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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by g_g_g_unit on September 10, 2009, at 23:08:11
is there a minimum dose i should push for in the hope it might abate? i've been using Seroquel to sleep, but am finding the hangover and lethargy annoying; i haven't really been able to leave bed during the day, despite sleeping deeply.
i don't mean to seem impatient, and i know there are a lot of others in far worse situations here. but i would rather titrate and endure side-effects, than hang around needlessly at low doses. my psych assured me that it passes at his oft-used dose of 20mg, but my impression from browsing the archives is that higher doses are required
Posted by SLS on September 11, 2009, at 0:35:58
In reply to question about Parnate insomnia, posted by g_g_g_unit on September 10, 2009, at 23:08:11
> i don't mean to seem impatient, and i know there are a lot of others in far worse situations here. but i would rather titrate and endure side-effects, than hang around needlessly at low doses. my psych assured me that it passes at his oft-used dose of 20mg, but my impression from browsing the archives is that higher doses are required
I think your doctor is doing you a disservice by targeting the dosage of Parnate at less than 40mg. Unfortunately, the silly manufacturer label calls for the following:
"Parnate Dosage and Administration
Dosage should be adjusted to the requirements of the individual patient. Improvement should be seen within 48 hours to 3 weeks after starting therapy.
The usual effective dosage is 30 mg per day, usually given in divided doses. If there are no signs of improvement after a reasonable period (up to 2 weeks), then the dosage may be increased in 10 mg per day increments at intervals of 1 to 3 weeks; the dosage range may be extended to a maximum of 60 mg per day from the usual 30 mg per day."
A more realistic dosing schedule would look like the following:
"Parnate Dosing for Depression
The recommended starting Parnate dose for depression is 30 mg per day (divided into two or three smaller doses during the day). If your depression does not improve in two weeks, your healthcare provider may slowly increase your dose up to a maximum of 60 mg per day."http://depression.emedtv.com/parnate/parnate-dosage.html
For someone who is taking Parnate for the first time, it is prudent to start at 10mg for a few days, and then 20mg for a few days before moving up to 30mg.
I am trying to look for a more persuasive source of information that might indicate that dosages of 40-60mg are more realistic for Parnate treatment.
- Scott
Posted by g_g_g_unit on September 11, 2009, at 1:41:18
In reply to Re: question about Parnate insomnia » g_g_g_unit, posted by SLS on September 11, 2009, at 0:35:58
thanks Scott. i've been on 20mg for three days now. it's three weeks until I see my psych again, but i've been prescribed 60 parnate tabs. would it be better to go up to 30mg sooner, so i have time to adjust to the dose before i see him?
my *only* concern is insomnia. i am happy to put up with any other sfx in the meantime. since it seems as likely that the insomnia will be present at 20mg as 30mg, it feels worth moving up.
Posted by viper1431 on September 11, 2009, at 5:46:18
In reply to Re: question about Parnate insomnia, posted by g_g_g_unit on September 11, 2009, at 1:41:18
how much seroquel do you take? When i was first given it the doc prescribed 200mg to help me sleep, it was horrible like you mentioned. I find that only 25mg works for me and i don't feel anything from it when i wake up except a slightly dry mouth.
Posted by SLS on September 11, 2009, at 5:58:24
In reply to Re: question about Parnate insomnia, posted by g_g_g_unit on September 11, 2009, at 1:41:18
> thanks Scott. i've been on 20mg for three days now. it's three weeks until I see my psych again, but i've been prescribed 60 parnate tabs. would it be better to go up to 30mg sooner, so i have time to adjust to the dose before i see him?
I guess that depends on the relationship you have with your doctor. Does he give you that kind of latitude? If it were me, I would want to be taking 30mg no later than day 7 of treatment. However, I don't believe you would sacrifice anything by waiting. I doubt that there would be any less chance of your responding to Parnate if you go up in dosage gradually.
> my *only* concern is insomnia. i am happy to put up with any other sfx in the meantime. since it seems as likely that the insomnia will be present at 20mg as 30mg, it feels worth moving up.
Ugh. That's a tough one. If your doctor is an enlightened prescriber of sleep aids, you should be able to surmount insomnia and not let it be an obstacle to your getting well on Parnate. If insomnia does emerge, try to consider it a condition that must be treated as aggressively as the depression. Combining Parnate and desipramine required me to use another combination to treat the resulting insomnia. Combining Halcion and Ativan worked very well. I guess you can cross that bridge when you come to it.
When I was more responsive to drugs, I found that insomnia was a good prognosticator for me. It was associated with a good response to treatment.
