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Dr. Bob is Robert Hsiung, MD,
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Posted by dragonblack on July 24, 2011, at 23:55:56
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by jono_in_adelaide on July 24, 2011, at 23:34:44
> Have you considered augmenting Parnate with either nortriptyline or desipramine?
Yeah, prior to my last appointment I put together a memo of sorts, emailed ahead of time, regarding options I was considering, and I included TCAs as possible Parnate augments (noting that while they are officially contraindicated, the combo is used by plenty of pdocs, especially people specializing in the treatment of refractory depression). I had a bunch of research too, but they couldn't open a Word 2007 doc. I was told that MAOI plus TCA was a no-no, and given the impression that it was not about to be considered. I can't just go somewhere else, though, I go to a free clinic that it took forever to get into, and have no means to do otherwise. I've heard the combo is dynamite, though.
Posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:18:54
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 23:55:56
Have you considered or tried other combos, such as
- Cymbalta 60mg plus Remeron 45mg
- Zoloft 100mg plus Welbutrin 300nmg
Posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:21:34
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 23:55:56
I guess you *could* go to a walkin clinic and get a script for nortriptyline, I'm pretty sure you'd get one fairly easily, it isnt a drug of abuse or anything.
The usual way of taking it with Parnate is to stop the parnate, and wait a week, then start taking Parnate 10mg and Nortriptyline 25mg, and slowly incrase to nortriptyline 100mg per day and Parnate xxxmg/day over a couple of weeks.
I'm nor advising you to do this, or saying it would be wise, just pointing out a slightly dishonest option
Posted by Phillipa on July 25, 2011, at 0:24:32
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:21:34
I feel both Link and Morgan are very knowledgeable so think about what they wrote. Phillipa
Posted by dragonblack on July 25, 2011, at 14:01:55
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:18:54
> Have you considered or tried other combos, such as
>
> - Cymbalta 60mg plus Remeron 45mg
>
> - Zoloft 100mg plus Welbutrin 300nmg
>
>Well, I had not been considering trying another SSRI, but I don't want to rule anything out. I am curious about Cymbalta, I know some people who love it, plus I have heard that it is "strong," in the words of some doctor, and that it hopefully wouldn't just be Effexor the Experiment Part 2. I think Cymbalta plus Wellbutrin, which a family member takes, with some success, would be an interesting combo. It's been years since I tried Zoloft, but back in the day when I was misdiagnosed as MDD and took it as monotherapy, it left me with completely flat affect and total anorgasmia. I don't remember it helping at all really, except that maybe I was more sedate and less out of control for a while. My situation has changed such that I need something stimulating at this point.
Posted by dragonblack on July 25, 2011, at 14:08:52
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:21:34
> I guess you *could* go to a walkin clinic and get a script for nortriptyline, I'm pretty sure you'd get one fairly easily, it isnt a drug of abuse or anything.
>
> The usual way of taking it with Parnate is to stop the parnate, and wait a week, then start taking Parnate 10mg and Nortriptyline 25mg, and slowly incrase to nortriptyline 100mg per day and Parnate xxxmg/day over a couple of weeks.
>
> I'm nor advising you to do this, or saying it would be wise, just pointing out a slightly dishonest optionI appreciate the idea, and the caveat. I have been trying to do this 'by the book,' for various reasons, and resisting the urge to substitute my own judgment and go ahead with a plan I can't get approved. It's tough to give up on Parnate without exploring some of these other options, though, I would love to avoid a situation where I ended up on a med that I previously discontinued due to failure to properly augment it before giving up. My life situation right now is such that it would be tough and stressful to try to hide what I was really doing, but it is tempting to try something like that. Maybe I'll try asking again and make sure I'm very specific about going through a washout and using a non-serotonergic TCA.
Posted by policebox on July 26, 2011, at 1:32:06
In reply to Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 17:04:46
If you have had any positive response to Parnate at all, then I might suggest seeing if you can stick with it while titrating your dosage upward. The 60 mg maximum dosage... I'm not really sure where they got that from. From my readings about Parnate, the therapeutic dosage is something along the lines of 1 mg per 1.5 kg of the patient's weight. For me at 175 lbs, that means I should be taking anything up to around 120 mg as a therapeutic dose (or possibly more).
Parnate is a very safe medication, provided you avoid anything that's contraindicated. Many people on this board have had success with "high" doses of Parnate and even report that many of the adverse side-effects disappear once they get above 60 mg.
Anyway, sorry this was so long. I just wanted to pass that thought along as a suggest for you to consider. I wish you the best.
