Shown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Uncouth on June 13, 2015, at 13:52:13
Hi
I had high hopes from parnate after failing on Nardil and Marplan due to various issues. I've been on it for about 2 months and about two weeks ago just pushed to 100mg.1) I am 125kg (thanks, Nardil!!!) and need to lose weight. Does parnate have a particular dose/kg target like Nardil supposedly does?
2). I still get very fatigued in the morning. When I take my 40mg of parnate, and i feel it kick in, it helps a little bit, but I definitely am getting some amount of orthostatic drop when I stand (though not enough to generate lightheadedness, just fatigue).
3) Fatigue, anhedonia, low motivation is still an issue. Was surprised as thought TCP would be good for this. Still need about 100mg of Armodafinil, sometimes more or sometimes less, to even get basic things done.
4) Where do I go from here??? I have read Chairman_MAOs posting (ARE YOU STILL HERE?!) about high dose TCP, like 150mg+, working phenomenally well for social phobia and confidence which is really what I need. I may talk to Dr. Gillman but given that I am already at a high dose, my doc doesn't seem to think I will see more benefit increasing but reports to the contrary abound. How does one increase when at already a high dose without promoting fatigue or other side effects?
5) Finally, what are possible adjuncts if I stay at say 100mg? I have done well for about a year at Atomoxetine but it eventually pooped out. I would prefer to not try a stimulant. Can't take abilify or AAP due to weight gain. Already taking Namenda 21mg XR. I am bipolar so stability is an issue too, also take a few caps of lithium orotate.
But really looking for something to give me the DESIRE back--motivation, social interest, optimism, libido. (Yes, testosterone is being managed too).
Any thoughts on what might work with Parnate? Any recent experiences of people needing to go much much higher than the 40-80mg recommended?
Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
Uncouth
Posted by Robert_Burton_1621 on June 30, 2015, at 10:06:32
In reply to Parnate 100mg what to do from here?!? Help!, posted by Uncouth on June 13, 2015, at 13:52:13
> Hi
> I had high hopes from parnate after failing on Nardil and Marplan due to various issues. I've been on it for about 2 months and about two weeks ago just pushed to 100mg.
>
> 1) Does parnate have a particular dose/kg target like Nardil supposedly does?Not that I am aware of. Are you experiencing orthostatic hypotension? That is one indicator that you have reached a therapeutic dose for you.
>
> 2). I still get very fatigued in the morning. When I take my 40mg of parnate, and i feel it kick in, it helps a little bit, but I definitely am getting some amount of orthostatic drop when I stand (though not enough to generate lightheadedness, just fatigue).At what time do you take your last dose of parnate, and what dose is it?
>
> 3) Fatigue, anhedonia, low motivation is still an issue. Was surprised as thought TCP would be good for this. Still need about 100mg of Armodafinil, sometimes more or sometimes less, to even get basic things done.
>Parnate has not assisted my motivation either, not has it improved my cognitive and affective capacities. It has been extraordinarily effective at preventing psychomotor retardation and catatonia.
> 4) Where do I go from here??? I have read Chairman_MAOs posting (ARE YOU STILL HERE?!) about high dose TCP, like 150mg+, working phenomenally well for social phobia and confidence which is really what I need. I may talk to Dr. Gillman but given that I am already at a high dose, my doc doesn't seem to think I will see more benefit increasing but reports to the contrary abound. How does one increase when at already a high dose without promoting fatigue or other side effects?
>Can you please explain the symptoms of your fatigue? Do you refer to somnolence? Or muscular weakness? If the later, you may be taking too much all at once. You may need to experiment with dosages. E.g., instead of 40mg in the morning, perhaps take 30mg + 30mg + 30mg + 10mg with 4 hour increments between the big doses. This may assist in preventing the drop in persistent blood pressure which parnate can induce if you take too much all at once.
> 5) Finally, what are possible adjuncts if I stay at say 100mg? I have done well for about a year at Atomoxetine but it eventually pooped out. I would prefer to not try a stimulant. Can't take abilify or AAP due to weight gain. Already taking Namenda 21mg XR. I am bipolar so stability is an issue too, also take a few caps of lithium orotate.
