![[dr. bob]](/dr-bob-sm.gif)
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 jparsell82` on December 28, 2004, at 19:03:18
I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
Posted by Eljakeo25 on December 29, 2004, at 9:21:39
In reply to About high-dose Parnate treatment, posted by jparsell82` on December 28, 2004, at 19:03:18
I think but not sure, talk to your doctor, but you might be able to augment Klonopin with Parnate for social phobia. I have been on Klonopin for over 2 years. 1mg in the morning 1 mg in the evening. And it is the primary drug I use for social phobic situations. Valium and Xanax are not a good choice because they are more addicting and treat mostly anxiety where the Klonopin really seems to target the phobia. It always seems to work fine for me at the 2mg/day dose and never have the urge to take more than that. They should approve Klonopin as a long term, non addicting, treatment for Social Phobia. As far as I am concerned the SSRI's are more addictive and does far less for SP for me at least. I give thumbs up for Klonpin as a treatment or augment for SP. And I think it would be compatable with an MOAI. Check it out. (unless you already take Klonopin (clonazempam) and it did not work for you). Good luck...I know how bad the symptoms can be at times I know what you are experiencing... take care.
Posted by Dreyfus on December 29, 2004, at 12:39:23
In reply to About high-dose Parnate treatment, posted by jparsell82` on December 28, 2004, at 19:03:18
> I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
I have recently begun the high dose Parnate therapy after reading some of the babble postings as well as some abstracts from articles and studies. I have been taking Parnate for most of the past 15 years, but it hasn't been doing the job lately. I began at 80mg and have just started 100mg increasing at about 10mg every 2 weeks or so. No improvement yet, but no increase in side effects either. I will keep everyone informed.
Michael
Posted by ed_uk on December 29, 2004, at 14:48:15
In reply to Re: About high-dose Parnate treatment » jparsell82`, posted by Dreyfus on December 29, 2004, at 12:39:23
Hello Michael!
I really hope the high-dose Parnate helps you :-) Please keep us updated... so many people will be interested.
All the best,
Ed.
Posted by MBAVON on December 29, 2004, at 17:28:27
In reply to Re: About high-dose Parnate treatment » Dreyfus, posted by ed_uk on December 29, 2004, at 14:48:15
I currently take Parnate and 1-2 mgs of Klonopin daily.
Posted by King Vultan on December 29, 2004, at 20:39:32
In reply to About high-dose Parnate treatment, posted by jparsell82` on December 28, 2004, at 19:03:18
> I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
I've been on Parnate since August and at 60 mg/day for about 6 weeks now. I am doing reasonably well but am not quite where I want to be moodwise and in a few other areas; for instance, my libido is still very much on the low side, which is surprising in view of Parnate clearly being quite dopaminergic. In thinking this all over, and considering my reactions to the other umpteen drugs I've taken, I believe that one thing that is occurring is that I am suffering some serotonergic related side effects from the Parnate increasing serotonin transmission. It would seem that one of my fundamental problems may be that I simply have too many 5-HT2A receptors, given the severity of the insomnia and certain other side effects I've suffered taking SSRIs.So rather than ask my pdoc to increase my Parnate dosage at this point in time, I've decided to pursue an augmentative strategy of adding a 5-HT2A blockader to see if my thoughts on this may be correct. Risperdal at low dosages (0.5-1.0 mg/day) is apparently the most selective 5-HT2A antagonist available, and my pdoc was quite aware of the potential benefits in using this kind of agent to augment drugs that increase serotonin transmission. I started at 0.125 mg/day for six days and just went up to 0.25 mg/day a few days ago. Even at this extremely low dosage, I'm already noticing some improvements, particularly, in the area of agitation and racing thoughts. I have a tendency when I read or think for my thoughts to get ahead of themselves, resulting in a certain amount of agitation and anxiety. I can already tell that the Risperdal is having some beneficial effects in this area, and I have not noticed any side effects as of yet. I think 0.5 mg/day is probably a good target to shoot for at this point, as I also have some concern about getting too high in dosage and starting to blockade substantial amounts of dopamine D2 receptors, which I certainly don't need given my ADD symptoms and anhedonia, as well as my general lack of any psychotic or manic symptoms.
So in my case, while I think it might make sense to go up on the Parnate in the future, particularly given the large improvement I noticed in drive and motivation going from 50 to 60 mg/day, it just seemed to make far more sense to try to augment it with something else at this point in time. My opinion and experience is that especially when you are already at a high dose of a drug, it may make more sense to explore possible synergistic effects with other drugs rather than just throwing more and more of the main drug at it.
