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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by SLS on December 30, 2012, at 11:53:56
In reply to Re: question for SLS » metamorphosis, posted by Phillipa on December 30, 2012, at 10:04:54
> Do you know the poster Ron Hill? He was a rapid cycler and Deplin seems to be the med that was the one that stopped the cycling. I think now they recommend 15mg but all are different. You might wish to google Ron Hill and see if you see similiarities? Phillipa
If I'm not mistaken, it was a combination of drugs that included Valdoxan (agomelatine) that helped extinguish Ron's rapid cycling. He was taking Keppra, too.
http://www.dr-bob.org/babble/20101020/msgs/966675.html
- Scott
Posted by metamorphosis on December 30, 2012, at 11:56:23
In reply to Re: question for SLS » metamorphosis, posted by Phillipa on December 30, 2012, at 10:04:54
> Do you know the poster Ron Hill? He was a rapid cycler and Deplin seems to be the med that was the one that stopped the cycling. I think now they recommend 15mg but all are different. You might wish to google Ron Hill and see if you see similiarities? Phillipa
Thanks,Phillipa, I have used 15mg before but I try to conserve, as I live of my pdocs samples. And it is so expensive. Hey, with the money I have paid him throughout the yrs. That is the least my pdoc can do. From reading the posts, you are so supportive. You always have kind and encouraging words for others!!!
If you don't mind answering-
Have you ever used an MAOI and do you take any meds. now?
Posted by metamorphosis on December 30, 2012, at 16:49:26
In reply to Re: question for SLS, posted by metamorphosis on December 30, 2012, at 11:56:23
Update on the use of sleep medication. I just talked to my pdoc on the phone. I explained to him about my insomnia and how Ambien is not working. I explained to him all of the research and anecdotal reports I have read about for sleep. I mentioned doxepin and amitriptyline, at 10mg, just to get a decent nights sleep for now,. Also mentioned trazodone, all of the above meds. I have here at the house.
He didn't go for one of them!!! Claiming 4 days in was to early to add any sleep agent besides Ambien. even though I said it did not work!!!
Maybe, I am way off base, but I thought at the least, a good 5-6 hrs. of sleep a night, at the least, is pretty important to relieve depression. after all that is when your body and brain heals itself and your mind sorts through the daily issues.It was almost like he was scared to add anything. I do not see him for a week. I mean he wouldn't even go for a very low dose of doxepin or amitriptyline (10mg). I mean c'mon. We have a good report and I thought that after noting the research I had done. He would at least approve one of them or trazodone.
Needless to say, I'm a little pissed!!!
Does he expect me to basically go sleepless until I see him in a week. I wish I had a printer. so, I could shove all of the pubmed, psychotropical articles in his face.Advice anyone???
If I can't sleep. I may try either 10mg of doxepin or amitryptiline. I will even consider 5mg amitryptiline initially. Just to get some decent sleep. He was about to okay the doxepin because he believes it has the lowest serotonergic effect. Than I asked if I should take 5-10mg. Suddenly his attitude changed and he said no to it.I can understand his concerns, but they are unwarranted,IMHO. He said it was bad medicine to add any of the above until my brain adjusts.
But I need sleep also. Not this phase 1-2 sleep cycle for 2-3 hrs.
I had to get this off my chest. He is a good pdoc and respects my opinion, but he is way off on this!!!
Posted by baseball55 on December 30, 2012, at 19:40:33
In reply to Re:question for SLS pdoc just shot down sleep aids, posted by metamorphosis on December 30, 2012, at 16:49:26
I went for three nights without sleep on parnate after I stopped augmenting it with perphenazine (my p-doc really wanted me off perphenazine because of the potential EPS effects). When I called him, he told me to up the perphenazine again to 12mg and that helped me sleep. Then that stopped working and he agreed to add trazadone. The pharmacy wouldn't fill the scrip without talking to him first. But I take 100mg with no problem, have been for a few years. I find trazadone keeps me asleep but doesn't get me to sleep, so I take ativan or xanax to put me out. At first he was resistant to this because I've had addiction problems, but the insomnia was literally driving me crazy. I think I'm now benzo-tolerant and still have insomnia problems. I think I always will unless I stop parnate. But my depression has gotten so much less severe, that I'm planning on cutting back the parnate after the new year.
