Psycho-Babble Medication Thread 1112094

Shown: posts 1 to 7 of 7. This is the beginning of the thread.

 

nardil or parnate?

Posted by creepy on September 24, 2020, at 3:00:02

Finally after 10 years of SSRI TRD hell I managed to get someone to put me on an MAOI. The washout period has been hellish. If I had any common sense I would have requested an SSRI with a short half-life for a month before-hand but I did not.
Has anyone with MDD, agitated depression really (irritable, grouchy.. when you force yourself to do things all that nastiness comes out) tried both parnate and nardil and had a preference for one or the other? Did either make you irritable like this at all? I have had that on one or two SSRIs.
Dr. Gillman is a big fan of parnate I noticed. That may be due to its faster response and lower chance of weight gain. So I am leaning towards that. But I hear there is more sedation during the day on parnate and that worries me a bit.

 

Re: nardil or parnate?

Posted by Lamdage22 on September 24, 2020, at 7:59:44

In reply to nardil or parnate?, posted by creepy on September 24, 2020, at 3:00:02

I would say that irritability responds better to Nardil. It has a calming Gaba-t inhibitory effect, which Parnate lacks!

 

Re: nardil or parnate?

Posted by Lamdage22 on September 25, 2020, at 1:24:49

In reply to nardil or parnate?, posted by creepy on September 24, 2020, at 3:00:02

I did not have any sedation on Parnate. It is true that you can gain weight on Nardil. Watch out for psychotic symptoms. MAOI can cause or worsen them.

 

Re: nardil or parnate?

Posted by creepy on September 28, 2020, at 13:48:59

In reply to nardil or parnate?, posted by creepy on September 24, 2020, at 3:00:02

another thing I wondered is whether one or the other was more noted for cognitive issues, ataxia, sedation than the other. I see nardil has more GABA action than parnate and Im pretty sensitive to those effects usually. could make topiramate harder to take than before since it adds some of all of those symptoms on its own.

 

Re: nardil or parnate?

Posted by Lamdage22 on November 22, 2020, at 5:42:15

In reply to Re: nardil or parnate?, posted by creepy on September 28, 2020, at 13:48:59

Nardil is definitely more on the sedating side due to toe GABAergic effect.

 

Re: nardil or parnate? creepy

Posted by SLS on November 23, 2020, at 20:25:52

In reply to nardil or parnate?, posted by creepy on September 24, 2020, at 3:00:02

A drug is only as good as your response to it is.

Nardil has been more effective for me than Parnate, although both drugs have worked on and off for many years.

Some people like Parnate because it spares you from certain startup side effects that Nardil is known for.

1. Anorgasmia
2. Urinary retention / micturition
3. Anorgasmia
4. Hypotension

I specified "startup" side-effects because I found that, for me, all four side effects disappeared entirely after three months. My advice is to titrate gradually on Nardil in order to avoid *triggering* side effects that would become significant obstacles otherwise. This time, I purposely started with 7.5 mg/day (1/2 tablet) and went up much slower than on previous trials. Side effects have not been nearly as severe. I think the key is that you not titrate so quickly as to trigger the side effects in the first place. In previous trials, once the side effects appeared, they lingered for months. I became dizzy very easily and sometimes had to sit on the ground to avoid fainting. I had to sit on the toilet for 30 - 45 minutes in order to urinate. Each time, I was scared that I would have to go to the emergency room to be catheterized. Fortunately, sitting 45 minutes was a worthwhile investment of time.

I know this is simplistic, but I think Nardil is more potent than Parnate at inhibiting MAO-A. My subjective experience is that both clorgyline (irreversible specific inhibitor of MAO-A) and moclobemide (reversible selective inhibitor of MAO-A) produced improvements for me that EMSAM (transdermal seligiline - irreversible selective inhibitor of MAO-B) did not. Most importantly, selegiline doesn't really help much with depression until the dosage is high enough to begin inhibiting MAO-A.

Reversible inhibitors of MAO-A (RIMAs), of which only one remains available, are not very effective antidepressants. Moclobemide almost always requires dosage escalation from 300 mg/day to 1200 mg/day - which is where doctors will stop. The initial response to moclobemide is often potent and approaches remission. I don't think it lasts for more than a few weeks until another dosage increase is required. Ultimately, moclobemide exacerbated my depression beyond anything I had experienced previously. It took a few weeks for it to wear off.

Anyway, I would say that Nardil gives me a more complete - a broader scope - antidepressant response. My guess is that Nardil is better suited to treat depressions where anhedonia or social anxiety predominate. Nardil inhibits another enzyme that Parnate does not: GABA transaminase(s). These enzymes are responsible for breaking down GABA - much like MAO is responsible for breaking down dopamine, serotonin, and norepinephrine. The result is the same. Nardil causes GABA levels to increase. This might contribute to Nardil's reputation for being better than Parnate for treating anxiety.

One other thing. For people who experienced childhood adversity (physical abuse, emotional abuse, or neglect), Nardil might yield better results than Parnate.

There are people who respond to one drug, but not the other. There are people who respond well to both drugs. Despite the different reputations that Parnate and Nardil each have - again: A drug is only as good as your response to it is. However, if you are willing to try both drugs if necessary, I would choose Parnate first.


- Scott

 

Re: nardil or parnate? SLS

Posted by undopaminergic on November 24, 2020, at 1:31:29

In reply to Re: nardil or parnate? creepy, posted by SLS on November 23, 2020, at 20:25:52

>
> There are people who respond to one drug, but not the other. There are people who respond well to both drugs. Despite the different reputations that Parnate and Nardil each have - again: A drug is only as good as your response to it is. However, if you are willing to try both drugs if necessary, I would choose Parnate first.
>

I would begin with Parnate (tranylcypromine) too, then Marplan (isocarboxazid), and finally Nardil (phenelzine). Tranylcypromine is a (relatively weak) amphetamine-like stimulant, and I have good experience from stimulants. If stimulants don't "agree" with you, I would start with Marplan. If your anxiety is prominent, it may be best to start with Nardil.

-undopaminergic


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