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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 Seige on September 8, 2011, at 8:21:31
Hi guys,
Today I'm starting a beastly augment, with the hope of keeping my parnate stimulation alive and finally beating anhedonia.My current situation has been to start parnate, and once the MAO inhibition kicks in to amplify the stimulation, I get a couple of good weeks where I feel normal again. The stimulation has always died quickly however, and I would need to take 6 months off the parnate to get that effect again.
The plan is:
1. Take 10mg memantine until I've worked off any side effects it may cause
2. Raise memantine to 20mg and start 60mg parnate.
3. ????????
4. ENJOY STUFFTook the first 10mg memantine today. I expected it to totally zonk me it. Surprisingly though, it felt slightly pleasant, and talking became a bit easier. Suspect a small amount of dopamine release? If that effect built up over the course I would be eternally grateful. For today however, it wore off after a couple of hours.
I did also feel a bit less present, but that didn't bother me with the pleasant feeling in the background and all. Am looking forward to starting the parnate.
Posted by SLS on September 8, 2011, at 21:19:36
In reply to Memantine + Parnate: Day 1, posted by Seige on September 8, 2011, at 8:21:31
> Hi guys,
> Today I'm starting a beastly augment, with the hope of keeping my parnate stimulation alive and finally beating anhedonia.
>
> My current situation has been to start parnate, and once the MAO inhibition kicks in to amplify the stimulation, I get a couple of good weeks where I feel normal again. The stimulation has always died quickly however, and I would need to take 6 months off the parnate to get that effect again.
>
> The plan is:
> 1. Take 10mg memantine until I've worked off any side effects it may cause
> 2. Raise memantine to 20mg and start 60mg parnate.
> 3. ????????
> 4. ENJOY STUFF
>
> Took the first 10mg memantine today. I expected it to totally zonk me it. Surprisingly though, it felt slightly pleasant, and talking became a bit easier. Suspect a small amount of dopamine release? If that effect built up over the course I would be eternally grateful. For today however, it wore off after a couple of hours.
>
> I did also feel a bit less present, but that didn't bother me with the pleasant feeling in the background and all. Am looking forward to starting the parnate.
Good luck.It sounds like a good plan.
I once added memantine (Namenda) to Parnate. It might possibly have helped, but Parnate was discontinued soon thereafter for lack of sufficient effect.
How do you respond to Lamictal?
- Scott
Posted by Seige on September 9, 2011, at 4:11:06
In reply to Re: Memantine + Parnate: Day 1 » Seige, posted by SLS on September 8, 2011, at 21:19:36
Hey Scott,
Lamictal is one of the only things I haven't tried yet, since my pdoc thought there was little chance of it working. I'm thinking of trying it with Parnate or Nardil failing memantine+parnate.
Also I'm sorry to hear that you've slipped on your Nardil cocktail. How did Parnate and Nardil differ for you? I was considering switching out Parnate for Nardil since once Parnate had lost stimulation, I got crazy insomnia and had so little energy or motivation, even less than when I'm on an SSRI I think. My Nardil trial was so long ago I can't remember how it was relative to Parnate.
Posted by Seige on September 11, 2011, at 4:01:08
In reply to Re: Memantine + Parnate: Day 1 » Seige, posted by SLS on September 8, 2011, at 21:19:36
K so I've ramped up to 20mg of memantine as of yesterday. It may have helped the anhedonia slightly after taking after, but the most noticeable effect was feeling a bit less present, yeah like being drunk as people have mentioned before. Didn't bother me too much since with the anhedonia I hardly feel present anyway. All round, memantine by itself has proven fairly subtle. Like every med I've taken, it knocks out the painful permanent anxiety. However unlike some meds (effexor, cymbalta, wellbutrin, agomelatine, I'm looking at you) it leaves my mood intact, which is a nice change.
Started with 60mg parnate today, and already can feel a bit of a boost. Looking forward to it building, and hopefully not pooping out this time. Man parnate, why do you tease me like this.
Posted by sigismund on September 11, 2011, at 9:56:57
In reply to Memantine + Parnate: Day 4, posted by Seige on September 11, 2011, at 4:01:08
> However unlike some meds (effexor, cymbalta, wellbutrin, agomelatine, I'm looking at you) it leaves my mood intact, which is a nice change.
What was your experience with agomelatine?
Does memantine aggravate insomnia?
