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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 54. This is the beginning of the thread.
Posted by S. Suggs on January 1, 2000, at 7:05:26
I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
S. Suggs
Posted by Jaime on January 1, 2000, at 8:32:23
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Yes. I am on PARNATE about six months from now and have the same cold problems. With NARDIL have the same problems.
> I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). Iwonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
>
> S. Suggs
Posted by Scott L. Schofield on January 1, 2000, at 8:56:23
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
> I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
Are you bipolar of unipolar? Either way, a Parnate + Lithium combination is a good choice.
Unfortunately, I have been on Parnate too often. I don’t think my more recent experiences with it are relevant because they must be viewed with the understanding that I have been exposed to it so many times. What I can offer are a few remembrances of what an early, somewhat successful trial was like.
What I feel is the most important aspect of my experience with Parnate to convey is that it was NOT an overnight, all-or-nothing response. Although I began to feel some improvement by the end of the third week, it took at least two months for the response to build up to its maximum.
Early on, I experienced cold hands, a cold nose, and very cold feet (probably left over from a recent marriage). I also had a tendency to feel cold all the time, but that is an intrinsic feature of my depressed state. As time progressed, I remember actually feeling too hot, especially in bed at night. I had to sleep without covers. I believe that one of the symptoms of some cases of depression is having somewhat impaired thermoregulation. Disautonomia – a screwed-up balance between sympathetic (fight-or-flight) and parasympathetic (eating, relaxing, sex) – is definitely a phenomenon seen in depression.
I’m going to go out on a limb here (it’s a pretty strong one) and suggest that, for some people, there lies a window situated between the depressed state and the recovery into euthymia (or at least something close to it) in which the disautonomia becomes exaggerated. During this time, cold can become colder, palpitations can become stronger, anxiety or nervousness can appear or become worse, dry mouth can appear or become worse, dizziness and orthostatic hypotension can occur or become worse, vision can become impaired due to a decrease in pupillary diameter, shakiness or hand tremors can appear or become worse… etc. These things can not only happen on the way up, but also on the way down. Only here, the symptoms may be of a much greater magnitude (but probably of a shorter duration). I have heard this phenomenon referred to as “rebound depressive-symptomology”.
As far as the increased thirst and urination are concerned, I don’t know what’s going on there. Certainly, having a dry-mouth (xerostomia) as a side-effect is a possibility. You might tend to drink more to satisfy a dry mouth when the body itself is well hydrated. Perhaps you are losing water through an increase in perspiration. You might not see an obvious wetness on your skin or clothes, but sweat may be secreted just slowly enough to evaporate quickly, yet quick enough to lead to periods of dehydration. Perhaps in response to the subsequent thirst, you overshoot and drink more than the system needs, and the rest is excreted as urine. I’ll let someone else address any potential involvements of electrolytes.
I too experienced a “healthy” sleepiness at around 10:30pm that I really didn’t have before. I have also experienced this with another activating MAOI. Here, however, I also hit a wall somewhere between 7:30 and 8:30 PM. This sleepiness was more profound. However, this seemed to dissipate over time.
I agree with you. If I were to respond to Parnate, these minor side-effects would soon become invisible.
Keep on feeling good.
- Scott
Posted by Scott L. Schofield on January 1, 2000, at 9:16:32
In reply to Re: Parnate Update, posted by Jaime on January 1, 2000, at 8:32:23
Hi Jaime.
How are you?
> Yes. I am on PARNATE about six months from now and have the same cold problems. With NARDIL have the same problems.
Did you feel well with Parnate or Nardil?
> > wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all.
Thyroid analysis is a tricky thing that I don’t trust the average run-in-the mill endocrinologist to perform.
The tests themselves may be simple enough, but interpreting them can be a real challenge. TRH, TSH, T4, T3, T4/T3 ratio… Now try to interpret them in the context of severe neurophysiological depression and the changes in thyroid function that may result from it. Now try to interpret them in the context of severe neurophysiological depression and the plethora of drugs the subject may be taking as treatment. Now consider all of the aforementioned as being totally irrelevant because, regardless of thyroid function, thyroid medications will be used as an allotropic adjunct to augment the current treatment being employed on the subject.What I mean to say is, I think the thyroid thing sounds pretty good.
Maybe that’s what the feeling cold stuff is all about.
- Scott
Posted by S. Suggs on January 1, 2000, at 11:51:07
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Many thanks for the rapid responses to my questions. FYI, I am dysthymic with ADD-H. Best wishes and blessings to all!!
