Posted by quarterwit on September 6, 2004, at 9:43:44
In reply to Re: Parnate to Cymbalta? » quarterwit, posted by King Vultan on September 5, 2004, at 11:21:02
Well, this is encouraging. Pdoc never delves into specific biochemistry with me, just vaguely pointing out the top 3. I've always known there are complexities in there beyond just this.
I'm giving the Parnate a full run. 4-6 weeks at 60 or higher. You think that's enough? Even if there's slight improvement, I'm inclined to stay on it unless it makes things worse. I just have a bad feeling about the Cymbalta, although the immediate effect on norepenephrine has its appeal. Doesn't it hit dopamine at small levels too?
Staying on Parnate also forces us to be cautious about combos -- Wellbutrin maybe, although it never did much (up to 300 mg but maybe not long enough) on its own. Reboxetine might be good cautious choice, although I don't know if it differs from Straterra much. But being cautious means I stay off at least serious doses of Dexedrine which to be honest has been a problem. Taking between 30-60 for several years caused an addiction of sorts, and I had tough times trying to go off it, including the pre-Parnate period.
Keep me posted on your own Parnate progress. Thanks --
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> This makes me think of an issue that was being discussed recently about certain people who get sleepy upon administration of stimulant type drugs. The hypothesis proposed was that these people may have hypersensitive dopamine autoreceptors, that is, too many inhibitory receptors keeping dopamine transmission at a chronically low level, and which may also tend to slow or shut down the firing rate of the dopamine neuron if there is any extra dopamine around, as what happens when taking a stimulant. If this does happen to be the case with you, in theory, anyway, Parnate has a good chance of ultimately working, as the hope would be that the extra dopamine available from its inhibition of MAO-B added to that from its stimulant effect may be enough in total to downregulate, or reduce in number, the inhibitory autoreceptors. The end result would be that the neuron's firing rate would speed up to normal and relieve your symptoms.
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> Unfortunately, I don't know how long this downregulation process, if it occurs, winds up taking. I have some of the same issues as you, as some drugs such as Provigil have made me paradoxically sleepy. Like you, I have also just started Parnate and am wondering what kind of time frame will be involved for the full therapeutic effects to be apparent. In my case, I seem to be tolerating it somewhat better, as I can't really say that it's made me sleepy; however, it does seem to be making me a bit more depressed at times. Again, this could perhaps involve some of the same autoreceptor hypersensitivity issues--it's really hard to say for sure what exactly is going on. I have noticed a big improvement in cognitive function, at least. This is my 5th day on 30 mg/day; I was on 20 mg/day for a week before that. I'll soon be making an appointment to see my pdoc about going up to 40 mg/day but am not really doing all that bad on 30--well, depending on the day, anyway.
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> Todd
poster:quarterwit
thread:386419
URL: http://www.dr-bob.org/babble/20040904/msgs/387021.html