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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 2 of 2. This is the beginning of the thread.
Posted by shalhevet on March 25, 2010, at 18:33:48
Hi. I've been reading this board for a few years but I've only just registered. I've stolen a lot of ideas from you here and my psychiatrist is lovely enough to entertain them, but I've hit a wall in my treatment and I'm hoping for some feedback.
I'm currently taking:
- 100mg Parnate
- 15 Dexedrine (mainly for mitigating hypotension)
- 200mg Lamictal
- Lithium[My diagnosis and history, in a nutshell: I'm 22 and have been dealing with PTSD for 5 years. Until the incident that caused it, I was otherwise normal save for what is in retrospect a suspicious sleep cycle. I've got a lot of symptoms under control, but my mood troubles have been unresponsive to the usual treatments. Hence, MAOIs.]
My biggest problem with Parnate is that I'll feel an incredible sense of recovery and feel genuinely euthymic, only for the effect to fade in only a few weeks. I don't crash so much as feel the psychomotor slowing and leaden paralysis creep up on me and then I'm left terribly "blah" again. But I never had such a profound response to any drug before it, and I don't want to give up on it yet.
I'm stuck for how to preserve the effect. The same thing has happened at 50mg and 80mg, and now I'm at 100mg and have a ridiculous zombie walk. My pupils are constantly dilated and I've got pretty conspicuous choreoathetoid movements. I had a little scare with Dexedrine awhile back because my jaw clenched completely shut for a few hours (and my blood pressure spiked way up, and I couldn't pee) when I increased the dose to 40mg, so I'm wary of going the route of the MAOI+stimulant combo apart from small doses of Dexedrine (5mg a few times a day) to keep me from passing out.
And gosh, I hate to complain so much in my first post, but I've never experienced insomnia and fatigue so intense, debilitating, and seemingly unrelated to each other in the same day the way I have with Parnate. Independent of any sleep-deprivation fogginess I'm crashing *hard* in the afternoons. My mind and muscles turn to jell-O. Before I was on Parnate, I used Provigil with magnificent results (I had never had such a regular sleep cycle, and it was so free of side-effects that I wouldn't have known I was taking it), but because there's no literature on combining the two (and because I'm already pushing my dear psychiatrist's comfort zone), I discontinued it.
So...what next? Mirapex? Provigil? Xyrem (Ha, I doubt it, but Ambien is practically like Pez at this point)? I'm intrigued by the potential for Mirapex and Provigil to be mood-brightening when combined with Parnate (and ideally, I'll lower my dose), but I'm worried about my poor little cardiovascular system, too. At this point, getting my sleep cycle under control would be a great first step, but I experienced such functionality with Parnate in the past that I'd love to keep going with it before entertaining TMS or ECT.
Well, thanks for reading. I'm aiming not to be a lurker anymore, so I'll probably be popping up in the Parnate threads now that I've registered.
Posted by desolationrower on March 25, 2010, at 23:15:40
In reply to Parnate and fatigue (and other things), posted by shalhevet on March 25, 2010, at 18:33:48
hm at least as far as tolerance for dopaminergics, vitamin d3, nmda antagonists (zinc, magnesium, memantine) might help.
i found the fatigue dissapated after a few weeks, same with insomnia. tho alpha1 antagonists, gabapentin/pregabalin,antihistamines might help.
i don't see any problem with added modafinal or mirapax
-d/r
This is the end of the thread.
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