![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 46. Go back in thread:
Posted by SLS on October 29, 2009, at 14:37:50
In reply to Parnate losing effectiveness. Why?? Help please., posted by Girlnterrupted78 on October 29, 2009, at 1:14:33
It seems that many people need 80mg of Parnate to obtain a stable response.
I am currently having luck with the following treatment regime:
Parnate 80mg
nortriptyline 150mg
Lamictal 200mg
Abilify 20mg
lithium 900mgMy illness has a bipolar counterpart to it. The amount of lithium I am taking is greater than what is usually needed when it is used as an augmenter in unipolar depression. 300-600mg has been shown to be an effective dosage range for this purpose. My opinion is that one can respond to blood levels as low as 0.3 mEq/L. The nice thing about lithium is that if it is going to work in this role, it works fast, often within 3 days. If you feel no better by the end of two weeks, it is probably of no therapeutic value.
Adding a tricyclic antidepressant like nortriptyline to Parnate can produce dramatic results. Unfortunately, I doubt many doctors are willing to prescribe such a combination.
The antipsychotic Abilify has some pro-dopaminergic properties that have been described by some as being a dopamine system stabilizer (DSS). It is unique in this regard.
Lamictal rarely works as an antidepressant on its own, but can act as an effective augmentor.
It is only natural that people extol the value of the various treatment strategies that they have had success with. I can think of other things to try, but for now, I prefer to describe the things that I have seen work well for me.
I wish you the best of luck. That you have been partially or transiently responsive to Parnate monotherapy bodes well for your eventual success in treating your depression.
- Scott
Posted by ColoradoSnowflake on October 29, 2009, at 17:18:53
In reply to Re: Parnate losing effectiveness. Why?? Help please. » Girlnterrupted78, posted by SLS on October 29, 2009, at 14:37:50
Hi Scott:
It's good to hear from you!
When you started Parnate didn't you go a lot higher at first, and then come down, Or at some point?
I'm sorry, I can't remember.
I think it is hard to tell what the right dose is.
Could you tell us how you determined your 80mg/day dose for yourself?
Thanks so much,
Gayle
Posted by bulldog2 on October 29, 2009, at 17:52:11
In reply to Re: Parnate losing effectiveness. Why?? Help please. » Girlnterrupted78, posted by SLS on October 29, 2009, at 14:37:50
> It seems that many people need 80mg of Parnate to obtain a stable response.
>
> I am currently having luck with the following treatment regime:
>
> Parnate 80mg
> nortriptyline 150mg
> Lamictal 200mg
> Abilify 20mg
> lithium 900mg
>
> My illness has a bipolar counterpart to it. The amount of lithium I am taking is greater than what is usually needed when it is used as an augmenter in unipolar depression. 300-600mg has been shown to be an effective dosage range for this purpose. My opinion is that one can respond to blood levels as low as 0.3 mEq/L. The nice thing about lithium is that if it is going to work in this role, it works fast, often within 3 days. If you feel no better by the end of two weeks, it is probably of no therapeutic value.
>
> Adding a tricyclic antidepressant like nortriptyline to Parnate can produce dramatic results. Unfortunately, I doubt many doctors are willing to prescribe such a combination.
>
> The antipsychotic Abilify has some pro-dopaminergic properties that have been described by some as being a dopamine system stabilizer (DSS). It is unique in this regard.
>
> Lamictal rarely works as an antidepressant on its own, but can act as an effective augmentor.
>
> It is only natural that people extol the value of the various treatment strategies that they have had success with. I can think of other things to try, but for now, I prefer to describe the things that I have seen work well for me.
>
> I wish you the best of luck. That you have been partially or transiently responsive to Parnate monotherapy bodes well for your eventual success in treating your depression.
>
>
> - ScottSeems like upping the lithium had a dramatic effect. Is that dose within the therapeutic range when being used as montherapy?
Posted by Girlnterrupted78 on October 29, 2009, at 18:02:13
In reply to Re: Parnate losing effectiveness. Why?? Help please. » Girlnterrupted78, posted by SLS on October 29, 2009, at 14:37:50
Thanks for sharing your combo.
My initial success came about once I hit 60mgs. From 60mgs, I requested to be taken higher because I knew I could feel even better--just how I felt on Celexa 7 years ago, which was still superior. So we went up to 70mgs, and then to 80mgs.
