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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Sunbath on October 3, 2009, at 10:41:05
Hey Delna,
this is great news. So out of a sudden you get much more stimulated by only half of provigil?How long have you been on Parnate and what dose are you taking now?
No I'm not on provigil or any other stimulant because it's not common practice in my country :(
They reserve them for *really* severe cases..
I really hope the sedation will resolve by itself.
Today is my first on 30mg.. blood pressure dropped quite a bit after last dose, but only for an hour or so.. tiredness increased, but I also feel a stimulating effect which is very pronounced in the evening and morning before taking my first dose.I'll try again taking it at night.
Do you also have difficulty concentrating or zombieish feelings?Thanks, curious how it's going to effect you!
Good luck!!
Posted by Sunbath on October 3, 2009, at 10:42:47
In reply to Re: being 'out of it', posted by Sunbath on October 3, 2009, at 10:41:05
Posted by delna on October 3, 2009, at 14:37:21
In reply to Re: being 'out of it', posted by Sunbath on October 3, 2009, at 10:41:05
> Hey Delna,
>
> this is great news. So out of a sudden you get much more stimulated by only half of provigil?How long have you been on Parnate and what dose are you taking now?Parnate for 3 days at 10mg at night
>
> No I'm not on provigil or any other stimulant because it's not common practice in my country :(
> They reserve them for *really* severe cases..
> I really hope the sedation will resolve by itself.Where do you live? Isn't there a way you can convince your pdoc that the sedation is ruining your life? And even if he agrees to give it to you for a while you can get through the next few weeks until stimulation sets in (which I hope it does)
> Today is my first on 30mg.. blood pressure dropped quite a bit after last dose, but only for an hour or so.. tiredness increased, but I also feel a stimulating effect which is very pronounced in the evening and morning before taking my first dose.
>
> I'll try again taking it at night.
> Do you also have difficulty concentrating or zombieish feelings?No today I have been thinking clearly. Though normally I AM a zombie
>
> Thanks, curious how it's going to effect you!
> Good luck!!You know what may have happened in my case- I think I may have switched into a mild hypomania (which is common for me on all AD's and even on geodon) because I have BPI. I think I will get a truer picture in a couple of weeks.
As gayle mentioned above (ColoradoSnowflake) Provigil will really really help the situation. You should try to convince your pdoc you need it...
Take care
Stay in touch
Posted by g_g_g_unit on October 3, 2009, at 17:56:48
In reply to Re: being 'out of it' » Sunbath, posted by delna on October 3, 2009, at 14:37:21
do you exercise Sunbath?
i decided to give Parnate another shot after all; i had dropped my dose down to 20mg, in order to taper off the drug, but the anxiety was too severe, so i came back up to 30mg, which is a lot calming. i also get that foggy/zombie feeling you describe - you're right it doesn't feel like normal brain fog, in that my senses feel quite clear, but then when i try concentrate or focus, i can't at all.
i also went away with some friends and could barely speak the whole trip. i have no desire to talk to others.
anyway, i mention exercise because if i wanted to i could sleep all day on Parnate, but as soon as i force myself to exercise, it seems to cover me til night.
i wish we had some better sleep aids like Trazodone available here. i'm going to try a low-dose TCA. if i still can't sleep, then at least i know i gave it my best shot on the drug.
Posted by ColoradoSnowflake on October 3, 2009, at 19:36:36
In reply to Re: being 'out of it', posted by g_g_g_unit on October 3, 2009, at 17:56:48
ggg:I'm happy you're going to give Parnate more time! I really felt awful for a long time on it...like you describe. I never miss my exercise classes but I didn't do them or much of anything else for quite a while...just stayed home and layed around and slept.
I feel VERY good now. I think Parnate takes a lot of time and patience. Yes, its a difficult drug to be on until it clicks and settles in.
Anytriptyline is great for sleep if it doesn't make you too tired.
