![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Alpam on April 8, 2012, at 6:51:24
Hi all,
Currently I suffer from panic attacks, GAD, Major depression, debhilitating fatigue, Occasianal insomnia, essential tremour, Adult ADD, and tension headachaches
I am currently taking Parnate 60mg, Abilify 20mg, Propranolol 160mg and Tomimax 50mg. Apon saying this I am the kind of person who sufferes minimimal to no side effects to medications.
THe Parnate has all but completely eliminated my panic disorder which is great, and the Propranolol has stopped my shakes.
I am meeting up with my Pdoc next week and I want to suggest some ideas to improve my depression and get my fatigue under control. I have him researching the combination of Dexamphetamine and a MAOI, so hopefully I will get that combination, but if I don't, does anyone have any suggestions on medications that reduce depression and fatigue but are safe to use with a MAOI?
I heard good things about Low Dose Naltrexone, would that be an option? How about Zyban, or is that contridicted?
Your help and comments would be appreciated.
I am getting desperate here, all I can say is thank god for government jobs.
Posted by g_g_g_unit on April 9, 2012, at 5:26:50
In reply to Parnate Augmentation, posted by Alpam on April 8, 2012, at 6:51:24
Do you mind me asking if you're taking anything to sleep on Parnate?
Posted by Alpam on April 10, 2012, at 2:44:26
In reply to Re: Parnate Augmentation » Alpam, posted by g_g_g_unit on April 9, 2012, at 5:26:50
> Do you mind me asking if you're taking anything to sleep on Parnate?
I used to be taking a whole heap of sleeping tablets to get to sleep, but since starting Parnate I seem to be sleeping better. I assume it's because my anxiety has lowered.
There are still one or two nights a week where I either can't get to sleep at all, or end up waking up at 4am, which is annoying, I am thinking of asking my doc for a PRN sleepaid like Pericyazine or something
Some people say that Parnate is stimulating, I don't find that effect at all, I can take a dose right before bed and go to sleep.
Posted by Alpam on April 13, 2012, at 0:43:38
In reply to Re: Parnate Augmentation, posted by Alpam on April 10, 2012, at 2:44:26
Well my doctor said that he spoke with other Psychs and came to the agreement that combining a stimulant with a MAOI is just too dangerous. Meanwhile I am struggling to stay awake here at work.
His answer was to reduce the Abilify to 10mg at night and send me off for another sleep study (my 3rd one)
I also asked to increase the Parnate but he said I was already on too many meds and there wasn't much improvement from previous increases (which wasn't true)
Posted by SLS on April 13, 2012, at 2:24:00
In reply to Re: Parnate Augmentation, posted by Alpam on April 13, 2012, at 0:43:38
> Well my doctor said that he spoke with other Psychs and came to the agreement that combining a stimulant with a MAOI is just too dangerous. Meanwhile I am struggling to stay awake here at work.
>
> His answer was to reduce the Abilify to 10mg at night and send me off for another sleep study (my 3rd one)
>
> I also asked to increase the Parnate but he said I was already on too many meds and there wasn't much improvement from previous increases (which wasn't true)
Instead of me making a list of drugs for you to try, I would offer that you begin to make a list of doctors to try. In your doctor's mind, what does the dosage of Parnate have to do with the number of other drugs that you are taking? I don't see the connection.Parnate can exceed dosages of 120 mg, although I find 80 mg to be optimal. Lots of people experience daytime fatigue with Parnate. Adding a stimulant to Parnate is not particularly dangerous. Neither is adding certain tricyclics (desipramine, nortriptyline, amitriptyline, trimipramine, doxepin). Clomipramine and imipramine must be avoided due to serotonergic activity and the risk of developing serotonin syndrome. Bupropion Wellbutrin; Zyban) is safe, too.
Reducing the dosage of Abilify might not be a bad idea if it is being used to treat depression. It might clear up any cognitive blunting that might be present. I guess you can try adding modafinil instead of a stimulant to treat the daytime fatigue.
I don't blame your doctor for not being comfortable using Parnate in combination with stimulants drugs. He likely was taught that this was strictly contraindicated. That's what is written in standard references. You need to find a doctor who has learned otherwise. You might contact a university teaching hospital to find a doctor or to get a list of referrals.
Believe it or not, Nardil can be less sedating than Parnate.
Lithium at low dosages (300 - 600 mg) makes an excellent augmenter for some people taking Parnate.
There are alternatives available to modify Parnate treatment. You just need to find a more experienced doctor who specializes in treatment-resistant depression (TRD).
Good luck.
