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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Lorraine on August 29, 2001, at 13:58:24
I just started Parnate (1 month) and have noticed that in the afternoon I have a serious crash in terms of energy and a deep need to sleep. Usually, this is after I have eaten lunch. Elizabeth complained of the same thing when she was on MAOs and thinks that it is common. I took my blood pressure during one of these slumps and found it to be 93 over 56--very low. I think the slump is tied to low blood pressure and possibly the diversion of blood to the stomach after eating. In addition, I was getting headaches in the morning, although these have abated.
With this in mind, I researched neurally mediated hypotension to see what remedies where suggested. John Hopkins (www.med.jhu.edu/peds/sfs.html) noted some of the symptoms as including chronic fatigue, headaches, mental fogs. The symptoms of true neurally mediated hypotension can be quite severe and do not apply to MAOs generally, but I thought some of the remedies might help with low blood pressure symptoms of MAOs. Among the do it yourself remedies were drinking lots of fluids, eating more frequent smaller meals, and increasing the amount of salt in the diet. They note that adults require between 2000 and 3000 mg of sodium normal, but that people with neurally mediated hypotension require much hight amount and and that it is diffifult to take too much if you drink lots of fluids. Table salt provides 2300 mg of sodium per teaspoon. You can also take salt tablets--they recommend stating with one 450 mg tablet 3x day and working up to two tablets (900mg) 3x day. They recommend Thermotab--which is a buffered salt tablet that is better tolerated. Thermotabs are carried in some pharmacies. I have ordered some and will be trying them out next week.
Does anyone have any thoughts about the MAO midday slump?
Posted by Jane D on August 29, 2001, at 14:18:30
In reply to MAO Midday Slump--Low Blood Pressure?, posted by Lorraine on August 29, 2001, at 13:58:24
Lorraine,
Do you have any reason to believe this is restricted to MAO's? I'm grappling with the same kind of slump on a mix of meds but I've never checked BP while it's happening.
Jane
Posted by IanSFO on August 29, 2001, at 19:27:24
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Lorraine, posted by Jane D on August 29, 2001, at 14:18:30
> Lorraine,
> Do you have any reason to believe this is restricted to MAO's? I'm grappling with the same kind of slump on a mix of meds but I've never checked BP while it's happening.
> JaneMidafternoon narcolepsy-like sleepiness is a common side effect with MAOIs. When I was on Parnate, I had the problem for at least a month, but it did go away within six weeks.
Posted by Lorraine on August 29, 2001, at 19:30:41
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Lorraine, posted by Jane D on August 29, 2001, at 14:18:30
> Do you have any reason to believe this is restricted to MAO's? I'm grappling with the same kind of slump on a mix of meds but I've never checked BP while it's happening.
Jane: I don't even know that that is what the deal is with MAOs--it's just my theory. Do the meds you are on cause low blood pressure generally or have orthostatic hypertension as a side effect?
Lorrraine
Posted by Grouch on August 29, 2001, at 21:34:05
In reply to MAO Midday Slump--Low Blood Pressure?, posted by Lorraine on August 29, 2001, at 13:58:24
I experienced the same daily "crash" (but at 4 PM or so, and not after eating) when I was on Parnate. I stayed on Parnate for several years, but that particular side effect never really went away. I don't know if my blood pressure was low during the slump. I always attributed it to the circadian rhythm disruption that Parnate causes, but that's just a guess.Have you checked your blood pressure before and after the slump for comparison?
Also, if the salt tablets aren't helpful, another option might be a very small dose of a stimulant, though this runs the risk of the opposite problem (hypertensive crisis), particularly with Parnate.
Posted by Rick on August 29, 2001, at 23:15:26
In reply to MAO Midday Slump--Low Blood Pressure?, posted by Lorraine on August 29, 2001, at 13:58:24
After I complained to my pdoc because Nardil turned me from hypertensive to way-hypotensive, he first suggested salt but then gave me Florinef when salt didn't work. The Florinef helped a lot, but it is a corticosteroid, so it definitely should not be taken for a protracted period of time.I always wondered if I would have adjusted to the hypostension had I stuck with Nardil more than four weird weeks. I recall one article on MAOI's that said the initial and sometimes-precipitous drop in BP is paradoxically replaced by a somewhat hypertensive effect after awhile. I'd be curious to know if any MAOI users have experienced this kind of reversal pattern.