>Have you tried lamotrigine? Nortriptyline might also be an option.
> But really looking for something to give me the DESIRE back--motivation, social interest, optimism, libido. (Yes, testosterone is being managed too).
>
> Any thoughts on what might work with Parnate? Any recent experiences of people needing to go much much higher than the 40-80mg recommended?
>I started parnate in February and am now taking 130 mg / day [40 + 40 + 40 + 10]. It is the most consistent medication I have ever taken, and if i reduce to 80 mg I definitely relapse. It has mostly obliterated anhedonia, though not always anticipatory anhedonia, and I have not had a single episode of retardation since being on it (whereas prior to parnate, such episodes were weekly occurances). However, it has not touched my affective, pre-frontal, capacities; the "lights" have not turned on. Nor has it increased motivation or drive. It has enabled me to keep nearly every appointment I make, however, even in the absence of subjective motivation or energetic interest.
> Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
>
> UncouthThat is not good at all. You do certainly seem to be affected seriously by anhedonia. I truly hope you find a solutuion. 8 weeks is not that long on parnate, by the way. You mention that you take lithium. Have you had your thyroid levels checked recently?
Posted by SLS on July 3, 2015, at 15:26:42
In reply to Parnate 100mg what to do from here?!? Help!, posted by Uncouth on June 13, 2015, at 13:52:13
I agree with everything that was said here about Parnate.
Nardil is better for anhedonia, but often doesn't continue to work (poop-out).
For me, Parnate and the other drugs I take make me more functional because they give me more mental energy and allow me to think a little faster. However, the rest of the depression remains. I don't take this improvement for granted, though.
My longest period of remission (6 months) was achieved with a combination of Parnate and desipramine. It could probably could have lasted indefinitely had the doctor not had me discontinue treatment. You might want to go up to 120 mg/day. This seems to be the minimum that was advocated by Jay Amsterdam and the other "high-dose Parnate" doctors. I am currently taking 100 mg/day. When I go to 120 mg/day, I experience "brain-fog" and some flattening of affect. I certainly lose some functionality. I initially felt better upon the dosage increase, but that improvement was short lived.
Robert_Burton_1621 is accurate in everything he has to say. I wouldn't have thought to write everything that he did.
Currently:
Parnate 100 mg/day
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/dayIf cariprazine ever comes to market, I would like to substitute it for Abilify. It more potent than Abilify at D3 receptors in limbic structures, and might produce some improvements in anhedonia. I expect theree to be residual depression, though. I am heading in the direction of brain stimulation treatments.
Good luck, Uncouth.
- Scott
Posted by uncouth on July 5, 2015, at 16:54:05
In reply to Re: Parnate 100mg what to do from here?!? Help! » Uncouth, posted by Robert_Burton_1621 on June 30, 2015, at 10:06:32
> > Hi
> > I had high hopes from parnate after failing on Nardil and Marplan due to various issues. I've been on it for about 2 months and about two weeks ago just pushed to 100mg.
> >
> > 1) Does parnate have a particular dose/kg target like Nardil supposedly does?
>
> Not that I am aware of. Are you experiencing orthostatic hypotension? That is one indicator that you have reached a therapeutic dose for you.I think so, at...I've read Dr. Gilman's guidelines. But I still feel bad. It's not super noticable orthostasis like i've had when on MAOIs in the past (or when just starting up), like when one gets so dizzy upon standing you need to sit back down. But I do find I get fatigued after sitting or laying down for a long time, then getting up.
> >
> > 2). I still get very fatigued in the morning. When I take my 40mg of parnate, and i feel it kick in, it helps a little bit, but I definitely am getting some amount of orthostatic drop when I stand (though not enough to generate lightheadedness, just fatigue).
>
> At what time do you take your last dose of parnate, and what dose is it?
> >I haven't standardized just yet on a dose. I'm taking either 100 or 110mg / day, usually 4, 4, 3, or sometimes 4, 3, 2, and 2. So my last dose is either 3 pills or 2 pills, usually mid afternoons/early evenings.