Shannon
Posted by floatingbridge on July 26, 2011, at 6:34:22
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by policebox on July 26, 2011, at 1:32:06
I second police box here. The maoi Parnate can take longer to settle in. To me, the fact you are sleeping on it is excellent. Don't many add a safe stimulant like pro vigil?
This is my opinion, but you are sounding a little desperate. If this is true, it's not the best place to make major drug changes unless it really can't be helped. Why not stick out the parnate a little longer and push that clinic to augment if necessary.
Just my opinion. Best to you DB.
Oh. Did you mention abilify? Why? The clinic suggest it? Not sure it's the best augmenter, though clinics and docs hand it out like it's Halloween and it's a treat. Not knocking it when it works, but it is indicated originally for mood stability.....
> If you have had any positive response to Parnate at all, then I might suggest seeing if you can stick with it while titrating your dosage upward. The 60 mg maximum dosage... I'm not really sure where they got that from. From my readings about Parnate, the therapeutic dosage is something along the lines of 1 mg per 1.5 kg of the patient's weight. For me at 175 lbs, that means I should be taking anything up to around 120 mg as a therapeutic dose (or possibly more).
>
> Parnate is a very safe medication, provided you avoid anything that's contraindicated. Many people on this board have had success with "high" doses of Parnate and even report that many of the adverse side-effects disappear once they get above 60 mg.
>
> Anyway, sorry this was so long. I just wanted to pass that thought along as a suggest for you to consider. I wish you the best.
>
> Shannon
Posted by g_g_g_unit on July 26, 2011, at 8:14:47
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by JONO_IN_ADELAIDE on July 25, 2011, at 0:21:34
Are you in Adelaide, Australia? I lived in New Zealand for a while, where the prescribed ceiling dose for Parnate was 30mg, which seemed unusually low in comparison to the US. I was just wondering if the same thing applied here (I'm currently in Melbourne) ..
> I guess you *could* go to a walkin clinic and get a script for nortriptyline, I'm pretty sure you'd get one fairly easily, it isnt a drug of abuse or anything.
>
> The usual way of taking it with Parnate is to stop the parnate, and wait a week, then start taking Parnate 10mg and Nortriptyline 25mg, and slowly incrase to nortriptyline 100mg per day and Parnate xxxmg/day over a couple of weeks.
>
> I'm nor advising you to do this, or saying it would be wise, just pointing out a slightly dishonest option
Posted by floatingbridge on July 26, 2011, at 10:01:48
In reply to Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 17:04:46
DB, I misread your post. I am truly sorry about that. (my excuse was being up almost all night. But still...:-/)
So you are on abilify. 2mg. For how long? And will you take it to 5mg? Or 10mg? Do you feel anything from it yet for better or worse?
It could help if you are finding your thoughts moving toward ECT. But I still think an alerting agent still sounds indicated. Is you chief worst symptom of the depression your fatigue?
I thought provigil/nuvigil was easier to come by than aderall or amphetamine stimulant..I know someone who did reasonably well on parnate, provigil, and let me think what tea it was. Didn't take much tca. Let me see if I can find out. (But those tca's seems so idyosyncratic and particular person to person.)
Still wishing you the best.
Posted by dragonblack on July 26, 2011, at 10:57:14
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by policebox on July 26, 2011, at 1:32:06
> If you have had any positive response to Parnate at all, then I might suggest seeing if you can stick with it while titrating your dosage upward. The 60 mg maximum dosage... I'm not really sure where they got that from. From my readings about Parnate, the therapeutic dosage is something along the lines of 1 mg per 1.5 kg of the patient's weight. For me at 175 lbs, that means I should be taking anything up to around 120 mg as a therapeutic dose (or possibly more).
>
> Parnate is a very safe medication, provided you avoid anything that's contraindicated. Many people on this board have had success with "high" doses of Parnate and even report that many of the adverse side-effects disappear once they get above 60 mg.
>
> Anyway, sorry this was so long. I just wanted to pass that thought along as a suggest for you to consider. I wish you the best.
>
> ShannonHi Shannon,
I've looked into going up on Parnate and I can't pull it off without doing it on my own, which I don't have the money to do. I hate stopping before reaching what might be a therapeutic dose for me, or at least dose-limiting sides that let me know one doesn't exist, but there it is. It's doubly frustrating having read about the successes some here have with high dose Parnate. Oh well, you go to war with the army you have, not the army you want.
Thanks for writing back. Take care.
P.S. What's your handle from? Cool name.
