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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 cubbybear on February 2, 2004, at 0:20:12
If you've checked this board regularly, you know that I've been an avid believer in Parnate since I've had superb results with it for nearly 20 years. It has always knocked out my (major) depression as well as the severe anxiety that I experience as a symptom of depression. My maintenace dose has been 30 mg./ day. It never pooped out on me in the past, but today I'm scared to death, afraid that it might be slipping. (There is no other AD that I would consider taking.) For your info, I'm also in the process of trying to complete my Klonopin taper, and have been taking a very small dose of .125 mg./day for the past few weeks, with occasional days skipped. (As I write this, I'm beginning to wonder if my anxiety might also be a result of the Klonopin tapering).
On some occasions in the past, certain negative circumstances and difficult people gave rise to a situation that led to heightened anxiety and my biggest fear was that the Parnate was quitting. My therapist in N.Y., who prescribes it, always assured me that it was not quitting, and that it is normal for one to experience occasional bouts of anxiety or other unpleasant feelings, even when getting the full benefits of Parnate. These feelings always subsided in time.
This time around, to be exact, I'm facing up to the scenario of seeing my mother, who is 75 and who has been suffering greatly with chronic back pain. This all started up a few weeks ago. When I visit her in March, I would also be seeing my stepfather in the midst of physical woes of his own. On top of this, I just had a serious crisis regarding my apartment neighbors as well as a visit from an unwanted ex-friend.
I won't bother going into other details. You can see that there are things going on in my life (as well as others) that would probably cause great stress for most people.
Over the past day or two, I've been feeling rotten with what I think is anxiety. I can't easily get in touch with my therapist since I'm living overseas. There is no doctor here (in Thailand) who has experience with Parnate since it isn't available here.
I would very much like to hear from anyone who was in a similar situation, i.e. who was afraid that their Parnate was pooping out. It seems to me that the most logical thing to do in this instance would be to try increasing my dose to 40 mg./day. Is this the generally accepted way to proceed when a patient thinks that their MAOI (or other AD) is maybe losing its effect?
(I don't want to get into augmenting the Parnate with any other med at this point, as I have no experience with that). And, I'm trying to avoid getting back onto a benzo for anxiety, since I'm also at the tail end of weaning off Klonopin, and getting back onto it or another benzo like Xanax would seem like a real defeat. So, what's the best way to proceed? Anyone who can offer an educated guess, please help.
cubbybear
Posted by EERRIICC on February 2, 2004, at 2:03:20
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
Increase the dose. I only got effects from it at 80mg and there really is no reason to avoid a dose increase if you believe 30mg isn't working anymore. Essentially - "Why not?"
Posted by Questionmark on February 2, 2004, at 9:24:19
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
It may very well be the combination of the recent added stress along with the continued reduction of your Klonopin-- rather than the Parnate actually pooping out. You might want to go back up to .25mg Klonopin for awhile until you can ride this crap out-- or .25mg every other day & .125 every other day. At the very least i think you should stay at .125mg every day until some of this major stress starts to decrease. In the meantime you might want to try to talk to your dr about your situation and maybe getting some extra Parnate/increasing your Parnate dose by 10mg. See if s/he thinks your problem (aside from the added stress) is a result of the continued Klonopin reduction or Parnate poop-out. Good luck.
Posted by stoked on February 2, 2004, at 9:39:40
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
Yeah, don't panic, for sure. I think it's just the rough stuff in your life that's making you feel bad. That's totally normal.
One thing I've heard from a guy who takes Parnate is that it doesn't keep him from feeling bad when there's a reason for feeling bad, and that's one of the things he likes about it. He just doesn't feel miserable nearly all the time like he did before he started taking it.
Talk this stuff out if it helps and once you get some of this stuff under control, you ought to feel better. Increasing you dose might not be a bad idea though, especially since you've got so much to deal with. The guy I know takes 50 mgs a day.
Sure hope you feel better
Posted by mattdds on February 2, 2004, at 10:27:57
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
Hey,
I really believe this is due to the Klonopin taper, especially since you mentioned that your main symptom is anxiety.
Also, it is widely known that the "tail end", as you described it, of benzo taper is by far the toughest! Actually, I've heard of many people ramping down fairly quicklyand easily, until reaching only a miniscule dose (like 0.125 mg) and then *really* getting the withdrawal symptoms.
Just out of curiosity, why are you so worried about being on Klonopin?
What about an experiment? You could temporarily raise the dose of Klonopin back to 0.25 mg or even 0.5 if necessary and see if your Parnate response comes back. This would pretty much pinpoint whether or not your "poop out" is due to the Klonopin taper. If this doesn't work, then you could explore other options.
20 years of Parnate success? I doubt it would just suddenly poop after this long. Just way out of the realm of likelihood.
