![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 75 to 99 of 106. Go back in thread:
Posted by elanor roosevelt on December 21, 2008, at 12:24:31
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » desolationrower, posted by Vincent_QC on December 21, 2008, at 11:22:11
it might be the parnate is not a good fit
that lethargy did me in to the point of self-loathing
that said, i've had few successes
do you see a therapist to talk?
Posted by JadeKelly on December 21, 2008, at 12:35:33
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » desolationrower, posted by JadeKelly on December 20, 2008, at 12:58:52
D/R,
Don't want to jinx myself but I gotta tell someone on this board, and YOUR IT! Not to make you jealous but to share what I did and hopefully this continues! Oh, I did tell Phillipa. She'd find out anyway. Day before yesterday, I took one 5mg Ritalin and felt nothing. I figured all the stim action in the Parnate canceled it out or something. But yesterday, it hit me around lunch time and hasn't stopped since. I feel like a normal human being! Like I did before depression! So I kept watch of my BP, it went up for small amount of time, then normal again. I was outa bed, cooked dinner, watched TV, haven't done that forever, spent time with my son and dogs. I'm on my 7th day of 60mg, and damn if that isn't when Scott said that it should kick in recently. And I forgot that till just now. No, I'm not imagining it. I asked him when to give it up and he said in one to three weeks after you hit your dose, for me he said 60mg (I would have gone to 70). So there it is! Ritalin (only one 5mg a day!) and 60mg of Parnate. Total time, 10 weeks. I've told you this but I took Ritalin for 12 years for ADD, and stopped a few months ago to try a/d's. Felt no withdrawal. My dose started at 5mg 3x day, then ended at 5mg 5x day, 12 years later. Never abused it. So there it is! I'll keep you posted, but if this continues, I highly recommed it. Oh, also taking klonopin 1mg 3x day. Don't need it but I'm not changing anything right now. If I start feeling tired again, I'll taper off the klon. And maybe add Lithium.
~Jade -
Btw-Thnx d/r for your help, hopefully all my pestering will help us both! This was one of two combos that PDoc in New york recommeneded for tr/dep: Parnate + stim + lithium. I have lithium so if I start goin south, I'll add that. Other was what we considered anyway: Parnate + Nort + ?
Posted by desolationrower on December 21, 2008, at 15:13:34
In reply to Re: Parnate Lethargy Jade to D/R » JadeKelly, posted by JadeKelly on December 21, 2008, at 12:35:33
> D/R,
>
> Don't want to jinx myself but I gotta tell someone on this board, and YOUR IT! Not to make you jealous but to share what I did and hopefully this continues! Oh, I did tell Phillipa. She'd find out anyway. Day before yesterday, I took one 5mg Ritalin and felt nothing. I figured all the stim action in the Parnate canceled it out or something. But yesterday, it hit me around lunch time and hasn't stopped since. I feel like a normal human being! Like I did before depression! So I kept watch of my BP, it went up for small amount of time, then normal again. I was outa bed, cooked dinner, watched TV, haven't done that forever, spent time with my son and dogs. I'm on my 7th day of 60mg, and damn if that isn't when Scott said that it should kick in recently. And I forgot that till just now. No, I'm not imagining it. I asked him when to give it up and he said in one to three weeks after you hit your dose, for me he said 60mg (I would have gone to 70). So there it is! Ritalin (only one 5mg a day!) and 60mg of Parnate. Total time, 10 weeks. I've told you this but I took Ritalin for 12 years for ADD, and stopped a few months ago to try a/d's. Felt no withdrawal. My dose started at 5mg 3x day, then ended at 5mg 5x day, 12 years later. Never abused it. So there it is! I'll keep you posted, but if this continues, I highly recommed it. Oh, also taking klonopin 1mg 3x day. Don't need it but I'm not changing anything right now. If I start feeling tired again, I'll taper off the klon. And maybe add Lithium.
>
> ~Jade -
>
> Btw-Thnx d/r for your help, hopefully all my pestering will help us both! This was one of two combos that PDoc in New york recommeneded for tr/dep: Parnate + stim + lithium. I have lithium so if I start goin south, I'll add that. Other was what we considered anyway: Parnate + Nort + ?Hey now how am i going to figure out if creatine has anti-fatigue effects in MAOI takers? Sounds like you found a good combination though. keep me updated. oh and promise you'll be carful if you notice signs of hypomania. not sure what i'll do, if the klonopin helps my anxiety i gues i'll have to stick with the pdoc, maybe i'll ask about guanfacine for days i am studying. if not i might go rogue again and try reboxetine or nortriptiline.
so is the ritalin what helped or is the parnate just kicking in on its own? maybe its not clear.
-d/r
Posted by desolationrower on December 21, 2008, at 15:22:00
In reply to Re: Parnate Lethargy Jade to D/R, posted by desolationrower on December 21, 2008, at 15:13:34
My guess is it would cost an arm and a leg, but ever try growth hormone? especially since MAOIs, excersise helps you the most. and i think you said GHB did as well. i think GH->igf-1
Running exercise- and antidepressant-induced increases in growth and survival-associated signaling molecules are IGF-dependent.
