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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Axmann on January 31, 2016, at 5:46:37
History: 24-year-old male with severe ADD-PI, extremely treatment-resistant depression, and lifelong insomnia.
I'm at the end of my second week of my first time trying Parnate. My response to Parnate has been absolutely miraculous: Social skills increased about tenfold, ability to put words together increased, finally feel somewhat happy for the very first time in my life.
-I take 10 mg dextroamphetamine TID for my ADD-PI.
-The first week I took 10 mg Parnate in the morning and 10 mg Parnate at noon.
-The second week I took 20 mg Parnate in the morning, and 10 mg Parnate at noon.There's one huge, GIGANTIC, severe roadblock to happiness: the insomnia with Parnate.
I have had insomnia my entire life, so I am not new to sleeping problems. However, something was always able to put me to sleep if needed, and I would always catch up with quite a few hours after a restless night before.
Then came Parnate. The insomnia I get with Parnate is so outrageous and extreme I honestly don't know how to proceed.
On my worst night, (keep in mind this is idiotic and dangerous, so please *DO NOT* attempt it), a sleep cocktail consisting of trazodone, Lunesta, 7.5 mg mirtazapine, Rozerem and suvorexant (Belsomra) put me out for a whole... 2.5 hours. I was absolutely floored. Before Parnate, 7.5 mg mirtazapine alone was my never-lets-me-down sleep med, which would knock me out for 16-17 hours on those days I really needed saving.
It's definitely the Parnate, not the dextroamp. I slept like a baby with only Lunesta when I was taking 75 mg Effexor XR and 30 mg Adderall IR daily. The stimulant med is absolutely non-negotiable; without it, functioning is impossible. I have given Focalin, Concerta, and Strattera fair trials which were unsuccessful.
I am at wit's end. What do I do? I don't want to give up on the one antidepressant that has given me my life back, but without sleep, this is not physically sustainable.
Would cutting back to 20 mg daily help? Taking the dose all at once in the morning? Higher dose of trazodone at night? Would switching to Nardil help?
I am not (nor have I ever been) suicidal, but I am desperate to be happy. Please help.
Posted by linkadge on January 31, 2016, at 6:47:30
In reply to Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 5:46:37
I briefly took parnate before, and while it was fantastic for mood, the insomnia ultimately made me a bit psychotic. Also, I developed spontaneous hypertensive reactions which put me in the hospital.
The thing to keep in mind is that parnate can intensify amphetamine substantially. The released monoamines (especially dopamine) are going to linger much longer in your brain. Elevated dopamine is what causes the sleep phase delay, often seen with MAOI's.
How much parnate are you taking? You may need to reduce it, and / or take something like Seroquel.
Serotonin antagonists (trazodone / mirtazapine etc) alone are likely not going to help the insomnia.I would focus on getting the insomnia under control before the ADD, but that's just me.
Linkadge
Posted by SLS on January 31, 2016, at 7:40:28
In reply to Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 5:46:37
Hi.
Welcome. Thanks for stopping in. I hope you decide to stick around for awhile. We can use some new faces. Try to ignore the troll (Please see below). Most forums seem to attract at least one.
> History: 24-year-old male with severe ADD-PI, extremely treatment-resistant depression, and lifelong insomnia.
What does the "PI" stand for in ADD-PI?
1. What happens when you go up to 15 mg of mirtazapine (Remeron)?
2. Quetiapine (Seroquel) at relatively low dosages (25-100mg) can help. Even low-dose risperidone (Risperdal) is worthy of consideration.
3. How do you respond to zolpidem (Ambien)?
4. It might be time for a high-potency benzodiazepine (BZD). Triazolam (Halcion) has the best chance of putting you to sleep (initiation). However, it has a very short half-life, and often doesn't keep you asleep (maintenance) for the whole night. You would need something with a longer half-life to combine it with. You can either experiment with the drugs you already take, or add a second BZD. I like lorazepam (Ativan) and temazepam (Restoril). They have an intermediate half-life, and do not tend to produce a hangover the next morning. Both are very clean drugs and don't make you feel sedated. Halcion really is the most potent hypnotic BZD, and should help more than Ambien or Lunesta. At some point in the future, Parnate might not cause as much insomnia such that you can perhaps remove the BZDs gradually, although I don't think it is necessary. Regarding BZDs, memory, and Alzheimer's Dementia, I would need to see more convincing evidence that there is a significant problem. If it does raise the risk, it can't be by that much. Untreated depression represents a greater risk. People take BZDs their whole lives without a problem. Anyway, you can use them as a temporary bridge until something better comes along.
5. Wait for the Parnate to settle-in. The first time I tried it, I could not sleep a single minute for the first three weeks. Then, I used the Halcion-Ativan strategy and slept very well. Now that I've been on Parnate 80-120 mg/day for an extended period of time, I sleep without needing sleep-aids.
6. You can give up on Parnate and go to Nardil, but there is no guarantee that it will not interfere with your sleep. Some people get insomnia with Nardil, although the incidence is less than Parnate. I should mention another MAOI called isocarboxazid (Marplan). My guess is that it would affect your sleep the least among the non-selective MAOIs, which tend to work best.
7. With Parnate on board, you might be able to reduce your dosage of amphetamine. Parnate was used for ADD many years ago. Parnate has amphetamine-like properties. It may be that the combination of Parnate and amphetamine works synergistically in producing insomnia.
