![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 35. This is the beginning of the thread.
Posted by delna on October 23, 2009, at 14:38:59
Hi,
Hope everyone is well (or at least improving)After much deliberation, I have decided finally to withdraw from Parnate. It's doing me no favors at all.
I plan to switch to Effexor 300mg, Wellbutrin 350mg and Provigil 400mg.
I have bipolar depression and am on Lamictal 200mg, so I don't think I will switch (like I did the last time on Effexor)
My main problems are:
Depression (atypical)with bad suicidal ideation
No motivation
Severe Fatigue/sleepiness/lack of energy
OCD (separate disorder)I read about others quitting Parnate and was wondering what you guys switched to and how you are doing on your new drugs?
Any input greatly appreciated...
ThanksLove D
Posted by bulldog2 on October 23, 2009, at 14:52:38
In reply to Those who quit Parnate...what r u on now?, posted by delna on October 23, 2009, at 14:38:59
> Hi,
> Hope everyone is well (or at least improving)
>
> After much deliberation, I have decided finally to withdraw from Parnate. It's doing me no favors at all.
>
> I plan to switch to Effexor 300mg, Wellbutrin 350mg and Provigil 400mg.
>
> I have bipolar depression and am on Lamictal 200mg, so I don't think I will switch (like I did the last time on Effexor)
>
> My main problems are:
> Depression (atypical)with bad suicidal ideation
> No motivation
> Severe Fatigue/sleepiness/lack of energy
> OCD (separate disorder)
>
> I read about others quitting Parnate and was wondering what you guys switched to and how you are doing on your new drugs?
>
> Any input greatly appreciated...
> Thanks
>
> Love D
>Now there is a thread here on a poster who is doing very well on effexor + zyprexa and he includes a study. Apparently the study indicates it may be good for trd.
Posted by delna on October 23, 2009, at 15:07:40
In reply to Re: Those who quit Parnate...what r u on now?, posted by bulldog2 on October 23, 2009, at 14:52:38
> Now there is a thread here on a poster who is doing very well on effexor + zyprexa and he includes a study. Apparently the study indicates it may be good for trd.
>
> http://www.dr-bob.org/babble/20091021/msgs/921993.htmlThanks for sharing that. Alas anti-psychotics r not for me because I developed TD symptoms on Geodon :(
There is a good study of venlafaxine + mirtazapine being equivalent to Parnate in efficacy which is really good news. But the mirtazapine is sedating and even if I take it at night, i will get a hangover because I am so ultra sensitive to sedation.
But thanks for sharing this thread!
Love DPS: how are you feeling??
Posted by Phillipa on October 23, 2009, at 16:45:47
In reply to Re: Those who quit Parnate...what r u on now? » bulldog2, posted by delna on October 23, 2009, at 15:07:40
Delna know one poster off parnate for years who managed to go med free with intense psychotherapy. I'd say google achieves. For me remeron didn't make me sleepy even with multiple benzos on board. I do wish you luck in your trial and hoping you post your're progress. Love Phillipa sorry didn't work out for you
Posted by bulldog2 on October 23, 2009, at 17:23:53
In reply to Re: Those who quit Parnate...what r u on now? » delna, posted by Phillipa on October 23, 2009, at 16:45:47
> Delna know one poster off parnate for years who managed to go med free with intense psychotherapy. I'd say google achieves. For me remeron didn't make me sleepy even with multiple benzos on board. I do wish you luck in your trial and hoping you post your're progress. Love Phillipa sorry didn't work out for you
Unfortunately psychotherapy rarely works for more serious cases. If so it's a tedious process that may take montns or years. Also it seems to work best when used in combo with meds. It would seem that Delna is in pain and wants some relief now. Psychotherapy will not likely give her the relief she needs now.
Posted by Maxime on October 23, 2009, at 20:49:18
In reply to Those who quit Parnate...what r u on now?, posted by delna on October 23, 2009, at 14:38:59
I'm sad that you are giving up. But at least you have a plan in place and I hope it works. Best of luck to you!
