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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by psychobot5000 on January 24, 2007, at 1:12:57
How long after starting Parnate/Tranylcypromine is it likely to be before (possible) cystic acne manifests? Is it a process that takes days? Weeks?
Does anyone know how likely it is for this side-effect to appear? It sounds obscure, but many people on this board seem to mention it.
Thanks for any shared information,
Psychbot5000
Posted by naughtypuppy on January 24, 2007, at 9:38:49
In reply to Parnate side-effects?, posted by psychobot5000 on January 24, 2007, at 1:12:57
> How long after starting Parnate/Tranylcypromine is it likely to be before (possible) cystic acne manifests? Is it a process that takes days? Weeks?
>
> Does anyone know how likely it is for this side-effect to appear? It sounds obscure, but many people on this board seem to mention it.
>
> Thanks for any shared information,
> Psychbot5000It took a few weeks for it to show up on me. Don't get too apprehensive about it since it is not that common, more likely if you have sensitive skin.
Posted by Quintal on January 24, 2007, at 10:01:47
In reply to Parnate side-effects?, posted by psychobot5000 on January 24, 2007, at 1:12:57
I didn't notice this side effect when I took Parnate though I only took it for a few months. In combination with Klonopin it was on of the most tolerable meds I've ever taken.
Q
Posted by halcyondaze on January 24, 2007, at 13:42:53
In reply to Re: Parnate side-effects? » psychobot5000, posted by Quintal on January 24, 2007, at 10:01:47
It took about three months to begin. It started as regular acne but of course since I have Body Dysmorphic Disorder I began picking at my face, which then turned regular acne cystic.
HOWEVER .. now that I am on a regimen of Differin and Duac topical, plus moisturizer, it seems to be getting a little bit better. I would suggest, if you're concerned that you have sensitive skin prone to acne, you get on some kind of topical medication when you begin taking it.
Last time, I was on it for 6 months and by the time I went to a dermatologist, they had to inject steroids into my face and there was even talk of Accutane. But it is not that bad now and I have elected to stay on it because it is worth it, to me, right now.
I am on 90 mg BTW.
Posted by halcyondaze on January 24, 2007, at 14:05:12
In reply to Re: Parnate side-effects? » psychobot5000, posted by Quintal on January 24, 2007, at 10:01:47
I've decided to stay on Parnate rather than going on Nardil. Parnate just works for me like no other antidepressant ever has before. There are a couple of things I am looking for feedback on, however.
1) DOSAGE: Currently, I am being prescribed 90 mg per day. I am fortunate to have a psychiatrist who is willing to examine the literature and talk directly to psychopharmacologists with expertise in prescribing MAOIs, and so she has agreed that the typical FDA-recommended dose (30 to 60 mg) is not consistent with what generally works, and that 80 to 120 mg is considered a better "range," especially for treatment-refractory patients. My questions are: What is the highest dose of Parnate you have been prescribed? What benefits did you find at higher doses that were absent at lower doses?
2) AKATHISIA: It has been pretty unbearable, and I am certain it is due to Parnate, as it has never happened on any other medication before. My doctor prescribed Cogentin (0.5 mg at night) but last night I had an episode of orthostatic hypotension after taking the Cogentin. We were thinking about Propanolol but doesn't that cause even MORE orthostatic hypotension than Cogentin? Is there anything else I can take for akathisia?
3) WEIGHT: When I first started taking Parnate (both times), I found that I lost a LOT of weight in a very short amount of time. However, as I became used to the effects of the drug, this side effect became absent and I started gaining (also because of the bingeing I do when the Seroquel and Sonata kick in). How can I stop this weight gain? Would going off for a few days and then re-starting it kind of "jump start" the profound appetite loss I experienced at the beginning?
4) GENERIC VS. BRAND: I'm still getting brand name Parnate. It's $30 versus $10 on my insurance but with the Sonata ($50 but my doctor writes it up so I have two months), Seroquel ($50 but my psychiatrist also writes this up or gives me samples), Cogentin ($10), Differin ($50), and Duac ($30), meds are quite an expense for me and I could use the $20. What have your experiences been with the generic version? Parnate is such a fickle drug, I'm nervous about changing formulation.
Thanks all.
Posted by halcyondaze on January 24, 2007, at 17:07:42
In reply to Decided to stay on Parnate. Questions + comments?, posted by halcyondaze on January 24, 2007, at 14:05:12
SEXUAL SIDE EFFECTS.
