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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by g_g_g_unit on June 15, 2012, at 21:32:23
Sorry for all the annoying questions -- just feeling somewhat frustrated with side-effects etc., which I currently have too much time to obsess over.
I find that I can only really handle 10mg of Parnate at a time, so I've been splitting up 60mg between 9am and 6-7pm. Dosing anymore than that results in agitation and is counter-productive to my cognition. For the record, I've been on 60mg for a week now.
Since moving up to 60mg, though, I'm waking up after 1-2 hours and just get really awful sleep thereafter. This is despite feeling really tired and naturally sleepy at around 11pm, which is when I'll usually take 0.75mg Klonopin.
I know that everyone says dosing in the evening will wreck your sleep, but I don't see how if the 'stimulant' effect only has a 2.5 hour half-life? From memory, I was sleeping through the night (though getting up to urinate occasionally) on 1mg Klonopin + 50mg Parnate (last dose around 6pm), but I wanted to try lower my Klonopin dose.
So will raising your Parnate dose produce disturbed sleep to begin with anyway?
I suppose I could either try going back to 1mg klonopin at night, or taking a low dose of k-pin in the morning and trying like 20 + 20 + 20 or 30 + 30mg of Parnate, with my last dose in the afternoon.
I also wonder if my Parnate dose might just be too high, but I've found taking 10mg quite stimulating regardless of the context.
Posted by Phillipa on June 15, 2012, at 23:07:14
In reply to Parnate dosing schedule, posted by g_g_g_unit on June 15, 2012, at 21:32:23
Is this the right med for you? If so I'd raise the klonopin back to lmg. Phillipa ps not an expert on Maois
Posted by g_g_g_unit on June 19, 2012, at 9:21:16
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by Phillipa on June 15, 2012, at 23:07:14
Sorry SLS! Hate to keep bugging you, but my pdoc has no experience with Parnate above 30mg.
Since raising to 60mg, I've been experiencing pretty bad muscle weakness. It's not incapacitating to the point where I can't do stuff around the house etc., but things like climbing stairs are difficult and any lifting is out of the question. I'm also unable to exercise (even go for a walk, really).
Just wondering if this is a familiar side-effect? It's been a week and a half since I raised to 60mg.
Thanks and hope you're doing well.
Posted by SLS on June 19, 2012, at 9:37:32
In reply to Another question for SLS » Phillipa, posted by g_g_g_unit on June 19, 2012, at 9:21:16
> Sorry SLS! Hate to keep bugging you, but my pdoc has no experience with Parnate above 30mg.
This is unfortunate. I'm just happy that you able to take a truly effective dosage.
> Since raising to 60mg, I've been experiencing pretty bad muscle weakness. It's not incapacitating to the point where I can't do stuff around the house etc., but things like climbing stairs are difficult and any lifting is out of the question. I'm also unable to exercise (even go for a walk, really).
I have found that this stuff can be a transient with Parnate. I am guessing that it is sometimes due to an exaggeration of depressive symptomatology, including dysautonomia. In other words, the fatigue, breathlessness, and weakness that are often symptoms of depression are being amplified temporarily. I think this phenomenon can be a prelude to an antidepressant response. I can't make any promises, of course.
Is there any teeth-clenching, dry mouth, blurred vision, or palpitations?
I'm doing pretty well - thanks. :-)
I spent the last week tweaking my dosage of prazosin. I am satisfied that it is now optimized. I might attempt to accelerate my rate of recovery by adding memantine 20 mg or Topamax 100 mg. I would need to titrate these drugs slowly in order to avoid the appearance of cognitive side effects.
- Scott
Posted by phidippus on June 19, 2012, at 18:01:53
In reply to Parnate dosing schedule, posted by g_g_g_unit on June 15, 2012, at 21:32:23
How often do you think about the drugs you're taking?
Eric
Posted by g_g_g_unit on June 19, 2012, at 21:31:51
In reply to Re: Another question for SLS, posted by SLS on June 19, 2012, at 9:37:32
> > Since raising to 60mg, I've been experiencing pretty bad muscle weakness. It's not incapacitating to the point where I can't do stuff around the house etc., but things like climbing stairs are difficult and any lifting is out of the question. I'm also unable to exercise (even go for a walk, really).
>
> I have found that this stuff can be a transient with Parnate. I am guessing that it is sometimes due to an exaggeration of depressive symptomatology, including dysautonomia. In other words, the fatigue, breathlessness, and weakness that are often symptoms of depression are being amplified temporarily. I think this phenomenon can be a prelude to an antidepressant response. I can't make any promises, of course.Okay, was just worried it meant I'd hit too-high-a-dose or something. The fatigue is unnaturally bad, and reminds me of the leaden paralysis I experienced while depressed.
