![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Rahilka on October 1, 2013, at 22:05:06
Hi everyone,
My name is Rahilka and I have tried many different SSRIs/SNRIs/AAPs etc. for my Major Depression, Generalized Anxiety Disorder, Body Dysmorphic Disorder, and Obsessive Compulsive Disorder. Some I have had a partial response to, but most were unsuccessful, so my doctor has finally put me on an MAOI, Parnate.
Firstly, I know he is a doctor and I really respect and trust his professional expertise/opinion (he ran the Parnate clinic at Yale in the 1970s,) but he has me titrating up on the dose very, very slowly (or at least compared to what I am reading about other peoples' experiences.) He started me on 5 milligrams for the first week, then I will go up to 10 milligrams for the second week, and then I am supposed to see him so we can discuss if I am tolerating the medication/side effects and I guess we will go up from there.
This concerns me because from what I have read, the lowest effective dose of Parnate is 30 milligrams. If I go from 10 to 20 milligrams the third week, and then from 20 to 30 milligrams the fourth week, then that means it will have taken me an entire month JUST to get to the lowest effective dose - not to mention that I will have to be at 30 milligrams for at least two or three weeks to see if there is going to be any benefit. By those calculations it will take me 6 OR 7 WEEKS just to see if the absolute lowest effective dose of Parnate will even begin to work! Does this seem too slow to anyone else? This is my first MAOI experience so excuse my ignorance; I am not really sure how the titration schedule is supposed to go. It's just frustrating because I ALREADY had to wait an entire MONTH with absolutely no AD in my system before I got to even take my first Parnate because my doctor had to leave the country for a family emergency for a few weeks and insisted that he be in the country while I was trying Parnate in case I had a severe adverse reaction. So I am really tired of waiting and I just want to see if the thing is going to work or not.
I am only on dose 5 of 5 milligrams, so I have a while to go.
I am also very concerned, worried, scared, anxious, apprehensive, etc. because I suffer from severe GAD in addition to my depression and after reading many, many first-hand accounts of Parnate experiences online it seems that Parnate is not good for anxiety disorders and actually makes them worse. PLEASE tell me this is not always the case! I absolutely do not want to have to augment it with a benzodiazopene (sorry for bad spelling...) because benzos and I don't really get along. They cause a lot of depression for me and even at tiny, tiny doses make it very hard for me to stay awake, feel clear-headed (as clear-headed as I CAN be since my memory and brain fog has gotten so bad...) and not feel completely sedated.
I am so frightened about this drug. For the past two days I have been having some shortness of breath; it feels like someone is sitting on my chest and it is very difficult for me to breathe deeply and fully which of course is making me freak out more. Is this a possible side effect of Parnate, even at a low dose of 5 milligrams? So far I have also experienced more mental clarity (which only lasted for two or three days, now I'm back to fogginess,) a definite increase in anxiety, dizziness, seeing 'floaters' in my vision when I move my head around, and lightheadedness. I have been able to coast just above deep depression for the past few weeks somehow but now that this Parnate is increasing my anxiety I can feel my mood drop and I am becoming irritable, hostile, snappy, and withdrawn. Some days I even feel more agoraphobic and paranoid, and everyone gets on my nerves even if they're not doing anything wrong.
Did my doctor and I pick the wrong medication? Anyone else with severe anxiety problems helped by Parnate? How about anyone with a lot of irritability problems?
Posted by Phillipa on October 1, 2013, at 22:23:56
In reply to My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 1, 2013, at 22:05:06
Since Your doc ran the clinic at Yale a prestigious hospital in CT I would definitely call him and let him know what you are experiencing. So you have taken all the SSRI's, SNRI's, Tricyclics, and others? No personal experience. Did he suggest EMsam as a patch and milder? Phillipa
Posted by Rahilka on October 1, 2013, at 22:59:57
In reply to Re: My doc is titrating up my Parnate dose v. slowly? » Rahilka, posted by Phillipa on October 1, 2013, at 22:23:56
> Since Your doc ran the clinic at Yale a prestigious hospital in CT I would definitely call him and let him know what you are experiencing. So you have taken all the SSRI's, SNRI's, Tricyclics, and others? No personal experience. Did he suggest EMsam as a patch and milder? Phillipa
I agree, Phillipa. I should call him and talk to him about what I have been experiencing; but at the same time, I was experiencing a lot of anxiety/restlessness/irritability even before I started taking the Parnate (it's part of my condition,) so I am not sure if I am actually experiencing a worsening of symptoms or if I am just my "baseline" level of "mood-disordered" and attributing it to the Parnate since I am scared. Maybe if I call him and tell him that I am feeling desperate he will say it is okay to increase my dose a few days early instead of waiting fooorreevvveerrrr just to get to 30 milligrams? Then I'll at least be able to find out MUCH sooner if Parnate is the drug for me. I mean it's not like I have a job or school that I need to be at every day (had to withdraw from college because of my severe anxiety and depression :'( ) so it's okay if I get side effects (as long as they go away eventually! lol)Surprisingly, my doctor has not tried me on any tricyclics or the other atypical antidepressants like Remeron (Wellbutrin was VERY BAD for me.) I'm not sure why but I guess he just prefers the SSRIs/SNRIs and MAOIs. There is no way in heck I could ever afford the EMSAM patch or the pills, I already am having trouble affording Parnate! I have no idea how I am going to be able to buy my next prescription once he raises my dose :'(
Sorry for the novel up there ^^^ I talk a lot when I am nervous or anxious about something!
