Psycho-Babble Medication Thread 1018986

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

parnate dose too high?

Posted by g_g_g_unit on May 31, 2012, at 4:45:17

I went up to 50mg of Parnate three days ago and am getting this relatively uncomfortable 'wired' sensation. It feels like excess noradrenergic activity and leaves me feeling kind of numb, blank-minded and interferes with the fluidity of my reading, for example (i.e. my focus becomes very choppy). Taking like 1/6 of a 0.5mg Klonopin tab (hey -- I'm sensitive) resolves the problem, but obviously isn't a long term solution.

I know there's some catch up that occurs between the stimulant and MAO-inhibiting effects, so should I wait it out a bit?

One good sign (per Dr. Gilman's formulation) is that my blood pressure has finally dropped to a noticeable degree, so I thought it might mean I was in fact hitting upon a therapeutic dose.

 

Re: parnate dose too high? g_g_g_unit

Posted by SLS on May 31, 2012, at 6:29:06

In reply to parnate dose too high?, posted by g_g_g_unit on May 31, 2012, at 4:45:17

> I went up to 50mg of Parnate three days ago and am getting this relatively uncomfortable 'wired' sensation. It feels like excess noradrenergic activity and leaves me feeling kind of numb, blank-minded and interferes with the fluidity of my reading, for example (i.e. my focus becomes very choppy). Taking like 1/6 of a 0.5mg Klonopin tab (hey -- I'm sensitive) resolves the problem, but obviously isn't a long term solution.
>
> I know there's some catch up that occurs between the stimulant and MAO-inhibiting effects, so should I wait it out a bit?
>
> One good sign (per Dr. Gilman's formulation) is that my blood pressure has finally dropped to a noticeable degree, so I thought it might mean I was in fact hitting upon a therapeutic dose.


I think you answered your own questions.

It is not unusual for old side effects to reemerge upon dosage increases and for new ones to develop. Hopefully, these will resolve in a week or two.

In the old days, a drop in blood pressure upon orthostatic challenge was used as an index of MAO inhibition. If I recall accurately, doctors looked for a 10% or greater decrease in pressure upon standing from a seated position.

I think it is prudent to give each dosage increase a period of three weeks before evaluating its effectiveness and making further adjustments.

I hope that you are getting closer and closer to a robust response to your treatment.

Good luck.


- Scott

 

Re: parnate dose too high?

Posted by Willful on May 31, 2012, at 10:07:00

In reply to parnate dose too high?, posted by g_g_g_unit on May 31, 2012, at 4:45:17

I think you should wait it out a bit. I've had similar effects with MAOIs when a dosage went too high, but later, when I was used to that dosage, these effects disappeared. Depending on how much you increased your dose, you could back down a little and increase more slowly, if the sensation is too disruptive. Otherwise, I would just wait a while and see if it resolves.

Willful

 

Re: memantine success

Posted by g_g_g_unit on June 1, 2012, at 2:34:07

In reply to Re: parnate dose too high?, posted by Willful on May 31, 2012, at 10:07:00

> I think you should wait it out a bit. I've had similar effects with MAOIs when a dosage went too high, but later, when I was used to that dosage, these effects disappeared. Depending on how much you increased your dose, you could back down a little and increase more slowly, if the sensation is too disruptive. Otherwise, I would just wait a while and see if it resolves.
>
> Willful

I only increased by 5mg so I'll wait it out.

Also, my psychiatrist agreed to add in Memantine either before or after we increase to 60mg! (Ideally before....). He said he didn't really think there was any evidence it would do much for OCD, but he didn't have any reasons against trying it. He also said he thought it would be a good augment for an MAOI, though didn't go into detail as to why .. maybe because it's cholinergic?

I'm so happy! Mostly because I'd been terrified of asking due to tenuous evidence re: it's stimulant-tolerance-preventing properties, so overcoming that fear was a big deal for me!

