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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Crazy Horse on May 30, 2006, at 11:22:57
Well, after about 5 months on Parnate i am now off the drug that i once believed was the best of the best. What went wrong? ...I was doing so well. I believe there were 3 major problems that contributed to me choosing to go off of Parnate.
1. Severe Insomnia. This started from the very beginning, and lasted and even worsened throughout my Parnate experience. The problem (i believe) is that my pdoc didn't treat my insomnia agressively enough. Ambien and Lunesta didn't work, so he insisted on useing Trazodone. For me Traz wasn't strong enough for Parnate induced insomnia..at least 2 nights a week i couldn't sleep at all. My doc wouldn't even consider trying other drugs such as Seroquel, halcion, or even chloral hydrate...he said the insomnia would lessen with time, it didn't!
2) Terrible daytime fatigue. This occured even after a good nights sleep. It was as if something was sucking every ounce of energy out of my body..Ugh! Many days it was almost paralysing, i couldn't get any work done and i felt useless! Again, my pdoc said, "This will pass with time." It didn't..it got worse. He wouldn't even think of trying a mild stimulant like provigil...so i was just supposed to accept this?? Well, i have a wife, 2 children and a home, i can't just stay in bed all day...i have responsibilities.
3) My dose was way too high. This was partly my fault. Because of studies and articles i had read i convinced my pdoc to take the dose up to 150 mgs. Some literature/studies make claims that doses in the 120-150 range has many benefits over lower doses, including reduced insomnia, and the elimination of daytime fatigue. Well, not true for me, the higher we went the more side effects i had..duh! But even when we went back down (slowly) to 60 mgs. a day the side effects remained. So, unable to even function like this anymore i (with my docs support) decided to taper off of parnate altogether. Being off Parnate now for one day is the best i have felt in about 1.5 mos.
As most of you know, Parnate can be very stimulating. For me, that stimulation was becoming uncomfortable, it was still a strong lift in the morning but after 2 hrs. it dropped me flat on my *ss...this even at 60 mgs. It was no longer a good feeling for me, it actually became annoying..almost too strong.
Anyway, i learned some lessens here, especially the fact that less is sometimes more. And I plan to be more agressive with my Pdoc, after all i am paying him and quite well i might add. Parnate will always be an option (at low dose of course) in case i get very deeply depressed and suicidal, so not all is lost. My plan now is to give EMSAM a try, and yes i will take things very slowly this time i promise! From what i have been reading i think EMSAM will be a better fit for me than Parnate was...i sure hope so anyway. In the meantime i am going through a wash out period and should have EMSAM on board in approx. 2 weeks. Please wish me luck and thank you for listening.
Monte
Posted by willyee on May 30, 2006, at 12:44:47
In reply to My Parnate Experience...what went wrong?, posted by Crazy Horse on May 30, 2006, at 11:22:57
Well just fyi i can relate to everyone of ur problems,in fact they are mine as well.
However the options available are so slim im terrifeied at the thought of being off parnate and not having something to help.
But i would definatly say its time for me as well to get off.Im working on a way.
BTW whoever tells u parnate insomnia goes away is totaly not famialiar enough,it surly doesent,its simply the actions of the drug,and it doesent disappear,it seems docs love to say this when any complain of a side effect is laid a there feet,oh it will pass.geez
Also i as well disagree with most of those studies on pub med i believe.....
1.Parnate with the addition of a stimulant......Wellbutrin.--- I found this just made me feel simply yucky,totaly dispruted parnates normal effects,and add absolutly no benifit.
2.Parnate with the addition of Amphemaines....-----Parnate with a ritalin combo,at first seemed ok,more energy,then in a matter of a day or so,it reversed,i was experiancing more fatigue,however my body was tired and weak but there was a certain part of my brain that seemed light and i could not sleep,it was very very annoying.
Also this combo put me in ER,i becaome maniac,at my pc for 2 days straight,dident shower,eat or anything,and i did not notice,until of course it was so obvious it was too late,i began haclunitaing falling in and out of min sleep patterns not knowing if i were in a dream or not,lets not forget either this combo in the literarature says this should be done under CLOSE supervision and for truly treatment resiseant,i simply dont see it as a option.
3.Parnate at high doses.
--- This is tricky,sometimes all that would help is a higher dose as in 50 maybe 60 mg,it feels like an aspirin to a headache.
HOWEVER i dont believe it is benificial on a everday basis,this is day three for me,the first day was good,second good,this morning i did everything the same,sleep last night,morning activities etc.......and that dose of parnate is very strong,im sweating,i fell internal shaking and knowing the drug well i feel simply as if i took too much,simple as that,and the dose is the same.
So that whole entire data about parnate combos,i hold little value to it,i mean its based on an extremly SMALL study,and there are also studies on headweb that showed the addition of stimulants to parnate did NOT offer addiotnal benifit.
What i personaly find is u cant just augment parnate with a single agent,as it behaves differently,at least for me.Now some succesful augmentors i have had with parnate ill share,
1.Klonopin of course,and xanax,however not all the time but in certain times absolutly.2.L -theanine --- nothing dramatic,however in addition to parnate,has shown in times to be very helpful.
3.Kava kava--- i have given up on it now,after many many attmepts,but when kava was more readly avaiable it too at times worked great in addition to parnate.
4.Caffine..... caffiene in the form of the pill,not soda has many times offered a subtle lift to a parnate dose,but again this was certain times,where other times it caused agittation.5.Xyrem/ghb same as l-theanine in combo with a benzo at times has worked GREAT!
