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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 delna on October 21, 2009, at 22:06:16
Hi
I am particularly curious about adding Nortriptyline in a while if I am not getting a good response from Parnate alone (am still only on 40mg). I know you are supposed to start them together ideally but people do add it on I believe.
My question is this: Parnate is prescribed mainly for atypical depression which is what I have (part of bipolar) and the defining features are fatigue and hypersomnia.
Nortriptyline is sedating (even though it maybe be less so than the other TCAs). So how can you get activated if you add such a drug? People on this board are saying that it makes all the difference and I read in the babble tips that these 2 drugs have a synergistic effect.
I have to take 200mg Provigil with the Parnate just to stay awake enough to sit in bed. Is this combination sensible for someone like me? Or for anyone with atypical depression?
My other question regards stimulants. I am on 200mg Provigil (but ready to raise it to 400mg despite what Dr Goldberg advised- am desperate)
It is not a traditional stimulant and I'm sure it acts in a totally different way to the traditional stimulants. I think pdocs use it with Parnate just to keep sleepy patients awake (though, not sure).
My question is this: are the traditional stimulants like ritalin also used just to keep people awake or do they actually act to potentiate the effects of Parnate making it more effective.Is anyone taking ritalin? If so how much? In one babble tip thread, Dr Goldberg says he adds as much as 60mg of Ritalin to Parnate!!!
"Date: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <psydoc@psycom.net>
Subject: Non-response to tranylcypromineThe commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate."
What do people think??
Thanks so much for your help. I know I keep badgering everyone with questions. But sadly I am really struggling on this drug :(
I am so appreciative of the support I have received here....
Thank you again...
Love
D
Posted by Maxime on October 21, 2009, at 22:20:21
In reply to Parnate + TCA + stimulants, posted by delna on October 21, 2009, at 22:06:16
You won't know how you will respond to the Nortrip until you try it. Maybe it won't make you tired. I've taken it before and it wasn't sedating. It wasn't activating either.
Anyway, one step at time. You need to get to a decent dosage of the Parnate first. :-)
I don't have an answer to your question about stimulants.
Posted by Phidippus on October 21, 2009, at 23:50:12
In reply to Parnate + TCA + stimulants, posted by delna on October 21, 2009, at 22:06:16
Dextroamphetamine is really the stimulant to go to. Not only does it hit those pleasure centers (dopamine), but it also effects seratonin and norepenephrine levels positively. It also affects glutamate levels in the PFC, further helping with depression. AND if you're the ruminative type, d-amphetamine is indicated in the APA guidelines for the treatment of OCD.
Methylphenidate has the potential for making you more depressed.
P
Posted by delna on October 22, 2009, at 0:19:13
In reply to Re: Parnate + TCA + stimulants, posted by Phidippus on October 21, 2009, at 23:50:12
:(
Sadly Dextroamphetamine is banned in India and if you try to bring it in (like my pdoc in the US had suggested, as he felt this would suit me best) you will get 10 years in prison! It's ridiculous because ritalin just came in 5-7 years ago and provigil has been here for even less time. So before that people with narcolepsy were treated with TCA's!!!!Anyway, enough complaining! Infact I do have OCD and I would love to have tried Dextroamphetamine as my pdoc is the US thought it would suit me well.
Ritalin makes me a bit aggressive but doesn't depress me at all. That's my only option for a traditional stimulant....Thanks for your input
Take Care
D> Dextroamphetamine is really the stimulant to go to. Not only does it hit those pleasure centers (dopamine), but it also effects seratonin and norepenephrine levels positively. It also affects glutamate levels in the PFC, further helping with depression. AND if you're the ruminative type, d-amphetamine is indicated in the APA guidelines for the treatment of OCD.
>
> Methylphenidate has the potential for making you more depressed.