Good luck,
Gayle
Posted by g_g_g_unit on October 3, 2009, at 23:29:52
In reply to Re: being 'out of it' » g_g_g_unit, posted by ColoradoSnowflake on October 3, 2009, at 19:36:36
>
> ggg:
>
> I'm happy you're going to give Parnate more time! I really felt awful for a long time on it...like you describe. I never miss my exercise classes but I didn't do them or much of anything else for quite a while...just stayed home and layed around and slept.
>
> I feel VERY good now. I think Parnate takes a lot of time and patience. Yes, its a difficult drug to be on until it clicks and settles in.
>
> Anytriptyline is great for sleep if it doesn't make you too tired.
>
> Good luck,
>
> Gayleyeah i had to stop swimming because my legs feel completely dead. but i can still go for a walk, etc.
i'm actually really glad i stuck with it. i've felt really peaceful these last two days at 30mg. Nardil worked quickly, but also made me really hypomanic; i was awake everyday at 7am exercising, constantly socializing etc. it didn't feel like me. Parnate is a lot more subtle.
i took amitriptyline to sleep as a teenager, and was okay on it. Trimipramine sounds like it might be the best option though; according to wikipedia: "Trimipramine is the only effective drug against insomnia known so far that does not alter the normal sleep architecture."
did the mental fogginess pass for you Colorado?
Sunbath, you could try creatine for the mental fatigue. i think it's shown to normalize sleep-deprivation-induced cognitive difficulties. i find it doesn't cancel out the Parnate fog, or give me much more physical energy, but i can do a few more things on it - for example, i could barely read after starting Parnate, due to lack of mental energy, but creatine seems to help a bit. there's also vitamin D and b12 for processing speed, etc.
Posted by Sunbath on October 4, 2009, at 16:06:56
In reply to Re: being 'out of it' » Sunbath, posted by delna on October 3, 2009, at 14:37:21
Hi Delna,
thanks for your message.
It's very difficult since in my country they only prescribe stimulants only for very very severe disorders.. it's not commong at all to prescribe them for treating some side effects caused by other medications!
It was even difficult to get my doc to prescribe partnate in the first place.. Parnate is considered very exotic in my country and it's even unavailable over here (had to import it).. I really don't know if it's possible to get a prescription of Provigil...I know there aren't any alternatives to parnate except maybe Nardil, so I will keep trying hard. If this daytime sedation won't pass I will try to get a Provigil subscription.. but I'd have to pay for it on my own since my insurance won't cover it, because I'm not suffering from serious narcolepsy which is the only real indication for it over here..
I think they are too much concerned about possible abuse or addiction to stimulants..
What do you think about that? Can you tell provigil's effects apart from parnates?Does one develop tolerance to it?
I could get parnate legally over a freind who is MD and who could write a prescription for me. I wouldn't like that since I'd like my pdoc to agree on that matter, but maybe if anything fails I would consider it.. what would you think?
However yesterday I took 20mg before sleep and I slept like a baby so maybe it's working!
I was much more clear headed during the day without taking my doses during the day!How are you doing? Did you increase your dose?
How's your sleep? If you are still suffering from insomnia.. are you going to consider a sedating antidepressant -maybe a serotonine antagonsit- as a sleep aid? I think considering insomnia is the most common side effect of parnate- it might be necessary.. what do you think?I wish you all the best!!
Posted by Sunbath on October 4, 2009, at 16:15:33
In reply to Re: being 'out of it', posted by g_g_g_unit on October 3, 2009, at 17:56:48
Hi g_g_g_
Thanks for writing :)
How are you doing? Are you considering amitriptyline? I think it might be great since it's an inverse 5ht2a agonist which seems very powerful!!! But of course everyone's different and maybe it would sedate you too much during the day? Who knows? You need to try it out for yourself!
