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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bleauberry on February 2, 2009, at 17:50:30
Compared to everyone who takes 20mg to 120mg Parnate daily, my story is child's play. But I thought I would mention it for grins.
Got UK Parnate a few weeks ago. Hesitant. Doc said we will do MAOI, but not until 2 weeks. I am so darn sensitive I figured I might as well test Parnate to rule it out of the choices.
A single 5mg dose. Then 2 hours of feeling much worse, similar to what Adderall did to me. But after that I felt somewhat better, got more active, more interested, and glad as heck that sinking spell was so short. Lost appetite. Sleep was lousy.
Next day was bad. People even said I looked sad and asked what was wrong. I usually do a good fake job hiding it. But the glumness was too strong. That night's sleep was real good though.
Third day, surprised as I looked back on it and realized it had been better than baseline. A bit more active, bit more energy, bit more social, bit less depressed, bit less overwhelmed, and a lot less aches and pains.
4th day, another fairly decent one. I was impressed at this point. Overall maybe a 20% improvement from baseline.
Up to this point, just that single 5mg dose.
5th day was a down day. Felt like the MAO enzymes were reviving themselves, not to my benefit.
6th day, another suprise good day.
7th day the party is definitely over. Bad anxiety like I haven't felt in months. Bad depression.
The 3rd and 4th days I got the dizzy headrush thing when I stood up. I was surprised such a small dose would do that several days later. Appetite was generally down, sleep was fine.
And now contemplating real treatment with Parnate rather than mere sampling. But I kind of had my first choice of Marplan set for the doc visit in a week and didn't want to be into Parnate at that time. So geez, got myself in a squeeze.
Anyway, a genetic lab test showed that of 4 diffefrent MAO genes, they all have double mutations. Since the suggestions were antidepressants, I assumed that meant the double mutations were overactive genes. Too much MAO. The obvious looks like an MAOI. But of course, nothing in psychiatry is as obvious as it looks. But based on the little bit of goodness I had over an entire week on a single 5mg dose, I thought that was noteworthy and of significance.
Since my preconceived expectations were purely negative and fearful, there was guaranteed no placebo effect here. I know placebo from authentic. The most astounding thing was how aches and pains that have been torturing me for weeks just vanished. That had never entered my mind.
I suspect if Parnate is my doc's choice, I would be the kind of person that needs 5mg once every two days for a couple weeks, 5mg a day for a couple weeks, and very slowly working high over a period of months, hopefully finding a sweet spot somewhere at a low dose.
Anyway, just thought I would share the story. The moral of the story is that I think Parnate is a massively powerful drug to do what it did in this circumstance.
Posted by SLS on February 2, 2009, at 18:07:15
In reply to SLS and all....My Parnate experience, posted by bleauberry on February 2, 2009, at 17:50:30
Hi BB.
If you have the patience, I don't see how it can hurt to increase the dosage so gradually. I doubt you will miss some sort of window of opportunity. If you can't tolerate the side effects, what good is it to push the dosage quickly.
In the beginning, I would try to take Parnate everyday, regardless of how low the dosage. Otherwise, I think the on-off-on-off cycle might not induce the body to begin compensating for the side effects. We know that the parent compound, tranylcypromine is in and out of the body within 5 hours. However, we don't know how long the occult metabolites persist for. Let's assume that it is the metabolites and not MAO inhibition that produces the things you experienced. I think you will accomodate faster to a more stable concentration than a sporadic one.
This is just an intuitive guess, nothing more.
- Scott
Posted by Phillipa on February 2, 2009, at 20:37:29
In reply to Re: SLS and all....My Parnate experience » bleauberry, posted by SLS on February 2, 2009, at 18:07:15
Scott makes sense to me. Maybe 2.5 everyday or is that purely ridiculous? Phillipa
Posted by SLS on February 2, 2009, at 21:18:22
In reply to Re: SLS and all....My Parnate experience » SLS, posted by Phillipa on February 2, 2009, at 20:37:29
> Scott makes sense to me. Maybe 2.5 everyday or is that purely ridiculous? Phillipa
I don't think that's ridiculous at all. I am not sure how long it makes sense to stay at that dosage, though.
Any thoughts?