- Scott
Posted by SLS on September 11, 2009, at 6:02:00
In reply to Re: question about Parnate insomnia, posted by viper1431 on September 11, 2009, at 5:46:18
> how much seroquel do you take? When i was first given it the doc prescribed 200mg to help me sleep, it was horrible like you mentioned. I find that only 25mg works for me and i don't feel anything from it when i wake up except a slightly dry mouth.
Good point.
25-50mg is ideal to treat insomnia. The higher the dosage, the less effective Seroquel becomes as a sleep aid. It probably has something to do with the Seroquel metabolite enhancing NE neurotransmission.
- Scott
Posted by g_g_g_unit on September 11, 2009, at 6:35:19
In reply to Re: question about Parnate insomnia » g_g_g_unit, posted by SLS on September 11, 2009, at 5:58:24
> I guess that depends on the relationship you have with your doctor. Does he give you that kind of latitude? If it were me, I would want to be taking 30mg no later than day 7 of treatment. However, I don't believe you would sacrifice anything by waiting. I doubt that there would be any less chance of your responding to Parnate if you go up in dosage gradually.
well, we've only met once, though i guess his willingness to prescribe Parnate after one meeting is a good sign. my old pdoc let me adjust the Nardil dose as i pleased; maybe i'll let this guy know i never responded until i reached higher doses (60mg+).
>
> > my *only* concern is insomnia. i am happy to put up with any other sfx in the meantime. since it seems as likely that the insomnia will be present at 20mg as 30mg, it feels worth moving up.
>
> Ugh. That's a tough one. If your doctor is an enlightened prescriber of sleep aids, you should be able to surmount insomnia and not let it be an obstacle to your getting well on Parnate. If insomnia does emerge, try to consider it a condition that must be treated as aggressively as the depression. Combining Parnate and desipramine required me to use another combination to treat the resulting insomnia. Combining Halcion and Ativan worked very well. I guess you can cross that bridge when you come to it.
>
> When I was more responsive to drugs, I found that insomnia was a good prognosticator for me. It was associated with a good response to treatment.
>
>
> - Scotti used 25mg of Seroquel last night. since Parnate has also been causing daytime lethargy in me, it's hard to know when the Seroquel 'hangover' eased off, and the Parnate lethargy kicked in, but i have been feeling lazier than usual today. it's strange, Parnate seems to superficially stimulate me (faster heartrate, clearer senses), but not produce any desire/energy to capitalize on that stimulation, which means i find myself acting almost aggressively withdrawn.
anyway, i sleep fine on Seroquel; my pdoc was willing to prescribe benzos as well, but i chose Seroquel because i thought it would be easier to discontinue (on Nardil, i would alternate between not sleeping and shoveling down benzos, but i don't have that kind of energy at the moment, so plan on taking something every night for sleep w/ Parnate). would it be safe to use amitriptyline instead, at a dose of say 20mg?
my only worry is that the insomnia will not pass, and that he will not go high enough dose-wise to allow it to abate naturally. i imagine i could push him to 40 or 50mg, but like i say, i am wondering if that is high enough to take care of the insomnia naturally. i understand i am being excessively anxious about this whole thing, but there are posts by Chairman MAO and ilk who say it never went away, regardless of dose. i just don't know if i have the wherewithal to find that, three months down the track or whatever, i am stuck on an insufficient dose, not sleeping etc. please understand that part of my OCD means i obsess over side-effects; part of that's legitimate (trying to avoid brain fog), but i am also so depressed that i *have* to try and stay on something.
Posted by SLS on September 11, 2009, at 6:59:01
In reply to Re: question about Parnate insomnia, posted by g_g_g_unit on September 11, 2009, at 6:35:19
That lazy feeling which may or may not be accompanied with "brain fog" early in treatment with Parnate is not so uncommon. It should disappear.
It is true that untreated insomnia can persist for months when taking Parnate. I would push the dosage despite your needing to treat the insomnia. If you can establish that Parnate works well for you, the potential for persistent insomnia might not seem like such a great sacrifice. It has been my observation that people who are accommodated to Parnate can have their insomnia abate significantly. It might take 6 months to a year, but it does happen. I no longer respond to MAOI + TCA combinations in a way that produces insomnia. Parnate monotherapy never produced insomnia, but then again, I never responded well to it.
What does all of this mean? I guess you have no better choice but to take one day at a time, and to treat the insomnia aggressively should it be necessary.
