![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Maxime on February 2, 2005, at 12:11:47
Clearly I am not meant to be on Nardil. I want to go back to Parnate. How can I augment the effect. I was taking 80-100 mg of it along with 30 mg of Adderall XR.
What else can I do or add and at what dosage. I need to get back on Parnate but I have to augment the effect.
Please help me. I am suicidal and I need help. I don't want to try Menerix for I fear it will not be strong enough for me. But clearly I cannot stay on Nardil.
Anyone who has any references I can look at or anything? My pdoc is open minded. He will let me try anything (within reason).
Maxime
Posted by zeugma on February 2, 2005, at 16:06:04
In reply to HELP ME - Augment the effect of Parnate, posted by Maxime on February 2, 2005, at 12:11:47
Posted by Optimist on February 2, 2005, at 16:34:46
In reply to HELP ME - Augment the effect of Parnate, posted by Maxime on February 2, 2005, at 12:11:47
How about augmenting with Lithium since it is supposed to prevent AD poopout? I read in previous posts that it became toxic for you in previous trials. Is it possible to titrate the dosage lower or some other strategy with it?
Posted by linkadge on February 2, 2005, at 18:48:30
In reply to Re: HELP ME - Augment the effect of Parnate » Maxime, posted by Optimist on February 2, 2005, at 16:34:46
Since Parnate is a potent MAO-B inhibitor, perhaps you should try augmenting it with some PEA (phenylathylamine) in a similar manner as would be used in conjunction with selegeline.
Linkadge
Posted by jujube on February 2, 2005, at 19:38:48
In reply to HELP ME - Augment the effect of Parnate, posted by Maxime on February 2, 2005, at 12:11:47
Maxime,
Just thought I would share the following with you FWIW. There are a number of options that you may wish to discuss with your pdoc. I'm so sorry you are suffering so, and hope that you and your pdoc can identify new treatment or augmenting options which will provide you with a least some measure of relief.
-------------------------------
http://www.aafp.org/afp/981200ap/cadieux.html
http://www.mddaboston.org/lect032200.html
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11448087&dopt=Abstract
------------------------------------------
Bupropion, a selective norepinephrine and dopamine reuptake inhibitor, has been
suggested for the treatment of bipolar depression, not only because of its
efficacy, but also because of a probably lower risk of inducing switches to
hypomania or mania. Most studies on bupropion treatment in bipolar patients have
been performed in moderately ill out-patients. In contrast, we report on a
sample of difficult-to-treat, predominantly severely ill, co-morbid, psychotic
or therapy-refractory bipolar depressive in-patients. In this open and
prospective study, 13 patients were treated with bupropion as an add-on strategy
mainly to other antidepressants and to various mood stabilizers. Our data
support the idea that bupropion is a first-line antidepressant in the treatment
of severe bipolar depression. Eight of 13 patients showed a >50% reduction of
Montgomery-Asberg Depression Scale ratings within 4 weeks. Co-medication with
drugs commonly used in treatment-resistant bipolar disorder including
venlafaxine, clozapine, lithium, topiramate and sodium valproate was safe in our
small sample. While adhering to the suggestion of Goren and Levin not to exceed
a daily dose of 450 mg of bupropion when treating bipolar depressed patients, we
did not observe any switch from depression to hypomania or mania. Copyright 2002
S. Karger AG, BaselPublication Types:
Review
Review, TutorialPMID: 11893875 [PubMed - indexed for MEDLINE]
-----------------------------------------
TCA + MAOI + CNS StimulantsIn an uncontrolled case series, Feighner et al (1985) reported the successful treatment of "treatment resistant" depression with the addition of a CNS stimulant (i.e., d-amphetamine, methylphenidate) to a MAOI or to a combination of TCA and MAOI. The literature on combination of CNS stimulants and MAOIs indicates that hypertensive and hyperthermic crises may occur when high doses are given. The author's state, "Our clinical experience is that these hypertensive crises are, at most, infrequent, and that this combination is often effective." It would appear that with many pharmacologic and non-pharmacologic treatment options available, this combination would be infrequently and carefully considered.
