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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by SLS on May 8, 2000, at 7:30:18
Hi all.
A recent consultation with a psychiatrist in NYC yielded an old answer to the question of how to treat my refractory bipolar depression.Parnate.
He thinks I should take Parnate and throw everything possible at it. He was thinking along the lines of using stimulants and dopaminergic drugs.
Any ideas?
I am particularly interested to receive some feedback regarding the following combinations:
1. Parnate + amisulpride or sulpiride
2. Parnate + Provigil (modafinil) or adrafinil
3. Parnate + mazindol (Mazinor)
4. Parnate + amineptine
5. Parnate + Adderal or Desoxyn
6. Parnate + pramepexole (Mirapex)
Any and all comments are greatly appreciated.Thanks.
- Scott
Posted by AndrewB on May 8, 2000, at 14:11:09
In reply to Parnate + amisulpride, Provigil, Mirapex..., posted by SLS on May 8, 2000, at 7:30:18
Scott,
There was a post about a month or so ago that you may want to search back for that talked of someone's experience combining a stimulant with an MAOI, Parnate I think. an excessive rise in blood pressure was a concern, so when the stimulant was first added, the doctor watched the blood pressure for awhile in his office.
Posted by JohnL on May 9, 2000, at 4:22:51
In reply to Parnate + amisulpride, Provigil, Mirapex..., posted by SLS on May 8, 2000, at 7:30:18
> Hi all.
>
>
> A recent consultation with a psychiatrist in NYC yielded an old answer to the question of how to treat my refractory bipolar depression.
>
> Parnate.
>
> He thinks I should take Parnate and throw everything possible at it. He was thinking along the lines of using stimulants and dopaminergic drugs.
>
> Any ideas?Though we don't hear too much of these combinations today, they weren't uncommon in the older days. MAOIs + dopamine drugs or norepinephrine drugs don't have nearly the danger of combinations with serotonin drugs. I would think all the combinations you mentioned are quite possible candidates.
You should rule out Amineptine though. A few suppliers still have it in stock--for a while--but it isn't being marketed anymore and will likely run out at some point. I would hate to get better on a drug only to find out I can't get it refilled down the road.
Of the other choices, I think what would be more in line with what they did in the older days would be to add Ritalin or Adderall. Amisulpride or adrafinil could be good choices too, but are not as easy to get. And if you have insurance, it won't cover them. Adding a norepinephrine AD like Desipramine could be considered as well.
Provagil and Mirapex are decent choices too, though they don't have hardly any track record yet for the purposes you mention. In your shoes I would start with just Parnate and see how that goes. It might be all you need. If something else is needed later, then I would look first at the more common things they used to do in the older days. After that I would branch out into uncharted waters. But only after trying more conventional things first. That's just what I would do.
JohnL
>
> I am particularly interested to receive some feedback regarding the following combinations:
>
> 1. Parnate + amisulpride or sulpiride
>
> 2. Parnate + Provigil (modafinil) or adrafinil
>
> 3. Parnate + mazindol (Mazinor)
>
> 4. Parnate + amineptine
>
> 5. Parnate + Adderal or Desoxyn
>
> 6. Parnate + pramepexole (Mirapex)
>
>
> Any and all comments are greatly appreciated.
>
> Thanks.
>
>
> - Scott
Posted by SLS on May 9, 2000, at 7:08:41
In reply to Re: Parnate + amisulpride, Provigil, Mirapex..., posted by JohnL on May 9, 2000, at 4:22:51
Hey guys.
Much thanks for your replies.
Scott:
> > I am particularly interested to receive some feedback regarding the following combinations:
> >
> > 1. Parnate + amisulpride or sulpiride
> >
> > 2. Parnate + Provigil (modafinil) or adrafinil
> >
> > 3. Parnate + mazindol (Mazinor)
> >
> > 4. Parnate + amineptine
> >
> > 5. Parnate + Adderal or Desoxyn
> >
> > 6. Parnate + pramepexole (Mirapex)
AndrewB:
> There was a post about a month or so ago that you may want to search back for that talked of someone's experience combining a stimulant with an MAOI, Parnate I think. an excessive rise in blood pressure was a concern, so when the stimulant was first added, the doctor watched the blood pressure for awhile in his office.I think that was me.
