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Switching from Parnate to Trintellix

Posted by SLS on May 10, 2018, at 5:06:55

The plan is to discontinue Parnate and replace it with Trintellix. I currently take 80 mg/day of Parnate. I should be able to taper the dosage and discontinue it in 7-10 days. I will then allow for a washout of 10-14 days in order to avoid serotonin syndrome. Trinellix, among other things, is a serotonin reuptake inhibitor. MAOIs like Parnate cannot be taken together with drugs that do this or else serotonin syndrome will result.

Trintellix is rather unique as an antidepressant. It potently normalizes or enhances cognitive and memory functions - even in people who do not have mood disorders. Trintellix is now indicated for depression with cognitive impairments. My depression has always expressed itself with major deficits in slow thinking, confusion, processing impairments, and memory difficulties (short-term, and recall). I was forced to drop out of college because of my depressive disorder; not because of negative thinking, but for my inability to read, learn, and remember. Perhaps Trintellix is a good match for this presentation. I have become enthusiastic to begin treatment.

In the meantime, I am performing an experiment. I would like to switch from taking Abilify to Saphris so that I can lose 50 pounds of weight and normalize my very high triglycerides. Saphris is not a dopamine D2/D3 partial agonist as is Abilify. I have always thought that it is this action of Abilify that confered upon it its antidepressant properties. Saprhis does not do this, so my optimism is guarded. However, there is the possibility that there are other properties that they share. Additionally, Saphris does a bunch more things; the importance of which has yet to be determined.

I have decided to wait until I have run the Abilify -> Saprhis experiment before beginning to wean off of Parnate. I should have an answer in 1-2 weeks. When an antipsychotic is to be effective for depression, it will usually demonstrate an improvement in the first 1-2 weeks - sometimes days. Once I have settled on one of these two drugs, I will begin to reduce the dosage of Parnate rather quickly. For me, one of the most difficult withdrawal effects of Parnate discontinuation is profound fatigue. My doctor and I agreed that I can try using methlylphenidate or amphetamine to soften the crash.

I have become more excited to try Trintellix. When I first expressed a desire to come off of Parnate, I had wanted to move to Effexor. I tried it several times in the past, the results of which were partial improvements. However, never have I tried Effexor with the other drugs I'm taking. In my mind, Effexor represented a sure thing to get to at least a 50% improvement. My doctor lobbied instead that I try Trintellix first. He had his reasons, I guess. He tells me everything, generally. However, much of what goes on in his mind is more abstract than verbal. In any event, Trintellix is simply a drug that I have not tried yet, and is different from all the others. For every new antidepressant that becomes available, a certain percentage of previously treatment resistant cases will respond to it. That's why I don't have some sort of disdain for drug companies when they bring a "me too" drug to market. The more the merrier. If a drug is truly worthless, capitalism will remove it from the market.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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