BTW: I did tolerate amitriptyline fine but hated doxepine.. it's all your personal neurochemistry I guess.. I just wanted to tell you that you need to try it out for yourself and that you shouldn't give up only because one med isn't working for you.. there's so much.. as you already mentioned, there's trimipramine, doxepine, amitriptyline, notriptyline and even mirtazapine!
I'm sure you'll find something working for you!BTW: You are from England right? Are you taking Provigil or any other stimulant with Parnate or are you like me taking Parnate without any "help"?
I tried to take my dose at night yesterday and it worked like a charm (with 200mg trazodone though).. I was MUCH better during the day..
I'll do the same tonight and won't take anything till I come home from university tomorrow...I wish you all the best!
Keep me updated please!
Posted by Sunbath on October 4, 2009, at 18:05:15
In reply to Re: being 'out of it', posted by g_g_g_unit on October 3, 2009, at 23:29:52
Thanks for the tips with creatine and the vitamins! I might really try that when the brain fog persists and my pdoic won't prescribe any stimulant!
Posted by Sunbath on October 5, 2009, at 17:25:14
In reply to Re: being 'out of it', posted by g_g_g_unit on October 3, 2009, at 23:29:52
>
> did the mental fogginess pass for you Colorado?
>Yes Gayle, please tell us.. also IF it's possible for you to tell apart: did the fogginess pass because/when you added Provigil or did it pass on its own?
Thank you!!
BTW: g_g_g you aren't taking any stimulants with parnate are you?
Posted by ColoradoSnowflake on October 5, 2009, at 22:19:41
In reply to Re: being 'out of it' )) ColoradoSnowFlake, posted by Sunbath on October 5, 2009, at 17:25:14
Hi Guys:
The fogginess just got less and less. Now I don't have it at all.
The fatigue is something else. I had it terribly bad from Amytriptyline and Parnate for a quite a while. When I dropped Amytrip and added Nortrip. I felt HUGELY better. But I still had some fatigue. It just wouldn't go away although I was feeling better in every other way...but that darn fatigue. So my pdoc recommended Provigil. That was the missing piece for me.
I was cutting back on it and breaking it in half etc because of the expense. Now, I take it regularly and I am feeling really really good. I think I get some fatigue from both the Parnate and the Nortript.
It seems some people get kind of jazzed up on Parnate. I think you just have to wait and see what it does to you.
Horrible fatigue has been a consistent bug-a-boo for me since my breakdown, so I'm probably more likely to get it than the next guy.
But if you DO have fatigue after the dust has settled I would DEFINITELY add a stimulant to the Parnate. Provigil isn't exactly a stimulant that's why it works so well for me with my history of abusing dexedrine. Some pdocs are scared of adding a stimulant like they are a TCA.
Provigil is great that way and a pdoc will usually be ok with it. It just costs so much and is not generic except outside the US.Maybe you wont need stimulants!! That would be great!! But you have to give it TIME to find out. I'm into my 6th month and am just recently getting Parnate tweaked so it works for me.
Patience!!The fogginess gradually subsides and the clarity increases.......Lots!!! It's pretty cool!!
Good wishes,
Gayle
Posted by delna on October 6, 2009, at 1:34:09
In reply to Re: being 'out of it' » delna, posted by Sunbath on October 4, 2009, at 16:06:56
Hi Delna,
>
> thanks for your message.
>
> It's very difficult since in my country they only prescribe stimulants only for very very severe disorders.. it's not commong at all to prescribe them for treating some side effects caused by other medications!That's too bad :( because one of Provigil's off-label uses ( and for which is commonly used)is for drug induced sedation. Also it has approval for shift workers who are sleep deprived. Here is an article about its off label uses. Although the title sound really bad there is a line in there stating that it is used for druginduced sleepiness http://www.news-medical.net/news/2007/10/28/31791.aspx
> It was even difficult to get my doc to prescribe partnate in the first place.. Parnate is considered very exotic in my country and it's even unavailable over here (had to import it).. I really don't know if it's possible to get a prescription of Provigil...