Chen MJ, Russo-Neustadt AA.Department of Biological Sciences, California State University, 5151 State University Drive, Los Angeles, CA 90032, USA. mchen@calstatela.edu
It is known that physical exercise increases hippocampal brain-derived neurotrophic factor (BDNF) mRNA and protein, as well as the expression of several pro-survival signaling proteins and that many of these effects depend on the uptake of peripheral insulin-like growth factor-1 (IGF-1) into the CNS. Because treatment with antidepressants has similar effects upon neurotrophin expression, we investigated whether antidepressant-induced BDNF changes also depend on IGF-1 uptake, as well as whether IGF-1 plays a role in the exercise/antidepressant-induced expression of molecules associated with plasticity/growth (GAP-43, SCG-10) and the intracellular activation of molecules associated with neuronal survival (Akt, ERK1/2). We evaluated the effects of a well known monoamine oxidase inhibitor, tranylcypromine, on BDNF mRNA and protein levels and phospho-Akt and phospho-ERK1/2 immunoreactivity, both with and without systemic blockade of IGF-1 uptake through the use of an antiserum raised against IGF-1. Anti-IGF-1 reversed the increase in BDNF mRNA and protein elicited by exercise as well as tranylcypromine. Exercise also significantly enhanced transcription of axon growth protein, GAP-43, an effect that was also evidenced to be IGF-1-dependent. The combination of exercise-plus-tranylcypromine also increased several cell survival signaling measures, but the BDNF changes associated with the combination treatment appeared to be independent of IGF-1 uptake. Together, these results indicate that the uptake of peripheral IGF-1 in the CNS is essential for antidepressant- as well as exercise-induced enhancement in hippocampal BDNF expression and thus, enhanced hippocampal neuronal survival and plasticity.PMID: 17852404 [PubMed - indexed for MEDLINE]-d/r
Posted by JadeKelly on December 23, 2008, at 10:15:09
In reply to Re: Parnate Lethargy Jade to D/R, posted by desolationrower on December 21, 2008, at 15:13:34
>
> >>
> Hey now how am i going to figure out if creatine has anti-fatigue effects in MAOI takers? Sounds like you found a good combination though. keep me updated. oh and promise you'll be carful if you notice signs of hypomania. not sure what i'll do, if the klonopin helps my anxiety i gues i'll have to stick with the pdoc, maybe i'll ask about guanfacine for days i am studying. if not i might go rogue again and try reboxetine or nortriptiline.
>
> so is the ritalin what helped or is the parnate just kicking in on its own? maybe its not clear.
>
> -d/rIt isn't clear except I'm only taking 1-5mg tab a day (nothing) and I wondered how that could make a difference, so more research, it seems at least at this one source, that the MAOI potentiates the Ritalin, not the other way around. Maybe then you feel more ritalin? Works with MAOI? Not sure. If you recall my biggest problem had become incapacitating lethargy. So. Its been 5 days, not at all like that feeling you get after dosing. (I wish) I'd say full remission, except I'll need to go slowly, as I'm finding after 10 weeks of laying around, I'm a little slow cognitively and physically. So at the gym I'll do half the work out I normally did and work up, I take longer at the grocery store, and a dinner party I had (thats right, I said Jade had a dinner party) well, lets just say everyone had a great time but it was far from my usually organized get togethers. But...WHO CARES!!!! I just wanted to feel like myself again and I do. What more could a girl ask for? (course, santas on his way)
As for the creatine, (thats whats in No-Xplode, right?) I took it once before a work-out and I felt mild lift and a bit more energy. My nephew took too much one time, and had an anxiety attack after a workout. I called the company about it, but I'm sure you know all about its properties, etc. I'd say the equivalent of 5mg ritalin, but I had tolerance to ritalin also. So its been 5 days, I think I'm there, I'm gonna try to jump back into my old routine as soon as possible so I don't back slide.
Okay, so where are you with everything? Change anything? You been staying out of that kitchen sink? Dumb question. Let me know whats up and I'll keep you posted. If I didn't say this before, thanks for ALL your help. Even tho I confuse you with my niceness, haha, you are a funny guy! Oh, Phillipa and I are placing bets on your age....care to cheat and accidentally hide it in a post?
Okay then, don't know where you are but Happy Holidays, in case I don't catch up with you by the wknd *<((: ^ )>>
~Jade
Posted by JadeKelly on December 23, 2008, at 10:47:25
In reply to Re: Lithium. ritalin, Parnate-have it-SCOTT » JadeKelly, posted by SLS on December 20, 2008, at 6:49:17
> Before the age of Lamictal, lithium was considered the augmenter of choice for Parnate. If it doesn't work within 2 weeks, it is probably not going to. It usually works within a week. Of course, it will be necessary to have established a dosage of Parnate that is going to be high enough for this strategy to work. What is that dosage? Odds are, 60mg for 2 weeks should be enough - ideally, 3 weeks. The dosage of lithium when used as an augmenter has been established by Harvard to be 300-600mg.
>
> It is important to note that Lamictal is not lithium and lithium is not Lamictal. Lithium might work where Lamictal may not. It makes sense to try the lithium first and get it over with within 1-2 weeks. Establishing a therapeutic level of Lamictal will take a minimum of 6 weeks.
>
> One step at a time.
>
> Did you try caffeine yet? For some people, it is more effective than Dexedrine or Ritalin.
