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Dr. Bob is Robert Hsiung, MD,
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Posted by Sunbath on October 17, 2009, at 6:49:49
In reply to Re: parnate - ready to throw in the towel, posted by g_g_g_unit on October 17, 2009, at 2:16:14
Hey g_g_g_unit!
Really sorry that you're having such problems!!
This damn insomnia! As I already said so often I think I'd also have already thrown the towel (maybe even much sooner than you as I'm so sensitive and desperate about sleep).
Is there really no option for you to use something else than damn seroquel and the benzo?
What about importing trazodone?
Scott so often told us that you need to treat the insomnia aggressively and to not let it be the reason to quit parnate.Did you try this combination of 2 different benzos like he was suggesting?
Maybe look at these threads:
http://www.dr-bob.org/babble/20090818/msgs/913180.html
If you have forgotten your thread here: http://www.dr-bob.org/babble/20090902/msgs/916464.html (he's talking about ativan + halcion)
It's a shame that insomnia is so difficult to treat and it's really a bummer if it's helping you (like you said it is with your anxiety and ocd) and you need to ditch it only because you don't get the right meds for being able to get rid of this troublesome side effect! If I hadn't the right tool (trazodone in my case) I'd sit in the same boat! Did you ask your doc about importing trazodone? He shouldn't have anything against it when he notices how weak it is as a sri!Maybe let him have a look at Dr. Gillman's article (who as you might know is an "internationally acknowledged authority on serotonin toxicity (ST)" having done so much of the research). He even doesn't consider trazodone and others to be real sri's because they are too weak.
In one of his articles about serotonin syndrome he says:
"Although clomipramine and imipramine do precipitate ST, none of the other TCAs are able to because they are too weak as SRIs. Trazodone, nefazodone, mianserin, mirtazapine are neither SRIs nor significantly serotonergic. Also, they do not precipitate serotonin toxicity with MAOIs see (21)."
it's here: http://www.psychotropical.com/1_st_intro.shtml
do you have mirtazapine or the nearly identical mianserine available in your country?
I wish you all the best and really GOOD LUCK!!!
You didn't already try out all options possible I think! You can make it!!!Please keep us updated :)
Posted by bulldog2 on October 17, 2009, at 10:24:42
In reply to parnate - ready to throw in the towel, posted by g_g_g_unit on October 16, 2009, at 23:40:49
> man, after more than 7 weeks, i feel consistently worse. there haven't even been any glimmers of hope, aside when i felt a dirty 'high'. i take 40mg a day. my sleep's appalling, even with Imovane and Seroquel.
>
> if anyone thinks there's a dose i should try - like 50mg - where i might sleep okay, then i will, otherwise i'm over Parnate. i'd rather feel less depressed and able to sleep.Some docs have gone as high as 120 mg or even higher on trd.
Have you tried Marplan which is supposed to be a gentler version of nardil?
Posted by Maxime on October 17, 2009, at 10:52:57
In reply to parnate - ready to throw in the towel, posted by g_g_g_unit on October 16, 2009, at 23:40:49
This is my second time on Parnate and I am tired all the time, except I can't sleep at night. It wasn't like this the first time I was on Parnate.
When do you take your last dose? Have you tried taking the entire dose in the morning?
Have you tried Ambien for sleep?
Sorry that you are having such a rough time. At least you know you are not alone. Hang in there.
Posted by Sunbath on October 17, 2009, at 11:25:37
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by Sunbath on October 17, 2009, at 6:49:49
Sorry g_g_g, I totally forgot about your massive brain fog on mirtazapine..
But what about importing trazodone?
Posted by Sunbath on October 17, 2009, at 11:52:02
In reply to Re: parnate - ready to throw in the towel » Sunbath, posted by Sunbath on October 17, 2009, at 11:25:37
Forgot something: regarding trazodone's usefulness in parnate insomnia maybe the article in current psychiatry could also convince your doc. They explicitely mention trazodone as useful!
If you don't have it and cannot find it online (is available for free) I can send it to you!
Posted by kirbyw on October 17, 2009, at 12:41:04
In reply to parnate - ready to throw in the towel, posted by g_g_g_unit on October 16, 2009, at 23:40:49
In my case, I have always had to deal with some insomnia while taking Parnate during over 25 years. Taking it in the morning helps, but definitely none after 2 pm. Right now I am on 30 mg.
