![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Vincent_QC on January 9, 2009, at 9:26:21
Hi Everyone ;-)Another long post here...Sorry...
I think a lot about my health since my last family doctor appointment and I wish to switch for a drug with less side-effects. I was already on 30mg/day of Parnate, I stop it cold turkey (I never had side-effects with abrupt interruption of Ads), I quit the Nardil before at 90mg/day to 0mg/day with no withdraw symptom at all. Don't worry ...I will be ok ;-) I'm used to switch from a drug to another...I never die of this!!! lol ;-)
The main reasons why I decide to quit the Parnate boat was the BIG physical fatigue I feel all day long. It was not the same kind of fatigue I had with the Nardil. It was really physical. It was also not the same fatigue than the one I always experience on all the SSRI's ADs (mental fatigue).
The "no energy at all" feeling is not tolerable for me. I had to kick my *ss so hard to succeed to leave my house at night and do something. Just take my shower and be ready to go out exhausted me to the point that I had some faint. I think it's related to the hypertensions that often occur at daytime, the hypotension that I had at night and my sensibility to the epinephrine effect. Such a variation on my blood pressure make me feel so tired, Im not able to do anything physical without having the feeling that I just do 3 hours of aerobic exercises. My muscles burns, I feel like I will do a faint at each corner of the street I reach I also continue to gain weight, even if I dont eat a lot and I have an oedema problem as well. With all this lack of energy, I see also a major degradation in my life organisation. Im not able to do my regular activities and do things like just cleaning my room or make good food to eat, thats unthinkable. I also lack the motivation or the interest I had before to things that always make me smile or just entertaining.
I also think the small improve I see on my social phobia was probably due to the fact that I put too much attention to the side-effects of the Parnate, It seem that I had so much side-effects that I forget almost anything else in my life and thats not good.
I'm not interested to wait another 3 weeks at 30mg/day of Parnate, and see if I will improve, and up my dose again and feel more side-effects for an undetermined period of time where I will be more disable that Im already in my life. I have a therapy (CTB) to do, some social exposition times and exercises to do also, I need to find again some energy (a minimum level) to be able at least to have a minimal normal life.
At this point I think that what I need is just an easy to tolerate drug to help me to cope more with the depression (lack of motivation and interest, lack of energy) and the panic disorder with agoraphobia I have in my lifenot a drug who will knock me out and cause a lot of side-effectsFor the social phobia, I can cope with this problem, especially if all the others problems are under control.
I have also to say that Im not really interested in a Stimulant drug, since they will produce a more bad energy feeling on me, increasing my anxiety in general (Ritalin was like this, Adderall-XR will not be more good and its not insurance cover anyway)If I need some not natural energy, I prefer to drink some coffeeor pop up some "Wake-up pills" even if I don't tolerate them very well...(panic attacks)...but not the coffee...
I have some questions and I hope some people here will be able to help me to answer them. Note that I never react well to the antidepressant drugs who hit harder the Serotonin, especially the Prozac, Paxil, Zoloft, Celexa or Lexapro. When the action on the SE is less selective like the Prozac, It makes my general anxiety, panic disorder with agoraphobia and depression worst, I feel very excited on it but tired at the same time, like I will do always a panic attack... Strange stuff for me really... When a SSRI is highly selective like Lexapro(Cipralex), I feel drained of all my energy (mentally or physically) and my depression, general anxiety, panic disorder or social phobia doesnt improve also, I just eat more and more and gain weight...to end up after 3 months with a low self-esteem because of my weight gain and no improve at all....I always get a massive weight gain on them...even if I eat or notbut in general I eat a LOT on themI cant stop.
I never get the chance to try correctly the SRNIs class of drugs because in the Canada we only have the Effexor-XR version, not the regular version and with my gastric by-pass, the drug dont have the time to reach a normal peak level in my blood stream, even if I up the dose to a very high level. I try to open my pills of Effexor-xr, chew the small round balls inside them but the taste was so bad, I never succeed to take one 37.5mg pill completely like this. I also never try the Cymbaltathats relatively new in Canada, thats not insurance cover but I think I can work it out with my pdoc, have some samplesbut I will have some question about it later for you For the Pristiq, forget it, in the Canada, we will not have it before 3 or 4 years...Health Canada is very slow on the approvoal of new drugs...We don't have also the Emsam patch, most of PDOC here are not aware of the existence of this produc. So you can see how we are retarded here in the Canada...;-)
It's why I want to try something different now. The only one class of AD's I never try completely is the TCA's. I try just the basic imipramine and it fails to produce a good effect, I don't remember it in fact, it'S a long time ago... If I don't remember it, it's probably because it was ok for the side-effects... I took also a little bit of Elavil to help me with my headache problem but thats never help me so I stop after 2 months at a very low dose...but I know it cause a lot of sedation at dose more than 25mg...
The first time I meet my new psychiatrist 2 months ago, he suggest me at first a TCA drug call Nortriptyline. I know it work more on the NE than the SE, so its maybe a good solution for me. Everyone else try it for depression and anxiety problems like the ones I have? Is it true that with all the TCAs, I will gain more weight? Is it worth the trail? Should I go for another TCAs than the Nortriptyline before, like the Desipramine or the Clomipramine??? Which one is the best for depression, anxiety and to retrieve more energy (physical and mentally).
