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Dr. Bob is Robert Hsiung, MD,
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Posted by ColoradoSnowflake on August 5, 2009, at 19:27:53
In reply to Re: To Scott - My Perceptions Of Parnate » bulldog2, posted by SLS on August 5, 2009, at 16:07:40
> > Once the surgery is done with and I am healed and off narcotics it will be time to start putting my new recipe together. Parnate as the base and nortriptyline as a strong contender as an augment to it.
>
>
> Sounds like a good plan.
>
> I don't know how the belief got started, but it is thought that it is safer to add an MAOI to a TCA rather than the other way around. However, I have added the TCA to the MAOI lots of times without adverse effect. So, this tradition leaves one with the option of starting the TCA first or starting them both at the same time. I don't believe this tradition, mainly because I haven't had a problem. However, I thought that you should know.
>
> Good luck.
>
>
> - Scott
>
>
>Hi:
Sounds like a good plan to me, too, Blulldog!I think the reason my pdoc started a TCA first was that I started it with Wellbutrin, and as I titrated down on Wellbutrin I went up on the TCA, so I wasn't left without an AD in my system for that time or for the 14 day washout period.
Bulldog, you'll be a new man with your new hip! A good friend of mine had both of hers done, a year apart, and never missed a ski season on the slopes! before or after. She loves her new hips; doesn't limp or anything! I hope it's good for you, too.
gayle
Posted by morganpmiller on August 6, 2009, at 21:38:28
In reply to Re: To Scott - My Perceptions Of Parnate, posted by ColoradoSnowflake on August 5, 2009, at 19:27:53
Hey Gayle,
How often do you dose Parnate? Is it just one time in the morning? And you said you take the Nortriptyline at night right?
Were you ever on Parnate alone? What side effects do you experience on Nortriptyline?
I remember you speaking of these things several weeks back but I can't remember what you said.
Posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
In reply to ColoradoSnowflake Parnate Dosing, posted by morganpmiller on August 6, 2009, at 21:38:28
> Hey Gayle,
>
> How often do you dose Parnate? Is it just one time in the morning? And you said you take the Nortriptyline at night right?
>
> Were you ever on Parnate alone? What side effects do you experience on Nortriptyline?
>
> I remember you speaking of these things several weeks back but I can't remember what you said.
Morgan'I'm sorry I've taken so long getting back to you.
I did not take Parnate alone. My pdoc believes Parnate should be taken with one of a few copacetic TCAs. He started me on Amytriptyline while I was washing out my system, then added the Parnate.
I titrated up to 50mg Parnate. I take 20mg first thing in the morning. then space out the other three before 3;30-4:00pm. I take the 25mg Nortriptyline at 6-6:30 pm. It mellows me out and helps me sleep.
I take some caffeine and some Provigil during the day. I am trying to cut way back on the Provigil and seem to be able to as time goes by.
It's working very well.
I believe there is a definite synergism with the Parnate and Nortriptyline. It is "The Bomb".!!
I haven't had too many side effects except lots of fatigue to begin with, but that could have been the amytriptyline. Once I started the Nortriptyline it's all leveling out with only normal fatigue. It has taken me almost six months to change ADs. I think it's worth it because I feel really well!
Hope this helps,
gayle
Posted by morganpmiller on August 9, 2009, at 2:11:23
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Gayle, thanks so much for getting back to me..I decided to go back to Zoloft for the time being. Your experience and others will definitely help me make a decision to take Parnate and Nortriptyline in the future if I feel it is necessary. Thanks again!
Morgan
Posted by SLS on August 9, 2009, at 4:58:41
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Hi Gayle.
> My pdoc believes Parnate should be taken with one of a few copacetic TCAs.
I wish my doctor would approach things like yours does. I really had to "break him in" in order to get him to mix drugs in this fashion. I would love to be able to speak to your doctor and pick his brains. It sounds like you have a good one there.
