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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Elizabeth Williams on March 1, 2008, at 19:54:22
I've been taking 30 mg of Parnate for more than two months for treatment-resistant atypical depression. At the 30 mg dose, the side effects are minimal. I had insomnia and myoclonic jerking, which went away after a few weeks. I also had afternoon fatigue, which has almost disappeared. I have lost over 25 pounds, which has been a great side effect. The problem is that I don't have any therapeutic effect. Every time I try to raise the dose past 30 mg, the postural hypotension is unbearable: severe fatigue, dizziness, sudden deafness and loud ringing in the ears. For the last couple of weeks, i have also been on 25 mcg Cytomel (t3) which has given me some more energy, but hasn't sigificantly improved the AD's therapeutic effect. Last week my Pdoc upped my Cytomel to 50mcg and upped my Parnate to 40 mg with the thought that maybe I could better tolerate the increase now that I've been on it for a while. Again, the hypotension is too much, and I am now doing the 50mcg Cytomel and 30 mg Parnate. Does anyone have any ideas that I could bring to my doctor regarding augmenting the Parnate so that I have some relief for my depression? I am feeling so disappointed because it seems that almost everyone on this site seems to have had good results from Parnate except for me. Please help!
Posted by bleauberry on March 2, 2008, at 13:34:16
In reply to Parnate Problems...I Need Help!, posted by Elizabeth Williams on March 1, 2008, at 19:54:22
I hear you on being disappointed, but please realize it is not just you. In literature the response rate of Parnate is not much better than anything else. Over the years there have been plenty of people here and at other forums that could never get a therapeutic effect out of Parnate because their bodies simply would not tolerate it.
What about Nardil? Already been there? California rocketfuel, aka Effexor+Remeron? SSRI plus stimulant?
With thyroid enhancement, that changes the whole picture. Things you once tried might now work. Other things you haven't tried but were sure would not work might indeed work better than dreamed.
Sorry about Parnate. I mean, if it can't get to a higher dose it probably just isn't going to have a chance, no matter what you augment it with.
What other meds have you been on and what were their effects?
Posted by Elizabeth Williams on March 2, 2008, at 14:14:26
In reply to Re: Parnate Problems...I Need Help!, posted by bleauberry on March 2, 2008, at 13:34:16
> I hear you on being disappointed, but please realize it is not just you. In literature the response rate of Parnate is not much better than anything else. Over the years there have been plenty of people here and at other forums that could never get a therapeutic effect out of Parnate because their bodies simply would not tolerate it.
>
> What about Nardil? Already been there? California rocketfuel, aka Effexor+Remeron? SSRI plus stimulant?
>
> With thyroid enhancement, that changes the whole picture. Things you once tried might now work. Other things you haven't tried but were sure would not work might indeed work better than dreamed.
>
> Sorry about Parnate. I mean, if it can't get to a higher dose it probably just isn't going to have a chance, no matter what you augment it with.
>
> What other meds have you been on and what were their effects?
>Thanks for the response! I have been on Wellbutrin, Lexapro, Concerta (for ADD, innatentive type) and Prozac combined with Sam-E. The only AD's that worked were the Prozac & Sam-E combination when I first started taking them. I was feeling better and stupidly went off them for a while. When I tried to go back on them, they didn't have any therapeutic effect.
I haven't tried Nardil, but I'm really afraid of weight gain. The only reason I've been on Parnate so long is because of the weight loss I've had. Even with a 25-pound weight loss, I'm still at least 30 pounds overweight, and I don't want to gain all the weight I've lost. Call me crazy and vain, but I'd rather be thin and depressed than fat and happy.
Because my depression is atypical, I can usually get motivated to do the things I have to do, like go to work and family gatherings (but not always). My biggest problem is getting motivated to do anything without any external force pulling me to do so. I generally just sit around the house and do nothing. That's why my different Pdocs have generally prescribed medicines that are considered stimulating or activating-hence Parnate rather than Nardil. With the thyroid, I do have a bit more energy, but still no motivation or focus.
By the way, the Concerta was terrible and exhausted me, so I've been afraid to try other stimulants for my ADD.
Posted by Justherself54 on March 2, 2008, at 20:14:25
In reply to Re: Parnate Problems...I Need Help!, posted by Elizabeth Williams on March 2, 2008, at 14:14:26
I was on Parnate (long story why I had to go off it) and am now on Nardil. Nardil had less side effects by far..my binging on food is more due to seroquel than Nardil in my opinion. I have little or no appetite during the day..my energy is way up and I'm social as all get out now..so my comparison between the two..Nardil wins hands down..
Posted by Elizabeth Williams on March 2, 2008, at 20:38:12
In reply to Re: Parnate Problems...I Need Help!, posted by Justherself54 on March 2, 2008, at 20:14:25
It's good to know that Nardil is working and giving you energy. I'm also suprised about your not being hungry during the daytime. Is the reason you think you binge at night because that's when you take your Seroquel, or because you don't eat all day and then you're starving?