For the Cymbalta, someone open a pill to see how its made inside? Is it like the Effexor-xr, small round balls that you cant chew or crunch, or its just a powder? Is it easy to open the capsule and is it possible to take it without the time release capsule? I absolutely need to know how its made inside the pills to be able to know if my intestine will be able to absorb the drug or not The cymbalta seem to work more on the NE than the SE alsomy sister take it since a couple of months, she told me that she dont improve a lot, she still have some energy slumps and depressive moment where she cry a lot... but she have more energy than when she was on the Celexa and she also lost some weight on it Do you think it worth the trial?
My last question is for the people who try the Manerix (reversible MAOI avaible in the Canada). Is it less hard on the hypertension or hypotension produce normally from more common MAOIs like Nardil and Parnate? Is it doing something good in the depression or anxiety disorders? Do you think it cause less side-effects than others SSRIs or SRNIs? If you experienced some side-effects, witch ones I will be more susceptible to have? Is it giving some energy or its more neutral on that domain? For the weight gain, is it neutral or not? I read that one 300mg dose of Manerix inhibit 80% of type-a and 30% of type-b MAOI...someone know the difference between the Type-A and the Type-B...If I well remember, Type-B play a role more in the DA and Type-A is more NE, SE ?
Well, so much questions, too few answers
If someone here can help me it will be really appreciate ;-)
Thanks for your support again!!!
Bye!
Vincent ;-)
Posted by SLS on January 9, 2009, at 10:13:56
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
I couldn't read your entire post, my concentration is a bit off today.
Anyway, if you can't convince your doctor to go higher with Parnate, you can look for another doctor who will, have him consult with a doctor more familiar with MAOIs, or cover his desktop with literature supporting the need to go to 40-80mg.
In my opinion, adding augmenting drugs to Parnate 30mg is a waste of time. These other drugs do not reduce the need for a full therapeutic dosage of Parnate.
You can download the following document as supportive literature:
http://www.slschofield.com/medicine/parnate_high_dosage.doc
Also, see:http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
http://www.dr-bob.org/tips/split/TCAs-+-MAOIs.html
---------------------------------------------DO NOT add Cymbalta or any other SRI drug to Parnate! The reaction can be fatal. There are two tricyclic drugs that I have added to both Parnate and Nardil safely: desipramine and nortriptyline. Theoretically, trimipramine should be safe as well, but I am unaware of anyone who has tried it.
---------------------------------------------
Once upon a time:
Parnate 120mg
desipramine 300mg
d-amphetamine 20mg
bromocriptine ?mg
throxine ?mcg
- Scott
Posted by Vincent_QC on January 9, 2009, at 10:57:42
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Vincent_QC, posted by SLS on January 9, 2009, at 10:13:56
> I couldn't read your entire post, my concentration is a bit off today.
>
> Anyway, if you can't convince your doctor to go higher with Parnate, you can look for another doctor who will, have him consult with a doctor more familiar with MAOIs, or cover his desktop with literature supporting the need to go to 40-80mg.
>
> In my opinion, adding augmenting drugs to Parnate 30mg is a waste of time. These other drugs do not reduce the need for a full therapeutic dosage of Parnate.
>
> You can download the following document as supportive literature:
>
> http://www.slschofield.com/medicine/parnate_high_dosage.doc
>
>
> Also, see:
>
> http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
>
> http://www.dr-bob.org/tips/split/TCAs-+-MAOIs.html
>
>
> ---------------------------------------------
>
> DO NOT add Cymbalta or any other SRI drug to Parnate! The reaction can be fatal. There are two tricyclic drugs that I have added to both Parnate and Nardil safely: desipramine and nortriptyline. Theoretically, trimipramine should be safe as well, but I am unaware of anyone who has tried it.
>
> ---------------------------------------------
>
> Once upon a time:
>
> Parnate 120mg
> desipramine 300mg
> d-amphetamine 20mg
> bromocriptine ?mg
> throxine ?mcg
>
>
> - ScottHi Scott!
Thanks for the informations. Well, I don't want to add something with the Parnate or to augment the dosage. I want to change completely my medication, try something else... something who will not cause so much side-effects...I'm tired of the physical lack of energy that the Parnate give to me...Anyway , thanks again ;-)Bye!
Vincent ;-)
Posted by Phillipa on January 9, 2009, at 10:59:24
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
Vincent keep forgetting you've had the intestinal bypass surgery as my first thought was EMSAM which would allow the drug to bypass the gut. I guess there is no way your doc could get it for you as that would seem to solve the problem. What does your doc say about the absorbing meds. Taken cymbalta no side effects for me was on 60mg of it didn't notice much but did when went off lots of aches and pains. It does also absorb in intestine hence enteric coating. Did you have the bypass when on the SSRI's and others meds as seems if you had side effects you must have been absorbing them. Emsam would be so perfect for you. But you are absorbing parnate right? So you must be able to absorb meds? Love Phillipa
Posted by Sissy35 on January 9, 2009, at 12:16:08
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
Vincent_QC
I also had the same problems you are now going through while on 30mg of parnate. I wanted to give up, but I read some posts here and deceided to increase to 40mg and the side effects started to abate. The awful tiredness and the BP problems are getting much better. I also had severe tension in the evenings too. I know its difficult I hated it too.
