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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 34. Go back in thread:
Posted by FrequentFryer on December 16, 2012, at 23:45:04
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants?, posted by jono_in_adelaide on December 16, 2012, at 17:07:49
Yeah that's what he meant.
But I would like to see em make one that aint toxic preferably in the near future. I recon it could be done.
Posted by SLS on December 16, 2012, at 23:51:58
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by FrequentFryer on December 16, 2012, at 23:42:23
Didn't you try Nardil once?
- Scott
Posted by FrequentFryer on December 16, 2012, at 23:52:42
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants?, posted by SLS on December 16, 2012, at 20:27:24
> > I'd take what the doctor said to mean that there isnt a pill that can make you 100% happy, 100% of the time. Even when your depression or whatever is in remission, you still have to deal with lifes normal ups and downs - its here where a course of CBT can be very usefull, teaching us how to deal with those down without letting them turn into catastrophes in our minds.
>
> This is exactly right.
>
> "Magic" is in the mind of the sufferer. My psychiatric drugs work magic for me to reduce the severity of my neurobiological dysfunction (MDD or BD) and the dysregulation of mood and impairments of cognition associated with it. These magic drugs will not live my life for me and find for me happiness any more than an antibiotic would. However, both of these types of magic drugs help facilitate one's ability to create happiness. This takes work. It does not come automatically with remission.
>
> I hate when psychologists say that there is no magic pill. To me, this is a rather ignorant and unenlightened emotional investment in their own sense of relevance. I have always come away with the impression that this represents a belief on their part that psychotherapy can heal depression as well as pills do. It is as if psychotherapy will make the depression go away as long as one works hard enough and long enough and pays enough. It seems self-serving to me. If the depression doesn't go away, whose fault is it?
>
> The pills do what they do. Psychotherapy does what it does. I don't feel that they are focused on the same targets of pathology. I consider them to be complementary rather than competitors. It is true that psychotherapy can reduce psychosocial stress by treating the mind. This can influence the course of brain disorders by effecting physiological changes. However, not all people need psychotherapy to find happiness after their depressive brain disorder is brought into remission by our truly magic pills. It does happen that this remission resolves the warping of mood, perceptions, and cognition such that one can go on to recover from illness and work to find happiness just like most other people do - without psychotherapy.
>
> I guess insulin is no magic elixir just because one can use diet (food therapy) to help manage blood sugar.
>
> I need to stop here before I end up writing an essay or a very long rant.
>
>
> - ScottHAHAHAHA. my thoughts exactly, I saw a psych for 3 years, and saw her in group not long ago and she said she I don't think I can really help you because you seem a little angry at me.
And yes I have to admit I do have a slight anger towards these people because they make a hell of allot of money off ya and like most goods and services if the service don't work you get your money back. like the 1000's of dollars these people have profited off me and I'm still not better, they may have kept me alive but that's about it.
Posted by SLS on December 17, 2012, at 6:19:20
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants?, posted by FrequentFryer on December 16, 2012, at 23:52:42
> I'm still not better, they may have kept me alive but that's about it.
That's interesting. I told my last psychologist that her job was to help keep me alive until my psychiatrist found a successful treatment for my depressive disorder. In the meantime, I asked that we also work on other stuff since I was already there.
- Scott
Posted by jono_in_adelaide on December 17, 2012, at 23:12:07
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 17, 2012, at 6:19:20
I stopped seeing my psychologist because it seemed to be a waste of money and time... the stuff she was spounting would only have been of any use to someone with absolutly no insight into their condition at all
Posted by g_g_g_unit on December 19, 2012, at 22:16:11
In reply to TRD MAOI heads. Tranylcip + Nortrip + Stimulants?, posted by FrequentFryer on December 15, 2012, at 19:26:40
were you prescribed stimulants in conjunction with an MAOI? or was it self-medication?
just curious 'cos I'm in Australia too (Melbourne) and e-mailed a resident depression "expert" who said he considered the combination far too dangerous .. so I figured the two were probably never used together here.
Posted by SLS on December 20, 2012, at 6:59:19
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by g_g_g_unit on December 19, 2012, at 22:16:11
> were you prescribed stimulants in conjunction with an MAOI? or was it self-medication?
