![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by J Kelly on March 1, 2016, at 14:17:16
Hello all.
The only med that ever worked on my major depression in a significant way was Parnate. However I had an unfortunate rare reaction to it years ago. I envy those who can tolerate it. Does Nardil run the same risks as Parnate re paranoid psychosis in susceptible ppl? Im remembering Ace the Nardil king and Im wondering why in all these years I did not try another MAOI.
Hello to anyone who remembers me. I really miss some of the old posters.
Jade
Posted by zonked on March 2, 2016, at 17:03:01
In reply to Nardil safe?, posted by J Kelly on March 1, 2016, at 14:17:16
Hiya Jade,
Parnate is an amphetamine *and* a MAOI, so the potential for psychosis could be higher than with Nardil. Nardil does have an amphetamine-like metabolite, phenethylamine, but not in worrisome amounts. Your reaction to Parnate is uncommon but not unheard of, given that it is an amphetamine (the only non-controlled substance amphetamine in the US Pharmacopoeia, AFAIK, just Rx-only.)
From Wikipedia:
"Phenelzine has also been shown to metabolize to phenethylamine (PEA).[11] PEA acts as a releasing agent of norepinephrine and dopamine, and produces effects very similar to those of amphetamine, though with markedly different pharmacokinetics such as a far shorter duration of action. Phenelzine's enhancement of PEA levels may contribute further to its overall antidepressant effects to some degree. In addition, phenethylamine is a substrate for MAO-B, and treatment with MAOIs that inhibit MAO-B such as phenelzine have been shown to consistently and significantly elevate its concentrations."The fact that Parnate (tranylcypromine) is, itself, an amphetamine (dopamine release and reuptake inhibition) combined with its MAO inhibitor action (more dopamine in the synapse) could have resulted in amphetamine psychosis, especially if you're sensitive. I am curious as to what dose of Parnate you were taking, and if you have had a psychotic reaction to any other drugs.
I would not worry so much about Nardil; it's not something I've ever seen here and Nardil, as you probably know, is very popular here. I still take it, all these years later! And it STILL works!
YMMV -
Best,
z> Hello all.
>
> The only med that ever worked on my major depression in a significant way was Parnate. However I had an unfortunate rare reaction to it years ago. I envy those who can tolerate it. Does Nardil run the same risks as Parnate re paranoid psychosis in susceptible ppl? Im remembering Ace the Nardil king and Im wondering why in all these years I did not try another MAOI.
>
> Hello to anyone who remembers me. I really miss some of the old posters.
>
> Jade
Posted by J Kelly on March 2, 2016, at 19:27:11
In reply to Re: Nardil safe? » J Kelly, posted by zonked on March 2, 2016, at 17:03:01
> Hiya Jade,
>
> Parnate is an amphetamine *and* a MAOI, so the potential for psychosis could be higher than with Nardil. Nardil does have an amphetamine-like metabolite, phenethylamine, but not in worrisome amounts. Your reaction to Parnate is uncommon but not unheard of, given that it is an amphetamine (the only non-controlled substance amphetamine in the US Pharmacopoeia, AFAIK, just Rx-only.)
>
> From Wikipedia:
> "Phenelzine has also been shown to metabolize to phenethylamine (PEA).[11] PEA acts as a releasing agent of norepinephrine and dopamine, and produces effects very similar to those of amphetamine, though with markedly different pharmacokinetics such as a far shorter duration of action. Phenelzine's enhancement of PEA levels may contribute further to its overall antidepressant effects to some degree. In addition, phenethylamine is a substrate for MAO-B, and treatment with MAOIs that inhibit MAO-B such as phenelzine have been shown to consistently and significantly elevate its concentrations."
>
> The fact that Parnate (tranylcypromine) is, itself, an amphetamine (dopamine release and reuptake inhibition) combined with its MAO inhibitor action (more dopamine in the synapse) could have resulted in amphetamine psychosis, especially if you're sensitive. I am curious as to what dose of Parnate you were taking, and if you have had a psychotic reaction to any other drugs.
>
> I would not worry so much about Nardil; it's not something I've ever seen here and Nardil, as you probably know, is very popular here. I still take it, all these years later! And it STILL works!