Posted by delna on October 23, 2009, at 23:45:27
In reply to Re: Those who quit Parnate...what r u on now? » delna, posted by Maxime on October 23, 2009, at 20:49:18
> I'm sad that you are giving up. But at least you have a plan in place and I hope it works. Best of luck to you!
Thanks Maxime.
How are you getting along?
Take care
D
Posted by Sunbath on October 24, 2009, at 7:14:55
In reply to Re: Those who quit Parnate...what r u on now? » Maxime, posted by delna on October 23, 2009, at 23:45:27
The best of luck to you Delna! I agree, sad that you are quitting but you sure have your reasons and you have been on a while now.
I'm very curious about what you'll try next :)Keeping my fingers crossed for you that you'll finally succeed with your next option!!
Posted by Maxime on October 24, 2009, at 11:08:39
In reply to Re: Those who quit Parnate...what r u on now? » Maxime, posted by delna on October 23, 2009, at 23:45:27
Still suffering although I slept last night thanks to Ativan. It's a start. I am up to 60 mg of Parnate now. Getting there.
Posted by bleauberry on October 24, 2009, at 17:59:12
In reply to Those who quit Parnate...what r u on now?, posted by delna on October 23, 2009, at 14:38:59
Well, I am going here completely on the experience of Dr Goldman. This is what he has seen in his practice:
When Parnate fails:
Nardil
Nortriptyline + Zoloft
Reboxetine + Zoloft
Amitriptyline
Clomipramine
Imipramine
Sometimes the addition of an antipsychoticMy own experience and gut says to take a look at where you've been in meds...and do something different than what has already been done.
For example, if someone has anxiety that has not done well with any anti-anxiety meds, then they should try a stimulant. Really! Just like the thread on this page about the person who did their first dose of Ritalin and saw their anxiety and depression vanish instantly. How can a stimulant improve anxiety? Who cares? Everything we do is experimental. My belief is that we should not limit our experiments to only things that look obvious. We have to give the unobvious lesser suspects a fair look also, or we might be missing out on something great. We would never know otherwise. Brain chemistry and biochemistry are too complex and mysterious for us to even begin to figure what will do what.
Low dose lithium? Zyprexa add-on? Abilify add-on?
Any of the above Dr Goldman recipes? Ritalin mono or combo?Ever tried an antimicrobial herb to see if you get a Herx reaction? I mean, if you have something...unsuspected bacteria, fungi, virus...and you don't know it, the toxins they produce are NOT going to be reversed by any psychiatric drug. Those toxins cause really stubborn depression that has nothing to do with anything the psychiatric meds do. I think this has to be ruled out by trial, not assumed. Easy and cheap to do.
What about natural stuff? Ever had a really good brand of Rhodiola Rosea? Rhodiola combined with your best SSRI or SNRI?
And of course we kind of have to give some weight to what has worked for people right here at pbabble when Parnate failed. Which happened to include all of the above; as well as a Effexor+Zyprexa combo. But still, when someone gets this far into the game and an MAOI doesn't do the job, I cannot help but think it is time to start broadening the horizons for what the real cause is...if it was simply a neurotransmitter deficit, that would have already been fixed by now. It is something else, which brings me back to the antimicrobials.
No matter what, there is no shortage of great ideas when Parnate fails. And you would not be the first one to fail Parnate and do great with a different approach.
Posted by Phillipa on October 24, 2009, at 20:31:41
In reply to Re: Those who quit Parnate...what r u on now? » delna, posted by Maxime on October 24, 2009, at 11:08:39
Maxie great that you slept your're halfway home. Phillipa
Posted by delna on October 25, 2009, at 2:57:15
In reply to Re: Those who quit Parnate...what r u on now?, posted by bleauberry on October 24, 2009, at 17:59:12
Hey,
Thanks for the tips!!!
>
> When Parnate fails:
> Nardil
> Nortriptyline + Zoloft
> Reboxetine + Zoloft
> Amitriptyline
> Clomipramine
> Imipramine
> Sometimes the addition of an antipsychoticThanks for those suggestions! makes me feel more hopeful.
>
>Everything we do is experimental. My belief is that we should not limit our experiments to only things that look obvious.I agree to some extent that it is experimental especially when we pick out own drugs (or go to a pdoc like mine in India). BUT I do believe that a really good pdoc sometimes knows exactly what to give you.