>
>
> - Scott
>
>
>
>
Hi Scott,I must say you know your Parnate! Day 5 or 6 on 60mg Parnate + 1-5mg ritalin and I'm in full remission. Its unbelievable. It took 10 weeks. Some not so fun s/e's and family telling me to stop. But you guys said keep going and here I am! While 10 weeks sucks, and is a long time to be lethargic, I'm SO glad I stuck with it. Thank you for the encouragement and info. You really do help people when you offer up your experience.I owe several people on the board thanks for the "keep on going" you are one. I have my life back, just like that. So wierd. So again, for your files, hah, I'm on 60mg Parnate, at remission was 5 days?, 1mg 3x day Klonopin (don't need this but I'm not changing a THING right now), and 1-5mg ritalin. No insomnia at all, a little slow physically and cognitively when I go out, but I blame that on 10 weeks of laying around. I'll get buzy at a reasonable pace and I think that'll do it. No where near as tired but still have small amount of fatigue I think will disipate when I get back to the Gym.
Again, thanks, and I'll be around if I forgot something.
~Jade
Posted by JadeKelly on December 23, 2008, at 11:32:58
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
> Hi,
>
> Sorry to hear you'r not feeling better.
>
> I think dosage is an individual thing. The PI states the normal dose of Parnate is from 20mg-80mg, but I know it can be dosed higher. Dr. Ivan Goldberg, a psychiatrist in the New York City area says that's just an average range and one could go higher. He see severe TRD and has good luck giving an; MAOI+TCA(orpsychostimulant)+Lithium.
>
> If you current psychiatrist isn't willing to work with you (show him some evidence that other psychiatrists use the above combination), fire him and find someone new. If all else fails, order via a mail order pharmacy not requiring a doctor's RX.
>
> A night of sleep deprivation can boost me out of the fatigue and excessive sleepiness I experiencemuch of the time.Hi Captain,
Hope you are still around. Wanted to thank you for your answers to my questions. Its the little things sometimes. For example, you posted that a well known Doc for trd has success with either Parnate + stim + Lithium (or tca I think instead of stim) Well it was a long shot but my GP gave me ritalin (I took it for 12 years for ADD (5mg 3xday) So that day added 1-5mg Ritalin, the timing for remission matched what Scott predicted, and I've been in full remission for I think 4 days maybe? It happened suddenly that day at lunchtime. After 10 "unpleasant" weeks on Parnate, in bed most of the time, I am now myself again. Not Like when first started or little high after each dose. Its just me and I'm grateful for your help. Btw-wondered how 1-5mg ritalin could even make a difference, I found a sit that said the MAOI potentiates the Ritalin. I'm sure you already knew that. I have Lithium, but wont take that unless needed. Thanks again!!
~Jade
Posted by CaptainAmerica1967 on December 23, 2008, at 17:36:23
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by JadeKelly on December 23, 2008, at 11:32:58
Glad you're feeling better!
Posted by desolationrower on December 24, 2008, at 1:54:38
In reply to Re: Parnate Lethargy Jade to D/R » desolationrower, posted by JadeKelly on December 23, 2008, at 10:15:09
>> It isn't clear except I'm only taking 1-5mg tab a day (nothing) and I wondered how that could make a difference, so more research, it seems at least at this one source, that the MAOI potentiates the Ritalin, not the other way around. Maybe then you feel more ritalin? Works with MAOI? Not sure. If you recall my biggest problem had become incapacitating lethargy. So. Its been 5 days, not at all like that feeling you get after dosing. (I wish) I'd say full remission, except I'll need to go slowly, as I'm finding after 10 weeks of laying around, I'm a little slow cognitively and physically. So at the gym I'll do half the work out I normally did and work up, I take longer at the grocery store, and a dinner party I had (thats right, I said Jade had a dinner party) well, lets just say everyone had a great time but it was far from my usually organized get togethers. But...WHO CARES!!!! I just wanted to feel like myself again and I do. What more could a girl ask for? (course, santas on his way)
>
> As for the creatine, (thats whats in No-Xplode, right?) I took it once before a work-out and I felt mild lift and a bit more energy. My nephew took too much one time, and had an anxiety attack after a workout. I called the company about it, but I'm sure you know all about its properties, etc. I'd say the equivalent of 5mg ritalin, but I had tolerance to ritalin also. So its been 5 days, I think I'm there, I'm gonna try to jump back into my old routine as soon as possible so I don't back slide.
>
> Okay, so where are you with everything? Change anything? You been staying out of that kitchen sink? Dumb question. Let me know whats up and I'll keep you posted. If I didn't say this before, thanks for ALL your help. Even tho I confuse you with my niceness, haha, you are a funny guy! Oh, Phillipa and I are placing bets on your age....care to cheat and accidentally hide it in a post?
>
> Okay then, don't know where you are but Happy Holidays, in case I don't catch up with you by the wknd *<((: ^ )>>
>
> ~Jade
>I've increased to 80mg, and between that and studying more i get tired. another week i should feel better though i'd think. did you compare creatine to methylphenidate? dinner parties? how curious, how odd. i still have no idea what this 'sink box' joke is. Under my sink is a bottle of bleach, a few extra sponges, and a mouse-trap. i'm sure i'll post a bit the next few days. only so long i can talk to relatives, and our family doesn't have any booze on holidays...i'll be thinking about whisky...enjoy your newfound energy....