Rick
Posted by SLS on September 1, 2001, at 7:45:44
In reply to MAO Midday Slump--Low Blood Pressure?, posted by Lorraine on August 29, 2001, at 13:58:24
Hi.
> Does anyone have any thoughts about the MAO midday slump?Well, if you experience this within an after eating, it might be an exaggeration of the normal sleepiness that many people experience. Parasympathetic stuff I guess.
Also, I think hours between 1:00 and 3:00 are normal "down-times". This is probably the impetus for the traditional siesta of the Spanish. I find 2:00 the absolute worst.
Your guess regarding low-blood pressure is a good one. While I was on Parnate, one of my doctors suggested that blood-pressure ebbs at about 4:00. I found this to be true. His suggestion was to drink a cup of coffee at this time. I found that it worked well.
That's about all I can think of.
- Scott
Posted by Lorraine on September 3, 2001, at 21:54:29
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Lorraine, posted by SLS on September 1, 2001, at 7:45:44
> Hi.
>
>
> > Does anyone have any thoughts about the MAO midday slump?
>
> Well, if you experience this within an after eating, it might be an exaggeration of the normal sleepiness that many people experience. Parasympathetic stuff I guess.
>
> Also, I think hours between 1:00 and 3:00 are normal "down-times". This is probably the impetus for the traditional siesta of the Spanish. I find 2:00 the absolute worst.
>
> Your guess regarding low-blood pressure is a good one. While I was on Parnate, one of my doctors suggested that blood-pressure ebbs at about 4:00. I found this to be true. His suggestion was to drink a cup of coffee at this time. I found that it worked well.
>
> That's about all I can think of.
>
>
> - Scott
Posted by kregpark@yahoo.com on September 9, 2001, at 4:31:46
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Lorraine, posted by Rick on August 29, 2001, at 23:15:26
Rick: Have you seen Jack Gorman's
"The Essential Guide to Psychiatric Drugs"?
Version 3 is available in small paperback, I think
1997. Excellent book, a lot in a small space,
a reference. Gorman is highly respected, I think
he heads or used to at either Columbia or was
it New York Psychiatric Institute. Could be
confusing with Liebotwitz.Anyway, Gorman has worked with Liebowitz and
others on social phobia over the years and has
*back to topic* (sorry) - the book covers all
antidepressants, benzos etc. The info on Nardil
and Parnate talks about how MAOI side effects
go away over seveal months (mostly go away) -
sexual side effects too but depending on dose
maybe not entirely. While increasing there is
a more benzo feeling like Xanax. More relaxing
during this time. Hypotension on Nardil rarely
a problem after stablizing a few months, it goes
away.Generally, when people stop Nardil due to side
effects after on them and stablizied many months
it will be sexual side effects, possibly insomnia.
With Parnate, it takes much less time to adjust
(not months, more like weeks) - but insomnia and
anxiety is usually the culprit. Actdually
daytime sedation coupled with nighttime insomnia
at high doses.I'm talking a bit too much like an expert here
which I'm not, but I do highly recommend Gorman
edition 3, 1997 smaller paperback.kregpark
>
> After I complained to my pdoc because Nardil turned me from hypertensive to way-hypotensive, he first suggested salt but then gave me Florinef when salt didn't work. The Florinef helped a lot, but it is a corticosteroid, so it definitely should not be taken for a protracted period of time.
>
> I always wondered if I would have adjusted to the hypostension had I stuck with Nardil more than four weird weeks. I recall one article on MAOI's that said the initial and sometimes-precipitous drop in BP is paradoxically replaced by a somewhat hypertensive effect after awhile. I'd be curious to know if any MAOI users have experienced this kind of reversal pattern.
>
> Rick
Posted by kregpark@yahoo.com on September 9, 2001, at 4:42:38
In reply to Re: MAO Midday Slump? Thank-you all nm, posted by Lorraine on September 3, 2001, at 21:54:29
Hi,
I took Nardil 90mg 2 years several years back
for severe SP, and I experienced exactly the same
thing.At the time I took lots of caffiene drinks.
Helped but problem still there for awhile.
Gormans' "Essential Guide to Psychiatric Drugs"
v3, 1997, paperback, small, $8, mentions this
about Nardil, and that timing of dosing makes
little difference, it tends to happen around 2-3
if it happens.I now take 60 Nardil, 2.5 Klonopin, 75 Provigil.
Amazingly I discovered something new yesterday.
