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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 249 to 273 of 317. Go back in thread:
Posted by Phillipa on March 22, 2012, at 20:55:17
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 22, 2012, at 7:58:06
This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Posted by SLS on March 23, 2012, at 0:33:09
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on March 22, 2012, at 20:55:17
> This is definitely the longest you have responded to a med combo since posting here. Congrats!!!! Phillipa
Yup. Thanks.
:-)
- Scott
Posted by SLS on March 24, 2012, at 9:58:08
In reply to Re: Adding Parnate and prazosin. » Phillipa, posted by SLS on March 23, 2012, at 0:33:09
Yesterday was the best day yet - maybe 35% improved.
The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
- Scott
Posted by Bob on March 24, 2012, at 15:50:40
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
> Yesterday was the best day yet - maybe 35% improved.
>
> The only side effect of prazosin that really sucks to have to live with is the abolishment of sex drive. This is common with this drug. My libido was greatly decreased by depression to begin with. Now I have none. Still, I must acknowledge that it is worth being without a libido if it also means being without depression.
>
>
> - Scott
>Indeed. Unfortunately I have found that sexual dysfunction really wears you down over time. That's me though.
Posted by sigismund on March 24, 2012, at 18:13:16
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So you are on 6mg/d, Scott?
Posted by Phillipa on March 24, 2012, at 20:18:04
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
So what if you now have or are getting a life there are lots of other things. What if you had a serious medical condition that rendered you this way like prostrate cancer? Phillipa
Posted by SLS on March 25, 2012, at 5:27:35
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 24, 2012, at 18:13:16
> So you are on 6mg/d, Scott?
Yes. I take 2 mg three times a day. In the grand scheme of things, this is a fairly low dose. I experienced an improvement in depression at 3 mg/day, but my "mood" was too variable during the day, and it was obviously at its worst at the end of a dosing period. I don't doubt that 3 mg/day will be sufficient for some people, though.
I'm sure you saw that the dosage range of prazosin for treating hypertension is 6 - 20 mg/day; with some people going as high as 40 mg/day.
When I first started 6 mg/day, I experienced fatigue and sleepiness. However, those things disappeared within a week.
Prazosin caused a diminution of my sex-drive almost immediately. I imagine that some libido will emerge as my depression remits. Prazosin has NOT produced erectile dysfunction nor anorgasmia. I can still enjoy sex once I get started.
- Scott
Posted by phidippus on April 3, 2012, at 18:44:29
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 24, 2012, at 9:58:08
Its upregulating dopamine! How is it killing your sex drive???
Eric
Posted by SLS on April 3, 2012, at 20:40:58
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 3, 2012, at 18:44:29
> Its upregulating dopamine! How is it killing your sex drive???
I really don't know, but I'm not particularly happy about it.
Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though. I began looking into this only after I recognized a major reduction in sexual appetite. If this is as bad as side effects get for me, it is worth the trade-off. I am hoping that I will recoup some libido as the depression evaporates.
In certain areas of the brain, NE alpha-1b receptors act as a gate to allow throughput for dopamine circuits afferent to the limbic system. Closing the gate by blocking these receptors serves to attenuate the increased locomotor activity produced by psychostimulants like cocaine. I don't know if this is also true of appetitive drives and cravings.
- Scott
Posted by phidippus on April 5, 2012, at 16:11:25
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
Are you planning on taking up cocaine?
Eric
Posted by sigismund on April 5, 2012, at 16:38:14
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 3, 2012, at 20:40:58
>Reduced libido is uncommon with prazosin from what I understand. You will find it described on some drug lists, though.
Some people said that on askapatient.
Posted by SLS on April 5, 2012, at 18:26:15
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 5, 2012, at 16:11:25
> Are you planning on taking up cocaine?
>
> Eric
No.Why do you ask?
- Scott
Posted by SLS on April 5, 2012, at 18:30:32
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on April 5, 2012, at 16:11:25
> > Are you planning on taking up cocaine?
> >
> > Eric
> No.
>
> Why do you ask?
Actually, prazosin can reduce cravings for cocaine.
- Scott
Posted by uncouth on April 5, 2012, at 22:28:21
In reply to Re: Adding Parnate and prazosin. » phidippus, posted by SLS on April 5, 2012, at 18:30:32
hey scott, what is your dosing schedule for prazosin? my pdoc just prescribed it for me for refractory insomnia...both falling asleep and staying asleep...incicentally i also have high blood pressure. nothing else for sleep has worked...only thing that kinda works was saphris and i had to take it multiple times per night. hoping prazosin can help turn off my brain so i can fall and stay asleep.
i started on 2mg at night last night, and couldn't sleep still, so tonight upped it to 6mg. what do you take? can you describe it's effects on your sleep latency and quality?
incidentally, i noticed today that my mood was very stable despite the extreme sleepiness. although it could have been from the zyprexa i popped last night to finally help me fall asleep.
is anyone else using prazosin for...anything? besides scott?