Posted by Phillipa on December 30, 2012, at 20:59:27
In reply to Re: question for SLS, posted by metamorphosis on December 30, 2012, at 11:56:23
Yes Deplin is extremly expensive. I once took 7.5mg of Deplin also but the expense was too much. No I haven't taken an MAOI but at one time wanted to try emsam. Pdoc at the time thought would be too stimulating for me. At the present taking 50mg of luvox and 5mg of lexapro .25mg of xanax and 7.5 mg of valium. For some reason now I sleep like a rock. Strange as initial and for so many years main dx was panic & anxiety. Now this doc says OCD. So on the anxiety spectrum. Thanks for the kind words. I didn't realize Ron took so many supplements either and that his remission was over two years ago. Time sure flies. Phillipa
Posted by metamorphosis on December 31, 2012, at 10:12:47
In reply to Re: question for SLS » metamorphosis, posted by Phillipa on December 30, 2012, at 20:59:27
Gillman_T...pdf
Download(157.7 KB)ADs_blood...pdf
Download(166.3 KB)
Download all as zip
Hi Christian> currently on 30 mg Parnate
30 mg is the minimum dose that is likely to be effective, many people need 50 mg and occasionally more. It at the monitor your sitting and standing blood pressure to gauge the effect of the drug, see attached PDF
> klonopin daily and the fact that Ambien also has a short half life. I think its the cross tolerance issue?
not really, but sort of I suppose. Drugs like Ambien are simply not used in the UK, indeed Halcion was essentially banned. Those very short acting drugs are of very limited use in people who are ill. Treating illness is what normalises the sleep pattern.
> So, I have noticed that people have and are using the TCAs-
> nortriptyline, amitriptyline, and doxepine.Is, all of those are safe with Parnate. Doxepin is really a sedative and has no significant antidepressant action and should probably not be classified as a TCA, rather as an antihistamine like from Phenergan. Nortriptyline it's probably better than AMI It to the because of its side-effect profile, see attached paper. It is not very sedative, but does improve sleep in some people.
> trazodone at 25-100mg for sleep. I though that combo would be dangerous. apparently the low 5HT effect of low dose trazadone makes it a careful but viable option?
despite everything that you read trazodone is actually an anti-serotonergic drug. It has significant five HT to be antagonistic properties which is probably why it helps sleep, and in that respect it is like doxepin but without the antihistamine effect. It seems to work well in conjunction with Parnate from what people and would probably be the first choice. It is definitely perfectly safe in combination with Parnate.> Also, some use zyprexa 25 mg for sleep. I am not a big fan of A.P./AAP�s, because of their potential side effects and also not needed for my diagnosis.
I would most definitely not be in favour of using antipsychotics as sleep aids. It is both unnecessary and carries completely unacceptable risks including that of NMS
> I would also like to start modafinil again. It works wonders for my alertness as a non-amp. stim. My pdoc is open to reintroducing it.
I would advise against reintroducing modafinil until the Parnate has shown its full effect been adjusted to optimal dosage. If at that point you think it might help it is certainly possible to combine it with Parnate.
Dr Ken Gillman
ken.psychotropical@gmail.com and kg@matilda.net.auWeb site for Serotonin toxicity research www.psychotropical.com
Please consider helping PsychoTropical Research see http://www.psychotropical.com/help.shtmlSkype kengillman
Postal
PO Box 86
Bucasia
Queensland 4750
Australia
Posted by SLS on December 31, 2012, at 11:29:57
In reply to A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on December 31, 2012, at 10:12:47
Do you trust this person?
- Scott
Posted by SLS on December 31, 2012, at 11:57:12
In reply to Re: question for SLS, posted by metamorphosis on December 30, 2012, at 11:56:23
I didn't mean to impugn this doctor as being incompetent. I am just curious how you came to trust him as a source of information. Obviously, not all doctors practice medicine the same way.
- Scott
Posted by schleprock on December 31, 2012, at 16:27:54
In reply to A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on December 31, 2012, at 11:57:12
> I didn't mean to impugn this doctor as being incompetent. I am just curious how you came to trust him as a source of information. Obviously, not all doctors practice medicine the same way.
>
>
> - ScottI'd be very surprised if this Doctor ever actually took Parnate or Modanfil himself. It would make much more sense to follow the advice of someone who has.
Don't trust doctors.
Posted by metamorphosis on December 31, 2012, at 17:24:06
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on December 31, 2012, at 11:29:57
I don't trust any pdoc 100%, at least so far. But a lot of what he recommends is on par with your recommendations. That is as far as medications to use as an adjunct to Parnate. So, taking all of the various information that I have been absorbing about Parnate, the TCA's, trazodone, and the do's and dont's of MAOI use. I must say that I see your ideas and suggestions, as being very similar to him. Are you familiar with him and his published papers?
