Posted by SLS on April 13, 2012, at 2:24:00
In reply to Re: Parnate Augmentation, posted by Alpam on April 13, 2012, at 0:43:38
> Well my doctor said that he spoke with other Psychs and came to the agreement that combining a stimulant with a MAOI is just too dangerous. Meanwhile I am struggling to stay awake here at work.
> His answer was to reduce the Abilify to 10mg at night and send me off for another sleep study (my 3rd one)
> I also asked to increase the Parnate but he said I was already on too many meds and there wasn't much improvement from previous increases (which wasn't true)
Instead of me making a list of drugs for you to try, I would offer that you begin to make a list of doctors to try. In your doctor's mind, what does the dosage of Parnate have to do with the number of other drugs that you are taking? I don't see the connection.
Parnate can exceed dosages of 120 mg, although I find 80 mg to be optimal. Lots of people experience daytime fatigue with Parnate. Adding a stimulant to Parnate is not particularly dangerous. Neither is adding certain tricyclics (desipramine, nortriptyline, amitriptyline, trimipramine, doxepin). Clomipramine and imipramine must be avoided due to serotonergic activity and the risk of developing serotonin syndrome. Bupropion Wellbutrin; Zyban) is safe, too.
Reducing the dosage of Abilify might not be a bad idea if it is being used to treat depression. It might clear up any cognitive blunting that might be present. I guess you can try adding modafinil instead of a stimulant to treat the daytime fatigue.
I don't blame your doctor for not being comfortable using Parnate in combination with stimulants drugs. He likely was taught that this was strictly contraindicated. That's what is written in standard references. You need to find a doctor who has learned otherwise. You might contact a university teaching hospital to find a doctor or to get a list of referrals.
Believe it or not, Nardil can be less sedating than Parnate.
Lithium at low dosages (300 - 600 mg) makes an excellent augmenter for some people taking Parnate.
There are alternatives available to modify Parnate treatment. You just need to find a more experienced doctor who specializes in treatment-resistant depression (TRD).
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw