Psycho-Babble Medication Thread 1005781

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Re: Adding Parnate and prazosin. uncouth

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
zopiclone

If 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

 

SLEEP -- please help? Prazosin?

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 anything

I 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?

 

Re: Adding Parnate and prazosin. SLS

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?

 

Re: Adding Parnate and prazosin. g_g_g_unit

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 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

 

Re: Adding Parnate and prazosin.

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

 

Re: Adding Parnate and prazosin. SLS

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.

 

Re: Adding Parnate and prazosin.

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.
>
>
> - Scott

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!

michael

p.s. still love that medication chart that you put online long ago! Is that still up?

 

Re: Adding Parnate and prazosin.

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

 

Re: Adding Parnate and prazosin.

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

 

Re: Adding Parnate and prazosin.

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

 

Re: Adding Parnate and prazosin. SLS

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

 

Re: Adding Parnate and prazosin. Tomatheus

Posted by SLS on April 16, 2012, at 13:11:47

In reply to Re: Adding Parnate and prazosin. SLS, posted by Tomatheus on April 16, 2012, at 10:45:34

> 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


Thanks!

:-)


- Scott

 

Re: Adding Parnate and prazosin.

Posted by uncouth on April 16, 2012, at 15:11:20

In reply to Re: Adding Parnate and prazosin. Tomatheus, posted by SLS on April 16, 2012, at 13:11:47

Scott what is your dosing schedule. I am taking 5-10mg at night for sleep, but it's not doing anything and I might try 15mg at night, or another dosing schedule, like starting with 5mg earlier in the day. What have you found works best for you? Do you feel any immediate effects...does it cause fatigue or sleepiness during the day?

 

Re: Adding Parnate and prazosin. uncouth

Posted by SLS on April 16, 2012, at 19:56:07

In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 16, 2012, at 15:11:20

> Scott what is your dosing schedule.

4 mg 3 times a day.

> I am taking 5-10mg at night for sleep, but it's not doing anything and I might try 15mg at night, or another dosing schedule, like starting with 5mg earlier in the day.

Prazosin is not improving my sleep at all. My sleep is disturbed by the other drugs I am taking. However, my main motivation for taking prazosin is to treat bipolar depression. For this purpose, it is working wonderfully.

I have not heard of anyone using prazosin to treat disturbed sleep except for in PTSD. If you are looking for a sympatholytic to be used for improving sleep, clonidine seems to be a better choice. You just need to be wary of clonidine producing depression as a side effect.

> What have you found works best for you? Do you feel any immediate effects...

I felt an improvement in depression within a 12 hours of increasing my dosage of prazosin from 6 mg to 12 mg.

> does it cause fatigue or sleepiness during the day?

I did experience sleepiness and fatigue for the first day after the dosage increase.

What conditions are you treating? What is the nature of your sleep disturbances?


- Scott

 

Re: Adding Parnate and prazosin.

Posted by uncouth on April 16, 2012, at 20:01:08

In reply to Re: Adding Parnate and prazosin. uncouth, posted by SLS on April 16, 2012, at 19:56:07

I'm using prazosin for sleep, both sleep initiation and sleep maintenance, right now I cannot initiate sleep without saphris or seroquel, which i'm trying to get off of. And for the past 9 months i've been getting up at 3-4am and am not able to get back to sleep. We tried clonidine, but it didn't really work. Nothing else I have tried works, especially for maintenance. Seroquel makes me super depressed and groggy next day. Saphris unfortunately seems to be the best option right now, but i have to redoes it at 3am, and even then it's iffy if it works or not.

I will try a higher dose of prazosin at night. I am also BP2, so I definitely am watching your response with interest. I'm on a high dose of wellbutrin 600mg and vyvanse so i may just be antagonizing the NE with prazosin so who knows.

 

Re: Adding Parnate and prazosin. SLS

Posted by Bob on April 16, 2012, at 21:41:06

In reply to Re: Adding Parnate and prazosin., posted by SLS on April 16, 2012, at 5:12:32

> > 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


Scott,

What is the current status of you sexual side effects?

Bob

 

Re: Adding Parnate and prazosin. Bob

Posted by SLS on April 17, 2012, at 6:57:03

In reply to Re: Adding Parnate and prazosin. SLS, posted by Bob on April 16, 2012, at 21:41:06

Hi Bob.