DB
Posted by dragonblack on July 26, 2011, at 11:01:58
In reply to Re: Giving up on Parnate: what's next before ECT? » policebox, posted by floatingbridge on July 26, 2011, at 6:34:22
> I second police box here. The maoi Parnate can take longer to settle in. To me, the fact you are sleeping on it is excellent. Don't many add a safe stimulant like pro vigil?
>
> This is my opinion, but you are sounding a little desperate. If this is true, it's not the best place to make major drug changes unless it really can't be helped. Why not stick out the parnate a little longer and push that clinic to augment if necessary.
>
> Just my opinion. Best to you DB.
>
> Oh. Did you mention abilify? Why? The clinic suggest it? Not sure it's the best augmenter, though clinics and docs hand it out like it's Halloween and it's a treat. Not knocking it when it works, but it is indicated originally for mood stability.....
>
>
> > If you have had any positive response to Parnate at all, then I might suggest seeing if you can stick with it while titrating your dosage upward. The 60 mg maximum dosage... I'm not really sure where they got that from. From my readings about Parnate, the therapeutic dosage is something along the lines of 1 mg per 1.5 kg of the patient's weight. For me at 175 lbs, that means I should be taking anything up to around 120 mg as a therapeutic dose (or possibly more).
> >
> > Parnate is a very safe medication, provided you avoid anything that's contraindicated. Many people on this board have had success with "high" doses of Parnate and even report that many of the adverse side-effects disappear once they get above 60 mg.
> >
> > Anyway, sorry this was so long. I just wanted to pass that thought along as a suggest for you to consider. I wish you the best.
> >
> > Shannon
>
>Hi FB,
I've been considering asking for Provigil, since it's schedule IV rather than II, one imagines it might not be a Herculean labor to get it. I feel like it is a shame to fall back on it, when there are plenty of potent options out there, but then again I've never tried it. I've heard that if you aren't new to PStims, though, it will feel like glorified caffeine. Probably cheaper than my current energy drink/coffee habit, though.
Posted by dragonblack on July 26, 2011, at 11:06:19
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by g_g_g_unit on July 26, 2011, at 8:14:47
> Are you in Adelaide, Australia? I lived in New Zealand for a while, where the prescribed ceiling dose for Parnate was 30mg, which seemed unusually low in comparison to the US. I was just wondering if the same thing applied here (I'm currently in Melbourne) ..
>
> > I guess you *could* go to a walkin clinic and get a script for nortriptyline, I'm pretty sure you'd get one fairly easily, it isnt a drug of abuse or anything.
> >
> > The usual way of taking it with Parnate is to stop the parnate, and wait a week, then start taking Parnate 10mg and Nortriptyline 25mg, and slowly incrase to nortriptyline 100mg per day and Parnate xxxmg/day over a couple of weeks.
> >
> > I'm nor advising you to do this, or saying it would be wise, just pointing out a slightly dishonest option
>
>No, good old U.S. The reason I can't go above 60 is that I get Parnate for free through GSK's Patient Assistance Program. I called to ask if they would fill it if I sent in a prescription for higher than 60, suspecting that they wouldn't. At first I was told the limit was 30, and I thought, oh great, I just alerted them to the fact that I'm already on 60, watch them drop me down (it did take 4 prescriptions and months to get 60 mg filled), then a supervisor said that the strict limit was 60. So, there I go. Beggars can't be choosers.
Posted by dragonblack on July 26, 2011, at 11:21:02
In reply to Re: Giving up on Parnate: what's next before ECT? » dragonblack, posted by floatingbridge on July 26, 2011, at 10:01:48
> DB, I misread your post. I am truly sorry about that. (my excuse was being up almost all night. But still...:-/)
>
> So you are on abilify. 2mg. For how long? And will you take it to 5mg? Or 10mg? Do you feel anything from it yet for better or worse?
>
> It could help if you are finding your thoughts moving toward ECT. But I still think an alerting agent still sounds indicated. Is you chief worst symptom of the depression your fatigue?
> I thought provigil/nuvigil was easier to come by than aderall or amphetamine stimulant..
>
> I know someone who did reasonably well on parnate, provigil, and let me think what tea it was. Didn't take much tca. Let me see if I can find out. (But those tca's seems so idyosyncratic and particular person to person.)
>
> Still wishing you the best.