Sometimes it seems like I spend the entire day with a vague sexual tension BUT then I can rarely achieve orgasm when I do try to relieve the sexual tension. It takes a LOT of effort for me to actually be able to achieve orgasm and while I have no problem becoming sexually excited, after a while, it seems that it only goes so far and I actually become numb. Unlike SSRIs, where I hardly ever became sexually excited at all. The thing is, sometimes during the day, the sexual tension is uncomfortable, almost like that with amphetamines and cocaine and yet it has this upper limit that I can't seem to break.
Posted by Crazy Horse on January 24, 2007, at 17:35:44
In reply to Parnate side-effects?, posted by psychobot5000 on January 24, 2007, at 1:12:57
> How long after starting Parnate/Tranylcypromine is it likely to be before (possible) cystic acne manifests? Is it a process that takes days? Weeks?
>
> Does anyone know how likely it is for this side-effect to appear? It sounds obscure, but many people on this board seem to mention it.
>
> Thanks for any shared information,
> Psychbot5000
No acne for me. I have been on Parnate twice in the last eight years, for a total of about 8 mos. The antidepressant effect was great, but the side effects i got were too severe to continue treatment. My side effects were severe chronic insomnia, and a debilitateing afternoon fatigue that pretty much ruined my life. We tried to treat the side effects to no avail.-Monte
Posted by psychobot5000 on January 24, 2007, at 22:21:33
In reply to Decided to stay on Parnate. Questions + comments?, posted by halcyondaze on January 24, 2007, at 14:05:12
Perhaps you could stop or diminish the weight-gain by switching off of Seroquel? It's so antihistaminic, that the increased appetite seems like it would be hard to deal with.
I know a doc that believes in using Xyrem for MAOI-induced insomnia--highly effective, apparently, but of course it's an off-label use of a highly controlled drug. But anyway, that might help with the binging, right?
Thanks all, for your responses to my questions, by the way. I'm trying to decide whether to go with EMSAM or Parnate, and it's a tricky decision.
Psychbot
Posted by naughtypuppy on January 25, 2007, at 9:44:01
In reply to Re: Decided to stay on Parnate. (one more), posted by halcyondaze on January 24, 2007, at 17:07:42
> SEXUAL SIDE EFFECTS.
>
> Sometimes it seems like I spend the entire day with a vague sexual tension BUT then I can rarely achieve orgasm when I do try to relieve the sexual tension. It takes a LOT of effort for me to actually be able to achieve orgasm and while I have no problem becoming sexually excited, after a while, it seems that it only goes so far and I actually become numb. Unlike SSRIs, where I hardly ever became sexually excited at all. The thing is, sometimes during the day, the sexual tension is uncomfortable, almost like that with amphetamines and cocaine and yet it has this upper limit that I can't seem to break.That's interesting. I lost all interest for about a month, then it came back fine. Nardil was like chemical casteration!
Posted by bulldog2 on January 25, 2007, at 10:26:00
In reply to Re: Decided to stay on Parnate. (one more) » halcyondaze, posted by naughtypuppy on January 25, 2007, at 9:44:01
I don't know wether the cystic acne is age related. When my brother was in his 20's (never had much acne before) he developed cyctic acne on parnate. It also persisted for a quite a few years. I don't know wether this is common in people in their 30's or 40's when the sebacious glands get quited down.
Posted by Declan on January 25, 2007, at 17:10:04
In reply to Re: Decided to stay on Parnate. Questions + commen » halcyondaze, posted by psychobot5000 on January 24, 2007, at 22:21:33
So psychobot, you had been on tianeptine, is that right?
And are now considering Parnate or Emsam? Hmmmmm.I suppose if things got really bad for me I could consider the Emsam or deprenyl thing and take mirtazepine 7.5mg early in the evening to sleep.
Posted by halcyondaze on January 25, 2007, at 18:16:56
In reply to Re: Decided to stay on Parnate. (one more), posted by bulldog2 on January 25, 2007, at 10:26:00
Did anyone who developed acne find anything that helped? Differin and Duac are making my skin dry, though the acne has calmed down. But now it's on my back and my neck too! :( I think it might be hormonal but I don't know which birth control will make it worse or better.
Posted by laima on January 25, 2007, at 18:33:07
In reply to Parnate-related acne, posted by halcyondaze on January 25, 2007, at 18:16:56
I thought cystic acne was a hormanal type thing which doesn't respond so great to topicals?
Posted by psychobot5000 on January 26, 2007, at 12:20:39
In reply to Parnate-related acne, posted by halcyondaze on January 25, 2007, at 18:16:56
> Did anyone who developed acne find anything that helped? Differin and Duac are making my skin dry, though the acne has calmed down. But now it's on my back and my neck too! :( I think it might be hormonal but I don't know which birth control will make it worse or better.
I've read that amineptine was supposed to cause acne by increasing dopamine, which leads to decreased prolactin, which in turn leads to increased testosterone, causing the acne. Since tranylcypromine/parnate increases dopamine by several mechanisms, maybe it's this same chain of action.