>
> YMMV -
>
> Best,
> z
>
> > Hello all.
> >
> > The only med that ever worked on my major depression in a significant way was Parnate. However I had an unfortunate rare reaction to it years ago. I envy those who can tolerate it. Does Nardil run the same risks as Parnate re paranoid psychosis in susceptible ppl? Im remembering Ace the Nardil king and Im wondering why in all these years I did not try another MAOI.
> >
> > Hello to anyone who remembers me. I really miss some of the old posters.
> >
> > Jade
>
>
Hi Zonked :)I actually remember you... thank you so much for your response. Just the info I needed to move forward. I'm not very good at researching things when I'm depressed. So glad to hear the Nardil is working for you. I may give it a try if my pdoc agrees. He may say h*ll no and who could blame him.
As for the dose of parnate it was 80mg per day (broken up ...don't recall details) My psychosis started when my pdoc added Dexedrine. I think I got to 40mg per day. He quickly shut that down but unfortunately he and several others pdocs continued me on the parnate. I was very ill for 9 months. Two weeks off parnate I was back to reality. No episodes of psychosis before or after.
So my dilemma... parnate worked very well on my depression for a time. I'm wanting to try Nardil but frankly i'm scared.
May I ask what your dose is, how its broken up, and how long it took you to respond? How do you augment it?
Again, thank you for your thoughtful response.
Jade
Posted by Lamdage22 on March 3, 2016, at 13:19:24
In reply to Re: Nardil safe?, posted by J Kelly on March 2, 2016, at 19:27:11
i was psychotic on both of these.
Posted by J Kelly on March 3, 2016, at 14:16:17
In reply to Re: Nardil safe?, posted by Lamdage22 on March 3, 2016, at 13:19:24
> i was psychotic on both of these.
>
>Hey I'm really sorry to hear that. Believe me I've been there and I know its traumatic. If you feel like elaborating I would like to know... did the psychosis stop and start with the use of MAOI's? Have you had other similar but unrelated episodes?
I'm just coming around to the idea of trying another MAOI such as Nardil. Its a balancing act sometimes trying to feel satisfied in life but not wanting to jeopardize what I already have.
Jade
Posted by Lamdage22 on March 3, 2016, at 14:53:25
In reply to Re: Nardil safe?, posted by J Kelly on March 3, 2016, at 14:16:17
> > i was psychotic on both of these.
> >
> >
>
> Hey I'm really sorry to hear that. Believe me I've been there and I know its traumatic. If you feel like elaborating I would like to know... did the psychosis stop and start with the use of MAOI's? Have you had other similar but unrelated episodes?
>
> I'm just coming around to the idea of trying another MAOI such as Nardil. Its a balancing act sometimes trying to feel satisfied in life but not wanting to jeopardize what I already have.
>
>
> Jade
>
>I never before and never again was as psychotic as i was on Nardil and Parnate.
First ever psychotic episode with Nardil.
Posted by J Kelly on March 3, 2016, at 15:12:00
In reply to Re: Nardil safe?, posted by Lamdage22 on March 3, 2016, at 14:53:25
> > > i was psychotic on both of these.
> > >
> > >
> >
> > Hey I'm really sorry to hear that. Believe me I've been there and I know its traumatic. If you feel like elaborating I would like to know... did the psychosis stop and start with the use of MAOI's? Have you had other similar but unrelated episodes?
> >
> > I'm just coming around to the idea of trying another MAOI such as Nardil. Its a balancing act sometimes trying to feel satisfied in life but not wanting to jeopardize what I already have.
> >
> >
> > Jade
> >
> >
>
> I never before and never again was as psychotic as i was on Nardil and Parnate.
>
> First ever psychotic episode with Nardil.
>Hey thanks for responding. Maybe I need to rethink this Nardil trial. I cant (nor can my family) go thru that hell again.
