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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by bleauberry on November 21, 2008, at 16:53:06
Realizing that side effects and efficacy vary widely from person to person, I am looking for some general expectations of Parnate, as well as any personal experiences of yours.
Side Effects:
Sleep...bad sleep or good sleep?
Weight...gain or loss?
Energy...energetic or lethargic?
Sexual for a man...libido/desire? Erection/ability? Anorgasmia?
Appetite...good or bad?
Blood pressure...hypotension?Thanks
Posted by desolationrower on November 21, 2008, at 18:02:09
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
> Realizing that side effects and efficacy vary widely from person to person, I am looking for some general expectations of Parnate, as well as any personal experiences of yours.
>
> Side Effects:
> Sleep...bad sleep or good sleep?
wake up a few times during the night, basically whenever i would have been in REM sleep otherwise. I take trazodone and now sleep normally.
> Weight...gain or loss?
Gained a bit, i think i just got my apetite back and didn't realize i was eating more the first few weeks, its going back to normal now though.
> Energy...energetic or lethargic?
at first, really sleepy by afternoon, now, not much effect
> Sexual for a man...libido/desire? Erection/ability? Anorgasmia?
lost libido and erection for the first few weeks, now its back to normal, no problem with orgasm
> Appetite...good or bad?
i think i just enjoy food a bit more now
> Blood pressure...hypotension?
slight hypotension at first
>
> Thanks-d/r
Posted by Phillipa on November 22, 2008, at 0:41:36
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
Bleauberry are you thinking of trying it? Love Phillipa
Posted by Justherself54 on November 22, 2008, at 11:59:36
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
>
> Side Effects:
> Sleep...bad sleep or good sleep?
I take sleep meds but didn't need to increase them (I did on Nardil)> Weight...gain or loss?
Loss
> Energy...energetic or lethargic?Energetic
> Sexual for a man...libido/desire? Erection/ability? Anorgasmia?
Sorry, I'm a gal
> Appetite...good or bad?
Less appetite
> Blood pressure...hypotension?
First time on Parnate, bad hypotension. The second trial unfortunately was a failure. For some reason my BP ran on the high side to the point where my GP was concerned I had developed high BP (runs in the family). After stopping it, BP is now in the normal range).
I was hoping MAOI's would be different for me and would work a second time as SSRI's don't, but it was a completely different experience. It felt like a different drug entirely. The first time I couldn't get past 20 mg. as the hypotension was so bad. The second time I was at 50 mg and my BP was high...go figure! I think I have a strange brain!!
Posted by JadeKelly on November 22, 2008, at 15:15:52
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
> Realizing that side effects and efficacy vary widely from person to person, I am looking for some general expectations of Parnate, as well as any personal experiences of yours.
Hi Bleauberry,
>
> Side Effects:
> Sleep...bad sleep or good sleep?Insomnia pretty bad at first, 6mg melatonin took care of most. Insomnia wore off in couple weeks or so
> Weight...gain or loss?
Quick weight loss, too much, have to remember to eat!
> Energy...energetic or lethargic?
2nd week, unbelievable energy. Wore off.
> Sexual for a man...libido/desire? Erection/ability? Anorgasmia?
n/a :)
> Appetite...good or bad?
I can eat, but not big appetite. Definite change.
> Blood pressure...hypotension?Mostly, but can go towards hypertension at times, also. Seems that's becoming less a problem. Some occasional dizziness (been on a month).
>
> ThanksYour welcome!
Jade
Posted by uncouth on November 22, 2008, at 16:33:56
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
sleep: bad all around. taking seroquel and trazadone helped. lunesta did not.
weight: actually weight gain, but could also be because of abilify
energy: very lethargic first few weeks, esp. in afternoon. needed lots of coffee. slowly starting to feel more normal.
sexual: libido/desire slight help, erection/ability no problem, anorgasmia no problem
appetite: initially less, now more appetite, because of abilify. increased parnate dose to 80, now feeling less need to eat. metformin can help i hear.
blood pressure: biggest issue. at 80mg i have baseline hypertension (160/90), but still have orthostatic at the same time, especially just after dose increase. we'll see if both normalize in time.Parnate is very effective, but dose has to be right, and you have to have patience, and deal with side effects. But overall, when it works (and it often poops out, requiring dose escalations and time before you feel better again, i've found), i think it's better overall than SSRIs. I've ALWAYS responded to effexor, and quickly, but i've found it makes me a bit hypomanic, and less "in control" (e.g., would go hours browsing the internet, porn, eating, more of a desire to drink, etc.).