JohnL:
> Though we don't hear too much of these combinations today, they weren't uncommon in the older days. MAOIs + dopamine drugs or norepinephrine drugs don't have nearly the danger of combinations with serotonin drugs. I would think all the combinations you mentioned are quite possible candidates.
I've tried the following:- Parnate 60mg + desipramine + Ritalin
- Parnate 120mg + desipramine + Lamictal
- Parnate 120mg + desipramine + Dexedrine + Synthroid (T4)
- Parnate 120mg + desipramine + bromocryptine (Parlodel)
- Parnate 80mg + imipramine + Lamictal + Depakote
Parnate monotherapy produces a mild three-day improvement beginning anywhere between one to two weeks after the first dose. Desipramine and imipramine each produce a moderate to robust three-day improvement beginning on day 13 or 14. Combinations of these can produce a mild improvement in energy that is longer lasting. Both Dexedrine and Parlodel each produce an additional mild improvement for the first three or four-days, and then fades.I haven't tried Adderal.
> You should rule out Amineptine though. A few suppliers still have it in stock--for a while--but it isn't being marketed anymore and will likely run out at some point. I would hate to get better on a drug only to find out I can't get it refilled down the road.
I know. Sometimes I just want to feel good no matter what.
> Provagil and Mirapex are decent choices too, though they don't have hardly any track record yet for the purposes you mention. In your shoes I would start with just Parnate and see how that goes. It might be all you need. If something else is needed later, then I would look first at the more common things they used to do in the older days. After that I would branch out into uncharted waters. But only after trying more conventional things first. That's just what I would do.
I am very, very interested in the combinations of Parnate with Provigil and/or mazindol (Mazinor). It is my hope that mazindol, an antiobesity drug, may be able to fill a role similar to amineptine. It is a potent dopamine reuptake inhibitor that is often used as a biological probe to assay dopamine transporter. It also inhibits the reuptake of norepinephrine to a degree. I had thought to use it as an adjunct to Parnate and/or amisulpride.
Feel free to continue brainstorming!
:-) Thanks again.
- Scott
Posted by Sherry on May 9, 2000, at 17:56:22
In reply to Re: Parnate + amisulpride, Provigil, Mirapex..., posted by SLS on May 9, 2000, at 7:08:41
Hey Scott,
I don't know much about your depression, but I am wondering if you have looked into physical causes of your depression? I have been researching cushing's syndrome, and I have pretty much all the symptoms. Plus, I don't respond to any AD's. However, unlike you, I can't tolerate them even at low doses. I go Thursday to begin being tested for it. I have been to many doctors and no one even thought of it. I did the research myself, and my doctor scratched his head, looked puzzled, and said, "it's a definite possibility." I don't know, but we'll see. Just a thought. ~Sherry
> Hey guys.
>
> Much thanks for your replies.
>
>
> Scott:
> > > I am particularly interested to receive some feedback regarding the following combinations:
> > >
> > > 1. Parnate + amisulpride or sulpiride
> > >
> > > 2. Parnate + Provigil (modafinil) or adrafinil
> > >
> > > 3. Parnate + mazindol (Mazinor)
> > >
> > > 4. Parnate + amineptine
> > >
> > > 5. Parnate + Adderal or Desoxyn
> > >
> > > 6. Parnate + pramepexole (Mirapex)
>
>
> AndrewB:
> > There was a post about a month or so ago that you may want to search back for that talked of someone's experience combining a stimulant with an MAOI, Parnate I think. an excessive rise in blood pressure was a concern, so when the stimulant was first added, the doctor watched the blood pressure for awhile in his office.
>
> I think that was me.
>
>
> JohnL:
> > Though we don't hear too much of these combinations today, they weren't uncommon in the older days. MAOIs + dopamine drugs or norepinephrine drugs don't have nearly the danger of combinations with serotonin drugs. I would think all the combinations you mentioned are quite possible candidates.
>
>
> I've tried the following:
>
> - Parnate 60mg + desipramine + Ritalin
>
> - Parnate 120mg + desipramine + Lamictal
>
> - Parnate 120mg + desipramine + Dexedrine + Synthroid (T4)
>
> - Parnate 120mg + desipramine + bromocryptine (Parlodel)
>
> - Parnate 80mg + imipramine + Lamictal + Depakote
>
>
> Parnate monotherapy produces a mild three-day improvement beginning anywhere between one to two weeks after the first dose. Desipramine and imipramine each produce a moderate to robust three-day improvement beginning on day 13 or 14. Combinations of these can produce a mild improvement in energy that is longer lasting. Both Dexedrine and Parlodel each produce an additional mild improvement for the first three or four-days, and then fades.