Best of luck,
Matt
Posted by sailor on February 2, 2004, at 13:36:03
In reply to Probably the Klonopin taper, IMO, not poop out » cubbybear, posted by mattdds on February 2, 2004, at 10:27:57
30 mg Parnate is a modest dose by most standards. (I'm still hopiung and waiting for a therapeutic response at 60mg/day. Not to discount benzos, but they do have their issues re tolerance and withdrawal, and at higher doses possible addiction. I respectfully disagree with the assumption that 20 years at one dose means it's unlikely that you might not now need more. For one thing it's been researched and documented that our dopamine production levels fall steadily after our thirties or so. Hardly anyone disputes that our brain chemistry changes with time, so after 20 years I'd be surprised if some significant aspects of your symptoms and med "needs" haven't changed as well. Increasing your Parnate dose modestly seems a low-risk and potentially beneficial choice to me. If that strategy allowed you to continue weaning from the benzo, well, so much the better. Regards, Sailor
Posted by f l y on February 2, 2004, at 23:28:37
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
i think it's a result of the two obvious points you mention, recent stress, and klon taper. i think the quickest way back to normalcy would be to up the klon not the parnate.
best to ya!
fly
Posted by cubbybear on February 3, 2004, at 0:29:36
In reply to Probably the Klonopin taper, IMO, not poop out » cubbybear, posted by mattdds on February 2, 2004, at 10:27:57
> Hey,
>
> I really believe this is due to the Klonopin taper, especially since you mentioned that your main symptom is anxiety.
>
> Also, it is widely known that the "tail end", as you described it, of benzo taper is by far the toughest! Actually, I've heard of many people ramping down fairly quicklyand easily, until reaching only a miniscule dose (like 0.125 mg) and then *really* getting the withdrawal symptoms.
>
> Just out of curiosity, why are you so worried about being on Klonopin?
>
> What about an experiment? You could temporarily raise the dose of Klonopin back to 0.25 mg or even 0.5 if necessary and see if your Parnate response comes back. This would pretty much pinpoint whether or not your "poop out" is due to the Klonopin taper. If this doesn't work, then you could explore other options.
>
Hi Matt and fly,
Your guesses about the anxiety being the result of my Klonopin taper seem to be proven out! Last night I tried taking the .125 mg. dose again. Slept pretty well and am feeling much less anxious today. I keep personal journals, a log and even a graph of my Klonopin taper and saw yesterday how I've responded over the past year or so to various Klon. dose decreases. After being on a mtnce. dose of 3.75 mg./day for months, I encountered withdrawal anxiety at the 2.75 mg mark and at the 1.75 mg. mark, with some tolerable insomnia coming right on the heels of every decrease.I've had it real easy for the past 6 months, without any withdr. anxiety until I started doing the following: .125 mg. for one day, no Klon. for 2 or 3 days etc. I had planned on going for four days without K, then the outside stresses came last week and wham!--the anxiety hit like a thunderbolt on Monday A.M.
So, like you say, Matt, it seems that I'm one of those who have done quite well ramping all the way down but have encountered miserable withdrawal anxiety at the tiny .125 mg dose, i.e. while going into the homestretch.
You asked why I'm so worried about being on Klonopin. . . For a number of reasons: knowing that in my pre-Klonopin days, Parnate was THE solution for my depression and anxiety. If I experienced intermittent stress or insomnia, I could always manage it with .5 mg. or .25 mg. Xanax as needed.
Also, I don't want to be on a benzo in the event of needing an anesthetic or painkiller; I've read that one could run into serious repsiratory problems when combining benzos with opioid analgesics or anesthesia. I went for about 17 years without being regular benzo user and really want to get back there again.
The big question now is, how am I going to get off this minuscule amount? Evidently, I'm so sensitive to even .125 mg that even decreasing at the rate I mentioned (one day on K, 2 days off, one day on, 3 days off, etc.) is "too fast."
I'm going to see if liquid Klonopin is available here (Thailand) or try getting my dr. to switch me to Valium and proceeding that way--it's the method that the big anti-benzo crusaders ( U.K. organization) use. Will also start another thread on Psychobabble about this. I want to be off this med before the next Ice Age!!
Posted by sailor on February 3, 2004, at 21:07:26
In reply to Re: Probably the Klonopin taper, IMO, not poop out » mattdds, posted by cubbybear on February 3, 2004, at 0:29:36
My intuition on this was obviously out of whack! Congrats to the rest of you contributors for your insight and I'll see it as an opportunity to learn! Patience, Persistence. Regards, Sailor
Posted by cybercafe on February 3, 2004, at 23:57:43
In reply to oh God, is this Parnate poopout?, posted by cubbybear on February 2, 2004, at 0:20:12
i have noticed that klonazepam nicely augments the effects (antidepressant and otherwise) of parnate
so i could see withdrawing it lessening parnate's antidepressant effects
Posted by cubbybear on February 4, 2004, at 0:57:07
In reply to Re: Probably the Klonopin taper, IMO, not poop out » mattdds, posted by sailor on February 3, 2004, at 21:07:26
> My intuition on this was obviously out of whack! Congrats to the rest of you contributors for your insight and I'll see it as an opportunity to learn! Patience, Persistence. Regards, Sailor
Even though my anxiety was evidently the result of the Klonopin tapering, you've given me some food for thought about dopamine depletion with age. I'm going to run this past my doctor one of these days,and see what he says.
This is the end of the thread.
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