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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by cybercafe on July 18, 2002, at 14:13:58
hey guys i am taking parnate and starting to think i may suffer from an attention deficit disorder........ i know a lot of stimulants are somewhat dangerous if combined with an MAOI, are there any that are not dangerous or much less so?
cheers ;)
Posted by dennison on July 18, 2002, at 21:01:56
In reply to any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 18, 2002, at 14:13:58
Pemoline ""cylert"" is safe to use!!! I with parnate.
Posted by cybercafe on July 19, 2002, at 2:33:05
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by dennison on July 18, 2002, at 21:01:56
> Pemoline ""cylert"" is safe to use!!! I with parnate.
thanks a lot for your reply :)
unfortunately they discontinued it here due to liver toxicity :(
Posted by jsarirose on July 19, 2002, at 17:41:34
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 19, 2002, at 2:33:05
> > Pemoline ""cylert"" is safe to use!!! I with parnate.
>
> thanks a lot for your reply :)
>
> unfortunately they discontinued it here due to liver toxicity :((We seem to have common interests...) From what I've read, formally Ritalin and other stimulant drugs are not allowed. However, as usual, some doctors have prescribed these meds to people taking MAOIs with great success. I think the important thing to remember is that you need to closely monitored by a doctor and pay close attention to any adverse reaction you may have. Keep a close eye on your dizziness and/or blood pressure levels if possible.
When I did a big search for various augmenting strategies for Parnate, methylin and another speed-type drug both came up as possibilities. As I said, it's officially verboten, but some have had success with it. Hopefully your pdoc is open to alternative ideas.
-Jessica
Posted by BekkaH on July 19, 2002, at 23:48:49
In reply to any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 18, 2002, at 14:13:58
When I was on Parnate, I had a paradoxical reaction to it (I have paradoxical rxns. to many meds!). I had severe daytime somnolence and narcolepsy-like attacks on Parnate. I would suddenly fall asleep at the most inconvenient times. Since this can be quite dangerous, especially when driving, I was given a small dose of Ritalin immediate release to take with the Parnate. I believe I took 5 mg of Ritalin twice a day. I had absolutely NO blood pressure problems whatsoever. Parnate actually drastically lowered my blood pressure. When Ritalin was added, my blood pressure was just about normal, and the Ritalin "cured" the narcolepsy-like attacks.
If you do add a psychostimulant to an MAOI, PLEASE DO IT ONLY UNDER YOUR DOCTOR'S SUPERVISION!!! AND BE SURE TO CONTINUE TO FOLLOW THE MAOI DIET!!!!!
Posted by Elizabeth on July 20, 2002, at 1:55:26
In reply to any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 18, 2002, at 14:13:58
MAOIs by themselves can be effective for ADHD -- especially Parnate.
If you still have symptoms, though, you can try (cautiously and under close supervision) adding a stimulant to the MAOI. Provigil (modafinil) or Cylert is liable to be safer than the amphetamine-type stimulants. (Adrafinil may also be useful.)
There are also other meds sometimes used for ADHD, such as clonidine and guanfacine, which are safe to use if they help you.
HTH
-elizabeth
Posted by cybercafe on July 20, 2002, at 8:17:42
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by jsarirose on July 19, 2002, at 17:41:34
> (We seem to have common interests...) From what I've read, formally Ritalin and other stimulant drugs are not allowed. However, as usual, some doctors have prescribed these meds to people taking MAOIs with great success. I think the important thing to remember is that you need to closely monitored by a doctor and pay close attention to any adverse reaction you may have. Keep a close eye on your dizziness and/or blood pressure levels if possible.
... hmmm... i am actually interested in taking methylphenidate ... ritalin.. not for antidepressant effect as much as to see if i have ADHD and if getting rid of possible ADHD will get rid of my depression...
... i think if i wanted to augment with a stimulant i would try something safe like effexor + stimulant ... (is this safe? i'm just guessing non-MAOI = safe) ...
.. and if i wanted to augment for antidepressant properties i would probably start with lamotrigine... or possibly lithium if the 0.5 level has no side-effects (?)...