>
> I haven't tried Adderal.
>
> > You should rule out Amineptine though. A few suppliers still have it in stock--for a while--but it isn't being marketed anymore and will likely run out at some point. I would hate to get better on a drug only to find out I can't get it refilled down the road.
>
> I know. Sometimes I just want to feel good no matter what.
>
> > Provagil and Mirapex are decent choices too, though they don't have hardly any track record yet for the purposes you mention. In your shoes I would start with just Parnate and see how that goes. It might be all you need. If something else is needed later, then I would look first at the more common things they used to do in the older days. After that I would branch out into uncharted waters. But only after trying more conventional things first. That's just what I would do.
>
> I am very, very interested in the combinations of Parnate with Provigil and/or mazindol (Mazinor). It is my hope that mazindol, an antiobesity drug, may be able to fill a role similar to amineptine. It is a potent dopamine reuptake inhibitor that is often used as a biological probe to assay dopamine transporter. It also inhibits the reuptake of norepinephrine to a degree. I had thought to use it as an adjunct to Parnate and/or amisulpride.
>
> Feel free to continue brainstorming!
>
> :-) Thanks again.
>
>
> - Scott
Posted by Janice on May 9, 2000, at 18:10:16
In reply to Re: Parnate + amisulpride, Provigil, Mirapex-SLS, posted by Sherry on May 9, 2000, at 17:56:22
Hi Scott,
I'm not sure why you can't tolerate ADs, if it's because of the side effects or because they increase rapid cycling.
Desipramine can really increase the cycling, if this is your problem. I've heard this is true for all the TCAs.
Have you tried stimulants before? They really helped my bipolar disorder. If I don't have ADD, I am definately on the continum towards it. But I believe the stimulants really helped my rapid cycling--keeping my energy stable, helping to prevent the mania. Let me know if you'd like to know more about it Scott.
Also read what Peter J wrote in the thread 'Drugs for Creativity', about stimulants and bipolar, if you are interested.
Good luck Scott, Janice
Posted by JohnL on May 10, 2000, at 3:28:14
In reply to Re: Parnate + amisulpride, Provigil, Mirapex..., posted by SLS on May 9, 2000, at 7:08:41
> Feel free to continue brainstorming!
>
> :-) Thanks again.
>
>
> - ScottScott,
I'm curious what other medications you have tried. I am aware of the list with all the Parnate combinations in your previous post. Very interesting. But I'm curious as to what other medications have been tried other than the Parnate combinations. ???
JohnL
Posted by SLS on May 11, 2000, at 6:36:59
In reply to Re: Parnate + amisulpride, Provigil, Mirapex-SLS, posted by Janice on May 9, 2000, at 18:10:16
Sherry:
>Hey Scott,
>
> I don't know much about your depression, but I am wondering if you have looked into physical causes of your depression? I have been researching cushing's syndrome, and I have pretty much all the symptoms. Plus, I don't respond to any AD's. However, unlike you, I can't tolerate them even at low doses. I go Thursday to begin being tested for it. I have been to many doctors and no one even thought of it. I did the research myself, and my doctor scratched his head, looked puzzled, and said, "it's a definite possibility." I don't know, but we'll see. Just a thought. ~SherryThank-you, Sherry.
I have been wondering quite a bit about this lately. Perhaps there is another component of my condition that is not being treated. Please let me know how you progress with your pursuit of Cushing's.
If you haven't already done so, grab a hold of Cam W.'s ear (monitor) and ask for his input regarding your thoughts on Cushing's. He has been concentrating much of his research recently on how disturbances in cortisol/ACTH/CRH functions may contribute to mood-disorders.
-------------------------------------------
Janice:Hi. :-)
> I'm not sure why you can't tolerate ADs, if it's because of the side effects or because they increase rapid cycling.
They don't produce rapid-cycling (although I wish they would sometimes). I did experience ultra-rapid cycling for the two years (age 20-22) prior to being diagnosed and treated. When I was given lithium, the cycling stopped.