-d/r
Posted by JadeKelly on December 24, 2008, at 12:16:52
In reply to Re: Parnate Lethargy Jade to D/R, posted by desolationrower on December 24, 2008, at 1:54:38
> >> It isn't clear except I'm only taking 1-5mg tab a day (nothing) and I wondered how that could make a difference, so more research, it seems at least at this one source, that the MAOI potentiates the Ritalin, not the other way around. Maybe then you feel more ritalin? Works with MAOI? Not sure. If you recall my biggest problem had become incapacitating lethargy. So. Its been 5 days, not at all like that feeling you get after dosing. (I wish) I'd say full remission, except I'll need to go slowly, as I'm finding after 10 weeks of laying around, I'm a little slow cognitively and physically. So at the gym I'll do half the work out I normally did and work up, I take longer at the grocery store, and a dinner party I had (thats right, I said Jade had a dinner party) well, lets just say everyone had a great time but it was far from my usually organized get togethers. But...WHO CARES!!!! I just wanted to feel like myself again and I do. What more could a girl ask for? (course, santas on his way)
> >
> > As for the creatine, (thats whats in No-Xplode, right?) I took it once before a work-out and I felt mild lift and a bit more energy. My nephew took too much one time, and had an anxiety attack after a workout. I called the company about it, but I'm sure you know all about its properties, etc. I'd say the equivalent of 5mg ritalin, but I had tolerance to ritalin also. So its been 5 days, I think I'm there, I'm gonna try to jump back into my old routine as soon as possible so I don't back slide.
> >
> > Okay, so where are you with everything? Change anything? You been staying out of that kitchen sink? Dumb question. Let me know whats up and I'll keep you posted. If I didn't say this before, thanks for ALL your help. Even tho I confuse you with my niceness, haha, you are a funny guy! Oh, Phillipa and I are placing bets on your age....care to cheat and accidentally hide it in a post?
> >
> > Okay then, don't know where you are but Happy Holidays, in case I don't catch up with you by the wknd *<((: ^ )>>
> >
> > ~Jade
> >
>
> I've increased to 80mg, and between that and studying more i get tired. another week i should feel better though i'd think. did you compare creatine to methylphenidate? dinner parties? how curious, how odd. i still have no idea what this 'sink box' joke is. Under my sink is a bottle of bleach, a few extra sponges, and a mouse-trap. i'm sure i'll post a bit the next few days. only so long i can talk to relatives, and our family doesn't have any booze on holidays...i'll be thinking about whisky...enjoy your newfound energy....
>
> -d/rHappy Holidays d/r
You're up to 80mg?? I'd geuss you'll be getting there soon. Might need some help from the pharm tho. Remember Phillipa was saying she kept an old box of meds under her kitchen sink? You said something like you had a box like that. I geuss I must have.....somehow I know your gonna hate this word.......assumed...... that you also kept your "box" under the kitchen sink. Maybe its in your closet. I think you are studying to be a pharmacist. On 80mg ouch!
~Jade
No booze on holodays? and you call me odd!
Posted by Phillipa on December 24, 2008, at 18:43:16
In reply to Re: Parnate Lethargy Jade to D/R » desolationrower, posted by JadeKelly on December 24, 2008, at 12:16:52
Ha box not under kitchen sink under one of the bathroom sinks. Love Phillipa
Posted by Phillipa on December 24, 2008, at 18:45:16
In reply to Re: Parnate Lethargy Jade to D/R » desolationrower, posted by JadeKelly on December 24, 2008, at 12:16:52
No booze in 14 years for me can't drink on meds. Miss my coronas and lime though. Love Phillipa
Posted by JadeKelly on December 30, 2008, at 22:51:49
In reply to Re: Parnate Lethargy Jade to D/R » JadeKelly, posted by Phillipa on December 24, 2008, at 18:45:16
Hey scott,
Couple questions if you don't mind. I seem to be backsliding some on the remission (was100%). It does seem like "remission" is based on time dose is taken, is that normal? Seems like A/D would either work or not. I've been waking 3-5 times a night which is unusual, fall alseep very easily ~11pm or so, but sometimes if not woken I'll sleep till 1-2pm. Then I've missed morn dose and feel like crap. What does this suggest? I had 10 days remission, that means what? I should go up to 70mg? I hate to this soon, but don't want to lose a/d effect. Should I add lithium or lamictal? (realized I had both) never added Lithium before as I was fine without it. I'm taking 5mg ritalin 2x day, is that enough? Not sure what to change here. tempted to go up to 70mg but not sure thats the answer. HELP! (again) Thanks
~Jade
Posted by JadeKelly on December 30, 2008, at 22:59:55
In reply to Re: Parnate-update Jade to SCOTT, posted by JadeKelly on December 30, 2008, at 22:51:49
> Hey D/R,
>
> Couple questions if you don't mind. I seem to be backsliding some on the remission (was100%). It does seem like "remission" is based on time dose is taken, is that normal? Seems like A/D would either work or not. I've been waking 3-5 times a night which is unusual, fall alseep very easily ~11pm or so, but sometimes if not woken I'll sleep till 1-2pm. Then I've missed morn dose and feel like crap. What does this suggest? I had 10 days remission, that means what? I should go up to 70mg? I hate to this soon, but don't want to lose a/d effect. Should I add lithium or lamictal? (realized I had both) never added Lithium before as I was fine without it. I'm taking 5mg ritalin 2x day, is that enough? Not sure what to change here. tempted to go up to 70mg but not sure thats the answer. HELP! (again) Thanks
>
>
Sending this to you/Scott/Captain, anyone else "in the know" that could help me with this? Just want to make sure I don't lose my WELL EARNED investement. Let me know how you are please. REALLY. A little chit chat never hurt anyone.~Jade
Posted by JadeKelly on December 30, 2008, at 23:09:44
In reply to Re: Parnate-update Jade to D/R, posted by JadeKelly on December 30, 2008, at 22:59:55
> > Hey Captain Jeff,
> >
> > Couple questions if you don't mind. I seem to be backsliding some on the remission (was100%). It does seem like "remission" is based on time dose is taken, is that normal? Seems like A/D would either work or not. I've been waking 3-5 times a night which is unusual(not complaining), fall alseep very easily ~11pm or so, but sometimes if not woken I'll sleep till 1-2pm. Then I've missed morn dose and feel like crap. What does this suggest? I had 10 days FULL remission (not mania of any kind), that means what? I should go from 60mg up to 70mg? I hate to this soon (10 days in remission/2 weeks at 60mg), but don't want to lose a/d effect. Should I add lithium or lamictal? (realized I had both) never added Lithium before as I was fine without it. I'm taking 5mg ritalin 2x day, is that enough? Not sure what to change here. Tempted to go up to 70mg but not sure thats the answer. HELP! (again) Thanks,
> >
> >
> Sending this to you/Scott/D/R, anyone else "in the know" that could help me with this? Just want to make sure I don't lose my WELL EARNED investement. Hope you are well.