My understanding is that doses of Parnate above 40mg have different effects on the brain and body than doses of 10-30mg.
I am not trying to talk you into anything. But just share what worked for me.
Sometimes just hope and faith in a different AD makes all the differece in its affect, and if you would feel more hope on something different than thats the course you should take.
Sissy35
Posted by Justherself54 on January 9, 2009, at 14:30:29
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » SLS, posted by Vincent_QC on January 9, 2009, at 10:57:42
The first time was on parnate I couldn't get over 20 mg as I was spending a lot of time crawling around on my hands and knees due to hypotension. Enter Nardil..worked wonders until I had awful urinary problems and started throwing up in my sleep..then parnate for a second time. No partial response even at 50 mg. Blood pressure was in the 130/110 range most of the time, sometimes higher with some drops to normal.
I came to terms that maoi's for me are no different than many of the SSRI's, SNRI's, and TCA's..some work, some side effects are intolerable, some don't work the second time around or different side effects crop up..they all poop out on me eventually..
Your mileage may vary on any med, or in my case, my side effects may vary! I hope you find the right med or combo that lets you get on with getting on..
Posted by Jay_Bravest_Face on January 9, 2009, at 19:54:39
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
> Hi Everyone ;-)Another long post here...Sorry...
>
> I think a lot about my health since my last family doctor appointment and I wish to switch for a drug with less side-effects. I was already on 30mg/day of Parnate, I stop it cold turkey (I never had side-effects with abrupt interruption of Ads), I quit the Nardil before at 90mg/day to 0mg/day with no withdraw symptom at all. Don't worry ...I will be ok ;-) I'm used to switch from a drug to another...I never die of this!!! lol ;-)
>
> The main reasons why I decide to quit the Parnate boat was the BIG physical fatigue I feel all day long. It was not the same kind of fatigue I had with the Nardil. It was really physical. It was also not the same fatigue than the one I always experience on all the SSRI's ADs (mental fatigue).
>
> The "no energy at all" feeling is not tolerable for me. I had to kick my *ss so hard to succeed to leave my house at night and do something. Just take my shower and be ready to go out exhausted me to the point that I had some faint. I think it's related to the hypertensions that often occur at daytime, the hypotension that I had at night and my sensibility to the epinephrine effect. Such a variation on my blood pressure make me feel so tired, Im not able to do anything physical without having the feeling that I just do 3 hours of aerobic exercises. My muscles burns, I feel like I will do a faint at each corner of the street I reach I also continue to gain weight, even if I dont eat a lot and I have an oedema problem as well. With all this lack of energy, I see also a major degradation in my life organisation. Im not able to do my regular activities and do things like just cleaning my room or make good food to eat, thats unthinkable. I also lack the motivation or the interest I had before to things that always make me smile or just entertaining.
>
> I also think the small improve I see on my social phobia was probably due to the fact that I put too much attention to the side-effects of the Parnate, It seem that I had so much side-effects that I forget almost anything else in my life and thats not good.
>
> I'm not interested to wait another 3 weeks at 30mg/day of Parnate, and see if I will improve, and up my dose again and feel more side-effects for an undetermined period of time where I will be more disable that Im already in my life. I have a therapy (CTB) to do, some social exposition times and exercises to do also, I need to find again some energy (a minimum level) to be able at least to have a minimal normal life.
>
> At this point I think that what I need is just an easy to tolerate drug to help me to cope more with the depression (lack of motivation and interest, lack of energy) and the panic disorder with agoraphobia I have in my lifenot a drug who will knock me out and cause a lot of side-effectsFor the social phobia, I can cope with this problem, especially if all the others problems are under control.
>
> I have also to say that Im not really interested in a Stimulant drug, since they will produce a more bad energy feeling on me, increasing my anxiety in general (Ritalin was like this, Adderall-XR will not be more good and its not insurance cover anyway)If I need some not natural energy, I prefer to drink some coffeeor pop up some "Wake-up pills" even if I don't tolerate them very well...(panic attacks)...but not the coffee...
>
> I have some questions and I hope some people here will be able to help me to answer them. Note that I never react well to the antidepressant drugs who hit harder the Serotonin, especially the Prozac, Paxil, Zoloft, Celexa or Lexapro. When the action on the SE is less selective like the Prozac, It makes my general anxiety, panic disorder with agoraphobia and depression worst, I feel very excited on it but tired at the same time, like I will do always a panic attack... Strange stuff for me really... When a SSRI is highly selective like Lexapro(Cipralex), I feel drained of all my energy (mentally or physically) and my depression, general anxiety, panic disorder or social phobia doesnt improve also, I just eat more and more and gain weight...to end up after 3 months with a low self-esteem because of my weight gain and no improve at all....I always get a massive weight gain on them...even if I eat or notbut in general I eat a LOT on themI cant stop.