... or perhaps thyroid hormone...how are you doing on lamotrigine btw? .. are you up to 400 mg yet ? .. any idea how long it takes to set in?
Posted by jsarirose on July 20, 2002, at 14:11:57
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 20, 2002, at 8:17:42
> ... hmmm... i am actually interested in taking methylphenidate ... ritalin.. not for antidepressant effect as much as to see if i have ADHD and if getting rid of possible ADHD will get rid of my depression...
>
> ... i think if i wanted to augment with a stimulant i would try something safe like effexor + stimulant ... (is this safe? i'm just guessing non-MAOI = safe) ...
> .. and if i wanted to augment for antidepressant properties i would probably start with lamotrigine... or possibly lithium if the 0.5 level has no side-effects (?)...
> ... or perhaps thyroid hormone...
>
> how are you doing on lamotrigine btw? .. are you up to 400 mg yet ? .. any idea how long it takes to set in?I guess I mentioned it as a stimulant because I wasn't sure if the correct term was amphetamine for a legally prescribed ADD drug. Ritalin & other drugs prescribed for ADD are basically legal speed. For people (like me) without ADD, they act like amphetamines and keep me awake and "speedy" feeling. For people with ADD (like my brother) they actually work to calm him down & help him concentrate.
I'd assume the risks are the same if you're coupling it with Parnate for depression whether it's used for energy or ADD.
I do take thyroid, .075 (haven't noticed a difference physically or emotionallY) but my levels are normal now.
And I got up to 100mg of Lamictal, and now I'm having insurance company problems so I'm kind of stuck on that dose and begging free samples from my doctor until I can get on GSK's patient assistant program. It's very expensive.
I have dropped down to 70mg of Parnate now with no (I think) adverse emotional effects. It's a little hard to tell as I've had a lot of stresses lately and felt a bit more depressed, but I don't know if it's a normal response or from decreasing the Parnte. No suicidal tendancies for the most part though.
I think I'll sit tight on the Parnate & Lamictal until I can figure out how to get on a higher dose of Lamictal.
-Jessica
Posted by cybercafe on July 21, 2002, at 1:27:40
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by jsarirose on July 20, 2002, at 14:11:57
>legal speed. For people (like me) without ADD, they act like amphetamines and keep me awake and "speedy" feeling. For people with ADD (like my brother) they actually work to calm him down & help him concentrate.
this is something that i am actually very very interested in --- if i could diagnose ADD by simply taking a med and seeing how i react to it, it would make things a lot easier ...
... have you heard the same thing from others? ... i remember reading from one source that those who don't have ADD don't like ritalin -- it causes them to feel anxious and agitated...> And I got up to 100mg of Lamictal, and now I'm having insurance company problems so I'm kind of stuck on that dose and begging free samples from my doctor until I can get on GSK's patient assistant program. It's very expensive.
damn that is really too bad jess, i would hate to think that you are suffering when you might just be on to the perfect combination for you... you must have a government med plan down there, no?
> I have dropped down to 70mg of Parnate now with no (I think) adverse emotional effects. It's a little hard to tell as I've had a lot of stresses lately and felt a bit more depressed, but I don't know if it's a normal response or from decreasing the Parnte. No suicidal tendancies for the most part though.
... that's too bad... personally i find parnate decreases depression but increases agitation (perhaps a bipolar specific effect?) so it has a strange effect on suicidal tendancies ...
... hopefully you are getting benefits from taking less parnate, perhaps better sleep, less hypotension?> I think I'll sit tight on the Parnate & Lamictal until I can figure out how to get on a higher dose of Lamictal.
is there a branch of Parke-Davis in your town??
Posted by jsarirose on July 21, 2002, at 1:42:46
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 21, 2002, at 1:27:40
> this is something that i am actually very very interested in --- if i could diagnose ADD by simply taking a med and seeing how i react to it, it would make things a lot easier ...
> ... have you heard the same thing from others? ... i remember reading from one source that those who don't have ADD don't like ritalin -- it causes them to feel anxious and agitated...