- Scott
Posted by SLS on August 9, 2009, at 5:04:40
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganpmiller on August 9, 2009, at 2:11:23
> Gayle, thanks so much for getting back to me..I decided to go back to Zoloft for the time being. Your experience and others will definitely help me make a decision to take Parnate and Nortriptyline in the future if I feel it is necessary. Thanks again!
Would you first add nortriptyline to the Zoloft and see what happens? It would be an efficient use of time. You could then d/c the Zoloft and add Parnate if necessary.
Good luck with the Zoloft.
- Scott
Posted by floatingbridge on August 9, 2009, at 12:04:10
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 1:27:30
Gayle,
Sounds like you have a great doctor!
fb
Posted by ColoradoSnowflake on August 9, 2009, at 22:07:45
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 9, 2009, at 4:58:41
Hi all:
I'm very fortunate having such a great pdoc. I just wished he would have pushed me into taking Parnate years ago, but he's not like that and I'm hard-headed.
The scary thing is, he's 70, doesn't need/want any more $$, works half time because he enjoys his patients. If he gets too much static he may just totally retire. There is no one else with my insurance providers who would do what he does. And we know/trust each other so well.
Eeek. So I'd better not worry about it now!
From what he tells me, I really do think that taking the Parnate + Nortrip is what makes it work so well. I have very few side effects and those I do have, mostly some times of fatigue, some hyper times and dry mouth, I think I can ameliorate by dosing.
Scott, thanks so much! and I hope your remission becomes more steady! I know my pdoc would love to talk to you, also!!
fb, I hope your present course continues to be OK. At least you know if it doesn't, you're not at a dead-end!
gayle
Posted by morganator on August 10, 2009, at 22:28:48
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 9, 2009, at 22:07:45
Hi Gayle,
How do you dose Parnate? Do you post it one time in the morning? Or, do you dose it 2 times a day, once in the morning and another in the evening?
Morgan
Posted by ColoradoSnowflake on August 11, 2009, at 9:20:05
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by morganator on August 10, 2009, at 22:28:48
Hi Morgan:
I'm trying to figure this out as we speak.
Right now, I take 20mg when I get up am (7am) along with a big cup of coffee.
Then I try to take the next 3 (10mg. ea) pills one at a time over the day but before 4pm. (So I can sleep)
Then I take the 25mg nortrip at 6pm.If I'm tired through the day I add some 1/2 pills (50mg ea) of Provigil up to 200mg over the day, not after 4pm.
I want to ask Scott how he doses his Parnate and Nortrip.
I'm wondering about adding another 25mg nortript at night, maybe 8pm?
I'm sort of confused about what I'm doing. But I do sleep fairly well. I'd like to add a little sleep enhancement but I'm so sensitive to "downers" that I'm afraid of a hangover. I'll ask my pdoc for some Sonata when I see him Aug 31st.
Any ideas?
gayle
Posted by morganator on August 11, 2009, at 17:21:25
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 11, 2009, at 9:20:05
Yeah I was just curious because I am trying to avoid having to dose something 2 or 3 times a day. I have heard that some people take Parnate once in the morning. Right now Zoloft may be what I need. We will see in the following 3 or 4 weeks.
Posted by FredPotter on August 11, 2009, at 20:59:12
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 11, 2009, at 17:21:25
not parnate and zoloft at the same time I hope?
Posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 11, 2009, at 17:21:25
Morgan,
Yes, I'd rather make my med dosing simpler, too! That's why I'd like to talk to Scott.
One day when I was fairy new on Parnate I accidentally took all five pills in the a.m. BAD
I kept falling down and lurching around. I fell in my exercise class. I felt totally out of it.Then I'm afraid to take it too late in the day because I don't want to give myself sleep problems. And maybe I'm mistaken in thinking an evening dose would do that?
I don't know, but I'm doing pretty darn well so I probably shouldn't change too many things around!
I'm still really liking the Parnate/Nortrip....a lot!! I'm feeling so much better!!! I'm very clear headed which is nice. I don't feel full of chemicals. I don't have any side effects to speak of either!
I have not taken Parnate and Nortrip at the same time yet. Not because I'm afraid of it, but I just don't understand it's functioning.