Methylphenidate in doses ranging from 10 to 40 mg/day was used to augment SSRI treatment in a case series of five patients. Self-reported symptom reduction was achieved rapidly in all cases (Stoll et al 1996).
Tamara
Posted by Maxime on February 2, 2005, at 22:14:04
In reply to Re: HELP ME - Augment the effect of Parnate, posted by linkadge on February 2, 2005, at 18:48:30
Phenylethylamine? I didn't think it was something one could buy and certainly not in Canada. Or is it contained in some other med?
Maxime
Since Parnate is a potent MAO-B inhibitor, perhaps you should try augmenting it with some PEA (phenylathylamine) in a similar manner as would be used in conjunction with selegeline.
>
>
> Linkadge
Posted by Maxime on February 2, 2005, at 22:15:52
In reply to Re: HELP ME - Augment the effect of Parnate » Maxime, posted by Optimist on February 2, 2005, at 16:34:46
My body doesn't like lithium in any quantity for some reason. Although I wish it did.
Maxime
> How about augmenting with Lithium since it is supposed to prevent AD poopout? I read in previous posts that it became toxic for you in previous trials. Is it possible to titrate the dosage lower or some other strategy with it?
Posted by Maxime on February 2, 2005, at 22:19:37
In reply to ask SLS about nortriptyline (nm) » Maxime, posted by zeugma on February 2, 2005, at 16:06:04
Yes, that is something I could try.
I will look up SLS's posts first and take it from there. I have to try and remember if that gave me a rash or not. Sigh. If I had knows years ago that I was going to be med resistant I would have kept a log book of all the meds and the symptoms. Most I remember, but some I do not.Maxime
Posted by Optimist on February 2, 2005, at 23:00:03
In reply to Re: HELP ME - Augment the effect of Parnate » Optimist, posted by Maxime on February 2, 2005, at 22:15:52
> My body doesn't like lithium in any quantity for some reason. Although I wish it did.
>
> MaximeThis guy's wife/girlfriend who manages the website crazymeds seems to be very sensitive to lithium.
"Mouse would get lithium toxicity above 100mg a day."
http://www.crazymeds.org/lithium.htmlWas it that your blood serum levels were too high i.e. above 1.0-1.5 mmol/L, or that you experienced a toxic reaction to a much lower blood serum level? It is possible that you may have needed much less than what you were taking before, lower than the usual 300mg pill size. Perhaps you may only need 100mg for a therapeutic concentration.
You've talked about your battles with anorexia before so I was wondering perhaps if your small stature, or something else may be effecting your metabolism of lithium.
Just a thought...
Brian
Posted by Willyee on February 2, 2005, at 23:43:23
In reply to HELP ME - Augment the effect of Parnate, posted by Maxime on February 2, 2005, at 12:11:47
> Clearly I am not meant to be on Nardil. I want to go back to Parnate. How can I augment the effect. I was taking 80-100 mg of it along with 30 mg of Adderall XR.
>
> What else can I do or add and at what dosage. I need to get back on Parnate but I have to augment the effect.
>
> Please help me. I am suicidal and I need help. I don't want to try Menerix for I fear it will not be strong enough for me. But clearly I cannot stay on Nardil.
>
> Anyone who has any references I can look at or anything? My pdoc is open minded. He will let me try anything (within reason).
>
> MaximeIf it makes you feel any better im in the same spot,what a tease,the medication works when it wants to,its very frustarting.
I too am looking for something that can help augment on a cosistent basis,until then i have certain things to do augment it well,however there are a few approaches because even in augmentation there is poop out.For fyi purposes heres some of the things i use to get parnate to be effective.
- Dose curving,this is dangerous though cause you dont want to end up using too much and running out early so only try this if you have adequate supply.but what works at times,is taking a large dose approx 40 mg,if you can tolerate that,then taking smaller ones through the day in short spurts,usualy this will work enough to build it up in your system,and is for me more effective then taking two large doses,one morning one afternoon,instead i take as i said the larger one first thing,maybe an hour later i take a 10 mg,and i take notice on how i feel,its very appearent when you hit a therputic dose,most times this ends up for me being 90-100 mg.