I too have to import it.
> I know there aren't any alternatives to parnate except maybe Nardil, so I will keep trying hard. If this daytime sedation won't pass I will try to get a Provigil subscription.. but I'd have to pay for it on my own since my insurance won't cover it, because I'm not suffering from serious narcolepsy which is the only real indication for it over here..That sucks. Nardil is more sedating than than Parnate apparently. May I ask why you are taking Parnate in the first place? Have you tried The SNRI's and failed with them? Provigil and Wellbutrin can easily be added to them and there are studies showing this
> I think they are too much concerned about possible abuse or addiction to stimulants..
>What do you think about that?Provigil is not addictive in my opinion but the patients info leaflet says it has potential to be so. http://www.provigil.com/media/PDFs/patient_info.pdf
Read the conclusion of this article about tolerance and dependence of Provigil- it is positive.
http://www.ncbi.nlm.nih.gov/pubmed/16737742?ordinalpos=32&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSumWell its not addictive like the traditional stimulants at all, I believe. In my experience it is not addictive anyway. You can stop it cold turkey without any side effects.
>Can you tell provigil's effects apart from parnates?
Yes for sure. It makes all the difference.
>Does one develop tolerance to it?
I haven't and I have been taking it for a few years.
> I could get parnate legally over a freind who is MD and who could write a prescription for me. I wouldn't like that since I'd like my pdoc to agree on that matter, but maybe if anything fails I would consider it.. what would you think?
Personally I would take it especially if it is a low dose. But I understand you wanting your pdoc to give the nod of approval. maybe it is safer considering Parnate is such a drug wherein drug-drug interactions are common and you need to be monitered.
>
> However yesterday I took 20mg before sleep and I slept like a baby so maybe it's working!
> I was much more clear headed during the day without taking my doses during the day!
>
Good to know!> How are you doing? Did you increase your dose?
Haven't increased yet, In fact may withdraw because it has too many drug interactions which my doctor didn't bother to tell me about and frankly Parnate takers need to be monitored and given all the information. Also, after having one good day, I have started getting suicidal again. Embarrassed as I am about saying this, it is also making me oversexed (not part of the bipolar because I don't have any other hypomanic symptoms)
>How's your sleep? If you are still suffering from insomnia.. are you going to consider a sedating antidepressant -maybe a serotonine antagonsit- as a sleep aid? I think considering insomnia is the most common side effect of parnate- it might be necessary.. what do you think?
>
My sleep is fine but then again I am a sleepy person by nature. also I take clonazepam at night to sleep.> I wish you all the best!!
thank you..I wish the same for you!
Take care
DPS: Here is an article speaking of adding traditional stimulants to Parnate. Old but looks promising:
http://www.ncbi.nlm.nih.gov/pubmed/3997787?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
Posted by Sunbath on October 6, 2009, at 4:09:08
In reply to Re: being 'out of it' » Sunbath, posted by delna on October 6, 2009, at 1:34:09
Delna, once more THANKS :)
Thanks a lot for all these infos and the links! I'm not so afraid of trying modafinil now anymore, if it isn't like "real" stimulants. Amazing that you can quit cold turkey too!
But what about you? So you are still on 10mg? As you know this is really low.
I started at 20mg the 3rd day, stayed there for a week, and when I began to try taking it at night too, I increased to 30mg. That was 3 days ago.
I found that the brain fog side effect didn't much increase with the dose increase at all, maybe because I'm taking the "megadose" at night. Right now 10mg/morning, 20mg evening.
Yesterday I noticed a really really nice effect after taking the 20mg at 9pm. It was a nice warm content and motivated feeling! Something I haven't felt for a many many years! It felt drug induced though so maybe it's just a transient effect, but it was really really pleasant! Also this 20mg dose at evening didn't make me sleepy at all, I was really motivated.
