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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 JadeKelly on October 29, 2008, at 16:08:45
Hello,
I'm a longtime stalker here.Your stories have helped me, hope this helps someone:
4-5 days on PARNATE and it hit me...not subtle. I was myself again after two years of trd/atyp depression. I felt normal/happy. 11 days in, hypertensive crisis (scary). I've read alot of Elizabeth's posts. Like hers, mine was completely spontanious. I'm anal about the diet. Every day after that, spike in BP(190)& headache after every dose.
How frustrating! Anyway, thought I'd share. I'm back on it, with Nifedipine daily, feeling good.
Questions:
1.Nifedipine daily ok? 10mg
2.Early response just a "high"? Or quick response good sign?
3. Any others have unprovoked hypertension (sudden spike in BP, crazy headache, etc.?)
4. Pdoc started me at Parnate/30mg in one morn dose. Any thoughts on that?PS-If anyone reads this, check ALL energy/protien bars and drinks for soy. Easily missed trigger.
THANX to all the unsung heroes here-Jade
Posted by Sigismund on October 30, 2008, at 2:31:41
In reply to PARNATE: rough start but WOW, posted by JadeKelly on October 29, 2008, at 16:08:45
I am not an expert, but like you I read Elizabeth's posts and I have taken it.
I think you should try taking less than 30mg/dose in the morning.
Whether this means you should drop the dose, or divide it and take some later in the day (at lunch?), I really don't know.
Posted by bulldog2 on October 30, 2008, at 8:32:46
In reply to PARNATE: rough start but WOW, posted by JadeKelly on October 29, 2008, at 16:08:45
> Hello,
>
> I'm a longtime stalker here.Your stories have helped me, hope this helps someone:
>
> 4-5 days on PARNATE and it hit me...not subtle. I was myself again after two years of trd/atyp depression. I felt normal/happy. 11 days in, hypertensive crisis (scary). I've read alot of Elizabeth's posts. Like hers, mine was completely spontanious. I'm anal about the diet. Every day after that, spike in BP(190)& headache after every dose.
>
> How frustrating! Anyway, thought I'd share. I'm back on it, with Nifedipine daily, feeling good.
>
> Questions:
> 1.Nifedipine daily ok? 10mg
> 2.Early response just a "high"? Or quick response good sign?
> 3. Any others have unprovoked hypertension (sudden spike in BP, crazy headache, etc.?)
> 4. Pdoc started me at Parnate/30mg in one morn dose. Any thoughts on that?
>
> PS-If anyone reads this, check ALL energy/protien bars and drinks for soy. Easily missed trigger.
>
> THANX to all the unsung heroes here-JadeI would divide the 30 mg into three doses of 10 mg. Even if your bp spikes it should be by much less.
Posted by JadeKelly on October 30, 2008, at 12:50:46
In reply to Re: PARNATE: rough start but WOW, posted by bulldog2 on October 30, 2008, at 8:32:46
I tried splitting dose into 3 (10mg 3xday) as you guys suggested, by 3rd dose it would spike (from low BP to 188-190 in a matter of 20-30 minutes). Tried cutting down to 2 doses of 10mg, some elevation but not as much. Also no response with either attempt. This makes me suspect of that initial amphetamine reaction ppl post about. Hmm. Course, it'd be hard to tell when the back of your head is pounding...
Pdoc said to stay on 30mg since great response but add "nifedipine". It worked. If I have another significant ht crisis I will have to stop Parnate...Noooooooooo! It works!
Hoping someone has knowledge about Nifedipine, without it, I'll have to go back to clean living as my only hope, yuk! (Have tried this, really doesnt work for my depression)
Where's Larry Hoover when you need him? Sorry, I've seen so many ppl post that had to give it a try.
If any one has Parnate answers/info, would like to hear from them. Curious about whether initial response lasts for most? Does it change? Stop wrkg after robust early response? I really don't think I was experiencing euphoria/mania (not BP, btw). I geuss I'll find out soon enough over the coming weeks, as initial response is now returning. I'll post my experience for anyone interested.