>
> I never get the chance to try correctly the SRNIs class of drugs because in the Canada we only have the Effexor-XR version, not the regular version and with my gastric by-pass, the drug dont have the time to reach a normal peak level in my blood stream, even if I up the dose to a very high level. I try to open my pills of Effexor-xr, chew the small round balls inside them but the taste was so bad, I never succeed to take one 37.5mg pill completely like this. I also never try the Cymbaltathats relatively new in Canada, thats not insurance cover but I think I can work it out with my pdoc, have some samplesbut I will have some question about it later for you For the Pristiq, forget it, in the Canada, we will not have it before 3 or 4 years...Health Canada is very slow on the approvoal of new drugs...We don't have also the Emsam patch, most of PDOC here are not aware of the existence of this produc. So you can see how we are retarded here in the Canada...;-)
>
> It's why I want to try something different now. The only one class of AD's I never try completely is the TCA's. I try just the basic imipramine and it fails to produce a good effect, I don't remember it in fact, it'S a long time ago... If I don't remember it, it's probably because it was ok for the side-effects... I took also a little bit of Elavil to help me with my headache problem but thats never help me so I stop after 2 months at a very low dose...but I know it cause a lot of sedation at dose more than 25mg...
>
> The first time I meet my new psychiatrist 2 months ago, he suggest me at first a TCA drug call Nortriptyline. I know it work more on the NE than the SE, so its maybe a good solution for me. Everyone else try it for depression and anxiety problems like the ones I have? Is it true that with all the TCAs, I will gain more weight? Is it worth the trail? Should I go for another TCAs than the Nortriptyline before, like the Desipramine or the Clomipramine??? Which one is the best for depression, anxiety and to retrieve more energy (physical and mentally).
>
> For the Cymbalta, someone open a pill to see how its made inside? Is it like the Effexor-xr, small round balls that you cant chew or crunch, or its just a powder? Is it easy to open the capsule and is it possible to take it without the time release capsule? I absolutely need to know how its made inside the pills to be able to know if my intestine will be able to absorb the drug or not The cymbalta seem to work more on the NE than the SE alsomy sister take it since a couple of months, she told me that she dont improve a lot, she still have some energy slumps and depressive moment where she cry a lot... but she have more energy than when she was on the Celexa and she also lost some weight on it Do you think it worth the trial?
>
> My last question is for the people who try the Manerix (reversible MAOI avaible in the Canada). Is it less hard on the hypertension or hypotension produce normally from more common MAOIs like Nardil and Parnate? Is it doing something good in the depression or anxiety disorders? Do you think it cause less side-effects than others SSRIs or SRNIs? If you experienced some side-effects, witch ones I will be more susceptible to have? Is it giving some energy or its more neutral on that domain? For the weight gain, is it neutral or not? I read that one 300mg dose of Manerix inhibit 80% of type-a and 30% of type-b MAOI...someone know the difference between the Type-A and the Type-B...If I well remember, Type-B play a role more in the DA and Type-A is more NE, SE ?
>
> Well, so much questions, too few answers
>
> If someone here can help me it will be really appreciate ;-)
>
> Thanks for your support again!!!
>
> Bye!
>
> Vincent ;-)
>
>
>
>Hi Vincent...a fellow Canadian here. Here are some of my experiences regarding your questions, but remember your experience may be very different.
-Moclobemide (Manerix(sp?) I found this med just way, way too stimulating, made me very irritable and angry.
TCA's: Nortriptyline, I've tried for a long time, but too much of a 'norepinephrine' factor for me. This drug has both stimulating and sedating properties. Better then imipramine, IMHO, especially in regards to no dry-mouth, and all usual anti-chol factors. I haven't tried trimipramine or clomipramine.
-Unfortunately I believe Cymbalta is a delayed-release capsule.
I am caught in a really bad time too. I don't know what med(s) work anymore. I hope the best for you. Please let us know how you make out.
Jay
Posted by Vincent_QC on January 9, 2009, at 23:46:25
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Vincent_QC, posted by Phillipa on January 9, 2009, at 10:59:24
Hi Phillipa ;-)
Well you're right, getting Emsam patch in Canada will be impossible, so I have to forget this option, since it will be the most "pratical" way to be sure I recieve the good amount of drug into my body...too bad I can't try it. I don't think it will be avaible in the Canada one of these day...like the Manerix will never be avaible in the USA ...My question about Cymbalta was about how it's made inside the pill???...is it small rounds balls like the Effexor-XR or it's just regular powder or it's hard? If it's not rounds balls, maybe I will be able to crush the pills and take it like this...if it's small round balls I will not be able to do this.
For you question, yes I can absorb most of the "regular" version of drugs...all the SSRI's was absorbed but I never answer well to them.
When a drug hit too much all the SE brains, I feel worst than ever...I just think about food, I gain weight, I lost all the small amount of motivation I have and my social anxiety get worse cause I feel just like a "fat" and ugly guy...since I always gain weight on them, so I can't improve my social phobia and I get more anxious because I loose more self-esteem and I feel guilty cause I can't stop eating...that's a big circle that never stop... Ho...I was able to do very strict diet on a SSRI's...but I loosing weight even on a strict diet on a SSRI drug is what I call a miracle...I don't had a gastric by-pass surgery to find myself again in the big wheel of the DIET...and the YO-YO (mean loose 10 pounds, gain 20 pounds after...)...The SSRI's seem to change something in my system and make me just fat, I don't know what to point, but that's a the reality I have to live on them...soi I prefer to don't play in that field again...