However, I do think before you try Parnate, you should try a mix of Pristiq and 10mg of Abilify. I hear this is a very powerful combo, as pristiq is more stimulating, Abilify helps normalize things, and potentailly can reduce some of the hypomania that Pristiq/Effexor might generate, while improving dopamine response which SSRIs often blunt. If/when the parnate poops out completely, I will try 100mg Pristiq and 10mg Abilify, which I have a feeling is a really technologocially advanced and sound strategy.
But what i'm really waiting for is my first shipment of Agomelatine to come in, Hoping to replace my sleep meds with it, and maintain my current regime of 80mg parnate, 37.5mg tianeptine, 500-1500mg of L-Tryptophan/day, 2.5mg Abilify, 300mg lithium, 100mcg levothyroxine and a sleeper (either 50mg seroquel or 50 mg trazodone or a combination of both if i really need to get through the night for sure). I also take deprenyl 2.5mg 3 times a week, 5-10mg of DHEA every day, B-complex vitamin, Metformin for weight control, NAC, Omega-3, and smoke weed occasionally to help with sleep.
Sometimes I wonder if i'm just putting in too much in my Brain, but this seems to be working, and no sign of serotonin syndrome. Just started the tianeptine a few days ago but so far so good, esp. w.r.t. anxiety.
Other things which everyone should do:
1. quit smoking
2. drink LOTS of green tea
3. easy on the caffeine
4. chocolate is good, lots of good stuff in there including PEA
5. i think very low doses of deprenyl should be taken by anyone with depression, even if they are on a SSRI or other MAOI. I'm talking 1-2.5mg oral even just 2-3 times a week. At that level, there is virtually no risk of serotonin syndrome because it's just MAO-B specific, but oral deprenyl itself, and it's metabolites, have incredible neuroprotective and neurotrophic properties, esepcially for dopamine neurons.
6. NAC seems to be a great supplement with a really convincing study being reported a few months ago. But it only seems to kick in long term, and you gotta take at least 1000mg a day, and make sure to take vitamin C with it. NAC is a highly potent antioxidant which reduces damage to cells, and can help alleviate some of the stress that all the other chemicals and drugs one uses puts on the brain.
6. Faith and prayer, no matter your religion. If one is agnostic or atheist, then meditate meditate meditate!Anyway that's my regime. Sure it's a lot, but i'm also very sick. And nobody should ahve to suffer with persistant, constant suicidal thinking. Which I did for a long time.
BLUEberry what is your current regime and why you looking to switch to parnate?
Posted by bleauberry on November 22, 2008, at 18:04:23
In reply to Re: Tell Me All About Parnate » bleauberry, posted by uncouth on November 22, 2008, at 16:33:56
> BLUEberry what is your current regime and why you looking to switch to parnate?
Thank you very much for the detailed post.
As you mentioned effexor+abilify, yeah, though I am not a fan of antipsychotics, I do feel there is some special synergy between an antipsychotic and an antidepressant...though finding the right two is the tricky part. When I added Zyprexa to Prozac many years ago it really changed the way Prozac worked and felt. Lasted a good 8 years.
Chocolate. I love it and eat lots. Don't think I can ever get off nicotine, though I have been at 1/2 pack per day for months now, down from a full pack most of my life. I like the fruit chill nicorette even better, though I still need the cig. Terrible deep dark depression without nicotine. NAC I worry about because it can loosen stored mercury and put it back into circulation, repoisoning, without having the power to fully excrete all that it stirs up. For me, with diagnosed mercury toxicity from amalgam fillings, that is a risky proposition.