Jade
Posted by JadeKelly on October 30, 2008, at 13:01:06
In reply to Re: PARNATE: rough start but WOW, posted by Sigismund on October 30, 2008, at 2:31:41
> I am not an expert, but like you I read Elizabeth's posts and I have taken it.
>
> I think you should try taking less than 30mg/dose in the morning.
>
> Whether this means you should drop the dose, or divide it and take some later in the day (at lunch?), I really don't know.Did you mean you have taken Elizabeth's advise in the past? Or you also took Parnate? If parnate, feel like sharing your experience?
Posted by Sigismund on November 1, 2008, at 17:08:41
In reply to Re: PARNATE: rough start but WOW » Sigismund, posted by JadeKelly on October 30, 2008, at 13:01:06
>Did you mean you have taken Elizabeth's advise in the past?
I read her posts with interest, yes.>Or you also took Parnate?
Yes, I took Parnate but it didn't really suit me.>If Parnate, feel like sharing your experience?
10mg was OK except for insomnia slightly aggravated. 20mg didn't feel helpful and I didn't think it wise to increase the dose and wait for some therapeutic effect down the line.
Posted by JadeKelly on November 1, 2008, at 20:15:08
In reply to Re: PARNATE: rough start but WOW, posted by Sigismund on November 1, 2008, at 17:08:41
> >Did you mean you have taken Elizabeth's advise in the past?
> I read her posts with interest, yes.
>
> >Or you also took Parnate?
> Yes, I took Parnate but it didn't really suit me.
>
> >If Parnate, feel like sharing your experience?
> 10mg was OK except for insomnia slightly aggravated. 20mg didn't feel helpful and I didn't think it wise to increase the dose and wait for some therapeutic effect down the line.
Yeah, bad insomnia for 3-4 nights for me. My pdoc started me out at 10mg 1st day, 20 2nd, and 30mg 3rd day. I doubt I would respond to less than 30mg but who knows? If you ever decide to try it again, I'd try going right for the 30mg. I had unbelievable response to both Emsam, and Parnate within week. I only say this because I've NEVER responded to any other AD. Were all different tho, huh? Wish there was one magic pill....!Thanks for the response,
Jade
PS-I'm rather low weight. Don't know if initial dose is based on that. It came up in another post, I'll find out.
>
> >
Posted by bulldog2 on November 2, 2008, at 14:52:30
In reply to PARNATE: rough start but WOW, posted by JadeKelly on October 29, 2008, at 16:08:45
> Hello,
>
> I'm a longtime stalker here.Your stories have helped me, hope this helps someone:
>
> 4-5 days on PARNATE and it hit me...not subtle. I was myself again after two years of trd/atyp depression. I felt normal/happy. 11 days in, hypertensive crisis (scary). I've read alot of Elizabeth's posts. Like hers, mine was completely spontanious. I'm anal about the diet. Every day after that, spike in BP(190)& headache after every dose.
>
> How frustrating! Anyway, thought I'd share. I'm back on it, with Nifedipine daily, feeling good.
>
> Questions:
> 1.Nifedipine daily ok? 10mg
> 2.Early response just a "high"? Or quick response good sign?
> 3. Any others have unprovoked hypertension (sudden spike in BP, crazy headache, etc.?)
> 4. Pdoc started me at Parnate/30mg in one morn dose. Any thoughts on that?
>
> PS-If anyone reads this, check ALL energy/protien bars and drinks for soy. Easily missed trigger.
>
> THANX to all the unsung heroes here-JadeA mood stabilizer such as lamictal.
Posted by JadeKelly on November 2, 2008, at 17:44:33
In reply to Re: PARNATE: rough start but WOW, posted by bulldog2 on November 2, 2008, at 14:52:30
You are a man of few words Bulldog!
Shall I interpret that to mean that lamictal could replace this antidote that I'm taking daily that Pdoc is probably about to d/c? So one side effect of lamictal is to stablize BP? Or lower it? Also,I take it there is no interaction with Parnate, other than maybe to augment? Fine with me. Have you ever been on that combo?