If I were you, I would not let the insomnia be an obstacle until you try a few more things to treat it aggressively. However, I would not head in the direction of using barbiturates. They are way too dangerous. Alcohol is counterproductive.
* One last note. Most people end up needing 40-80 mg/day of Parnate for maximum benefit. If you begin to lose the therapeutic effect or plateau, don't worry about it too much. You should be able to recapture the antidepressant response at higher dosages.
My vote is to first add Halcion to what you are already taking. It would be the simplest thing to try first. If you find that it puts you to sleep, but you find yourself waking up 3 hours later, despite your taking other drugs, you might then drop the Lunesta and replace it with either Ativan or Restoril.
I'm sure other people here will be able to come up with other ideas for you. These are the strategies I am most familiar with.
Good luck.
- Scott---------------------------------------------
Internet troll:
"In Internet slang, a troll (/ˈtroʊl/, /ˈtrɒl/) is a person who sows discord on the Internet by starting arguments or upsetting people, by posting inflammatory,[1] extraneous, or off-topic messages in an online community (such as a newsgroup, forum, chat room, or blog) with the deliberate intent of provoking readers into an emotional response[2] or of otherwise disrupting normal on-topic discussion,[3] often for their own amusement."
-Wikipedia
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Posted by SLS on January 31, 2016, at 7:47:06
In reply to Re: Parnate insomnia: please help., posted by linkadge on January 31, 2016, at 6:47:30
> I briefly took parnate before, and while it was fantastic for mood, the insomnia ultimately made me a bit psychotic. Also, I developed spontaneous hypertensive reactions which put me in the hospital.
>
> The thing to keep in mind is that parnate can intensify amphetamine substantially. The released monoamines (especially dopamine) are going to linger much longer in your brain. Elevated dopamine is what causes the sleep phase delay, often seen with MAOI's.
>
> How much parnate are you taking? You may need to reduce it, and / or take something like Seroquel.
> Serotonin antagonists (trazodone / mirtazapine etc) alone are likely not going to help the insomnia.Good stuff.
> I would focus on getting the insomnia under control before the ADD, but that's just me.I very much agree with this.
Again, the Parnate alone might help with the ADD more than one would expect. Older studies demonstrate this.
- Scott
Posted by Axmann on January 31, 2016, at 9:13:18
In reply to Re: Parnate insomnia: please help. » Axmann, posted by SLS on January 31, 2016, at 7:40:28
If I were to, say, stop the Parnate completely, do I really need to wait the full 2 weeks before switching to a SNRI (say, Effexor or Pristiq), considering I've only been on Parnate 2 weeks? And how would I manage any withdrawal until then?
Posted by Axmann on February 2, 2016, at 11:28:06
In reply to Re: Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 9:13:18
Anyone?
Posted by baseball55 on February 2, 2016, at 19:02:31
In reply to Re: Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 9:13:18
> If I were to, say, stop the Parnate completely, do I really need to wait the full 2 weeks before switching to a SNRI (say, Effexor or Pristiq), considering I've only been on Parnate 2 weeks? And how would I manage any withdrawal until then?
What I was led to understand, when I switched to parnate, is that you have to do the two week washout no matter how short a period you have been using an MAOI. But I am not an expert. Your doctor should know this.
As for dealing with parnate withdrawal, when I stopped parnate (I have since restarted), I just stopped and had no withdrawal issues at all. But I was using a low dose - 40mg - and I've never had withdrawal problems from SSRIs and SNRIs. My experience may be unusual.
Posted by rose45 on February 6, 2016, at 14:09:46
In reply to Re: Parnate insomnia: please help., posted by baseball55 on February 2, 2016, at 19:02:31
I have many similar symptoms to you... Suffered from insomnia for many years before having to take medication.
I take parnate, 45 mg first thing in the morning. At first I took sleep meds every night as I couldnt sleep at all without them. I would alternate between oxazepam, temazepam and zopiclone ( these are uk names as I live in the Uk). I have now been on parnate for 3 years, and have managed to cut down on the sleep meds and take them only 3 nights per week approx. Also I find that without sleeping meds, I tend to sleep better if I go to bed really late, ie after 2 AM.
Alternatively, you could try Nardil. I was on it for many years, and though it did make me slightly manic, I was finally able to sleep without using any meds at all. At first, when I first took it, it made my insomnia worse, but once it kicked in, after 8 weeks, I was able to sleep really well. I only changed to parnate when the nardil stopped working after 20 years.
Hope that helps and good luck.... I think we all need to experiment and find what suits us best.
Posted by babbler20 on February 8, 2016, at 15:40:02
In reply to Parnate insomnia: please help., posted by Axmann on January 31, 2016, at 5:46:37
I was on parnate and slept like 4 hours a night total. You can't live like that for long and I can't imagine that you are truly happy or productive. You gotta give up the med and find something else.
Posted by Lamdage22 on February 28, 2016, at 7:21:06
In reply to Re: Parnate insomnia: please help. » Axmann, posted by SLS on January 31, 2016, at 7:40:28
Remeron, (but weight gain)
Neurontin, (but weight gain)
Trazodone, (no weight gain)
?
Posted by Lamdage22 on February 28, 2016, at 7:22:45
In reply to Re: Parnate insomnia: please help. » Axmann, posted by SLS on January 31, 2016, at 7:40:28
Low dose Seroquel also.
Trazodone may not be safe with your other meds i dont know.
This is the end of the thread.
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