Posted by Tomatheus on December 25, 2006, at 0:04:35
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 18, 2006, at 5:55:36
Scott,
See below for my responses to different sections of your post...
> > I've actually been feeling ok for most of the past week on a combination of the Goldshield Parnate (20 mg/day) and SAM-e (200 mg/day).
>
> Interesting combination. It makes sense. I received a boost from S-AMe for the short time I took it with Parnate. I didn't continue with it because my system was very unstable at the time, and I was about to see a new doctor. I wanted to leave him with as simple a regime as possible to work with.You might considering giving it another try if the addition of Nardil to your med cocktail doesn't ultimately work out for you (and I'm sorry to hear that it hasn't been as of late).
Despite the fact that I couldn't get more than an initial 3-day response out of the Goldshield Parnate as monotherapy, it does seem to be significantly more potent than the GlaxoSmithKline Parnate. When I took the GSK Parnate, I felt that charged-up stimulant effect (which was probably the result of the drug's amphetamine metabolite) for a few hours on my first two days of the drug, but it always seemed to have a powerful hypnotic effect on me in the mid to late afternoon no matter what I tried to do to combat it. I didn't give it anything close to a full trial (I stopped after about two weeks at 20 mg/day) because the sleep attacks were causing me to sleep through afternoon and evening classes that I was taking at a university at the time. Now, sleeping through morning classes was sometimes a problem for me during my college days, but sleeping through afternoon and evening classes was just too far out of the ordinary for me. But in the time that I spent on the GSK Parnate, I did not notice much of an antidepressant effect at all. Just that charged-up kind of energy for a few hours on the first two days and sleep attacks in the middle of the day every day.
Considering that I didn't give the GSK Parnate much of a trial, the fact that I didn't notice a significant antidepressant effect from it might sound like something that's just to be expected. And in and of itself, it is. After all, when I took Nardil, I didn't even start to feel its AD effect until I had been at 75 mg/day for more than a week. That was after more than a month of titrating upward and then waiting for a response at 60 mg/day. The thing is that when I took the Goldshield Parnate, I noticed a partial boost in both mood and energy on day one, an even stronger boost on day two (something that I would consider to be a partial response, but not full remission), pretty much the same thing on day three as on day two, a slightly weaker version of that same AD effect on day four, and then pretty much nothing on day five or at any point thereafter. That's the "tease" that I was referring to, and I seem to get that on a lot of meds. It sounds like you've probably also experienced it quite a bit yourself, unfortunately. Even though that "tease" effect that I had on the Goldshield Parnate may not sound like anything to get hyped up about, it was far different than the response that I had to the GSK Parnate. I did not notice *any* midday fatigue whatsoever on the Goldshield version, which was quite a surprise to me.
Interestingly, I tried taking a partially homemade version of the GSK Parnate at one point (preparing it in the enteric PlasminPlus capsules as I did at times with both the Australian Nardil and the "new" U.S. Nardil), and I responded to it in pretty much the same way that I responded to the Goldshield version. The Goldshield Parnate has an enteric coating. The GSK version does not. SmithKline Beecham changed Parnate's formulation in the early 1990s, but even the "old" U.S. Parnate did not have an enteric coating. So, I don't have any reason at this point to think that the "old" Parnate was necessarily any different from the "new" version, but I can say that based on my experience, the Goldshield version had a much more potent and consistent AD effect than the current GSK version. It wasn't consistent in terms of its effects over the long haul (not in my case, at least), but when I did feel its AD effect, it was more or less consistent over the course of a day, much unlike the GSK Parnate.
Obviously, your response to the Goldshield Parnate might not be the same as mine was, but my guess is that you'd probably notice a difference between that version and the GSK version.
But anyway, before I spend the rest of the night going into excessive detail on my response to the Goldshield Parnate as monotherapy, I should probably update you on my response to the Goldshield Parnate-SAM-e combo that I've been on.