Todd
Posted by Maxime on December 30, 2004, at 1:58:22
In reply to Re: About high-dose Parnate treatment » jparsell82`, posted by King Vultan on December 29, 2004, at 20:39:32
I've gone as high as 135 mg of Parnate. Unfortunately the side effects were too much. But you can augment with stimulant and TCAs despite the fact they are suppose to be contraindicated.
Here is some info.
Maxime
1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
CNS stimulant potentiation of monoamine oxidase inhibitors in
treatment-refractory depression.Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.
Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center,
Chicago,
Illinois.We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard
antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.PMID: 2056139 [PubMed - indexed for MEDLINE]
2: J Clin Psychiatry. 1985 Jun;46(6):206-9.Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.
Feighner JP, Herbstein J, Damlouji N.
Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative
therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases. This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment of intractable depression.PMID: 3997787 [PubMed - indexed for MEDLINE]
MAOIs in high doses and with stimulantsDate: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.
Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: MAOIs in high doses and with stimulantsThere are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.
From: "Steven L. Dubovsky" <Steven.Dubovsky@UCHSC.edu>
Date: 15 Apr 95 08:47:17 MST-0700
Subject: MAOIs in high doses and with stimulantsIt is common practice where I come from to combine MAOIs and stimulants for MAOI-induced hypotension and treatment resistance. This is also mentioned in Jan Fawcett's book of a number of years ago. Also, remember Feighner's report of MAOI + TCA + stimulant in ECT-resistant depression. I have tried this a number of times and found it helpful. Since half the caucasian population are (is?) rapid acetylators, higher doses of Parnate are frequently necessary. Other patients are rapid metabolizers of hydrazide MAOIs and need high doses of those. The PDR is a legal, not a medical, document, so I don't think their doses are always reliable.
From: Donald Franklin Klein <dfk2@columbia.edu>
Date: Sun, 16 Apr 1995 23:44:11 -0400
Subject: MAOIs with stimulantsMAOIs plus methylphenidate (Ritalin) has not been a problem in my hands although theoretical risk requires discussion with patient, consent, and available nifedipine . Very useful for orthostatic hypotension.
Date: 06 Sep 95 11:38:03 EDT
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: MAOIs with stimulantsNone other than my teacher, John Rush, some years ago referred just such a refractory person to me specifically to try adding a stimulant to her MAOI. This was in the days when doctors could still hospitalize and had authority to do things. Apparently, we private practitioners had a bit more autonomy than the university MDs at that time, so I got the referral.
Social commentary aside, I put the pt in the ICU and added very slowly Dexedrine or Desoxyn to the patient's regimen. It was wonderful -- a grand remission occurred -- and complications were zero. I've tried it since a few times, starting a low doses and titrating gradually upward, and each time no complications arose. Like all treatment efforts, it has been variably effective, but definitely worth trying. Of course, give them nifedipine as an antidote to carry.
Date: Fri, 09 Feb 1996 10:57:43 -0600
From: Kevin Miller <MillerKB@wpogate.slu.edu>
Subject: MAOIs with stimulantsHypotension is a frequent side-effect of MAOIs. If hypotension limits appropriate dosage increases, either based on clinical response, or on not reaching the target dose of about 1 mg/kg in the case of phenelzine (Robinson and Nies), the slow and careful addition of stimulants while monitoring BP makes wonderful sense. The hypotension is treated, the antidepressant effect is augmented, and, if methylphenidate is used, there may be pharmacokinetic effects as well. This is riskier with tranylcypromine given that spontaneous elevations of BP have been noted with this MAOI despite strict dietary adherence. It's also easier to do safely on an inpatient basis.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Sun, 18 Feb 1996 21:43:52 -0500
Subject: MAOIs with stimulantsThere is fortunately a small literature on combining MAOI and stimulant medication: Fawcett, J Clin Psychopharm 1991, 127-132; Feighner, J Clin Psych 1985, 206-209. Also, Clary, J Clin Psych 1990, 226-231, reported in a survey of prescribing habits of Pennsylvania psychiatrists that among those who prescribed MAOIs, use of high doses and combined use of MAOIs with stimulant meds were not unusual.