Why Parnate? Well, I had an expensive genetic profile test done recently. Took 8 weeks to get the results. They are in. Genes involved with methylation and other stuff are fine. But, of 5 different MAO genes and several COMT genes, they are all in the red, shown as "double mutations". My doc got the results, and so did I, but we haven't met yet to discuss what they mean. It either means my MAO is working overtime and needs to be slowed down (thus Parnate), or it means MAO is not working much, and maybe something like Tianeptine would be better.
Long history of melancholic anhedonic depression, a couple almost-suicides, one hospitalization, a course of ECT, tons of med failures or intolerances. But a good life. Purely biological. Mercury is almost surely the blame, but how to bypass its damage is really a tough mystery to solve. At least now I can see clearly what it did to MAO genes.
Posted by uncouth on November 22, 2008, at 18:27:05
In reply to Re: Tell Me All About Parnate » uncouth, posted by bleauberry on November 22, 2008, at 18:04:23
where did you get the genetic test? how much did it cost? was it yoru dcotor's idea or yours?
also -- it's very likely not the nicotine which your addicted to. i realized this when i quit with the patch and started feeling like sh*t for a week. cigarette smoke has VERY significant MAO inhibiting factors, on the order of 40-60% I believe. It's not enough to cause serotonin syndrome when smoking with an SSRI, but it's very significant to be the cause of mood improvement, in concert with nicotine.
So parnate might be the right drug for you. If you've had ECT and been hospitalized before, I'm shocked it's taken this long for you to consider parnate. Why did you consider ECT before an MAOI?
Also, i should note, that when I quit smoking, I had to increase my dose of MAOI. I like you have probably a very overactive MAO system. I know this becuase when I came off of the Emsam patch, I didn't taper, and within 2-3 days I had a suicidal depression. It usually takes 2 weeks for the MAO enzyme to regenerate, but I seem to overproduce it. So it's highly possible that that's why you smoke and why parnate might be just the ticket for you. But don't be shy about the dose, and remember that parnate does have significant startup side effects which do eventually go away. But if you stick with it, and push the dose as far as it needs to go to get a response (I don't know if your doctor has experience with MAOIs, but the typical dose range for parnate is 20-60 max, although for TRD studies have shown that big impacts can come if you push it all the way up to even 100-130, if a lower dose doesn't do the trick or is only partially beneficial.).
That's the one suggestion with MAOIs, especially if you overproduce the MAO enzyme. Do not put up with just partial response. You will definitely feel something on parnate, but regardless of what your doctor says or suggests, push hard on him to let you push the dose as high as it needs to go.
Will you be taking anything else besides parnate? Have you tried tianeptine on it's own? MAOIs + Lithium are a very powerful combo, and you may only need 300 - 600mg of lithium which shouldn't cause any cognitive problems in most people.
Can you do chelation therapy to get rid of the mercury?
What are you on right now?
Posted by desolationrower on November 22, 2008, at 18:54:58
In reply to Re: Tell Me All About Parnate » bleauberry, posted by uncouth on November 22, 2008, at 16:33:56
hm you take the deprenyl with the parnate? How do you find that? I have piles of deprenyl left over from when i was trying it as monotherapy (probably years worth if i was just taking a gram or two a day) and thought about adding it to the parnate just for the nuetrophic stuff it seems to do.
-d/r
Posted by uncouth on November 22, 2008, at 19:37:48
In reply to Re: Tell Me All About Parnate » uncouth, posted by desolationrower on November 22, 2008, at 18:54:58
honestly, it's hard to tell. i'm in general not so good about being able to tell specifically how psychotropic drugs effect me except over the long term (e.g., it took me 2 years and a severe depression to realize just how much of my compulsive internet use, eating, and lack of libido was due to SSRIs)
but i find that I don't even really notice the additional deprenyl. even if i take 5mg one day instead of 2.5 (and i take the oral pill form, not the sublingual solution form) it's hard to tell that i'm taking anything.
if your shooting for the neurotrophic effects and the beneficial antioxidant stuff, i think 10mg a week should be a good target, or 2.5mg every other day or so.
if your on an MAOI already, 10mg a week is actually enough to provide some meaninful MAO-B inhibition, so i'm not sure what that would mean for the other MAOI (like i'm on parnate 80mg). It may mean the other MAOI has more room to attack MAO-A, or it may just mean that MAO-B is essentially being hit by two different drugs and thus 100% inhibited, which i think for people depressed, especially those who when euthymic still have lots of anhedonia, attention problems, and other dopamine connected things, a very good thing.
