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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 50. Go back in thread:
Posted by Bob on December 12, 2009, at 10:50:24
In reply to Re: Swapping Parnate for Effexor. » Bob, posted by SLS on December 12, 2009, at 5:37:07
> > I had good luck with Effexor about 15 years ago for maybe two months. I got up to maybe 225mg, and then it degenerated into hypersomnolence during the day followed by insomnia at night. I had nasty bruxism, even when awake and completely numb genitals. Then the anger set it and I decided it was time to get off. At the time it was by FAR the worst withdrawl I ever had, and possibly still is to this day. I have had some other bad withdrawls though. I promised myself I would never go there again because I'm not sure I'd survive it this time. I wonder if I'll be able to keep that promise?
>
> I understand your predicament. At some point, you will do anything to escape the crushing suffocation that is depression, even if it means returning to a drug that you were sure was counterproductive at the time you were taking it. You ask yourself, "will it work better this time?" What makes things particularly problematic in making a decision is that it is difficult to remember exactly how it felt to be taking the drug in comparison to the way you feel now. If you could flick a switch between the two states, it would be easier to compare them. As it is, choosing to return to a failed drug is an act of desparation, especially when one is willing to neglect the difficulty in discontinuing that drug should it fail again.
>
> So far, life sucks.
>
>
> - ScottYes, what you have described is my experience exactly. Sometimes when I'm trying to think of a drug that will be better I will think for days about one I might have already taken and only after much reflection remember some very unpleasant aspect of it that made me discontinue.
You're not alone in even some of the more obscure aspects of your suffering, I assure you.
- Bob
Posted by bulldog2 on December 12, 2009, at 11:08:42
In reply to Re: Swapping Parnate for Effexor. » Bob, posted by SLS on December 12, 2009, at 5:37:07
I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
Posted by SLS on December 12, 2009, at 11:48:07
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by bulldog2 on December 12, 2009, at 11:08:42
> I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
- Scott
Posted by bulldog2 on December 12, 2009, at 13:21:19
In reply to Re: Swapping Parnate for Effexor. » bulldog2, posted by SLS on December 12, 2009, at 11:48:07
> > I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
>
> There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
>
>
> - ScottLet's examine the idea. There are four irreversible maois currently on the market(nardil,marplan,parnate,emsam). Each one has cases where one has worked where the others have not. So each maoi while in theory boosts neurotransmitters also has something unique. Now there are supposed to be cases where nardil and parnate have been blended to yield a new blend that has worked.
I would search for these cases or studies and see wether this has actually occurred. What doses were used and were there specific ratios that were used such as 50 to 50 . Were there any cases of serotonin syndrome? How safe is this method when certain controls are in place.The following has always baffled me. Nardil appears to hit serotonin more strongly than parnate. Does one get serotonin syndrome when the dose of nardil goes to high? So why does parnate which seems more norepinephrine oriented precipitate serotonin crisis if used in low doses with nardil?
Posted by SLS on December 12, 2009, at 15:10:37
In reply to Re: Swapping Parnate for Effexor., posted by bulldog2 on December 12, 2009, at 13:21:19
> > > I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
> >
> > There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
> >
> >
> > - Scott
>
> Let's examine the idea. There are four irreversible maois currently on the market(nardil,marplan,parnate,emsam). Each one has cases where one has worked where the others have not. So each maoi while in theory boosts neurotransmitters also has something unique. Now there are supposed to be cases where nardil and parnate have been blended to yield a new blend that has worked.
> I would search for these cases or studies and see wether this has actually occurred. What doses were used and were there specific ratios that were used such as 50 to 50 . Were there any cases of serotonin syndrome? How safe is this method when certain controls are in place.
>
> The following has always baffled me. Nardil appears to hit serotonin more strongly than parnate.I can attest to that. I twice experienced a mild-to-moderate serotonin syndrome when I combined Nardil with imipramine, a drug with significant serotonin reuptake inhibition. I had no such problem when combining Parnate with imipramine.
> Does one get serotonin syndrome when the dose of nardil goes to high? So why does parnate which seems more norepinephrine oriented precipitate serotonin crisis if used in low doses with nardil?
If stroke is the sequalae of combining the two drugs, I would think it be the result of some sort of catecholaminergic reaction.
- Scott
Posted by RocketMan on December 12, 2009, at 16:39:36
In reply to Re: Swapping Parnate for Effexor., posted by SLS on December 12, 2009, at 15:10:37
Hi Scott,
I hope you are feeling well during your transition. Do you have a date in mind for starting effexor?