- Scott
Posted by FrequentFryer on April 21, 2012, at 23:59:55
In reply to Re: Parnate Augmentation » Alpam, posted by SLS on April 13, 2012, at 2:24:00
> > Well my doctor said that he spoke with other Psychs and came to the agreement that combining a stimulant with a MAOI is just too dangerous. Meanwhile I am struggling to stay awake here at work.
> >
> > His answer was to reduce the Abilify to 10mg at night and send me off for another sleep study (my 3rd one)
> >
> > I also asked to increase the Parnate but he said I was already on too many meds and there wasn't much improvement from previous increases (which wasn't true)
>
>
> Instead of me making a list of drugs for you to try, I would offer that you begin to make a list of doctors to try. In your doctor's mind, what does the dosage of Parnate have to do with the number of other drugs that you are taking? I don't see the connection.
>
> Parnate can exceed dosages of 120 mg, although I find 80 mg to be optimal. Lots of people experience daytime fatigue with Parnate. Adding a stimulant to Parnate is not particularly dangerous. Neither is adding certain tricyclics (desipramine, nortriptyline, amitriptyline, trimipramine, doxepin). Clomipramine and imipramine must be avoided due to serotonergic activity and the risk of developing serotonin syndrome. Bupropion Wellbutrin; Zyban) is safe, too.
>
> Reducing the dosage of Abilify might not be a bad idea if it is being used to treat depression. It might clear up any cognitive blunting that might be present. I guess you can try adding modafinil instead of a stimulant to treat the daytime fatigue.
>
> I don't blame your doctor for not being comfortable using Parnate in combination with stimulants drugs. He likely was taught that this was strictly contraindicated. That's what is written in standard references. You need to find a doctor who has learned otherwise. You might contact a university teaching hospital to find a doctor or to get a list of referrals.
>
> Believe it or not, Nardil can be less sedating than Parnate.
>
> Lithium at low dosages (300 - 600 mg) makes an excellent augmenter for some people taking Parnate.
>
> There are alternatives available to modify Parnate treatment. You just need to find a more experienced doctor who specializes in treatment-resistant depression (TRD).
>
> Good luck.
>
>
> - ScottYup I reckon stims and maoi is way to dangerous 100% I have had like 200/125 BP and 150 rate form maoi + dexamphetamine and almost died.
If you dont get hypertension from an maoi and strong stim your adrenalin system must be pretty f*ck*d.
I now have permenant heypertension sensitivity to sh*t like cafein and badt Tachy cardia.... not cool.
Im a hell insomniac, but also got weird 2 hour sleeps 3 times a day, aparently its because parnate metaabalates or oxidises into L-Amphetamine (I think).
Nardil at it's peak (three weeks 4 me) I can only get 3 hrs sleep a night on like 400mg's of seroquel.
Posted by Porkpiehat on August 3, 2017, at 12:14:38
In reply to Re: Parnate Augmentation » Alpam, posted by SLS on April 13, 2012, at 2:24:00
> Instead of me making a list of drugs for you to try, I would offer that you begin to make a list of doctors to try. In your doctor's mind, what does the dosage of Parnate have to do with the number of other drugs that you are taking? I don't see the connection.
>
> Parnate can exceed dosages of 120 mg, although I find 80 mg to be optimal. Lots of people experience daytime fatigue with Parnate. Adding a stimulant to Parnate is not particularly dangerous. Neither is adding certain tricyclics (desipramine, nortriptyline, amitriptyline, trimipramine, doxepin). Clomipramine and imipramine must be avoided due to serotonergic activity and the risk of developing serotonin syndrome. Bupropion Wellbutrin; Zyban) is safe, too.
>
> Reducing the dosage of Abilify might not be a bad idea if it is being used to treat depression. It might clear up any cognitive blunting that might be present. I guess you can try adding modafinil instead of a stimulant to treat the daytime fatigue.
>
> I don't blame your doctor for not being comfortable using Parnate in combination with stimulants drugs. He likely was taught that this was strictly contraindicated. That's what is written in standard references. You need to find a doctor who has learned otherwise. You might contact a university teaching hospital to find a doctor or to get a list of referrals.
>
> Believe it or not, Nardil can be less sedating than Parnate.
>
> Lithium at low dosages (300 - 600 mg) makes an excellent augmenter for some people taking Parnate.
>
> There are alternatives available to modify Parnate treatment. You just need to find a more experienced doctor who specializes in treatment-resistant depression (TRD).
>
> Good luck.
>
>
> - Scott
Scott this is an old post, but you referrenced lithium as a good good augmented to parnate. Is this for depression or side effects? I'm finding a low dose 5-10 myself of propranolol is cutting through some of the parnate lethargy and doesn't contribute to beta blocker sleepiness. I'm not in love with having to dose throughout the day to stay awake.