I have noticed that as I have gotten older that exercise during the day or early evening will make me tired by 11 pm. How much exercise would probably depend on your age and physical condition. What I have been doing recently at about 10 pm, is walking up and down stairs several times to get myself tired. Stairs are great at getting one tired. I have done as many as ten to 15 times up and down the stairs within a half hour period, which for me is a fair amount. Or a long walk (or run if you can) early in the evening.
Sometimes I just go with the flow. If I can't sleep I read, watch TV, or do any number of things on the internet. Since I am less depressed these activities can be enjoyable until I finally get tired.
Also on a day when Parnate has kept me awake the night before, I am a little tired during my activities, but then the following night I can go sleep early and sleep great. So I just try to get through the day, even though I am tired.
Occasionally I will also skip the 3rd parnate pill, if I know that I really need to get a good night's sleep because of my activities the following day. But this is not good as I may notice the difference in terms of mood.
And I do get some relief by taking 1 mg Klonapin about 3 hours before bedtime.
Perhaps the difference is in the age factor. I am 61. How old are you if you don't mind saying?
(Also I assume you don't drink coffee or tea or coke, all of those seem to be additive with Parnate)
Rick in Costa Rica
Posted by Phillipa on October 17, 2009, at 20:44:32
In reply to Re: parnate - ready to throw in the towel, posted by kirbyw on October 17, 2009, at 12:41:04
Another oldie but goodie!!!! Wow the stairs and running still? Bet it's that wonderful climate. Just wanted to say hello and congratulate you. Love Phillipa
Posted by g_g_g_unit on October 18, 2009, at 0:40:15
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by Sunbath on October 17, 2009, at 6:49:49
> Hey g_g_g_unit!
>
> Really sorry that you're having such problems!!
> This damn insomnia! As I already said so often I think I'd also have already thrown the towel (maybe even much sooner than you as I'm so sensitive and desperate about sleep).
> Is there really no option for you to use something else than damn seroquel and the benzo?
> What about importing trazodone?
> Scott so often told us that you need to treat the insomnia aggressively and to not let it be the reason to quit parnate.
>
> Did you try this combination of 2 different benzos like he was suggesting?
>
> Maybe look at these threads:
>
> http://www.dr-bob.org/babble/20090818/msgs/913180.html
>
> If you have forgotten your thread here: http://www.dr-bob.org/babble/20090902/msgs/916464.html (he's talking about ativan + halcion)
>
>
> It's a shame that insomnia is so difficult to treat and it's really a bummer if it's helping you (like you said it is with your anxiety and ocd) and you need to ditch it only because you don't get the right meds for being able to get rid of this troublesome side effect! If I hadn't the right tool (trazodone in my case) I'd sit in the same boat! Did you ask your doc about importing trazodone? He shouldn't have anything against it when he notices how weak it is as a sri!
>
> Maybe let him have a look at Dr. Gillman's article (who as you might know is an "internationally acknowledged authority on serotonin toxicity (ST)" having done so much of the research). He even doesn't consider trazodone and others to be real sri's because they are too weak.
>
> In one of his articles about serotonin syndrome he says:
>
> "Although clomipramine and imipramine do precipitate ST, none of the other TCAs are able to because they are too weak as SRIs. Trazodone, nefazodone, mianserin, mirtazapine are neither SRIs nor significantly serotonergic. Also, they do not precipitate serotonin toxicity with MAOIs see (21)."
>
> it's here: http://www.psychotropical.com/1_st_intro.shtml
>
> do you have mirtazapine or the nearly identical mianserine available in your country?
>
> I wish you all the best and really GOOD LUCK!!!
> You didn't already try out all options possible I think! You can make it!!!
>
> Please keep us updated :)thanks for the info. i tried asking for mirtazipine, but it was contraindicted in the textbook he checked. he also said a TCA would have been okay if we had added it first, but it's too late now.
truth be told, i do sleep okay, but i am taking a high benzo dose to achieve that, which is making me uncomfortable.
he wants me to be on Risperdal long-term - both as a sleep-aid and as OCD therapy, but i'd rather not risk TD and raised prolactin, which he can't really fathom. i really don't think he'd want to import Trazodone, given how bent he is on me taking Risperdal. i'm tired of psychiatrists not caring about my quality of life. i'm thinking of just trying CBT.
Posted by g_g_g_unit on October 18, 2009, at 0:43:08
In reply to Re: parnate - ready to throw in the towel, posted by bulldog2 on October 17, 2009, at 10:24:42
>
> Some docs have gone as high as 120 mg or even higher on trd.