I have used this combination for the treatment of refractory depression and have at times have found it a great help and at other times useless. I do not remember it being helpful when a patient was not at least partially responsive to either the stimulant or the MAOI alone. However if there is a partial response to one of those meds, then when the two are combined, there can be either an additive or synergistic effect.
I have never had a problem with elevated BP, however I most often add the MAOI to the stimulant rather than the reverse... If I do add a stimulant to an MAOI, I start with 1.25 mg d-amphetamine or equivalent, the idea being that it probably takes at least 5 mg tyramine to precipitate a hypertensive crisis, and since the molecular weights are about the same 1.25 mg amphetamine would be sub-threshold. Starting at that level has not caused any reactions, but I still prefer to start with the stimulant and add the MAOI later.
I find that with time, as more treatment options are available, I use this combination less but there are still some patients for whom nothing else seems to work. The side effects that do cause problems include activation sometimes resembling or identical to dysphoric mania. Stereotypy and choreiform movements including bucco-facial dyskinesia can also occur. These side effects have to watched for closely. If it is essential to continue the regimen, pimozide can usually alleviate the movement disorder.
From: "David A. Kahn" <kahndav@cpmc3.cpmc.columbia.edu>
Date: Wed, 21 Feb 1996 10:31:11 EDT
Subject: MAOIs with stimulantsI'm always in the position of trying to augment an existing MAOI regimen, so it's never seemed feasible to stop the MAOI, start the stimulant, and then restart the MAOI. I just add the stimulant. The only adverse reaction I've encountered is an odd lability of blood pressure on two occasions, where supine blood pressure was somewhat elevated on a tonic basis, together with a worsening of orthostatic hypotension. The supine elevation made it impossible to think of Florinef, etc., so we had to stop the combination. Interestingly, both of these individuals had prior histories of intermittent bordereline essential hypertension which had resolved on the MAOI alone.
From: JoelSHoffm@aol.com (Joel S Hoffman)
Date: Wed, 21 Feb 1996 08:29:48 -0500
Subject: MAOIs with stimulantsBy the way, I do not get signed consent. I do not think that that holds up very well anyway. Well documented clear chart notes indicating the clinical rationale and including what is told to the patient should always be standard practice and especially with atypical treatment modalities such as this.
Posted by Dreyfus on December 30, 2004, at 14:47:59
In reply to Re: About high-dose Parnate treatment » Dreyfus, posted by ed_uk on December 29, 2004, at 14:48:15
> Hello Michael!
>
> I really hope the high-dose Parnate helps you :-) Please keep us updated... so many people will be interested.
>
> All the best,
> Ed.Ed,
I promise to keep everyone updated. If this doesn't work, it's back to square one.
Michael
Posted by jparsell82` on December 31, 2004, at 0:15:30
In reply to Re: About high-dose Parnate treatment, posted by Eljakeo25 on December 29, 2004, at 9:21:39
Hi, actually I already take Klonopin. I'm prescribed 2mg a day but sometimes take less or none. It works somewhat well for social phobial but it gives me cognitive problems such as with memory and slower thinking. I even tried augmenting the Klonopin with many memory improving drugs to no avail. But it's always nice to have the Klonopin around for certain situations... if you know what I mean.
> I think but not sure, talk to your doctor, but you might be able to augment Klonopin with Parnate for social phobia. I have been on Klonopin for over 2 years. 1mg in the morning 1 mg in the evening. And it is the primary drug I use for social phobic situations. Valium and Xanax are not a good choice because they are more addicting and treat mostly anxiety where the Klonopin really seems to target the phobia. It always seems to work fine for me at the 2mg/day dose and never have the urge to take more than that. They should approve Klonopin as a long term, non addicting, treatment for Social Phobia. As far as I am concerned the SSRI's are more addictive and does far less for SP for me at least. I give thumbs up for Klonpin as a treatment or augment for SP. And I think it would be compatable with an MOAI. Check it out. (unless you already take Klonopin (clonazempam) and it did not work for you). Good luck...I know how bad the symptoms can be at times I know what you are experiencing... take care.
Posted by jparsell82` on December 31, 2004, at 0:23:31
In reply to Re: About high-dose Parnate treatment » jparsell82`, posted by Dreyfus on December 29, 2004, at 12:39:23
> > I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
>
> I have recently begun the high dose Parnate therapy after reading some of the babble postings as well as some abstracts from articles and studies. I have been taking Parnate for most of the past 15 years, but it hasn't been doing the job lately. I began at 80mg and have just started 100mg increasing at about 10mg every 2 weeks or so. No improvement yet, but no increase in side effects either. I will keep everyone informed.