S. Suggs
Posted by Scott L. Schofield on January 1, 2000, at 13:21:12
In reply to Re: Parnate Update-Thanks!, posted by S. Suggs on January 1, 2000, at 11:51:07
> Many thanks for the rapid responses to my questions. FYI, I am dysthymic with ADD-H. Best wishes and blessings to all!!
Have you ever tried a tricyclic?
- Scott
Posted by S. Suggs on January 1, 2000, at 15:45:18
In reply to Re: Parnate Update-Thanks!, posted by Scott L. Schofield on January 1, 2000, at 13:21:12
Have tried amitriptyline, nortriptyline, desipramine...I think that is all I can remember at this point. I do know that at one point I had a wonderful response to Zoloft and Pamelor, but due to GI problems (GERD)- TCA's can really be a problem when you have ongoing reflux. By the way I take Prevacid now and will go for the new endoscopic procedure within the next 6 months to correct this additional 110.00 med. Blessings,
S. Suggs
Posted by anita on January 1, 2000, at 16:33:53
In reply to Re: Parnate Update - Feeling Cold, posted by Scott L. Schofield on January 1, 2000, at 9:16:32
Hiya,
I had the same cold problem on Parnate, and on Nardil. On Parnate I only felt intense cold (like it was in my bones), but on nardil I had extremes in both feeling cold and feeling hot. It was severe, especially the hot part, with excessive sweating, and one of the main reasons I stopped nardil. I was on nardil for 3 years and it only got worse, but ymmv. BTW, on nardil my thyroid results were odd -- low TSH and low T4 & T3 -- but it was determined that this was a reaction to the drug and that nothing inherently was wrong with my thyroid. I did try thyroid supplementation (Cytomel), but that only made me anxious and hotter.
The worst for me was air conditioning, or a draft -- I'd get so cold no amount of blankets or heaters could warm me, and eventually my mind would get confused and I'd nod off. It was worse when I didn't get enough sleep.
I've always been curious about the temperature dysregulation with MAOIs, but never got any relief from it no matter what I did. Weird, eh?
anita
Posted by Scott L. Schofield on January 1, 2000, at 20:29:18
In reply to Re: Parnate Update-Thanks!, posted by S. Suggs on January 1, 2000, at 15:45:18
> > Have you ever tried a tricyclic?> Have tried amitriptyline, nortriptyline, desipramine...I think that is all I can remember at this point. I do know that at one point I had a wonderful response to Zoloft and Pamelor, but due to GI problems (GERD)- TCA's can really be a problem when you have ongoing reflux. By the way I take Prevacid now and will go for the new endoscopic procedure within the next 6 months to correct this additional 110.00 med.
I am curious (this occurs from time to time).
1. What properties of the tricyclics exacerbate your GI situation? Noradrenergic/anticholinergic, other?
2. What is Prevacid? How does it work?
3. What is a 110.00 med?
4. Why did the cow jump over the moon?I haven’t been here that long, and I don’t know any of your treatment history. If the endoscopic procedure is successful, will you be able to go back to a tricyclic? Are there any drugs that you can take that would abolish the GI effects of a tricyclic?
How about combining Zoloft and Wellbutrin instead? It seems to be an excellent combination for some people. Wellbutrin has also been used for AD/HD, although I don’t know how effective it is. In addition, it often counteracts the sexual side-effects of the SSRIs.
Thanks for providing any answers to the silly questions I have asked.
- Scott
Posted by ann faber on January 1, 2000, at 21:12:35
In reply to Re: Parnate Update-Thanks!, posted by Scott L. Schofield on January 1, 2000, at 20:29:18
>I don't understant how this works so I may be doing it wrong. Anyway, I have been one Nardil for about two years. I take 45mgs one day and 30 the next. I also take 35micrograms of cytomel and 100-150 of Seroquel. I also expereince the temperature disregulation problem. I go between sweating and freezing. I am 52, thought it was the "change" though I have always had warm flashes since on Nardil. Also, I have an odd question-has anyone experienced that their urine smells like burnt rubber with use of Nardil? Kind of like after you eat asparagus. Good luck with your explorations.
ann.
> > > Have you ever tried a tricyclic?
>
> > Have tried amitriptyline, nortriptyline, desipramine...I think that is all I can remember at this point. I do know that at one point I had a wonderful response to Zoloft and Pamelor, but due to GI problems (GERD)- TCA's can really be a problem when you have ongoing reflux. By the way I take Prevacid now and will go for the new endoscopic procedure within the next 6 months to correct this additional 110.00 med.
>
> I am curious (this occurs from time to time).
>
> 1. What properties of the tricyclics exacerbate your GI situation? Noradrenergic/anticholinergic, other?