Neostigmine reversed some (what I thing wass
anticholinergic sedation) when I was out late,
tired and took 7mg more Nardil, about 10mg
Wellbutrin, and 25mg Provigil, but felt lousy
and unsocial. Was late and I was going to head out
when I decided to try a 7.5 neostigmine just
for the heck of it.(I usually don't tinker around anymore like
above as it doesn't usually pay for me, I did,
but was *amazed* how quickly I turned around
on the 7.5 (very little) neostigmine.I was alert and happy again, hung around till 1am
and left. Driving home suddenly I was feeling
something like either hypomanic (a first I believe)
or else a lift of some sort of dysthmia beyond
what I though I had) I felt so good I couldn't
believe it, alert, not stoned, happy as hell,
(it was a great week for me though) - etc.Neostigmine last a few hours.
2 years ago I wanted to try the new cholinergic
called Aricept (donepezil). BTW bethanechol
might also help like neostigmine in afternoon.Aricept has long duration and is getting press now.
I noticed it often can cause mania.I'm not surpirsed and wonder if I had a bit
of hypomania going.In any case, just wanted to throw it out.
kregpark
> > Hi.
> >
> >
> > > Does anyone have any thoughts about the MAO midday slump?
> >
> > Well, if you experience this within an after eating, it might be an exaggeration of the normal sleepiness that many people experience. Parasympathetic stuff I guess.
> >
> > Also, I think hours between 1:00 and 3:00 are normal "down-times". This is probably the impetus for the traditional siesta of the Spanish. I find 2:00 the absolute worst.
> >
> > Your guess regarding low-blood pressure is a good one. While I was on Parnate, one of my doctors suggested that blood-pressure ebbs at about 4:00. I found this to be true. His suggestion was to drink a cup of coffee at this time. I found that it worked well.
> >
> > That's about all I can think of.
> >
> >
> > - Scott
Posted by Rick on September 9, 2001, at 15:36:34
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Rick, posted by kregpark@yahoo.com on September 9, 2001, at 4:31:46
I do highly recommend Gorman
> edition 3, 1997 smaller paperback.
>
> kregparkGood info! I'll have to check out that book.
Rick
Posted by Rick on September 9, 2001, at 15:58:33
In reply to Re: MAO Midday Slump? Thank-you all nm » Lorraine, posted by kregpark@yahoo.com on September 9, 2001, at 4:42:38
> I usually don't tinker around anymore like
> above as it doesn't usually pay for me, I did,
> but was *amazed* how quickly I turned around
> on the 7.5 (very little) neostigmine.I've never heard of neostigmine, although I looked it up. Was that prescribed for psychotrpoic purposes, or did you just accidentally discover that it helps mentally?
>I felt so good I couldn't
believe it, alert, not stoned, happy as hell> (it was a great week for me though)
I don't think I have manic episodes myself, although it's possible (they'd be classified as mild, though). I *do* usually find that when I feel mild euphoria or unusually "up" that life has been treating me well that day or that week, so I'm beginning to doubt that the unusually contented feeling is entitely due to meds and/or spontaneous brain chemistry. Most likely it's a pleasantly synergistic combination chemical and environmental. Spiking the Provigil up definitely adds to the likelihood of such a reaction for me, although as mentioned before, modafinil's been used safely in bp.
Rick
P.S. Do you prefer to be addressed as Kregpark?
Please don't answer, "You can call me Kregpark, you can call me rick_1001, you can call me whatever you want. Just don't call me late for dinner."
Posted by Lorraine on September 10, 2001, at 20:37:28
In reply to Re: MAO Midday Slump--Low Blood Pressure? » Rick, posted by kregpark@yahoo.com on September 9, 2001, at 4:31:46
> Rick: Have you seen Jack Gorman's
> "The Essential Guide to Psychiatric Drugs"?
> Version 3 is available in small paperback, I think
> 1997. Excellent book, a lot in a small space,
> a reference. Gorman is highly respected, I think
> he heads or used to at either Columbia or was
> it New York Psychiatric Institute. Could be
> confusing with Liebotwitz.
>
> Anyway, Gorman has worked with Liebowitz and
> others on social phobia over the years and has
> *back to topic* (sorry) - the book covers all
> antidepressants, benzos etc. The info on Nardil
> and Parnate talks about how MAOI side effects
> go away over seveal months (mostly go away) -
> sexual side effects too but depending on dose
> maybe not entirely. While increasing there is
> a more benzo feeling like Xanax. More relaxing
> during this time. Hypotension on Nardil rarely
> a problem after stablizing a few months, it goes
> away.
