![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 53. Go back in thread:
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!
Posted by emmanuel98 on July 28, 2011, at 20:46:34
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by dragonblack on July 27, 2011, at 19:13:31
Bileteral ECT did nothing for my depression, but it did blow holes in my memory. It took about six weeks before I started remembering things. I'm not talking about forgetting one major event. I'm talking about forgetting how to drive from my home to work, forgetting my neighbors names and how I knew them, forgetting almost everything that happened during the ECT treatments. Furthermore, talk about side effects. Parnate gives me insomnia, which I can control with other meds, and gave me hypotension which went away. ECT left me a complete and utter basket case for 24 hours after treatment, with a headache, nausea, not knowing where I was.
Bilateral ECT has to be done inpatient. All the friends in the world (and I have a lot of friends) aren't going to be able to take you home and stay all day with you until you know where you are.
I know some people swear by ECT, but I have had both unilateral (which can be done outpatient) and bilateral (which must be done inpatient) treatments and had no change in mood whatsoever.
Not to talk you out of it. If parnate isn't helping, ECT is something to try, but it's no walk in the park.
Posted by emmanuel98 on July 28, 2011, at 20:49:30
In reply to Pretty little pills, posted by dragonblack on July 28, 2011, at 19:21:04
10mg abilify was magic for me. But it made me gain weight rapidly. Apparently, abilify isn't notorious for this. Some people benefit but don't gain weight.
Posted by floatingbridge on July 28, 2011, at 20:57:02
In reply to Re: Pretty little pills, posted by emmanuel98 on July 28, 2011, at 20:49:30
> 10mg abilify was magic for me. But it made me gain weight rapidly. Apparently, abilify isn't notorious for this. Some people benefit but don't gain weight.
DB, once again, good luck. I think positive reports like emmanuel's on abilify are valuable supportive optimism.
Posted by morgan miller on July 29, 2011, at 7:50:31
In reply to Re: Abilified, and other semantic cruelties » dragonblack, posted by floatingbridge on July 27, 2011, at 21:34:37
It may be wise to just stick with around 3 mg Abilify for a few weeks to see if this is enough. Ask your doctor about this, you have two weeks to spare I'm sure, no need to rush into anything.
I've read reports that 3 mg may be more effective as an AD than 5 mg. It really is a very powerful drug, far to powerful for me(1.5 mg sent me spinning). I believe it can be very effective for treating bad and chronic cases of depression.
Though I'm not crazy about the use of AAP's for anything other than severe acute manic episodes and psychosis, I do think some cases of depression are exceptions. I really hope it helps you!
Morgan
Posted by floatingbridge on July 29, 2011, at 9:48:03
In reply to Re: Abilified, and other semantic cruelties, posted by morgan miller on July 29, 2011, at 7:50:31
Excellent advice, methinks. Do 'they' make a 3mg dose?
(And if so, why the rush in my own case to go up so fast. Oh, grrrrr.)
Morgan, I didn't knew you had been abilified..... I recall you mentioning zyprexa....
> It may be wise to just stick with around 3 mg Abilify for a few weeks to see if this is enough. Ask your doctor about this, you have two weeks to spare I'm sure, no need to rush into anything.
>
> I've read reports that 3 mg may be more effective as an AD than 5 mg. It really is a very powerful drug, far to powerful for me(1.5 mg sent me spinning). I believe it can be very effective for treating bad and chronic cases of depression.
>
> Though I'm not crazy about the use of AAP's for anything other than severe acute manic episodes and psychosis, I do think some cases of depression are exceptions. I really hope it helps you!
>
> Morgan
Posted by morgan miller on July 29, 2011, at 13:56:30
In reply to Re: Abilified, and other semantic cruelties » morgan miller, posted by floatingbridge on July 29, 2011, at 9:48:03
> Excellent advice, methinks. Do 'they' make a 3mg dose?
>
> (And if so, why the rush in my own case to go up so fast. Oh, grrrrr.)
>
> Morgan, I didn't knew you had been abilified..... I recall you mentioning zyprexa....
>
>
>
> > It may be wise to just stick with around 3 mg Abilify for a few weeks to see if this is enough. Ask your doctor about this, you have two weeks to spare I'm sure, no need to rush into anything.
> >
> > I've read reports that 3 mg may be more effective as an AD than 5 mg. It really is a very powerful drug, far to powerful for me(1.5 mg sent me spinning). I believe it can be very effective for treating bad and chronic cases of depression.