>
> P
Posted by Phillipa on October 22, 2009, at 0:46:12
In reply to Re: Parnate + TCA + stimulants » Phidippus, posted by delna on October 22, 2009, at 0:19:13
Are there add children there are they treated? Phillipa
Posted by delna on October 22, 2009, at 1:44:59
In reply to Re: Parnate + TCA + stimulants » delna, posted by Phillipa on October 22, 2009, at 0:46:12
> Are there add children there are they treated? Phillipa
I hate to bi**h but psychiatry is SO backward in India that AAD is only now being recognized...
Posted by Sunbath on October 22, 2009, at 6:00:21
In reply to Parnate + TCA + stimulants, posted by delna on October 21, 2009, at 22:06:16
Hey Delna, just a thought about Nortriptyline:
I think it's sedating mainly because of its antagonistic activity at h1 receptors.. you should grow tolerant to most of that effect relatively fast I think. But of course noone can predict anything and how it would feel. Of course it should be activating because its nri properties. I think some people reported that it helped them sleep at night but was much more activating during the day! Some don't get tired at all.
Maybe I'll try it out too some day, but I didn't like the feel of Nortriptyline in monotherapy so much (though didn't give it enough time as it wasn't working for my insomnia)..
I was wondering if there was anyone who ever tried bupropion with parnate?
Posted by delna on October 22, 2009, at 6:29:07
In reply to Re: Parnate + TCA + stimulants » delna, posted by Sunbath on October 22, 2009, at 6:00:21
> I was wondering if there was anyone who ever tried bupropion with parnate?
My pdoc wants to put me on that and says it can be done even though it contraindicated. He claims to have done before. But you know how I feel about him.....
Are you still looking for something for the daytime sedation? something to activate you more?
Posted by Sunbath on October 22, 2009, at 6:38:17
In reply to Re: Parnate + TCA + stimulants » Sunbath, posted by delna on October 22, 2009, at 6:29:07
Yes, but without increasing anxiety if possible..
I thought about adding wellbutrin but when I took it in combination with a SSRI I didn't like it.. it increased my anxiety and worsened insomnia A LOT! That could be different now with parnate though (of course).
However I'll get some Adrafinil next week and am very excited about trying it!This night I didn't sleep well and had some nightmares.. Now I'm very tired and foggy :( I never had that feeling again since Parnate started working for me.. I really hope that it's the alcohol (withdrawal) and not parnate pooping out on me..
Also increased dose to 50mg yesterday...
Good luck delna! So you now that you are on a higher dose you have insomnia at night? When do you take your doses of parnate?Maybe you take it too late? You might need a sleep aid don't you think?
Posted by delna on October 22, 2009, at 6:58:02
In reply to Re: Parnate + TCA + stimulants » delna, posted by Sunbath on October 22, 2009, at 6:38:17
Hmm, Wellbutrin does increase anxiety and I can't see why it would be any different on Parnate.... maybe worse because Parnate increases both NA and Dopamine and so does Wellbutrin.Happy you are getting the Adrafinil. I really hope it works for you and you don't need anything else!
When you say alcohol withdrawal, what do you mean? Have just suddenly stopped drinking?
> Also increased dose to 50mg yesterday...
Hope that works even better!> So you now that you are on a higher dose you have insomnia at night? When do you take your doses of parnate?Maybe you take it too late? You might need a sleep aid don't you think?
No, infact the insomnia was there before I upped to 40mg. I mean I do sleep, but only for a few hours. I don't want a sleep aid.
Because I have been so erratic about dosing times (because everyday I plan to quit) that I cannot tell if it would be better to take it during the day. The couple of times I have taken it inthe day, It makes me woozy headed.Last night I took 40mg at night (8pm and 3 pm) and I slept from 4- 7am. The hypotensive effect sort of knocks me out. I took a nap in the afternoon (my parents insisted).
Believe it or not , i like sleeping little. I prefer insomnia to oversleeping. At least I feel alive.
