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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Chairman_MAO on October 21, 2005, at 0:11:48
Man, life on 120mg/day Parnate just isn't as good as Nardil (though still good for SP and better than any other AD by far taht I've ever tried); I've barely made it to the gym at all. I hope I can find something to augment it with ...
And it's been three weeks off the Nardil and my sexual functioning is still screwed up (on Parnate normally all I would have to do is take Cialis and I'd have GREAT sex; now I still feel "anesthetized"...)Anyone have experience with Nardil's sex effects taking a long time to go away? I will shoot myself in the foot if I find that ALL of the sexual side effects are due to buprenorphine and not Nardil; I will then promptly taper off that stuff and go back on Nardil. What a waste of time and seemingly endless months of anaorgasmia!
Posted by Declan on October 21, 2005, at 3:44:43
In reply to My situation: please comment, posted by Chairman_MAO on October 21, 2005, at 0:11:48
Yeah Hi
How much bupe are you on? Is the sex thing anorgasmia? Or ED? Or something else? I mean I wouldn't worry about anorgasmia myself, I'd just be Taoist about it and say I was conserving my vital essence. What happened about Tonkat Ali? Was that useful?
Declan
Posted by SLS on October 21, 2005, at 8:48:06
In reply to My situation: please comment, posted by Chairman_MAO on October 21, 2005, at 0:11:48
I forget...
What prompted you to discontinue the Nardil in the first place?
Empathetically,
Scott
Posted by Optimist on October 21, 2005, at 11:41:36
In reply to My situation: please comment, posted by Chairman_MAO on October 21, 2005, at 0:11:48
Hey Chairman,
I've been following your posts for awhile as I have similar drug interests and dx's.
I recall Parnate working wonderfully for you in the past... I'm guessing that it's either lost some of it's efficacy, or pooped out on occasion?
I was on a trial of Parnate this spring/summer and had a wonderful response the first month followed by diminishing results. I went all the way up to 100mg a day. At that dose I noticed sexual dysfunction(anaorgasmia, and reduced sex drive). Even at 40mg a day I was noticing some reduced sex drive, and emotional flatness. To some degree that may have been my depression coming through. It's hard to tease them out sometimes, but I do know the SE's were much worse on Parnate than without.
I'm currently on 300mg Wellbutrin SR, 5mg Selegiline, and 600mg Lithium. I'm figuring Wellbutrin and Selegiline may be more hormonally friendly for males, and they seem to have a synergistic effect on one another. My sociability has improved marketedly as well. I've had dimishing returns on this combo as well after an initial great response.
I've only been on Lithium for 48 hours but am amazed at the response I've gotten thus far. It's like it's brought the Wellbutrin and Selegiline back to life. I have greater feelings of motivation, energy, sociability, and ability to be humourous. Obviously 48 hours isn't much to go on. A longer trial will be needed to further verify Lithium's augmentation ability, but I have read similar reports of quick improvements over such and short perioud of time.
At low Lithium dosages needed for augmentation, there are virtually no side effects. Many people can get a response at blood concentrations of 0.4-0.6 millimoles/L, when used for augmentation not mood stabilization.
Personally, I think if anyone has a poopout after a good response to an AD, lithium should be added rather than switching to another AD. There may be either latent bipolar tendencies or something else similarily going on.
Brian
Posted by tecknohed on October 21, 2005, at 13:25:03
In reply to My situation: please comment, posted by Chairman_MAO on October 21, 2005, at 0:11:48
Hi
> Anyone have experience with Nardil's sex effects taking a long time to go away?
I took it for 8 months before this side effect went for me. Well, it never COMPLETELY went but was managable. Still, I could certainly 'last a long time!' ;-)
Have you tried Bethanechol? Not only can it help with urinary retention (another side effect of Nardil), it has also been used for MAOI sexual dysfunction:
"Bethanechol, a cholinergic agonist, was reported to reverse tricyclic and MAOI induced sexual dysfunction (Gross 1982). Doses, from 10 to 40 mg taken as needed, have reversed erectile and ejaculatory disturbances. "Side effects from bethanechol include diarrhea, cramps and excessive sweating (Gitlin 1995)."
http://sulcus.berkeley.edu/mcb/165_001/papers/manuscripts/_684.htmlI intend to try some myself!
