![[dr. bob]](/dr-bob-sm.gif)
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 PilledOut on July 31, 2016, at 13:37:20
I have treatment-resistant depression, generalized anxiety, social anxiety, OCD, and PTSD.
Nardil didn't work for me - the side effects were too extreme and numerous. I tend to be very sensitive to meds. I've had no luck with meds, and I've taken many of them over the years.
Parnate and Nardil are both MAOIs. If Nardil was so bad for me, would Parnate even be worth trying?
If I do try Parnate, should I take it in combination with other drugs to reduce side effects, improve efficacy, etc.? Is brand name better than generic? Would one generic brand be better than the other?
How about ECT? None of my pdocs have mentioned it, and when I bring it up, they don't take it seriously.
Thanks in advance for your help.
Posted by SLS on July 31, 2016, at 15:32:20
In reply to Nardil was bad - is Parnate worth trying? ECT?, posted by PilledOut on July 31, 2016, at 13:37:20
Hi.
> Nardil didn't work for meIs it that Nardil didn't work for you, or did you stop it because of side effects? How long did you take it for, and what was the dosage? What were the side effects that gave you the most trouble?
> Parnate and Nardil are both MAOIs. If Nardil was so bad for me, would Parnate even be worth trying?
Yes. Parnate is usually more tolerable. I guess it depends on what were your reasons for stopping Nardil. The drugs are different enough such that one can respond well to one and not the other. I must say, though, that your case profile is one that Nardil is tried before Parnate. There is also Marplan, a MAOI in the same chemical family as Nardil (hydrazine) that usually has mild side effects. However, this drug is often described as being a "weak" Nardil. Yet, there are people who do better on it than they do on Nardil.
> If I do try Parnate, should I take it in combination with other drugs to reduce side effects, improve efficacy, etc.?One step at a time, of course. Patience is a virtue that I all but lack, but it can eventually pay off. Yes, there are remedies for MAOI side effects - even for Nardil. And yes, there are drugs you can add as adjuncts to a MAOI, but you really have to be confident that there is a need for one.
> Is brand name better than generic? Would one generic brand be better than the other?
I don't really know. Some people swear by Mercurypharma (formerly Goldshield). I take whatever type of tranylcypromine that the pharmacy gives me. So far, I haven't found a difference between manufacturers, including the original name brand.
> How about ECT? None of my pdocs have mentioned it, and when I bring it up, they don't take it seriously.
I had a course of 15 ECT treatments in 1991. It didn't work at all. Perhaps it has been improved upon since then. I would recommend trying intranasal ketamine before ECT. I don't know what you have tried, so I can't really offer any suggestions on what treatments to explore first.
How old were you when you first developed symptoms?
How old are you now?
Is there a history of bipolar disorder in your family?
Have you tried clomipramine (Anafranil) yet? It cannot be combined with a MAOI. Neither can SSRIs, SNRIs, nor any drug that is a serotoning (5-HT) reuptake inhibitor.
I have bipolar depression that very likely emerged as a result of a history of developmental PTSD (complex trauma). Social anxiety had been a big part of my overall condition. However, I think psychotherapy may have helped to reduce its magnitude, though.
This is what I currently take:
Parnate 80 mg/day
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 30 mg/daySo, you see, medication regimes can get complicated. I am responding partially at this point. The nortiptyline dosage might be too low. I won't know for another week. The other drugs have proven necessary, and I am taking the lowest effective dosage of each one as has been ascertained through clinical experimentation. It took quite a few years to develop this treatment. If I don't respond fully to this combination, I might drop the Parnate and substitute it with Effexor at a minimum dosage of 300 mg/day.
- Scott
Posted by linkadge on July 31, 2016, at 17:06:14
In reply to Re: Nardil was bad - is Parnate worth trying? ECT? » PilledOut, posted by SLS on July 31, 2016, at 15:32:20
I agree, that you should exhaust major treatment options before trying ECT.
Ketamine, scopolamine, or rTMS may be worth exploring. The venlafaxine / remeron combination can be highly effective as well.
If you haven't tried SAMe, this is an 'alternative' adjunct with fairly solid clinical data to support its use.