 

Re: memantine success g_g_g_unit

Posted by SLS on June 1, 2012, at 3:03:16

In reply to Re: memantine success, posted by g_g_g_unit on June 1, 2012, at 2:34:07

> > I think you should wait it out a bit. I've had similar effects with MAOIs when a dosage went too high, but later, when I was used to that dosage, these effects disappeared. Depending on how much you increased your dose, you could back down a little and increase more slowly, if the sensation is too disruptive. Otherwise, I would just wait a while and see if it resolves.
> >
> > Willful
>
> I only increased by 5mg so I'll wait it out.
>
> Also, my psychiatrist agreed to add in Memantine either before or after we increase to 60mg! (Ideally before....). He said he didn't really think there was any evidence it would do much for OCD, but he didn't have any reasons against trying it. He also said he thought it would be a good augment for an MAOI, though didn't go into detail as to why .. maybe because it's cholinergic?
>
> I'm so happy! Mostly because I'd been terrified of asking due to tenuous evidence re: it's stimulant-tolerance-preventing properties, so overcoming that fear was a big deal for me!
>


I hope the memantine makes a difference for you. I had once added it to Parnate. I actually thought that it had helped. Unfortunately, I had also been switched to a generic lamotrigine (Lamictal) at about the same time. I began to deteriorate, so I discontinued the memantine before realizing that it was the generic lamotrigine that had been the culprit. I keep my bottle of memantine handy. Adding it back to my treatment regime would be the first thing I would do were my recovery to stall or poop-out. Memantine is claimed to be pro-dopaminergic by some researchers. If it is, perhaps it acts to augment Parnate as an antidepressant rather than simply prevent tolerance to its amphetamine-like effects. Memantine does several other things pharmacologically. It even increases BDNF production, which is known to be both neuroprotective and neurotrophic. Memantine might help to prevent or delay the onset of Parkinsons and Alzheimers. I think I am talking myself into trying it again.

Regarding OCD, I have encountered several studies reporting a therapeutic effect for memantine.

Good luck.


- Scott

 

Re: memantine success SLS

Posted by g_g_g_unit on June 1, 2012, at 3:38:45

In reply to Re: memantine success g_g_g_unit, posted by SLS on June 1, 2012, at 3:03:16

>Memantine does several other things >pharmacologically. It even increases BDNF >production, which is known to be both >neuroprotective and neurotrophic. Memantine might >help to prevent or delay the onset of Parkinsons >and Alzheimers. I think I am talking myself into >trying it again.
>
> Regarding OCD, I have encountered several studies reporting a therapeutic effect for memantine.
>
> Good luck.
>
>
> - Scott


Hey Scott

Yeah -- I've shown those studies to a couple of psychs now, though none have been particularly impressed (I think because the were open-blind?). However, I know that Michael Jenike, an OCD researcher at Harvard, prescribes it to his patients.

I don't see any reason not to try it if you're otherwise stable. The only precaution I've come across is to ensure that you dose at the same time each day in order to maintain a therapeutic effect, because even small perturbances in blood-levels can disrupt its actions.

Someone also claimed it interfered with long-term memory formation, based on this study conducted on post-menopausal women http://www.ncbi.nlm.nih.gov/pubmed/18705678.

However, I don't know if combination with a stimulant would offset that effect?

 

Re: memantine success g_g_g_unit

Posted by SLS on June 1, 2012, at 7:47:58

In reply to Re: memantine success SLS, posted by g_g_g_unit on June 1, 2012, at 3:38:45

Hi GGG.

> >Memantine does several other things >pharmacologically. It even increases BDNF >production, which is known to be both >neuroprotective and neurotrophic. Memantine might >help to prevent or delay the onset of Parkinsons >and Alzheimers. I think I am talking myself into >trying it again.
> >
> > Regarding OCD, I have encountered several studies reporting a therapeutic effect for memantine.

> Hey Scott
>
> Yeah -- I've shown those studies to a couple of psychs now, though none have been particularly impressed (I think because the were open-blind?). However, I know that Michael Jenike, an OCD researcher at Harvard, prescribes it to his patients.

