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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by bulldog2 on December 5, 2009, at 9:13:43
After just a few days on parnate 10 mg have had a remarkable remission of depression. But the bad news is I have to stop.
Reason 1. Insomnia - Inability to sleep all night and I have a part time job that demands I get up at 5:00. That is hard to do on zero hours sleep.
Reason 2. Pain. Had hip surgery a couple months ago and recently finally weaned myself off of percocet. That in itelf makes my legs ache. But the cold weather is coming on and the parnate also really makes me feal chilly. The combination is quite painful.
Ah maybe try again when the weather warms up during Springtime.
Posted by Phillipa on December 5, 2009, at 10:58:11
In reply to Parnate Good Drug - Wrong Time, posted by bulldog2 on December 5, 2009, at 9:13:43
Bulldog sorry. So back at same job? So on any meds now? Love Phillipa
Posted by bulldog2 on December 5, 2009, at 12:14:03
In reply to Re: Parnate Good Drug - Wrong Time » bulldog2, posted by Phillipa on December 5, 2009, at 10:58:11
> Bulldog sorry. So back at same job? So on any meds now? Love Phillipa
same job a couple days a week. Really need the money. Off the percocet. Using neurontin as my ad now. It does an okay job and works for anxiety.
Posted by bleauberry on December 5, 2009, at 14:48:26
In reply to Parnate Good Drug - Wrong Time, posted by bulldog2 on December 5, 2009, at 9:13:43
Since you did so well at a very low dose, I think there are ways to manage this situation.
Obviously straight out it would make sense to take a strong sleep med. 5mg-10mg amitriptyline (my guess is this ultra low dose would not pose much risk with a mere 10mg parnate) or a normal dose of lunesta for example. A smidgen of remeron works good too...3mg to 7mg...much more sedating than higher doses. I do not favor low dose antipsychotic of any kind if the intention is sleep, in case seroquel was a consideration. At 10mg parnate I don't see a huge risk of
I think sometimes we can cut ourselves short by an all-or-nothing approach. For example, if we can't take 10mg parnate every day, then we can't take it at all. I just don't agree with that. You could try 10mg every other day, or once every 3 days. You are still going to get some benefit from it, which is better than having no benefit at all. Try 5mg a day. Try 5mg one day, 10mg the next, and a day off. Maybe just 2.5mg a day. Play with it and see.
With me I got a pretty decent boost from a mere 2.5mg once every other day. Even though the drug is gone from the system in hours, the MAO enzymes it impacted are shut down for days, so the benefit goes on even without another dose. With me I noticed the MAO enzymes were coming back to life in about 3 to 4 days...depression and anxiety were coming back fairly strong by then.
The cold chilly feeling is the same thing that kept me away from parnate. I mean, it was 60 degrees out, most everyone else was in a T-shirt, and I was freezing with 3 layers of warm clothes on and my fingers felt like ice. I don't know what it is parnate does that causes that. I think some herbal teas or supps might help that...ginger tea, cayenne capsules, things that stimulate microcirculation and are known as "warm" herbs. I'll have to do some research to find out more about what plants stimulate body heat and circulation.
I think it is probably related to the boost of norepinephrine causing a feedback loop impacting cortisol and stuff. My best guess is this would all adapt and be fine, but would probably take 3 to 6 months for that to happen.
I just think you should work with parnate if it helps you that much. Maybe it wouldn't be a perfect world, but better than none. Maybe?
Choose a sleep aid and play with the doses. That's what I would do.
Posted by bulldog2 on December 5, 2009, at 17:09:43
In reply to Re: Parnate Good Drug - Wrong Time, posted by bleauberry on December 5, 2009, at 14:48:26
> Since you did so well at a very low dose, I think there are ways to manage this situation.
>
> Obviously straight out it would make sense to take a strong sleep med. 5mg-10mg amitriptyline (my guess is this ultra low dose would not pose much risk with a mere 10mg parnate) or a normal dose of lunesta for example. A smidgen of remeron works good too...3mg to 7mg...much more sedating than higher doses. I do not favor low dose antipsychotic of any kind if the intention is sleep, in case seroquel was a consideration. At 10mg parnate I don't see a huge risk of
>
> I think sometimes we can cut ourselves short by an all-or-nothing approach. For example, if we can't take 10mg parnate every day, then we can't take it at all. I just don't agree with that. You could try 10mg every other day, or once every 3 days. You are still going to get some benefit from it, which is better than having no benefit at all. Try 5mg a day. Try 5mg one day, 10mg the next, and a day off. Maybe just 2.5mg a day. Play with it and see.
>
> With me I got a pretty decent boost from a mere 2.5mg once every other day. Even though the drug is gone from the system in hours, the MAO enzymes it impacted are shut down for days, so the benefit goes on even without another dose. With me I noticed the MAO enzymes were coming back to life in about 3 to 4 days...depression and anxiety were coming back fairly strong by then.
