Posted by delna on October 21, 2009, at 22:06:16
Hi
I am particularly curious about adding Nortriptyline in a while if I am not getting a good response from Parnate alone (am still only on 40mg). I know you are supposed to start them together ideally but people do add it on I believe.
My question is this: Parnate is prescribed mainly for atypical depression which is what I have (part of bipolar) and the defining features are fatigue and hypersomnia.
Nortriptyline is sedating (even though it maybe be less so than the other TCAs). So how can you get activated if you add such a drug? People on this board are saying that it makes all the difference and I read in the babble tips that these 2 drugs have a synergistic effect.
I have to take 200mg Provigil with the Parnate just to stay awake enough to sit in bed. Is this combination sensible for someone like me? Or for anyone with atypical depression?
My other question regards stimulants. I am on 200mg Provigil (but ready to raise it to 400mg despite what Dr Goldberg advised- am desperate)
It is not a traditional stimulant and I'm sure it acts in a totally different way to the traditional stimulants. I think pdocs use it with Parnate just to keep sleepy patients awake (though, not sure).
My question is this: are the traditional stimulants like ritalin also used just to keep people awake or do they actually act to potentiate the effects of Parnate making it more effective.Is anyone taking ritalin? If so how much? In one babble tip thread, Dr Goldberg says he adds as much as 60mg of Ritalin to Parnate!!!
"Date: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate."
What do people think??
Thanks so much for your help. I know I keep badgering everyone with questions. But sadly I am really struggling on this drug :(
I am so appreciative of the support I have received here....
Thank you again...
Love
D
poster:delna
thread:921876
URL: http://www.dr-bob.org/babble/20091021/msgs/921876.html