Single-blind:

http://www.ncbi.nlm.nih.gov/pubmed/20075645

> I don't see any reason not to try it if you're otherwise stable. The only precaution I've come across is to ensure that you dose at the same time each day in order to maintain a therapeutic effect, because even small perturbances in blood-levels can disrupt its actions.

Thanks for the tip. I might ask my doctor about revisiting memantine. He may feel that my rate of improvement can be accelerated.

- Scott

 

Re: memantine success g_g_g_unit

Posted by psychobot5000 on June 2, 2012, at 0:40:07

In reply to Re: memantine success, posted by g_g_g_unit on June 1, 2012, at 2:34:07


>
>
> Also, my psychiatrist agreed to add in Memantine either before or after we increase to 60mg! (Ideally before....). He said he didn't really think there was any evidence it would do much for OCD, but he didn't have any reasons against trying it. He also said he thought it would be a good augment for an MAOI, though didn't go into detail as to why .. maybe because it's cholinergic?
>
> I'm so happy! Mostly because I'd been terrified of asking due to tenuous evidence re: it's stimulant-tolerance-preventing properties, so overcoming that fear was a big deal for me!
>

Happy to hear! Fingers crossed, hope the parnate trial smooths out and the memantine helps you!

 

Re: parnate dose too high? Willful

Posted by g_g_g_unit on June 2, 2012, at 8:26:36

In reply to Re: parnate dose too high?, posted by Willful on May 31, 2012, at 10:07:00

> I think you should wait it out a bit. I've had similar effects with MAOIs when a dosage went too high, but later, when I was used to that dosage, these effects disappeared. Depending on how much you increased your dose, you could back down a little and increase more slowly, if the sensation is too disruptive. Otherwise, I would just wait a while and see if it resolves.
>
> Willful

Was the feeling you had basically akin to overstimulation, or like a noradrenaline excess? I don't really feel 'panicky' .. in fact, the opposite, just kind of robotic and unflabbable and blank-minded .. it's really weird and annoying, I've had it before on other stims when the dose was too high.

Anyway, it's only been 6 days at this new dose, but I guess I'm impatient.

Interesting combo, by the way. What's the rilutek for?

 

Re: memantine success g_g_g_unit

Posted by SLS on June 5, 2012, at 16:03:21

In reply to Re: memantine success, posted by g_g_g_unit on June 1, 2012, at 2:34:07

> Also, my psychiatrist agreed to add in Memantine either before or after we increase to 60mg!

I have decided to perform a trial of memantine to see if we can't speed things along. Although I am improved, I am not satisfied with the rate of recovery. I would like to accelerate it if possible.

Currently:

Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg
memantine 20 mg

I suppose some people will think that it is irrational to take so many drugs at the same time. Some people take twice as many "supplements" as I do drugs. They argue that each supplement does something different, and that many of them need other supplements to work properly. That is exactly how my treatment regime works. My grandmother took 11 drugs to treat comorbid hypertension and heart failure. She lived to reach age 99.

I have no qualms about adding Topamax on top of all of this if the addition of memantine doesn't help. Topamax is a drug that is currently being studied to treat PTSD, and has some utility in treating bipolar disorder. That would be 8 drugs that I would be taking. That is not such a big deal to me, though. It is only a number. This regime is still rational polypharmacy as far as I'm concerned. There are no safety concerns at this point. If I feel tremendously well for adding Topamax, I would then try to discontinue memantine. If I feel worse, then I'll keep both of them, and hopefully live happily ever after.

If the addition of memantine and Topamax do not produce a robust improvement, I will discontinue both drugs and then pursue rTMS.


- Scott

 

Re: memantine success SLS

Posted by g_g_g_unit on June 6, 2012, at 11:35:54

In reply to Re: memantine success g_g_g_unit, posted by SLS on June 5, 2012, at 16:03:21

Best of luck Scott! keep us updated


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