For example when I presented to a NYC pdoc (who specializes in psychopharmacolgy) with tiredness and suicidal thoughts, he added Geodon to my concoction (much to my horror)! It made ZERO sense.I resisted it for days because it is sedating, if you read about it (although less so than other AP's) or talk to other patients about it ( who usually curse it).
Plus I was not psychotic in my opinion and I was also terrified of this class of drugs.
I also insisted that I wasn't depressed and that his diagnosis of BPI (I have always been seen as BPII or being somewhere on the BP spectrum) could not be right. Plus how can you give a sedating drug to an exhausted patient? It made no sense. To be honest I was really annoyed/angry.But he was so convinced, he just did not budge especially on his drug choice. I took it with great reluctance after he 'snapped' at me on the phone for not taking it (since I was suicidal).
To cut a long story short, within 2-3 doses, i leapt out of bed and felt like I had woken up from a long coma. It took care of EVERYTHING; exhaustion (wherein stimulants had failed), anxiety and also made me see that I had been very depressed and that I had been living in my own world. It also made me sharp and confident.
My point is simply that he KNEW it would work- he wasn't at all surprised. Really, he wasn't...
> if it was simply a neurotransmitter deficit, that would have already been fixed by now.
Actually, I was COMPLETELY fine and fully functional (and holding down a high stress job) on Geodon (plus other stuff) and so I do believe it is totally a neurotransmitter problem.
Unfortunately, I had to give Geodon up because I developed a 'possible' TD syndrome. I am still trying to find out if that was related to TD at all, because I want to go back on Geodon (ideally). It made me 100% fine and I was like that throughout the time I was on it (nearly 2 yrs). It's pathetic but I miss it and grieve/cry over it like people do over a lost loved-one ;)But for the moment, I cannot take any of the antipsychotics because of the fear.
Effexor has worked in the past but it was under different circumstances because I went high. I need to reassess if works with a mood stabilizer. (like I am on now). It had worked for all the various aspects of my problem like OCD, anxiety and depression/tiredness (but then I was high so I can't say how it will help depression/tireness now)
But the positive thing about Effexor is that, I need little help from my (idiotic) pdoc to titrate it or to augment it (unlike Parnate wherein I am so darn dependent on him)and I know the safe ways to augment it. If this fails I will go back to NYC or even to Dr Thase.
I'm sick of being given random drugs by dumb doctors. Sorry, but I do blame them- they are meant to know more than us.
>
> No matter what, there is no shortage of great ideas when Parnate fails. And you would not be the first one to fail Parnate and do great with a different approach.
well thank you so much for that positive spin on things. I really appreciate it alot.
Love D
Posted by g_g_g_unit on October 25, 2009, at 5:28:40
In reply to Re: Those who quit Parnate...what r u on now? » bleauberry, posted by delna on October 25, 2009, at 2:57:15
hey i've decided to give up Parnate indefinitely too. like you i've just gotten stuck with a pdoc who just can't treat me properly, and refuses to augment in "experimental" (low-dose TCA) but ultimately safer ways than AP's for sleep
the insomnia is just too much for me, i feel like i'm on the verge of losing it. Dr Golberg said in his opinion tolerance doesn't really grow to it. he also said he *never* uses AP's unless psychotic symptoms are present (my pdoc is pushing risperdal, despite my worries about TD)
oh well, thankfully we're moving overseas to a bigger city centre soon where my Uncle is a hospital MD, so i think i'll just hold off for better treatment
Posted by kirbyw on October 25, 2009, at 7:13:33
In reply to Re: Those who quit Parnate...what r u on now?, posted by g_g_g_unit on October 25, 2009, at 5:28:40
Delna
I have been following some, but not all of your posts. It seemed as if you were getting better with Parnate, that is just my impression. I think that those of us who have serious depression have to measure our successes in small percentages. If you were even ten percent better on Parnate, then maybe it was worth it. That's how I think. During my long Parnate history I have had very bad times, and days that I was very suicidal. But when I think back clearly to how I was before Parnate, on other meds, it was always clear to me that Parnate was better than anything else. Parnate requires varying the dose according to your overall mood and changing life circumstances. At times I was on a "maintenance dose" of 20 mg, and then if I had a crisis, I would go up to 30 mg or 40 mg. In fact back in the mid and late 80s I would occasionally take 80 mg. Parnate side effects can also be no fun, including insomnia, tiredness during the day, lack of sex drive, etc etc. but I weigh the side effects against the overall severity of the depression. I have learned that any side effect is bearable. What is not bearable is the depression at its worst. Yesterday I had a good day on Parnate, today was not quite so good, hopefully tomorrow will be better. I know that tonight I will have trouble sleeping, but at least I don't have to get up early. I will try to enjoy my insomnia as much as possible by keeping busy with internet, TV, household chores or whatever, anything to pass the time until I tire myself out.