> What is the current status of you sexual side effects?

My libido is very much suppressed by prazosin. However, this is being offset by the return of some of the libido that was stripped away by the depression. Unfortunately, the net effect still leaves me disappointed. I don't seem to have lost very much capacity to maintain an erection and reaching orgasm. Since it has been only three days since increasing my dosage of prazosin, I don't know where things will end up. My guess is that reduced libido will continue to be a problem. It really isn't such a bad trade-off for being free of depression and starting a new life. I did have a very successful and satisfying experience two days ago.


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by Bob on April 17, 2012, at 11:58:49

In reply to Re: Adding Parnate and prazosin. Bob, posted by SLS on April 17, 2012, at 6:57:03

> Hi Bob.
>
> > What is the current status of you sexual side effects?
>
> My libido is very much suppressed by prazosin. However, this is being offset by the return of some of the libido that was stripped away by the depression. Unfortunately, the net effect still leaves me disappointed. I don't seem to have lost very much capacity to maintain an erection and reaching orgasm. Since it has been only three days since increasing my dosage of prazosin, I don't know where things will end up. My guess is that reduced libido will continue to be a problem. It really isn't such a bad trade-off for being free of depression and starting a new life. I did have a very successful and satisfying experience two days ago.
>
>
> - Scott


Hey Scott,

Maybe you'll find that the higher dose eventually ups the dopamine a little more or whatever, thus bringing it back in line.

I'm pulling for you.

Bob

 

Re: Adding Parnate and prazosin. SLS

Posted by Alexei on April 19, 2012, at 14:46:50

In reply to Re: Adding Parnate and prazosin., posted by SLS on April 7, 2012, at 6:23:20

> 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


Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.

May I ask your opinion on Parnate? How would you rate its efficacy compared with ssri & snri meds? Does it have any merit for OCD? I'm finding venlafaxine to be merely average.

Do you prefer nortriptyline to desipramine? If so, why?

Also, you've spoken of some type of synergy between abilify and lamictal. Could you elaborate a bit on this? I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.

Thank you for reading ...

 

Re: Adding Parnate and prazosin. Alexei

Posted by SLS on April 20, 2012, at 7:22:30

In reply to Re: Adding Parnate and prazosin. SLS, posted by Alexei on April 19, 2012, at 14:46:50

> Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.
>
> May I ask your opinion on Parnate?

I like Parnate more than Nardil because it has milder side effects. In addition, I find that Nardil produces a euphoric effect that I would prefer to do without. Everyone reacts to these two drugs differently. Some people do not respond to Parnate who do respond to Nardil. In my experience as a TRD patient, I have found it necessary to take a MAOI in order to respond well to treatment. I have always had to combine a MAOI with a tricyclic in order to glean a lasting improvement in depression.

> How would you rate its efficacy compared with ssri & snri meds?

MAOI > SNRI > SSRI

> Does it have any merit for OCD?

There are several anecdotal reports for success in treating OCD using either Parnate or Nardil. These drugs have not been the focus of study in this disorder. One study of Nardil (phenelzine) reported negative results, but its design had some significant flaws.

Study:
http://www.ncbi.nlm.nih.gov/pubmed/9286186

Rebuttal:
http://ajp.psychiatryonline.org/article.aspx?Volume=156&page=159&journalID=13

Do you have any other types of anxiety disorder?

> I'm finding venlafaxine to be merely average.

There are plenty of studies demonstrating the efficacy of clomipramine, fluoxetine, and fluvoxamine. Only a few studies exist using venlafaxine or paroxetine.

> Do you prefer nortriptyline to desipramine? If so, why?

I have used both drugs, and while I find them both effective in my case, nortriptyline produces better results. The autonomic side effects tend to be milder with nortriptyline. I experience a greater elevation of heart rate and palpitations with desipramine. I also get more dry mouth and blurred vision with desipramine. Sometimes you don't have a choice between the two. There are people who respond only to desipramine just as there are people who respond only to nortriptyine.

> Also, you've spoken of some type of synergy between abilify and lamictal.

I do better when I take both drugs together than when I take either one alone. I also know someone with depression who takes only these two drugs. She does not take any of the standard antidepressants, although she has tried most of them. Her system needs both drugs for her to feel well.