Posted by Seige on September 11, 2011, at 17:18:40
In reply to Re: Memantine + Parnate: Day 4 » Seige, posted by sigismund on September 11, 2011, at 9:56:57
> > However unlike some meds (effexor, cymbalta, wellbutrin, agomelatine, I'm looking at you) it leaves my mood intact, which is a nice change.
>
> What was your experience with agomelatine?
>
> Does memantine aggravate insomnia?
>
>Hey sigismund,
Ago was also a tease. It made me do this wierd cycling thing where I would feel better (about 10%) for a few days, then become heavily depressed for a week. At first it was awesome for sleep, but it is definitely stimulating and made sleep really light after a while.
Posted by sigismund on September 11, 2011, at 22:11:58
In reply to Re: Memantine + Parnate: Day 4, posted by Seige on September 11, 2011, at 17:18:40
> but it is definitely stimulating and made sleep really light after a while.
Yes, and if my experience is anything to go by, this gets worse over time.
Tolerance seems to build more to the melatonin receptor agonism than the 5ht2c antagonism.
I need to go back to half a tablet when I wake and see how I go.
Posted by Seige on September 12, 2011, at 6:55:11
In reply to Re: Memantine + Parnate: Day 4 » Seige, posted by sigismund on September 11, 2011, at 22:11:58
> > but it is definitely stimulating and made sleep really light after a while.
>
> Yes, and if my experience is anything to go by, this gets worse over time.
>
> Tolerance seems to build more to the melatonin receptor agonism than the 5ht2c antagonism.
>
> I need to go back to half a tablet when I wake and see how I go.
>
>
I think that's the whole reason ago works - 5ht2c downregulating in response to antagonism, so yeah tolerance is nothing. Definitely got stronger over time.Also today was day 5 of parnate + Memantine. Could feel the parnate today, it was nice, was so sleepy and out of the IT the entire day though. It was still pleasant however, I a nice respite from feeling so flat since last time I started up parnate.
Also the opportunity to participate in trials for DCS have come up. You have to technically be in a depressive episode to qualify however, and I know at least for the next couple of weeks, I won't satisfy that. I wonder what the chances would be of DCS helping with anhedonia... Sounds like it would be a better long term option if it worked than trying to push back parnate tolerance.
Posted by sigismund on September 12, 2011, at 14:05:08
In reply to Re: Memantine + Parnate: Day 4, posted by Seige on September 12, 2011, at 6:55:11
>Also the opportunity to participate in trials for DCS have come up.
What's DCS?
Posted by Seige on September 15, 2011, at 8:09:08
In reply to Re: Memantine + Parnate: Day 4 » Seige, posted by sigismund on September 12, 2011, at 14:05:08
> >Also the opportunity to participate in trials for DCS have come up.
>
> What's DCS?Direct Current Stimulation.I think its similar to reverse Transcranial Magnetic Stimulation.
About the Parnate + Memantine trial, I think I'm giving up on the memantine. I know its only been a week, but the parnate stimulation has already died down, quicker than it has each other time it got 6 month break, and the memantine has made me feel really out of it for the most part of each day.
Pretty disappointed about this, thought it had a chance at working, Going to sign myself up for the DCS trials now.
Posted by Sailboat77 on September 18, 2011, at 20:43:19
In reply to Memantine + Parnate: Day 1, posted by Seige on September 8, 2011, at 8:21:31
I myself struggle with anhedonia. I'm constantly trying to find new ways to battle it because the lack of joy or interest is the worst part of my Treatment-Resistant Depression. All the typical antidepressants and mood stabilizes did nothing for me.
I've been on Parnate for 10 months and I'm finding it's no longer as effective as it used to be. About 3 months ago I started taking stimulants to help with the depression and found that it was very effective against anhedonia. In the past, taking a stimulant alone would elevate my mood to the point I felt perfectly content, but I would emotionally crash after it wore off (it was the only time I ever experienced Bipolar-like symptoms). The Parnate + stimulant combination seems to stop the emotional crash and work against the anhedonia.
Recently however, the combo has become less effective. Right now I'm taking 40mg of Vyvanse and 60mg of Parnate. I'm still working through it to see if I can get the combination to work at an effective level, but if doesn't work, I got to try something else.
DCS sounds like an interesting alternative. Have you ever had ECT treatments? I know for myself that ECT seemed to make me feel worse.