>
> just curious 'cos I'm in Australia too (Melbourne) and e-mailed a resident depression "expert" who said he considered the combination far too dangerous .. so I figured the two were probably never used together here.The following is a list of drugs that are usually listed as contraindicated in combination with a MAOI which are generally safe. I would say that Parnate is the preferred MAOI to use with these drugs. Side effects are generally less problematic with it. I experience significant urinary retention and hypotension when combining Nardil with TCA. Nardil + amphetamine should be more tolerable.
* nortriptyline
* desipramine
* amphetamine
* methylphenidate
* bupropion
doxepin
trimipramine* I have taken these drugs in combination with both Parnate and Nardil.
Once, I was treated with the following drugs concomitantly:
Parnate 120 mg/day
desipramine 150 mg/day
amphetamine 20 mg/day
thyroxine
bromocriptineOf course, this doesn't mean that everyone else will tolerate these drugs in combination.
http://www.mdshrink.com/drgrossiblog-menu/44-maoisdrug-interactions.htmlhttp://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
Perhaps your doctor can find the full-text articles of the following:http://www.ncbi.nlm.nih.gov/pubmed/2056139
http://www.ncbi.nlm.nih.gov/pubmed/3997787
http://www.ncbi.nlm.nih.gov/pubmed/2017568
http://www.ncbi.nlm.nih.gov/pubmed/2275949
http://www.ncbi.nlm.nih.gov/pubmed/15554766
http://www.ncbi.nlm.nih.gov/pubmed/14970373
- Scott
Posted by FrequentFryer on December 21, 2012, at 20:21:16
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by g_g_g_unit on December 19, 2012, at 22:16:11
Well I had tried 25mg of Dex on 90 mg of Nardil and I got really sick, Hypertension, felt like my head was going to explode. But parnate dosnt seem to mind Noradranergic stuff. I have treied these combo's in and out of hospital.
> were you prescribed stimulants in conjunction with an MAOI? or was it self-medication?
>
> just curious 'cos I'm in Australia too (Melbourne) and e-mailed a resident depression "expert" who said he considered the combination far too dangerous .. so I figured the two were probably never used together here.
Posted by FrequentFryer on December 21, 2012, at 20:33:08
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 16, 2012, at 23:51:58
> Didn't you try Nardil once?
>
>
> - ScottYeah I have tried Nardil dozens of times, It was my favorite. Gave me every side effect in the book but I didn't care because it made me feel so good. But every time I took it the positive effects got less and less until now it doesn't hardly help at all.
I don't think the Parnate is doing much either but it has hardly any side effects or interactions I'm gonna stick with it.
It amazes me how I can take stimulants on it whereas for me Nardil and stims gives me deadly hypertension.
Posted by SLS on December 21, 2012, at 20:43:34
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by FrequentFryer on December 21, 2012, at 20:33:08
> It amazes me how I can take stimulants on it whereas for me Nardil and stims gives me deadly hypertension.
That surprises me to.
Good luck with building a treatment regime around Parnate.
What drugs are you planning to combine with it?
- Scott
Posted by FrequentFryer on December 23, 2012, at 1:49:36
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 21, 2012, at 20:43:34
> > It amazes me how I can take stimulants on it whereas for me Nardil and stims gives me deadly hypertension.
>
> That surprises me to.
>
> Good luck with building a treatment regime around Parnate.
>
> What drugs are you planning to combine with it?
>
>
> - ScottI have pretty much given up chopping and changing Scott I had a large dose of Phentermine which would have used to have me cleaning the house and stuff but this mourning it did nothing I'm just stick with 50mg Parnate and 100mg Nortrip like you take or used to take, theoretically it should be a pretty kick *ss combo.... And I'm not to bad.. I thing the meds / drugs for me are a way of escaping my fear which I need to try and do without the pills maybe I should see a therapist again??
What is or was your favorite add on to the parnate and nortrip combo??
Anything that really stood out and remained constant.
I'm pretty sure I'm Unipolar with bad Depression / Anxiety, which I think all was caused by social anxiety. And of coarse I have EXTREME Dysthymia / Dysphoria.Thanks for listening.
Posted by FrequentFryer on December 23, 2012, at 1:53:45
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 21, 2012, at 20:43:34
> > It amazes me how I can take stimulants on it whereas for me Nardil and stims gives me deadly hypertension.
>
> That surprises me to.
>
> Good luck with building a treatment regime around Parnate.
