![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Noa on January 27, 2000, at 7:41:42
I'm taking a risk by starting a new thread at the bottom of such a long page--it is sure to get archived soon, but oh, well. If it does, someone will hopefully bring it forward.
Just wanted to know how you all are feeling. Each of you has posted recently about your struggles of late.
Thinking of you.
Posted by Elizabeth on January 27, 2000, at 21:27:50
In reply to Donut, Kelly, Phil, Elizabeth, posted by Noa on January 27, 2000, at 7:41:42
Hi Noa. Thank you for thinking of me. :)
I stopped Marplan on Tuesday and started Parnate (at 10mg/day) today. I'm hoping the food cravings and fatigue will go away soon. I'd like to be able to take more than 30mg/day of Parnate, maybe by using an antihypertensive with it.
Posted by Noa on January 27, 2000, at 21:40:09
In reply to Re: Donut, Kelly, Phil, Elizabeth, posted by Elizabeth on January 27, 2000, at 21:27:50
Was the marplan not working? What drew you to parnate? What is a "typical" therapeutic dose of parnate? Is it more of a problem for hypertension than other meds?
Posted by Scott L. Schofield on January 27, 2000, at 22:59:21
In reply to Re: Donut, Kelly, Phil, Elizabeth, posted by Elizabeth on January 27, 2000, at 21:27:50
> I stopped Marplan on Tuesday and started Parnate (at 10mg/day) today.
I'm not sure I could ever get my doctor to go along with such a short waiting period between two MAOIs. What convinced you that this was safe?
And while we're at it, can the safety of this overlap be extrapolated to the actual combining of two MAOIs, specifically Nardil with Parnate?
Thanks.
- Scott
Posted by Elizabeth on January 29, 2000, at 4:48:20
In reply to Re: Donut, Kelly, Phil, Elizabeth, posted by Noa on January 27, 2000, at 21:40:09
> Was the marplan not working?
It was at first, but then I started having withdrawal symptoms while still on it (in particular, mood swings, fatigue, agitation, and REM rebound). My pdoc felt it was best for me to get off of it and back on Parnate ASAP, hence the short washout. (This is not SOP -- does that answer your Q, Scott? And no, you shouldn't mix them!)
> What drew you to parnate?
Taken it before, for about a year; it is the "lesser evil" of the MAOIs for me (no weight gain, no poop-out), though I have trouble getting up to an adequate dose.
> What is a "typical" therapeutic dose of parnate?
30mg/day is a sort of basic minimal effective dose.
> Is it more of a problem for hypertension than other meds?
Yes. It potentiates tyramine more than Nardil does, for example, and occasionally it can cause spontanous hypertensive crises (lucky me, I was one of the people who got this side effect, which didn't diminish with time -- had to keep it down to 10mg, maybe 20, in any single dose).
Posted by Kim on January 31, 2000, at 1:25:11
In reply to followup to Noa & Scott, posted by Elizabeth on January 29, 2000, at 4:48:20
> > Was the marplan not working?
>
> It was at first, but then I started having withdrawal symptoms while still on it (in particular, mood swings, fatigue, agitation, and REM rebound). My pdoc felt it was best for me to get off of it and back on Parnate ASAP, hence the short washout. (This is not SOP -- does that answer your Q, Scott? And no, you shouldn't mix them!)
>
> > What drew you to parnate?
>
> Taken it before, for about a year; it is the "lesser evil" of the MAOIs for me (no weight gain, no poop-out), though I have trouble getting up to an adequate dose.What is "REM rebound"? I'm on Parnate, but will probably be trying Marplan soon. I've been having sleep problems and wonder if they're related.
Kim
Posted by Scott L. Schofield on February 1, 2000, at 10:19:43
In reply to Re: followup to Noa & Scott, posted by Kim on January 31, 2000, at 1:25:11
> What is "REM rebound"? I'm on Parnate, but will probably be trying Marplan soon. I've been having sleep problems and wonder if they're related.
That’s a real good question. Don’t know.
Parnate is known to cause insomnia and perhaps other sleep disturbances. These side-effects can abate with time, but often they must be dealt with. Benzodiazepine sleeping medications can be used, but many doctors now use trazodone (Desyrel), a drug originally developed as an antidepressant that is very sedating.
As far as “REM rebound” is concerned, this is a phenomenon seen when discontinuing some antidepressants, especially MAO-inhibitors. These drugs tend to suppress the REM stage of sleep, the one normally associated with dreaming. The “downward” force exerted by the drug is fought by the brain as an “upward” pressure. When the drug is discontinued, the extra REM pressure springs upwards without restraint – it rebounds. The REM stage overshoots, leading to increased time spent in REM sleep, and more vivid dreams. Some people even experience a sort of wakeful dreaming as they begin to fall asleep.