Jade
Posted by zonked on March 3, 2016, at 21:34:20
In reply to Re: Nardil safe?, posted by J Kelly on March 3, 2016, at 15:12:00
Jade,
I would encourage you to still consider Nardil -
as I've said, the phenethylamine metabolites of Nardil itself are negligible (for an extra boost of dopamine, I often eat 87% dark chocolate, which has a much higher PEA content than the PEA from my Nardil dose) - no ill effects, blood pressure or otherwise. And the boost from that is so subtle as to be be barely noticeable--nothing like taking 40mg of Dexedrine concurrently (which I *also* have done, with Nardil, except the effect is rather pronounced--not subtle at all--and fortunately I didn't have any psychosis.)If you start slowly and titrate up (as described in Nardil's prescribing information HERE):
http://dailymed.nlm.nih.gov/dailymed/medguide.cfm?setid=b7ec6ae7-3d76-42aa-9d8a-fc3e187769b5
See the "Dosage and Administration" Section: Usual starting dosage is 15mg three times per day = 45mg/day. (I take 90mg/day.)
.. then you should be okay. How did your psychosis present last time? If you are worried, could you have someone "watch" you? Remember, you added 40mg of amphetamine last time!
YMMV but truly, this drug has saved me and many others from suicide. Drugs don't do everything, but they at least bring you up to baseline so you can work on yourself and recover from mental illness.... and this is the only antidepressant that has consistently worked for me.
Two last recommendations:
1. get the same generic from your pharmacy every time (either Gavis, *OR* Greenstone, which is the same as the Pfizer brand; I actually have no preference as long as it's the same every time.)
2. Read "The Greenhorn's Guide to Nardil" HERE:
http://www.socialanxietysupport.com/forum/f30/the-greenhorn-s-guide-to-nardil-51461/The part about sleeping while on Nardil I found really helpful (currently on 25-50mg of doxylamine succinate at hs for sleep) and yes, the inability to go number 2 happened to me at first, too. (No longer, it goes away!)
Best,
-zPS: Any other questions do let me know. I'll try my best to answer them - I have been locked out of my Google account since last year unfortunately and no longer receive post alerts. (Yes, by the way, I have tried all account recovery options.)
you should have nothing to worry about
> > > > i was psychotic on both of these.
> > > >
> > > >
> > >
> > > Hey I'm really sorry to hear that. Believe me I've been there and I know its traumatic. If you feel like elaborating I would like to know... did the psychosis stop and start with the use of MAOI's? Have you had other similar but unrelated episodes?
> > >
> > > I'm just coming around to the idea of trying another MAOI such as Nardil. Its a balancing act sometimes trying to feel satisfied in life but not wanting to jeopardize what I already have.
> > >
> > >
> > > Jade
> > >
> > >
> >
> > I never before and never again was as psychotic as i was on Nardil and Parnate.
> >
> > First ever psychotic episode with Nardil.
> >
>
> Hey thanks for responding. Maybe I need to rethink this Nardil trial. I cant (nor can my family) go thru that hell again.
>
> Jade
>
>
Posted by SLS on March 4, 2016, at 6:56:45
In reply to Nardil safe?, posted by J Kelly on March 1, 2016, at 14:17:16
> Hello all.
Hi Jade.
Possible diagnosis: 296.53 (F31.4):
Bipolar I Disorder; Most Recent Episode Depressed, Severe Without Psychotic Features* Your depression does not have psychotic features as a natural part of the illness. However, a psychotic reaction to drugs indicates Bipolar Disorder I if the manic reaction persists after the offending drug is discontinued.
If you are concerned about a MAOI-induced psychotic reaction, you should consider:
1. Taking an antipsychotic or mood stabilizer right from the start to be used as a prophylactic. Once you respond to the MAOI and are stable for awhile, you can then try discontinuing the antipsychotic or mood stabilizer. You are likely to be Bipolar I based upon the severity of your psychotic reaction. Our cases are very similar.
2. Start the MAOI by itself and take an antipsychotic (Zyprexa) as an emergency drug if psychosis develops. The problem with this strategy is that it often happens that the patient does not recognize the onset of psychosis early enough to want to act on it. Once the emergency has passed, you can then choose to use another antipsychotic with a more acceptable side effect profile.
For me, Abilify helps with depression and seems to prevent mania while taking an MAOI. I would caution against using Geodon because it is a serotonin reuptake inhibitor and might precipitate serotonin syndrome.