Posted by SLS on August 4, 2017, at 6:58:32
In reply to Re: Parnate Augmentation » SLS, posted by Porkpiehat on August 3, 2017, at 12:14:38
Hi.
> Scott this is an old post, but you referrenced lithium as a good good augmented to parnate. Is this for depression or side effects? I'm finding a low dose 5-10 myself of propranolol is cutting through some of the parnate lethargy and doesn't contribute to beta blocker sleepiness. I'm not in love with having to dose throughout the day to stay awake.
Low dosages of lithium (300-600 mg/day) can be used to augment antidepressants when treating unipolar depression. I find 300 mg/day to be a necessary agent in my treatment regime, even though I fit into the bipolar spectrum. Higher dosages actually depress me. Side effects for lithium are dosage-dependent, so lower dosages carry much reduced risks for thyroid and kidney damage. Interestingly, I found Nardil to be more stimulating during the day than Parnate.
What you describe about propranalol is fascinating. What happens when you take higher dosages? Does it still help with daytime sleepiness?
I'm currently taking:
Parnate 80 mg/day
nortriptyline 100 mg/day
Lamictal 300 mg/day
lithium 300 mg/day
Abilify 15 mg/day
prazosin 30 mg/day
- Scott
Posted by porkpiehat on August 4, 2017, at 8:35:07
In reply to Re: Parnate Augmentation » Porkpiehat, posted by SLS on August 4, 2017, at 6:58:32
I'm not really sure. I may have spoken too soon.
Yesterday I had mixed results with the propranolol. I did some research and the drug is a weak NE reuptake inhibitor and inverse agonist of 5ht1a,
I remember reading that the weakness and sedation from parnate is from an initial drop in NE. This would make sense then? Nortriptyline helped with the weakness if I remember when I was starting up.
Posted by Lamdage22 on September 13, 2017, at 11:38:43
In reply to Re: Parnate Augmentation » SLS, posted by porkpiehat on August 4, 2017, at 8:35:07
> I remember reading that the weakness and sedation from parnate is from an initial drop in NE. This would make sense then? Nortriptyline helped with the weakness if I remember when I was starting up.
Your reactions to certain psychmeds may have nothing to do with NE. Nobody knows.
Posted by chumbawumba on September 21, 2017, at 1:00:08
In reply to Parnate Augmentation, posted by Alpam on April 8, 2012, at 6:51:24
> Hi all,
>
> Currently I suffer from panic attacks, GAD, Major depression, debhilitating fatigue, Occasianal insomnia, essential tremour, Adult ADD, and tension headachaches
>
> I am currently taking Parnate 60mg, Abilify 20mg, Propranolol 160mg and Tomimax 50mg. Apon saying this I am the kind of person who sufferes minimimal to no side effects to medications.
>
> THe Parnate has all but completely eliminated my panic disorder which is great, and the Propranolol has stopped my shakes.
>
> I am meeting up with my Pdoc next week and I want to suggest some ideas to improve my depression and get my fatigue under control. I have him researching the combination of Dexamphetamine and a MAOI, so hopefully I will get that combination, but if I don't, does anyone have any suggestions on medications that reduce depression and fatigue but are safe to use with a MAOI?
>
> I heard good things about Low Dose Naltrexone, would that be an option? How about Zyban, or is that contridicted?
>
> Your help and comments would be appreciated.
>
> I am getting desperate here, all I can say is thank god for government jobs.I take Parnate 60 mg and can't sleep at all without 45 mg of Dalmane. But as far as augmentation I have found low dose (600 mg) of Lithium to be very helpful. Also I was using ketamine lozenges daily for awhile and I think it actually was somewhat curative. I don't use it anymore but my Doctor was fine with prescribing low dose ketamine with an MAOI.
If one digs through case reports and anesthesiology guidelines the impression is that the combination of ketamine and an MAOI is not as dangerous as was thought
The weirdest thing with Parnate was having episodes of orthostatic hypotension and just falling on my *rs* if I stood up quickly. Fortunately that didn't last long.
I tried low dose naltrexone and oddly it gave me vicious insomnia but not much else. But your mileage may vary.
Posted by porkpiehat on September 21, 2017, at 19:04:38
In reply to Re: Parnate Augmentation, posted by chumbawumba on September 21, 2017, at 1:00:08
Does the topomax not make your fatigue worse? This is going to sound super obvious but I couldn't sleep for months on parnate until I found hydroxyzine and then trazodone. The sedation is better for me now that I sleep.
I found low dose stimulants were great but they metabolize MUCH slower and when I then took my parnate in the afternoon I would get very nervous and sketchy.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.