Many antidepressants have actually made the depression itself much worse. I don't recall discontinuing an antidepressant because of side effects, although they have been pretty bad sometimes. The only drug I recall having to stop was Neurontin once I exceeded 1200mg/day. It really screwed me up cognitively. It was as if I were living behind a pane of shattered glass. Weird.
My biggest problem is that any significant improvement produced by drug therapy only lasts for a few days to a week.
> Desipramine can really increase the cycling, if this is your problem. I've heard this is true for all the TCAs.
I've heard this too.
> Have you tried stimulants before? They really helped my bipolar disorder. If I don't have ADD, I am definately on the continum towards it.
I was once given Dexedrine by itself. I experienced a partial improvement for a fraction of a day, and then faded. I have tried adding both Dexedrine and Ritalin separately while I was taking a combination of Parnate and desipramine. I don't recall what happened with Ritalin, but Dexedrine helped me a bit for a few days.
I recently consulted with a doctor in NYC who basically recommended that I try throwing stimulants at Parnate while taking mood stabilizers.
> But I believe the stimulants really helped my rapid cycling--keeping my energy stable, helping to prevent the mania.
I am stunned by this. I absolutely believe you.
> Also read what Peter J wrote in the thread 'Drugs for Creativity', about stimulants and bipolar, if you are interested.
I took your suggestion and read Peter's post. I was very surprised. I am so glad that you respond to stimulants this way. Perhaps I will to.
> Let me know if you'd like to know more about it Scott.
- What drugs are you currently taking?
- How are you doing on them?
- How has your cycle(s) changed?
- How long have you been responding to them?
- How has your sleep been affected?
- Which of the stimulants have you found to be the most helpful?
- Do you think that you are all fixed?> Good luck Scott, Janice
You are such a doll.
- Scott
Posted by Janice on May 13, 2000, at 0:20:05
In reply to Re: Parnate + amisulpride, Provigil, Mirapex-SLS, posted by SLS on May 11, 2000, at 6:36:59
hello Scott
>
> - What drugs are you currently taking?•1200 mg of lithium & Dexedrine as needed.
> - How are you doing on them?
•Pretty good, other than the acne and feeling pretty stupid--both from the lithium.
> - How has your cycle(s) changed?
•now instead of 1/2 week high and 1/2 week low (14 years), I'm 1 week with a mood level at a 6 and the next week I am at a mood level of a 4. I am hoping this continues to flatten.
> - How long have you been responding to them?
•sorry Scott not sure what you mean.
> - How has your sleep been affected?
•Of course, my sleep goes again with my moods. On my good week, I need 8.5 hours of sleep. On my not so good week, it's an effort to get out of bed (If I let myself, I'd sleep at about 10 hours).
> - Which of the stimulants have you found to be the most helpful?
•I've only tried Dexedrine. When something works, I'm very loyal.
> - Do you think that you are all fixed?
•I'm hoping I'm pretty damn close, just some fine tuning. It's starting to feel kind of like a miracle that I'm scared to believe in.
I can see why you've learnt so much Scott. Your disorder sounds like a very difficult variety of an already difficult disorder to treat.Please keep us updated.
Janice
Posted by SLS on May 13, 2000, at 9:16:15
In reply to Scott…, posted by Janice on May 13, 2000, at 0:20:05
Hi Janice.
> > - How has your cycle(s) changed?
>
> •now instead of 1/2 week high and 1/2 week low (14 years), I'm 1 week with a mood level at a 6 and the next week I am at a mood level of a 4. I am hoping this continues to flatten.It sounds awfully promising. I'll be keeping my eyes crossed for you.
> > - How long have you been responding to them?
>
> •sorry Scott not sure what you mean.I guess I was asking for how long you have felt better. I was hoping to hear that there had been a stable improvement. I'm glad to see that there has. That's really great to hear.
Does the Dexedrine help you now as much as when you first began using it?
> > - Which of the stimulants have you found to be the most helpful?
>
> •I've only tried Dexedrine. When something works, I'm very loyal.Oh yeah.
> > - Do you think that you are all fixed?
>
> •I'm hoping I'm pretty damn close, just some fine tuning. It's starting to feel kind of like a miracle that I'm scared to believe in.I know this feeling.
> I can see why you've learnt so much Scott. Your disorder sounds like a very difficult variety of an already difficult disorder to treat.
Yes. (tears)
Thanks for your heart-warming concern.
- Scott
This is the end of the thread.
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