I got my gastric by-pass in 2001. Before 2001, I had already tried a lot of AD's...most of them was on the SSRI's class...I gain most of my weight on the Paxil, I was on it from 19yo to 24yo...I was the first patient my Pdoc had at the time and who gain more than 60 pounds in 2 months...He had never see that before...
So you understand why I don't want to gain more weight again...I had this surgery and I don't want to be fat again...Since last october, I gain more than 45 pounds from Lexapro (Cipralex) and it seem that on the Parnate I continue to gain weight, so that's a major issue for me.
For all the extended version or the slow release drugs, it's hard to predict how many percent of the drugs is absorb by my system. I have a small intestine track, only 1 meter on 6-7 meters for a normal person, I eat something and it's out of my body 4 hours after...and it's not even digested...(I don't want to be disgusting...sorry...lol).
So it's why I was asking for the Cymbalta. If I can make it a regular version by crushing the pill and swallow it after, it can be a good try...But if it's made like the effexor-XR with small rounds balls inside I will not be able to do it and try it...
So for now, my only hope will be the Cymbalta (if I can crush it), a TCA's with the fewer side-effects profile, no weight gain as a side-effect if it's possible and the one with the less side effect also on the blood pressure.
The Manerix is also an option, it's seem to be only a milder MAOI's with reversible action. My family doctor always call the Manerix a drug for "cats"...mean that it was not really good and it was for minor problems of depression or social phobia...to be effective he always told me the dose had to be at least 900mg and sometimes 1200mg and at this stage, it act like a irreversible MAOI, so he always said that old MAOI's was more good for treatment resistant patient...
I get a lot tired from the last month experiment on the Parnate and if I have to feel like i'm running a marathon each day of my life just to be relieve of a little bit of my social phobia but not my depression I think I prefer to stay shy and have some social phobia problem than feel like I will pass out everytime...I don't think the ratio of side-effects and improve I see with the Parnate is a good reason to continue the adventure. I deserve at least a minimum of quality of life and I want to be able to keep it... I don't want to wait again 2 months just to see if the side-effects of the Parnate will fade away, i'm not ready to live another 2 months like the one I just had...
Another time, that's just my point of view...Thanks for you support...and if you can tell me how the Cymbalta is made inside, it will help me a lot!!! ;-)
Have a nice weekend ;-)
Bye!
Vincent ;-)
Posted by Justherself54 on January 9, 2009, at 23:50:57
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Phillipa, posted by Vincent_QC on January 9, 2009, at 23:46:25
Sorry Vincent.Cymbalta has small, round, white balls inside a capsule.. :(
Posted by Vincent_QC on January 9, 2009, at 23:55:08
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Sissy35 on January 9, 2009, at 12:16:08
> Vincent_QC
> I also had the same problems you are now going through while on 30mg of parnate. I wanted to give up, but I read some posts here and deceided to increase to 40mg and the side effects started to abate. The awful tiredness and the BP problems are getting much better. I also had severe tension in the evenings too. I know its difficult I hated it too.
> My understanding is that doses of Parnate above 40mg have different effects on the brain and body than doses of 10-30mg.
> I am not trying to talk you into anything. But just share what worked for me.
> Sometimes just hope and faith in a different AD makes all the differece in its affect, and if you would feel more hope on something different than thats the course you should take.
> Sissy35Hi Sissy35 ;-)
I was on 40mg for more than a week and I don't see a big difference with 30mg, I had in fact more side-effects, especially hypotension orthostatic at night and high blood pressure in the daytime...that don't fade away with time...I totally agree with you, if you have a lot of hope about an AD, it can help a lot to encounter the side-effects...but in my case I just don't have the energy right now to make it and to take more and more side-effects...I prefer something less hard on my system and my minds...
I had high hopes on the Parnate, I suggest it to my Pdoc, that's was not his idea...but I was not aware of the side-effects profile at the time or so little... Now I know that in my case it's not the good drug.
At least, I try it...I will try to not see this as another failure...
Thanks again and good luck to you...I hope everything is fine for you ;-)
Bye!
Vincent ;-)
Posted by Phillipa on January 9, 2009, at 23:57:19
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Justherself54 on January 9, 2009, at 23:50:57
Vincent it's true hard enteric coated balls that can't be crushed. I'm so sorry. Was on the med myself and have looked. This weight gain sounds so strange no thyroid problems right? When they did the bypass was there anything they saw that could account for the fast weight gain? Are others in your family overweight? Love Phillipa
Posted by Vincent_QC on January 10, 2009, at 0:00:22
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Vincent_QC, posted by Justherself54 on January 9, 2009, at 14:30:29
Hi Justherself54 ;-)
I totally agree with you also... Normally, I also react differently at the second try of a drug and the second time it's worse...Paxil story here...lolI hope you find the good drug to help you ;-)
I will hope that I will find the good one for me also!!!
Thanks for your support...and also for the Cymbalta information, I just read it 2 minutes ago...too bad it's white rounds balls inside...I will not be able to open the capsule and crush them... So the Cymbalta solution have to be remove from my list I guess...
Anyway, thanks again!!!
Bye!