> 2. What is Prevacid? How does it work?
> 3. What is a 110.00 med?
> 4. Why did the cow jump over the moon?
>
> I haven’t been here that long, and I don’t know any of your treatment history. If the endoscopic procedure is successful, will you be able to go back to a tricyclic? Are there any drugs that you can take that would abolish the GI effects of a tricyclic?
>
> How about combining Zoloft and Wellbutrin instead? It seems to be an excellent combination for some people. Wellbutrin has also been used for AD/HD, although I don’t know how effective it is. In addition, it often counteracts the sexual side-effects of the SSRIs.
>
> Thanks for providing any answers to the silly questions I have asked.
>
>
> - Scott
Posted by S. Suggs on January 2, 2000, at 4:55:15
In reply to Re: Parnate Update-Thanks!, posted by Scott L. Schofield on January 1, 2000, at 20:29:18
> I am curious (this occurs from time to time).
>
> 1. What properties of the tricyclics exacerbate your GI situation? Noradrenergic/anticholinergic, other? Anticholinergic-slow gi tract
> 2. What is Prevacid? - kissing cousin of Prilosec-Proton Pump Inhibitor-basically, one step beyond the zantacs of the world. Prevacid and Prilosec are once a day dose. How does it work? Not sure but it stops the process before it got to the step where ex. zantac / axid etc. would.
> 3. What is a 110.00 med? Sorry for lack of info. This is my term for a month's supply. I pay for all my meds out of pocked and submit on my own and get 80% back in about a month-better than nothing.
> 4. Why did the cow jump over the moon? He doubled his Nardil dose with an extra bottle of red wine.
>
> I haven’t been here that long, and I don’t know any of your treatment history. If the endoscopic procedure is successful, will you be able to go back to a tricyclic? ae there any drugs that you can take that would abolish the GI effects of a tricyclic? Probably could go back to a TCA, but the side effects I can put up with right now. I just want to get off the Prevacid. It was also discovered that I have a hiatial hernia (part of my stomach sticks up through my diaphragm).
>
> How about combining Zoloft and Wellbutrin instead? It seems to be an excellent combination for some people. Wellbutrin has also been used for AD/HD, although I don’t know how effective it is. In addition, it often counteracts the sexual side-effects of the SSRIs. This could be a possibiblity in the future, and thanks for the suggestion, but I probably will stick where I am unless things get worse. By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
>
> Thanks for providing any answers to the silly questions I have asked. Thank you for giving me a chance to respond, please continue with further ones, it allows me to share my experiences with others who might need it. BlessingsS. Suggs
>
>
> - Scott
Posted by S. Suggs on January 2, 2000, at 4:58:43
In reply to Re: Parnate Update-Thanks!, posted by ann faber on January 1, 2000, at 21:12:35
It seems that temperature deregulation is a common side effect that is not mentiond (unless I've missed it). Do not have any idea about the burnt rubber thing. Good luck and blessings,
S. Suggs
Posted by Scott L. Schofield on January 2, 2000, at 11:28:10
In reply to Re: Parnate Update-Thanks!, posted by S. Suggs on January 2, 2000, at 4:55:15
> By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
If it ain’t broke, don’t fix it.
My doctor uses a range of 40mg – 80mg per day as his therapeutic standard. In my case, he has worked me up to dosages as high as 150mg/day. This is not all that rare. It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose. If there is one common gripe regarding the use of Parnate (and many other antidepressants) is that the dosage is not pushed high enough, and that the trial is not continued for long enough.
I’m pretty sure you can find this information at either the Dr. Bob’s Tips section or at Ivan Goldberg’s Depression Central.
- Scott
Posted by Elizabeth on January 3, 2000, at 9:33:11
In reply to Re: Parnate Update-Thanks!, posted by Scott L. Schofield on January 2, 2000, at 11:28:10
> > By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
>
> If it ain’t broke, don’t fix it.
> It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.Any properties I should know about?
Posted by cn. michele on January 3, 2000, at 11:41:59
In reply to Parnate "properties" :), posted by Elizabeth on January 3, 2000, at 9:33:11
> > > By the way, my doc gave me the permission to slowly increase above the 60 mg (FDA max) if necessary. He said I was probably the only one of his patients he would allow to do so, based on my increased knowledge. And to all reading, this is another reason Psycho-Babble is crucial to keeping educated. He tells me I have educated him on MAOI's. But 60 works great (excluding a few side effects).
> >
> > If it ain’t broke, don’t fix it.
> > It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.