I have never felt that with the 10 or 20mg only doses.. ok maybe it was just the time, but I don't think so.What I wanted to say is that maybe you get all the negative side effects but no or too little positive ones.
If I had just the brain fog and sleepiness I don't know if I hadn't quit it already. The fog is really troubling, but Gayle saying it will pass is really encouraging me.
May I ask what other medications you'd like to take but can't now that you take Parnate? If you think of other augmenting antidepressants, maybe Parnate alone would be enough?Thanks again for all the info and please keep telling me how you are doing!
All the best and take care!
Sunbath
Posted by Sunbath on October 6, 2009, at 4:17:24
In reply to Re: being 'out of it' )), posted by ColoradoSnowflake on October 5, 2009, at 22:19:41
Hey Gayle,
thanks very much for your message!
That the fogginess faded into clarity with time is really encouraging!I was also thinking that maybe Parnate was increasing trazodone's (xr) sedative effects during the day.. maybe I should switch my sleep help, but that'd be really tough. Also sad enough Nortriptyline isn't enough for me staying asleep.
Ok so I'll wait and wait and hope that the side effects pass. At the same time I will try to convince my doc to try Provigil..
It's really nice to hear from you and that you are still doing so well!!!
Keep up the cheerfulness :)
Have a nice day!
Sunbath
Posted by Sunbath on October 6, 2009, at 6:07:37
In reply to Re: being 'out of it' » Sunbath, posted by delna on October 6, 2009, at 1:34:09
Hi, sorry I forgot to answer your question about why I'm taking Parnate:
yes I tried really much before and nothing was helping much. I noticed some little effects from some SSRIs/SNRIs but nothing to talk home about and these little effects pooped out really fast. I even don't know if it might have been only placebo effects. Ok that's not completely true, I really think paroxetine once helped me reducing my OCD symptoms 6 years ago!
In the past I've tried (not in this order) paroxetine, sertraline, citalopram, escitalopram, venlafaxine, milnacipran, reboxetine, different atypical neuroleptics (always in combination with ssris or snris), mirtazapine, trazodone, nortriptyline (only for 10days I couldn't take the side effects, couldn't sleep), buspirone (in combination), tianeptine. Most of those drugs I tried in combination with other drugs. Example: mirtazapine + venlafaxine. Most of the antipsychotics I couldn't tolerate with the exception of ziprasidone. But it didn't help me against OCD and I really don't like taking APs anyway.
I also tried some TCAs but didn't tolerate them or was too afraid of weight gain.
That's why I'm now trying Parnate and I of course really hope that it will work and that those side effects pass. As mentioned in another post I already begin noticing some strange but very pleasant effects :) I also think that my social anxiety improved a little bit already. Of course I don't know whether those effects are transient and maybe only acute (side-) effects of parnate than the real -longer lasting- antidepressant effects..
I really hope it will work for both of us!Good luck!!!
Posted by delna on October 6, 2009, at 7:19:06
In reply to Re: being 'out of it' » delna, posted by Sunbath on October 6, 2009, at 4:09:08
> Delna, once more THANKS :)
>
> Thanks a lot for all these infos and the links! I'm not so afraid of trying modafinil now anymore, if it isn't like "real" stimulants. Amazing that you can quit cold turkey too!
>
> But what about you? So you are still on 10mg? As you know this is really low.
> I started at 20mg the 3rd day, stayed there for a week, and when I began to try taking it at night too, I increased to 30mg. That was 3 days ago.
> I found that the brain fog side effect didn't much increase with the dose increase at all, maybe because I'm taking the "megadose" at night. Right now 10mg/morning, 20mg evening.
> Yesterday I noticed a really really nice effect after taking the 20mg at 9pm. It was a nice warm content and motivated feeling! Something I haven't felt for a many many years! It felt drug induced though so maybe it's just a transient effect, but it was really really pleasant! Also this 20mg dose at evening didn't make me sleepy at all, I was really motivated.