I think you'd like Parnate!! Why don't you take it so we can figure it out together?? I need some company and help!
(sort of kidding).I'm Unipolar so it might affect me differently, I don't know.
I hope you're doing well.
gayle
Posted by morganator on August 12, 2009, at 1:39:44
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
Gayle,
Thanks for getting back to me as usual, I appreciate it. Yeah I am not crazy about having to spread out the dosing of anything.
I think for now I am going to stick with Zoloft and give it another 4 to 6 weeks. By that time I will figure out if I should get off zoloft and try something else, or merely add something like Nortriptyline.
It is so awesome that you are feeling that much better. Yeah I would love to go on that ride with you and figure things out. That would mean I was feeling like you are right now.
Keep feeling good!!!!
Morgan
Posted by SLS on August 12, 2009, at 6:53:24
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by morganator on August 12, 2009, at 1:39:44
It makes sense to add the nortriptyline to the Zoloft, unless you are intolerant of the Zoloft. Combining the two really enhances both serotonin and norepinephine. Then, you can discontinue the Zoloft and move on to something else while remaining on the nortriptyline.
Of course, depending on results and side effects, you might need to remain flexible and deviate from "the master plan". If you do add nortriptyline, you might need to allow 3 weeks for it to work after you get up to a therapeutic dosage - 75mg.
Wouldn't it be nice if Zoloft by itself did the trick?
Good luck.
- Scott
Posted by SLS on August 12, 2009, at 7:07:09
In reply to Re: ColoradoSnowflake Parnate Dosing » morganator, posted by ColoradoSnowflake on August 12, 2009, at 1:27:14
Two ways to dose Parnate are most used.
1. Spit into two equal doses; taking one at breakfast and the other no later than 3:00pm. I prefer this method now that I no longer experience hypotension.
2. Take one pill every few hours. You can take more at breakfast if necessary. This is good if you have problems with hypotension. With this method, I used to take my last dose at 7:00pm. You might find that taking it too late will disturb your sleep, so try to be somewhat flexible with dosing. Take 2 pills every few hours if necessary to make your last dose no later than 3:00pm. Also, having caffeine at 4:00pm helps to raise blood pressure at a time of day when blood pressure is normally at its lowest.
If you seem to plateau with your treatment, you still have quite a bit of room to raise the dosage of nortriptyline.
- Scott
Posted by FredPotter on August 12, 2009, at 16:42:24
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 12, 2009, at 7:07:09
Apparently there are good reasons for thinking that postural hypotension shows you're at a therapeutic dose of Parnate
Posted by SLS on August 12, 2009, at 17:13:27
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by FredPotter on August 12, 2009, at 16:42:24
> Apparently there are good reasons for thinking that postural hypotension shows you're at a therapeutic dose of Parnate
Exactly.
- Scott
Posted by morganator on August 12, 2009, at 22:16:00
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by SLS on August 12, 2009, at 6:53:24
>Wouldn't it be nice if Zoloft by itself did the trick?
For 7 years it did do the trick all by itself..If I had only stayed on it, I still be on it alone. I think I still would have had to eventually add a mood stabilizer like depakote(which I am currently on) or lithium. I will forever miss those days of popping Zoloft in the morning with a few fish oil caps and working out and feeling great at times. I have to admit, I probably needed a moderate dose of depakote, maybe 500 mgs, for much of the time during those 7 years. My behavior and work performance would have benefitted. I do believe that some forms of therapy could have helped me modify many of my bipolar behaviors.
Posted by ColoradoSnowflake on August 12, 2009, at 22:51:31
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by SLS on August 12, 2009, at 6:53:24
> It makes sense to add the nortriptyline to the Zoloft, unless you are intolerant of the Zoloft. Combining the two really enhances both serotonin and norepinephine. Then, you can discontinue the Zoloft and move on to something else while remaining on the nortriptyline.
>
> Of course, depending on results and side effects, you might need to remain flexible and deviate from "the master plan". If you do add nortriptyline, you might need to allow 3 weeks for it to work after you get up to a therapeutic dosage - 75mg.