> >
> > Though I'm not crazy about the use of AAP's for anything other than severe acute manic episodes and psychosis, I do think some cases of depression are exceptions. I really hope it helps you!
> >
> > Morgan
>
>Yep FB, been Abilified. I can't say that I gave it a good shot. I took one dose and that was enough for me to stay away. It was a fragile and very unstable time for me, so this could have played a role in the sensitive reaction I had to such a low dose of the stuff. Out of all the AP's, I admit a 2 to 3 mg dose of Abilify has been the one that has intrigued me the most. Ya know, people talk about being relieved of depression but too hyped up and numb on some SSRIs, but for me, I think I might have that problem with Abilify. It's soooo powerful. 60 mg of Cymbalta didn't touch what one tiny dose of Abilify did.
And again I have read that 2 or 3 mg of Abilify as an antidepressant adjunct may be more effective than 5 mg, where a little too much dopamine attenuation starts to take place. Sort of like so many people that are trying really low doses of SSRIs now and doing much better(12.5 and 25 mg Zoloft/2.5 to 5 mg Lexapro).
Morgan
Posted by Phillipa on July 29, 2011, at 21:23:53
In reply to Re: Abilified, and other semantic cruelties, posted by morgan miller on July 29, 2011, at 13:56:30
Morgan it's that powerful a med? Took 60mg of cymbalts once. But 12.5 of seroquel my head fell in my lap and was asleep. Woke easily though. Phillipa
Posted by dragonblack on July 31, 2011, at 3:28:50
In reply to Re: Giving up on Parnate: what's next before ECT?, posted by emmanuel98 on July 28, 2011, at 20:46:34
> Bileteral ECT did nothing for my depression, but it did blow holes in my memory. It took about six weeks before I started remembering things. I'm not talking about forgetting one major event. I'm talking about forgetting how to drive from my home to work, forgetting my neighbors names and how I knew them, forgetting almost everything that happened during the ECT treatments. Furthermore, talk about side effects. Parnate gives me insomnia, which I can control with other meds, and gave me hypotension which went away. ECT left me a complete and utter basket case for 24 hours after treatment, with a headache, nausea, not knowing where I was.
>
> Bilateral ECT has to be done inpatient. All the friends in the world (and I have a lot of friends) aren't going to be able to take you home and stay all day with you until you know where you are.
>
> I know some people swear by ECT, but I have had both unilateral (which can be done outpatient) and bilateral (which must be done inpatient) treatments and had no change in mood whatsoever.
>
> Not to talk you out of it. If parnate isn't helping, ECT is something to try, but it's no walk in the park.Thanks for posting your experience. I'm not anxious to try ECT, I'm pretty afraid of it, to be honest, but I am also pretty frustrated with going nowhere, feeling like I am watching myself slowly become treatment resistant, and just throwing years of my life into unsuccessful drug trials. I wonder how long I can do it before I opt for a more drastic intervention, if ECT can be called such. I feel like it's such a gamble, I have absolutely no way of predicting whether it will be worth it, unlike with drug trials, where I don't have that feeling of complete uncertainty. Anyway, it's still a year or more away for me, I think, so I'll cross that electric stream when I get to it.
Posted by dragonblack on July 31, 2011, at 3:30:58
In reply to Re: Pretty little pills, posted by emmanuel98 on July 28, 2011, at 20:49:30
> 10mg abilify was magic for me. But it made me gain weight rapidly. Apparently, abilify isn't notorious for this. Some people benefit but don't gain weight.
Did you go off due to the weight issue, or stick with it because it was working?
Posted by dragonblack on July 31, 2011, at 3:35:54
In reply to Re: Abilified, and other semantic cruelties, posted by morgan miller on July 29, 2011, at 7:50:31
> It may be wise to just stick with around 3 mg Abilify for a few weeks to see if this is enough. Ask your doctor about this, you have two weeks to spare I'm sure, no need to rush into anything.
>
> I've read reports that 3 mg may be more effective as an AD than 5 mg. It really is a very powerful drug, far to powerful for me(1.5 mg sent me spinning). I believe it can be very effective for treating bad and chronic cases of depression.
>
> Though I'm not crazy about the use of AAP's for anything other than severe acute manic episodes and psychosis, I do think some cases of depression are exceptions. I really hope it helps you!
>
> MorganThis was my thought exactly, I'm actually taking some days at 2.5 mg first, then I think I am going to sit at 3 mg for a while. Even though it' only 3 mg, I can't help but view it as a 50% dose increase! Jumping to 5 seems to make little sense to me, especially when you hear over and over how strong so many people find 2 mg.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.