Have you checked out his website?
And is there something I should know about him, th I do not know?BTW another night 3 hrs of weak sleep. I am seriously considering starting either amitrip. or trazodone?
I cannot function with this kind of insomnia. and it just agitates my conditions more. I do not see my pdoc until the 10th. I need sleep now. This is the only side-effect that is really hurting me.Which would you recommend for sleep? and at what dose?
Or any other ideas? It is taking it's toll on me and I'm only 5 days in. But that is my only issue besides cold sensitivity!!!
Posted by baseball55 on December 31, 2012, at 18:31:11
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on December 31, 2012, at 17:24:06
Perphenazine helped me with sleep, but my p-doc felt it was too dangerous a drug to continue regularly. So I went to trazadone, which helped. Also ativan or xanax. I take 200mg trazadone without a problem and my doc is very conservative about combining things with parnate. But the insomnia can be hell.
Posted by Phillipa on December 31, 2012, at 20:47:08
In reply to A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on December 31, 2012, at 10:12:47
I agree with Dr Gillman on not using antipsychotics for sleep. He's been mentioned here quite a few times by others. Phillipa
Posted by SLS on January 1, 2013, at 7:01:25
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by Phillipa on December 31, 2012, at 20:47:08
> I agree with Dr Gillman on not using antipsychotics for sleep. He's been mentioned here quite a few times by others. Phillipa
Benzodiazepine (BZD) receptor agonists don't work for everyone. It is not unusual for people with MAOI-induced insomnia to be resistant to these drugs. Ativan and Klonopin were not sufficient for me when I first began taking Parnate + TCA in combination.
What drugs would you recommend for BZD-resistant insomnia?
Dr. Ken Gillman is good, and I agree with much of he has to say. However, some of his views are not shared by other good doctors who also have websites, publish papers, and give lectures. It is difficult to know who to listen to.
- Scott
Posted by metamorphosis on January 1, 2013, at 9:48:03
In reply to Re: A nice surprise, Dr. Gillman responds to question » Phillipa, posted by SLS on January 1, 2013, at 7:01:25
> > I agree with Dr Gillman on not using antipsychotics for sleep. He's been mentioned here quite a few times by others. Phillipa
>
> Benzodiazepine (BZD) receptor agonists don't work for everyone. It is not unusual for people with MAOI-induced insomnia to be resistant to these drugs. Ativan and Klonopin were not sufficient for me when I first began taking Parnate + TCA in combination.
>
> What drugs would you recommend for BZD-resistant insomnia?
>
> Dr. Ken Gillman is good, and I agree with much of he has to say. However, some of his views are not shared by other good doctors who also have websites, publish papers, and give lectures. It is difficult to know who to listen to.
>
>
> - ScottSo far I am leaning toward trazodone, second, a low dose of doxepin. I have added melatonin. One of my New Years resolutions is to eat better, exercise and lower my coffee consumption, all of which should help.
Last night was I actually slept for around 6 hrs. Interestingly, though I woke up feeling I had been run over by a truck! And there was no partying involve. I agree that after being on klon. for a rew yrs. It does nothing for my sleep.What is your first choice?
One other question. i know a guy who is starting Parnate. basically, he wnats a chill pill to prevent agitation and to much stimulating properties.
Here's the catch, he doesn't want a benzo and he couldn't tolerate pregabalin. So, i am quessing gabapentin is out. What other anti-anxirety/anxiolytic drugs can be used effectively with Parnate? He is on the fence with the TCA's and I am not sure which one would do the trick. Maybe some low doses of a particular TCA or trazodone/ I just don't want him to feel like "Shaun Of The Dead.
I haven't kept up with the newest meds. That have just appeared on the scene. I know Agomelatine is a is a melatonergic agonist at MT1 MT2 receptor and 5-HT2C antagonist.It has no effect on monoamine uptake and no affinity for adrenergic, histaminergic, cholinergic, dopaminergic and benzodiazepine receptors, nor other serotonergic receptors.
Would there be a contra-indication there with the 5HT activity?
It sounds promising but MAOI's and meds. can be tricky.Happy New Year's to you and all!!!
Any New Years resolutions?-Chris
Posted by SLS on January 1, 2013, at 9:52:25
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on January 1, 2013, at 9:48:03
> So far I am leaning toward trazodone, second, a low dose of doxepin.
Nice choices!