>
> ~Jade
>
>
Posted by SLS on December 31, 2008, at 7:23:05
In reply to Re: Parnate-update Jade to SCOTT, posted by JadeKelly on December 30, 2008, at 22:51:49
Complete remission from depression is rarely quick and without a bumpy ride, regardless of treatment. It might take you months to gradually reach 100% and remain stable. Until then, you will have ups and downs, but the trend will be upwards. You might want to keep a mood chart and see for yourself the trend that emerges.
Your experience of a sudden improvement is what I continue to call a "blip" response. It could begin during the first 5 days and last a day to three days. This is my observation, anyway. That this happens at all, I believe is indicative of a good prognosis.
I think 60mg is a good dosage of Parnate to try for at least three weeks. More people respond well to 60mg than do need to be as high as 80mg.
Although lithium or lamictal might help, I think you should remain doing what you are doing for at least three weeks. By then, you will have a better feel for what next to do based on the previous results.
Here is the mood chart that I have used:
http://www.slschofield.com/medicine/mood_chart_beam.pdf
- Scott
Posted by Vincent_QC on December 31, 2008, at 9:11:27
In reply to Re: Parnate-update Jade to D/R, posted by JadeKelly on December 30, 2008, at 22:59:55
> > Hey D/R,
> >
> > Couple questions if you don't mind. I seem to be backsliding some on the remission (was100%). It does seem like "remission" is based on time dose is taken, is that normal? Seems like A/D would either work or not. I've been waking 3-5 times a night which is unusual, fall alseep very easily ~11pm or so, but sometimes if not woken I'll sleep till 1-2pm. Then I've missed morn dose and feel like crap. What does this suggest? I had 10 days remission, that means what? I should go up to 70mg? I hate to this soon, but don't want to lose a/d effect. Should I add lithium or lamictal? (realized I had both) never added Lithium before as I was fine without it. I'm taking 5mg ritalin 2x day, is that enough? Not sure what to change here. tempted to go up to 70mg but not sure thats the answer. HELP! (again) Thanks
> >
> >
> Sending this to you/Scott/Captain, anyone else "in the know" that could help me with this? Just want to make sure I don't lose my WELL EARNED investement. Let me know how you are please. REALLY. A little chit chat never hurt anyone.
>
> ~Jade
>
>Hi Jade ;-)
I know, the question is not for me, but I think it's related to the short half-life of the Parnate in the blood system. From the web research I do and informations I have on the Parnate, the half-life of the Parnate is between 4.4 hours to 8 hours... So for what I think, it's normal to feel like you feel when you miss a dose. That's one of the reason they do extend release of drugs, to make them acting more long time and stay in your blood at the same level for a more long time also...The hypertension I have since i'm at 35-40mg of Parnate day is probably come from the same problem , short half-life of the Parnate in the blood... Blood pressure increase at daytime with my intake of Parnate, since I take my last dose at 3PM, I have an accumulation of active Parnate in my blood ...being more concentrated after 3PM, making my blood pressure to augment to the hypertension level at the end of the afternoon and at the evening and after the 8 hours of active Parnate in my blood, my blood pressure return to a normal state with a gradual reduction of it...That's logical...I think...
So it's probably what happen to you also. Maybe a good trick to not miss your morning dose will be to put your alarm clock...I know, sometimes with insomnia that's suck to have to wake up just for taking pills, but it's a good trick... I do this for now, I don't want to take my first morning dose after 8AM so I put my alarm clock, since I fall asleep very fast but wake up several times at night and I sleep more well in the morning, I don't want to miss my morning dose and be destabilized for all the day after...
Well...Maybe Scott answer already, I don't read the others post...but I hope you will be find and you will find a good solution for your problems ;-)
Have a nice day and take care of you ok ;-)
Bye!
VIncent ;-)
Posted by Vincent_QC on December 31, 2008, at 9:17:33
In reply to Re: Parnate-update Jade to SCOTT » JadeKelly, posted by SLS on December 31, 2008, at 7:23:05
> Complete remission from depression is rarely quick and without a bumpy ride, regardless of treatment. It might take you months to gradually reach 100% and remain stable. Until then, you will have ups and downs, but the trend will be upwards. You might want to keep a mood chart and see for yourself the trend that emerges.
>
> Your experience of a sudden improvement is what I continue to call a "blip" response. It could begin during the first 5 days and last a day to three days. This is my observation, anyway. That this happens at all, I believe is indicative of a good prognosis.