- Second when i first added vivarin 200 mg caffiene to parnate i had a short period of uncorfotablitlity,then whan it synergized so well.I believe i had a straight week of uninterupted consistency.This too only works partialy now,in fact now i can usualy fall asleep upon taking a vivarin tab,is the body wierd or what.
- I have also noticed grapejuice,for me in the form of jelly has been helping a lot latly,for whatever reason the jelly is noticable wheras juice isnt.
- Then of course you have adding a sedative,at times if i feel maniac ill take klonopin which at first negativitly impacts parnate,however the next day parnate seems more effective.- Lopressor a beta blocker sometimes works as well,and very rarly l-theanine an amino acid that raises both gaba and dopamine blood levels also has helped.
- Last,and this is not for everyone is possably dangerous,at times kava kava has worked very very well with parnate,unfrotunatly since the kava pull there are few good brands,in the past however it was very very effective combo.
For me adding a stimulant to parnate actualy creates more times a sleepy feeling,where as adding a sedative to it "can" if the dose is just right clash and make you high,and not in a good way,nuerontion was for me infamous for this,i was a blabbering mess.Kava is neiter a pure sedative or stimulant,i miss having it as an option.
These are my options,i of course rotate them,i try to listen to my body and decide what will benifit the most,they have all at one point of time worked great,and now joined parnate in poop out central,so even these augment stratergies are a hit or miss.
My belief is personaly our bodys are smarter then we give credit for,they become aware of invading unatural substance and fight it,how long something works just depends on how quickly your body catches on that you manipulating its normal process.
When i first added vivarin to parnate it was an icredable anti depressant effect,i thought i was in the clear,now its just another damn pill.Good luck and pls if anyone does have any ideas share them,this medication is begging for a friend to help it along better/we just have to find one it will play nice with.
Posted by SLS on February 3, 2005, at 3:18:03
In reply to Re: ask SLS about nortriptyline » zeugma, posted by Maxime on February 2, 2005, at 22:19:37
Hi Maxime.
I saw my name tossed around, so I figured I'd chime in. I think it makes sense to try augmenting with either lithium or Lamictal first before moving on to more exotic treatments. I am currently taking:
Parnate 60mg
nortriptyline 100mg
Lamictal 300mg
Abilify 10mgI have once been on a comination of Parnate + desipramine + d-amphetamine + T4. Things like this are done, albeit infrequently. I would avoid imipramine and clomipramine, as they are a bit too serotonergic to be mixing with MAOIs. My personal experience with Nardil + imipramine was that I experienced serotonin syndrome. Choosing desipramine or nortripyline is probably best.
The other thing, of course, is to try taking the Parnate way up to 120mg or higher. It can act like a different drugs at these dosages. Some study that I read 10 years ago suggested that high dose Parnate downregulated 5-HT2 serotonin receptors, something not seen at lower dosages. It was an animal study. (Sacraficing and decapitating humans was still frowned upon in those days).
- Scott
Posted by Maxime on February 3, 2005, at 21:19:48
In reply to Re: ask SLS about nortriptyline » Maxime, posted by SLS on February 3, 2005, at 3:18:03
I think I will try adding the nortriptyline. Lamictal makes me VERY depressed. Abilify isn't available in Canada, although I have wanted to try it. My trileptal is working very well though as a stabiliser. I'm bipolar type 2, are you? All I know is that I have to get off the Nardil and back to Parnate. I am going to lose my job if I stay on it. TOday I had to leave work because I was throwing up all morning from it. I also passed out again.
Maxime
> Hi Maxime.
>
> I saw my name tossed around, so I figured I'd chime in. I think it makes sense to try augmenting with either lithium or Lamictal first before moving on to more exotic treatments. I am currently taking:
>
> Parnate 60mg
> nortriptyline 100mg
> Lamictal 300mg
> Abilify 10mg
>
> I have once been on a comination of Parnate + desipramine + d-amphetamine + T4. Things like this are done, albeit infrequently. I would avoid imipramine and clomipramine, as they are a bit too serotonergic to be mixing with MAOIs. My personal experience with Nardil + imipramine was that I experienced serotonin syndrome. Choosing desipramine or nortripyline is probably best.