Lets see you answer that in one line.
Anyway, thanks for the info!
Jade
Posted by Medline on November 3, 2008, at 5:08:30
In reply to Re: PARNATE: rough start but WOW » bulldog2, posted by JadeKelly on November 2, 2008, at 17:44:33
I don't really understand Bulldog's answer too. Of course Lamictal could be a good augment to a MAOI, but it will do nothing for the blood pressure and can not replace Nifedipine as an antidote in case of hypertensive crisis.
To reduce the risk of tyramine-rich food provoved hypertension, noradrenergic TCAs or NARIs like Reboxetine could be used. But such combos must be taken under supervision of psychiatrists very familiar with MAOIs and are usually reserved for very treatment resistent cases.
Posted by JadeKelly on November 3, 2008, at 12:13:51
In reply to Re: PARNATE: rough start but WOW, posted by Medline on November 3, 2008, at 5:08:30
> I don't really understand Bulldog's answer too. Of course Lamictal could be a good augment to a MAOI, but it will do nothing for the blood pressure and can not replace Nifedipine as an antidote in case of hypertensive crisis.
>
> To reduce the risk of tyramine-rich food provoved hypertension, noradrenergic TCAs or NARIs like Reboxetine could be used. But such combos must be taken under supervision of psychiatrists very familiar with MAOIs and are usually reserved for very treatment resistent cases.Thanks for the resonse. I though he meant Lamictal would put ceiling on BP. My particular problem is unusual in that I went 11 days on Parnate, and felt great. Then out of the blue this hypertensive crisis. What has me baffled/worried is that I had spike in BP (185-190) after EVERY dose after that. Not food or drug induced. Wierd, huh? Elizabeth is only other poster I've seen with spontaneous hypertention. Have never corresponded with her, as just joined.
So its unlikely that Pdoc will have antidote that can be taken daily other than another type AD? I'm afraid to do that. Aren't they contraindicated? Do you feel these would be as effective as Nifedipine? As my spikes aren't related to food/drug reaction. That stuff works but the fatigue sorta offsets the benefits of the Parnate. So frustrating to finally find an AD that works to find that I may not be able to take it.
Btw-Any personal experience on these or similar drugs? I have TR/atyp MDD. Almost 3 years. Many triggers, but should be over it by now.Thanks!
Jade
Posted by dcruik518 on February 26, 2009, at 16:48:47
In reply to Re: PARNATE ideas for Hypertension » Medline, posted by JadeKelly on November 3, 2008, at 12:13:51
Topamax will lower your blood pressure significantly and also help you lose weight.
Adding a primarily noradrenergic TCA like Desipramine or Nortriptyline will also make Nardil safer. Unfortunately, very few p-docs know this and are actually inclined to think the opposite. Here's what I found on Dr. Gillman's highly informative site, www.psychotropical.com :
Antidepressants - Combinations with MAOIs
Date Created: 04/04/1999 Last Modified: 07/10/2002 Last Checked: 05/04/2003Combinations of MAOIs and TCAs got a bad name in the sixties because imipramine was used. It occasionally proved to have enough activity as an serotonin reuptake inhibitor to cause serotonin toxicity (serotonin syndrome). Such reactions were not then understood. Serotonin toxicity reactions were sometimes wrongly interpreted as hypertensive reactions.
Many current pharmacological texts still get all this wrong by mixing up serotonin syndrome and tyramine induced hypertension. The irony is that mixing a TCA (one which is not also an SRI-- see relevant notes on serotonin syndrome) with an MAOI makes it safer! (see references). This is because the cheese reaction (potentially catastrophic hypertension) requires that the provoking dietary component (the amino acid tyramine) must first enter the pre-synaptic nerve, from whence it displaces noradrenalin which then mediates the hypertension.
Tyramine is actively moved into the pre-synaptic nerve by the very same reuptake mechanism that is blocked by TCAs, which are non-specific noradrenalin reuptake inhibitors NRIs!
This is the end of the thread.
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