![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by KaraS on December 8, 2004, at 0:01:13
I thought I was positive that I wanted to try Parnate soon because of the side effect profile (less weight gain, edema and exercise issues) and because my depression has been so anergic and Parnate is more dopaminergic. My doctor wants me to try Nardil instead. I had intended to fight for the Parnate because I thought it has the best chance of downregulating my dopamine autoreceptors and actually providing me with some motivation and energy. The problem is that I've recently developed a lot of anxiety issues. In the last couple of years I hadn't experienced much anxiety but lately it has become overwhelming. I feel like I'm on that old road that ended up with panic attacks and agoraphobia - the same increased startle response, tight chest, difficulty breathing etc. So now I'm wondering if Nardil might be better - at least for now. I know it's supposed to be a great medication for GAD. Since I would probably react to Parnate by becoming drowsy (as that's how I currently react to stimulant type medications), I'm not so worried that it will increase my anxiety (at least initially). I do wonder if it will be enough to help the anxiety that I have now though. Any advice would be welcome. Thanks.
Posted by cosis on December 8, 2004, at 0:18:05
In reply to Nardil or Parnate decision, posted by KaraS on December 8, 2004, at 0:01:13
> I thought I was positive that I wanted to try Parnate soon because of the side effect profile (less weight gain, edema and exercise issues) and because my depression has been so anergic and Parnate is more dopaminergic. My doctor wants me to try Nardil instead. I had intended to fight for the Parnate because I thought it has the best chance of downregulating my dopamine autoreceptors and actually providing me with some motivation and energy. The problem is that I've recently developed a lot of anxiety issues. In the last couple of years I hadn't experienced much anxiety but lately it has become overwhelming. I feel like I'm on that old road that ended up with panic attacks and agoraphobia - the same increased startle response, tight chest, difficulty breathing etc. So now I'm wondering if Nardil might be better - at least for now. I know it's supposed to be a great medication for GAD. Since I would probably react to Parnate by becoming drowsy (as that's how I currently react to stimulant type medications), I'm not so worried that it will increase my anxiety (at least initially). I do wonder if it will be enough to help the anxiety that I have now though. Any advice would be welcome. Thanks.
>
>
nardil has worked wonderful for my severe social anxiety along with depression... i would say i did experience some weight gain... but i have been able to keep my same weight now for awhile by watching what i eat...... also some sexual problems, other than that i can't complain....
Posted by King Vultan on December 8, 2004, at 0:37:44
In reply to Nardil or Parnate decision, posted by KaraS on December 8, 2004, at 0:01:13
Well, I've tried both of them, and I think they're both good drugs, but Nardil does have more side effects for most people. However, in your case, there is some chance you might find the Parnate excessively sedating due to your dopamine autoreceptor issue, but keep in mind that Parnate is not as stimulating as the amphetamines, Ritalin, or selegiline. Therefore, it might not be as sedating for you and might be tolerable, depending on exactly how much of a problem you've had tolerating stimulating meds.
I think it's unlikely you would have the same kind of problem with Nardil, and this is also a very good drug for anxiety. I have panic attack like symptoms associated with my social phobia, and Nardil dealt with them pretty effectively. Nardil is a more conservative drug, and it is also safer than Parnate as far as the food interactions. I think your doctor may be making a prudent recommendation, but you also need to be comfortable with whatever choice is made.
Todd
Posted by cubbybear on December 8, 2004, at 6:34:09
In reply to Re: Nardil or Parnate decision, posted by King Vultan on December 8, 2004, at 0:37:44
I've been on Parnate for 20 years and my major depression always had the component of severe anxiety. Parnate has been excellent in counteracting it. It has the very welcome attribute of being a bit stimulating while killing off the anxiety.
Posted by SLS on December 8, 2004, at 8:05:03
In reply to Nardil or Parnate decision, posted by KaraS on December 8, 2004, at 0:01:13
Hi Kara.
I'm not sure I would be so committed to the idea that your depression is caused by sensitive dopamine autoreceptors. Perhaps it is, but I don't think there is yet enough evidence that things are as simple as that. I doubt they are. I prefer to approach the brain as a phenomenon too complex to explain with the paucity of data and understanding that we currently have; that an empirical approach - trial and error - is still necessary to fully explore therapeutic strategies.
What does this mean for you?
I think you should choose the drug that evidence has indicated is best suited to treat your symptom cluster (Nardil), and not allow your autoreceptor theory to exclude any drug from future consideration.
You know, a good way to test your autoreceptor theory is to use a preferential DA antagonist like sulpiride or amisulpride at low dosages to see if they produces a clinically significant improvement. Another drug that would be selective for dopamine would be pemoline. The problem with using psychostimulants and Wellbutrin to assess DA function is that each has significant effects on NE pathways as well.
I'd be curious to know how you came to your conclusion.