Posted by SLS on April 6, 2012, at 1:32:33
In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 5, 2012, at 22:28:21
> hey scott, what is your dosing schedule for prazosin? my pdoc just prescribed it for me for refractory insomnia...both falling asleep and staying asleep...incicentally i also have high blood pressure. nothing else for sleep has worked...only thing that kinda works was saphris and i had to take it multiple times per night. hoping prazosin can help turn off my brain so i can fall and stay asleep.
What psychiatic conditions do you suffer from?
I hope the prazosin works to help you sleep. I take 6 mg/day in three divided doses of 2 mg. One can take 20 mg/day or more safely with this drug. Your doctor chose a good dosage for you to enhance sleep. Some people with PTSD go up to 12 mg or higher
I can't say that prazosin helps keep me asleep. Perhaps I am not taking enough at night to see a difference. My sleep is choppy, and I wake up a several times during the night. This disturbed sleep is the result of both adding Parnate and poor sleep hygiene. I allow myself to sleep too much during the day. I often fall asleep somewhere between 7:30 PM to 9:00 PM and wake at midnight. I have trouble going back to sleep after that. I just took some Ativan so that I can get through the rest of the night. I will use a sleep aid only occasionally.
What drugs have you already tried to treat insomnia? What were the dosages and outcomes? Do you have any trouble falling asleep initially? I once had complete insomnia when I first combined Parnate and desipramine. Combining two BZDs helped: triazolam (Halcion) to initiating sleep and lorazepam (Ativan) to maintain sleep. It worked like a charm, and I had very little hangover the next morning. A more modern combination might use zaleplon in place of the triazolam.
Would your doctor be willing to try GHB (Xyrem)?
Linkadge or Phiddipus might be of help to you. I have a list of treatments in mind, but I would rather know what you have tried first before describing alternatives. I believe Sigismund has already tried prazosin for sleep. Perhaps he will comment here.
I believe that it is justified to be as aggressive in the use of drugs to treat insomnia as it is for using drugs to treat MDD and BD.
http://www.leeheymd.com/charts/dep5.html
This is not a comprehensive list. Each drug has it strength and weaknesses and treat different presentations of medical conditions.
alprazolam
amitriptyline
buspirone
carbamazepine
chloral hydrate
chlordiazepoxide
chlorpheniramine
clonazepam
clorazepate
cyproheptadine
diazepam
diphenhydramine
doxepin
estazolam
eszopiclone
flunitrazepam
flurazepam
gabapentin
hydroxyzine
lorazepam
melatonin
midazolam
mirtazepine
nitrazepam
phenytoin
pregabilin
promethazine
propoxyphene
quetiapine
ramelteon
requip
Seroquel
temazepam
tiagabine
trazodone
triazolam
trimipramine
valproate
zaleplon
zolpidem
zopicloneIf all else fails, one may elect to treat insomnia with the cautious and responsible use barbiturate:
amobarbital
pentobarbital
phenobarbital
secobarbital> incidentally, i noticed today that my mood was very stable despite the extreme sleepiness. although it could have been from the zyprexa i popped last night to finally help me fall asleep.
Well, prazosin worked rather quickly for me to improve depression and reduce its variability during the day. Lithium has also helped with this also, but acts more so to stabilize my depression throughout the week.
By the way, I continue to improve gradually. The ride is not entirely smooth, though. This is to be expected in my case. Right now, my improvement ebbs and flows rather gently; the general direction of improvement still being upwards towards remission. Periodic worsenings now last for hours rather than days. I am gaining more and more confidence in my therapeutic response.
I am wondering if combining guanfacine and prazosin would yield somnolent effects without causing too much dizziness.
- Scott
Posted by uncouth on April 6, 2012, at 12:26:31
In reply to Re: Adding Parnate and prazosin. » uncouth, posted by SLS on April 6, 2012, at 1:32:33
Scott, thanks for taking the time to write such n extensive response. I am bipolar 2 with some obsessive tendencies and ADHD, both of which are relatively controlled for the first time in a long time. I am on a LOT of meds/supplements as I have posted about here before. I have some suspicions that use of low dose naltrexone for a few months may have caused some epigenetic changes that persist despite stopping the LDN.