At 80mgs I felt equally as well as on 60mgs, no difference at all, so by this point my doctor said "Ok let's go back down to 60mgs since 80mgs is not making any difference." And it wasn't.
So I first went back to 70mgs, and around this time Parnate lost some of its effectiveness. It did not poop out completely, but it definitely lost part of the effects. This makes no sense, since 60mgs had been the initial dose that worked.
Anyway, I'm back on 80mgs today, yesterday my doctor did notice me feeling and acting more subdued now than when Parnate was working best. But he still said "Maybe what you were feeling was just 'too good'" referring to when I told him I could finally be very pleasant and smile to strangers, whereas normally I was completely ice cold and would barely talk to anyone. I don't get how could this be 'too good'??? A lot of non-depressed people are this way, how could that be 'too good'???
The stranger (and more annoying) part is that he said the exact same thing about Celexa--that it was just 'too good to be true' and maybe not normal. How does he want me to feel then? Flat and serious and unfriendly? Jesus, sometimes he really pisses me off with his comments. Every time something seems to work and makes me feel great, it's just 'too good.' Maybe if I tell him I'm slightly depressed but not completely depressed, he'll say that's finally normal and not 'too good' and I should stay right there for the rest of my life. Slight distress over anything that is 'too good' seems to be his aim.
Thanks again for the comments.
Posted by bleauberry on October 29, 2009, at 18:46:22
In reply to Parnate losing effectiveness. Why?? Help please., posted by Girlnterrupted78 on October 29, 2009, at 1:14:33
I agree with ace and other posters on several things:
1. Increase the dose...80mg to 120mg.
2. Give it more time. I'm talking 3 months at a high dose. It appears you will need a higher dose to push over the roadblock to get there.I personally would not even consider adding another agent to it until you have been on as high as 120mg for 3 months.
Posted by SLS on October 30, 2009, at 6:47:28
In reply to Re: Parnate losing effectiveness. Why?? Help please. » SLS, posted by Girlnterrupted78 on October 29, 2009, at 18:02:13
To be conservative, you should give each dosage adjustment three weeks to work. It might not be a valid gauge for prognosis to evaluate how a dosage adjustment affects you within the first few days.
I have taken 150mg of Parnate and combined it with 200mg of desipramine and 20mg of amphetamine. I did not respond much better at this high dosage of Parnate than I did at lower dosages. However, I really should have been taking 300mg of desipramine.
I would consider adding an adjunct drug after three weeks at 80mg of Parnate before going with a high-dose strategy.
You are going to receive a variety of opinions as to what to do next. I can't be sure that high-dose Parnate wouldn't work. It is definitely effective for some people, but I am dubious that the percentage of responders is that high of those people who do not respond to lower dosages. I have read the works of Jay Amsterdam, MD and Andrew Nierenberg, MD regarding high-dose Parnate therapy. Neither doctor seems to have followed up by embracing this treatment strategy such that they include it in their treatment algorithms.
- Scott
Posted by Maxime on October 31, 2009, at 16:50:20
In reply to Re: Parnate losing effectiveness. Why?? Help please. » SLS, posted by Girlnterrupted78 on October 29, 2009, at 18:02:13
God, how could you feel too good? I don't understand that comment at all.
Posted by Girlnterrupted78 on November 1, 2009, at 2:05:44
In reply to Re: Parnate losing effectiveness. Why?? Help please. » Girlnterrupted78, posted by Maxime on October 31, 2009, at 16:50:20
> God, how could you feel too good? I don't understand that comment at all.
I know, it's horrible to think my doctor finds it "too good".When I told him I had suddenly become friendly and pleasant, and would smile or strike conversations with strangers easily, he didn't say much. But now that I told him that Parnate lost some of its potency and I feel more subdued and not that friendly anymore, he said "what you were feeling before was just 'too good'" Almost like if it was a negative thing to feel that way.
Too good for what??!!! It infuriates me to hear him talk like that. Like if I didn't deserve to feel good and should not have a right to feel friendly and pleasant. Same thing happened when I described Celexa as being 3 extra layers of emotional skin that would never come off in a whole year and protected me from everything. He said, kind of demeaningly "well, that's too good.. , not sure that's normal."
It makes me wonder if he wants me to feel just a little good? Or maybe just flat, to avoid anything close to what I had already experienced with 2 antidepressants? Because both are just "too good".