>
> Any properties I should know about?I am thinking about Parnate for relief of GAD/depression would you mind posting any side-effects your have experienced with this drug. Thanks, Michele
Posted by Frymet on January 3, 2000, at 15:42:22
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Did your doctor check you kidney function?
Lithium can cause kidney problems and perhaps the combination may increase the possibility.
Posted by Scott L. Schofield on January 3, 2000, at 17:01:24
In reply to Parnate "properties" :), posted by Elizabeth on January 3, 2000, at 9:33:11
> > It should be noted that Parnate exhibits properties at a high dose that it does not at a standard dose.
>
> Any properties I should know about?When I get a chance, I'll see if I can find some of the stuff about it. I'm sure you would be quite interested to know about them, but nothing I read indicates any kind of risk involved with these dosage-emergent pharmacodynamic effects.
- Scott
Posted by S. Suggs on January 3, 2000, at 18:55:50
In reply to Parnate Update-response to S.Snuggs, posted by Frymet on January 3, 2000, at 15:42:22
>
> Did your doctor check you kidney function?
> Lithium can cause kidney problems and perhaps the combination may increase the possibility.Just curious, what type of kidney function test are you mentioning. (I believe in leaving no stones unturned - no pun intended). Thanks and many blessings,
S. Suggs
Posted by Elizabeth on January 4, 2000, at 19:26:47
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 3, 2000, at 17:01:24
> When I get a chance, I'll see if I can find some of the stuff about it. I'm sure you would be quite interested to know about them, but nothing I read indicates any kind of risk involved with these dosage-emergent pharmacodynamic effects.
Thanks -- I'd appreciate that. I am interested to hear what you've found about high-dose Parnate. I'm thinking seriously of switching back due to weight gain on Marplan. I suggested maybe trying to figure out a way to get the Parnate dose a little higher than I did before, which my pdoc referred to -- with a smile -- as "cowboy psychopharmacology." :-)
Posted by Adam on January 4, 2000, at 22:07:09
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 4, 2000, at 19:26:47
>I suggested maybe trying to figure out a way to get the Parnate dose a little higher than I did before, which my pdoc referred to -- with a smile -- as "cowboy psychopharmacology." :-)Not trying to be a pain here...
I'd be very interested in hearing about this "cowboy psychopharm." if and when you can share such info. (I promise no more talk of selegiline, or anything else!...I'm just interested)
Thanks! :)
Posted by Michael on January 5, 2000, at 5:54:08
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
> I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
>
> S. SuggsHaving been on Parnate for many years, I also experience cold intolerance. Fortunately, there are few other side effects.
Posted by S. Suggs on January 5, 2000, at 6:15:20
In reply to Re: Parnate Update, posted by Michael on January 5, 2000, at 5:54:08
Michael, thanks for the reply. The cold intolerance is a minor side effect that I can put up with. What I've also noticed is a huge improvement in the social aspect. For ex. while at Home Depot (wood worker and tool freek) I,m talking briefly to strangers and just being plain nice. Also, when the Parnate wears off, I do crash (get sleepy), this is fine since I end up getting a full and restful nights sleep. For years I never slept well. It's good (I've tried so many AD's).
My main question to you is what is your dose of Parnate, I'm at 60?
Blessings,
S. Suggs
Posted by Elizabeth on January 5, 2000, at 19:31:05
In reply to Re: Parnate "properties" :), posted by Adam on January 4, 2000, at 22:07:09
> I'd be very interested in hearing about this "cowboy psychopharm." if and when you can share such info.
I'm sort of confused by this...can you rephrase the question please?
Posted by Phillip Marx on January 6, 2000, at 1:31:01
In reply to Re: Parnate Update-Thanks!, posted by ann faber on January 1, 2000, at 21:12:35
> >Also, I have an odd question-has anyone experienced that their urine smells like burnt rubber with use of Nardil? Kind of like after you eat asparagus. Good luck with your explorations.
>
> ann.Burning rubber smell (urine?)
http://www.childrenwithdiabetes.com/dteam/1999-06/d_0d_3wu.htm
http://www.med.harvard.edu/AANLIB/cases/case25/mr1/013.html
http://williamcalvin.com/bk7/bk7ch5.htm
http://www.google.com/search?q=burning+rubber+smell+urine&num=10&sa=Google+Search
I’m going to be asleep in a few minutes so I can’t say more.
Lucky us.
pm
Posted by Noa on January 6, 2000, at 6:17:11
In reply to --burnt rubber - urine--, posted by Phillip Marx on January 6, 2000, at 1:31:01
> I’m going to be asleep in a few minutes so I can’t say more.
>
> Lucky us.
>
> pmPhillip, LOL. I am glad to see you have a good sense of humor.
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