Posted by Scott L. Schofield on December 5, 1999, at 12:14:24
In reply to would you believe 250mg?, posted by george o on December 1, 1999, at 1:22:55
> i developed rapid tolerance to parnate and had to have it increased every week or two until we got over 200mg, my doctor did this after consulting with an expert at his school (he was a resident). the horrible thing was that there seemed to be a rebound effect, where not only did my depression return as i developed tolerance but i became twice as depressed as i had been to start.
I've had similar experiences with Parnate, but it never made my depression worse. Perhaps you experience some sort of dopamine burn-out due to the effects of amphetamine metabolites of Parnate.
At 40mg/day for two weeks, I would get the beginnings of a response, only to lose it within a few days. My doctor titrated me up to 150mg/day. I found that it helped slightly with anergia and dementia, but did nothing for anhedonia and depressed mood.
As an aside, the only treatment that produced a robust antidepressant response that lasted for more than a couple of weeks was a combination of Parnate 60mg/day and desipramine 150mg/day. You may want to consider looking into using a similar combination. I have found imipramine (Tofranil) to be a better antidepressant than desipramine (Norpramin), although the side-effects of desipramine are of a lesser magnitude. I believe there is a consensus that you want to either start them together or add the MAOI while the tricyclic is already on board. This is supposed to lessen the risk of having a severe reaction (high blood-pressure among others). I'm not sure what this consensus is based on. I have added a tricyclic to an ongoing MAOI trial on multiple occasions and have not experienced any adverse events.
You might also want to explore adding thyroid or possibly low-dose lithium (300-600mg/day).
I hope this helps.
poster:Scott L. Schofield