Sorry, I could write about this forever, it frustrates and infuriates me so much that I could stab myself over it.
Next time he sees me he will have to listen to me on this.
Thanks for your support. In these moments, the last thing I need is to hear is that my initial response was "too good". For the first (ok, second after Celexa) time in my life I felt normal and rid of that chronic emotional distress. But he claims that such recovery was just 'too good' and not what we're aiming for. I guess we're aiming to achieve some slight (as opposed to severe) chronic emotional distress and a flat face, with no emotions, no friendliness and nevermind smiling or joking..just to make sure it never gets to be "too good". arhhggg
Posted by floatingbridge on November 1, 2009, at 11:26:54
In reply to Re: Parnate losing effectiveness. Why?? Help please. » Maxime, posted by Girlnterrupted78 on November 1, 2009, at 2:05:44
Hi GI78,
I don't know where your doc is coming from. Too good, like manic? When I first started AD, I, too felt like it was an extra skin (I couldn't have put it any better than you). My doc then thought that was great.
Yes, guess it is time to talk w/ your doc. I hope it goes well for you--and good for you for standing up for yourself!
fb
Posted by metafunj on November 1, 2009, at 12:06:47
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Girlnterrupted78, posted by floatingbridge on November 1, 2009, at 11:26:54
I know someone who felt so good on nardil that they became manic and this person reported that it was so abnormal they started to become psychotic. Maybe your doctor is worried about this. Even when I took prozac the first time nothing bothred me. It was unnatural because I couldn't relate to anyone feeling bad after awhile, since things couldn't bother me for a long time.
Posted by Girlnterrupted78 on November 2, 2009, at 12:10:44
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Girlnterrupted78, posted by floatingbridge on November 1, 2009, at 11:26:54
Well, I doubt my behavior would qualify as manic. The reason he said I had been "too good" at first is that I told him I had become very pleasant with people and could smile to strangers and even strike up conversations.
The weird part is that when that was taking place, he seemed to be happy for me. But once those feelings were replaced with a more flat, subdued, and less cheerful mood, that's when he said, "what you were feeling before was just "too good"" He said "too good" like if being too good was a bad thing.
Since I began trying different antidepressant treatment about 8 years ago, the only 3 states I've been able to experience have been either 1)very depressed, 2)somewhat depressed, or 3)very good (when the medication works.) He seems to not want me to be "very good" but rather just flat. No smiles to strangers, or whatever happiness I was feeling.
He said the same thing when I told him that even though Parnate was doing a great job, Celexa had been superior. He then said that when I was on Celexa, I had just been "too good". Again, with the connotation that being 'too good' was a negative thing. Now he claims that Parnate (when working great), compared to Parnet itself (but with less potent effects) was also 'too good'! How low is he going to go? Every time something works, it's just "too good"??!!!
When Parnate first started working, I asked him if he noticed any difference in my behavior, and he said 'of course'. He said I looked more alive, my face was more expressive, I was a lot more talkative, and I even joked around with him, whereas before I barely spoke and didn't even want to look at him.
Now that the effects began to diminish, I asked him again if he's seen a difference and he said I seemed more subdued.
So it seems that he thought the initial response was "too good" but now that I'm no longer lively or happy it's ok. No more smiles, jokes, or liveliness, just flatness seems to be what he'd call 'good enough'. This is horribly frustrating.
Thanks for your comments
> Hi GI78,
>
> I don't know where your doc is coming from. Too good, like manic? When I first started AD, I, too felt like it was an extra skin (I couldn't have put it any better than you). My doc then thought that was great.
>
> Yes, guess it is time to talk w/ your doc. I hope it goes well for you--and good for you for standing up for yourself!
>
> fb
Posted by Girlnterrupted78 on November 2, 2009, at 12:36:49
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » floatingbridge, posted by metafunj on November 1, 2009, at 12:06:47
Well, he's always asking me about that. He asks me whether I'm overspending, engaging in any risky behavior, talking excessively to people, etc, and my answer is always no. So I'd say I was never manic while it was working better (better than now.. it's still working, but at a much lower level.)
One of the features of my depression is that I feel a gut-wrenching feeling whenever I engage in social interactions. It's an unexplainable emotional distress that makes absolutely no sense at all and makes me subdued, uncomfortable, awkward and upset. It was so distressing that I avoided most social interactions and the ones that were inevitable (work for the most part) caused me horrible grief, ruminations, and loss of confidence and self-esteem, which in turn, worsened my depression. I avoided things because I knew they'd have the effect of slowly depressing me more and more, and I was afraid of falling too low.