Good luck.
- Scott
Posted by KaraS on December 8, 2004, at 21:49:40
In reply to Re: Nardil or Parnate decision, posted by cosis on December 8, 2004, at 0:18:05
> > I thought I was positive that I wanted to try Parnate soon because of the side effect profile (less weight gain, edema and exercise issues) and because my depression has been so anergic and Parnate is more dopaminergic. My doctor wants me to try Nardil instead. I had intended to fight for the Parnate because I thought it has the best chance of downregulating my dopamine autoreceptors and actually providing me with some motivation and energy. The problem is that I've recently developed a lot of anxiety issues. In the last couple of years I hadn't experienced much anxiety but lately it has become overwhelming. I feel like I'm on that old road that ended up with panic attacks and agoraphobia - the same increased startle response, tight chest, difficulty breathing etc. So now I'm wondering if Nardil might be better - at least for now. I know it's supposed to be a great medication for GAD. Since I would probably react to Parnate by becoming drowsy (as that's how I currently react to stimulant type medications), I'm not so worried that it will increase my anxiety (at least initially). I do wonder if it will be enough to help the anxiety that I have now though. Any advice would be welcome. Thanks.
> >
> >
>
>
> nardil has worked wonderful for my severe social anxiety along with depression... i would say i did experience some weight gain... but i have been able to keep my same weight now for awhile by watching what i eat...... also some sexual problems, other than that i can't complain....
>Thanks so much for your help. Did you ever have a problem with motivation before Nardil and, if so, has it done anything to help you in that department? I am coming to the conclusion that it is a really good antidepressant and I bet it would lift my mood and help with the anxiety (which right now sounds wonderful) but I also desperately need to get some motivation and drive going.
Posted by KaraS on December 8, 2004, at 21:56:13
In reply to Re: Nardil or Parnate decision, posted by King Vultan on December 8, 2004, at 0:37:44
> Well, I've tried both of them, and I think they're both good drugs, but Nardil does have more side effects for most people. However, in your case, there is some chance you might find the Parnate excessively sedating due to your dopamine autoreceptor issue, but keep in mind that Parnate is not as stimulating as the amphetamines, Ritalin, or selegiline. Therefore, it might not be as sedating for you and might be tolerable, depending on exactly how much of a problem you've had tolerating stimulating meds.
>
> I think it's unlikely you would have the same kind of problem with Nardil, and this is also a very good drug for anxiety. I have panic attack like symptoms associated with my social phobia, and Nardil dealt with them pretty effectively. Nardil is a more conservative drug, and it is also safer than Parnate as far as the food interactions. I think your doctor may be making a prudent recommendation, but you also need to be comfortable with whatever choice is made.
>
> Todd
It sounds like you're saying that I won't make a mistake with either choice. I think at this point that I might be comfortable with both choices. Did you find any improvement in motivation from Nardil? I know it won't be as much as with Parnate but if there isn't any at all, then it might just be a short-term solution for me.It must be so nice to find that you're now able to socialize and do things out in the world that you didn't feel comfortable doing before. I'm so glad you've had such a good response to Parnate, Todd.
Thanks,
Kara
Posted by KaraS on December 8, 2004, at 21:59:48
In reply to Re: Nardil or Parnate decision, posted by cubbybear on December 8, 2004, at 6:34:09
> I've been on Parnate for 20 years and my major depression always had the component of severe anxiety. Parnate has been excellent in counteracting it. It has the very welcome attribute of being a bit stimulating while killing off the anxiety.
Wow, that's good to know! Thank you for letting me know that. And how amazing that Parnate has worked for you for so long! You're really lucky (or maybe just lucky - really lucky is when you don't need the stuff at all...)
K
Posted by KaraS on December 8, 2004, at 22:28:46
In reply to Re: Nardil or Parnate decision, posted by SLS on December 8, 2004, at 8:05:03
> Hi Scott,
>
>> I'm not sure I would be so committed to the idea that your depression is caused by sensitive dopamine autoreceptors. Perhaps it is, but I don't think there is yet enough evidence that things are as simple as that. I doubt they are. I prefer to approach the brain as a phenomenon too complex to explain with the paucity of data and understanding that we currently have; that an empirical approach - trial and error - is still necessary to fully explore therapeutic strategies.
Absolutely. I think that the possibility of me having the dopamine autoreceptor problem is a good one (or if not that, then something else is not working which involves dopamine) but I don't think that this is my entire problem. I would bet that I have problems with all of the other major neurotransmitters plus other things I can't even begin to know about. I was depressed for many years before I developed the overwhelming anergic, no motivation depression that I have today. I wonder if long-term use of SSRIs led to my condition now but I was very depressed before the SSRIs so I already had plenty of issues.I'm concentrating on the dopamine autoreceptor theory because my biggest concern is getting some motivation (or at least it was until I got socked with all of this anxiety lately). I can find other antidepressants that would lift my mood somewhat but I've been so nonfunctional career-wise for so long that I've been feeling I have to make fixing that the priority. (I feel like it's now or never for me because of my age.)
