of quetiapine, start really low and increase very gradually. The risk of hypotension seems to be much reduced by this method. For example, try 12.5mg at night to start with.
>
> Best regards,
>
> Ed :)
>
> PS. And finally, don't forget that some people get a much better AD effect from Nardil than Parnate. If Parnate doesn't work out, Nardil could be a fantastic choice.Hi Ed!
I take tranyl 20mg before breakfast and 20mg after breakfast so perhaps 10min apart. I have been thinking of spreading it out but yesterday was a such a good day that the plans of doing any changes are on hold, it's also less hassle taking it all in the morning. It was the first day in ages I was active the whole day, exercising and fixing on my car etc. I got seven hours of sleep tonight and got out of bed at 8am. I hope today will be good as well. My bp is returning to normal it seems, well tranyl-normal, it was 106/68 this morning which is an improvement from the last days of systolic pressure lower than 100 or even 90.
But thanks for the information, I will keep it in mind, especially about Lamictal, it may be a real choice again. However if side effects diminish and I need more AD effect it's likely I will go up to 50mg first. If needed and if possible side effect-wise I would like to try 60mg first before adding a second medication.Regards,
tensor
Posted by ed_uk2010 on October 28, 2013, at 18:10:52
In reply to Re: Parnate - raise or augment? » ed_uk2010, posted by tensor on October 23, 2013, at 0:59:03
Fantastic M, please keep me posted on your progress!
This is the end of the thread.
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