Posted by elanor roosevelt on November 22, 2008, at 22:36:27
In reply to Re: Tell Me All About Parnate, posted by JadeKelly on November 22, 2008, at 15:15:52
Parnate was a strange one for me
I lost weight and was very motivated on the physical fitness thing
little or no joint/muscle pain
i had perfect nails and cuticles
unfortunately it was bad for my head--however, i do not think my pdoc did well fine-tuning this
Posted by desolationrower on November 22, 2008, at 23:26:09
In reply to Re: Tell Me All About Parnate, posted by elanor roosevelt on November 22, 2008, at 22:36:27
Girls, you have libidos as well.
-d/r
Posted by bleauberry on November 23, 2008, at 19:40:20
In reply to Re: Tell Me All About Parnate » bleauberry, posted by uncouth on November 22, 2008, at 18:27:05
> where did you get the genetic test? how much did it cost? was it yoru dcotor's idea or yours?
Doctor's idea. $500. A lab in Maine that specializes in it.
>
> also -- it's very likely not the nicotine which your addicted to. i realized this when i quit with the patch and started feeling like sh*t for a week. cigarette smoke has VERY significant MAO inhibiting factors, on the order of 40-60% I believe.The cigarette/nicotine/MAOI connection makes sense. I remember the very first cigarette I ever had, I said, "wow, this is what's been missing my whole life". There was no buzz, and in a few puffs I certainly wasn't addicted. I just instinctively knew there was something good about cigarettes.
>
> So parnate might be the right drug for you. If you've had ECT and been hospitalized before, I'm shocked it's taken this long for you to consider parnate. Why did you consider ECT before an MAOI?The doctors in the psychiatric ward, where I was for a week, pushed ECT on me. I was in such bad shape and at the end of the line with no hope, so it didn't sound like a bad idea. Looking back, yeah, a good ole MAOI makes a lot more sense.
>
> Will you be taking anything else besides parnate? Have you tried tianeptine on it's own? MAOIs + Lithium are a very powerful combo, and you may only need 300 - 600mg of lithium which shouldn't cause any cognitive problems in most people.Tianeptine I don't like. It numbs me out as bad as ssris do and with more cognitive dysfunction than ssris. Don't know why. Lithium, bad news, much worse depression on it.
I know my doc is going to push all kinds of natural things on me and maybe revisit meds I've already been on, but I am going to point to the genetic test results and say, look, that stuff spells MAOI as clear as can be. Isn't that why we did the test? To find out what to take?
>
> Can you do chelation therapy to get rid of the mercury?Chelation therapy is even more of a gamble than psychiatry. Many people have been seriously screwed up by the common IV chelation. It moves too much mercury too fast, and dumps a lot of it before being excreted. Successful for some, disaster for others. High risk. The safest way is low dose frequent dose DMSA chelation, which I have done 9 rounds of. But it takes 60 rounds or so to make a real impact, and nothing gets mercury out of the brain until alpha-lipoic acid is added to the chelation mix.
>
> What are you on right now?Nothing. I try things here and there. Out of dozens of meds, herbs, or supplements, the only one that held any promise, despite totally intolerable side effects, was Milnacipran. Practically anything else makes me worse. My baseline, as bad as it is, is actually better than drug-induced deterioration.
Parnate makes sense. Good luck finding someone in Maine to prescribe it. But I will get my doctor to go along. It will be a tough sell, I can already predict the see-saw back and forth debate, but we'll see.