>
> What drugs are you planning to combine with it?
>
>
> - ScottI have pretty much given up chopping and changing Scott I had a large dose of Phentermine which would have used to have me cleaning the house and stuff but this mourning it did nothing I'm just stick with 50mg Parnate and 100mg Nortrip like you take or used to take, theoretically it should be a pretty kick *ss combo.... And I'm not to bad.. I thing the meds / drugs for me are a way of escaping my fear which I need to try and do without the pills maybe I should see a therapist again??
What is or was your favorite add on to the parnate and nortrip combo??
Anything that really stood out and remained constant.
I'm pretty sure I'm Unipolar with bad Depression / Anxiety, which I think all was caused by social anxiety. And of coarse I have EXTREME Dysthymia / Dysphoria.Thanks for listening.
Posted by SLS on December 23, 2012, at 7:06:48
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by FrequentFryer on December 23, 2012, at 1:53:45
> What is or was your favorite add on to the parnate and nortrip combo??
> Anything that really stood out and remained constant.Dosages:
First of all, if I don't take at least 80 mg/day of Parnate, I do not receive maximum benefit. With nortriptyline, one is either a slow metabolizer and can respond to 50-75 mg/day, or a rapid metabolizer and needing 150 mg/day. Tests for nortriptyline blood levels can determine this.
I am having a difficult time trying to rate the importance of the other drugs I am taking. Abilify 10 mg/day and Lamictal 200 mg/day have been part of my treatment for quite a few years. I added lithium 300 mg/day earlier this year. It provided some mild antidepressant effects and smoothed out the "mood drift" that I would often experience. Prazosin has made a big difference for depression since I began taking it a year ago. It was chosen by my doctor because I reported having had a childhood marked by chronic traumas - "developmental PTSD". More recently, I have been experimenting with higher dosages of prazosin and adding minocycline. Minocycline does a variety of things, including neuroprotection, reducing brain inflammation, and glutamate suppression. The latter effect is thought by some to work together with Lamictal to improve depression.
http://www.dr-bob.org/babble/20120803/msgs/1023257.html
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
lithium 300 mg
Abilify 10 mg
prazosin 15 mg
minocycline 200 mg.How do you respond to Wellbutrin?
How do you respond to N-acetylcysteine (NAC)?
- Scott
Posted by Phillipa on December 23, 2012, at 20:02:03
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 23, 2012, at 7:06:48
I thought you went off the minocycline? When did you again start it? Phillipa
Posted by SLS on December 23, 2012, at 20:51:36
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by Phillipa on December 23, 2012, at 20:02:03
> I thought you went off the minocycline? When did you again start it? Phillipa
I restarted the minocycline at 200 mg/day two days ago.
I felt that I had given the increased dosage of prazosin enough time to settle in. It appeared to me that my degree of improvement plateaued, and I think I may have actually deteriorated. I hate to see myself run around in circles, but I really hoped to be able to function without minocycline. So, the trial-and-error process continues...
- Scott
Posted by Phillipa on December 24, 2012, at 17:29:05
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » Phillipa, posted by SLS on December 23, 2012, at 20:51:36
Scott what do you feel this means? I see you took your meds off your profile. Also have info on Kat. Can't post. Phillipa
Posted by g_g_g_unit on December 27, 2012, at 3:39:52
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » g_g_g_unit, posted by FrequentFryer on December 21, 2012, at 20:21:16
> Well I had tried 25mg of Dex on 90 mg of Nardil and I got really sick, Hypertension, felt like my head was going to explode. But parnate dosnt seem to mind Noradranergic stuff. I have treied these combo's in and out of hospital.
>So psychiatrists prescribed you an MAOI + stimulant while you were an inpatient? Do you mind me asking what your dx. is and what state of Australia you're in? Did you request the combination or was it suggested to you?
Posted by FrequentFryer on December 27, 2012, at 5:53:25
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by g_g_g_unit on December 27, 2012, at 3:39:52
> > Well I had tried 25mg of Dex on 90 mg of Nardil and I got really sick, Hypertension, felt like my head was going to explode. But parnate dosnt seem to mind Noradranergic stuff. I have treied these combo's in and out of hospital.
> >
>
> So psychiatrists prescribed you an MAOI + stimulant while you were an inpatient? Do you mind me asking what your dx. is and what state of Australia you're in? Did you request the combination or was it suggested to you?