>
> I think 60mg is a good dosage of Parnate to try for at least three weeks. More people respond well to 60mg than do need to be as high as 80mg.
>
> Although lithium or lamictal might help, I think you should remain doing what you are doing for at least three weeks. By then, you will have a better feel for what next to do based on the previous results.
>
> Here is the mood chart that I have used:
>
> http://www.slschofield.com/medicine/mood_chart_beam.pdf
>
>
> - ScottAie Scott...that's a nice mood chart...I will use it also I think !!! Thanks again!
Posted by CaptainAmerica1967 on December 31, 2008, at 11:22:22
In reply to Re: Parnate-update Jade to D/R, posted by JadeKelly on December 30, 2008, at 22:59:55
Monamine oxidase breaks down neurotransmitters throughout the day/night so taking your Parnate in varied doses should help and if you're missing the morning and afternoon dose until 1 or 2pm, it seems like it could definitely affect you.
If I wake up in the middle of the night and am not sleepy, I just stay up for that day. Remember, sleep deprivation is highly effective (no REM or other sleep so the neurons stay on overdrive producing various neurotransmitters that would otherwise slow down production) as an antidepressant and augments them just like taking cold showers and exercise does.
The Parnate may be making you wake up during the night as it suppresses REM sleep and in some cases virtually eliminates REM to almost 100% (one needs very little REM to survive) which is one of the other mechanisms believed to produce the antidepressant effect.
Maybe not taking your Parnate too late in the evening or only early/late afternoon can help or taking something else to help you sleep like a small dose of amitriptyline or something else your physician may recommend.
Maybe some trazodone as many don't have any interaction with MAOI's with a small dose of trazodone (some not even at higher doses) and many psychiatrists use trazodone to help when switching or going off one MAOI to another.
Maybe Benadryl (antihistamine) prior to bedtime if your depression isn't atypical. MAOI's tend to enhance histamine and work well with atypical depression where as TCA's block histamine and don't tend to work as well with those suffering from atypical depression.
Adding lithium or lamictal should augment the Parnate along with your Ritalin and along trazodone or amitriptyline .
20mg-60mg of Parnate is just a general dosage that is written in the PI (package insert) for physician recommended dosage, but others like David Sheehan, M.D. (lives in Tampa), who is one of the foremost authority on anxiety with depression (The Anxiety Disease) will use 80mgs of Parnate a day, and even others like Ivan Goldberg, M.D. (lives in NYC), suggest using 90 mg to 170 mg of Parnate daily based on a study.
http://www.psycom.net/depression.central.resistant.html
http://www.ncbi.nlm.nih.gov/pubmed/2710808?dopt=AbstractI live in Houston, TX and had to educate my physician on the dosage range used for normal and treatment resistant depression based upon what I found online (spoke quite a few times via email with Dr. Goldberg..he'll answer your questions).
Hope this helps and hope you have a great New Year.
Jeff
Posted by CaptainAmerica1967 on December 31, 2008, at 12:52:08
In reply to Re: Parnate-update Jade to D/R, posted by CaptainAmerica1967 on December 31, 2008, at 11:22:22
This is a must read report on an expert opinion on combining the so called class of "no no" meds with MAOIs and this pyschiatrist has so many years experience (since MAOIs first came out when Dr Donald Kline used the first MAOI to treat a depressed patient) that he's never had any bad reaction except one that was just from taking an MAOI alone, I think. Pages 4-5
Also a discussion on the MAOI diet and what really is safe which is much more than one usually thinks like mozzarella, and red wine which I've always avoided. Pages 6-7
Jonathan Cole, M.D.. Reflections on the Use of MAOIs. Professor of Psychiatry, Harvard Medical School,. Senior Consultant, McLean Hospital
http://www.thecarlatreport.com/documents/general/TCR.pdf
Posted by JadeKelly on December 31, 2008, at 13:58:13
In reply to Re: Parnate-update Jade to D/R, posted by Vincent_QC on December 31, 2008, at 9:11:27
> > > Hey D/R,
> > >
> > > Couple questions if you don't mind. I seem to be backsliding some on the remission (was100%). It does seem like "remission" is based on time dose is taken, is that normal? Seems like A/D would either work or not. I've been waking 3-5 times a night which is unusual, fall alseep very easily ~11pm or so, but sometimes if not woken I'll sleep till 1-2pm. Then I've missed morn dose and feel like crap. What does this suggest? I had 10 days remission, that means what? I should go up to 70mg? I hate to this soon, but don't want to lose a/d effect. Should I add lithium or lamictal? (realized I had both) never added Lithium before as I was fine without it. I'm taking 5mg ritalin 2x day, is that enough? Not sure what to change here. tempted to go up to 70mg but not sure thats the answer. HELP! (again) Thanks
> > >
> > >
> > Sending this to you/Scott/Captain, anyone else "in the know" that could help me with this? Just want to make sure I don't lose my WELL EARNED investement. Let me know how you are please. REALLY. A little chit chat never hurt anyone.
> >
> > ~Jade
> >
> >
>
> Hi Jade ;-)
> I know, the question is not for me,No Vincent! I'm glad you joined in, anytime.I can use all the help I can get!
but I think it's related to the short half-life of the Parnate in the blood system. From the web research I do and informations I have on the Parnate, the half-life of the Parnate is between 4.4 hours to 8 hours... So for what I think, it's normal to feel like you feel when you miss a dose.