In that case, though I know nothing about hormones, maybe a hormonal med like birth-control would have an effect, by somehow changing the balance away from testosterone...just speculation.
Pbot
Posted by psychobot5000 on January 26, 2007, at 12:41:03
In reply to Re: Decided to stay on Parnate. Questions + commen » psychobot5000, posted by Declan on January 25, 2007, at 17:10:04
> So psychobot, you had been on tianeptine, is that right?
> And are now considering Parnate or Emsam? Hmmmmm.
>
> I suppose if things got really bad for me I could consider the Emsam or deprenyl thing and take mirtazepine 7.5mg early in the evening to sleep.
>Yup, I'm still on tianeptine, actually. Since it's by far the most useful (partial AD response, no side-effects) med, I generally don't come off of it. Considering combining it with one of the MAOis for increased AD effect. I expect whichever of them I take, sleep will be disturbed (it is already), but I'm hoping I can controll that enough with Ativan, and maybe antihistamines (like mirtazapine, but probably shorter acting ones, so I'm not sedated all day). So I'm assessing all the MAOis based on side-effects and such. Tranylcypromine has advantage on strength, I think, EMSAM on tolerability...
Problem is, after a few days on MAOis, I seem to reach some threshold of MAO inhibition, and experience a sensory side-effect all over my body--it's like when a limb 'falls asleep,' but much milder. And -more unfortunately- it slows my mind down--as though all my nerves are overstimulated, and my mind can't make it through the fog.
I've occasionally read others having similar 'foggy' issues on MAO inhibitors on this board. I'd love to hear whether anyone ever stuck it out on an MAOi for a couple months, and found the side-effect went away or reduced substantially. My doc doesn't know, but I'd rather find out before submitting months of my life to a cognitively debilitating side-effect...
Anyone had the sensory/mental experience I describe with an MAO inhibitor?
Best,
Psychbot
Posted by Quintal on January 26, 2007, at 15:35:57
In reply to Parnate-related acne, posted by halcyondaze on January 25, 2007, at 18:16:56
A birth control pill that contains cyproterone might help with the acne by blocking androgen receptors. Dianette is one brand that contains cyproterone.
Posted by bulldog2 on January 26, 2007, at 15:48:09
In reply to Re: Parnate-related acne, posted by psychobot5000 on January 26, 2007, at 12:20:39
> > Did anyone who developed acne find anything that helped? Differin and Duac are making my skin dry, though the acne has calmed down. But now it's on my back and my neck too! :( I think it might be hormonal but I don't know which birth control will make it worse or better.
>
> I've read that amineptine was supposed to cause acne by increasing dopamine, which leads to decreased prolactin, which in turn leads to increased testosterone, causing the acne. Since tranylcypromine/parnate increases dopamine by several mechanisms, maybe it's this same chain of action.
>
> In that case, though I know nothing about hormones, maybe a hormonal med like birth-control would have an effect, by somehow changing the balance away from testosterone...just speculation.
>
> PbotDon't think the birth control thing would matter..I also got cystic acne from amphetemine when I was young...If you notice your pores get filled with this cheesey stuff called sebum which erupt once bacteria get in there...Some people have luck with an oral antibiotic...Also diet might help...Avoid fatty foods especially trans fats. I've heard that some facial treatments such as mud masks or something like that might help...What you want is something that will draw the sebum out of your pores before they get infected...
I've heard that accutane works well but I don't know if they use that anymore...It shrinks the sweat glands..I would go to a dermatologist if it's bad because systic acne can cause scars...
Posted by ed_uk on January 26, 2007, at 15:55:28
In reply to Re: Parnate-related acne » halcyondaze, posted by Quintal on January 26, 2007, at 15:35:57
Yes, Dianette (Diane) might help. Yasmin is another option.
Ed
Posted by bulldog2 on January 26, 2007, at 17:59:35
In reply to Re: Parnate-related acne, posted by ed_uk on January 26, 2007, at 15:55:28
More thoughts on parnate related acne. Increased dopamine also increases human growth hormone. Increased hgh increases igf1 (insuline growth factor) which actually may be the main player in stimulating those oil glands. There may be some drugs that increase prolactin and lower hgh and Testosterone by reducing dopamine but than that may be negating the effectivness of parnate.
Posted by laima on January 27, 2007, at 7:28:09
In reply to Re: Parnate-related acne » halcyondaze, posted by Quintal on January 26, 2007, at 15:35:57
I've heard that accutane is still used- but not often-because patient has to get a pregnancy test MONTHLY, or something truely strict like that.
This is the end of the thread.
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