Take care,
Rocket
Posted by uncouth on December 12, 2009, at 17:09:53
In reply to Re: Swapping Parnate for Effexor., posted by SLS on December 12, 2009, at 15:10:37
Scott did you ever decide to try Zyprexa at any point?
Good luck with teh parnate -> effexor experience. I think i said it in another post but that transition is what caused me to end up getting ECT as the suicidal thoughts came on strong after a few weeks on effexor and off of parnate. I wish I had known about Zyprexa's effectiveness then, however.
Posted by West on December 16, 2009, at 11:36:29
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
Good luck Scott. Make it happen.
W
Posted by SLS on December 16, 2009, at 12:59:40
In reply to Re: Swapping Parnate for Effexor., posted by West on December 16, 2009, at 11:36:29
> Good luck Scott. Make it happen.
Thanks.:-)
- Scott
Posted by floatingbridge on December 21, 2009, at 2:19:47
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
Scott,
How are you doing?
fb
Posted by SLS on December 21, 2009, at 6:41:56
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by floatingbridge on December 21, 2009, at 2:19:47
> Scott,
>
> How are you doing?Thanks for asking. I really appreciate it.
So far, I have not plunged into the abyss. I discontinued taking Parnate 7 days ago. I am grateful that I am not feeling worse. We'll see what happens over the next week as MAO activity continues to recover.
I am going through an emotional crisis right now, so I am experiencing anxiety along with the depression. It has been difficult.
- Scott
Posted by mtdewcmu on December 21, 2009, at 11:03:54
In reply to Re: Swapping Parnate for Effexor. » linkadge, posted by SLS on December 10, 2009, at 18:41:44
> What do you think of coenzyme Q10? I was looking at adding that along with NAC at some point.
>
>
> - ScottIf you want to go the "alternative" route, you ought to try SAMe if you haven't. I gave it a try years ago and it was definitely more than mere placebo. It made everything look super-bright. I did not stay on it, though, for reasons I can't remember, and since then I have gone the mainstream medicine route.
Posted by mtdewcmu on December 21, 2009, at 11:12:02
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
> Is this as good as it gets?
>
> I don't think so. I won't settle for being barely employable and doomed to live an empty life. I want more. Parnate is not making it happen for me. It was nice in the beginning. However, even with the lithium added, I'm stuck. I believe that a greater improvement in the quality of my life is there for me to be had. I am not looking for perfection. Complete remission may not be in my future. However, I do expect to feel greater than a 50% improvement. I am stuck at 35%. That sucks. However, if that indeed is as good as it gets, at least I will have tried to move forward.
>
> Five or six years ago, I had been taking a combination of Effexor 300mg and nortriptyline 75mg. It helped, but was inadequate. The doctor should have tested my blood level of nortriptyline. He did not. In retrospect, we now know that I was significantly underdosed with nortriptyline. I predict that I will do better with the 150mg that I am currently taking when we combine it with the Effexor.
>
> I know that I can always go back to an MAOI if my planned treatment changes do not produce adequate results. Although making these changes is a gamble of sorts, I think it is a good investment of time to look for a better quality of life.
>
>
> - ScottAs long as you are piling on the meds, you might as well add a drug like Remeron, which will synergistically enhance the effects of the Effexor and Nortriptyline. Adding Serzone or an atypical would be other options for adding 5-HT2 inhibition. Why stop at only 2 or 3 meds?
Posted by SLS on December 21, 2009, at 11:18:57
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by mtdewcmu on December 21, 2009, at 11:12:02
> As long as you are piling on the meds, you might as well add a drug like Remeron, which will synergistically enhance the effects of the Effexor and Nortriptyline. Adding Serzone or an atypical would be other options for adding 5-HT2 inhibition. Why stop at only 2 or 3 meds?
Remeron seemed to exacerbate my depression, although I didn't stay on it for more than a week. I guess I could try it again. I am taking Abilify.
Currently:
nortriptyline 150mg
Lamictal 150mg
Abilify 10mgI still need to wait another week before starting the Effexor.
Still hanging in there...
- Scott
Posted by West on December 21, 2009, at 11:58:18
In reply to Re: Swapping Parnate for Effexor. » mtdewcmu, posted by SLS on December 21, 2009, at 11:18:57
I would not give this advice to anyyone but given the outstanding circumstances, get hold of some ketamine.
It will relieve suffering acutely and provide a buffer between your med trials. I'm sure you know the rap anyway. Rooting for you.
Posted by floatingbridge on December 21, 2009, at 13:52:23
In reply to Re: Swapping Parnate for Effexor. » floatingbridge, posted by SLS on December 21, 2009, at 6:41:56
Scott,
I'm sorry to hear about the anxiety and difficult crisis. Do you have or can you take something for anxiety? I don't like to think of you suffering. Can you do a short term benzo? Your washout seems to be moving along swiftly--good.