That makes sense because I've been taking it really late (early afternoon) when usually I take it at 8am. The holidays and family, etc.
That's one of the reason they do extend release of drugs, to make them acting more long time and stay in your blood at the same level for a more long time also...
Is there a XR Parnate?>
> The hypertension I have since i'm at 35-40mg of Parnate day is probably come from the same problem , short half-life of the Parnate in the blood... Blood pressure increase at daytime with my intake of Parnate, since I take my last dose at 3PM, I have an accumulation of active Parnate in my blood ...being more concentrated after 3PM, making my blood pressure to augment to the hypertension level at the end of the afternoon and at the evening and after the 8 hours of active Parnate in my blood, my blood pressure return to a normal state with a gradual reduction of it...That's logical...I think...Yeah, me too. I've noticed a small increase in frequency of low BP too. Lots of insomnia also. So maybe by not sticking to a firm dosing schedule, I did this by accident/stupidity-Ha?
>
> So it's probably what happen to you also. Maybe a good trick to not miss your morning dose will be to put your alarm clock...I know, sometimes with insomnia that's suck
what sucks is being depressed! I'll be back on morning schedule anyway after the weekend for school
to have to wake up just for taking pills, but it's a good trick... I do this for now, I don't want to take my first morning dose after 8AM so I put my alarm clock, since I fall asleep very fast but wake up several times at night and I sleep more well in the morning, I don't want to miss my morning dose and be destabilized for all the day after...
>
> Well...Maybe Scott answer already, I don't read the others post...but I hope you will be find and you will find a good solution for your problems ;-)
>
> Have a nice day and take care of you ok ;-)
>
> Bye!
>
> VIncent ;-)Thanks Vincent, you helped me a lot. I have a better understanding of the importance of timing now. Sounds like were on the same path so lets keep each other posted, ok? I read I think you are going to use the chart from Scott, me too. Lets see how we do!
~Jade
Posted by JadeKelly on December 31, 2008, at 15:02:38
In reply to Re: Parnate-update Jade to D/R, posted by CaptainAmerica1967 on December 31, 2008, at 11:22:22
> Monamine oxidase breaks down neurotransmitters throughout the day/night so taking your Parnate in varied doses should help and if you're missing the morning and afternoon dose until 1 or 2pm, it seems like it could definitely affect you.
>
> If I wake up in the middle of the night and am not sleepy, I just stay up for that day. Remember, sleep deprivation is highly effective (no REM or other sleep so the neurons stay on overdrive producing various neurotransmitters that would otherwise slow down production) as an antidepressant and augments them just like taking cold showers and exercise does.
>
> The Parnate may be making you wake up during the night as it suppresses REM sleep and in some cases virtually eliminates REM to almost 100% (one needs very little REM to survive) which is one of the other mechanisms believed to produce the antidepressant effect.
>
> Maybe not taking your Parnate too late in the evening or only early/late afternoon can help or taking something else to help you sleep like a small dose of amitriptyline or something else your physician may recommend.
>
> Maybe some trazodone as many don't have any interaction with MAOI's with a small dose of trazodone (some not even at higher doses) and many psychiatrists use trazodone to help when switching or going off one MAOI to another.
>
> Maybe Benadryl (antihistamine) prior to bedtime if your depression isn't atypical. MAOI's tend to enhance histamine and work well with atypical depression where as TCA's block histamine and don't tend to work as well with those suffering from atypical depression.
>
> Adding lithium or lamictal should augment the Parnate along with your Ritalin and along trazodone or amitriptyline .
>
> 20mg-60mg of Parnate is just a general dosage that is written in the PI (package insert) for physician recommended dosage, but others like David Sheehan, M.D. (lives in Tampa), who is one of the foremost authority on anxiety with depression (The Anxiety Disease) will use 80mgs of Parnate a day, and even others like Ivan Goldberg, M.D. (lives in NYC), suggest using 90 mg to 170 mg of Parnate daily based on a study.
>
> http://www.psycom.net/depression.central.resistant.html
> http://www.ncbi.nlm.nih.gov/pubmed/2710808?dopt=Abstract
>
> I live in Houston, TX and had to educate my physician on the dosage range used for normal and treatment resistant depression based upon what I found online (spoke quite a few times via email with Dr. Goldberg..he'll answer your questions).
>
> Hope this helps and hope you have a great New Year.
>
> JeffThanks Jeff,
That helped alot, I realize that shortly after my "remission" My family stayed here, we had no morning schedule really, there were days I didn't take my usual 8am dose until 2pm. Thats when the 4xnight wake-up mystery started.
Again, thank you for all that you know and pass on, I'd be lost if it wasn't for this site and the help I get here.
~Jade
Posted by JadeKelly on December 31, 2008, at 15:24:03
In reply to Re: Parnate-update Jade to SCOTT » JadeKelly, posted by SLS on December 31, 2008, at 7:23:05
> Complete remission from depression is rarely quick and without a bumpy ride, regardless of treatment. It might take you months to gradually reach 100% and remain stable. Until then, you will have ups and downs, but the trend will be upwards. You might want to keep a mood chart and see for yourself the trend that emerges.
>
> Your experience of a sudden improvement is what I continue to call a "blip" response. It could begin during the first 5 days and last a day to three days. This is my observation, anyway. That this happens at all, I believe is indicative of a good prognosis.
>
> I think 60mg is a good dosage of Parnate to try for at least three weeks. More people respond well to 60mg than do need to be as high as 80mg.
