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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by g_g_g_unit on August 1, 2012, at 8:25:57
Sorry to endless harass you SLS. I don't know if you recall me mentioning it, but I have a stressful time coming up over the next 2 weeks. A friend from overseas has decided to visit (with very little warning), and we're going to be attending a film festival together, which requires at least some concentrative power on my part.
I had been on 60mg of Parnate, which was helping keep my mood somewhat stable, but was too stimulating. I take 1.5mg of Clonazepam at night and 0.5mg in the morning, which was added to try and counteract the overstimulation, but didn't help.
When I was titrating up, the best dose for ADHD was around 30mg, so I (stupidly) figured if I just dropped back to 30mg over the course of a week, I'd reap the same benefits. But the past two days I've just been feeling spacey, tired, depressed. I wasn't even really taking into consideration that fluctuating levels of MAO would affect things etc.
Anyway, my friend arrives in two days. Since it's only been a week, do you think returning to 60mg is probably the wisest option? Otherwise, is there going to be an adjustment period with any other dose I choose (30mg, or 45mg, which was also kinda useful .. though neither very much for mood). I thought about doing that and maybe upping the morning clonazepam dose to 1mg. This whole thing would just be temporary. Afterwards, I'd taper off the Parnate, and slower lower my Clonazepam dose.
Posted by phidippus on August 2, 2012, at 21:20:29
In reply to another question SLS - sorry!!!!, posted by g_g_g_unit on August 1, 2012, at 8:25:57
I think upping your CLonazepam a great idea - 1 in the morning and 1 at night would give you great ccoverage.
*ss for the Parnate, can you go to 45?
Eric
Posted by SLS on August 3, 2012, at 5:56:24
In reply to another question SLS - sorry!!!!, posted by g_g_g_unit on August 1, 2012, at 8:25:57
No apologies necessary!
Trial-and-error. (How's that for being non-committal).
Marplan is a pretty mild drug with regard to side effects. For me, therapeutically, it felt very much like an intermediate between Parnate and Nardil. It didn't produce the stimulation of Parnate and didn't produce the initial euphoriant and weight-gain effects of Nardil. It was a "cleaner" antidepressant response. Of course, with me, this response didn't last very long - about three days.
You already take Klonopin, and will have a difficult time discontinuing it. The worst of withdrawal occurs at the end of the taper period, so it might not hurt to increase the dosage of Klonopin at this point. You will be no more dependent on it than you are already. It would just take a little longer to reach that critically lowest dosage before withdrawal symptoms are not easily avoided. As an aside, Trileptal (oxcarbazepine), an anticonvulsant, has been reported to greatly reduce the withdrawal effects from discontinuing benzodiazepines and alcohol.
http://www.ncbi.nlm.nih.gov/pubmed/18821451
- Scott
Posted by phidippus on August 3, 2012, at 23:01:11
In reply to Re: another question SLS - sorry!!!! » g_g_g_unit, posted by SLS on August 3, 2012, at 5:56:24
The key to a smooth transition off Klonopin is doing it slowly. Like minus .5 grams every week. Lyrica can also help with withdrawal symptoms.
Eric
Posted by g_g_g_unit on August 4, 2012, at 8:58:09
In reply to Re: another question SLS - sorry!!!! » g_g_g_unit, posted by phidippus on August 2, 2012, at 21:20:29
> I think upping your CLonazepam a great idea - 1 in the morning and 1 at night would give you great ccoverage.
>
> *ss for the Parnate, can you go to 45?
>
> EricI tried adding 1mg in the morning, but it only seems to help until 5pm or so, and then I get anxious and overstimulated again.
I could go to 45mg, yeah. I donno how long it would take to stabilize. Each time I drop below 60mg, the drug makes me overly emotional and depressed. My mood's most stable at 60mg but I pay with excess anxiety.
Posted by phidippus on August 4, 2012, at 19:06:33
In reply to Re: another question SLS - sorry!!!! » phidippus, posted by g_g_g_unit on August 4, 2012, at 8:58:09
>it only seems to help until 5pm or so
Klonopin has a 18 hour half-life. I htink what you're experiencing in the afternoon is psychological.
Eric
Posted by g_g_g_unit on August 4, 2012, at 19:38:38
In reply to Re: another question SLS - sorry!!!! » g_g_g_unit, posted by phidippus on August 4, 2012, at 19:06:33
> >it only seems to help until 5pm or so
>
> Klonopin has a 18 hour half-life. I htink what you're experiencing in the afternoon is psychological.
>
> EricAnother explanation would be that Parnate has a 2.5 hour half-life, which means it would assume a cumulative effect throughout the day (when dosed every 3 hours), potentially resulting in peak stimulation during the afternoon.
Unless you think my psychiatrist is wrong?
Posted by phidippus on August 4, 2012, at 23:31:17
In reply to Re: another question SLS - sorry!!!! » phidippus, posted by g_g_g_unit on August 4, 2012, at 19:38:38
i'm not going to second guess your pdoc! I just hadn't considered Parnate's half-life. Do youu take an afternoon dose?
Eric
Posted by SLS on August 5, 2012, at 2:27:46
In reply to Re: another question SLS - sorry!!!! » phidippus, posted by g_g_g_unit on August 4, 2012, at 19:38:38
> > >it only seems to help until 5pm or so
> >
> > Klonopin has a 18 hour half-life. I htink what you're experiencing in the afternoon is psychological.
> >
> > Eric
>
> Another explanation would be that Parnate has a 2.5 hour half-life, which means it would assume a cumulative effect throughout the day (when dosed every 3 hours), potentially resulting in peak stimulation during the afternoon.It is possible that this effect is less a matter of the accumulation of Parnate in the blood and brain tissues and more the peaking of MAO inhibition. I guess it makes sense that any stimulation effected by the Parnate molecule itself would be amplified by the increase in enzyme inhibition and an attendant rise in catecholamine release. You could try dosing every three hours throughout the day to see if this schedule mitigates these side effects. At some point, you might be able to consolidate your dosings again as the stimulant reaction ameliorates on its own.
You can do this.
Good luck.
- Scott
This is the end of the thread.
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