>
>Hey,
No worries. Not to bore you with my Abilify tale, but it sorta happened in backwards fashion. It was on my list of possible Parnate augments, particularly if I couldn't get a stimulant prescribed, which I can't (they told me it was illegal to prescribe a schedule II stimulant in OH. Pretty sure untrue). I had to go off of lithium, and just assumed that I was to switch to another mood stabilizer, but once Abilify was in the picture my NP said I could just do that since it's indicated for Bipolar. I only wanted to try Abilify at a low dose, as an augment, and didn't want to use it as an AP per se, but it was attractive to me to just start one med instead of two, and see how Abilify does first. I was surprised they were fine with me just going off lithium without replacing it, frankly. So, I've been on 2 mg for about 3 weeks, and it's been helpful, overall, I seem a little more active and the sexual sides of Parnate diminished, libido started to return. I do plan on going up on Abilify, just because I don't have a mood stabilizer in place, but I'll be pretty cautious in doing so. I'm going to ask to go to 5 mg for the time being. It's particularly enervating for me, and it certainly hasn't touched the Parnate fatigue, so I'm not big on the idea of sitting tight on Parnate while I titrate up on Abilify. I like to go slow, and these med trials take so long anyway, if I have to leave everything else untouched while I adjust each med I really will lose it. Without being able to go up on Parnate, if I can't augment it with a stim or tca I want to just move on.
Posted by dragonblack on July 26, 2011, at 11:24:44
In reply to Abilified, and other semantic cruelties, posted by dragonblack on July 26, 2011, at 11:21:02
I meant it ISN'T particularly enervating.
Posted by floatingbridge on July 26, 2011, at 12:36:36
In reply to Abilified, and other semantic cruelties, posted by dragonblack on July 26, 2011, at 11:21:02
Hey DB,
Sorry for all the constraints you havebto deal with regarding medications :-/
Abilify changed it's effect as the dose went up. What's that phrase folks use? Sweet spot? My doc pushed the dose up and up past efficacy.....
Posted by utopizen on July 26, 2011, at 18:49:07
In reply to Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 17:04:46
what's wrong with ECT?
I know folks who've done it, and it's changed their lives for the better... and far fewer side effects than Parnate.
All the cheese you can eat, too. Honestly, what's the hesitation?
Posted by g_g_g_unit on July 26, 2011, at 21:17:41
In reply to Absurdly low dosage ceilings, posted by dragonblack on July 26, 2011, at 11:06:19
Sorry, my post was actually directed at jono_in_adelaide .. but yeah, you're lucky to even have 60mg prescribed; it took weeks of pushing before my psychiatrist would even consider finally raising the dose to 40mg. I too discontinued Parnate due to an inadequate therapeutic response, but wonder if I'd respond to higher doses.
> No, good old U.S. The reason I can't go above 60 is that I get Parnate for free through GSK's Patient Assistance Program. I called to ask if they would fill it if I sent in a prescription for higher than 60, suspecting that they wouldn't. At first I was told the limit was 30, and I thought, oh great, I just alerted them to the fact that I'm already on 60, watch them drop me down (it did take 4 prescriptions and months to get 60 mg filled), then a supervisor said that the strict limit was 60. So, there I go. Beggars can't be choosers.
Posted by bleauberry on July 27, 2011, at 16:15:54
In reply to Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 24, 2011, at 17:04:46
Giving up on Parnate: what's next before ECT?
Read some plant medicine books. In case someone missed it, the writing on the wall spells rather clearly at this point that the psych meds are the equivalent....in your case....of barking up the wrong tree.
Posted by dragonblack on July 27, 2011, at 19:07:43
In reply to Re: Absurdly low dosage ceilings -jono_in_adelaide » dragonblack, posted by g_g_g_unit on July 26, 2011, at 21:17:41
> Sorry, my post was actually directed at jono_in_adelaide .. but yeah, you're lucky to even have 60mg prescribed; it took weeks of pushing before my psychiatrist would even consider finally raising the dose to 40mg. I too discontinued Parnate due to an inadequate therapeutic response, but wonder if I'd respond to higher doses.
>
> > No, good old U.S. The reason I can't go above 60 is that I get Parnate for free through GSK's Patient Assistance Program. I called to ask if they would fill it if I sent in a prescription for higher than 60, suspecting that they wouldn't. At first I was told the limit was 30, and I thought, oh great, I just alerted them to the fact that I'm already on 60, watch them drop me down (it did take 4 prescriptions and months to get 60 mg filled), then a supervisor said that the strict limit was 60. So, there I go. Beggars can't be choosers.
>
>Sorry, should have realized that.
Posted by dragonblack on July 27, 2011, at 19:13:31
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by utopizen on July 26, 2011, at 18:49:07
> what's wrong with ECT?
>
> I know folks who've done it, and it's changed their lives for the better... and far fewer side effects than Parnate.