Thinking of you,
fb
> >
> > How are you doing?
>
> Thanks for asking. I really appreciate it.
>
> So far, I have not plunged into the abyss. I discontinued taking Parnate 7 days ago. I am grateful that I am not feeling worse. We'll see what happens over the next week as MAO activity continues to recover.
>
> I am going through an emotional crisis right now, so I am experiencing anxiety along with the depression. It has been difficult.
>
>
> - Scott
>
>
>
Posted by SLS on December 21, 2009, at 14:35:51
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by floatingbridge on December 21, 2009, at 13:52:23
Hi FB.
> I'm sorry to hear about the anxiety and difficult crisis.
It is a pretty heavy-duty crisis. I prefer not to medicate the anxiety at this point. It is a very difficult series of issues that I am up against. There are no remedies - only acceptance. These things are too big to accept all at once.
My workout today was terrible. I just went through the motions. I think I am just now starting to enter a more severe depression with anergia and fatigue as MAO activity is recovering.
- Scott
Posted by floatingbridge on December 21, 2009, at 16:11:48
In reply to Re: Swapping Parnate for Effexor. » floatingbridge, posted by SLS on December 21, 2009, at 14:35:51
You're in my thoughts,
hugs,
fb
Posted by Bob on December 21, 2009, at 17:29:30
In reply to Re: Swapping Parnate for Effexor. » floatingbridge, posted by SLS on December 21, 2009, at 14:35:51
> Hi FB.
>
> > I'm sorry to hear about the anxiety and difficult crisis.
>
> It is a pretty heavy-duty crisis. I prefer not to medicate the anxiety at this point. It is a very difficult series of issues that I am up against. There are no remedies - only acceptance. These things are too big to accept all at once.
>
> My workout today was terrible. I just went through the motions. I think I am just now starting to enter a more severe depression with anergia and fatigue as MAO activity is recovering.
>
>
> - Scott
Hang in there, Scott. I know these withdrawals and periods in between drugs can be brutal and dangerous. I've been there many times. It's one of the reasons I've avoided an MAOI for so long. For me, the washout would be very difficult. Not much longer for you, anyhow. Stay the course.Bob
Posted by SLS on December 21, 2009, at 17:33:28
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by Bob on December 21, 2009, at 17:29:30
> Hang in there, Scott. I know these withdrawals and periods in between drugs can be brutal and dangerous. I've been there many times. It's one of the reasons I've avoided an MAOI for so long. For me, the washout would be very difficult. Not much longer for you, anyhow. Stay the course.
Thanks, Bob. I appreciate the well-wishes and support.
- Scott
Posted by uncouth on December 21, 2009, at 18:19:53
In reply to Re: Swapping Parnate for Effexor. » Bob, posted by SLS on December 21, 2009, at 17:33:28
I went through the same Parnate -> effexor switch earlier this year. It got BAD - Very bad.
I highly suggest you try Zyprexa, in addition to your Abilify. 5mg may be all you need. It has proved to be probably the most effective and fast acting psych meds I've been on. At least until the effexor kicks in.
I wish I would have known about it earlier this year...i'm 80% sure it would have prevented a course of 20+ bilateral ECTs.
Hang in there.
Posted by Phillipa on December 21, 2009, at 19:15:31
In reply to Re: Swapping Parnate for Effexor. » floatingbridge, posted by SLS on December 21, 2009, at 14:35:51
Scott you can do this I know and believe in you. Hang in there time passes quickly. Love Phillipa
Posted by SLS on January 26, 2010, at 6:48:53
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by Bob on December 11, 2009, at 23:17:34
The gamble might be paying off after all.
I woke up this morning feeling mildly, but significantly improved. There is no way that I would feel this way normally. I did take my first dose of Adderall yesterday afternoon, but I doubt that it contributed to my current improvement. I am going to discontinue the Adderall for now and see what happens. I don't want to complicate things unnecessarily.
- Scott
Posted by floatingbridge on January 26, 2010, at 10:23:04
In reply to Re: Swapping Parnate for Effexor., posted by SLS on January 26, 2010, at 6:48:53
Oh. Pristiq took awhile to ramp up. My response to effexor ten years ago was more immediate--. (Ten years ago....)
Not related to your adderall dose?
I trust your sense of slow, careful trial!
Posted by Phillipa on January 26, 2010, at 20:06:28
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by floatingbridge on January 26, 2010, at 10:23:04
Scott fingers and toes crossed. Phillipa
This is the end of the thread.
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