>Perth WA Abbotsford hospital West Leederville.
Theres been times where he hasn't wanted to but I did via multiple Doc's and proved to him so now he's cool with it.
Posted by SLS on December 27, 2012, at 6:17:32
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » g_g_g_unit, posted by FrequentFryer on December 27, 2012, at 5:53:25
> Theres been times where he hasn't wanted to but I did via multiple Doc's and proved to him so now he's cool with it.
Do you have any literature from the Internet that you would recommend?
For me, adding nortriptyline to Parnate helps more than adding amphetamine. If you are extremely anergic or display psychomotor retardation, you could even add desipramine instead of the nortriptyline. Desipramine can feel pretty harsh at first, though. You could remain on a stimulant while adding a TCA. Just stay away from imipramine and clomipramine. They are too serotonergic.
I hope the amphetamine does the trick for you. It would be a simple fix.
- Scott
Posted by FrequentFryer on December 27, 2012, at 6:19:45
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 23, 2012, at 7:06:48
> > What is or was your favorite add on to the parnate and nortrip combo??
> > Anything that really stood out and remained constant.
>
> Dosages:
>
> First of all, if I don't take at least 80 mg/day of Parnate, I do not receive maximum benefit. With nortriptyline, one is either a slow metabolizer and can respond to 50-75 mg/day, or a rapid metabolizer and needing 150 mg/day. Tests for nortriptyline blood levels can determine this.
>
> I am having a difficult time trying to rate the importance of the other drugs I am taking. Abilify 10 mg/day and Lamictal 200 mg/day have been part of my treatment for quite a few years. I added lithium 300 mg/day earlier this year. It provided some mild antidepressant effects and smoothed out the "mood drift" that I would often experience. Prazosin has made a big difference for depression since I began taking it a year ago. It was chosen by my doctor because I reported having had a childhood marked by chronic traumas - "developmental PTSD". More recently, I have been experimenting with higher dosages of prazosin and adding minocycline. Minocycline does a variety of things, including neuroprotection, reducing brain inflammation, and glutamate suppression. The latter effect is thought by some to work together with Lamictal to improve depression.
>
> http://www.dr-bob.org/babble/20120803/msgs/1023257.html
>
> Currently:
>
> Parnate 80 mg
> nortriptyline 150 mg
> Lamictal 200 mg
> lithium 300 mg
> Abilify 10 mg
> prazosin 15 mg
> minocycline 200 mg.
>
> How do you respond to Wellbutrin?
> How do you respond to N-acetylcysteine (NAC)?
>
>
> - Scott
>Bupropion dose nothing... N-acetylcysteine sounds interesting and I will put on my shopping list..
If I last that long until the Doc gets back from holiday, the last few weeks I have been in a fetal position in bed crying, can't even be bothered turning the tv.. I'm a bit drunk right now that's what gave me the motivation to get out of bed and reply, alcohol seems to be the best for elevating my mood (Baclofen was almost as good but the tolerance gets really bad really quickly. (But yeah, with alcohol no half life & toxic I know) I am strongly considering looking for a lethal liquid recipe. Put it in a syringe and go to bed with a couple of juicy pizzas and chocolate and inject the poison because every second feels like an hour of hell.. (possibly cos of the high dose amphetamines combined with the parnate has burned the $hit out of my DA & NA receptors... I dunno.
Maybe I should go back into hospital again,,,, I don't think it helps much but its so hot where I am my hyperhydrosis is so bad I'm like a wet sponge all day and I don't know of any anti-cholonergics that help H/H with a half-life of more then 2 hrs
Posted by SLS on December 27, 2012, at 7:34:29
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by FrequentFryer on December 27, 2012, at 6:19:45
> If I last that long until the Doc gets back from holiday, the last few weeks I have been in a fetal position in bed crying, can't even be bothered turning the tv.
Oh my God. You are in critical condition as far as I am concerned.
You need to do something quickly. Every waking moment must seem like an eternity in hell. I can't guarantee that it will help, but Zyprexa often reduces the intensity of the pain and can actually dissipate a suicidal state. It can also help improve clarity of thought.
You might need hospitalization. It could save your life and preserve it long enough for you to explore untried treatments.
Trileptal
Lamictal
Abilify
MinocyclineIf developmental PTSD was a part of the evolution of your depressive illness, prazosin might help.