- Scott
Posted by J Kelly on March 5, 2016, at 6:12:40
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 4, 2016, at 6:56:45
Hi Scott :)
> Possible diagnosis: 296.53 (F31.4):
> Bipolar I Disorder; Most Recent Episode Depressed, Severe Without Psychotic FeaturesCould be. The pdoc I now see hasn't given me a formal diagnosis although I guess he must have one for billing purposes.
> a psychotic reaction to drugs indicates Bipolar Disorder I if the manic reaction persists after the offending drug is discontinued.Here's where I'm confused. I've always assumed it was the parnate that caused my psychosis. But it started after I/we added Dexedrine. The Dexedrine was removed but the psychosis continued for nine months. It stopped when parnate was removed AND I was put on a heavy dose of Geodon.
Any thoughts as to which was the offending med or was it possibly both?
>
> If you are concerned about a MAOI-induced psychotic reaction, you should consider:
>
> 1. Taking an antipsychotic or mood stabilizer right from the start to be used as a prophylactic. Once you respond to the MAOI and are stable for awhile, you can then try discontinuing the antipsychotic or mood stabilizer. You are likely to be Bipolar I based upon the severity of your psychotic reaction. Our cases are very similar.>
> 2. Start the MAOI by itself and take an antipsychotic (Zyprexa) as an emergency drug if psychosis develops. The problem with this strategy is that it often happens that the patient does not recognize the onset of psychosis early enough to want to act on it. Once the emergency has passed, you can then choose to use another antipsychotic with a more acceptable side effect profile.I am very concerned and I would definitely choose #1. Sick mind doesn't know its sick. I absolutely did not ever recognize that I was ill until it was over. In addition, I would likely continue on my Zyprexa while on an MAOI. Just can't risk it.
Geodon caused severe anxiety and hypersomnia in me (unless it was a result of the abrupt withdrawal from parnate)
>
>
> - ScottJade
Posted by J Kelly on March 5, 2016, at 6:30:12
In reply to Re: Nardil safe? » J Kelly, posted by zonked on March 3, 2016, at 21:34:20
Hi again Zonked,
>
> I would encourage you to still consider NardilI am still considering it.
>How did your psychosis present last time? If you are worried, could you have someone "watch" you? Remember, you added 40mg of amphetamine last time!
One day I was fine, better than fine actually. The next I thought ppl were living in my attic. I became a master at hiding my illness. It infuriated my family. I was hospitalized 3 times during that period. I will never take Dexedrine again.
> YMMV but truly, this drug has saved me and many others from suicide. Drugs don't do everything, but they at least bring you up to baseline so you can work on yourself and recover from mental illness.... and this is the only antidepressant that has consistently worked for me.This is resonating with me. Im seriously considering Nardil for my depression.
Thank you for your thoughtful posts Zonked.
Jade
Posted by SLS on March 5, 2016, at 9:57:29
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 6:12:40
Hi Jade
> > Possible diagnosis: 296.53 (F31.4):
> > Bipolar I Disorder; Most Recent Episode Depressed, Severe Without Psychotic Features
> Could be. The pdoc I now see hasn't given me a formal diagnosis although I guess he must have one for billing purposes.
> > a psychotic reaction to drugs indicates Bipolar Disorder I if the manic reaction persists after the offending drug is discontinued.
> Here's where I'm confused. I've always assumed it was the parnate that caused my psychosis. But it started after I/we added Dexedrine. The Dexedrine was removed but the psychosis continued for nine months. It stopped when parnate was removed AND I was put on a heavy dose of Geodon.
>
> Any thoughts as to which was the offending med or was it possibly both?In my experience, I would say that the Parnate was a necessary component to the induction of your manic episode. Whether or not the amphetamine acted in synergy with the Parnate must be considered, but I doubt it would by itself be sufficient to trigger mania. So, if you must return to a MAOI, I would try it first without the amphetamine while remaining on an antipsychotic other than Geodon. (Geodon is theoretically incompatible with a MAOI). If, then, you feel the need to add the amphetamine, I would not be terribly afraid of doing it.