I tried 6mg of prazosin last night, and accidentally also took my clonidine 0.2mg -- I went to bed around 8:30 - 9pm and was still awake after 1am. I may have had minimal and light sleep between that time. But I got up multiple times to EAT...that has also been my pattern at night, insatiable hunger and carb cravings. Since I've been off the saphris for a few days, which was the only thing that helped initiate sleep, I had to try some SGAs again last night. First started with 20mg latuda, then when i was still awake, tried 25-50mg of seroquel, then still couldn't initiate sleep, so finally topped it off with 12.5mg ambien CR. i had also taken 2.5mg melatonin, valerian, tryptophan, and 2 capsules of MRM Relax-All (which contained 250mg of phenibut) earlier in the evening. All of this and I still only got 4-5 hours of non restful sleep. This has been going on for almost 9 months now, and it is seriously impacting my mental and physical health, stamina, and ability to do much of anything in the evening. I exercise every day in the mid afternoon, intensely, which gets me so tired, but i still can't initiate sleep. I have a lot on my mind, and am under significant stress because of unemployment, but my depression is better than it has been in a long time, so I don't get it.
We did a 24 hour cortisol test a few weeks ago which showed slightly elevated cortisol at night, so my naturapathic MD prescribed 300mg phosphatidylserine which apparently reduces cortisol.
In the last 9 months, I have tried the following drugs for insomnia:Saprhis which worked in the beginning, and still seems to be the only thing that initiate sleep, but i have to take it multiple times per night and at the end, it wasn't even helping continuity or depth at all. Caused me significant weight gain and I'm trying to get off it.
Seroquel...cannot initiate sleep unless very high dose, does not help with continuity, totally out of it next day and feel really bad.
Trazadone up to 150mg. Used to work for years at 50mg
Ambien CR -- very poor quality sleep, out of it next day, usually cannot initiate sleep on its own.
Sonata - didn't work
Lunesta - used to work, does not do much of everything.
Clonidine - does not work alone at 0.2mg
Prazosin - Just starting to try now
Vistral - failure
Benadryl - failure
Low dose remeron - failure
Zyprexa - could not initiate sleep, did not really help with continuity, don't want to take because of weight gain.
Xanax - worked the first night or two when i took it after waking up in the middle of the night, does not seem to work anymore.
Gabapentin - total failure
Melatonin - nope
Valerian - nope
higher dose phenibut (2-3g), worked the first few times, then nothing
L-Tryptophan - still take it every night, but doesn't do anything
Taurine 1000mg doesn't do anythingI am on some pretty strong stimulants, but reducing then or dropping them hasn't effected sleep at all, and i've been on this dose for a while, and sleep was OK for many months on it. I am on 600mg wellbutrin, 20mg prozac, 60mg vyvanse, 0.5mg mirapex (tapering off), paxil 25mg (tapered off today) cerefolin NAC, take a total of 2600mg of NAC a day (could that be causing it?), and of course trying the above mentioned drugs for sleep. I also take a bunch of supplements, but haven't been able to isolate any of them as causing problems. I do have some suspicion that D-Phenylalanine might be causing some problems, I take 500mg of it a day, but i can't seem to give it up. When i've stopped for a few days, it doesn't seem to have much of an impact, but I do think there is risk.
I am going to probably drop the wellbutrin again to 300mg and see if that helps sleep at all, though i've done this before to no effect. I am trying to rebuild my adrenals via reducing my caffeine intake, regular intense exercise, siberian ginseng, ashwagahnda, adrenal cortex, high dose vitamin C, etc. as I suspect the insomnia might be cortisol related.
The thing is I am just SO SLEEPY, it's not like i'm wired, my eyes are so heavy and i am just totally exhausted every night, i just can't initiate sleep!
Cranial electrotherapy - just starting this up again, but even using it for a few hours yesterday, it didn't seem to help. Will continue with it though.
Thats a long list of potential medications which i haven' tried, my doctor is not convinced a benzo will be good for me in the long term, but if prazosin doesn't work, I may ask to try another benzo. I haven't thought about xyrem, i thought that was for narcolepsy, can that help with insomnia too?