As Parnate began working, that feeling disappeared completely and was replaced with happiness and social excitement coming from within. I noticed I was able to change people's moods, smile and just do the same thing I had done before (made people uncomfortable) but in the opposite way--I made people at ease and happy. They say that energy doesn't disappear, it just changes, so I guess that negative energy I had before turned into positive somehow. I remember it was the same thing when Celexa was working, but even better.
So according to my doctor, that was "too good". I don't know how does he want me to feel. Maybe he wants me to be less happy and smile less? Or not be as friendly and outgoing? He especially mentioned the 'talking to strangers' part, as being too much. Like if talking to strangers was a sign of mania or a negative thing.
There is one thing, though, unrelated to this, that I was feeling while Parnate was working, and that I don't remember telling my doctor about. When I came home at night, I began talking to myself nonstop. I couldn't stop it. I tried to say "ok, now you're going to shut up" but I kept saying the things i was thinking, nothing crazy, just like those people who are constantly talking to themselves about things they have to do, things they have to finish, things they are going to tell other people, etc. And I was extremely hyper during the nighttime. I don't think this happened during the day... but at night it was really bad.
When Parnate began losing it's potency, that effect stopped completely and was replaced with total exhaustion at night, to the point I almost can't do anything and a lot of times I'm too exhausted to even cook myself dinner.
I always wondered what was all that talking out loud all about. I really liked the energy, though, it was a nice feeling, but I don't know why even if I tried to shut up, I just couldn't do it. One day I told myself "Ok, that's it. You're shutting up right now." And I really just couldn't. Again, this was only at night, and it was a lot of energy that I wish I'd had during the day instead.
Now I barely open my mouth, lol, and I'm too tired to do anything, even more tired than before I started Parnate. I have no idea what could have happened to cause this change.
Thanks for your response and the info regarding mania. I haven't engaged in any risky behavior, or spent all my money, or anything that characterizes mania. The only effect Parnate had on me was that it turned my distress into happiness. Not into flatness, but into actual happiness. Is that a sign of mania? I really hope not..
> I know someone who felt so good on nardil that they became manic and this person reported that it was so abnormal they started to become psychotic. Maybe your doctor is worried about this. Even when I took prozac the first time nothing bothred me. It was unnatural because I couldn't relate to anyone feeling bad after awhile, since things couldn't bother me for a long time.
Posted by bulldog2 on November 2, 2009, at 12:57:40
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » metafunj, posted by Girlnterrupted78 on November 2, 2009, at 12:36:49
> Well, he's always asking me about that. He asks me whether I'm overspending, engaging in any risky behavior, talking excessively to people, etc, and my answer is always no. So I'd say I was never manic while it was working better (better than now.. it's still working, but at a much lower level.)
>
> One of the features of my depression is that I feel a gut-wrenching feeling whenever I engage in social interactions. It's an unexplainable emotional distress that makes absolutely no sense at all and makes me subdued, uncomfortable, awkward and upset. It was so distressing that I avoided most social interactions and the ones that were inevitable (work for the most part) caused me horrible grief, ruminations, and loss of confidence and self-esteem, which in turn, worsened my depression. I avoided things because I knew they'd have the effect of slowly depressing me more and more, and I was afraid of falling too low.
>
> As Parnate began working, that feeling disappeared completely and was replaced with happiness and social excitement coming from within. I noticed I was able to change people's moods, smile and just do the same thing I had done before (made people uncomfortable) but in the opposite way--I made people at ease and happy. They say that energy doesn't disappear, it just changes, so I guess that negative energy I had before turned into positive somehow. I remember it was the same thing when Celexa was working, but even better.
>
> So according to my doctor, that was "too good". I don't know how does he want me to feel. Maybe he wants me to be less happy and smile less? Or not be as friendly and outgoing? He especially mentioned the 'talking to strangers' part, as being too much. Like if talking to strangers was a sign of mania or a negative thing.
>
> There is one thing, though, unrelated to this, that I was feeling while Parnate was working, and that I don't remember telling my doctor about. When I came home at night, I began talking to myself nonstop. I couldn't stop it. I tried to say "ok, now you're going to shut up" but I kept saying the things i was thinking, nothing crazy, just like those people who are constantly talking to themselves about things they have to do, things they have to finish, things they are going to tell other people, etc. And I was extremely hyper during the nighttime. I don't think this happened during the day... but at night it was really bad.
