Posted by SLS on May 1, 2012, at 8:43:41
In reply to question for SLS, posted by g_g_g_unit on May 1, 2012, at 3:47:09
> Scott, I've seen a couple of people in the archives (including Chairman_MAO) referring to Parnate's 'amphetamine-like' metabolites becoming active at a certain dose (I think 100mg+).
Parnate (tranylcypromine) does a few things at higher dosages that it does not do at lower dosages. For instance, only high dosages downregulate 5-HT2a receptors - those that are blocked by amitriptyline, nortriptyline, Remeron, and atypical antipsychotics. It also downregulates tryptamine receptors. However, I don't know of anything that would suggest that high-dosage Parnate produces an amphetamine effect. It may. I found one report of Parnate overdose indicating that amphetamine was found in the blood stream. There has been a debate regarding the possibility of Parnate having amphetamine metabolites since its introduction in the 1960s. I don't know if there is a consensus yet.
I tried Parnate at higher dosages. I felt somewhat more energized and my head was clearer. I worked up to 150 mg/day and subsequently added d-amphetamine to it while also taking desipramine. Actually, adding desipramine to Parnate 60 mg might produce both an antidepressant effect and an anti-ADHD effect. Not too many doctors would be willing to do this.
> I feel like I'm at a bit of a crossroads. My psychiatrist is really happy that I'm experiencing an improvement in ADHD on Parnate, but from what I understand (according to board members etc. and also Dr Gilman), this 'stimulant' effect is more than likely going to disappear.
They might be talking about the subjective sense of activation rather than the persistence of an anti-ADHD effect. Do you feel activated when you take amphetamine chronically? If not, then perhaps the subjective feeling of activation is not necessary for Parnate to produce an enduring therapeutic effect. Unfortunately, there isn't much data using adults as subjects. Zametkin et al (1985) used it for children and found Parnate to be effective. In another study, Zametkin reported an immediate therapeutic effect of Parnate for ADHD and theorized that this indicated that it was the result of a different mechanism than that mediating antidepressant effects. I wish that I still had access to Len Adler. I could have asked him about Parnate for you.
If the anti-ADHD effects of Parnate poop-out on you, perhaps you could have your doctor look at guanfacine coadministration. It might produce some dizziness as a side effect, although this might abate over time. "On paper", the combination should not be toxic. However, I cannot know for sure as I could not find any evidence that the combination is ever used. Neither I could find any suggestions that the combination is unsafe. The PI makes no mention of MAOIs as a contraindicated substance.
- ScottSome see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1016531
URL: http://www.dr-bob.org/babble/20120425/msgs/1016838.html