> I have never felt that with the 10 or 20mg only doses.. ok maybe it was just the time, but I don't think so.
>
> What I wanted to say is that maybe you get all the negative side effects but no or too little positive ones.
> If I had just the brain fog and sleepiness I don't know if I hadn't quit it already. The fog is really troubling, but Gayle saying it will pass is really encouraging me.
> May I ask what other medications you'd like to take but can't now that you take Parnate? If you think of other augmenting antidepressants, maybe Parnate alone would be enough?
>
> Thanks again for all the info and please keep telling me how you are doing!
>
> All the best and take care!
> SunbathHi
Thanks for the concern. My doctor started me on 10mg and has kept me there for about a week. Considering I am extremely suicidal I am surprised he hasn't raised the dose. He's just so blase about the whole thing. I am still suicidal and he keeps making me wait for appointments and tells me to take clonazapam and 'sleep it off'
Basically I have lost faith in him because he never warned me about taking antihistamines etc. I had to do all the research myself and I am frankly sick of it especially when I am so low.
Plus about having surgery. I have had 2 emergency surgeries in the past 5 years and in India where I live now, no doctor knows about MAOI's except pdocs so if you end up in hospital they'll probably kill you.
To be honest I would like to add wellbutrin to the parnate because I am a highly sleepy person but that is not possible with Parnate.
Anyway at the moment things suck and I am seeing him tomorrow and he may switch me to an SNRI (which I have been on before but my depression is so bad I don't know if will work)I will keep you posted. I am glad you are feeling a bit better and also more positive about Parnate.
Hope you get well soon
Love
D
Posted by delna on October 7, 2009, at 7:46:50
In reply to Re: being 'out of it' » delna, posted by Sunbath on October 6, 2009, at 6:07:37
> Hi, sorry I forgot to answer your question about why I'm taking Parnate:
>
> yes I tried really much before and nothing was helping much. I noticed some little effects from some SSRIs/SNRIs but nothing to talk home about and these little effects pooped out really fast. I even don't know if it might have been only placebo effects. Ok that's not completely true, I really think paroxetine once helped me reducing my OCD symptoms 6 years ago!
> In the past I've tried (not in this order) paroxetine, sertraline, citalopram, escitalopram, venlafaxine, milnacipran, reboxetine, different atypical neuroleptics (always in combination with ssris or snris), mirtazapine, trazodone, nortriptyline (only for 10days I couldn't take the side effects, couldn't sleep), buspirone (in combination), tianeptine. Most of those drugs I tried in combination with other drugs. Example: mirtazapine + venlafaxine. Most of the antipsychotics I couldn't tolerate with the exception of ziprasidone. But it didn't help me against OCD and I really don't like taking APs anyway.Ziprasidone is magic isn't it! But like you it didn't help my OCD so I added Lexapro. I hope the Parnate works for OCD too. I posted on an OCD board and some people said it was great for their treatment resistant OCD.
> I also tried some TCAs but didn't tolerate them or was too afraid of weight gain.
> That's why I'm now trying Parnate and I of course really hope that it will work and that those side effects pass. As mentioned in another post I already begin noticing some strange but very pleasant effects :) I also think that my social anxiety improved a little bit already. Of course I don't know whether those effects are transient and maybe only acute (side-) effects of parnate than the real -longer lasting- antidepressant effects..
>
>
> I really hope it will work for both of us!Me too. Saw my pdoc today and he increased to 20mg. As for the modafinil I asked him what the maximum I could go up to and he said 200mg! That was disappointing news because I usually need 400mg to stay alert and have been allowed 600mg by a very senior pdoc in NYC.
My pdoc here said he would look up how high is safe with Parnate but (as we found) there is no information supporting modafinil with Parnate. But he really feels the Parnate will itself be stimulating and that these are early days. Hope it makes us both feel better. Keep in touch even if its by babblemail.
Love D
> Good luck!!!
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