>
That's exactly the reaction I get when I take it. I don't know if just taking the med and seeing your reaction would be a sufficient test. You would also have to get the med somehow. : )
> damn that is really too bad jess, i would hate to think that you are suffering when you might just be on to the perfect combination for you... you must have a government med plan down there, no?
>
Actually, I'm on the lovely state health plan. WITH insurance I have to pay 50% of name brand drugs whether there is a generic available or not. Today I talked to a friend who takes Lamictal (800mg) and she's on the assistance program through the manufacturer. It's easy to get on (since I'm on disability and below their income level). She also has a bunch of 25mg pills she can give me until the free order comes in. So, between samples from my doctor and some pills from my friend I should be able to stay on it.> ... hopefully you are getting benefits from taking less parnate, perhaps better sleep, less hypotension?
>
In general I have less dizziness, but every time I decrease it I have increased dizziness for a couple days. Can't win. ; )I'm thinking of holding firm at 70mg for now. I'm a little nervous about my mood. In another month or so I should be able to start therapy again and I think that might help as I'm trying to wean off Parnate.
>
> is there a branch of Parke-Davis in your town??Not that I know of, but I thought Lamictal was Glaxo-Smith-Kline (sp?). I already get free Parnate from them so I should be able to tag on the request for Lamictal (hopefully).
Take care,
Jessica
Posted by cybercafe on July 21, 2002, at 2:09:18
In reply to Re: any ADD med not dangerous when combined with MAOI? » cybercafe, posted by jsarirose on July 21, 2002, at 1:42:46
> Actually, I'm on the lovely state health plan. WITH insurance I have to pay 50% of name brand drugs whether there is a generic available or not. Today I talked to a friend who takes
you have to pay for 50% of your meds? what happens if you can't afford to?
>Lamictal (800mg) and she's on the assistance program through the manufacturer. It's easy to get on (since I'm on disability and below their
I fully support intelligent and well informed patients showing a blatant disregard for the medical profession when it is mere red tape keeping them from leading productive lives :)
> I'm thinking of holding firm at 70mg for now. I'm a little nervous about my mood. In another month or so I should be able to start therapy again and I think that might help as I'm trying to wean off Parnate.
i don't remember exactly how fast you've been ramping down... but from personal experience i would definately recommend staying at a dose for 3 weeks to see if there any negative effect on mood... assuming your depression is as severe as mine (which it probably is)... (i judge severity of depression by side effects patients are willing to put up with) ...
> > is there a branch of Parke-Davis in your town??
>
> Not that I know of, but I thought Lamictal was Glaxo-Smith-Kline (sp?). I already get free Parnate from them so I should be able to tag on the request for Lamictal (hopefully).you're right, i'm wrong :(
i was thinking of gabapentin, ... i used to pay $300/month for that drug ...
... i can actually get the gov't to cover 100% of it, and i have about $2000 - $3000 worth of receipts sitting here, but my doc filed out the paperwork wrong and now he is taking about 3 months just to SIGN A BLOODY FORM ....
monday i am going to sit outside his office till i get some attention....
really i don't want to physically assault psychiatrists (anymore?) .... i just sometimes have fantasies of giving a psychiatrist a slap, him suddenly waking up, and saying "OH! Thank You!" and starting to express some higher cognitive function :)
Posted by jsarirose on July 21, 2002, at 2:28:40
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 21, 2002, at 2:09:18
> > Actually, I'm on the lovely state health plan. WITH insurance I have to pay 50% of name brand drugs whether there is a generic available or not. Today I talked to a friend who takes
>
> you have to pay for 50% of your meds? what happens if you can't afford to?
>
> >Lamictal (800mg) and she's on the assistance program through the manufacturer. It's easy to get on (since I'm on disability and below their
>
> I fully support intelligent and well informed patients showing a blatant disregard for the medical profession when it is mere red tape keeping them from leading productive lives :)
>
> > I'm thinking of holding firm at 70mg for now. I'm a little nervous about my mood. In another month or so I should be able to start therapy again and I think that might help as I'm trying to wean off Parnate.