>
> Is there any teeth-clenching, dry mouth, blurred vision, or palpitations?I have blurred vision at times and a dry mouth, yeah.
> I'm doing pretty well - thanks. :-)
>
> I spent the last week tweaking my dosage of prazosin. I am satisfied that it is now optimized. I might attempt to accelerate my rate of recovery by adding memantine 20 mg or Topamax 100 mg. I would need to titrate these drugs slowly in order to avoid the appearance of cognitive side effects.
>Good luck with that!
Posted by g_g_g_unit on June 19, 2012, at 21:32:50
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by phidippus on June 19, 2012, at 18:01:53
A lot.
Posted by SLS on June 20, 2012, at 1:44:42
In reply to Re: Parnate dosing schedule » phidippus, posted by g_g_g_unit on June 19, 2012, at 21:32:50
> A lot.
Whenever I start a new drug, I usually defer thinking about my ultimate response to it for a few weeks. I know that it will take at least that long for it to work, so I try to put it out of my mind and go about my business. However, when I enter the third week and nothing happens, I begin to think about what to do next. I don't have very much patience at this point, especially if the depression is particularly painful.
Many of us are so focused on reaching our goal, it occupies much of our waking hours thinking about how to achieve it. The quality of our lives remains so poor in the meantime, that our pain and cognitive dysfunction are always right in our faces. It is hard not to think about it. There is no escape from misery without finding a successful treatment.
GGG, you are in a position where effects are pummeling you 24/7. How can you not focus on your treatment so intently?
I told my doctor that, at this point, I only want to learn the minimum necessary to get well and continue my journey through life. I lost my passion for neuroscience and psychiatry a long time ago. Once I have achieved the goal, I can begin thinking about other things. My doctor noted that it is perfectly understandable that a person in my position be motivated and driven to reach the goal of remission to a point where it looks very much like obsession. Is it obsession to focus your attention on nothing else when your hand is being held over a flame?
There must be balance. Obsessing over illnesses and treatments every moment of every day takes away from one's ability to live in the moment and extract as much positive experience and personal growth as the illness will allow for. Of course, the more severe the depression, the less there is to work with. Many people have no capacity to experience anything beyond their depression. For them, there is nothing left but emptiness and in constant pain. There is no other moment to live in. Life is a prison, and each moment is Hell.
The moment I achieve my goal of responding adequately to treatment is the moment I take my first step away from psychopharmacology and toward the building of a new life with my focus on positive, constructive, rewarding, and fun things. I think I'll sell some cars and resume my study of women.
- Scott
Posted by g_g_g_unit on June 20, 2012, at 8:47:42
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by SLS on June 20, 2012, at 1:44:42
Thanks for your empathetic response, Scott. I suppose the fact that I have OCD makes me even more susceptible to obsessing over side-effects.
Right now, my problem isn't so much that I inhabit the Hell of depression. Granted, there is the aforementioned OCD, which is its own kind of hell; but at the moment I generally find myself stuck in a state of perpetual boredom where I am not profoundly depressed, but either too apathetic or lacking in the necessary cognitive abilities to do the stuff I'd like to do. So I try to kill time as best I can, but being stuck at home, with few friends, not very much money, etc. is just demoralizing. Plus, it's kind of a double-bind because OCD forces me to feel guilty regardless of what I'm doing (if I watch TV, I feel like I should be working on my OCD; if I try to work on my OCD, I realize it's too difficult without a therapist etc. etc.).
Given my slow titration, I actually realized I've been on Parnate for over 4 months. But since I've only been on a therapeutic dose for just under two weeks, I can't make a judgement at this point, so I'll take your advice and try to defer worrying for another week and a half.
I still have to consider what I'll do about my ADHD. Being free of depression and anxiety is great, but if I can't concentrate on anything, it just leaves me stuck in limbo. As I've said before, nobody in my state is going to prescribe amphetamine with Parnate. So that is a valid concern. Anyway, I'll stick with the Parnate for now and try to take one day at a time.
I hope you find the remission you're looking for, Scott. I'm by no means a Buddhist, but I've been reading a Buddhist-derived book on suffering (which I'd recommend to anyone on this board, by the way) called "When Things Fall Apart" by Pema Chodron. Given your condition, I can see how it might be easy for you to fall into bitterness and jealousy over others' remission or good health. But, without wanting to sound cheesy, you embody a selfnessness and lack of ego in your attitude to others which is noble; in other words, by Buddhist contentions, you are truly Wise and your support means a lot to me.
I hope you get what you want. Cars and women doesn't sound like a bad place to start.