I'm just so grateful that I am able to sleeping so little even though I know in the long run it isn't too good. I don't want a sleep aid stronger than what I take which is 2mg clonazepam because anything else would give me a hangover the next day. And you know how much I despise being sleepy ;DMaybe it will settle by itself or once I can tolerate the hypotension, I will take it in the day.
Take Care
Thanks for the concern
Love
D
Posted by Rosy Crucifiction on October 25, 2009, at 10:50:04
In reply to Parnate + TCA + stimulants, posted by delna on October 21, 2009, at 22:06:16
You might try concerta. I've tried Ritilan, Adderall XL and found concerta to be far superior for the symptoms you describe. Much less of a feeling of taking speed, and more level effects. You might also look at boosting thyroid t4/t3. This increases general energy and specifically norepinephrine.
Since you haven't been on Parnate long, you may want to take it slow adding things. Let us know what you end up with.
Posted by delna on October 25, 2009, at 13:59:57
In reply to Re: Parnate + TCA + stimulants, posted by Rosy Crucifiction on October 25, 2009, at 10:50:04
> You might try concerta.
Oh, I really wish I could. Its banned here in India (we only have ritalin) which sucks.
> You might also look at boosting thyroid t4/t3. This increases general energy and specifically norepinephrine.
Even if my tests we all normal?? Do you think it can still help?
> Since you haven't been on Parnate long, you may want to take it slow adding things. Let us know what you end up with.
I will definitely be in touch. Thanks for your tips and concern
Love
D
Posted by Rosy Crucifiction on October 25, 2009, at 14:38:22
In reply to Parnate + TCA + stimulants, posted by delna on October 21, 2009, at 22:06:16
Numerous studies have shown thyroid to be an effective augmentation strategy. The web is full of thyroid sites, kooks and studies. I personally have found it quite helpful. Here are 3 studies:
http://www.ncbi.nlm.nih.gov/pubmed/16483669
http://www.jfponline.com/Pages.asp?AID=4267
http://cat.inist.fr/?aModele=afficheN&cpsidt=1697409
Let us know if you try it and how it comes out. FYI - Some doctors are very reluctant to prescribe thyroid if your tests are normal. Usually psychiatrists are more comfortable since they are familiar with the practice. It never hurts to print out a few studies.
Posted by delna on October 25, 2009, at 15:08:20
In reply to Re: Parnate + TCA + stimulants, posted by Rosy Crucifiction on October 25, 2009, at 14:38:22
Oh Wow,
Thanks you so much!
Just when I was feeling hopeless.
This may well help me alot (especially since I am an overly-tired person)
I will talk to a pdoc about it....Thanks again for the help!!
I will surely let you know the outcome if I try it.TC
Love
D
Posted by Rosy Crucifiction on October 25, 2009, at 17:34:23
In reply to Re: Parnate + TCA + stimulants » Rosy Crucifiction, posted by delna on October 25, 2009, at 15:08:20
I would try that first, then modafinil, then go from there. Good luck.
Posted by bulldog2 on October 26, 2009, at 15:23:53
In reply to Re: Parnate + TCA + stimulants » Rosy Crucifiction, posted by delna on October 25, 2009, at 14:59:57
> > You might try concerta.
>
> Oh, I really wish I could. Its banned here in India (we only have ritalin) which sucks.
>
> > You might also look at boosting thyroid t4/t3. This increases general energy and specifically norepinephrine.
>
> Even if my tests we all normal?? Do you think it can still help?
>
> > Since you haven't been on Parnate long, you may want to take it slow adding things. Let us know what you end up with.
>
> I will definitely be in touch. Thanks for your tips and concern
> Love
> D
>
>Delna what is called normal is that your results came in between a very low and a very high range. What is called normal may in fact be low. Sometimes low dose t3 can give your ad a real boost.
Posted by FredPotter on November 1, 2009, at 13:45:08
In reply to Re: Parnate + TCA + stimulants » Sunbath, posted by delna on October 22, 2009, at 6:58:02
I would try 10mg doxepin about 2 hours before bed time to help sleep
This is the end of the thread.
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