>
> The cold chilly feeling is the same thing that kept me away from parnate. I mean, it was 60 degrees out, most everyone else was in a T-shirt, and I was freezing with 3 layers of warm clothes on and my fingers felt like ice. I don't know what it is parnate does that causes that. I think some herbal teas or supps might help that...ginger tea, cayenne capsules, things that stimulate microcirculation and are known as "warm" herbs. I'll have to do some research to find out more about what plants stimulate body heat and circulation.
>
> I think it is probably related to the boost of norepinephrine causing a feedback loop impacting cortisol and stuff. My best guess is this would all adapt and be fine, but would probably take 3 to 6 months for that to happen.
>
> I just think you should work with parnate if it helps you that much. Maybe it wouldn't be a perfect world, but better than none. Maybe?
>
> Choose a sleep aid and play with the doses. That's what I would do.
>
>It was so nice after the third day to find I wanted to listen to music again which I had lost interest in.
I think your right about norepinephrine. I get that side of being cold on drugs such as strattera. I was on parnate for 8 weeks in April. I guess I was more resiliant at that time. I got up to 60 mg. The cold feeling and insomnia abated after about 6 weeks. The ad effect lasted for a decent amount of time after discontinuing. At that time I incremented 5 mg at a time which I will try again. I'm med sensitive.
The cold is rough right now because the weather has become cold and raw. Also had a hip repl in sept and the weather plus the parnate is not to pleasant on the recuperating leg.
But you have a good pt on the all or nothing approach. Our docs give us medication level goals and we often quit if we can't meet they're therapuetic level goals. We may still get something out of lessor levels. I've heard of some achieivng remission on 10 mg of parnate.
Posted by bleauberry on December 6, 2009, at 7:44:16
In reply to Re: Parnate Good Drug - Wrong Time, posted by bulldog2 on December 5, 2009, at 17:09:43
>
> It was so nice after the third day to find I wanted to listen to music again which I had lost interest in.Yeah, me too. I am a really good guitarist, but wow I got amazing on parnate by day 3.
> I think your right about norepinephrine. I get that side of being cold on drugs such as strattera. I was on parnate for 8 weeks in April. I guess I was more resiliant at that time. I got up to 60 mg. The cold feeling and insomnia abated after about 6 weeks. The ad effect lasted for a decent amount of time after discontinuing. At that time I incremented 5 mg at a time which I will try again. I'm med sensitive.
I'm sensitive too. That's why my doses were only 2.5mg.
> The cold is rough right now because the weather has become cold and raw. Also had a hip repl in sept and the weather plus the parnate is not to pleasant on the recuperating leg.
> But you have a good pt on the all or nothing approach. Our docs give us medication level goals and we often quit if we can't meet they're therapuetic level goals. We may still get something out of lessor levels. I've heard of some achieivng remission on 10 mg of parnate.I got these ideas from other people.
My Lyme doctor has patients doing well on stuff like 1mg Lexapro? Yeah, 1 mg. His patients are notoriously med sensitive...that is itself I think is a clue there is something going on.
At Lyme forums, most people do not take herbs or meds continuously for mood improvement. Instead, they take them as-needed to fit the day, the time, the demand, whatever. A lady might be on SAMe for a couple days, SJW for a couple weeks, B vitamins for a week, Ritalin for a day, some obscure Chinese formula for months...each person has discovered through their own battles what helps, what doesn't, and when they help...usually not all the time, but at specific times.
Let's assume for the sake of an example that you are 100% better on 10mg Parnate but the side effects are too much to live with.
Let's assume you are 60% better on 5mg and side effects are more tolerable.
Let's assume you are 30% better on 5mg taken once every two days and side effects are low.
Let's assume you are 0 % better on 0mg Parnate.
Well, any of the above scenarios look...in my eyes...to be better than 0mg parnate. Over time, the side effects should lessen, allowing a higher dose if needed. And you are correct, people have found remission in 10mg Parnate. It usually takes a few months to really settle in, but it happens. Sometimes I think our doctors erroneously have us overshoot our needed dose...thus creating a new chemical imbalance the opposite of the one we started with...we blew right past the balance point, right past our magic window. Sometimes I wonder if too much is as bad as not enough. I think it is common actually. But that's just me. I see things in ways most people don't.
I don't know about anyone else, but given a choice of the above options, I would take a 30% gladly versus no improvement. It's obviously not the ultimate goal, but for now, it is very welcome.
Posted by bulldog2 on December 6, 2009, at 9:13:55
In reply to Re: Parnate Good Drug - Wrong Time, posted by bleauberry on December 6, 2009, at 7:44:16
>
> >
> > It was so nice after the third day to find I wanted to listen to music again which I had lost interest in.