Posted by g_g_g_unit on April 7, 2012, at 0:37:03
In reply to Re: Adding Parnate and prazosin. » uncouth, posted by SLS on April 6, 2012, at 1:32:33
> I can't say that prazosin helps keep me asleep. Perhaps I am not taking enough at night to see a difference. My sleep is choppy, and I wake up a several times during the night. This disturbed sleep is the result of both adding Parnate and poor sleep hygiene. I allow myself to sleep too much during the day. I often fall asleep somewhere between 7:30 PM to 9:00 PM and wake at midnight. I have trouble going back to sleep after that. I just took some Ativan so that I can get through the rest of the night. I will use a sleep aid only occasionally.
Do you suspect that the choppy sleep will improve the longer you stay on Parnate?
Posted by SLS on April 7, 2012, at 6:18:13
In reply to Re: Adding Parnate and prazosin. » SLS, posted by g_g_g_unit on April 7, 2012, at 0:37:03
> > I can't say that prazosin helps keep me asleep. Perhaps I am not taking enough at night to see a difference. My sleep is choppy, and I wake up a several times during the night. This disturbed sleep is the result of both adding Parnate and poor sleep hygiene. I allow myself to sleep too much during the day. I often fall asleep somewhere between 7:30 PM to 9:00 PM and wake at midnight. I have trouble going back to sleep after that. I just took some Ativan so that I can get through the rest of the night. I will use a sleep aid only occasionally.
>
> Do you suspect that the choppy sleep will improve the longer you stay on Parnate?Perhaps. I am not sure how things will play out at this point.
When I was younger, I experienced total sleep deprivation when Parnate was combined with desipramine, but not when taking Parnate alone. For me, insomnia has been a good prognosticator of positive response to treatment. For the entire time I was on combination treatment, I don't think that the insomnia mitigated over time. However, it would be difficult for me to know for sure because the treatment of my insomnia was so effective.
triazolam (Halcion) 1.0 mg
lorazepam (Ativan) 4.0 mgLater in my treatment history, the Parnate + desipramine combination treatment no longer produced insomnia. It also never worked again. Now, if I am losing too much sleep, I will take a combination of zaleplon (Sonata) and lorazepam (Ativan). If initiating sleep were to be refractory to this treatment, I would have to convince my doctor to use triazolam in place of zaleplon. Doctors are squeamish about prescribing triazolam. The drug got developed a reputation for having amnestic effects. However, I think zolpidem (Ambien) is just as bad as triazolam with respect to producing amnesia.
- Scott
Posted by SLS on April 7, 2012, at 6:23:20
In reply to Re: Adding Parnate and prazosin. » g_g_g_unit, posted by SLS on April 7, 2012, at 6:18:13
I continue to improve, albeit gradually and with some occasional dips. These brief worsenings can last for a few hours or a few days. I usually emerge from these dips feeling better than I did prior to the dip.
I still like my chances of achieving remission with this treatment:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6mg
- Scott
Posted by g_g_g_unit on April 7, 2012, at 8:34:27
In reply to Re: Adding Parnate and prazosin. » g_g_g_unit, posted by SLS on April 7, 2012, at 6:18:13
> Do you suspect that the choppy sleep will improve the longer you stay on Parnate?
>
> Perhaps. I am not sure how things will play out at this point.
>
> When I was younger, I experienced total sleep deprivation when Parnate was combined with desipramine, but not when taking Parnate alone. For me, insomnia has been a good prognosticator of positive response to treatment. For the entire time I was on combination treatment, I don't think that the insomnia mitigated over time. However, it would be difficult for me to know for sure because the treatment of my insomnia was so effective.
>
> triazolam (Halcion) 1.0 mg
> lorazepam (Ativan) 4.0 mg
>
> Later in my treatment history, the Parnate + desipramine combination treatment no longer produced insomnia. It also never worked again. Now, if I am losing too much sleep, I will take a combination of zaleplon (Sonata) and lorazepam (Ativan). If initiating sleep were to be refractory to this treatment, I would have to convince my doctor to use triazolam in place of zaleplon. Doctors are squeamish about prescribing triazolam. The drug got developed a reputation for having amnestic effects. However, I think zolpidem (Ambien) is just as bad as triazolam with respect to producing amnesia.
>
>
> - Scott
>Right now, I'm able to fall (and stay) asleep with 0.3mg of Clonidine and 5mg of Valium. But I just raised my Parnate dose to 30mg (finally) and things are a little worse now. One of my hobbies involves niggling over every prospective thing that could go wrong with a med trial, and reading through the archives, it seems like there are very few people who've managed to successfully remain on Parnate without an adjunctive sleep aid. It's a pity there isn't much available that actually preserves sleep architecture (aside from Xyrem and Trimipramine?). I know it's a bridge I'll have to cross when I get to it, but I'm just a little concerned about the long term effects of benzodiazepines on sleep and health. I know Zolpidem is less intrusive, and can supposedly be used in the long-run without rebound insomnia, but I suffer terrible withdrawal anxiety/depression on it. However, I've wondered if - pending I respond to Parnate - it might mitigate the next-day withdrawal.