> Have you tried Marplan which is supposed to be a gentler version of nardil?no, it's not available where i live unfortunately. my issue isn't so much with respect to the dose i'm on - my doc said he's willing to keep going higher. i just wondered if there's a dose i should try sleep-wise before giving up. i don't care about the depression so much, since i'm used to it, but i just need decent sleep
Posted by g_g_g_unit on October 18, 2009, at 0:47:04
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by Maxime on October 17, 2009, at 10:52:57
> This is my second time on Parnate and I am tired all the time, except I can't sleep at night. It wasn't like this the first time I was on Parnate.
>
> When do you take your last dose? Have you tried taking the entire dose in the morning?
>
> Have you tried Ambien for sleep?
>
> Sorry that you are having such a rough time. At least you know you are not alone. Hang in there.thanks. i take my first 20mg at 11am and then 20mg again at 1pm. i was scared of having a hypertensive crisis, but maybe i'll try taking all 40mg together.
i sleep fine on Imovane - i mean, it's okay, but not restful. i just don't want to take it forever - partly due to addiction and partly because i am (i don't believe irrationally?) worried about the effects disrupted sleep architecture might have on my development
Posted by g_g_g_unit on October 18, 2009, at 0:54:20
In reply to Re: parnate - ready to throw in the towel, posted by kirbyw on October 17, 2009, at 12:41:04
> In my case, I have always had to deal with some insomnia while taking Parnate during over 25 years. Taking it in the morning helps, but definitely none after 2 pm. Right now I am on 30 mg.
>
> I have noticed that as I have gotten older that exercise during the day or early evening will make me tired by 11 pm. How much exercise would probably depend on your age and physical condition. What I have been doing recently at about 10 pm, is walking up and down stairs several times to get myself tired. Stairs are great at getting one tired. I have done as many as ten to 15 times up and down the stairs within a half hour period, which for me is a fair amount. Or a long walk (or run if you can) early in the evening.
>
> Sometimes I just go with the flow. If I can't sleep I read, watch TV, or do any number of things on the internet. Since I am less depressed these activities can be enjoyable until I finally get tired.
>
> Also on a day when Parnate has kept me awake the night before, I am a little tired during my activities, but then the following night I can go sleep early and sleep great. So I just try to get through the day, even though I am tired.
>
> Occasionally I will also skip the 3rd parnate pill, if I know that I really need to get a good night's sleep because of my activities the following day. But this is not good as I may notice the difference in terms of mood.
>
> And I do get some relief by taking 1 mg Klonapin about 3 hours before bedtime.
>
> Perhaps the difference is in the age factor. I am 61. How old are you if you don't mind saying?
>
> (Also I assume you don't drink coffee or tea or coke, all of those seem to be additive with Parnate)
> Rick in Costa Ricathanks for the advice. i'm 24. conventional sleep hygiene methods don't seem to help unfortunately; i've tried exercising, avoiding caffeine, etc. but regardless of what i do during the day, without Imovane i literally lie awake all night until 6/7am, when i drop off for 3 hours.
sorry, i hate complaining. it probably makes me sound less depressed than i am.
Posted by delna on October 18, 2009, at 3:55:51
In reply to Re: parnate - ready to throw in the towel » kirbyw, posted by g_g_g_unit on October 18, 2009, at 0:54:20
What have you decided?
Sorry I can't be of help. Insomnia is not something I have ever looked into....
Hope u feel better and update us on what you are planning on doing.Love
D
Posted by Maxime on October 18, 2009, at 11:38:04
In reply to Re: parnate - ready to throw in the towel » kirbyw, posted by g_g_g_unit on October 18, 2009, at 0:54:20
I feel your pain. :( Last night I took 200 mg of Trazodone and I still didn't sleep. I feel like absolute crap. Getting some sleep would make all the difference in the world.
Posted by bulldog2 on October 18, 2009, at 12:25:07
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by Maxime on October 18, 2009, at 11:38:04
> I feel your pain. :( Last night I took 200 mg of Trazodone and I still didn't sleep. I feel like absolute crap. Getting some sleep would make all the difference in the world.
When I was on parnate I initially had insomnia and than it just went away after six weeks and than I could sleep okay.
Posted by metafunj on October 18, 2009, at 14:42:53
In reply to Re: parnate - ready to throw in the towel, posted by bulldog2 on October 18, 2009, at 12:25:07
Any way to get Remeron? Its the most powerful antihistamine out there. Way more potent than trazodone
Posted by Maxime on October 18, 2009, at 15:40:36
In reply to Re: parnate - ready to throw in the towel » bulldog2, posted by metafunj on October 18, 2009, at 14:42:53
> Any way to get Remeron? Its the most powerful antihistamine out there. Way more potent than trazodone
It's contraindicated with Parnate.