> Could you elaborate a bit on this?

I am going to have to disappoint you on demonstrating an explanation for the mechanics of interaction of the two drugs to produce a synergy. I don't know of any scientific studies investigating this. I have proposed my own pet theory which might explain a dopaminergic synergy between of these two drugs. Abilify seems to increase DA tone in neurons that are hypoactive in the nucleus accumbens via D2/D3 partial agonism. I think that Abilify is more of a modulator than it is a stimulant. Lamictal might produce an increase in DA activity in the nucleus accumbens via disinhibition. Lamictal reduces glutamate release in the thalamus. These glutamate circuits normally travel to the nucleus accumbens whereupon they act to reduce DA activity when activated. Lamictal reduces GLU activity in the thalamus and thus allows for increased DA activity in the the nucleus accumbens.

> I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.

These things are very ofen startup side effects that disappear within a week or two. However, there are enough people who continue to react badly to Abilify that aborting a trial is necessary.

What dosage of Ability did you start at?

It may be that people with unipolar depression are more sensitive to Abilify than those with bipolar disorder. I had no problem treating my bipolar depression with a starting dosage of 20 mg. People with unipolar depression often respond to dosages of 5 mg and lower. Some respond well at 2.5 mg, but suffer intolerable side effects at 5 mg.

So, what's your plan?


- Scott

 

Re: Adding Parnate and prazosin. SLS

Posted by uncouth on April 20, 2012, at 8:07:50

In reply to Re: Adding Parnate and prazosin. Alexei, posted by SLS on April 20, 2012, at 7:22:30

Scott, quick question...have you ever tried much higher dose lamictal? Or memantine added on, at like 40mg? I know you're seeing great results with prazosin now and don't need/want to screw with anything, but i'm just curious...namenda is seeming to become really popular in a lot of treatment resistant mental health cases...may require higher dosages than the 20mg used in studies though. Same deal with lamictal, i think i posted to you a few months ago that in the rehab i went to two years ago, they said thy were seeing really great things happen with lamictal at 400-600-even 800 mg. I think going up on lamictal is probably a really easy thing to try and one can just back off if cognitive issues arise. Seems like there is definitely some magic pushing up dosages.

 

Re: Adding Parnate and prazosin.

Posted by SLS on April 20, 2012, at 14:10:55

In reply to Re: Adding Parnate and prazosin. SLS, posted by uncouth on April 20, 2012, at 8:07:50

> Scott, quick question...have you ever tried much higher dose lamictal?

I went up to 450 mg once. I couldn't remember my own name. I spent several years at 300 mg. I had constant brain-fog along with profound impairments in short-term memory. It wasn't until I tried reducing the dosage as an experiment that I discovered that 200 mg was the highest dosage I could take without cognitive side effects.

> Or memantine added on,

I tried adding 20 mg to Lamictal. Nothing. When I increased the dosage of memantine to 40 mg, I felt drunk and got scared. I stopped taking it. Perhaps the drunkeness would have disappeared if I stuck with it.

I came upon this not too long ago:

Original listing:

http://clinicaltrials.gov/ct2/show/NCT00305578

Results:

http://www.ncbi.nlm.nih.gov/pubmed/22329473

I'll keep memantine on hand, just in case.

Thanks for the suggestion.


- Scott

 

Re: Adding Parnate and prazosin.

Posted by uncouth on April 20, 2012, at 16:52:29

In reply to Re: Adding Parnate and prazosin., posted by SLS on April 20, 2012, at 14:10:55

Yes that is typical memantine reaction, and does go away. If your depression gets bad again, try 40mg on top of your lamictal. High dose namenda is going to change psychiatry.

 

Re: Adding Parnate and prazosin. uncouth

Posted by g_g_g_unit on April 21, 2012, at 10:27:51

In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 20, 2012, at 16:52:29

are you on Namenda at the moment uncouth? I wanna add it to Parnate for OCD, ADHD, impulse control issues ..

any problems with insomnia, dissociation etc.?

 

Re: Adding Parnate and prazosin.

Posted by SLS on April 24, 2012, at 18:51:05

In reply to Re: Adding Parnate and prazosin. uncouth, posted by g_g_g_unit on April 21, 2012, at 10:27:51

Best day yet!

Woohoo!

Currently:

Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg


- Scott


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