Regards,
teck
Posted by Declan on October 21, 2005, at 14:06:13
In reply to My situation: please comment, posted by Chairman_MAO on October 21, 2005, at 0:11:48
Chairman, how are you sleeping? Are you still taking Rozarem (or whatever that new thing's called)? It still works?
Declan
Posted by SLS on October 21, 2005, at 15:51:33
In reply to Re: My situation: please comment » Chairman_MAO, posted by Optimist on October 21, 2005, at 11:41:36
Hi Brian.
> I've only been on Lithium for 48 hours but am amazed at the response I've gotten thus far.
This is quite common with responders to lithium augmentation.
> It's like it's brought the Wellbutrin and Selegiline back to life. I have greater feelings of motivation, energy, sociability, and ability to be humourous.
Woohoo!
> Obviously 48 hours isn't much to go on. A longer trial will be needed to further verify Lithium's augmentation ability, but I have read similar reports of quick improvements over such and short perioud of time.
I'll say a prayer for you.
> At low Lithium dosages needed for augmentation, there are virtually no side effects. Many people can get a response at blood concentrations of 0.4-0.6 millimoles/L, when used for augmentation not mood stabilization.This usually equates to 300-600mg of lithium.
> Personally, I think if anyone has a poopout after a good response to an AD, lithium should be added rather than switching to another AD. There may be either latent bipolar tendencies or something else similarily going on.EXCELLENT!
- Scott
Posted by Chairman_MAO on October 22, 2005, at 14:28:13
In reply to Re: My situation: please comment » Chairman_MAO, posted by SLS on October 21, 2005, at 8:48:06
I have actually decided to go back on it (I *REALLY* hope my doctor approves). 120mg/day Parnate isn't even helping my illness very much anymore. It helps the social phobia a lot, but my dysthymia is in full swing. I've been to the gym less in the 3.5 weeks I've been on it than I'd go in 1 week on Nardil. Man, can I say again that I hope my doctor approves? I need to start feeling normal again. I will deal with the sexual dysfunction and get it treated somehow (the Dr. the Rx's the bupe I think will order some hormone tests, etc, and agreed to be my internist outside of the clinic). A bodybuilder friend of mine has some testosterone propionate leftover; if I get a negative response from my physicians I will inject like 50mg and see if it helps my sexual dysfunction. 250mg/wk is very safe.
I am so nervous that my Dr. will not let me go back on Nardil for some reason. However, I have no BASIS for this, really.
Posted by Chairman_MAO on October 22, 2005, at 14:33:28
In reply to Re: My situation: please comment, posted by Declan on October 21, 2005, at 14:06:13
It is great for normalizing one's sleep cycle. If you are a jet-setter, get that drug. It is best for those who cannot initiate sleep.
Unfortunately, it is no good in situations where you REALLY need a downer, such as being on Parnate. :(
I have a feeling on Nardil it may work well, though; and I hope to be back on Nardil ASAP.
Right now (120mg/day Parnate) I can sleep fine, but only after 2AM.
Posted by Chairman_MAO on October 22, 2005, at 14:35:09
In reply to Re: My situation: please comment » Chairman_MAO, posted by tecknohed on October 21, 2005, at 13:25:03
My doctor would not Rx it. I have a feeling taht the drug galantamine would help just as much and provide nootropic effects, as it has been used to treat psychogenic impotence.
I am going to order some of these drugs myself when I get some money and treat myself. I am totally frustrated with the tortouse's pace of my treatment.
My Dr. is great, but his case load is unreal.
Posted by Declan on October 22, 2005, at 17:45:14
In reply to Re: My situation: please comment » tecknohed, posted by Chairman_MAO on October 22, 2005, at 14:35:09
Really? Because it's cholinergic?
Posted by Chairman_MAO on October 25, 2005, at 22:27:22
In reply to Galantamine for psychogenic impotence, posted by Declan on October 22, 2005, at 17:45:14
Yes. I have taken it ages ago and indeed it lived up to the Bulgarian's claims in that dept. Great erections, even on heroin.
Sometimse I'd take bromocriptine 2.5-5mg and galantamine 10mg before sex if I were on heroin and have a fantastic time (galantamine would negate the respiratory depression and sedation, etc). Nowadays I just want to be able to have sex on my meds!