>
> All the cheese you can eat, too. Honestly, what's the hesitation?Well, I'm not in a position to argue the merits of ECT, as I've never had it. However, I have significantly impaired memory, which I believe to be the result of hippocampal atrophy stemming from repeated depressive episodes, and the main drawback to ECT seems to be memory loss. Someone close to me who has had ECT is highly against me going this route. Also, I presume that you can't just ask for it but rather I would have to "qualify" for it, and a person like myself, who is not currently suicidal or experiencing psychosis, may need to have demonstrated that a wide range of medications don't work. That's just my guess, though, I haven't pursued it in order to find out what it would take to get it. I do realize that it boasts success rates that nothing else out there can compare to (I think, forgive me if I'm shortchanging some other treatment).
Posted by dragonblack on July 27, 2011, at 19:18:52
In reply to Re: Abilified, and other semantic cruelties » dragonblack, posted by floatingbridge on July 26, 2011, at 12:36:36
> Hey DB,
>
> Sorry for all the constraints you havebto deal with regarding medications :-/
>
> Abilify changed it's effect as the dose went up. What's that phrase folks use? Sweet spot? My doc pushed the dose up and up past efficacy.....Thanks, FB, it is a very frustrating process. Hopefully it will make remission all the sweeter, if I ever learn what that word means in any personal sense. Abilify's "Goldilocks" quality, changing it's dopaminergic action depending on the endogenous situation, as dosage is increased, is what attracted me to it, and now they are calling it a "dopamine system stabilizer" for this reason. I'm hoping to reach that sweet spot before I get to an AP-type dosage. I've read that at 10 mg and up it's essentially working as an AP, but I guess I'll have to see how it changes for me. How high did you go, and where do you think the sweet spot was, if you passed it?
Posted by floatingbridge on July 27, 2011, at 21:34:37
In reply to Re: Abilified, and other semantic cruelties, posted by dragonblack on July 27, 2011, at 19:18:52
>
> Thanks, FB, it is a very frustrating process. Hopefully it will make remission all the sweeter, if I ever learn what that word means in any personal sense. Abilify's "Goldilocks" quality, changing it's dopaminergic action depending on the endogenous situation, as dosage is increased, is what attracted me to it, and now they are calling it a "dopamine system stabilizer" for this reason. I'm hoping to reach that sweet spot before I get to an AP-type dosage. I've read that
at 10 mg and up it's essentially working as an AP, but I
guess I'll have to see how it changes for me. How high did you go, and where do you think the sweet spot was, if you
passed it?
Hi DB, since you asked, can I skip all the disclaimers about
not endorsing, encouraging, or attempting to prescribe?Started at 2 or 2.5mg. Emotionally bracing. After about three-four months doc says 5mg. I feel worse and then the big rush to 10mg. That was a disaster. Interesting you say that at 10mg it theoretically becomes a full-on AP.
In retrospect, it was never a good med for me. But it's effect at the low dose was interesting and, I suppose, useful. I think it's a potent little pill. Plus the starter color was the prettiest. I am so into aesthetics it's silly.
I am wishing you a sweet remission.
Posted by dragonblack on July 28, 2011, at 19:21:04
In reply to Re: Abilified, and other semantic cruelties » dragonblack, posted by floatingbridge on July 27, 2011, at 21:34:37
> Hi DB, since you asked, can I skip all the disclaimers about
> not endorsing, encouraging, or attempting to prescribe?
>
> Started at 2 or 2.5mg. Emotionally bracing. After about three-four months doc says 5mg. I feel worse and then the big rush to 10mg. That was a disaster. Interesting you say that at 10mg it theoretically becomes a full-on AP.
>
> In retrospect, it was never a good med for me. But it's effect at the low dose was interesting and, I suppose, useful. I think it's a potent little pill. Plus the starter color was the prettiest. I am so into aesthetics it's silly.
>
> I am wishing you a sweet remission.In the future, please write out all the disclaimers : )
At 2 mg I find it somewhat helpful, though I'm starting to run into sleep issues. I'm hoping to go up to 5 mg tomorrow so hopefully I won't share your negative experience. I also like the look of the pills, they look different than anything I've ever taken. Not sure what to call that color - I'm thinking "Sun-dried Turquoise." Can't wait to see what the 5's look like lol.
Posted by floatingbridge on July 28, 2011, at 20:22:34
In reply to Pretty little pills, posted by dragonblack on July 28, 2011, at 19:21:04
Subjectively speaking, the subsequent color was a disappointment.....
Hey, good luck!
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Dr. Bob is Robert Hsiung, MD,
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