- Scott
Posted by Phillipa on February 2, 2009, at 21:31:30
In reply to Re: SLS and all....My Parnate experience » Phillipa, posted by SLS on February 2, 2009, at 21:18:22
Well since not an MAOI expert by any means. I myself have never tolerated large doses of meds. Off topic when I wanted so bad to try Ensam the pdoc said for me about a sixth of a patch as the people she gave it to try didn't seem to need even the 6mg size. I say that if it works for BB (not talking behind your back general discussion of those who do better on low doses of meds) titrate up very slowly and judge by response to the med. BTW thanks for asking. Phillipa
Posted by bleauberry on February 3, 2009, at 5:22:33
In reply to Re: SLS and all....My Parnate experience » bleauberry, posted by SLS on February 2, 2009, at 18:07:15
Scott,
Yeah, I was thinking 2.5mg every day to start. Or, absurd as it sounds, even 1.25mg every day. Tricky to split those small pills though.
I have to hesitate because my Lyme labs will be reviewed with me this Thursday. Antibiotics look likely at this point. Therefore, I need to be sure that whatever ones I take are compatible with MAOIs.
Lyme patients are extremely sensitive to meds. That is a common hallmark character of the infection. An herb called Samento, a modified version of Cat's Claw, is known to be extremely potent against the Lyme bacteria. Instructions are to take 1 drop 3 times a day and work up to 15 drops 3 times per day, but sensitive individuals may have to start with 1/4 of a drop once a day. I laughed at how ridiculous that sounded, and how puzzling it would be to split a drop into quarters. Anyway, I have tried Samento. One lousy drop sent me into the most viscious die-off effect that was rather scary and took me by surprise. That is how sensitive I am. Or how infected I am. Either way. I am definitely one of those individuals that would have to figure out how to divide a drop into quarters. :-)
Do you know about safety of MAOI and antibiotic combinations? Are any antibiotics off limits with MAOIs? MAOIs are so rare in my neck of the woods I doubt any clinicians will know the answer to that question. As usual, we patients have to become our own best experts.
Posted by SLS on February 3, 2009, at 8:16:59
In reply to Re: SLS and all....My Parnate experience » SLS, posted by bleauberry on February 3, 2009, at 5:22:33
> Do you know about safety of MAOI and antibiotic combinations?
No, I don't. There are just so many of them. So far, I have not encountered a doctor or medical literature that indicated that there was a contraindication. The monograph makes no mention of antibiotics. I think I was on doxycycline while taking Parnate a few years back.
I think the best thing to do is for you to look up each antibiotic you are considering on http://www.rxlist.com and see if MAOIs are contraindicated.
- Scott
Posted by Phillipa on February 3, 2009, at 19:49:20
In reply to Re: SLS and all....My Parnate experience » SLS, posted by bleauberry on February 3, 2009, at 5:22:33
BB might account for my sensitivity as well. Will you let me know what happens with the results and the antibiotics. For sure not much knowledge around your area. You'd think there would be a lot here but nooooooo. Love Phillipa
Posted by uncouth on February 4, 2009, at 11:17:57
In reply to SLS and all....My Parnate experience, posted by bleauberry on February 2, 2009, at 17:50:30
bleu,
you mentioned you got a genetic test. how much was it, and did your doctor suggest it or did you suggest it. what lab did you use, and what else did it tell you besides MAO mutations?i'm very interested in getting a genetic test but not sure how useful it will be for my doctor. based on my research on reward deficiency syndrome, adhd, and depression, i suspect i have mutations in genes that control dopamine transporter expression and probably the SERT genes (of course these are pretty wildass guesses) or maybe the COMT Val/Met variations.
What else did you learn with the test?
Posted by bleauberry on February 4, 2009, at 20:23:31
In reply to Re: SLS and all....My Parnate experience, posted by uncouth on February 4, 2009, at 11:17:57
> bleu,
> you mentioned you got a genetic test. how much was it, and did your doctor suggest it or did you suggest it. what lab did you use, and what else did it tell you besides MAO mutations?It was a few hundred dollars, highly suggested by my doctor, some place called Neurological Research Institute, and looked at 30 different genes. At least now I know which genes, which metabolic pathways, are trouble spots and which aren't. I hope that will help to lessen guesswork.
I think the results of my Lyme labs tomorrow though will trump all. That's the big one.
> i'm very interested in getting a genetic test but not sure how useful it will be for my doctor. based on my research on reward deficiency syndrome, adhd, and depression, i suspect i have mutations in genes that control dopamine transporter expression and probably the SERT genes (of course these are pretty wildass guesses) or maybe the COMT Val/Met variations.
>
> What else did you learn with the test?
Posted by Phillipa on February 4, 2009, at 20:26:13
In reply to Re: SLS and all....My Parnate experience » uncouth, posted by bleauberry on February 4, 2009, at 20:23:31
Any results on lymes test? Love Phillipa
This is the end of the thread.
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