Posted by Phillipa on November 23, 2008, at 19:46:49
In reply to Re: Tell Me All About Parnate, posted by bleauberry on November 23, 2008, at 19:40:20
Bleauberry you're going on Parnate what happened to all the natural stuff? Love Phillipa
Posted by uncouth on November 23, 2008, at 20:14:26
In reply to Re: Tell Me All About Parnate, posted by bleauberry on November 23, 2008, at 19:40:20
What about Emsam?
It sounds like you're a perfect candidate for Parante. I'd also suggest at some point adding L-Tryptophan, carefully, starting slow, to Parnate. L-Tryptophan, NOT 5-htp.
If your problem is dopamine, you could also take 250 DL-Phenylalanine per day. Both should be taken on an empty stmoach, with some fruit juice.
Posted by Maria3667 on November 24, 2008, at 14:25:57
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
Hi Bleauberry,
Why do you want to take Parnate?
Isn't the LDN working anymore?
I've just started on LDN.Maria
Posted by bleauberry on November 24, 2008, at 18:01:01
In reply to Re: Tell Me All About Parnate » bleauberry, posted by Phillipa on November 23, 2008, at 19:46:49
I'm not sure what natural stuff you're talking about. I haven't taken anything in months. The only thing I found mildly helpful was 1000mg Vitamin D3, which I need to buy more of. Everything else...the fish oils, borage oils, vitamins of every kind, minerals of every kind, endless herbs and such...good for most people, bad news for me.
My genetic testing showed double mutations on all of my MAO genes. And it is a drug I haven't tried, so ya know, it kinda makes sense.
> Bleauberry you're going on Parnate what happened to all the natural stuff? Love Phillipa
Posted by bleauberry on November 24, 2008, at 18:05:00
In reply to Re: Tell Me All About Parnate » bleauberry, posted by uncouth on November 23, 2008, at 20:14:26
Ensam, too pricey and lacks the solid reputation on old-time MAOIs.
L-tryptophan and DLPA, tried them both numerous times and various doses. Both pretty darn lousy feeling substances. My baseline feels better than what those things did to me.
Mercury screws up just about everything, including the routes of metabolism of things like Ltrypt and DLPA. They can turn into other substances, or not turn into as much of what you want, or too much. I have to somehow just make-do with what I have and make that work.
> What about Emsam?
>
> It sounds like you're a perfect candidate for Parante. I'd also suggest at some point adding L-Tryptophan, carefully, starting slow, to Parnate. L-Tryptophan, NOT 5-htp.
>
> If your problem is dopamine, you could also take 250 DL-Phenylalanine per day. Both should be taken on an empty stmoach, with some fruit juice.
>
>
>
>
Posted by bleauberry on November 24, 2008, at 18:11:51
In reply to Re: Tell Me All About Parnate - Why? » bleauberry, posted by Maria3667 on November 24, 2008, at 14:25:57
Crazy thing. I got off LDN because after increasing from 1.5mg to 3mg I got really a lot more depressed to where I was just so much worse I was scared and could hardly make it. Instead of going back down to 1.5mg, I just paniced and washed out completely, planning to restart again at 1.5mg. When I did, the very first day was like running into an elephant dart. I don't know why the second time around was so different.
Anyway, here is something cool. AFter I stopped LDN, there was about 3 days of feeling yucky, withdrawal, depression. Then it lifted, and for 3 days in a row I actually felt fairly good. I was calm, I had at least some motivation for a change, I was thinking clearer. Once in a great while I might have some random 2 or 3 hour window that might be like that, but not an entire day. And then a next day. And a next. Wow. It is almost like the after-effects of LDN had somehow changed chemistry in a positive way that stayed.
Then I got the genetic profile back, it suggested very low dose 5htp and some scattered vitamins, all of which I knew from previous experience were really bad news for me, but I had faith and did them anyway, only to be reminded again of how bad they are to me. What a fool I am sometimes. In the process, I lost all the goodness of LDN.
So, I'm lost now.
> Hi Bleauberry,
>
> Why do you want to take Parnate?
>
> Isn't the LDN working anymore?
> I've just started on LDN.