What are your thoughts on this?
Are there people around you who you trust to identify the emergence of another manic episode and who you would listen to?
Are there any concerns you have with using Zyprexa for the long term? Weight-gain? Diabetes?
> > If you are concerned about a MAOI-induced psychotic reaction, you should consider:
> >
> > 1. Taking an antipsychotic or mood stabilizer right from the start to be used as a prophylactic. Once you respond to the MAOI and are stable for awhile, you can then try discontinuing the antipsychotic or mood stabilizer. You are likely to be Bipolar I based upon the severity of your psychotic reaction. Our cases are very similar.
> >
> > 2. Start the MAOI by itself and take an antipsychotic (Zyprexa) as an emergency drug if psychosis develops. The problem with this strategy is that it often happens that the patient does not recognize the onset of psychosis early enough to want to act on it. Once the emergency has passed, you can then choose to use another antipsychotic with a more acceptable side effect profile.
> I am very concerned and I would definitely choose #1. Sick mind doesn't know its sick. I absolutely did not ever recognize that I was ill until it was over. In addition, I would likely continue on my Zyprexa while on an MAOI. Just can't risk it.> Geodon caused severe anxiety and hypersomnia in me (unless it was a result of the abrupt withdrawal from parnate)
As I mentioned earlier, Geodon is theoretically incompatible with a MAOI due to concerns regarding serotonin syndrome. However, severe anxiety and profound fatigue are possible side effects of abrupt Parnate discontinuation. Hypersomnia can occur with Geodon by itself or be a withdrawal effect of amphetamine discontinuation.
My guess is that the anxiety was a result of Parnate discontinuation and hypersomnia the result of a high dosage of Geodon. The timing of these effects might help you tease out cause and effect. It really doesn't matter much, though.
1. You need to avoid Geodon one way or another.
2. Parnate withdrawal can be difficult to suffer through.
3. You will likely need to be on an antipsychotic or mood stabilizer to avoid medication-induced psychotic mania (at least with MAOIs).
- Scott
Posted by SLS on March 5, 2016, at 10:13:30
In reply to Re: Nardil safe? » zonked, posted by J Kelly on March 5, 2016, at 6:30:12
> > I would encourage you to still consider Nardil
> I am still considering it.I would not be afraid to try Nardil as long as you are protected against a manic reaction by having an anti-manic agent on board. Obviously, Parnate by itself was missing something, or you would not have felt the need to add the amphetamine. I like the idea of choosing Zyprexa to combine with Nardil, at least at first. If side effects become an issue with Zyprexa, there are many alternatives.
Please be aware that one can feel "too good" at the beginning of Nardil treatment. This occurs even in unipolar depression. Zyprexa might prevent this, but if it doesn't, any feelings of hypomania might dissipate on their own.
What are the features of your depression that you most need to remedy?
- Scott
Posted by J Kelly on March 5, 2016, at 12:23:37
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 9:57:29
Hi again,
> > > a psychotic reaction to drugs indicates Bipolar Disorder I *if* the manic reaction persists after the offending drug is discontinued.Here's where I'm confused. When the offending med (parnate) was dc'd, I was no longer manic.
Still think I'm bi-polar I?
> Are there people around you who you trust to identify the emergence of another manic episode and who you would listen to?
This is tricky. My family suffered greatly as a result of my "episode". Nine months is a long time to witness a family member live in a fantasy world. However, my family is close enough that it would be noticed and acted upon early this time.
>sick mind doesn't know its sick.
I cant emphasize this enough. Experience tells me I would not listen to anyone unless given an ultimatum of some sort.
>
> Are there any concerns you have with using Zyprexa for the long term? Weight-gain? Diabetes?Yes. But I would deal if need be. Abilify gave me bad akathisia, I mentioned my poor reaction to Geodon. I would stay on Zyprexa for the duration. And maybe a mood stabilizer. What would you recommend?
>
>
> - Scott
>Thanks for your responses. They help.
Jade
Posted by J Kelly on March 5, 2016, at 12:46:36
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 10:13:30
Hey Scott,
> > > I would encourage you to still consider Nardil
>
> > I am still considering it.