- Scott
Posted by SLS on January 1, 2013, at 10:15:41
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on January 1, 2013, at 9:48:03
> One other question. i know a guy who is starting Parnate. basically, he wnats a chill pill to prevent agitation and to much stimulating properties.
Low-dose Seroquel has its drawbacks in terms of metabolic side effects, but it really can work well as a sleep aid and anxiolytic. To the best of my knowledge, tardive dyskinisia at low dosages is rare.
> What other anti-anxirety/anxiolytic drugs can be used effectively with Parnate?
http://www.dr-bob.org/babble/20121231/msgs/1034272.html
In regard to agomelatine (Valdoxan), it should be perfectly fine to combine with a MAOI. A buddy of mine is combining it with Nardil 90 mg/day, and has being doing better for several years. The 5-HT2c antagonism yields an increase in NE and DA activity in the prefrontal cortex. Serotonin is not involved. After investigating this, I was unafraid to add agomelatine to Nardil.
> Happy New Year's to you and all!!!
Ditto!
> Any New Years resolutions?
Get well and find a job.
- Scott
Posted by metamorphosis on January 1, 2013, at 12:10:38
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on January 1, 2013, at 10:15:41
> > One other question. i know a guy who is starting Parnate. basically, he wnats a chill pill to prevent agitation and to much stimulating properties.
>
> Low-dose Seroquel has its drawbacks in terms of metabolic side effects, but it really can work well as a sleep aid and anxiolytic. To the best of my knowledge, tardive dyskinisia at low dosages is rare.
>
> > What other anti-anxirety/anxiolytic drugs can be used effectively with Parnate?
>
> http://www.dr-bob.org/babble/20121231/msgs/1034272.html
>
> In regard to agomelatine (Valdoxan), it should be perfectly fine to combine with a MAOI. A buddy of mine is combining it with Nardil 90 mg/day, and has being doing better for several years. The 5-HT2c antagonism yields an increase in NE and DA activity in the prefrontal cortex. Serotonin is not involved. After investigating this, I was unafraid to add agomelatine to Nardil.
>
> > Happy New Year's to you and all!!!
>
> Ditto!
>
> > Any New Years resolutions?
>
> Get well and find a job.
>
>
> - ScottSo did agomelatine help with sleep with it's melotonergic effects?
Also, as I mentioned my buddy wants an anoxyilitic to take the edge off. Does agomelatine help at all with this. What would be your top choices?Some of my choices won't jive. He does not want to use a benzo, pregabalin, or gabapentin. Besides some basic supplements like mag. glycinate pwd., I am searching for meds. to help him. He is on the fence with the TCA's and I'm not sure how helpful they would be?
what do you think of Gabatril or Topomax (dopeomax) ;p. Other ideas for him ?
Thanks!
Posted by SLS on January 1, 2013, at 14:00:26
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by metamorphosis on January 1, 2013, at 12:10:38
Your friend is lucky to have you.
Q: For how long has your friend had anxiety?
Q: How severe is the anxiety?
Q: Will he be using an anxiolytic drug everyday, or as a PRN only when needed?
I realize that he wants to avoid benzodiazepines, but Ativan is a clean drug that I didn't find too difficult to discontinue. It might make an ideal drug, especially if used as a PRN.> So did agomelatine help with sleep with it's melotonergic effects?
It helped at first. It really isn't very good for sleep in the long-term, though. My friend finds that agomelatine has greatly reduced his bipolar ultra-rapid cycle. I guess it's a hypothalamus thing.
> Also, as I mentioned my buddy wants an anoxyilitic to take the edge off. Does agomelatine help at all with this.
I would have to say no.
> What would be your top choices?
"Taking the edge off" doesn't sound like his anxiety is too severe.
I am reluctant to place low-dose Seroquel (quetiapine) at the top of the list, but it really does work. It can be used everyday or as a PRN. Many doctors are vehemently against using an antipsychotic for anything but psychosis. The only real downside I can see with Seroquel is metabolic. Weight gain is common, and diabetes is a possibility. EPS (extrapyramidal side effects) is also a possibility, but it happens infrequently. I have never seen it for myself, and I spent about 8 years interacting with patients who were taking Seroquel. As with other psychotropic drugs, reactions to taking Seroquel can vary between individuals. I found that Seroquel made me irritable.
Buspar (buspirone) might help, but it often takes a few weeks to begin working.
Someone I know had good results with Phenergan (promethazine). He was a difficult case, and had previously needed Zyprexa (olanzapine) to manage his anxiety.