>
> Maria
Posted by Maria3667 on November 25, 2008, at 2:29:42
In reply to Re: Tell Me All About Parnate - Why? » Maria3667, posted by bleauberry on November 24, 2008, at 18:11:51
Hi BB,
Trouble is... how do you know the depression stemmed from the LDN? I could also be your 'normal' depression, not responding yet to the LDN. Some people say it takes about 6-12 weeks to work properly. And works best when taken at the full dose of 4.5 mg.
I've been on LDN for 1 week now (1.5 mg). Side effect is nauseousness and a slight headache. But sleep is so much better! Maybe my respons is different because I have an auto-immune disease (Sjogren's Syndrome)? Guessing here...
Best wishes,
Maria> Crazy thing. I got off LDN because after increasing from 1.5mg to 3mg I got really a lot more depressed to where I was just so much worse I was scared and could hardly make it. Instead of going back down to 1.5mg, I just paniced and washed out completely, planning to restart again at 1.5mg. When I did, the very first day was like running into an elephant dart. I don't know why the second time around was so different.
>
> Anyway, here is something cool. AFter I stopped LDN, there was about 3 days of feeling yucky, withdrawal, depression. Then it lifted, and for 3 days in a row I actually felt fairly good. I was calm, I had at least some motivation for a change, I was thinking clearer. Once in a great while I might have some random 2 or 3 hour window that might be like that, but not an entire day. And then a next day. And a next. Wow. It is almost like the after-effects of LDN had somehow changed chemistry in a positive way that stayed.
>
> Then I got the genetic profile back, it suggested very low dose 5htp and some scattered vitamins, all of which I knew from previous experience were really bad news for me, but I had faith and did them anyway, only to be reminded again of how bad they are to me. What a fool I am sometimes. In the process, I lost all the goodness of LDN.
>
> So, I'm lost now.
>
> > Hi Bleauberry,
> >
> > Why do you want to take Parnate?
> >
> > Isn't the LDN working anymore?
> > I've just started on LDN.
> >
> > Maria
>
>
Posted by bleauberry on November 25, 2008, at 16:53:25
In reply to Parnate or LDN???? » bleauberry, posted by Maria3667 on November 25, 2008, at 2:29:42
> Hi BB,
>
> Trouble is... how do you know the depression stemmed from the LDN? I could also be your 'normal' depression, not responding yet to the LDN. Some people say it takes about 6-12 weeks to work properly. And works best when taken at the full dose of 4.5 mg.
>Well, you are correct. I don't know. I am pondering yet another restart. That's the problem when all the doctors just shrug and stare and guess and really have no idea what's going on...you are kind of left on your own to be your own guide, which is sometimes masterful and sometimes a puzzle.
Posted by Jimmyboy on November 26, 2008, at 14:32:15
In reply to Re: Parnate or LDN????, posted by bleauberry on November 25, 2008, at 16:53:25
I am/was also taking LDN on and off...
I am having very similar expereinces. The first few days I take it I don't feel awful, but definitely "off" , just kind of fuzzy and flu like. Very hard to explain. But I have come off it 3 times and the few days after I stop, I also get a stretch of a few days at a time where I feel absolutely great. Then I return to normal.. unfortunately.
my theory ( just a theory) is that by taking the LDN ( which is temporarily blocking your mu opiod receptors)- you down-regulate the number of mu receptors thus making yourself more sensitive to endogenous endorphins (which hit mu) for a little while. Actvation of mu receptors releases dopamine in the right places in the brain and makes you feel good. After a few days homeostasis does its thing and they go back to normal, erasing the down regulation. If this is true cycling it may be an option, but you would have to go through the bad to cash in on the good.
Again, just a theory.
PS- i know three other people taking LDN and they feel great on it all the time and really like it. Lucky them!
Posted by JadeKelly on November 28, 2008, at 22:06:37
In reply to Tell Me All About Parnate, posted by bleauberry on November 21, 2008, at 16:53:06
Hi Bleauberry,
Let me know if you are still considering Parnate. I'm on for 7 weeks, also talked to someone a couple months ahead of me, he's in full remission. What kind of depression do you have, symptom-wise? I can give you a much broader picture if you're still interested.
~Optomistic Jade!
This is the end of the thread.
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