> > 3) Fatigue, anhedonia, low motivation is still an issue. Was surprised as thought TCP would be good for this. Still need about 100mg of Armodafinil, sometimes more or sometimes less, to even get basic things done.
> >
>
> Parnate has not assisted my motivation either, not has it improved my cognitive and affective capacities. It has been extraordinarily effective at preventing psychomotor retardation and catatonia.
>
> > 4) Where do I go from here??? I have read Chairman_MAOs posting (ARE YOU STILL HERE?!) about high dose TCP, like 150mg+, working phenomenally well for social phobia and confidence which is really what I need. I may talk to Dr. Gillman but given that I am already at a high dose, my doc doesn't seem to think I will see more benefit increasing but reports to the contrary abound. How does one increase when at already a high dose without promoting fatigue or other side effects?
> >
>
> Can you please explain the symptoms of your fatigue? Do you refer to somnolence? Or muscular weakness? If the later, you may be taking too much all at once. You may need to experiment with dosages. E.g., instead of 40mg in the morning, perhaps take 30mg + 30mg + 30mg + 10mg with 4 hour increments between the big doses. This may assist in preventing the drop in persistent blood pressure which parnate can induce if you take too much all at once.
>Oh, this is interesting, I actually thought it was the opposite. Can you explain more? I thought the BP drop (orthostatic hypotension) was a result of the long term inhibition of MAO enzyme (e.g. not related to dose), and that Parnate's stimulating (and anti-hypotensive, perhaps) effects would come from each individual dose...so that's why I've been lumping in 40 or 30mg doses, so get some added "kick". Are you saying it's the other way around?
> > 5) Finally, what are possible adjuncts if I stay at say 100mg? I have done well for about a year at Atomoxetine but it eventually pooped out. I would prefer to not try a stimulant. Can't take abilify or AAP due to weight gain. Already taking Namenda 21mg XR. I am bipolar so stability is an issue too, also take a few caps of lithium orotate.
> >
>
> Have you tried lamotrigine? Nortriptyline might also be an option.I just started atomoxetine and am ramping up on it, currently at 60mg. Feeling actually a lot worse, but i think it may be the clomiphene my endo has me on to help increase natural testosterone after I stopped testosterone replacement therapy 6 months ago and my levels have been rock bottom since.
>
> > But really looking for something to give me the DESIRE back--motivation, social interest, optimism, libido. (Yes, testosterone is being managed too).
> >
> > Any thoughts on what might work with Parnate? Any recent experiences of people needing to go much much higher than the 40-80mg recommended?
> >
>
> I started parnate in February and am now taking 130 mg / day [40 + 40 + 40 + 10]. It is the most consistent medication I have ever taken, and if i reduce to 80 mg I definitely relapse. It has mostly obliterated anhedonia, though not always anticipatory anhedonia, and I have not had a single episode of retardation since being on it (whereas prior to parnate, such episodes were weekly occurances). However, it has not touched my affective, pre-frontal, capacities; the "lights" have not turned on. Nor has it increased motivation or drive. It has enabled me to keep nearly every appointment I make, however, even in the absence of subjective motivation or energetic interest.
>Hmm, that sounds familiar, and thanks for the info. At what dose did it start "kicking in" and are you planning to go up even higher? I suspect I may need supratherapeutic as I usually need high doses of meds given my weight and comorbid issues.
> > Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
> >
> > Uncouth
>
> That is not good at all. You do certainly seem to be affected seriously by anhedonia. I truly hope you find a solutuion. 8 weeks is not that long on parnate, by the way. You mention that you take lithium. Have you had your thyroid levels checked recently?Yes, thyoid is OK, and I just take lithium orotate, very low dose, so i'm not too worried about thyroid.