>
> Generally, when people stop Nardil due to side
> effects after on them and stablizied many months
> it will be sexual side effects, possibly insomnia.
> With Parnate, it takes much less time to adjust
> (not months, more like weeks) - but insomnia and
> anxiety is usually the culprit. Actdually
> daytime sedation coupled with nighttime insomnia
> at high doses.
>
> I'm talking a bit too much like an expert here
> which I'm not, but I do highly recommend Gorman
> edition 3, 1997 smaller paperback.
>
> kregpark
>
>
> >
> > After I complained to my pdoc because Nardil turned me from hypertensive to way-hypotensive, he first suggested salt but then gave me Florinef when salt didn't work. The Florinef helped a lot, but it is a corticosteroid, so it definitely should not be taken for a protracted period of time.
> >
> > I always wondered if I would have adjusted to the hypostension had I stuck with Nardil more than four weird weeks. I recall one article on MAOI's that said the initial and sometimes-precipitous drop in BP is paradoxically replaced by a somewhat hypertensive effect after awhile. I'd be curious to know if any MAOI users have experienced this kind of reversal pattern.
> >
> > Rick
Posted by kregpark@yahoo.com on September 12, 2001, at 4:43:36
In reply to Re: MAO Midday Slump? Thank-you all nm » kregpark@yahoo.com, posted by Rick on September 9, 2001, at 15:58:33
Rick:
I first read of it in a couple journal articles since thrown away on treatment of MAOI side effects.
Prior to the "great SSRI's" MAOI use was more common and neostigmine and bethanechol (both cholinergics) were recommended for anticholinergic side effects (cognition, dry mouth, etc). Those effects actually are far more significant with many tricyclics, but are not that strong usually with MAOI's once adjusted to therapuetic dose.
I'd tried bethanechol which was a bit stimulating but I rarely took it, on a fluke a recent doc gave me neostigmine when I called in for bethanechol (it's been discontinued or else very hard to get - no big loss there probably)
Actually I'd only tried it once for energy on n + K and it does work!
Neostigmine activates the muscles sort of. Bethanechol's effect seems a bit different.\
Bethanechol tended to make me a bit aggressive (too much) - neostimine so far is prosexual, seems to substitute for
provigil partially reducing insomnia, and so far I've favored it, not going above 60mg provigil and 1/4 tab (very very little) in am neostigmine.
So far I like in AM because I take all Nardil then and am a bit more (I think) getting "anticholinergic" effect which may
make me less "upbeat" and less "horny" (is that an appropriate word here?)OK - on that note I better sign out.
kregpark
> I've never heard of neostigmine, although I looked it up. Was that prescribed for psychotrpoic purposes, or did you just accidentally discover that it helps mentally?
>
> I don't think I have manic episodes myself, although it's possible (they'd be classified as mild, though). I *do* usually find that when I feel mild euphoria or unusually "up" that life has been treating me well that day or that week, so I'm beginning to doubt that the unusually contented feeling is entitely due to meds and/or spontaneous brain chemistry. Most likely it's a pleasantly synergistic combination chemical and environmental. Spiking the Provigil up definitely adds to the likelihood of such a reaction for me, although as mentioned before, modafinil's been used safely in bp.
>
> Rick
>
> P.S. Do you prefer to be addressed as Kregpark?
> Please don't answer, "You can call me Kregpark, you can call me rick_1001, you can call me whatever you want. Just don't call me late for dinner."
Posted by kregpark@yahoo.com on September 12, 2001, at 4:51:39
In reply to Re: MAO Midday Slump? Thank-you all nm » kregpark@yahoo.com, posted by Rick on September 9, 2001, at 15:58:33
(BTW, kregpark or kreg or Kreg is fine!!!)
Or anything else noninsulting similar to above!! :)My last post, I meant at end:
I take all Nardil in AM, and am getting (I think)
some minor anticholinergic effect mainly in first
few hours of work (ie; 8:30 - noon). As day
goes on I tend to feel more social.So far it seems the very low dose of neostigmine
corrects this. Maybe the few hour half life
is about right to make my regimen more normalized
24 hours a day in terms of normalizing cholinergic
function.Well - that's the hypothesis - which is probably
wrong!!! :) All I know that really counts I
guess is that so far I like it!!!kregpark
This is the end of the thread.
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