If your friend will consider a TCA, doxepin might be the best choice.
I am having a difficult time creating a list sorted in order of preference. I guess I would try doxepin first and Seroquel second. Either drug can conceivably help Parnate to work better, but might require higher dosages than what might be effective for treating anxiety. Amitriptyline and nortriptyline are also worth mentioning. Antihistaminergic drugs (doxepin and Seroquel included) often help. Hyroxyzine, promethazine, and cyproheptadine are examples of this.
- Scott
Posted by jono_in_adelaide on January 1, 2013, at 17:12:28
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on January 1, 2013, at 14:00:26
I think the way to approach his ideas are try them and see, they are probably just the ticket for some people (they were for me) but like anything, they arnt going to work for everybody.
Posted by metamorphosis on January 1, 2013, at 17:24:02
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on January 1, 2013, at 14:00:26
I have just started Parnate and the prices are high. The cheapest generic I found was $149 for 10mg, 90ct. (Par). Which is the one I am using.
The name brand is an astounding $423 for the same script. (GlaxoSmithKline)
Which I can not afford, as my job doesn't offer insurance benefits to part-timers. These companies will label you as part time, if they can manage to do so. Many insurance companies do not cover the GlaxoSmithKline anyway.So, do you Parnate users out there buy the generic or the brand name?
Does the generic work well for you?
And anyone who has used both. Did you notice a difference?
Here is a link to a great website that offers discounts:
http://www.goodrx.com/
Posted by baseball55 on January 1, 2013, at 18:49:12
In reply to Which do you use generic vs. brand name Parnate, posted by metamorphosis on January 1, 2013, at 17:24:02
I never used anything but generic. Didn't even realize there was a brand-name of parnate. I'm sure my insurance company would refuse to pay for the brand-name and I don't blame them. Parnate has been around so long, it's remarkable a brand name even exists. It's like having brand name penicillin.
Posted by Phillipa on January 1, 2013, at 20:29:21
In reply to Re: A nice surprise, Dr. Gillman responds to question » Phillipa, posted by SLS on January 1, 2013, at 7:01:25
Poster doesn't want weight gain and seems to really wish to use trazadone. Antipsychotics are in very many cases weight gaining med that can lead to diabetes.
Again the quote from Dr Gillman
"I would most definitely not be in favour of using antipsychotics as sleep aids. It is both unnecessary and carries completely unacceptable risks including that of NMS"
So I base what I wrote on his. Phillipa
Posted by g_g_g_unit on January 2, 2013, at 1:12:54
In reply to Re: A nice surprise, Dr. Gillman responds to question » SLS, posted by Phillipa on January 1, 2013, at 20:29:21
You should try Skyping with him sometime too. Really nice, funny, caring, personable guy.
Posted by caller on January 4, 2013, at 14:46:20
In reply to Re: A nice surprise, Dr. Gillman responds to question » metamorphosis, posted by SLS on January 1, 2013, at 14:00:26
> Buspar (buspirone) might help, but it often takes a few weeks to begin working.
Ah, precisely the kind of information I was looking for!
Do you think 5 mg BID of buspirone should be safe with 50 - 60 mg Parnate?
I'm a bit worried about the noradrenergic metabolite of buspirone! Especially since it's supposed to hit you pretty hard. I've already added amphetamine as well..
I could of course eat lots of grapefruit (CYP34A inhibitor) but on the other hand I'm also taking modafinil (CYP34A inducer).
(Yeah lot of drugs I know but I need them badly unfortunately :/)
Posted by SLS on January 5, 2013, at 8:56:04
In reply to Re: A nice surprise, Dr. Gillman responds to question, posted by caller on January 4, 2013, at 14:46:20
You have a good handle on pharmacology.
> > Buspar (buspirone) might help, but it often takes a few weeks to begin working.
>
> Ah, precisely the kind of information I was looking for!
> Do you think 5 mg BID of buspirone should be safe with 50 - 60 mg Parnate?1-PP? Yeah, it works in a manner similar to Remeron. I am hesitant to suggest that the combination is perfectly safe. I haven't tried it myself. Hypertension is the major concern. 1-PP is the reason I have avoided Buspar. Remeron and an investigational drug called idazoxan both exacerbate my depression. I think the culprit mechanism is NE alpha-2 antagonism.
I wish I could be of more help. Perhaps someone who has actually tried combining a MAOI with Buspar will offer some feedback.
- Scott
This is the end of the thread.
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