>
> I would not be afraid to try Nardil as long as you are protected against a manic reaction by having an anti-manic agent on board. Obviously, Parnate by itself was missing something, or you would not have felt the need to add the amphetamine. I like the idea of choosing Zyprexa to combine with Nardil, at least at first. If side effects become an issue with Zyprexa, there are many alternatives.Yes. Zyprexa with Nardil is what I'm considering. And possibly adding a mood stabilizer.
As for the the added stimulant, parnate got me halfway there. Added stimulants got me all the way there. Of course that didn't end well.
>
> Please be aware that one can feel "too good" at the beginning of Nardil treatment. This occurs even in unipolar depression. Zyprexa might prevent this, but if it doesn't, any feelings of hypomania might dissipate on their own.I know that feeling. I had it early on with Parnate. I'm okay with that (I liked it and it didn't cause me any problems)
>
> What are the features of your depression that you most need to remedy?All of them :)
Fatigue. Lack of mental clarity. No enthusiasm no joy. I could go on all day here. Not being a whiner. It just affects every aspect of my being :(
Jade
ps-when I reached 60mg of parnate, I took a 5mg tablet of left over Ritalin that I had. I might have done this two days in a row. I had a TEN day FULL remission. When I asked my new pdoc about this he said "dopamine".
I know you get this. Its so frustrating to know that your brain is not functioning properly. I wasn't "high" I was just "normal". How much I miss that.
Posted by SLS on March 5, 2016, at 14:33:00
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 12:23:37
> > > > a psychotic reaction to drugs indicates Bipolar Disorder I *if* the manic reaction persists after the offending drug is discontinued.
> Here's where I'm confused. When the offending med (parnate) was dc'd, I was no longer manic.When was Geodon first added relative to your discontinuation of Parnate?
> Still think I'm bi-polar I?
I am still leaning in that direction. I am taking into consideration your description of your traveling. It really depends upon how you answered the question regarding the timing of Geodon administration.
Have you ever tried Lamictal? If you think you are bipolar, I would consider adding Lamictal for the long term to help with your present depression and protect you from future depressions. Lamictal is a "bottom-up" mood stabilizer that acts on low mood to raise it to euthymia. It acts much like a antidepressant. Conversely, drugs like Trileptal, Depakote, or lithium are "top-down". They help to cap mania and lower mood to euthymia. If rapid cycling ever becomes a problem, you might consider combining Lamictal with a top-down mood stabilizer. I don't foresee this happening to you, though.
IF Nardil doesn't work out, you might end up back on Parnate. If you remain on Zyprexa, you can add back methylphenidate since you liked how you felt on the combination. As an alternative, you can add Lamictal to Parnate immediately so that you arrive at a therapeutic dosage of Lamictal as quick as possible. It can take 6 weeks to reach at a therapeutic dosage (200-300 mg/day).
----------------------------------
One possible aggressive scenario:
1. Continue Zyprexa.
2. Begin Nardil on day 1 and titrate to 60-75 mg/day.
3. Begin Lamictal on day 1. It takes 6 weeks to reach a therapeutic dosage (200-300 mg/day) using a very gradual titration schedule. Screen for the emergence of a rash-reaction.
4. Add methylphenidate or amphetamine if necessary after being on Nardil 75 mg/day for 3-4 weeks.
5. Return to Parnate if necessary following a 14 day washout beginning from the last dose of Nardil.
6. Continue Lamictal.
7. Continue methylphenidate or amphetamine.
8. After you have been euthymic for an extended period of time, you might decide to discontinue the stimulant, Nardil, and Zyprexa - in that order.
9. Remain on Lamictal to prevent future relapses into depression.
* This is meant to give you ideas. It might not end up being the exact protocol that you find yourself following.
----------------------------------
Hopefully, adding Nardil to Zyprexa will be sufficient. Simple is good. Take one day at a time. Make one decision at a time. Be patient.
One time when I became manic on Nardil, adding Zyprexa worked within 12 hours and I did not feel at all slowed-down. Actually, Zyprexa gave me an increase in thought clarity. I wish that I had continued to feel that way.