I hope you have the energy to respond to this post. I just want to know where you are at with things. If you don't have the energy, don't worry. Just take care of yourself.
- Scott
Posted by FrequentFryer on December 28, 2012, at 23:11:46
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 27, 2012, at 7:34:29
> > If I last that long until the Doc gets back from holiday, the last few weeks I have been in a fetal position in bed crying, can't even be bothered turning the tv.
>
> Oh my God. You are in critical condition as far as I am concerned.
>
> You need to do something quickly. Every waking moment must seem like an eternity in hell. I can't guarantee that it will help, but Zyprexa often reduces the intensity of the pain and can actually dissipate a suicidal state. It can also help improve clarity of thought.
>
> You might need hospitalization. It could save your life and preserve it long enough for you to explore untried treatments.
>
> Trileptal
> Lamictal
> Abilify
> Minocycline
>
> If developmental PTSD was a part of the evolution of your depressive illness, prazosin might help.
>
> I hope you have the energy to respond to this post. I just want to know where you are at with things. If you don't have the energy, don't worry. Just take care of yourself.
>
>
> - Scott
>Thanks man It's ok my previous post might have been a bit of an exaggeration... It's just not gonna be a very happy new year.
Posted by metamorphosis on December 29, 2012, at 9:14:04
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » FrequentFryer, posted by SLS on December 27, 2012, at 6:17:32
I just started Parnate and am having insomnia. I hope this will mellow or pass with time. I have used Ambien but it just isn't strong enough. I believe I am cross tolerant with the benzo, Klonopin. Which I take daily.
My question is everyone seems to be mentioning nortriptyline as an adjunct to Parnate. What about amitriptyline, either as a sleep aid or to potentiate and complement Parnate???
My p-doc is open to adding a TCA in time. I have used 10mg of amitrytilyine in the past for insomnia. What doses are used for sleep and/or therapeutic value?
Also, are there major benefits of using nortriptyline over amitriptyline?
Thanks
Posted by SLS on December 29, 2012, at 13:54:26
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants?, posted by metamorphosis on December 29, 2012, at 9:14:04
> Also, are there major benefits of using nortriptyline over amitriptyline?
Only if you do not tolerate the side effects of amitriptyline. Otherwise, you probably have a greater chance of responding to amitryptyline than to nortriptyline. Antichoinergic and sedative side effects are much reduced with nortriptyline. However, the amitriptyline might help you sleep. In order to receive the full benefit from either of these drugs when combined with an MAOI, one must usually take a dosage that would otherwise be effective if the drug were used alone. That would require a dosage of 150 mg/day of amitriptyline or 75 mg/day of nortripytyline. However, you would still want to titrate each drug gradually. My only concern with taking amitriptyline in combination with a MAOI would be the development of serotonin syndrome. Amitriptyline would be less apt to do this than imipramine or clomipramine, but it is still theoretically possible. I would not let that be the deciding factor in choosing amitryptyline, though. You would probably want to take your entire daily dose of amitriptyline at night.
- Scott
Posted by caller on January 1, 2013, at 8:58:03
In reply to Re: TRD MAOI heads. Tranylcip + Nortrip + Stimulants? » SLS, posted by Phillipa on December 24, 2012, at 17:29:05
Hey guys, I just need to check: when you're saying that "amphetamine" should be OK with MAOI's, are you then referring to dexamphetamine or racemic amphetamine/Adderall?
I'm asking since I suffer from ADHD and don't respond particularly well to dex - I feel it's way too dopaminergic and mostly makes me tired, giving me a tunnel-vision kind of focus.
I don't have access to Adderall but racemic amphetamine works wonders for my ADHD - vastly improving working memory and not decreasing lateral thinking as much as dex.
I'm currently on 60 mg of Parnate for atypical depression and modafinil and nicotine for ADHD. Usually both the latter substances helps greatly with attention but now even they're feeling too dopaminergic, especially when combined (and on their own they don't provide enough relief).Also, is my doctor correct when stating that tranylcypromine absolutely has to be taken at least twice a day, as to not disturb plasma concentrations in the blood? I'd prefer talking it in the evening/night only, even though this messes more with sleep, since taking it in the morning makes me very very tired for the first 5 hours or so.
Would really appreciate your input!!
/caller
This is the end of the thread.
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