Vincent ;-)
Posted by desolationrower on January 10, 2009, at 1:48:39
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 10, 2009, at 0:00:22
HI vincent. If you haven't answered to sris before, i would think it best to go right to a TCA. duloxetine is more of a sri than nri. Do you have reboxetine in canada? That would be good, or desipramine, if you want an energising drug with low weight gain. Of course any drug the nri will increase heart rate and possibly blood pressure affect.
Try also to remember drugs can take a while to take effect; you need to give them time to give their benefit.
-d/r
Posted by Sissy35 on January 10, 2009, at 2:17:11
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
Keep in mind you did NOT fail!!!!!!!!!!!!!
The meds failed you!!!!!!!!!!
I hope you find a med soon that is kinder to you.
Its hard I know. I have taken more different ADs more then I can count or remember.I wish you luck and hope
Sissy35
Posted by Vincent_QC on January 10, 2009, at 8:28:40
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by desolationrower on January 10, 2009, at 1:48:39
> HI vincent. If you haven't answered to sris before, i would think it best to go right to a TCA. duloxetine is more of a sri than nri. Do you have reboxetine in canada? That would be good, or desipramine, if you want an energising drug with low weight gain. Of course any drug the nri will increase heart rate and possibly blood pressure affect.
>
> Try also to remember drugs can take a while to take effect; you need to give them time to give their benefit.
>
> -d/rHi -d/r ;-)
Thanks for the informations, that's very helpfull...No, reboxetine is not avaible yet in Canada...health Canada is very slow on the release of new AD's drugs...it goes on the list with Emsam, Pristiq and many others drugs that we don't have here...Yeah, for the Cymbalta, I will avoid it, since I know it's made like the Effexor-XR, with the small rounds balls inside. It will not work on me, even if I double the dose...That's what I do with the Effexor-XR and it never work, in fact, between 375 and 450 of Effexor-XR, I never felt something except an increase in my benzo drugs intake, more anxiety, more bad habit like smooking more cigarettes, drink more coffee, eat more fast food and things like that. You also specified it's more a SRI than a NRI...I remember having read somewhere and also hear it from my Pdoc that Cymbalta have a more strong noradrenaline inhibition action than serotonin action...but well, I don't lost my time with it, especially if it will not be absord by my intestine...
So, Desipramine seem to be a more selective and strong NE with an interresting side-effects profile, it's what you told me and what I read also, in fact, more good than Nortriptyline...I should ask for it, since I lack any energy or motivation do to anything...I just feel exhausted all the time. I have insomnia at night so I don't know if it will help with this or not?...Do you know what is the target dose of Desipramine to treat someone with all these disorders? (social phobia, panic disorder with agoraphobia, general anxiety disorder and depression)...
I also see in the list of avaible drugs in Canada that we have something call Doxepin, it's another TCA but it seem to be a lot sedating and work more for anxiety disorder...do you know that drug a little bit or try it before? We have also the Maprotiline, who seem to be more a "tetracyclic antidepressant". And another TCA call "Trimipramine" who seem to be a lot like Doxepin...so I suppose major weight gain and also a lot more sedation also...
I'm also aware that drug who play more in the NE field can cause more blood pressure and heart problems...but nothing will beat the problems I had with the Parnate, so in this regard, I don't fear any TCA's...I just fear the weight gain and the too much "Daytime sedation), that I already have when i'm not on an AD's...
Anyway, thanks for your help, that was really interresting for me, I think I will probably ask for Desipramine, since it's seem to be the more interresting and promising for my kind of problems...
Have a nice day!
Vincent ;-)
Posted by Vincent_QC on January 10, 2009, at 8:41:31
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Vincent_QC, posted by Sissy35 on January 10, 2009, at 2:17:11
> Keep in mind you did NOT fail!!!!!!!!!!!!!
> The meds failed you!!!!!!!!!!
> I hope you find a med soon that is kinder to you.
> Its hard I know. I have taken more different ADs more then I can count or remember.
>
> I wish you luck and hope
> Sissy35Hi Sissy35!!!
Yeah, you're absolutely right, I never see this by this angle of view before... (Sorry, bad english again...lol).The med fail, not me!!! I like that point of view...and it makes me feel like i'm not the one to blame...for one time...You know, doctors or PDocs always said things like "you are not like the others, you don't react like the majority of the others patients I have, you're reaction are unpredactible...), you ended by asking yourself if everything is not your fault and if you do a mistake by not keep taking an AD's drugs who don't produce the good effects on you or make you feel sick or worse...
I also try so many pills that I stop counting them since a little while!!! I think I try all the drugs that are avaible in the Canada for all the "psychologics" disorders as well as other more "off-label" uses drugs for social phobia...Everything except a lot of TCA's drugs , Manerix and Cymbalta...So it's why I will jump in that boat probably in 2 weeks...since I meet my Pdoc next week and I have to wait 2 weeks before I begin a TCA's drug after a MAOI...
I still wonder if a shorter period of time is acceptable for a washout from the Parnate, since it's seem to be reversible more fast than the Nardil? After 2 days without taking the Parnate, I already recover my REM sleep stage at night time...it's a sign that the MAO begin to reform in my brains...well I think...Anyway...
So I don't see this like the end for me and like a no hope story...I will find the good drug to help me with all my problems i'm sure...
Thanks again for your support ;-)
Bye!