What are your thoughts?
- Scott
Posted by J Kelly on March 5, 2016, at 16:18:10
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 14:33:00
> When was Geodon first added relative to your discontinuation of Parnate?
Here's the timeline:
-Parnate started/titrated to 80mg
-Ritalin added/good response/ten day remission
-Ritalin replaced with Dexedrine
-Great response
-Parnate 80mg/Dexedrine 40mg
-Full remission/some mania (non psychotic)
-Psychosis (80mg parnate/2 weeks on 40mg Dexedrine)
-Dexedrine removed after 2 weeks
-Psychosis ongoing/Parnate cont'd for 9 months
-3rd hospitalization parnate removed/Geodon added
-2 weeks on Geodon/off parnate/psychosis ends
> > Still think I'm bi-polar I?
>
> I am still leaning in that direction. I am taking into consideration your description of your traveling. It really depends upon how you answered the question regarding the timing of Geodon administration.
>
> Have you ever tried Lamictal? If you think you are bipolar, I would consider adding Lamictal for the long term to help with your present depression and protect you from future depressions.I've never paid much attention to a diagnosis but I'm remembering my first pdoc speculated that I maybe was bi-polar 2. Not sure what that was based on but it was prior to my psychotic episode. I believe I tried Lamictal and Lithium. Its been long enough though that I'd be willing to try one or both again.
>
> IF Nardil doesn't work out, you might end up back on Parnate.No. Unfortunately Parnate is no longer an option. My family will not support that and after what I put them through I just can't go there.
>
> ----------------------------------
>
> One possible aggressive scenario:
>
> 1. Continue Zyprexa.
>
> 2. Begin Nardil on day 1 and titrate to 60-75 mg/day.
>
> 3. Begin Lamictal on day 1. It takes 6 weeks to reach a therapeutic dosage (200-300 mg/day) using a very gradual titration schedule. Screen for the emergence of a rash-reaction.
>
> 4. Add methylphenidate or amphetamine if necessary after being on Nardil 75 mg/day for 3-4 weeks.
>
> 5. Return to Parnate if necessary following a 14 day washout beginning from the last dose of Nardil.
>
> 6. Continue Lamictal.
>
> 7. Continue methylphenidate or amphetamine.
>
> 8. After you have been euthymic for an extended period of time, you might decide to discontinue the stimulant, Nardil, and Zyprexa - in that order.
>
> 9. Remain on Lamictal to prevent future relapses into depression.
>
> * This is meant to give you ideas. It might not end up being the exact protocol that you find yourself following.Other than the parnate, I like these ideas. I don't see my pdoc going for this however. He's pretty conservative. I'd have to find a new pdoc but I'm willing.
>
> ----------------------------------
>
> Hopefully, adding Nardil to Zyprexa will be sufficient. Simple is good. Take one day at a time. Make one decision at a time. Be patient.Wasn't it you who used to say "be a patient patient"? I know I picked that up here :)
> One time when I became manic on Nardil, adding Zyprexa worked within 12 hours and I did not feel at all slowed-down. Actually, Zyprexa gave me an increase in thought clarity. I wish that I had continued to feel that way.I'm curious. Were you aware of your manic state? Or did others call you out?
>
> What are your thoughts?See above!
>
>
> - ScottJade
Posted by SLS on March 5, 2016, at 16:52:41
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 4, 2016, at 6:56:45
________________________________________
DSM V
Diagnosis: 296.53 (F31.4): Bipolar I Disorder
- Most Recent Episode Depressed, Severe Without Psychotic Features* Medication-induced mania qualifiers:
Diagnostic Features
The diagnostic features of substance/medication-induced bipolar and related disorder are essentially the same as those for mania, hypomania, or depression. A key exception to the diagnosis of substance/medication-induced bipolar and related disorder is the case of hypomania or mania that occurs after antidepressant medication use or other treatments and persists beyond the physiological effects of the medication. This condition is considered an indicator of true bipolar disorder, not substance/medication-induced bipolar and related disorder. Similarly, individuals with apparent electroconvulsive therapy-induced manic or hypomanic episodes that persist beyond the physiological effects of the treatment are diagnosed with bipolar disorder, not substance/medication-induced bipolar and related disorder.
