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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by eric wagner on August 21, 2008, at 15:06:26
Does anyone know of any medical reports stating doses of Parnate above 60 mgs. are/can be effective?
I saw my Psychiatrist yesterday & have been on Tranylcypromine for 54 days w/ no positive response
5 days at 10 mgs.
5 days at 20 mgs.
6 days at 30 mgs.
10 days at 40 mgs.
7 days at 50 mgs.
21 days at 60 mgs.I had asked him if he thought it would possibly be beneficial to gradually increase dose to 80 mgs./day &/or augment w/ a stimulant or tricyclic (Nortriptyline)
I have read posts where people didn't respond until their dosage was higher than 60 mgs. &/or augmented
My Dr. said there are no studies which prove doses above 60 mgs. are more effective if there is no response at a lower dose
The same w/ augmenting w/ a stimulant or tricyclic (contraindicated)
I believe my Dr. is not too well informed in prescribing MAOI's & does not do it much
He told me as the dosage of a MAOI is increased, the side effects are increased logarithmically
I did have bad side effects for 2 1/2 weeks when I hit 60 mgs. - especially dizziness/lightheadedness to the point when I stood up/walked a short distance, if I did not kneel/sit down, I felt like I was going to faint
Along with anxiety, insomnia, headaches, nausea, a hissing sound in my head which lasted about 20 seconds a couple times a day, lethargy, etc.
The side effects have since totally disappeared
I previously trialed Emsam for 12 weeks also w/ no response
He has previously stated we are running out of options
I just want to feel better & be able to live a worthwhile life
I have a high tolerance for medications - of the approximately 30 medications I have trialed over the past 10 years, I only briefly responded positively to Daytrana until tolerance set in after 2 weeks the 5 times & restarted it
I am a 33 year old active healthy male suffering for a long time w/ depression/ADHD
Any help/info. on the above (including where I may find the requested studies) will be very much appreciated
Take Care & Be Well,
Eric M. Wagner
Posted by Phillipa on August 21, 2008, at 16:45:03
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
Any large universities in your area? Could have more knowledeable docs. Hang in as I know you receive a lot of helpful suggestions. So sorry. Phillipa But things will improve. Don't know why have a feeling they will.
Posted by Justherself54 on August 21, 2008, at 18:47:15
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
I'd be interested too, although I have experienced some partial response to Parnate, I'm nowhere near feeling really well. I'm currently at 50 mg., a little more dizziness when I get up..that's about all the side effects I have. My pdoc also says the side effects will increase along with an increased dosage. I react very badly to TCA's, so that's probably why he hasn't mentioned that.
We're at the end of the med trials also. We could revisit meds that have worked for me in the past, however, they have all pooped out on me. I can relate to how frustrated and nervous you are getting, as I'm feeling the same way. If this doesn't work..what next?
Posted by Nadezda on August 21, 2008, at 21:25:38
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
Pharmacopsychiatry. 1989 Jan;22(1):21-5.
Prog Neuropsychopharmacol Biol Psychiatry. 1988;12(4):523-32. Suggests that parnate can be combined with tricyclics, esp. amitriptyline --done in West Germany, so don't know if your pdoc believes non-American studies as some pdocs are suspicious of them
J Clin Psychiatry. 1987 Jan;48(1):31-2 Report of two treatment resistant patients who responded to high-dose Maios
J Clin Psychopharmacol. 1992 Apr;12(2):104-9.Links
Blood pressure effects of tranylcypromine when prescribed singly and in combination with amitriptyline.Am J Psychiatry. 1980 Nov;137(11):1422-5.Click here to read Links
Combined monoamine oxidase inhibitor-tricyclic antidepressant treatment: a pilot study.
White K, Pistole T, Boyd JL.I have to note that these are older studies-- on the other hand there maybe no reason to doubt the results.
I couldn't access my usual source of psych med studies, so I can't report on that. I hope to be able to do that in the next few days. These either report positive results from high doses, or safety and efficacy of maois with tricyclics.
Nadezda
Posted by Tomatheus on August 21, 2008, at 21:49:05
In reply to Re: Parnate Dosage - Studies Proving 60+ Effective » eric wagner, posted by Nadezda on August 21, 2008, at 21:25:38
> Pharmacopsychiatry. 1989 Jan;22(1):21-5.
Here's the abstract of that study, which found that four out of seven participants with treatment-refractory depression were completely responsive to Parnate in doses ranging from 90-130 mg/day.
Tomatheus
==============================
Abstract below from http://www.ncbi.nlm.nih.gov/pubmed/2710808
1: Pharmacopsychiatry. 1989 Jan;22(1):21-5.Links
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.
PMID: 2710808 [PubMed - indexed for MEDLINE]
Posted by UGottaHaveHope on August 22, 2008, at 20:23:04
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
Eric, I read your post where your pdoc said that he felt like you were beginning to "run out of options"
I hope you do not believe that, because that is hardly the case. There are countless medicinal COMBINATIONS left to try. And if your pdoc is not willing to experiment with them, then you may have to find another pdoc that will.
The best way to convince any pdoc to let you try any medical combo is to print out medical studies (which some have posted for you) and take it that pdoc.
Also, go through the archives of Dr. Bob to see the different combos attempted.
Above all, please don't feel like "you're running out of options." That will never happen, especially with new meds and new uses of old meds being discovered all the time. Michael
Posted by aussie_jon on August 22, 2008, at 22:35:06
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
There is evedence that welbutrin and parnate can be taken together safely, and one would expect this to give the effect a major kick start.
As you have ADHD, have you tried an amphetamine?
Posted by SLS on August 23, 2008, at 6:42:01
In reply to Parnate Dosage - Studies Proving 60+ Effective?, posted by eric wagner on August 21, 2008, at 15:06:26
Hi Eric.
The lack of controlled studies can be supplanted by anecdotal data from clinical experience. Personally, I consider the therapeutic range of Parnate to be 40-80mg.
The key to your doctor's rationale is that it is not worth going higher than 60mg if no partial response has occurred by that point. He might be right, but I would not stop titrating at 60mg if you are tolerating it. You are on the stuff, so you might as well fully explore its potential.
Adding nortriptyline or desipramine to Parnate can work wonders.
- Scott
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