>
> Yeah, me too. I am a really good guitarist, but wow I got amazing on parnate by day 3.
>
> > I think your right about norepinephrine. I get that side of being cold on drugs such as strattera. I was on parnate for 8 weeks in April. I guess I was more resiliant at that time. I got up to 60 mg. The cold feeling and insomnia abated after about 6 weeks. The ad effect lasted for a decent amount of time after discontinuing. At that time I incremented 5 mg at a time which I will try again. I'm med sensitive.
>
> I'm sensitive too. That's why my doses were only 2.5mg.
>
> > The cold is rough right now because the weather has become cold and raw. Also had a hip repl in sept and the weather plus the parnate is not to pleasant on the recuperating leg.
> > But you have a good pt on the all or nothing approach. Our docs give us medication level goals and we often quit if we can't meet they're therapuetic level goals. We may still get something out of lessor levels. I've heard of some achieivng remission on 10 mg of parnate.
>
> I got these ideas from other people.
>
> My Lyme doctor has patients doing well on stuff like 1mg Lexapro? Yeah, 1 mg. His patients are notoriously med sensitive...that is itself I think is a clue there is something going on.
>
> At Lyme forums, most people do not take herbs or meds continuously for mood improvement. Instead, they take them as-needed to fit the day, the time, the demand, whatever. A lady might be on SAMe for a couple days, SJW for a couple weeks, B vitamins for a week, Ritalin for a day, some obscure Chinese formula for months...each person has discovered through their own battles what helps, what doesn't, and when they help...usually not all the time, but at specific times.
>
> Let's assume for the sake of an example that you are 100% better on 10mg Parnate but the side effects are too much to live with.
>
> Let's assume you are 60% better on 5mg and side effects are more tolerable.
>
> Let's assume you are 30% better on 5mg taken once every two days and side effects are low.
>
> Let's assume you are 0 % better on 0mg Parnate.
>
> Well, any of the above scenarios look...in my eyes...to be better than 0mg parnate. Over time, the side effects should lessen, allowing a higher dose if needed. And you are correct, people have found remission in 10mg Parnate. It usually takes a few months to really settle in, but it happens. Sometimes I think our doctors erroneously have us overshoot our needed dose...thus creating a new chemical imbalance the opposite of the one we started with...we blew right past the balance point, right past our magic window. Sometimes I wonder if too much is as bad as not enough. I think it is common actually. But that's just me. I see things in ways most people don't.
>
> I don't know about anyone else, but given a choice of the above options, I would take a 30% gladly versus no improvement. It's obviously not the ultimate goal, but for now, it is very welcome.
>
>To many doctors take a cook book approach to meds. They haul out that heavy pdr and look up the dosage levels. Maybe these dosages are averages that fit most cases but also may be to much for some. You're right in that to much in fact may be as bad as to little. I wonder how many med failures are caused by aggressive dosing where the patient quits because of intolerable sides. The doc often refuses to try a smaller dose and think outside the box. Treat patients as individuals and not use a cookbook approach to dosing.
Years ago when prozac burst on the scene my primary doc was an internist and a pharmacologist. He voiced concern to me about the standard 20 mg starting dose and was there really a need to boost serotonin so aggressively.He related a story to me about an elderly patient who chipped a bit of amitriptyline from a 25 mg pill now and than for her depression and it worked. Most doctors would never think of such a plan or endorse it.
In the
Posted by inanimate peanut on December 6, 2009, at 15:56:38
In reply to Parnate Good Drug - Wrong Time, posted by bulldog2 on December 5, 2009, at 9:13:43
So sorry to hear that! I wish you the best in finding something else that works on the depression!
Posted by bulldog2 on December 7, 2009, at 10:49:22
In reply to Re: Parnate Good Drug - Wrong Time » bulldog2, posted by inanimate peanut on December 6, 2009, at 15:56:38
> So sorry to hear that! I wish you the best in finding something else that works on the depression!
Well since my response was so good on 10 mg I restarted on 5 mg and am now back up to 10 mg. I am feeling well at this dose.
Posted by floatingbridge on December 9, 2009, at 0:05:19
In reply to Re: Parnate Good Drug - Wrong Time, posted by bulldog2 on December 7, 2009, at 10:49:22
Bulldog,
You sound better--hope that's true--and I hope this works for you. (I don't get the 'cold' thing. Interesting. On Strattera, too? Hmmm. That's the sound of me thinking....)
hang in there,
fb
> > So sorry to hear that! I wish you the best in finding something else that works on the depression!
>
> Well since my response was so good on 10 mg I restarted on 5 mg and am now back up to 10 mg. I am feeling well at this dose.
This is the end of the thread.
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