>
> When Parnate began losing it's potency, that effect stopped completely and was replaced with total exhaustion at night, to the point I almost can't do anything and a lot of times I'm too exhausted to even cook myself dinner.
>
> I always wondered what was all that talking out loud all about. I really liked the energy, though, it was a nice feeling, but I don't know why even if I tried to shut up, I just couldn't do it. One day I told myself "Ok, that's it. You're shutting up right now." And I really just couldn't. Again, this was only at night, and it was a lot of energy that I wish I'd had during the day instead.
>
> Now I barely open my mouth, lol, and I'm too tired to do anything, even more tired than before I started Parnate. I have no idea what could have happened to cause this change.
>
> Thanks for your response and the info regarding mania. I haven't engaged in any risky behavior, or spent all my money, or anything that characterizes mania. The only effect Parnate had on me was that it turned my distress into happiness. Not into flatness, but into actual happiness. Is that a sign of mania? I really hope not..
>
>
>
> > I know someone who felt so good on nardil that they became manic and this person reported that it was so abnormal they started to become psychotic. Maybe your doctor is worried about this. Even when I took prozac the first time nothing bothred me. It was unnatural because I couldn't relate to anyone feeling bad after awhile, since things couldn't bother me for a long time.
>
>1. There seems to be a cultural bias against happiness in our culture. Perhaps your happiness offends your doctor. We are hear to work, have kids go to church, work and more work. The old puritan ethic.
2. Perhaps he thought you were going into mania which can result in dangerous conditions or actions.
3. From my point of view one can never be to happy. I even enjoy a bit of mania if my behavior is under control. I don't believe in point one and point two would be the only valid consideration.
4. Maybe he wants you to learn to settle for less. That makes his job easier. Anyhow unless you have become dangerously manic in the past I would ditch him for a doc who believes in happiness!
Posted by Phillipa on November 2, 2009, at 19:02:05
In reply to Re: Parnate losing effectiveness. Why?? Help pleas, posted by bulldog2 on November 2, 2009, at 12:57:40
No idea what the night time talking was unless you were just alone in your house and this lessened feeling alone. As for the rest of your responses when I felt good I had a good time even at work and had my patients laughing. I was simply happy. Wish I had that feeling back and no mania at all as slept well, was just content to be me in my skin. Love Phillipa ps I'd ask the doc what he means as it's so distressing to you. I feel there is some miscommunication and he doesn't mean what it sounds like.
Posted by Maxime on November 2, 2009, at 20:12:22
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » metafunj, posted by Girlnterrupted78 on November 2, 2009, at 12:36:49
I am curious to know what this pdoc is like. Is he happy? Does he smile? Is he serious? What's he like?
I don't like him!
Posted by metafunj on November 2, 2009, at 23:34:23
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » metafunj, posted by Girlnterrupted78 on November 2, 2009, at 12:36:49
It does sound slightly hypomanic but not manic. I think it probably is easier for him if you stay on this med and accept things rather than striving for happiness. There used to be this quaint saying about pursuing happiness being a right. I don't know I think I read it somewhere... anyway.
I think you have built a tolerance to Parnate. The way you sound seems similar to someone who has built a tolerance to a drug of abuse and feels tired and flat without increasingly higher dosages.
Also it sounds like you have crashed from the hyperactivity. The pendulum swings both ways and perhaps your body is asking for some rest. Maybe when you feel exhausted the best thing to do is sleep and let your brain restore is balance. I read that parnate totally fragments sleep.
Posted by creepy on November 3, 2009, at 13:28:01
In reply to Parnate losing effectiveness. Why?? Help please., posted by Girlnterrupted78 on October 29, 2009, at 1:14:33
Either youre not at a high enough dose or youre chasing a hypomanic effect. Id say its the prior and that you may want to raise the dose.
Someone else wrote about blood testing MAO levels to get them close to zero with the medication. might be a way to measure whether you are at the right dose or not.