- Scott
Posted by Kim on February 2, 2000, at 0:00:23
In reply to Re: followup to Noa & Scott, posted by Scott L. Schofield on February 1, 2000, at 10:19:43
> As far as “REM rebound” is concerned, this is a phenomenon seen when discontinuing some antidepressants, especially MAO-inhibitors. These drugs tend to suppress the REM stage of sleep, the one normally associated with dreaming. The “downward” force exerted by the drug is fought by the brain as an “upward” pressure. When the drug is discontinued, the extra REM pressure springs upwards without restraint – it rebounds. The REM stage overshoots, leading to increased time spent in REM sleep, and more vivid dreams. Some people even experience a sort of wakeful dreaming as they begin to fall asleep.
>
>
> - ScottVery interesting--I've noticed that if I sleep in and don't take my first Parnate dose on time, I'm almost always awakened by intense bad dreams. If I take my meds when I'm supposed to, I hardly ever dream (that I remember). I'll be discontinuing the Parnate soon--wonder how that will be, considering what happens when I'm just late with my dose!
Kim
Posted by Elizabeth on February 2, 2000, at 21:03:38
In reply to Re: followup to Noa & Scott, posted by Scott L. Schofield on February 1, 2000, at 10:19:43
> As far as “REM rebound” is concerned, this is a phenomenon seen when discontinuing some antidepressants, especially MAO-inhibitors. These drugs tend to suppress the REM stage of sleep, the one normally associated with dreaming. The “downward” force exerted by the drug is fought by the brain as an “upward” pressure. When the drug is discontinued, the extra REM pressure springs upwards without restraint – it rebounds. The REM stage overshoots, leading to increased time spent in REM sleep, and more vivid dreams. Some people even experience a sort of wakeful dreaming as they begin to fall asleep.
Very well described. :-) One other effect of MAOIs on sleep is that, even before they start suppressing REM sleep (the suppression of REM with MAOIs is near 100%), they cause muscle tone during REM to be retained. When the drug is withdrawn, this effect persists for a short time, resulting in movement during dreams. This can be especially bad for someone like me who has a preexisting REM sleep behavior disorder.
Posted by Scott L. Schofield on February 2, 2000, at 22:55:13
In reply to Re: followup to Noa & Scott, posted by Elizabeth on February 2, 2000, at 21:03:38
> > As far as “REM rebound” is concerned, this is a phenomenon seen when discontinuing some antidepressants, especially MAO-inhibitors. These drugs tend to suppress the REM stage of sleep, the one normally associated with dreaming. The “downward” force exerted by the drug is fought by the brain as an “upward” pressure. When the drug is discontinued, the extra REM pressure springs upwards without restraint – it rebounds. The REM stage overshoots, leading to increased time spent in REM sleep, and more vivid dreams. Some people even experience a sort of wakeful dreaming as they begin to fall asleep.
> (the suppression of REM with MAOIs is near 100%)Having to again face this fact scares the hell out of me. The first few times I tried both Parnate and Nardil, I experienced no dreaming at all (that I can remember). Now, these drugs don't have nearly the same effect. This REALLY scares the HELL out of me. Damn it.
> One other effect of MAOIs on sleep is that, even before they start suppressing REM sleep (the suppression of REM with MAOIs is near 100%), they cause muscle tone during REM to be retained. When the drug is withdrawn, this effect persists for a short time, resulting in movement during dreams.
My fist and the lamp on my night-table would agree.
> One other effect of MAOIs on sleep is that, even before they start suppressing REM sleep (the suppression of REM with MAOIs is near 100%),
This still scares the hell out of me.
It might be appropriate here to mention that the time it takes to begin REM after falling asleep (REM latency) is reduced in depression. Normally, REM latency is about 90 minutes. In depression it is closer to 60 minutes. In addition, the duration of the REM periods, particular the first one, are lengthened. Perhaps there is some connection between this and the REM suppression seen with antidepressants. I believe there is a dopaminergic - cholinergic balance that helps regulate sleep, and this is thought by some to be involved in the causes of depression.
I'm really getting sick of typing that damned word.
- Scott
Posted by Scott L. Schofield on February 3, 2000, at 8:59:24
In reply to followup to Noa & Scott, posted by Elizabeth on January 29, 2000, at 4:48:20
> > What is a "typical" therapeutic dose of parnate?
> 30mg/day is a sort of basic minimal effective dose.
My doctor has established his own therapeutic guideline for Parnate dosages as being between 40 – 80 mg/day.
- Scott
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.