Linkadge
Posted by PilledOut on July 31, 2016, at 19:15:58
In reply to Re: Nardil was bad - is Parnate worth trying? ECT? » SLS, posted by linkadge on July 31, 2016, at 17:06:14
Hi linkadge,
I've tried dozens of different meds over the years. It's even more if you count combinations. But I have not tried ketamine, scopolamine, or rTMS yet.
I've tried venlafaxine two separate times, one time for over a year. It didn't help, and it gave me severe nausea all the time. I believe I've tried Remeron, too, and it didn't help.
I haven't tried SAMe yet. But I tried various supplements, including St. John's Wort, Ashwagandha, fish oil pills, L-Theanine, and more. I tried them for months at a time, but none of them helped.
Posted by PilledOut on July 31, 2016, at 19:27:10
In reply to Re: Nardil was bad - is Parnate worth trying? ECT? » PilledOut, posted by SLS on July 31, 2016, at 15:32:20
Hi SLS, I wrote about my Nardil experience here:
http://www.dr-bob.org/babble/20160609/msgs/1090174.html>Is it that Nardil didn't work for you, or did you stop it because of side effects?
I stopped it because of extreme and numerous side effects. I really gave it a good try.>How long did you take it for, and what was the dosage?
About 1.5 months. Started at 7.5mg, titrated up to 45 mg.>What were the side effects that gave you the most trouble?
Worst was the panic attack - it was terrifying, and I thought I needed to go to the ER. And there was another day that I had extreme symptoms as well - felt extremely sick, couldn't stand/walk straight, sharp zaps in head, dizzy, and weirdest of all - loud sounds were much louder, distinct, tinny, and trippy. Some of these symptoms sound typical, but on that day, they were extreme.>How old were you when you first developed symptoms?
About age 11>How old are you now?
Mid-30s>Is there a history of bipolar disorder in your family?
No.>Have you tried clomipramine (Anafranil) yet?
Yes, also gave me panic attack on the bus. Also made me weak, sickly, pallor in face, dilated eyes, etc.Thanks for your responses - I appreciate it.
Posted by Christ_empowered on August 2, 2016, at 9:10:48
In reply to Nardil was bad - is Parnate worth trying? ECT?, posted by PilledOut on July 31, 2016, at 13:37:20
I hope you don't opt for ECT. The relapse rates are high, even with meds, and the ill effects can be devastating for some people.
Effexor+remeron has been studied and found to about as effective as parnate, with different (and less deadly) adverse effects and no dietary restrictions. Remeron can be used as a booster for any number of antidepressants, but I don't think other combinations have been well-studied.
I'm clearly not any kinda expert,but I'd give "california rocket fuel" a whirl before you sign up for electroshock.
Posted by Lamdage22 on August 2, 2016, at 15:49:20
In reply to Re: Nardil was bad - is Parnate worth trying? ECT?, posted by Christ_empowered on August 2, 2016, at 9:10:48
I dont like electroshock either. I have seen a few do it and they were not better afterwards.
Posted by SLS on August 2, 2016, at 15:51:41
In reply to Re: Nardil was bad - is Parnate worth trying? ECT?, posted by Christ_empowered on August 2, 2016, at 9:10:48
> Effexor+remeron has been studied and found to about as effective as parnate,
This can be a very deceptive way of wording things. I see it used all of the time, even by scientists.
Statistically, the two treatments might produce an equal number of therapeutic responses, but not for the same people. In other words, Parnate most definitely can be more effective than Effexor+Remeron in one individual but not in another. It is not true that we can discontinue the manufacture of Parnate, or all other antidepressants, just because Effexor+Remeron has been shown to work on the greatest number of people. (I doubt that it does). There is no magic bullet here - not yet, anyway.
- Scott
Posted by Baseball55 on August 2, 2016, at 20:51:15
In reply to Re: Nardil was bad - is Parnate worth trying? ECT?, posted by SLS on August 2, 2016, at 15:51:41
I did both unilateral and bilateral ECT and neither relieved my depression at all. But bilateral sure screwed up my memory (though it came back, fortunately). Given the cost, time and general misery of doing ECT, I'd treat it as a last resort.
This is the end of the 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.