I realize that every diagnosis is different and and every person's biochemistry is different so Parnate may not be for you, but I just wanted to throw in my two cents worth.
(By the way, I worked in India for three months in 2006)
Rick
Posted by delna on October 25, 2009, at 7:54:32
In reply to Re: Those who quit Parnate...what r u on now?, posted by g_g_g_unit on October 25, 2009, at 5:28:40
> hey i've decided to give up Parnate indefinitely too.>
> the insomnia is just too much for me, i feel like i'm on the verge of losing it. Dr Golberg said in his opinion tolerance doesn't really grow to it.I'm really glad he responded so quickly and even though it may not be what you would have wanted to hear, at least you know one way or another.
> he also said he *never* uses AP's unless psychotic symptoms are present (my pdoc is pushing risperdal, despite my worries about TD)
It makes perfect sense! I know AP's are useful in depression etc but the risk of TD is not one to be taken lightly.
I took Geodon just to show my sister and family that infact I HAD given in a last shot and tried what the doctor suggested so I wasn't bothered about the TD. I never thought it would work anyway and I had short term plans. Off topic though, once I took it I realized that I did have alot of psychotic symptoms. But for now I am happy to stick to AD's and be slightly out of touch with the real world because TD is indeed terrifying!
>
> oh well, thankfully we're moving overseas to a bigger city centre soon where my Uncle is a hospital MD, so i think i'll just hold off for better treatmentI really hope you find the right med combination and a good pdoc with some ideas up his sleeve. This search for 'normalacy' is so exhausting and disheartening at times.......
Well I hope you keep your spirits up till then. Wishing you lots of luck
Love
D
Posted by metafunj on October 25, 2009, at 10:13:30
In reply to Re: Those who quit Parnate...what r u on now? » g_g_g_unit, posted by delna on October 25, 2009, at 7:54:32
What is having TD like btw? Did any of it get back to normal?
Posted by delna on October 25, 2009, at 10:52:13
In reply to Re: Those who quit Parnate...what r u on now? » delna, posted by metafunj on October 25, 2009, at 9:13:30
> What is having TD like btw? Did any of it get back to normal?
Its back to normal, thanks..
To be honest I only discovered that it was/may have been a TD response after I got off Geodon. What I got was bad nerve pain which no doctor thought was TD or anything. But then I found a paper saying that AP's can give pain, just like I had in the same location.Tc
Love
Divya
Posted by delna on October 25, 2009, at 14:26:11
In reply to Re: Those who quit Parnate...what r u on now?, posted by kirbyw on October 25, 2009, at 6:13:33
Full heading:
Rick,a reply BUT possible **trigger** Please feel free to ignore this.I wish the subject line was longer....:)
Hi,
> I have been following some, but not all of your posts. It seemed as if you were getting better with Parnate
Yes, me too. Just a little bit but it was so erratic that overall I was till suicidally depressed.
> Parnate side effects can also be no fun, including insomnia, tiredness during the day, lack of sex drive, etc etc. but I weigh the side effects against the overall severity of the depression. I have learned that any side effect is bearable. What is not bearable is the depression at its worst.