-Best of Luck
Posted by Seige on September 22, 2011, at 8:56:36
In reply to Re: Memantine + Parnate: Day 1, posted by Sailboat77 on September 18, 2011, at 20:43:19
> I myself struggle with anhedonia. I'm constantly trying to find new ways to battle it because the lack of joy or interest is the worst part of my Treatment-Resistant Depression. All the typical antidepressants and mood stabilizes did nothing for me.
>
> I've been on Parnate for 10 months and I'm finding it's no longer as effective as it used to be. About 3 months ago I started taking stimulants to help with the depression and found that it was very effective against anhedonia. In the past, taking a stimulant alone would elevate my mood to the point I felt perfectly content, but I would emotionally crash after it wore off (it was the only time I ever experienced Bipolar-like symptoms). The Parnate + stimulant combination seems to stop the emotional crash and work against the anhedonia.
>
> Recently however, the combo has become less effective. Right now I'm taking 40mg of Vyvanse and 60mg of Parnate. I'm still working through it to see if I can get the combination to work at an effective level, but if doesn't work, I got to try something else.
>
> DCS sounds like an interesting alternative. Have you ever had ECT treatments? I know for myself that ECT seemed to make me feel worse.
>
>
> -Best of LuckHey Sailboat,
Yeah anhedonia has got to be one of the worst things in the world ever. Like worse than Hitler bad. It takes away the point of living, pretty much.
It affects everything, all the time. And the thing I hate most about it is that it takes away who you are. I really liked who I was. I hate talking to people and now only able to answer their questions and no more. I used to be really funny, and loved talking to people. But each conversation now feels like another person who won't know who I actually was. I also really miss music.
Sounds like you're becoming tolerant to the Vyvanse. Maybe memantine could help you here? Also even taking a break from it could help restore some effectiveness.
As far as parnate goes, it definitely raises my base mood. Parante and Nardil are the only two meds which have been able to do this for me. It actually makes me feel kinda happy all the time, in a really wired kind of way. However, I suspect once the stim effect has gone, it actually makes the anhedonia a bit worse, and I've just felt like doing nothing at all for these years I've been on parnate.
Its actually a fairly disconcerting feeling, being in a good mood but having 0 variance in it, especially when it feels too good for the situation, and you just want to be relaxed.
That said, parnate between 60mg-150mg has been what's been keeping me alive the last few years.
The DCS turned out to be false hope, apparently it'll take 2 hours each day due to cognitive testing etc, so would be pretty much impossible while I'm working (they actually said that). Bummer.
Good news though, my Adrafanil arrived on Monday. Have been taking it at 600mg since then, stacking on top of 40mg Parnate. It's now day 4. I've actually given Modafinil a shot before, which was a pretty rough month. It would make my brain feel a bit more active in a very NE kind of way, but at the same time felt uncomfortable, and needless to say did nothing for the anhedonia.
But I think its still worth giving Adrafanil a shot, if it needs weeks to work it must be somehow different to Modafinil, and maybe the Parnate base will help out somehow.
The first day felt like modavigil, but haven't really felt anything from it since then. Lets see how it goes over the next couple of weeks.
Posted by Chairman_MAO on September 29, 2011, at 18:50:31
In reply to Memantine + Parnate: Day 4, posted by Seige on September 11, 2011, at 4:01:08
Get your dose up to 1.5mg/kg/day (maximum 200mg/day) in divided doses. I have no idea how you'd be able to pull this off, but see if you can get a compounding pharmacy to make a sustained (or extended!) release preparation.
IMHO (and it is humble and nobody cares, but I like people to feel better), if you've exhausted enough options to get to tranylcypromine, cut to the chase and go high-dose. There are fewer side effects. The drug and its metabolites do _so much more_ than inhibit MAO. Tranylcypromine is in a class by itself.
The major pain is that with the 10mg tabs, you have to somehow carry around 12-20 of them _per day_ and take 20-30mg doses every two hours or so in order to get a consistent effect.
Please, if anyone has the money, get someone to compound you an sustained/extended release preparation!
I cannot post copyrighted articles here but there is a rationale for this. Anyone who's really curious can contact me privately and I can explain ...
The memantine's a good idea. It is actually safe, believe it or not, to also [gingerly] add d-amphetamine to high-dose tranylcypromine. Still, even this outstanding treatment doesn't work for everyone, but it is absolutely nothing like most antidepressants. If our regulatory goons ever figured out how good it was possible to feel on tranylcypromine, it would get scheduled.
