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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Ben on March 2, 2022, at 7:39:35
Hello
I have bipolar disorder type II
I am taking Parnate since several years along with other meds (see below). The mood is quite stable but I experience most days a bad fatigue in the afternoon. I tried to split the Parnate dose but if I take the second dose too late I have problems with sleep. If I forget to take the second one I also have the fatigue. Beside the fatigue I have anhedonia and a lot of weight gain. I am thinking its time to change the medication. When I remember right, I was reeding from Scott, that the TCA Nortriptylin is better than Doxepin in this case of problems?! Do you have any ideas or experiences ?best regards, Ben
--------
Parnate (6x 20 mg in the morning)
Lithium (at night)
Lamotrigin (2x 150 mg)
Abilify (1x 2.5 mg at night)
Doxepine (1x 100 mg at night)
L-Thyroxine (1 x 125 mcg in the morning)
Posted by linkadge on March 2, 2022, at 14:16:14
In reply to Parnate and fatigue, posted by Ben on March 2, 2022, at 7:39:35
Nortriptyline would and doxapin are somewhat similar, but doxapin is much more sedating, has more anticholinergic side effects, and is more of an appetite stimulant. Hence, you might find that switching to nortriptyline gives you a bit more energy.
Linkadge
Posted by rjlockhart37 on March 2, 2022, at 14:52:52
In reply to Parnate and fatigue, posted by Ben on March 2, 2022, at 7:39:35
i've read many many times here on babble in the past of parnate's fatigue symptom that happens later in the day. You have keep dosing, ask you doctor maybe for a dose increase to help fight it's fatigue side effect.
I'm on Prozac 80mg, i want to move up to 120mg but that's above maximmum dose.
Let's let other posters anwser this, espcially SLS would know more about this
Posted by Jay2112 on March 2, 2022, at 18:37:52
In reply to Re: Parnate and fatigue, posted by linkadge on March 2, 2022, at 14:16:14
> Nortriptyline would and doxapin are somewhat similar, but doxapin is much more sedating, has more anticholinergic side effects, and is more of an appetite stimulant. Hence, you might find that switching to nortriptyline gives you a bit more energy.
>
> Linkadge
>Sorry Linkadge...it is not my place to 'correct'...but Doxepin is mostly antihistamine. I was on it, and *wow*...my pdoc told me to take it at 7pm, as the hangover effects are quite nuclear!..lol
Jay
Posted by SLS on March 2, 2022, at 20:31:42
In reply to Re: Parnate and fatigue, posted by Jay2112 on March 2, 2022, at 18:37:52
> > Nortriptyline would and doxapin are somewhat similar, but doxapin is much more sedating, has more anticholinergic side effects, and is more of an appetite stimulant. Hence, you might find that switching to nortriptyline gives you a bit more energy.
> >
> > Linkadge
> >
>
> Sorry Linkadge...it is not my place to 'correct'...but Doxepin is mostly antihistamine. I was on it, and *wow*...my pdoc told me to take it at 7pm, as the hangover effects are quite nuclear!..lol
>
> Jay
I read somewhere a long time ago that doxepin was the most potent antihistamine.
- Scott
Posted by Christ_empowered on March 5, 2022, at 6:38:06
In reply to Re: Parnate and fatigue, posted by SLS on March 2, 2022, at 20:31:42
doxepin is mostly used for sedation. that, and...if I recall correctly...doxepin can be compounded for topical use, for itchy skin problems.
way back when, Dr.Ivan Goldberg -- an old school psychiatrist, practice dating back to the hey day of psychopharmacology (early 60s, things got less awesome in the mid-70s or so...) had a website. Maybe its available somewhere, somehow? at any rate...
I think he recommended nortip...Pamelor, I think is the brand name? That and uppers. He was old school, after all. Dexedrine, occasionally Desoxyn. I don't remember any mention of Ritalin preparations on his website in depression or with MAOI drugs.
The other thing I thought about was maybe seeing if taking the Abilify every 2nd or 3rd day was/is a viable option for you? Abilify has a long, long half life, which is awesome when the drug is used in people who need a tranquilizer that is easier for a good number of people to tolerate than many other available options. However...
when used at (very) low doses to augment the main drugs, there's the potential for the low dose to build up, becoming...less of a "booster," more of a tranquilizer with less EPS, less pronounced dysphoria and cognitive blunting. Just....a random thought. Please, please, please try to talk to your doctor about your needs and desired results, of course.
oh, and...perhaps talk to your PCP about blood work? Depletion of B-vitamins can be an issue for those on Rx meds, in general...
and other nutrients can be affected, as well. Simple blood work can spot deficiencies that should be corrected asap. :-)
Posted by undopaminergic on March 5, 2022, at 10:00:21
In reply to Parnate and fatigue, posted by Ben on March 2, 2022, at 7:39:35
> Hello
Hello!