Posted by Phillipa on November 3, 2009, at 18:51:39
In reply to Re: Parnate losing effectiveness. Why?? Help please., posted by creepy on November 3, 2009, at 13:28:01
Blood levels of Maoi's didn't know you could test them. Phillipa
Posted by Girlnterrupted78 on November 4, 2009, at 5:51:28
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Girlnterrupted78, posted by Maxime on November 2, 2009, at 20:12:22
Other than this comment he recently made, he's actually a very nice person. This is probably the first time I am seriously upset over something he said. He's more the serious type, but he does smile and he seemed happy when he first learned of the positive results I was having.
It was until now that there was a negative change, that he began to say that "before you were too good" which makes no sense, considering he was very pleased with the results. I don't know if it's a way to show control over the situation--he does seem to be a little sensitive about showing his expertise, since he's been in the research field for 20+ years.
So I don't know, I am actually seeing him today and I will definitely ask him to clarify his comments, because to me, he makes it sound like being 'too good' is actually a bad thing, so it sounds like he's looking for mediocre results rather than great results.
> I am curious to know what this pdoc is like. Is he happy? Does he smile? Is he serious? What's he like?
>
> I don't like him!
Posted by SLS on November 4, 2009, at 6:15:56
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Maxime, posted by Girlnterrupted78 on November 4, 2009, at 5:51:28
I don't know if this was already suggested, but perhaps your doctor was worried about hypomania.
- Scott
Posted by floatingbridge on November 4, 2009, at 17:40:50
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Girlnterrupted78, posted by SLS on November 4, 2009, at 6:15:56
> I don't know if this was already suggested, but perhaps your doctor was worried about hypomania.
>
>
> - ScottYes, I think when I said manic earlier, hypomanic was more appropriate. (You have never 'sounded' manic imho.) Please let us know how it goes with your doctor, if you would.
best regards, (and fellow sufferer of social anxiety!),
fb
Posted by Girlnterrupted78 on November 5, 2009, at 18:38:21
In reply to Re: Parnate losing effectiveness. Why?? Help please., posted by creepy on November 3, 2009, at 13:28:01
I don't understand when you say I'm chasing a hypomanic effect. Feeling subdued, quiet and uncomfortable, and wanting to be more social and confident, equals in your view: "chasing a hypomanic effect"? Didn't know about that.
My dose is 80mgs. And I had the best effects at 60mgs. Check my post on September 14:
http://www.dr-bob.org/babble/20090912/msgs/917009.htmlI had no idea those levels could be tested. Would a doctor suggest this? Is it common practice?
Thanks.
> Either youre not at a high enough dose or youre chasing a hypomanic effect. Id say its the prior and that you may want to raise the dose.
> Someone else wrote about blood testing MAO levels to get them close to zero with the medication. might be a way to measure whether you are at the right dose or not.
Posted by Girlnterrupted78 on November 5, 2009, at 19:41:18
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » Girlnterrupted78, posted by metafunj on November 2, 2009, at 23:34:23
> It does sound slightly hypomanic but not manic.
I never thought that could be hypomanic! So many normal people without depression act this way. It just seemed to me that the depression was removed completely and I was able to be myself, my normal self. Or like my doctor, maybe you think I had it "too good". Anyway, this is what I wrote in the very first post when my medication began to work:
On September 14 I wrote:
*Parnate 60mgs helping with social anxiety, finally* --- (http://www.dr-bob.org/babble/20090912/msgs/917009.html)
"Just wanted to let you know the improvement I've had so far with Parnate.
This is just my 1st month on Parnate, and last week was my first week on 60mgs, in addition to 10mgs of Adderall--which were added just a week earlier.
My depression began to improve gradually within the first two weeks. All the ruminations, gut wrenching guilt, chronic emotional distress, etc, began to slowly become less and less intense to the point I was able to feel some peace again.This past week I was finally allowed to raise my dose to 60mgs, and by the 2nd day on it I finally began to feel comfortable socially.
I don't feel anxious or awkward anymore. I can chat with people, I can laugh and joke. I'm not a social animal by any means; I'm not there yet, but I did get a comment from a friend, who said: "You definitely seem more chatty and engaged than 3 weeks ago." This week I was able to smoothly and easily handle certain people I was incredibly uncomfortable with just 2 weeks earlier.
I'm also able to smile without forcing it and communicate difficult feelings without terrible emotional distress, guilt, or visible internal struggle.
I also had a phone conversation with one of my siblings, one who usually dominates the conversation. I dominated this time, and surprisingly, my vocabulary is returning to my memory. It's been gone for a long time, more than 2 years probably, ever since my dreadful encounter with Nardil. Seems to be back now, I feel so more fluent.