> Whenever I start a new drug, I usually defer thinking about my ultimate response to it for a few weeks. I know that it will take at least that long for it to work, so I try to put it out of my mind and go about my business. However, when I enter the third week and nothing happens, I begin to think about what to do next. I don't have very much patience at this point, especially if the depression is particularly painful.
>
> Many of us are so focused on reaching our goal, it occupies much of our waking hours thinking about how to achieve it. The quality of our lives remains so poor in the meantime, that our pain and cognitive dysfunction are always right in our faces. It is hard not to think about it. There is no escape from misery without finding a successful treatment.
>
> GGG, you are in a position where effects are pummeling you 24/7. How can you not focus on your treatment so intently?
>
> I told my doctor that, at this point, I only want to learn the minimum necessary to get well and continue my journey through life. I lost my passion for neuroscience and psychiatry a long time ago. Once I have achieved the goal, I can begin thinking about other things. My doctor noted that it is perfectly understandable that a person in my position be motivated and driven to reach the goal of remission to a point where it looks very much like obsession. Is it obsession to focus your attention on nothing else when your hand is being held over a flame?
>
> There must be balance. Obsessing over illnesses and treatments every moment of every day takes away from one's ability to live in the moment and extract as much positive experience and personal growth as the illness will allow for. Of course, the more severe the depression, the less there is to work with. Many people have no capacity to experience anything beyond their depression. For them, there is nothing left but emptiness and in constant pain. There is no other moment to live in. Life is a prison, and each moment is Hell.
>
> The moment I achieve my goal of responding adequately to treatment is the moment I take my first step away from psychopharmacology and toward the building of a new life with my focus on positive, constructive, rewarding, and fun things. I think I'll sell some cars and resume my study of women.
>
>
> - Scott
Posted by phidippus on June 25, 2012, at 16:36:56
In reply to Re: Parnate dosing schedule » phidippus, posted by g_g_g_unit on June 19, 2012, at 21:32:50
Why do you spend so much time thinking about the medications you are taking, scrutinizing them for every effect they may have on you? Sometimes I wonder if you're able to make the distinction between a symptom and an effect of whatever drug you may be on.
Eric
Posted by phidippus on June 25, 2012, at 18:20:39
In reply to Parnate dosing schedule, posted by g_g_g_unit on June 15, 2012, at 21:32:23
You really should be taking Parnate in the morningg-one per day. You shouldn't be experiencing any agitation no matter when you take it. You may be atttributing a symptom to the drug.
Eric
Posted by g_g_g_unit on June 26, 2012, at 7:33:19
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by phidippus on June 25, 2012, at 16:36:56
> Why do you spend so much time thinking about the medications you are taking, scrutinizing them for every effect they may have on you? Sometimes I wonder if you're able to make the distinction between a symptom and an effect of whatever drug you may be on.
>
> EricWell, I don't usually experience daytime sleepiness, abnormally low blood-pressure, physical weakness, mild forgetfulness and confusion, extreme insomnia or periodic improvements in cognition in my baseline state, so I think I'm fairly adept at picking out symptoms from side-effects. Plus, it's not like I'm performing this trial via mail-order; unless my psychiatrist is equally incompetent, I trust we have some picture of what's going on.
And the reason I agonize over side-effects is because I have a right to -- when you are too cognitively dysfunctional or socially alienated to do much else, what are you meant to think about?
Posted by g_g_g_unit on June 26, 2012, at 7:36:04
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by phidippus on June 25, 2012, at 18:20:39
> You really should be taking Parnate in the morningg-one per day. You shouldn't be experiencing any agitation no matter when you take it. You may be atttributing a symptom to the drug.
>
> EricDr Gilman has said that agitation is a common start-up effect of Parnate. I prefer not to take the entire dose at once because I want to maximize the psychostimulant effect.
Posted by psychobot5000 on June 28, 2012, at 13:27:41
In reply to Re: Parnate dosing schedule » g_g_g_unit, posted by phidippus on June 25, 2012, at 18:20:39
> You really should be taking Parnate in the morningg-one per day. You shouldn't be experiencing any agitation no matter when you take it. You may be atttributing a symptom to the drug.
>
> Eric
>
>Parnate gave me agitation.
Posted by phidippus on July 11, 2012, at 18:18:52
In reply to Re: Parnate dosing schedule » phidippus, posted by g_g_g_unit on June 26, 2012, at 7:33:19
>And the reason I agonize over side-effects is >because I have a right to?
Sure you have a right to, but I don't honestly believe you want to.
> -- when you are too cognitively dysfunctional or >socially alienated to do much else, what are you >meant to think about?
That's what you're telling yourself, man. You're a perfectly articulate person with a lot of brain in his skull. There's is no doubt in my mind you can formulate a plan to be less 'socially ackward' human being.
Eric
This is the end of the thread.
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