>
> Michael
>
>That's great... please keep us up to date. How high will you try going? I've heard as high as 200mg. I think I will soon be giving a "short" 90mg/day trial.
Josh
Posted by jparsell82` on December 31, 2004, at 0:47:34
In reply to Re: About high-dose Parnate treatment » jparsell82`, posted by King Vultan on December 29, 2004, at 20:39:32
> > I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
>
>
> I've been on Parnate since August and at 60 mg/day for about 6 weeks now. I am doing reasonably well but am not quite where I want to be moodwise and in a few other areas; for instance, my libido is still very much on the low side, which is surprising in view of Parnate clearly being quite dopaminergic. In thinking this all over, and considering my reactions to the other umpteen drugs I've taken, I believe that one thing that is occurring is that I am suffering some serotonergic related side effects from the Parnate increasing serotonin transmission. It would seem that one of my fundamental problems may be that I simply have too many 5-HT2A receptors, given the severity of the insomnia and certain other side effects I've suffered taking SSRIs.
>
> So rather than ask my pdoc to increase my Parnate dosage at this point in time, I've decided to pursue an augmentative strategy of adding a 5-HT2A blockader to see if my thoughts on this may be correct. Risperdal at low dosages (0.5-1.0 mg/day) is apparently the most selective 5-HT2A antagonist available, and my pdoc was quite aware of the potential benefits in using this kind of agent to augment drugs that increase serotonin transmission. I started at 0.125 mg/day for six days and just went up to 0.25 mg/day a few days ago. Even at this extremely low dosage, I'm already noticing some improvements, particularly, in the area of agitation and racing thoughts. I have a tendency when I read or think for my thoughts to get ahead of themselves, resulting in a certain amount of agitation and anxiety. I can already tell that the Risperdal is having some beneficial effects in this area, and I have not noticed any side effects as of yet. I think 0.5 mg/day is probably a good target to shoot for at this point, as I also have some concern about getting too high in dosage and starting to blockade substantial amounts of dopamine D2 receptors, which I certainly don't need given my ADD symptoms and anhedonia, as well as my general lack of any psychotic or manic symptoms.
>
> So in my case, while I think it might make sense to go up on the Parnate in the future, particularly given the large improvement I noticed in drive and motivation going from 50 to 60 mg/day, it just seemed to make far more sense to try to augment it with something else at this point in time. My opinion and experience is that especially when you are already at a high dose of a drug, it may make more sense to explore possible synergistic effects with other drugs rather than just throwing more and more of the main drug at it.
>
> ToddHey Todd,
I hope this Risperdal works well for you. It probably is the most selective ap you could get. With my social phobia, I've read a study that people with social anxiety disorder have lower binding potential for the d2 receptor than healthy subjects so I'm going to stay away from D2 blockers. (Note: I have been on Risperdal a long time ago combined with Prozac). Anyways, my other problem with Risperdal is I've read it raises prolactin a good deal and I really wouldn't want that. But, all the other anti-psychotics that don't effect prolactin as much or at all aren't selective enough... like you said... and they effect way too many receptors. Perhaps the raise in Prolactin won't pose a problem for you or you can use another med to block that effect... I don't know??My current status with Parnate is as follows. I've increased to 60mg a day now and don't really feel any different than on 30mg. I haven't had many side effects at all since day 1 on Parnate. The only ones I really have now are some insomnia, daytime weakness/drowsiness(really bothers me), urinary hesitance(getting better), weird appetite and maybe some other little things. The only things that bother me are the insomnia which I think I'm gonna try out Zopiclone for that. It has a shorter half-life than Ambien so no morning drowsiness. Plus I tried it before and it was pretty strong. And the other thing is the daytime drowsiness and lack of motivation,etc. which I think may be somewhat(not all) related to my low blood pressure. I always have low blood pressure on Parnate... you have any suggestions? One day, I even ate a bunch of cheddar cheese fries, took 200mg of provigil, a caffeine pill, and some rhodiola rosea because I was tired and my bp was low... I wanted to test it out... still my bp barely raised. Anyways, hopefully when I get the chance to try a short trial of high dose Parnate it will help my ADD also. Good luck with your ideas and let me know of any success or interesting augmentations. Thanks.