In terms of getting out of the house, I definitely need to be more social. I've become a real hermit, which is weird because people always say how outgoing and friendly I am. I always dread going out even though I'm usually fine once I AM out. It's just getting past the resistence and lack of motivation that is the key.
I'm just curious. If you don't mind my asking, did you also have social anxiety and you think the Nardil is helping to alleviate your anxiety... or do you think that the Nardil is giving you the necessary motivation to get out of the house because you are less depressed?
From what you posted, maybe I should reconsider the Nardil. Do you happen to know anyone else who DIDN'T have weight gain or cravings from Nardil?
> I was on Parnate (long story why I had to go off it) and am now on Nardil. Nardil had less side effects by far..my binging on food is more due to seroquel than Nardil in my opinion. I have little or no appetite during the day..my energy is way up and I'm social as all get out now..so my comparison between the two..Nardil wins hands down..
>
>
Posted by Justherself54 on March 2, 2008, at 23:03:19
In reply to Re: Parnate Problems...I Need Help!, posted by Elizabeth Williams on March 2, 2008, at 20:38:12
My pdoc thinks it's the seroquel although I can be a comfort eater..I cut down on the seroquel last night and already I don't feel the cravings for sweets as much..tonight I'm not taking any..so we'll see what tomorrow brings..that's one thing I can't seem to get motivated about is starting to eat three meals a day..but I'm just not hungry..although I know I have to get it together and start..
As far as the socializing goes, I think as Nardil lifted the depression, relieved my anxiety and gave me energy which in turn motivated me to get out and about.. I now want to be around people again..I was a terrible self-isolator..I often wouldn't even answer the phone as I was so depressed to engage in conversation..it's so strange to feel like this..to actually want to have people over and go visiting..crowds don't bother me anymore..and I can chat up a complete stranger in the grocery lineup..
As far as knowing of others who haven't gained weight, perhaps there are posters may be able to answer that..unfortunately from what I've read most have gained weight..I'm hoping I'll start to lose once I'm off the seroquel..but time will tell..maybe it was the combination of both that made me crave and it's too soon to tell as I won't know until I've been off the seroquel for a few days..here's hoping anyway..
Maybe Nardil will be better for you than Parnate..I don't have the terrible hypotension I did on Parnate..sometimes I had to go on my hands and knees I would get so dizzy..nothing like that has happened with Nardil..constipation, insomnia, some balance problems and really bad gas are the side effects I have..all I can live with except the insomnia..
Sorry for the novel! I'd give Nardil a try..I'm glad now I had to go off Parnate and tried Nardil..let me know what you decide..
> It's good to know that Nardil is working and giving you energy. I'm also suprised about your not being hungry during the daytime. Is the reason you think you binge at night because that's when you take your Seroquel, or because you don't eat all day and then you're starving?
>
> In terms of getting out of the house, I definitely need to be more social. I've become a real hermit, which is weird because people always say how outgoing and friendly I am. I always dread going out even though I'm usually fine once I AM out. It's just getting past the resistence and lack of motivation that is the key.
>
> I'm just curious. If you don't mind my asking, did you also have social anxiety and you think the Nardil is helping to alleviate your anxiety... or do you think that the Nardil is giving you the necessary motivation to get out of the house because you are less depressed?
>
> From what you posted, maybe I should reconsider the Nardil. Do you happen to know anyone else who DIDN'T have weight gain or cravings from Nardil?
>
>
>
>
> > I was on Parnate (long story why I had to go off it) and am now on Nardil. Nardil had less side effects by far..my binging on food is more due to seroquel than Nardil in my opinion. I have little or no appetite during the day..my energy is way up and I'm social as all get out now..so my comparison between the two..Nardil wins hands down..
> >
> >
>
>
Posted by cumulative on March 3, 2008, at 6:55:59
In reply to Parnate Problems...I Need Help!, posted by Elizabeth Williams on March 1, 2008, at 19:54:22
that is if it's worth it to you to stay on the parnate. so, extremely careful stimulant augmentation is an avenue -- see the dr-bob page on augmenting MAOIs with stimulants, which is not always as dangerous as one would believe -- i.e. it is very doable with a good doctor and slow titration.
Posted by Elizabeth Williams on March 3, 2008, at 8:21:40
In reply to obviously you need to combat the hypotension., posted by cumulative on March 3, 2008, at 6:55:59
> that is if it's worth it to you to stay on the parnate. so, extremely careful stimulant augmentation is an avenue -- see the dr-bob page on augmenting MAOIs with stimulants, which is not always as dangerous as one would believe -- i.e. it is very doable with a good doctor and slow titration.
Thanks for the response. Are you saying that the stimulants help with hypotension? When my Pdoc mentioned the possibility of augmentation, he didn't tell me that. I hate 15 minute consultations. They're always so rushed!
About the dr-bob page...I'm interested in learning more. Do I just search with the key words to find it?
Posted by Elizabeth Williams on March 3, 2008, at 8:36:53
In reply to Re: Parnate Problems...I Need Help!, posted by Justherself54 on March 2, 2008, at 23:03:19
Thanks Justherself54 for sharing your experiences with me!