I agree. but I cannot tolerate sedation. I think that alone can worsen my suicidal feelings and push me over the edge. Insomnia, I love. Sexual dysfunction etc i don't care about. Luxuries for the well :)
>Yesterday I had a good day on Parnate, today was not quite so good, hopefully tomorrow will be better. I know that tonight I will have trouble sleeping, but at least I don't have to get up early. I will try to enjoy my insomnia as much as possible by keeping busy with internet, TV, household chores or whatever, anything to pass the time until I tire myself out.
TRIGGER ALERT ****** Please ignore this if you are feeling slightly unsure...
I guess I am just really fed up and can't live with being erratic. It's just not an option for me anymore. How can i ever build a life if I am not stable? Plus taking Geodon really spoiled me- I sincerely wish I had never taken it. It made me feel what it felt like to be well/normal and now I want that so desperately. It's like tasting blood I guess. Before Geodon, I was 'content' just to have an average (terrible) day, do nothing and sleep most of the time. Now I am intolerant of being in such a state. Maybe I have become greedy. But it's normal (or near normal) or nothing at all. (sorry for the morbid thought)> I realize that every diagnosis is different and and every person's biochemistry is different so Parnate may not be for you, but I just wanted to throw in my two cents worth.
Thanks for sharing!
> (By the way, I worked in India for three months in 2006)
Doing what? What was it like??Thanks again Rick and I certainly hope I didn't trigger any bad feelings
Love
D
Posted by bulldog2 on October 25, 2009, at 17:51:50
In reply to Rick,a reply BUT poss trigger* Pls be free to igno » kirbyw, posted by delna on October 25, 2009, at 14:26:11
> Full heading:
> Rick,a reply BUT possible **trigger** Please feel free to ignore this.
>
> I wish the subject line was longer....:)
>
>
>
> Hi,
>
> > I have been following some, but not all of your posts. It seemed as if you were getting better with Parnate
>
> Yes, me too. Just a little bit but it was so erratic that overall I was till suicidally depressed.
>
>
>
> > Parnate side effects can also be no fun, including insomnia, tiredness during the day, lack of sex drive, etc etc. but I weigh the side effects against the overall severity of the depression. I have learned that any side effect is bearable. What is not bearable is the depression at its worst.
>
> I agree. but I cannot tolerate sedation. I think that alone can worsen my suicidal feelings and push me over the edge. Insomnia, I love. Sexual dysfunction etc i don't care about. Luxuries for the well :)
>
> >Yesterday I had a good day on Parnate, today was not quite so good, hopefully tomorrow will be better. I know that tonight I will have trouble sleeping, but at least I don't have to get up early. I will try to enjoy my insomnia as much as possible by keeping busy with internet, TV, household chores or whatever, anything to pass the time until I tire myself out.
>
>
> TRIGGER ALERT ****** Please ignore this if you are feeling slightly unsure...
>
>
> I guess I am just really fed up and can't live with being erratic. It's just not an option for me anymore. How can i ever build a life if I am not stable? Plus taking Geodon really spoiled me- I sincerely wish I had never taken it. It made me feel what it felt like to be well/normal and now I want that so desperately. It's like tasting blood I guess. Before Geodon, I was 'content' just to have an average (terrible) day, do nothing and sleep most of the time. Now I am intolerant of being in such a state. Maybe I have become greedy. But it's normal (or near normal) or nothing at all. (sorry for the morbid thought)
>
> > I realize that every diagnosis is different and and every person's biochemistry is different so Parnate may not be for you, but I just wanted to throw in my two cents worth.
>
> Thanks for sharing!
>
> > (By the way, I worked in India for three months in 2006)
> Doing what? What was it like??
>
> Thanks again Rick and I certainly hope I didn't trigger any bad feelings
>
> Love
> D
>
>Why did you stop Geodon?
Posted by delna on October 25, 2009, at 18:22:25
In reply to Re: Rick,a reply BUT poss trigger* Pls be free to igno, posted by bulldog2 on October 25, 2009, at 17:51:50
A bizarre nerve pain that is a rare manifestation of TD.
I'm still trying to find out if it was TD by sending my case to neurologists and pain specialists or if the the pain was triggered by some other mechanism. But I am 100% sure it was induced by Geodon. still if it is not TD related I will go back on Geodon and have a nerve block...but its too soon to tell and it all depends on what the doctors say..