>
> i don't remember exactly how fast you've been ramping down... but from personal experience i would definately recommend staying at a dose for 3 weeks to see if there any negative effect on mood... assuming your depression is as severe as mine (which it probably is)... (i judge severity of depression by side effects patients are willing to put up with) ...
>
> > > is there a branch of Parke-Davis in your town??
> >
> > Not that I know of, but I thought Lamictal was Glaxo-Smith-Kline (sp?). I already get free Parnate from them so I should be able to tag on the request for Lamictal (hopefully).
>
> you're right, i'm wrong :(
>
> i was thinking of gabapentin, ... i used to pay $300/month for that drug ...
>
> ... i can actually get the gov't to cover 100% of it, and i have about $2000 - $3000 worth of receipts sitting here, but my doc filed out the paperwork wrong and now he is taking about 3 months just to SIGN A BLOODY FORM ....
>
> monday i am going to sit outside his office till i get some attention....
>
> really i don't want to physically assault psychiatrists (anymore?) .... i just sometimes have fantasies of giving a psychiatrist a slap, him suddenly waking up, and saying "OH! Thank You!" and starting to express some higher cognitive function :)Umm, I could easily rant for a looong time about our (lack of) health care system and the republicans and Bush and bleepin' idiot Americans (the US-type) who believe every biased report they see.... (Ooops, forgot the pharaceutical company lobbyists!)
But, I won't! Before I got on this insurance, which took 7 months, I had none. I was paying out of pocket for all my meds and bought them mail-order through a Canadian Pharmacy. MUCH cheaper. And I, very luckily, have a mother who helped me out when she could with the meds.
My friend is on Gabapentin too! We often swap meds when necessary because we've both been on so many different ones and we're both always broke. (She has no insurance at all even though she works 30hrs/wk. She's been a "temp" for the city for over 6 years and they technically don't have to pay benefits since she's a "temp".)
And lastly - YES - I can think of several pdocs and therapists too that I would like to slap back into reality. My favorite was the psychiatrist who wouldn't bill insurance (I had to pay out of pocket and get reimbursed) and charged $210 per hour. He would then talk on and on about the lawsuit he had pending against his former condo owner. I wanted to kill him whenever he'd charge me by the clock (that he ran up)!
-Jessica (ready to become a Canadian any time they'll let me!)
Posted by cybercafe on July 21, 2002, at 3:07:56
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by jsarirose on July 21, 2002, at 2:28:40
> But, I won't! Before I got on this insurance, which took 7 months, I had none. I was paying out of pocket for all my meds and bought them mail-order through a Canadian Pharmacy. MUCH cheaper. And I, very luckily, have a mother who helped me out when she could with the meds.
What?? Because for me, depression is something I cannot tolerate, and I would rather not resort to suicide, I think I would
1. have myself hospitalized ... you must get free meds that way
2. rob a drug store ....
i mean what happens if your illness is physical in nature, and you will DIE if you don't get your medication???
... can you sign up for a drug assistance program while you are still on an older and cheaper medication?
how did you get on the insurance plan? did you have to lie ? i was actually told by a doc that charged $250/hour in the UK that i should sign up for insurance and claim that i developed the disorder later ....... (he was a very very reputable doc)
> My friend is on Gabapentin too! We often swap meds when necessary because we've both been on so many different ones and we're both always broke.... what does gabapentin do for you? ... i just use it for anxiety.. but you don't have any anxiety problems do you ?
>(She has no insurance at all even though she works 30hrs/wk. She's been a "temp" for the city for over 6 years and they technically don't have to pay benefits since she's a "temp".).... wow... i don't think i could hold down a job feeling this way .... certainly nothing more than 4 hours a day...
> And lastly - YES - I can think of several pdocs and therapists too that I would like to slap back into reality. My favorite was the psychiatrist who wouldn't bill insurance (I had to pay out of pocket and get reimbursed) and charged $210 per hour. He would then talk on and on about the lawsuit he had pending against his former condo owner. I wanted to kill him whenever he'd charge me by the clock (that he ran up)!