Vincent ;-)
Posted by desolationrower on January 10, 2009, at 11:36:01
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Sissy35, posted by Vincent_QC on January 10, 2009, at 8:41:31
Yes, in general the TCAs and other older ADs similar you face a trade off, there are ones that are better for anxiety, but they cause more sedation and weight gain, no way around that.
Cymbalata is more noradrenergic than venlafaxine, in fact i am skeptical that venlafaxine has much effect on NA at all.
Have you ever tried an anticonvulsant? It might help with anxiety but not be addictive the way you find benzos since they take a long time to build up effect. pregabalin and gabapentin are the most benzo like, but topirimate, valproate, tiagabine, vigabatrin all might be helpful and wouldn't have the same risks.
-d/r
Posted by bulldog2 on January 10, 2009, at 13:09:51
In reply to Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by Vincent_QC on January 9, 2009, at 9:26:21
There's a drug available overseas called minalciprin that is supposed to be very effective.
Posted by Vincent_QC on January 10, 2009, at 16:39:17
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by desolationrower on January 10, 2009, at 11:36:01
> Yes, in general the TCAs and other older ADs similar you face a trade off, there are ones that are better for anxiety, but they cause more sedation and weight gain, no way around that.
>
> Cymbalata is more noradrenergic than venlafaxine, in fact i am skeptical that venlafaxine has much effect on NA at all.
>
> Have you ever tried an anticonvulsant? It might help with anxiety but not be addictive the way you find benzos since they take a long time to build up effect. pregabalin and gabapentin are the most benzo like, but topirimate, valproate, tiagabine, vigabatrin all might be helpful and wouldn't have the same risks.
>
> -d/rHi -d/r ;-)
Yeah, I try a lot of anticonvulsives drugs...Topamax (Topiramate)...had a lot of cognitives problems (short term memory loss and word-finding difficulty) on that one, but I also loose more than 20 pounds on it, in less than 1 month. It was not really helpfullfor social phobia, so I stop it. I had also cold extrimities...feets, hands...I was always feeling like it was freezing everywhere...even in a hot bath...I try also Lyrica before the Gabapentin. Lyrica was hard to tolerate for me, too much sedation and some rash on the skin...it was strange...I dont use it for more than 1 month also. Gabapentin was more easy to tolerate but the excessive amount of pills you have to take each day because of it's short half-life was borred me at the time. I was on it for more a couple of months at the max dose, don't remember the exact mg...but I stop because it was innefective on me and I never had any improve of my social phobia and my anxiety. I was on the rivotril at the same time (8mg/day)...I remember that I had a lot of pins and needles feeling in my head, my legs and hands...but nothing else.
I never try the lithium, the valporate acid or vigabatrin...or the lamictal as well...In fact, when I will find the good AD with a tolerable side-effects profile for myself and good results on my social phobia or in my anxiety in general and some help in the depression, I will maybe ask for a mood stabilizer...
I'm also skeptical about the Effexor NA or the so minimum DA effects it's suppose to have...in fact, i'm sure at a dose of 370-450mg/day, I had some drug in my system , even if I have a small intestine track, and I was not feeling good at all on it...It was like I was on the Prozac or something like this...more energizing profile, but more anxious in any way...
The onlyt one SSRI I never try is the Luvox...but I think I will also avoid this solution cause I know that I don't react well on the others SSRI's...I know he have a different structure than the regular SSRI and a shorter half-life, but I will not take any chance of trying it...
So for now, I will discuss the options with my PDOC next week...it will be probably a TCA's or the Manerix, even if the Manerix fail to show some positives results in some studies compare to the placebo group...but well, it work and help some people so maybe I will be one of them!!!
For the Parnate, I read in another post that people who persist are the one who will get more positive results...I don't argue on that statement. But for me it was too much... I can feel the difference now, i'm off the Parnate since 3 days soon and I had some panic attacks today and I had to return to my normal dose of Valium, so 20mg/day...I'm not stupid, I know that the Parnate had some good effects on my social anxiety and general anxiety, but the side-effects was untolerable for me. I was too much tired at the end...
Maybe my Pdoc will ask to return on the Parnate also but a 20mg or something like this....but I will absolutely try to change his minds and talk about others possibilities...
So for now I take my valium again, i'm more anxious than in my one month try of Parnate, but that's maybe just the withdraw efects I feel for now, since I stop cold turkey...who know...A lot of things can make me feel more anxious and more fragile to the panic attacks, especially in social events like I had last night and that I will have tonight...i'm suppose to go out with a friend and i'm not really in the mood for that...but well if I stay at home I will also be anxious so why lost another evening at home alone...I'm used to do panic attacks, I will not die...lol
Anyway, i'm out of subject for now...thanks for your help !!! That's very nice from you!!!
Bye!
Vincent ;-)
Posted by JadeKelly on January 10, 2009, at 17:47:26
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » desolationrower, posted by Vincent_QC on January 10, 2009, at 16:39:17
Hi Vincent,
well, I think this is the most recent post. I'm sorry Parnate didn't work for you with the side effects. Sometimes I try to think back to remember how I felt before Parnate, but all I have to do is forget my pills once or twice and I figure I better stay on it. Whats funny to me is that you go out I'M SURE more than I do and you're the one with SA. Aren't you seeing a CBT? Is that helping? Must be! I'm becoming quite agoraphobic, well actually I have been for a while, I just don't like to admit it! The thought of going out with my friends like I used to makes me cringe. I had a very minor panic attack at my own brother's house! That was at Thanksgiving and alot of family I don't see often were visiting.