Posted by kirbyw on October 26, 2009, at 1:37:44
In reply to Rick,a reply BUT poss trigger* Pls be free to igno » kirbyw, posted by delna on October 25, 2009, at 15:26:11
Delna
your reply was just fine. It doesn't bother me. We all need to be honest. And I am a very resilient person.... We are all so different and these kinds of postings just give us bits and pieces about our problems, our reactions to meds etc...., it would be so much better if we could sit in a room together and really understand each others issues and problems. Maybe Dr. Bob will eventually be able to create a "virtual" room where we can talk together over the internet and this would be so much more effective.
As for India, I there for three months working on a project for access to medical treatment for People Living with HIV/AIDS. In those days, I was not depressed and I was functioning very well. I worked with various NGO's in Delhi, collaborating with them to seek strategies force the Indian government to provide treatment for people with AIDS. It was a great adventure for me and a very meaningful experience. That was not so long ago, and one of my goals is to get back to that level of functioning. Ironically, if I was given the same job tomorrow, I think my depression would lift rather quickly. In the mean time I am partially relying on Parnate and also doing what I can to retake control of my life, in terms of work, peer relationships, family issues etc.
I didn't get out of Delhi much, but at least I got to Agra to see the Taj Mahal I made some good friends in Delhi that I miss very much.
Anyway Delna, I hope your decisions about meds work for you. Lets keep in touch
Rick
Posted by delna on October 26, 2009, at 5:03:28
In reply to Re: Rick,a reply BUT poss trigger* Pls be free to igno, posted by kirbyw on October 26, 2009, at 1:37:44
Hi
Maybe Dr. Bob will eventually be able to create a "virtual" room where we can talk together over the internet and this would be so much more effective.I think there is a virtual room already. I see it on top of the page. I think its called babblechat but there is usually no one there. anyway I dont know how it works.
>
> As for India, I there for three months working on a project for access to medical treatment for People Living with HIV/AIDS.How interesting! My MSc thesis was on HIV (with a focus on India.)Your experience sounds fascinating
.
Will be in touch via babblemail
TC
D
Posted by Sunbath on October 26, 2009, at 7:34:30
In reply to Re: Those who quit Parnate...what r u on now?, posted by g_g_g_unit on October 25, 2009, at 5:28:40
> hey i've decided to give up Parnate indefinitely too. like you i've just gotten stuck with a pdoc who just can't treat me properly, and refuses to augment in "experimental" (low-dose TCA) but ultimately safer ways than AP's for sleep
>
> the insomnia is just too much for me, i feel like i'm on the verge of losing it. Dr Golberg said in his opinion tolerance doesn't really grow to it. he also said he *never* uses AP's unless psychotic symptoms are present (my pdoc is pushing risperdal, despite my worries about TD)Hi g_g_g,
of course sad that you need to give it up for now, BUT GREAT respect and congratulations that you decided for yourself and took responsibility despite what your pdoc might have wanted to *force* you on!
Opinions about APs are different, but I'm -like you- one who believes that they're sometimes doing more harm than good.
Also great that Dr. Goldberg only uses them to treat psychotic symptoms!
> oh well, thankfully we're moving overseas to a bigger city centre soon where my Uncle is a hospital MD, so i think i'll just hold off for better treatmentI wish you all the best and good luck!!
What are you planning to take till then?Keeping my fingers crossed for you that you'll get through that hard time well and without too much trouble!
Sunbath
Posted by maxime on October 26, 2009, at 12:53:37
In reply to Re: Those who quit Parnate...what r u on now?, posted by g_g_g_unit on October 25, 2009, at 5:28:40
That makes me so angry because it's the doctor's fult for sure. Hopefully you will be able to try again. *hugs*
Posted by g_g_g_unit on October 26, 2009, at 22:20:42
In reply to Re: Those who quit Parnate...what r u on now? » g_g_g_unit, posted by maxime on October 26, 2009, at 12:53:37
> That makes me so angry because it's the doctor's fult for sure. Hopefully you will be able to try again. *hugs*
thanks. i dropped down to 40mg but started feeling worse. i've just been sitting at that dose. i really don't know what to do, i don't want to stop taking Parnate
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