So I'm feeling good, feeling good. Parnate is doing a great job. I feel more confident, more social and more assertive.
The only strange side effect I began to experience upon raising the dose to 60mgs is that about 1-2 hours after each dose, especially the 2nd dose (each dose is 30mgs Parnate+ 5mgs Adderall) my head begins to feel very hot, my face begins to blush, I begin to feel very sleepy and my eyes start to close and I feel very tired and heavy. Not a bad or painful feeling at all, just a bit strange. Something I can live with, but I was just curious if anyone knows what that might be. Thanks"Most definitely hypomania, right? I was "too good" and should have just been maybe a little more subdued and more uncomfortable to ensure I didn't reach that dreadful hypomanic state of feeling comfortable and confident. You and my doctor would probably be best friends.
> I think you have built a tolerance to Parnate. The way you sound seems similar to someone who has built a tolerance to a drug of abuse and feels tired and flat without increasingly higher dosages.
Could you build tolerance to a medication in just 1 month? That's so little time..
> Also it sounds like you have crashed from the hyperactivity. The pendulum swings both ways and perhaps your body is asking for some rest. Maybe when you feel exhausted the best thing to do is sleep and let your brain restore is balance. I read that parnate totally fragments sleep.
No, I don't think I crashed. I've read that exhaustion is a side effect of Parnate. But hell, yeah, that horrible hypomania I had for a month must be causing this crash now.
Posted by Phillipa on November 5, 2009, at 20:48:02
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » metafunj, posted by Girlnterrupted78 on November 5, 2009, at 19:41:18
To me if that is your personality it's neighter hypomania or mania just you. Phillipa
Posted by Girlnterrupted78 on November 8, 2009, at 19:21:35
In reply to Re: Parnate losing effectiveness. Why?? Help pleas » SLS, posted by floatingbridge on November 4, 2009, at 17:40:50
So I spoke to my doctor and asked him about all this nonsense regarding the feeling 'too good', etc. And yes, like some people guessed, he now claims he thinks I was rather hypomanic, and seems to discredit the initial positive effects of Parnate. This I find infuriating, but more so because I suspect he does it out of frustration and because of an ego problem, and not because he truly believes I was hypomanic.
Last week, when he said I had been 'too good' when Parnate was working better, he backed up his claim by saying, "talking to strangers on the street? C'mon, that's just 'too good'.."
Why would that be 'too good'? There's tons of normal people out there who talk to strangers, for god's sake!!! What if that's my personality when I'm not depressed? This is ridiculous.
I told him I had become very pleasant to people, including strangers--people who happened to be in my way for whatever reason. I explained this to him in order to show my improvement over the irritable, angry person I used to be, and how relieved I felt now. Before, I used to just hate everyone and I viewed every single person as an angry, horrible New Yorker with an attitude. Now I realize that was not a reality but just the view I held because of my depression. There's some really nice people out there, and it was ME who had some bad experiences with a few angry New Yorkers and decided that everyone was a jerk. I was thrilled to be able to be one of the nice ones in the city. So anyway, my "talking to strangers" was "too good" and a sign of "hypomania." I found this absolutely RIDICULOUS.
But anyway, this week he changed things around and no longer claimed that my friendliness was hypomanic.
In our last session, I was more direct and asked him "so what exactly do you mean I was "too good"? And I put some examples. "When I came into your office and you said I seemed more alive, more talkative and engaged.... that was hypomania???" He obviously said no to that one.
His response this time was that certain things I was doing seemed not normal. He said that the fact that I stayed up all night and yet I could keep going the next day, and could do it again a second night in a row, was a sign of hypomania. And the fact that I had these compulsions where I'd go and buy clothes instead of doing the things I wanted to do, which we spoke about some weeks ago, was also a sign of hypomania. But of course, he ignored my explanations. We spoke about the reason this was happening and I made it VERY clear at the time it was nothing like mania. He even asked me if I was spending more money than I had, and I said NO, so he said, "ok, so it seems things are ok then.." Yet, NOW he suddenly changes his mind and makes a new claim about something we had already spoken about and dismissed as normal. In the end, he really made a fool of himself and I will show why:
1. His new "claim" for hypomania was that I was staying up all night and sometimes 2 nights in a row and still going forward. Well, surprise, surprise! I've had treatment resistant insomnia for 10+ years now and he KNOWS this. I began to see this doctor while participating in a research study where I tested an experimental drug. During this period, he gave me Ambien because he KNEW I did not sleep at night. This was several weeks BEFORE we even considered Parnate. But now, this insomnia is BECAUSE Parnate is making me hypomanic? Give me a break!