> I have bipolar disorder type II
> I am taking Parnate since several years along with other meds (see below). The mood is quite stable but I experience most days a bad fatigue in the afternoon. I tried to split the Parnate dose but if I take the second dose too late I have problems with sleep. If I forget to take the second one I also have the fatigue. Beside the fatigue I have anhedonia and a lot of weight gain. I am thinking its time to change the medication. When I remember right, I was reeding from Scott, that the TCA Nortriptylin is better than Doxepin in this case of problems?! Do you have any ideas or experiences ?
>Two thoughts:
1) Try to get off the doxepin, it is very sedating; even if you take it at night, there may be a "hangover" next day. If you need its antidepressant effects, then yes, nortriptyline could be a better alternative.
2) Maybe introduce a stimulant; be cautious, especially with amphetamines, but even methylphenidate can be problematic in certain sensitive individuals.
-undopaminergic
Posted by Ben on March 5, 2022, at 12:15:47
In reply to Re: Parnate and fatigue, posted by Christ_empowered on March 5, 2022, at 6:38:06
> doxepin is mostly used for sedation. that, and...if I recall correctly...doxepin can be compounded for topical use, for itchy skin problems.
>
> way back when, Dr.Ivan Goldberg -- an old school psychiatrist, practice dating back to the hey day of psychopharmacology (early 60s, things got less awesome in the mid-70s or so...) had a website. Maybe its available somewhere, somehow? at any rate...
>
> I think he recommended nortip...Pamelor, I think is the brand name? That and uppers. He was old school, after all. Dexedrine, occasionally Desoxyn. I don't remember any mention of Ritalin preparations on his website in depression or with MAOI drugs.
>
> The other thing I thought about was maybe seeing if taking the Abilify every 2nd or 3rd day was/is a viable option for you? Abilify has a long, long half life, which is awesome when the drug is used in people who need a tranquilizer that is easier for a good number of people to tolerate than many other available options. However...
>
> when used at (very) low doses to augment the main drugs, there's the potential for the low dose to build up, becoming...less of a "booster," more of a tranquilizer with less EPS, less pronounced dysphoria and cognitive blunting. Just....a random thought. Please, please, please try to talk to your doctor about your needs and desired results, of course.
>
> oh, and...perhaps talk to your PCP about blood work? Depletion of B-vitamins can be an issue for those on Rx meds, in general...
>
> and other nutrients can be affected, as well. Simple blood work can spot deficiencies that should be corrected asap. :-)Thanks for your Infos. I tried a very much of Options With my pdoc also stims. He is treating those who are pretty treatment resistant to drugs. I am doing also a thearapy.
Van you Tell me why i Sound take the abilify each second day. 2.5 mg is very los dose and I dont Hage the intention That it makes me tired. Thanks, Ben
Posted by Ben on March 5, 2022, at 12:32:01
In reply to Re: Parnate and fatigue, posted by undopaminergic on March 5, 2022, at 10:00:21
> > Hello
>
> Hello!
>
> > I have bipolar disorder type II
> > I am taking Parnate since several years along with other meds (see below). The mood is quite stable but I experience most days a bad fatigue in the afternoon. I tried to split the Parnate dose but if I take the second dose too late I have problems with sleep. If I forget to take the second one I also have the fatigue. Beside the fatigue I have anhedonia and a lot of weight gain. I am thinking its time to change the medication. When I remember right, I was reeding from Scott, that the TCA Nortriptylin is better than Doxepin in this case of problems?! Do you have any ideas or experiences ?
> >
>
> Two thoughts:
>
> 1) Try to get off the doxepin, it is very sedating; even if you take it at night, there may be a "hangover" next day. If you need its antidepressant effects, then yes, nortriptyline could be a better alternative.
>
> 2) Maybe introduce a stimulant; be cautious, especially with amphetamines, but even methylphenidate can be problematic in certain sensitive individuals.
>
> -undopaminergic
>Hi
Thanks for your thoughts.I dont feel a hangover only a fatigue in the afternoon. But i know that Doxepine is very sedating and the H1 antagonism leads also to Weight gain.
I tried d-amphetamine and metylphenidate in several doses and galenic forms. I tried also modafinil with no effect. Amphetamines are conflicting with my sleep also in low doses and in the right timing of intake. Methylphenidate seems better concerning sleep but the stimulating effect is much lower than Amphetamines. So these options are not the best. I Hope switching to Nortriptyline will do the Trick also the weight management. Thanks,Ben
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