>
> The other thing, of course, is to try taking the Parnate way up to 120mg or higher. It can act like a different drugs at these dosages. Some study that I read 10 years ago suggested that high dose Parnate downregulated 5-HT2 serotonin receptors, something not seen at lower dosages. It was an animal study. (Sacraficing and decapitating humans was still frowned upon in those days).
>
>
> - Scott
Posted by Maxime on February 3, 2005, at 21:30:53
In reply to Re: HELP ME - Augment the effect of Parnate » Maxime, posted by Optimist on February 2, 2005, at 23:00:03
I don't remember what my serum level was. But I was on 50mg and 100mg both with the same effect - throwing up in more public places than I care to mention. I don't know if size has anything to do with it. How come I can tolerate 100 mg of Parnate? And I have always been on high dosages of the meds I do tolerate. But you do bring up a good point. I just don't think my body like lithium. It could also be that I wasn't drinking enough liquids.
Maxime
> > My body doesn't like lithium in any quantity for some reason. Although I wish it did.
> >
> > Maxime
>
> This guy's wife/girlfriend who manages the website crazymeds seems to be very sensitive to lithium.
>
> "Mouse would get lithium toxicity above 100mg a day."
> http://www.crazymeds.org/lithium.html
>
> Was it that your blood serum levels were too high i.e. above 1.0-1.5 mmol/L, or that you experienced a toxic reaction to a much lower blood serum level? It is possible that you may have needed much less than what you were taking before, lower than the usual 300mg pill size. Perhaps you may only need 100mg for a therapeutic concentration.
>
> You've talked about your battles with anorexia before so I was wondering perhaps if your small stature, or something else may be effecting your metabolism of lithium.
>
> Just a thought...
>
> Brian
Posted by Iansf on February 4, 2005, at 19:18:08
In reply to Re: ask SLS about nortriptyline » Maxime, posted by SLS on February 3, 2005, at 3:18:03
> The other thing, of course, is to try taking the Parnate way up to 120mg or higher. It can act like a different drugs at these dosages. Some study that I read 10 years ago suggested that high dose Parnate downregulated 5-HT2 serotonin receptors, something not seen at lower dosages. It was an animal study. (Sacraficing and decapitating humans was still frowned upon in those days).
>
> - ScottIn what way does Parnate act like a different drug at higher doses?
By the way, there are STILL some people who frown upon sacrificing and decapitating humans. It's amazing how uptight and prissy some people can be.
John
Posted by gromit on February 5, 2005, at 2:52:33
In reply to Re: HELP ME - Augment the effect of Parnate » linkadge, posted by Maxime on February 2, 2005, at 22:14:04
> Phenylethylamine? I didn't think it was something one could buy and certainly not in Canada. Or is it contained in some other med?
Well Linkage doesn't seem to be around. I'm thinking he is talking about taking D,L-Phenylalanine, either the D or the L half is converted to Phenylethylamine. Search for DLPA Selegiline and you should find useful information.
Rick
Posted by SLS on February 5, 2005, at 6:21:30
In reply to Re: ask SLS about nortriptyline » SLS, posted by Iansf on February 4, 2005, at 19:18:08
> > The other thing, of course, is to try taking the Parnate way up to 120mg or higher. It can act like a different drugs at these dosages. Some study that I read 10 years ago suggested that high dose Parnate downregulated 5-HT2 serotonin receptors, something not seen at lower dosages. It was an animal study. (Sacraficing and decapitating humans was still frowned upon in those days).
> In what way does Parnate act like a different drug at higher doses?It seemed to have a remarkable effect to reverse some of the depression-induced cognitive and memory impairments. It didn't do so much for mood, but I do remember getting more things done around the house. I am not the best example because of how refractory I am to treatment. However, King Vultan has described quite a few times recently how the character of Parnate changes at higher dosages as he experiences it. He would be the best person to ask. I think he is doing well on it.
> By the way, there are STILL some people who frown upon sacrificing and decapitating humans. It's amazing how uptight and prissy some people can be.I know. Things went down hill after the emergence of political correctness.
Be well.
- 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.