In addition, isn't Parnate known for being a stimulating drug, which would obviously make my insomnia even worse? I told him that I've always had insomnia, but that while on Parnate, I felt less tired the next day. This is because Parnate is a stimulant drug. Or don't tell me that any person who feels more stimulated on Parnate is hypomanic?
(parenthesis: My doctor never claimed I was hypomanic while Parnate was actually working great. He only claims that NOW that the med stopped working. He claims it was all "too good", most likely because he's angry at himself or at the the fact that his treatment somehow failed. I get the feeling of a big ego in there.)
2. Compulsions: During my therapy with this doctor, it came out that I have problems with compulsion and procrastination--once again, a problem I have battled for YEARS. For years I have been ignoring some of the things I set myself to do (I have 3 books I want to read, but somehow I can't finish them) and instead I spend my time going out, checking out stores, buying clothes, etc. Very unusual female behavior, right?
I explained to my doctor that I've always been this way, and it's true. However, recently I began doing it a lot more often, and I explained him why.
Right during the time I started Parnate, (this was really a coincidence) I discovered how great the low carb diets work for me. So I stayed on a low carb diet for about 2 months and suddenly I'm 20 lbs lighter. I reached a point where I couldn't stop losing and people started to tell me to STOP losing weight or I'd look anorexic. Anyway, I was just very happy with my new weight and felt I could finally wear things I wouldn't have worn before. I haven't been this thin in years; actually I don't think I'd been this thin EVER. So what woman would NOT be thrilled and go and try all the clothes that didn't fit before?? In addition to that, I made a new friend in a depression group, who introduced me to a bunch of amazing thrift stores in NYC. So I did explain to my doctor: This whole thing just happened at the wrong time: I lost 20 lbs, and discovered thrift stores with amazing, cheap clothes. I need clothes for my new weight, so who would NOT go crazy at a time like this? His answer is that I'm hypomanic because I'm going out and buying clothes instead of reading my books and cleaning my apartment, even though I told him I've always been a procrastinator and compulsive. I am infuriated that he is incapable of listening to me when I explain the reasons and the situation.My doctor only listens to what he wants to listen, and while he saw my point at the time this was taking place (he understood and did not make any claims of hypomania) now he's decided to change his mind and claim that I was "too good" and that this is yet another sign of hypomania.
I just wonder why do I waste my time talking to him if he's going to ignore everything I say anyway?But here's the good part and the reason I say he made a fool of himself:
I began to feel great on Parnate when I went on 60mgs. This whole thing about buying clothes and staying up all night began to take place during the time the med was working ok. Even though we discussed this at the time, my doctor NEVER said I was hypomanic during the time the med was working. He never said "You seem 'too good'".
It was only once the medication began losing effectiveness that my doctor began to repeatedly say that it all had been 'too good', and this is what makes me suspect it's all an ego thing for him; he's either angry or frustrated over the fact that his treatment is not being effective for me.
And here's the reason I say he made a fool of himself:
When a patient is developing hypomania, what would be the course of action for the pdoc to follow? I myself don't know, but here's what my doctor did: When I was at 60mgs and the medication started working very well, I told my doctor that I wanted to try to go higher because I knew hadn't reached my full potential. Guess what he did? He allowed me to increase the dose, not just to 70mgs, but later to 80mgs.
If he thought I was hypomanic, is that the way to go? Increase the dose? I thought he'd have to give me a mood stabilizer rather than increase the dose... am I wrong on this?
And I'm also surprised that he NEVER, not even ONCE, during the time the med did work, did he claim I was "too good."
He never EVER said the dreaded "too good" while Parnate was working at its highest. He only began to claim things had been "too good" once the medication stopped working. WHY???? Because he's angry and frustrated that his treatment failed?
I would not even blame HIM over this. Medications work differently for people, and I know I am treatment resistant. The last person I'd blame is him. But I think he blames himself. But why take it out on me?? I am not accusing him or acting differently. I just want things to work out. I don't get what his problem is, but it's just causing me a lot of anger and grief.
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