..... well i dunno... violence is bad, .. but from my personal experience in martial arts, being physically hurt NEVER EVER compared to the agony of depression ....
.... i just don't know how else you can force someone to *think*, or to *pay attention*
actually jess i don't think violence is necessary, ... i have looked into it (easy when you've left the lame doc, and your depression has lifted) and i'm quite sure i could have him found incompetent ..... i just don't want to do anything so extreme... there should be some middle ground between ruining your docs career and letting him get away with murder...
.. the only reason i mention violence is because my docs SEEM LIKE NICE PEOPLE.... they just don't seem awake... i actually think a better idea might be to fire a tranquilizer dart at my doc filled with amphetamine (and no tranquilizer) .... a stimulant dart, if you will
Posted by jsarirose on July 21, 2002, at 3:40:25
In reply to Re: any ADD med not dangerous when combined with MAOI?, posted by cybercafe on July 21, 2002, at 3:07:56
Well, I have been tempted to admit myself to a psych ward just to make them pay way more than they ever would have needed to if they covered my meds in the first place. But, basically my bottom-line is my own mental health above all else. That's why I don't bother ruminating about getting even and I don't admit myself to a hospital, etc. The more I can attempt to maintain a semi-normal life the better it is for me. I can't always, but considering where I am now (working 12 hrs/wk for the first time in years, relatively financially self-sufficient with disability, not in a bad relationship, living on my own) I'd rather keep what I have than move backward and spend 6 months in a hospital.
>
> ... can you sign up for a drug assistance program while you are still on an older and cheaper medication?The drug assistance programs are 100% run by the individual pharmaceutical companies. Their plans, their rules. And they don't tend to talk to one another. I think it's pretty much just paper work and they'll give me whatever I need. (Actually, the pdoc has to do most of the paperwork.) They'll give you an automatic 90 days worth and if you need more after that you have to submit low income/neediness information.
> how did you get on the insurance plan? did you have to lie ? i was actually told by a doc that charged $250/hour in the UK that i should sign up for insurance and claim that i developed the disorder later ....... (he was a very very reputable doc)Here the insurance is based on economic need. However there is still a waiting list even if you're needy. My income (on disability) is well below the level for state subsidized insurance. There is also federal government Medicaid (which sucks), but for some strange reason it doesn't kick in until you're on disability for two years. It doesn't cover prescripts or much else anyway. Also, the state insurance is different in every state. Some states have much better coverage than Washington.
My brother & his wife have been living in the UK for the last two years and explained the health system to me in great detail. In some ways it sounds better and in others worse. I think Canada somehow manages to have the best government sponsored health care system that I know of.
> ... what does gabapentin do for you? ... i just use it for anxiety.. but you don't have any anxiety problems do you ?
>
Sorry, I don't take it, my friend does. She's bi-polar with borderline personality disorder. I believe she takes it for anxiety as well. She's also on a few other meds (Lamictal & can't remember the others right now).> ..... well i dunno... violence is bad, .. but from my personal experience in martial arts, being physically hurt NEVER EVER compared to the agony of depression ....
>
> .... i just don't know how else you can force someone to *think*, or to *pay attention*
>
> actually jess i don't think violence is necessary, ... i have looked into it (easy when you've left the lame doc, and your depression has lifted) and i'm quite sure i could have him found incompetent ..... i just don't want to do anything so extreme... there should be some middle ground between ruining your docs career and letting him get away with murder...
>
> .. the only reason i mention violence is because my docs SEEM LIKE NICE PEOPLE.... they just don't seem awake... i actually think a better idea might be to fire a tranquilizer dart at my doc filled with amphetamine (and no tranquilizer) .... a stimulant dart, if you willOr, maybe they should have to try every med before they're allowed to prescribe them. (Then they can know what withdrawal is all about!) I actually am an extremely non-violent person and would never dream of doing physical harm to any of my doctors. And I rather like my current one although she, too, is not as knowledgeable as I'd hope at times. Mostly I just wish some of them could walk a mile in our shoes on occasion. But then, I wouldn't wish long-term depression on my worst enemy.
-Jessica
This is the end of the thread.
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