Posted by g_g_g_unit on October 18, 2009, at 18:42:32
In reply to Re: parnate - ready to throw in the towel » bulldog2, posted by metafunj on October 18, 2009, at 14:42:53
hmm, maybe i'll try raising to 50mg for a week and see how i go. if not, at least i know i tried my best. thanks for all your responses.
Posted by Maxime on October 18, 2009, at 19:01:57
In reply to Re: parnate - ready to throw in the towel, posted by g_g_g_unit on October 18, 2009, at 18:42:32
I'm glad you are sticking with it. It would be a shame to give up before it has a chance to do its magic.
Keep us posted.
Posted by Maxime on October 18, 2009, at 19:02:32
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by delna on October 18, 2009, at 3:55:51
Delna, did you decide to stick with it or have you given up?
Posted by g_g_g_unit on October 18, 2009, at 19:44:39
In reply to Re: parnate - ready to throw in the towel » g_g_g_unit, posted by Maxime on October 18, 2009, at 19:01:57
> I'm glad you are sticking with it. It would be a shame to give up before it has a chance to do its magic.
>
> Keep us posted.thanks Maxime. i hope you see some results soon. what dose are you currently at?
i'm starting CBT this week soon, so hopefully that should help, especially if i have to withdraw. coming off Nardil, even after 12 weeks, was hell.
Posted by delna on October 19, 2009, at 1:46:48
In reply to Re: parnate - ready to throw in the towel » delna, posted by Maxime on October 18, 2009, at 19:02:32
> Delna, did you decide to stick with it or have you given up?
Sticking with it. I didn't take it for 2 days so am back down to 20mg but today I will up it to 30mg.
Hypotension is bad- it appeared 7 hours after dosing and knocked me out. How weird. But my pdoc days it will go.....Thanks for asking..
Posted by Sunbath on October 19, 2009, at 1:53:03
In reply to Re: parnate - ready to throw in the towel » metafunj, posted by Maxime on October 18, 2009, at 15:40:36
> > Any way to get Remeron? Its the most powerful antihistamine out there. Way more potent than trazodone
>
> It's contraindicated with Parnate.Hi Maxime,
that's true but so is your trazodone!
They are both so damn weak sris, mirtazapine might be even weaker ..
Sorry that you are feeling so bad :( I really hope it's helping you soon!!!
Wow 200mg of trazodone isn't helping you at all?
Did it help you in the past when you didn't take parnate with your insomnia?I know a few people by person who don't get sedated at all with trazodone..
I also had insomnia before taking parnate and trazodone helped me really much before and now on parnate tooIf it was helping you in the past, how long is it since you took it at last?
Take care, keeping my fingers crossed for you!
Posted by Maxime on October 19, 2009, at 14:25:52
In reply to Re: parnate - ready to throw in the towel » Maxime, posted by Sunbath on October 19, 2009, at 1:53:03
Hi, I was taking Trazodone in August to help me sleep. 200 mg would always do the trick. I tried 200 mg again last night and once again, I did not sleep. I am tempted to try 300 mg and see what happens.
Posted by Maxime on October 19, 2009, at 14:27:39
In reply to Re: parnate - ready to throw in the towel » Maxime, posted by g_g_g_unit on October 18, 2009, at 19:44:39
> thanks Maxime. i hope you see some results soon. what dose are you currently at?
>
> i'm starting CBT this week soon, so hopefully that should help, especially if i have to withdraw. coming off Nardil, even after 12 weeks, was hell.
>I went up to 40 mg today. I've been titrating it slowly as per pdoc's instructions, but now I am taking matters into my own hands and I am going to go up 10 mg every 3-4 days.
Doing CBT is a good idea. I hope it helps.
Posted by Sunbath on October 19, 2009, at 17:38:39
In reply to Re: parnate - ready to throw in the towel » Sunbath, posted by Maxime on October 19, 2009, at 14:25:52
Sorry Maxime that I even tried to motivate you not to take the 200mg the first night :(
What's the maximum recommended dose for immedate release trazodone anyway?300mg sounds like really really much..
What would you say to mirtazapine as a sleep aid? Too much weight gain?Good luck Maxime, I really hope you find something that let's you sleep! Insomnia is sooo terrible!
Feeling for you,
Sunbath
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