It sounds like Nardil has really been a great drug for you. I totally understand about self-isolating and not answering the phone. Although I don't have social anxiety, sometimes the thought of relating seems unbearable. And crowds...forget it! I can't believe how much of a turnaround you've had. That's amazing!
About the food thing...I also can relate about having to force myself to eat during the day on the Parnate. (Although I seem to be a little hungrier with the T3 suppementation.)Or I'll just "forget" to eat! Never in my life before Parnate did I forget to eat. I was always craving food. It's good that you are making yourself eat, even if you don't want to. I'll be curious to see how your weight reacts to that and your Seroquel change. Keep me updated.
I'll also let you know what I decide about Nardil. I still have to do a lot of research and thinking about it and other options before I make a decision and talk with my doctor.
Posted by Elizabeth Williams on March 3, 2008, at 8:50:47
In reply to Re: Parnate Problems...I Need Help!, posted by Justherself54 on March 2, 2008, at 23:03:19
Hi. This is a duplicate of my previous post, but since I'm a newbie, I didn't understand how to post a follow up to a specific person...but now I do! Yea!!!!
Thanks Justherself54 for sharing your experiences with me!
It sounds like Nardil has really been a great drug for you. I totally understand about self-isolating and not answering the phone. Although I don't have social anxiety, sometimes the thought of relating seems unbearable. And crowds...forget it! I can't believe how much of a turnaround you've had. That's amazing!
About the food thing...I also can relate about having to force myself to eat during the day on the Parnate. (Although I seem to be a little hungrier with the T3 suppementation.)Or I'll just "forget" to eat! Never in my life before Parnate did I forget to eat. I was always craving food. It's good that you are making yourself eat, even if you don't want to. I'll be curious to see how your weight reacts to that and your Seroquel change. Keep me updated.
I'll also let you know what I decide about Nardil. I still have to do a lot of research and thinking about it and other options before I make a decision and talk with my doctor.
Posted by Elizabeth Williams on March 3, 2008, at 8:55:06
In reply to Re: Parnate Problems...I Need Help!, posted by bleauberry on March 2, 2008, at 13:34:16
Hi bleauberry. This is a duplicate of my previous post, but since I'm a newbie, I didn't understand how to post a follow up to a specific person...but now I do! Yea!!!!
Thanks for the response! I have been on Wellbutrin, Lexapro, Concerta (for ADD, innatentive type) and Prozac combined with Sam-E. The only AD's that worked were the Prozac & Sam-E combination when I first started taking them. I was feeling better and stupidly went off them for a while. When I tried to go back on them, they didn't have any therapeutic effect.I haven't tried Nardil, but I'm really afraid of weight gain. The only reason I've been on Parnate so long is because of the weight loss I've had. Even with a 25-pound weight loss, I'm still at least 30 pounds overweight, and I don't want to gain all the weight I've lost. Call me crazy and vain, but I'd rather be thin and depressed than fat and happy.
Because my depression is atypical, I can usually get motivated to do the things I have to do, like go to work and family gatherings (but not always). My biggest problem is getting motivated to do anything without any external force pulling me to do so. I generally just sit around the house and do nothing. That's why my different Pdocs have generally prescribed medicines that are considered stimulating or activating-hence Parnate rather than Nardil. With the thyroid, I do have a bit more energy, but still no motivation or focus.
By the way, the Concerta was terrible and exhausted me, so I've been afraid to try other stimulants for my ADD.
Posted by cumulative on March 3, 2008, at 13:56:48
In reply to Re: obviously you need to combat the hypotension., posted by Elizabeth Williams on March 3, 2008, at 8:21:40
Hey, here's the page, hope it's helpful:
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
From: "Steven L. Dubovsky" <Steven.Dubovsky@UCHSC.edu>
Date: 15 Apr 95 08:47:17 MST-0700
Subject: MAOIs in high doses and with stimulantsIt is common practice where I come from to combine MAOIs and stimulants for MAOI-induced hypotension and treatment resistance. This is also mentioned in Jan Fawcett's book of a number of years ago. Also, remember Feighner's report of MAOI + TCA + stimulant in ECT-resistant depression. I have tried this a number of times and found it helpful. Since half the caucasian population are (is?) rapid acetylators, higher doses of Parnate are frequently necessary.
---
"MAOIs plus methylphenidate (Ritalin) has not been a problem in my hands although theoretical risk requires discussion with patient, consent, and available nifedipine. Very useful for orthostatic hypotension."
Posted by Elizabeth Williams on March 3, 2008, at 19:58:27
In reply to Re: obviously you need to combat the hypotension., posted by cumulative on March 3, 2008, at 13:56:48
Thank you for the page. The information is very helpful in figuring out how to approach the possibility of stimulants with my doctor.
The link you sent also opens up a whole new world for me on how to search dr-bob. I was only accessing the psycho-babble medication thread and it's archives. I hadnt even seen the tips search option. Wow!
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