Differential Diagnosis
Substance/medication-induced bipolar and related disorder should be differentiated from other bipolar disorders, substance intoxication or substance-induced delirium, and medication side effects (as noted earlier). A full manic episode that emerges during antidepressant treaqtment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar I diagnosis. A full hypomanic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a bipolar II diagnosis only if preceded by a major depressive episode.
________________________________________
- Scott
Posted by J Kelly on March 5, 2016, at 17:18:18
In reply to Re: Nardil safe? » SLS, posted by SLS on March 5, 2016, at 16:52:41
Thanks Scott.
I'm realizing it's probably important at this juncture for me to get an accurate diagnosis. No point in making med changes without direction. I promise not to be surprised when my pdoc tells me I'm bipolar. I see him next week.
My brain hurts.
I hope you are feeling better :)
Jade
Posted by SLS on March 5, 2016, at 17:22:25
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 16:18:10
> > When was Geodon first added relative to your discontinuation of Parnate?
> Here's the timeline:
>
> -Parnate started/titrated to 80mg
> -Ritalin added/good response/ten day remission
> -Ritalin replaced with Dexedrine
> -Great response
> -Parnate 80mg/Dexedrine 40mg
> -Full remission/some mania (non psychotic)
> -Psychosis (80mg parnate/2 weeks on 40mg Dexedrine)
> -Dexedrine removed after 2 weeks
> -Psychosis ongoing/Parnate cont'd for 9 months
> -3rd hospitalization parnate removed/Geodon added
> -2 weeks on Geodon/off parnate/psychosis ends
> > > Still think I'm bi-polar I?I can't tell from the timing. It takes 2 weeks for the physiological effects of Parnate to wear off. However, antidepressant-induced mania is considered uncommon in unipolar depression.
It was very stupid of your doctor to leave you on Parnate for 9 months while you presented with mania/psychosis. This makes me very angry.
- Scott
Posted by SLS on March 5, 2016, at 17:30:31
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 17:18:18
> My brain hurts.
I'm sure it does. You've had to process a lot of new information and perspectives.
> I hope you are feeling better :)I'm okay. I'm not in pain. However, I remain conflicted over what I should do with desipramine. I am very tempted to cross-over back to nortriptyline. I guess I should wait, though.
I'm trying to be a patient patient.
:-)
- Scott
Posted by J Kelly on March 5, 2016, at 17:37:47
In reply to Re: Nardil safe? » J Kelly, posted by SLS on March 5, 2016, at 17:22:25
>> It was very stupid of your doctor to leave you on Parnate for 9 months while you presented with mania/psychosis. This makes me very angry.
>
>
> - ScottMy brothers were out for blood. But as I said I was very adept at hiding it. Enough so that not only did my pdoc miss it, so did the pdocs at the first two places I was hospitalized. They just kept giving me parnate. And 80mg. I remember talking the 2nd pdoc into going over the 60mg recommended dose. To be fair, I was good. I think my docs failed me in not listening to my (large) family. A family knows.
Jade
Posted by Lamdage22 on March 6, 2016, at 14:26:25
In reply to Re: Nardil safe? » SLS, posted by J Kelly on March 5, 2016, at 17:37:47
personally i wouldnt trial it if i were you.
If you do trial, please be careful. Dont wait until you are in full blown psychosis. Stop taking it when you can tell that it is going wrong.
Are you able to tell?
Posted by Lamdage22 on March 6, 2016, at 14:29:28
In reply to Nardil safe?, posted by J Kelly on March 1, 2016, at 14:17:16
Do you have psychosis right now? Or only while on Parnate? Do you take Antipsychotics?
Posted by J Kelly on March 6, 2016, at 14:46:27
In reply to Re: Nardil safe?, posted by Lamdage22 on March 6, 2016, at 14:26:25
> personally i wouldnt trial it if i were you.
>
> If you do trial, please be careful. Dont wait until you are in full blown psychosis. Stop taking it when you can tell that it is going wrong.
>
> Are you able to tell?No. And therein lies the rub :(
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