>>What does this mean for you?
>
> I think you should choose the drug that evidence has indicated is best suited to treat your symptom cluster (Nardil), and not allow your autoreceptor theory to exclude any drug from future consideration.
But the complete lack of motivation is part of the symptom cluster too, isn't it?
>> You know, a good way to test your autoreceptor theory is to use a preferential DA antagonist like sulpiride or amisulpride at low dosages to see if they produces a clinically significant improvement. Another drug that would be selective for dopamine would be pemoline.
>>The problem with using psychostimulants and Wellbutrin to assess DA function is that each has significant effects on NE pathways as well.
Yeah, the Amisulpride or Sulpiride are better choices and they directly block the D2 autoreceptors, right? (Pemoline is so hard to get prescribed these days.)
>> I'd be curious to know how you came to your conclusion.That makes two of us!
> Good luck.
>
>
> - Scott
Thanks,Kara
Posted by cosis on December 9, 2004, at 2:05:12
In reply to Re: Nardil or Parnate decision » cosis, posted by KaraS on December 8, 2004, at 21:49:40
> > > I thought I was positive that I wanted to try Parnate soon because of the side effect profile (less weight gain, edema and exercise issues) and because my depression has been so anergic and Parnate is more dopaminergic. My doctor wants me to try Nardil instead. I had intended to fight for the Parnate because I thought it has the best chance of downregulating my dopamine autoreceptors and actually providing me with some motivation and energy. The problem is that I've recently developed a lot of anxiety issues. In the last couple of years I hadn't experienced much anxiety but lately it has become overwhelming. I feel like I'm on that old road that ended up with panic attacks and agoraphobia - the same increased startle response, tight chest, difficulty breathing etc. So now I'm wondering if Nardil might be better - at least for now. I know it's supposed to be a great medication for GAD. Since I would probably react to Parnate by becoming drowsy (as that's how I currently react to stimulant type medications), I'm not so worried that it will increase my anxiety (at least initially). I do wonder if it will be enough to help the anxiety that I have now though. Any advice would be welcome. Thanks.
> > >
> > >
> >
> >
> > nardil has worked wonderful for my severe social anxiety along with depression... i would say i did experience some weight gain... but i have been able to keep my same weight now for awhile by watching what i eat...... also some sexual problems, other than that i can't complain....
> >
>
> Thanks so much for your help. Did you ever have a problem with motivation before Nardil and, if so, has it done anything to help you in that department? I am coming to the conclusion that it is a really good antidepressant and I bet it would lift my mood and help with the anxiety (which right now sounds wonderful) but I also desperately need to get some motivation and drive going.
>Yes it has helped in this area, the social anxiety would make me afraid to go out many times... which would cause me to be depressed. So when the social anxiety was eased up I was able to do the things I would have done before.
Posted by SLS on December 9, 2004, at 6:48:29
In reply to Re: Nardil or Parnate decision » SLS, posted by KaraS on December 8, 2004, at 22:28:46
When Nardil works, it covers everything. You will receive as much of a boost in energy and motivation as you would with any other antidepressant. Sometimes with Parnate, there is residual anhedonia. As you have already concluded, either drug would be a good choice, as either is capable of treating your symptoms. If one doesn't work, the other one may.
- Scott
Posted by zeugma on December 9, 2004, at 20:01:24
In reply to Re: Nardil or Parnate decision » KaraS, posted by SLS on December 9, 2004, at 6:48:29
Hi all. if I rememeber correctly, imipramine and SSRI's upregulate post-synaptic DA receptors, which ought to compensate at least partially for hyper-sensitive DA autoreceptors. Presumably, the parkinson's-like DA hypofunction seen sometimes with SSRI's is related to other interactions within the 5-HT/DA system. In this context, I think it's interesting that Anafranil seems to work well for anhedonia as well as the symptoms that SSRI's tend to alleviate.
Since Anafranil, and TCA-SSRI combinations, have a good reputation for alleviating the 'negative' symptoms of depression, I would think Nardil would be a good bet for them too.
I don't think drugs that work directly on the DA system are really very good for anergia, or the other 'negative' symptoms of depression. Ritalin works for the pathological fatigue of narcolepsy, but I think this is because narcoleptics have severe dysregulation of global arousal systems, to a much greater degree than that present in atypical depression. TCA-MAOI combinations seem a lot more helpful than AD-stimulant combinations for atypical depression. Stims, in fact, can easily induce depression. I am convinced that Parnate's effects on atypical depression are at least as much a consequence of its effects on 5-HT as DA.
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.