Posted by Robert_Burton_1621 on July 6, 2015, at 8:56:30
In reply to Re: Parnate 100mg what to do from here?!? Help! » Robert_Burton_1621, posted by uncouth on July 5, 2015, at 16:54:05
> Oh, this is interesting, I actually thought it was the opposite. Can you explain more? I thought the BP drop (orthostatic hypotension) was a result of the long term inhibition of MAO enzyme (e.g. not related to dose), and that Parnate's stimulating (and anti-hypotensive, perhaps) effects would come from each individual dose...so that's why I've been lumping in 40 or 30mg doses, so get some added "kick". Are you saying it's the other way around?
>I wouldn't wish to generate the misapprehension of an expertise I in no sense possess. And, in any case, the mechanisms by which MAOIs affect many aspects of blood pressure are not fully understood. There is, however, some correlation between *peak* plasma MAOI levels and hypotension, so that minimising these levels by smaller dosages might assist you in avoiding the lethargy and muscular fatigue induced (hypothetcially) by hypotensive effects. While taking a big dose all at once may *initially* generate a stimulating effect, in an hour or so when plasma levels rise the physiological effect may be the exact opposite. This is what I experienced. And it was easily solved by reducing my doses and taking them more frequently during the day, leaving an interval of 3-4 hours. In fact, my fatigue and weakness disappeared in one day after I modified my dosage regime. Sorry I can't explain the mechanism by which this occured. But it may be worth your while just to experiment with dosing and see if your side-effects are also remedied.
> I just started atomoxetine and am ramping up on it, currently at 60mg. Feeling actually a lot worse, but i think it may be the clomiphene my endo has me on to help increase natural testosterone after I stopped testosterone replacement therapy 6 months ago and my levels have been rock bottom since.
>I wonder whether a more potent NRI might be helpful? Nortriptyline?
> Hmm, that sounds familiar, and thanks for the info. At what dose did it start "kicking in" and are you planning to go up even higher? I suspect I may need supratherapeutic as I usually need high doses of meds given my weight and comorbid issues.
>Parnate "kicked in" relatively quickly - within one week. However it was also accompanied by side-effects (related to sleeping, weakness, appetitie) which did not resolve for a month. When I say "kicked in" I refer only to its remarkably positive effect on my psychomotor retardation. It has not "kicked in" when it comes to more subjective symptoms like attention, motivation, interest (although it has also prevented any recurrence of nauseating and alienating anhedonia). The studies I have read on "supra-therapeutic" doses involved 120 - 170 mgs. I am now on 140 mgs. There is a slight improvement in cognitive interest and attentive capacities, and a slight improvement in motivation and future-directed thought. Early days I think.
Before I do augment (I have augmented with Lithium 750mg but it did not work; made me worse because it increased by TSH dramatically even though I only took lithium for a month) I wish to give parnate on its own its best chance of working (in my case). My doctor has recommended lamotrigine as the next augmentation strategy if high-dose parnate does not fully work. He is very hesitant for me to go beyond 130 mg because he thinks it could kill me because I have already experienced two hypertensive crises. It appears I am in that 5% of people who are very sensitive to tyramine.
I must confess that you ought read my personal report on my experience on parnate in light of the fact that I have difficulty in stopping alcohol consumption. Such consumption both acts as a CNS depressant in its own right and affects the efficiacy of medication. I have tried a number of strategies to stop but it is difficult because it does provide me relief at night time.
I should be dry for three months before I can evaluate parante truly on its own terms. This is what I am aiming for now.
We also ought be mindful of the fact that chronic depressive illnesses shrink the hippocampus, and that reparative neurogenesis induced by the administration of (the right class of) anti-depressants takes a lot of time.
> > > Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
> > >
> > > Uncouth
> >
> > That is not good at all. You do certainly seem to be affected seriously by anhedonia. I truly hope you find a solutuion. 8 weeks is not that long on parnate, by the way. You mention that you take lithium. Have you had your thyroid levels checked recently?
>
> Yes, thyoid is OK, and I just take lithium orotate, very low dose, so i'm not too worried about thyroid.
>May I ask why you are taking this lithium compound which is, insofar as I am aware, not usually recommended as a therapeutic agent?
This is the end of the thread.
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