- Scott
Posted by g_g_g_unit on September 11, 2009, at 7:23:01
In reply to Re: question about Parnate insomnia » g_g_g_unit, posted by SLS on September 11, 2009, at 6:59:01
> That lazy feeling which may or may not be accompanied with "brain fog" early in treatment with Parnate is not so uncommon. It should disappear.
actually, brain fog was a problem prior to treatment. it cleared up a bit at 10mg, and has redeveloped at 20mg, but i have confidence it will pass.
you're right - i should see if i respond before making a decision, and if i'm doing well on the drug, but the insomnia has yet to pass, then that might convince my pdoc to raise the dose. you aren't a soothsayer (though close enough :)).
i just have to keep reminding myself that my previous situation was in no way better than this (albeit less riddled with side effects). one comment (i think it was you who made it?) keeps coming back to me, namely that it's impossible to envision a better situation for myself while depressed. i've just begun to accept living like this (while simultaneously convincing myself that i have every other affliction in the book .. ), but i'm beginning to realise now that depression is indeed a 'disease', or something that's at least beyond my ability to influence through pure will power, so i guess i owe it to myself to at least see what remission feels like. thanks for all your responses.
Posted by ColoradoSnowflake on September 11, 2009, at 12:34:21
In reply to Re: question about Parnate insomnia, posted by g_g_g_unit on September 11, 2009, at 7:23:01
ggg:
I'm in my 5th month of Parnate and I have never experienced any insomnia at all!!!!! I'm up to 60mg/day Parnate. My sleep is getting deeper as time goes on. I take 25mg nortriptyline about 6pm. I also take 200mg Provigil over the day, and can take some as late as 4pm and still have no sleep issues.
I was afraid of insomnia also because it has always been a big problem for me. That's why I started with amytriptyline instead of nortriptyline. I did NOT want to experience insomnai. I was sort of afraid of it.
My Parnate didn't really kick in for me until I let go of the amytriptyline and made that switch to nortrip.
I was also really really tired and lazy and just felt icky for many weeks. Scott kept encouraging me to let go of the amytrip and switch to the Nortrip.(than you, Scott) which was my miracle. It took me too long to make that switch, but it was because I'm so terrified of insomnia. If I hadn't finally done that I probably would have thought Parnate was a total bust for me and quit it with another med failure to add to my list.
I was tired on Parnate until my pdoc added Provigil which has been a great addition for me.
I know that for some people Parnate works on the first day and off they go! But I think there are also many of us who are very slow responders and have to be patient and be prepared to work with augmentation until we get it right. My pdoc made me promise him I would work with it for six months!!
It's worth it!!
Hang in there!! You may not get any insomnia at all!!
Gayle
Posted by bulldog2 on September 11, 2009, at 15:27:34
In reply to question about Parnate insomnia, posted by g_g_g_unit on September 10, 2009, at 23:08:11
> is there a minimum dose i should push for in the hope it might abate? i've been using Seroquel to sleep, but am finding the hangover and lethargy annoying; i haven't really been able to leave bed during the day, despite sleeping deeply.
>
> i don't mean to seem impatient, and i know there are a lot of others in far worse situations here. but i would rather titrate and endure side-effects, than hang around needlessly at low doses. my psych assured me that it passes at his oft-used dose of 20mg, but my impression from browsing the archives is that higher doses are requiredI personally do not like seqoquel as a sleep aid with parnate. For me it inactivated the parnate and brought back the depression.
Posted by emmanuel98 on September 11, 2009, at 19:40:09
In reply to Re: question about Parnate insomnia, posted by bulldog2 on September 11, 2009, at 15:27:34
I just started parnate a month ago (30mg/day) and it pulled me out of a deep depression but gave me insomnia like I have never experienced before. Up all night, night after night, not even tired the next day. Ativan didn't help, so I went to seroquel, 100 mg and trilafon (which I had been taking with the parnate), 8mg at bedtime. Now I'm sleeping fine and feeling great. I've never had much success with ADs in the past and I've tried most of them. But parnate is like a miracle as long as I can control the insomnia.
Posted by g_g_g_unit on September 11, 2009, at 20:43:14
In reply to Re: question about Parnate insomnia, posted by bulldog2 on September 11, 2009, at 15:27:34
> I personally do not like seqoquel as a sleep aid with parnate. For me it inactivated the parnate and brought back the depression.yeah i took seroquel again last night and feel gross today
Posted by g_g_g_unit on September 11, 2009, at 20:45:15
In reply to Re: question about Parnate insomnia, posted by ColoradoSnowflake on September 11, 2009, at 12:34:21
>
> Hang in there!! You may not get any insomnia at all!!
>
> Gaylei tried going without a sleep aid once i moved to 20mg but didn't sleep a wink. even melatonin didn't do anything. doesn't nortriptyline act as a sleep aid anyway?
Posted by ColoradoSnowflake on September 12, 2009, at 1:01:14
In reply to Re: question about Parnate insomnia, posted by g_g_g_unit on September 11, 2009, at 20:45:15
ggg
Yes, Nortrip does help me sleep...and no hangover!
Gayle
This is the end of the thread.
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