Posted by michael on April 9, 2012, at 10:25:05
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
> I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD, if it even exists in me. I thought it was worth a shot. Certainly, childhood abuse and neglect contributed to the evolution of my depressive illness.
>
> I added Parnate on Monday. I am titrating as quickly as I can while avoiding the development of hypotension. The prazosin might work synergistically with Parnate to significantly reduce my blood pressure. We'll have to see. 30 mg is a small dose of prazosin. There is room to increase it.
>
> So...
>
> I'm feeling better than I should be. Yesterday, I met some family and friends at a hotel bar. I was comfortable, gregarious, and talkative. My mind was very active. I really enjoyed myself for the first time in many years.
>
> Two things are different about my current regime compared to the last time I took Parnate lithium and prazosin. I wonder
>
> Currently:
>
> Parnate 40 mg (titrating rapidly)
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 30 mg
>
> Wish me luck! I could sure use it.
>
>
> - ScottHey Scott,
Don't know if you remember me, I haven't been around for years... But I was just responding to a question someone asked me from an ancient thread...
In any case, I appreciate the feedback, suggestions, etc. that you've given me over the years, and wanted to say that I'm glad to hear that you're finding some relief, and sound optimistic! I hope that continues, and continues to improve!
Thanks again, and GOOD LUCK!
michael
p.s. still love that medication chart that you put online long ago! Is that still up?
Posted by SLS on April 12, 2012, at 15:54:31
In reply to Re: Adding Parnate and prazosin., posted by michael on April 9, 2012, at 10:25:05
> Hey Scott,
>
> Don't know if you remember me, I haven't been around for years... But I was just responding to a question someone asked me from an ancient thread...
>
> In any case, I appreciate the feedback, suggestions, etc. that you've given me over the years, and wanted to say that I'm glad to hear that you're finding some relief, and sound optimistic! I hope that continues, and continues to improve!
>
> Thanks again, and GOOD LUCK!
Thank you, Michael. You are kind.
> p.s. still love that medication chart that you put online long ago! Is that still up?Yes. I still have it up, but have not been diligent in keeping it up to date. I get to it occasionally, but I'm about six months behind.
http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
- Scott
Posted by SLS on April 12, 2012, at 16:17:58
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Hi.
I am still improving - I think.
I have been in a slump for the past week. I have not felt as well as I had two weeks ago. This is the second week-long slump that I have experienced since beginning to respond to treatment in late December. In addition, my mood has been variable during the day. I have experienced significant episodic dips that can last for 3 - 6 hours and then disappear. It has been a bumpy ride.
Periodic worsenings are to be expected in my case. I am becoming less and less concerned when they occur, but I still worry that the beast may be lurking.
I feel better today.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
- Scott
Posted by SLS on April 16, 2012, at 5:12:32
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 12, 2012, at 16:17:58
> Hi.
>
> I am still improving - I think.
>
> I have been in a slump for the past week. I have not felt as well as I had two weeks ago. This is the second week-long slump that I have experienced since beginning to respond to treatment in late December. In addition, my mood has been variable during the day. I have experienced significant episodic dips that can last for 3 - 6 hours and then disappear. It has been a bumpy ride.
>
> Periodic worsenings are to be expected in my case. I am becoming less and less concerned when they occur, but I still worry that the beast may be lurking.
I became suspicious. Through a bit of experimentation, I discovered that I had beem underdosing prazosin. I have increased my dosage from 6 to 12 mg. 20 mg is the maximum recommended. The dosages currently used for PTSD are between 12 - 15 mg. Within 48 hours of my doubling the doses, I was amazingly improved. It has been 25 years since I felt this well. I think this shall be the last of the treatment adjustments necessary for me to achieve remission.Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg
- Scott
Posted by Tomatheus on April 16, 2012, at 10:45:34
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 16, 2012, at 5:12:32
Wow, Scott, it's great to hear that you've been feeling really well, and I certainly hope that your response continues. Feeling the best that you've felt in 25 years is quite a feat, and I think it's something to be excited about. Let's hope that you're right about not needing any more medication adjustments to achieve remission.
Tomatheus
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Dr. Bob is Robert Hsiung, MD,
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