Sorry, off track there. I know someone who got really good results from Cymbalta and Wellbutrin. Ask your Doc, but I think there's a reason for this combo. What was interesting was that he had been on each individually and they did nothing for him. Together he was no longer depressed. He suffers from anxiety as well, not sure if something was added for that or not. Have you ever been on Wellbutrin? I'm sorry if I'm making you repeat yourself here! I just remember when I was on it I had lots of energy, especially in the beginning, and I lost weight. No side effects that I remember, except that finally I did go off it as the benefits wore off, and I became a little irritable. Maybe combined with Cymbalta i'd be great, I don't know. I might try that combo eventually if Parnate doesn't work. But it will...haha. So get back to me, I miss your funny stories, put my name on a post.
Be well my friend!
~Jade
Posted by Phillipa on January 10, 2009, at 19:12:29
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » desolationrower, posted by Vincent_QC on January 10, 2009, at 16:39:17
Vincent luvox at theraputic doses of 250-300mg worked very well for me til a stupid pdoc decided to trial me on celexa. It's the most sedating of SSRI's and I didn't gain weight still take low dose of it. Phillipa
Posted by desolationrower on January 11, 2009, at 1:50:20
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-) » Vincent_QC, posted by Phillipa on January 10, 2009, at 19:12:29
my impression is fluvoxamine is the worst for erectile dysfunction. it inhibits NO as well as the usual sri problems.
-d/r
Posted by Vincent_QC on January 18, 2009, at 5:56:35
In reply to Re: Switch from Parnate to (TCAs, Cymbalta)?Help ;-), posted by desolationrower on January 11, 2009, at 1:50:20
> my impression is fluvoxamine is the worst for erectile dysfunction. it inhibits NO as well as the usual sri problems.
>
> -d/rThe Luvox option is a no no option for me , a ssri is a ssri anyway...so I don't see why I will answer to the Luvox more weel than another one...
SSRI tend to make me feel like I have some anhedonia feeling...mean that each time I try one SSRI drug that I never try or I do a second try of a drug, I lost all the minimum amount of motivation and energy I have when I start it and after i'm left without any motivation or energy and i'm worse than ever...
I try some "cocktails" or "combos" to help me, I add some anticonvulsives drugs on the top of my regular SSRI, I add stimulant drug like the Ritalin, I also try to add a NDRI like the Wellbutrin...nothing seem to help to help me with the energy and motivation levels in my case.
So I wonder now if it's a good thing to ask for a TCA who work by giving more energy than one who will help me more with anxiety (Desipramine VS imipramine or Nortriptyline)...since anxiety is often associated with a calming effect of a drug, not the stimulation...but it's another "fight" here...since some people like me never had more anxiety from things who excited them like the Coffee for example...maybe a stimulant drug alone will help? Something like the generic version of Adderall-XR, since it's not cover ny insurrance here and it's very expensive...
For now I have to drink more than 8 to 10 big "glass" of coffee to stay awake a little bit at daytime and to be able to do something (like comming visit this website and answer to some posts or threads)...
So my question is for you -d/r , witch ones (TCA) I have to ask to my Pdoc? Desipramine, for the no weight gain and increase energy level??? Or I ask just for a stimulant...Do you think it's possible to mix a stimulant with a TCA?... Did I will get some help in social phobia departement with a TCA, since they are rated to be inneffective for social phobia in a lot of books and also in a lot of studies on the internet...???
Well thanks for you future answer and help!
Take care of you ;-)
Posted by desolationrower on January 23, 2009, at 12:14:14
In reply to Re: Switch from Parnate to (TCAs) For -d/r ... » desolationrower, posted by Vincent_QC on January 18, 2009, at 5:56:35
just planning on trying one in addition to nardil or marplan then?
-d/r
Posted by Vincent_QC on January 24, 2009, at 15:55:25
In reply to Re: Switch from Parnate to (TCAs) For -d/r ..., posted by desolationrower on January 23, 2009, at 12:14:14
> just planning on trying one in addition to nardil or marplan then?
>
> -d/rNot sure...PDoc told me the TCA's have more NE potential...so mean more effects on the heart...since my blood pressure is still higher than usual, even if I stop the Parnate 2 weeks ago, I don't think i'm ready to play in that field again...
I still wait for an answer from Validus Pharma compagny for the importation of the Marplan in Canada...I write an e-mail to them the 21th January...and I still wait for an answer...we will see...if it's too expensive or it's too much trouble to get it in the Canada, I will return on the Nardil and try to up the dosage at the highest dose I will be able to take it...and wait what will happen... Maybe the second try will be the good one, maybe not...but one thing is sure, I hate the Manerix...and I already stop it after 3 days....intense headache and too much anxiety for me...
Adding Lamictal on the top of the Nardil or the Marplan, if nothing improve after severals weeks, will be a possibility that I never explore before...
We will see!
Thanks for your answer ;-)
Have a nice weekend!
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