>
> Wouldn't it be nice if Zoloft by itself did the trick?
>
> Good luck.
>
>
> - Scott
>Scott :
This sounds like a great idea and great way for Morgan to "bridge the gap". It's like I did with the Wellbutrin.
(sort of......... zzzz zzzzz zzzz amytriptyline)Could have done without that side trip!
Hello nortrip.!!gayle
Posted by ColoradoSnowflake on August 12, 2009, at 23:12:01
In reply to Re: ColoradoSnowflake Parnate Dosing » ColoradoSnowflake, posted by SLS on August 12, 2009, at 7:07:09
> Two ways to dose Parnate are most used.
>
> 1. Spit into two equal doses; taking one at breakfast and the other no later than 3:00pm. I prefer this method now that I no longer experience hypotension.
>
> 2. Take one pill every few hours. You can take more at breakfast if necessary. This is good if you have problems with hypotension. With this method, I used to take my last dose at 7:00pm. You might find that taking it too late will disturb your sleep, so try to be somewhat flexible with dosing. Take 2 pills every few hours if necessary to make your last dose no later than 3:00pm. Also, having caffeine at 4:00pm helps to raise blood pressure at a time of day when blood pressure is normally at its lowest.
>
> If you seem to plateau with your treatment, you still have quite a bit of room to raise the dosage of nortriptyline.
>
>
>
> - Scott
Hi Scott:Thanks for the information!!
I think it helps to take the Parnate with a little bit of a Nuvigil pill or a little bit of a caffeine pill, or a cup of coffee.
I think I'll try your #1 suggestion. That's sort of what I do now only simpler. Should I cut a Parnate in half and take 2 1/2 in the AM and 2 1/2 at 3pm? Or take 3 at once and then 2 at once??
Then I take the Nortriptyline about 7pm (or later if I get home later.
Last night I took 25mg nortrip at about 6pm and then 25mg at 11pm. I was tired this morning, but I had a big meeting at my house last night and I would have been tired anyway. I took nortrip to sleep better "for sure" and it did do that. So maybe it's not good for me to take nortrip that late. When I try 50mg again I'll do them both earlier. Is that right?
I am still feeling better!!! I can't believe it!!
I had a group of women at my house for a meeting last night and normally I would have been a walking, talking panic attack, but I was FINE....just regular. WOWThanks so much, Scott, for all your help!
I sure hope you're feeling better!!!! Remember what you told me about it not being up and up!! Maybe it's just a settling in period and you will feel really good again, soon.
I HOPE SO!!Thanks again for all your help!
gayle
Posted by SLS on August 13, 2009, at 5:15:55
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by ColoradoSnowflake on August 12, 2009, at 23:12:01
Hi Gayle.
I wouldn't worry about splitting pills. Take 30mg in the morning and 20mg in the afternoon, ideally before 3:00pm. Many people find that taking it any later disturbs their sleep.
Thanks for your kind sentiments.
- Scott
Posted by FredPotter on August 13, 2009, at 16:01:18
In reply to Re: ColoradoSnowflake Parnate Dosing » FredPotter, posted by SLS on August 12, 2009, at 17:13:27
Scott do you know the mechanism that connects postural hypotension and low MAOI?
Posted by FredPotter on August 13, 2009, at 16:02:26
In reply to Re: ColoradoSnowflake Parnate Dosing » FredPotter, posted by SLS on August 12, 2009, at 17:13:27
...sorry I should have said "connects postural hypotension and low MAO"
Posted by SLS on August 13, 2009, at 16:42:10
In reply to Re: ColoradoSnowflake Parnate Dosing, posted by FredPotter on August 13, 2009, at 16:01:18
> Scott do you know the mechanism that connects postural hypotension and low MAOI?
I really don't know. I have wondered about this many times myself, but have never found an answer.
Stimulation of central postsynaptic NE alpha-2 receptors?
I don't believe that peripheral NE alpha-1 antagonism is involved.
- Scott
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