Josh
Posted by Dreyfus on December 31, 2004, at 12:22:55
In reply to Re: About high-dose Parnate treatment » Dreyfus, posted by jparsell82` on December 31, 2004, at 0:23:31
> > > I've read Chairman_Mao's information and experience about high dose Parnate and the 1989 study on pubmed.org. Anyways, is anybody on Parnate here considering trying this out? Chairman_Mao made it sound really good. Especially because I don't think there are a whole lot of good drugs you can augment Parnate with for Social Phobia, Depression, and ADD. Anyone asked their doctor about trying it? I think it would be hard for me to find a doctor willing to try this. I know of a really cheap Parnate source on the internet but even still it would cost nearly $150 to take 100mg/daily. And I don't know how high you would need to go...
> >
> > I have recently begun the high dose Parnate therapy after reading some of the babble postings as well as some abstracts from articles and studies. I have been taking Parnate for most of the past 15 years, but it hasn't been doing the job lately. I began at 80mg and have just started 100mg increasing at about 10mg every 2 weeks or so. No improvement yet, but no increase in side effects either. I will keep everyone informed.
> >
> > Michael> >
> >
>
> That's great... please keep us up to date. How high will you try going? I've heard as high as 200mg. I think I will soon be giving a "short" 90mg/day trial.
>
> JoshJosh,
I may go up to 200mg depending on what my doctor says. As a point of information, I also take 1mg Ativan, 10mg Prinivil (an ACE inhibitor), 20mg Zocor, and 30mg Ritalin.
Michael
Posted by don_bristol on December 31, 2004, at 14:05:01
In reply to About high-dose Parnate treatment, posted by jparsell82` on December 28, 2004, at 19:03:18
> I've read Chairman_Mao's information and
> experience about high dose Parnate and the
> 1989 study on pubmed.org.I would very much like to read this.
Google is not my friend and I can't locate either Chairman_Mao's post here nor the 1989 study you refer to.
Can someone kindly post links to these two.
I want to see my p-doc in the next week and increase my Parnate from 40mg to 50mg and as she was very reluctant to put me on to 40mg then I need all the ammuniaton I can get!
Thank you.
Posted by ed_uk on December 31, 2004, at 14:48:30
In reply to Re: About high-dose Parnate treatment, posted by don_bristol on December 31, 2004, at 14:05:01
Hi!!
Pharmacopsychiatry. 1989 Jan;22(1):21-5.High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
Posted by Chairman_MAO on November 4, 2004, at 4:10:07In reply to Re: Downregulating dopamine autoreceptors, posted by King Vultan on October 17, 2004, at 0:15:35
For what any anecdote is worth:
I used to take trazodone to sleep on Parnate. I absolutely hated it, primarily because of its adrenergic antagonism. I found it negated a good part of the motivational and anti-ADD effects of the Parnate that are essential for me.
At any rate, once I got over 150mg/day, the insomnia paradoxically disappeared, and I sleep like a baby. Jay Amsterdam's study of tranylcypromine in treatment-resistant depression is right on the money. At 200mg/day, I find Parnate profoundly calming, not activating. The insomnia is gone--although I can choose to stay up, as I did tonight, but that's a sleep hygene issue of mine that should not be band-aided with drugs--as is any agitation. The improvement in depression compared to, let's say, when I was taking 80mg/day is minimal, but the improvement in social phobia and self-esteem is INCREDIBLE and worlds beyond 80mg/day. Also, the hypersexuality of the lower (10-30mg/day) doses and the occasional anaorgasmia of 80mg/day seem averaged together to create a healthy, moderate sex drive with AMAZING orgasms and erotic sensorium.
I am convinced that the reason everyone thinks Nardil is better than Parnate for social phobia is that the doses of Parnate used are woefully inadequate. Honestly, I could not conceive of anyone needing any adjunctive medication for social phobia at 200mg/day, but if they did, I'm sure a pinch of clonazepam, beta-phenyl-GABA/baclofen, Neurontin, or your MAOI-friendly treatment of choice would fill in any gaps. I personally find that picamilon works wonders with it, although if there were a safe GABA-T inhibitor on the market, I'd definitely try that to push things more toward the Nardil end of things.
Maybe I should try a high quality valerian extract; anyone know of anything else besides Depakote, gama-vinyl-gaba, and the hydrazine MAOIs that inhibits GABA-T?
Posted by jparsell82` on January 1, 2005, at 2:33:17
In reply to Re: About high-dose Parnate treatment, posted by don_bristol on December 31, 2004, at 14:05:01
This is the end of the thread.
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