Posted by Declan on October 26, 2005, at 1:01:06
In reply to Re: Galantamine for psychogenic impotence » Declan, posted by Chairman_MAO on October 25, 2005, at 22:27:22
Isn't that interesting? That must be why there was a formulation of morphine here that contained tacrine.
The tacrine might have kept me alive once when I took (by mouth) tablets with a total of 240mg morphine in them (no habit).
Who is the Bulgarian?
Declan
Posted by Chairman_MAO on October 26, 2005, at 11:32:52
In reply to morphine and tacrine » Chairman_MAO, posted by Declan on October 26, 2005, at 1:01:06
The Bulgarians I refer to are SoPharma, a premier eastern european pharma mfg. IIRC, Bulgaria was where most of the former USSR's pharma development took place.
Check out www.nivalin.com for a great review of its mechanism of action.
AChEs in overdose conditions:
1: Klin Med (Mosk). 1996;74(8):58-61.
[Aminostigmine-a novel drug against home poisoning]
[Article in Russian]
Bonitenko II, Safronov GA, Sosiukin AE, Pershin VN, Shpilenia LS.
Miltary Medical Academy, Saint-Petersburg.
Aminostigmin, a novel reversible inhibitor of cholinesterase developed in
Russia, has been tried in management of poisoning with cholinolytyics,
antihistamine drugs, tricycle antidepressants and derivatives of
1,4-benzodiazepine. The treatment of 144 patients with aminostigmin and 20
patients with galantamin showed close to similar efficacy of these drugs. The
scheme of aminostigmin administration is proposed warranting fast relief of
cholinolytic syndrome in subjects poisoned with cholinolytics, antihistamine
drugs and antidepressants. Benzodiazepines poisoning was unresponsive to
aminostigmin. Rare side effects were caused by overdose. Aminostigmin is an
effective antidote in cholinolytic poisoning.1: Anaesthesia. 1974 Sep;29(5):581-4.
Treatment of respiratory depression with the anticholinesterase drug
galanthamine hydrobromide.Cozanitis DA, Toivakka E.
Galantamine in other novel applications:
1: Clin Neuropharmacol. 2002 Sep-Oct;25(5):272-5.
Adjuvant galantamine administration improves negative symptoms in a patient with
treatment-refractory schizophrenia.Rosse RB, Deutsch SI.
Mental Health Service Line, Department of Veterans Affairs Medical Center,
Washington, DC 20422, USA.Because of the demonstration of a selective alpha nicotinic receptor abnormality
in patients with schizophrenia, galantamine was added to the stable regimen of
atypical and other antipsychotic medications in a 43-year-old man manifesting
severe and persistent positive and negative symptoms, as well as mood
disturbance and cognitive dysfunction. Galantamine is an inhibitor of
acetylcholinesterase and a positive allosteric modulator of nicotinic
cholinergic receptors (with a FDA-approved indication for the treatment of
patients with mild to moderate Alzheimer disease (AD) under the trade name
Reminyl). Galantamine HBr was initiated at a dose of 4 mg po BID, which was
maintained for the first week of adjuvant therapy, and eventually was increased
to 12 mg po BID during the final weeks of his 2-month trial. Remarkably, within
1 week of its initiation, there was a dramatic and clinically significant
decrease of negative symptoms, as reflected in formal ratings on the Scale for
the Assessment of Negative Symptoms. Moreover, within a few days of galantamine
discontinuation, negative symptoms worsened, returning to the baseline level of
severity. In addition to targeting memory dysfunction in AD,
acetylcholinesterase inhibitors may have an expanded range of targets and
clinical indications, including behavioral and psychotic symptoms. Galantamine
is distinguished from other acetylcholinesterase inhibitors by its positive
allosteric modulatory properties, improving the efficiency of transduction of
the acetylcholine signal at nicotinic receptors. This latter property may have
contributed to the observed improvement in negative symptoms observed in this
patient. Importantly, positive symptoms were unchanged during this 2-month
trial.(7)Hence my idea of using benzos (5-20mg/day) for positive symptoms and concomitant galantamine (4-24mg/day) for negative symptoms. A touch of a neuroleptic, lithium, etc would probably even out any residual symptoms. VERY toleable treatment considering the benzo and AchE inhibitor will balance out each others untoward effects to a significant degree.
This is the end of the thread.
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