6.Lopressor.... a beta blocker,again nothing dramtic but many times has helped in a small degree that was well wworth it.
7.L-dperenyl liquid........ at times offered a kinda kick start to parnate,however its a very serious combo.8.Taurine......simple over the counter taurine in combo with a benzo again has helped.
So finaly ill say this,probualy the best combo i have found using parnate is as follows.
30---40 mg parnate
.25--.5mg of klonopin
Partial tab of -theanine-cap opened and poured into war water.
---a few droplets of xyrem,prob 500 mg to 1 gram max.
Let this settle over a time frame of at least an hour,then judge how u feel,at this point if there is excess stimulation best thing is additonal klonopin in very small amounts.
If sedation the small portions of a caffine tab work.Here it seems as if ur basicaly trying to balance the main neuros,since the substances mention hit all of them somehow,i know it sounds like a lot,but actualy all of the stuff i mentioned,l theanine etc are mostly neuro protective and pretty safe.
The brain is so complex,i dont see how a single pill with a single action will ever work,mainly because raisng chemicals in the brain only lead to both rebound and imbalinces of other chemicals,this is just a fact.
Sorry for the long post.
Posted by Phillipa on May 30, 2006, at 22:05:12
In reply to My Parnate Experience...what went wrong?, posted by Crazy Horse on May 30, 2006, at 11:22:57
Monte you know I am wishing you luck . If you get bored E-mail me. I stiil have your pic with you wife. Love Phillipa
Posted by tepiaca on June 1, 2006, at 0:12:47
In reply to My Parnate Experience...what went wrong?, posted by Crazy Horse on May 30, 2006, at 11:22:57
Good luck my dear friend. I didn´t like o read about the Parnate problemns.
Ey seroquel as u mentioned can save u from that.Anyhow I wish u the best of luck with the ensam
u can return parnate anytime u want and attack agressevely those side effects , don t you think?Im here to help in the little I can
Tep
Posted by ed_uk on June 2, 2006, at 17:41:02
In reply to My Parnate Experience...what went wrong?, posted by Crazy Horse on May 30, 2006, at 11:22:57
Hi Crazy,
Perhaps you could try Parnate at 10mg three times a day? It might take longer to 'kick in' than a higher dose but it might still help. I'm sure it would be cheaper than Emsam!
ED
Posted by christophrejmc on June 6, 2006, at 7:48:16
In reply to My Parnate Experience...what went wrong?, posted by Crazy Horse on May 30, 2006, at 11:22:57
I'm currently taking EMSAM and I think most would agree with me that it's just as bad as Parnate with regards to insomnia (I'm typing this after a sleepless night). Still, I think it may be worth trying if you've exhuasted all other options.
Was your doctor willing to try any benzos for the insomnia? In my opinion, Seroquel and (perhaps especially) chloral hydrate would not be appropriate medications in your case. I know a lot of pdocs have been using Seroquel as a sedative, but I think the very real risks and side-effects of neuroleptic medications outweigh any benefits except in cases of psychosis, mania, or serious obsessive symptoms (eg: suicidal ideation). Also, I believe that, like most atypical neuroleptics, Seroquel is a direct agonist at certain serotonin receptors--mixing any serotonergic drugs with an MAOI is definitely not something to take lightly. Chloral hydrate and Halcion are both considered to lead to habituation and development of tolerance so are usually only prescribed for short-term use. Also, all of these are particularly horrendous in terms of lingering, day-after drowsiness and fuzzy-headedness.
I know exactly what you mean about the daytime fatigue.. I would literally pass out during class when I was on a comparatively tiny 30mg dose. I tried adding Provigil, which helped the first couple of days before it quit on me and just made me extremely anxious (it also caused a significant change in blood pressure). My doctor has had a lot of success with adding Ritalin to MAOIs, perhaps that would be something to discuss with your doctor if you go back on Parnate.
Unless you're doctor insisted that you stay the course with Parnate (or it was clearly providing you relief from your depression), I don't think being more aggressive would have been very effective. He may have had concerns about your safety--doctors are reluctant to even prescribe MAOIs alone let alone in potential dangerous combinations. Unfortunately, unnecessary litigation (I take it you've heard of Libby Zion?) has caused many psychiatrists to put their [I assume Dr. Bob still considers "*ss" a violation of civility?]es before their clients' sanity, especially as far as MAOIs are concerned.
If you haven't tried Nardil yet, I would definitely recommend doing so; orthostatic hypotension was the only side-effect I ever experienced while on it.
Best of luck whatever you do.
-CJMC
Posted by Phillipa on June 6, 2006, at 20:23:05
In reply to Re: My Parnate Experience...what went wrong? » Crazy Horse, posted by christophrejmc on June 6, 2006, at 7:48:16
I took 5cc's of chhloral hydrate for years and never developed tolerance or sleepiness the next day. Guess I have a high tolerance for anything that is for sleep. And I just stopped it and went on valium. Main symtom anxiety since age 24 panic attacks now I'm 60 and still on valium. And have also taken ativan, klonopin.xanax. Love Phillipa
Posted by christophrejmc on June 7, 2006, at 9:17:42
In reply to Re: My Parnate Experience...what went wrong? » christophrejmc, posted by Phillipa on June 6, 2006, at 20:23:05
But were you taking it for sleep? I assume there's a reason it's not used very much.. I seem to recall it being harder on the liver than other depressants and it probably has a low safety threshold similar to barbiturates.
What made you stop taking it? How did it compare to benzodiazepines for anxiety?
This is the end of the thread.
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