>
> Although lithium or lamictal might help, I think you should remain doing what you are doing for at least three weeks. By then, you will have a better feel for what next to do based on the previous results.
>
> Here is the mood chart that I have used:
>
> http://www.slschofield.com/medicine/mood_chart_beam.pdf
>
>
> - ScottHi Scott,
coulda sworn I sent a thanx to you but maybe I didn't hit submit. As I said to Jeff, I would be really lost on this journey with out the help I get here and lost is not a good feeling for me. I'll stick with this as long as it makes sense, and you keep making it do that. Damn! So, I'll give it some more time, only thing I'm confused about is the 10 day remission, happened NOT at dosing time, but was sudden. The other thing is it started the day after I started 5mg ritalin. That is nothing to me as I took 5mg 5xday for 12 years for ADD, no A/D's. Maybe that kick started a temporary "blip". Oh well, onward. Thank you again for your much needed help. I will be using your mood chart btw-thanx for that also.
~Jade
Posted by SLS on December 31, 2008, at 15:45:37
In reply to Re: Parnate-update Jade to SCOTT, posted by JadeKelly on December 31, 2008, at 15:24:03
There is certainly enough reason to pursue increasing the methylphenidate at a time that makes sense to you. After 3 weeks of Parnate 60mg, you might consider raising the methylphenidate first before increasing the Parnate. You could certainly do it sooner.
- Scott
Posted by Vincent_QC on January 1, 2009, at 9:42:37
In reply to Re: Parnate-update Jade to D/R » Vincent_QC, posted by JadeKelly on December 31, 2008, at 13:58:13
Hi Jade!!! Happy New year BTW...I hope familly dinner anr others things like that don't make you a lot tired...like me! lol
> That makes sense because I've been taking it really late (early afternoon) when usually I take it at 8am. The holidays and family, etc.
> >Same here...I go to the bad at 4 AM this morning, and have to get up at 8 for my 20mg dose of Parnate...I don't return in my bed, since I always get a little rush of energy after that dosage ...and my familly come over here for the lunch time...so I will be a lot tired!!!
> Is there a XR Parnate?
>
> >Hummm no...I was talking about others AD...Wellbutrin, Effexor, Paxil, Luvox, Cymbalta...they all have now extend release...
They will never invest money in making a MAOI's XR version...Anyway, Nardil and Parnate change in formulation back in 2003 for Nardil and Parnate (I don'T know when) seem to have make them less efficienties drugs...Especially for the Nardil...since a lot of people complain about the loose of the efficacity of the Nardil after that change... I think they remove the hard coated film on them (Nardil and Parnate), and a good amount of the drug don't support the acid (PH) in the stomach...but I don't know really since I Was not involve in Maoi's world before 2003...
> Yeah, me too. I've noticed a small increase in frequency of low BP too. Lots of insomnia also. So maybe by not sticking to a firm dosing schedule, I did this by accident/stupidity-Ha?
>
> >It's seem to fade away for me...since yesterday my highest blood pressure was something like 140/80... This morning it's a little bit high and I get an headache like usual, but it's more relaterd to the fact that I don't sleep a lot. I also have less orthostatic hypotension, or it's more easy to deal with...or I get used of it...I think I was right about the fact that my panic disorder make it more worse when I begin to experience it, especially last sunday night. For my blood pressure, it's the same...I will continue to monitor it, but less often... Parnate is not the first AD to make my blood pressure to rise a little bit...
I remember than Nardil was a lot more bad for hypotension problem, especially for orthostatic hypotension and general hypotension...and it's probably why I was always tired on it...low blood pressure make me tired as hell... A more highg blood pressure like 130/75-80 like the one I normally have now on the Parnate at 40mg/day seem to make me more energic...
>
> what sucks is being depressed! I'll be back on morning schedule anyway after the weekend for school
>
>Yeah, that's hard to get a good schedule of intake of the pills when it's Chritsmas vacation...with the familly dinners, friends and other partys...that's more hard...Next week, I will probably get more used to the 40mg/day dose and less tired than now...I plan to begin to walk each day, I continue also my CTB with my psychologist, I see my doctor...so I will get a lot of things fix...
But for now, i'm a lot more well than I was sunday and monday... that's the important!!!
For the insomnia, that weird...I know a lot of people find the parnate to cause hyperactivity and find it stimulating... For me, except for the dose of 20mg in the morning, I can return in my bed in the afternoon, after my 10mg/dose if the luch time and fall asleep and do a nap... I don't found it worse the insomnia...Well for me... In fact, with each increase I do, I find it to be more sedative and it remember me more the Nardil effect... I can sleep 4 hours in a row now, it was impossible before...
IF you take a look at the web link CaptainAmerica1967 post on this topic, that's very interresting to see the difference between each MAOI's drugs...
You can also read that from the experience of the doctor, he found also the Parnate to be more sedating than stimulating...
Anyway, I keep the weblink in my favorite shortcut and will bring this to my family doctor...I Want him to be inform that more high dose of Parnate seem to cause less side effects and make people like me (treatments resistant) recover at a more high % than the small 30mg the glasko compagny recommend and what the general psychiatrist doctor also recommend (60mg max in general)...
Anyway, I have to go , familly lunch time soon and nothing is done...We talk more later!
I hope you will have a nice day, even if it's more hard in these time, because of the Christmas holidays... ;-)
Take care of you Jade!!!
Bye!
Vincent ;-)
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.