Posted by Seige on September 30, 2011, at 20:27:21
In reply to Re: Memantine + Parnate: Day 4 » Seige, posted by Chairman_MAO on September 29, 2011, at 18:50:31
I totally understand the reasoning there. Unfortunately its something I've already tried, up to 150mg/day (and I only weigh 70kg). Even at this dose the stimulating effects wore off after a couple of days. Other than that, it made me kinda high, and really unstable when drunk. Felt like a lot of dopamine. Still no pleasure though. Basically just amplified the "being in a bubble" feeling that I get past 60mg, where you feel an odd kind of happy no matter what your situation is.
Situation update: at 60mg parnate now, as 40mg was outright depressing. Also it seems that, at 2 weeks, the Adrafanil isn't doing anything at all :(
Posted by Seige on October 1, 2011, at 2:06:26
In reply to Re: Memantine + Parnate: Day 4 » Seige, posted by Chairman_MAO on September 29, 2011, at 18:50:31
I totally understand the reasoning there. Unfortunately its something I've already tried, up to 150mg/day (and I only weigh 70kg). Even at this dose the stimulating effects wore off after a couple of days. Other than that, it made me kinda high, and really unstable when drunk. Felt like a lot of dopamine. Still no pleasure though. Basically just amplified the "being in a bubble" feeling that I get past 60mg, where you feel an odd kind of happy no matter what your situation is.
Situation update: at 60mg parnate now, as 40mg was outright depressing. Also it seems that, at 2 weeks, the Adrafanil isn't doing anything at all :(
Posted by SLS on October 1, 2011, at 6:40:16
In reply to Re: Memantine + Parnate: Day 4, posted by Seige on October 1, 2011, at 2:06:26
> I totally understand the reasoning there. Unfortunately its something I've already tried, up to 150mg/day (and I only weigh 70kg). Even at this dose the stimulating effects wore off after a couple of days. Other than that, it made me kinda high, and really unstable when drunk. Felt like a lot of dopamine. Still no pleasure though. Basically just amplified the "being in a bubble" feeling that I get past 60mg, where you feel an odd kind of happy no matter what your situation is.
> Situation update: at 60mg parnate now, as 40mg was outright depressing. Also it seems that, at 2 weeks, the Adrafanil isn't doing anything at all :(Hi. I am sorry that things are not working as well as expected. I was wondering if you could leave a message along the following thread detailing your experience with adrafinil. If you do, please explain the relationship between adrafinil and Provigil. Thanks.
http://www.dr-bob.org/babble/20110925/msgs/998262.html
- Scott
Posted by Chairman_MAO on October 1, 2011, at 15:07:13
In reply to Re: Memantine + Parnate: Day 4, posted by Seige on September 30, 2011, at 20:27:21
> I totally understand the reasoning there. Unfortunately its something I've already tried, up to 150mg/day (and I only weigh 70kg).
There are so many off-label options, I don't even know where to begin. I can tell you what generally worked for me, though:
(1) MAOI: I have tried Nardil (up to 120mg/day) and Parnate (up to 200mg/day). I "have" (I prefer to take a psychopharmacological approach, but let's just work with the conventions here) agoraphobia/social phobia in addition to dysthymia, just to give you an idea of what I was trying to treat. I eventually went off of Parnate because the ups-and-downs of it were too much to handle. If there was an extended-release preparation, I would have taken that around-the-clock and waited until I started sleeping again. I had to stop Nardil due to 50% body weight gain (at least 30% of which was due to not having access to Dexedrine for a few years).
Right now, I want to do Marplan. Doctor has done MAOI + dexedrine combination in the past, but said he didn't want to "go there yet". Gave me a sample pack of Viibryd. Absolutely horrible experience, had to give up before even getting to 40mg. Felt _awful_, physically and mentally.
(2) 60mg/day Dexedrine helps me, especially with an MAOI. I'm on clonazepam now and want to get off of it and back onto an MAOI without the weight gain) because they worked even better for the social phobia. Yay, benzo taper, fun! Anyway, back to you. Your doctor probably won't do this, but try asking to switch to Marplan. After you do that, ask too add a psychostimulant. Most won't do this, some will.
(3) Buprenorphine helped with motivation _a lot_. I wish I never stopped taking it. I took 4mg qid.
You can start off with as little as 0.3mg qid. The qid is important. This is off-label, but it is really a great treatment.I'm not a doctor, just some guy. But I've read a fair amount and I've tried all this stuff on my own body. ;-)
You may also want to look into pramipexole or ropinirole--those can work for anhedonia.
Best of luck.
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