Posted by g_g_g_unit on July 22, 2012, at 8:39:45
In reply to Re: Parnate decision » g_g_g_unit, posted by SLS on July 21, 2012, at 12:49:52
> > So I cut back to 50mg for a week and experienced the worst crying/suicidal episodes etc.
Thanks Scott. I was hoping I'd hear from you.
> Are crying and suicidal episodes ever a part of your depression? I find that my symptoms are at their worst right at the beginning of a relapse, whether it be from drug poop-out, dosage reduction, or ultra rapid cycling.
The crying (or increased emotions) I've tended to notice more on noradrenergics. In my depressed state, I'm quite numb, but yeah, suicidal planning plays a big part.
> In my experience, there can be a dramatic difference in the therapeutic effects of Parnate when 50 mg/day is compared to 60 mg/day. Going from 50 to 60 is a 20% increase. That is substantial.
Yeah, I thought it might be. I don't want to knock my psychiatrist -- because he's highly knowledgeable in other areas -- but MAOIs just aren't something he deals with, and he didn't think dropping 10mg would be enough to produce a depressive rebound.
> What are the depressive symptoms that Parnate has remedied? Which have persisted?
It's helped leaden paralysis and I guess made me more likely to keep busy, but I live in a highly stressful home environment, so the busyness is also quite anxiety-driven (I notice more anxiety/agitation on Parnate). It's also helped rejection sensitivity. This dose is overstimulating, but there are windows (or points on the U-curve, I suppose) where my ADD is improved.
One thing I've noticed, or did previously, was that, at night, I'd experience this amazing effect - it was nothing like hypomania (I had a little of that on Nardil). My emotions just felt warmer, I felt genuinely happy, optimistic, close to others. I thought that might be indicative of what the AD response would be like, but sadly, its disappeared.
> My guess is that the depressive symptoms you experience when reducing the dosage of Parnate from 60 mg/day to 50 mg/day is more of a relapse than a withdrawal phenomenon. You might get some REM rebound and vivid dreams, but probably not that much.
> Parnate does not sound like a good drug for you. You gave it every chance to work, and have been very resolved an patient while taking it.
I suppose you're right. I just figured it would be fair to give it the 3 months for anxiety, though it's proving hard. My guess is I'll stay on it for the next few weeks -- because like I say, now is a bad time to withdraw -- and then call it quits if there's no difference (which would be 9 weeks @ 60mg).
> What is your history with Nardil?
Tried it. Got up to 75mg and felt pretty anxious/couldn't sleep. I definitely didn't give it a fair chance, though, as I think I gave up on 75mg after a few weeks. The trial was about 2 months total.
The problem is the only sleep aid I can tolerate is Clonazepam. Every other one produces rebound.
> I was under the impression that Nardil was more often effective than Parnate when treating OCD, and probably less anxiogenic. Perhaps this is an old idea. Has the doctor at Yale ever commented on this?
Not specifically, no. He just said he found MAOIs in general effective for OCD comorbid with panic.
> You are in a difficult situation right now, and I don't know of any sure ways to make it any easier. To discontinue Parnate and endure a washout period will be painful. It would be interesting to know what your doctors recommend as a "bridge" between treatments. As for using a benzodiazepine, Xanax might be better than Klonopin. Xanax has some antidepressant properties. Even using Zyprexa temporarily is an option.
Thanks for the recommendation. It's strange, but not even the 1.5mg of Klonopin I take at night does much for daytime anxiety (somatic or otherwise), and the extra 0.5mg I added in the morning today was like a sugar pill. I've just gone from 50mg back to 60mg after a week's break though, so maybe there's more initial anxiety.
Yeah I think I preferred Xanax. My doctor tried me on a low dose (0.25mg four times a day), then stopped when it didn't work. But when I self-experimented with 0.5mg it was a good anxiolytic.
I've convinced my doctor to let me try Memantine with Dexedrine as an anti-depressant combination next, as I think that'd give me more success in the ADD realm (and hopefully help anxiety too, since Memantine was quite beneficial in that respect last time I tried it). Failing that, I might resort to Nardil, but I guess I just don't think it'll do anything for ADD.