In my last post, I wrote that I had been noticing a partial AD response (a boost in both mood and energy, but I don't think that I wrote that in my post) for about a week. But I also mentioned that I was noticing some of what I described as residual fatigue. Generally speaking, the fatigue seemed to be the strongest right after taking my dose of SAM-e in the morning. Unfortunately, the fatigue seemed to slowly build over the course of time until it just became too much. I started feeling extremely unfocused, and my symptom of leaden paralysis was particularly bad. I still didn't feel quite as drained as energy as I feel when I'm not taking any meds, but my ability to function and to concentrate on things like writing Psycho-Babble posts became severely impaired.
As I mentioned, the fatigue that I was experiencing seemed to grow slowly worse with time until I finally started to feel overwhelmed by it. In addition to that, the fatigue seemed to be the worst shortly after taking my SAM-e dose (not immediately after taking it, but 1-2 hours after taking it, which is to be expected when taking something with an enteric coating). Before the fatigue started to get out of control, I was able to control it to an extent with caffeine, which as you probably know, is an adenosine antagonist. Among other things SAM-e breaks down into adenosine, and it's been suggested that the effects of SAM-e often tend to build up over time. So, I suspected that the increasing fatigue that I was experiencing was probably due to the SAM-e. Or in other words, the balance that I was trying to achieve between the Goldshield Parnate and SAM-e seemed to be not quite so balanced, with the effects of the SAM-e outweighing the effects of the Goldshield Parnate. So, the first thing that I tried doing was reducing my SAM-e dose to 100 mg/day (I cut my 200 mg tablet in half and then broke up the contents of each half until I could get 100 mg worth to fit into an enteric capsule). That didn't do much good. I ended up feeling slightly more irritable than I had been feeling at 200 mg/day of SAM-e (and still 20 mg/day of the Parnate) and not any more energized. So, finally, I did what I probably should have done instead of lowering my SAM-e dose and raised my dose of SAM-e back to 200 mg/day and then went up to 30 mg/day on the Parnate. Considering that my symptom of leaden paralysis was particularly bad at 20 mg/day of Parnate and 200 mg/day of SAM-e and that MAOIs tend to be effective at treating depressive states associated with leaden paralysis, it made sense that I would probably benefit from a little more MAO inhibition.
So far, my approach seems to be working. This is now my third day taking 30 mg/day of the Goldshield Parnate and 200 mg/day of SAM-e and my second consecutive day feeling the AD effects (a boost in both mood and energy). I still notice a little bit of fatigue right after taking my dose of SAM-e in the morning, but it seems to be more mild than it was when I was taking it with 20 mg/day of Parnate. And if anything, the fatigue seems to be becoming less intense with time instead of becoming more intense, which is probably a good sign. So, now it's just a matter of waiting to see if the response that I'm getting now will last. I have some reason to believe that it might. Even though a partial response lasting about a week at 20 mg/day of the Goldshield Parnate and 200 mg/day might not sound like much to most people, an AD response lasting more than 3-4 days is almost unheard of for me. More significantly, I was able to get a more prolongued response out of 20 mg/day of Parnate with SAM-e than I could get with the same dose of Parnate as monotherapy. I also have some theoretical reasons as to why I think combining the Goldshield Parnate with SAM-e might work, but that would take quite a while to explain. But given my response so far, I do think that there is some reason to be optimistic that I might be able to get a sustained AD response out of this combo at the dose that I'm currently at. But as I've said, I'm still nowhere close to the point of being ready to declare victory.
(Wow, that was long. Hopefully you won't find it to be too long.)
> Yup. I hope you don't mind if I send a few prayers your way.
I don't mind at all. Thank you.
I hope that your holiday celebrations are as happy as they can be. Please take care.
Tomatheus
poster:Tomatheus
thread:714163
URL: http://www.dr-bob.org/babble/20061224/msgs/716247.html