Oh yeah, and thanks for responding, Phillipa! I really appreciate it.
Posted by SLS on October 2, 2013, at 7:44:50
In reply to My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 1, 2013, at 22:11:59
> Hi everyone,
>
> My name is Rahilka and I have tried many different SSRIs/SNRIs/AAPs etc. for my Major Depression, Generalized Anxiety Disorder, Body Dysmorphic Disorder, and Obsessive Compulsive Disorder. Some I have had a partial response to, but most were unsuccessful, so my doctor has finally put me on an MAOI, Parnate.What other drugs are you currently taking?
What is your doctor's rationale for titrating so slowly?
Why was Parnate chosen instead of Nardil?
> This concerns me because from what I have read, the lowest effective dose of Parnate is 30 milligrams.
Historically, I have needed a minimum dosage of 40 mg/day.
> If I go from 10 to 20 milligrams the third week, and then from 20 to 30 milligrams the fourth week, then that means it will have taken me an entire month JUST to get to the lowest effective dose - not to mention that I will have to be at 30 milligrams for at least two or three weeks to see if there is going to be any benefit.
Yup. However, it has been my experience that taking lower dosages of Parnate "set up" for a quicker response once the minimum effective dosage is reached. You might not have to wait a full 3 weeks at 30 mg/day for it to work.
> I am also very concerned, worried, scared, anxious, apprehensive, etc. because I suffer from severe GAD in addition to my depression and after reading many, many first-hand accounts of Parnate experiences online it seems that Parnate is not good for anxiety disorders and actually makes them worse.
Perhaps it depends on which anxiety disorder is being treated.
http://www.ncbi.nlm.nih.gov/pubmed/20036427
Notice how 30 mg/day of Parnate was ineffective while 60 mg/day produced a clinical improvements.
> PLEASE tell me this is not always the case!
I can't speak from experience regarding Parnate in the treatment of GAD. However, I have seen Nardil bring about a remission in a woman who suffered from depression, GAD, and panic disorder. When I take Nardil, I find that it produces an anxiolytic effect early in treatment, often before the antidepressant effects emerge.
> I absolutely do not want to have to augment it with a benzodiazopene (sorry for bad spelling...) because benzos and I don't really get along. They cause a lot of depression.
Can you describe this depression?
Which benzodiazepines cause depression for you?
> I am so frightened about this drug.
The breathing thing may be temporary and is sometimes referred to "air hunger". It can appear as a side effect of drug treatment and even as a symptom of the depression itself. Air hunger appeared in me before I was ever treated.
> For the past two days I have been having some shortness of breath; it feels like someone is sitting on my chest and it is very difficult for me to breathe deeply and fully which of course is making me freak out more. Is this a possible side effect of Parnate, even at a low dose of 5 milligrams? So far I have also experienced more mental clarity (which only lasted for two or three days, now I'm back to fogginess,) a definite increase in anxiety, dizziness, seeing 'floaters' in my vision when I move my head around, and lightheadedness. I have been able to coast just above deep depression for the past few weeks somehow but now that this Parnate is increasing my anxiety I can feel my mood drop and I am becoming irritable, hostile, snappy, and withdrawn. Some days I even feel more agoraphobic and paranoid, and everyone gets on my nerves even if they're not doing anything wrong.
Parnate is stimulating and can display amphetamine-like effects. You might be experiencing autonomic dysregulation - even at 5.0 mg/day - as a side effect. This is usually not dangerous. However, I would ask your doctor about it. With me, these things eventually disappear with continued treatment.
For now, there might be a synergism between a Parnate-induced dysautonomia and your anxiety. This will be uncomfortable, but you might be able to minimize the severity of this anxiety psychologically knowing that you are safe and that others have experienced side effects similar to yours. I have. I would say that there is a chance that Parnate can work in your case, but you are going to need to be patient and titrate the dosage at a rate that avoids the exacerbation of your anxiety.
> Did my doctor and I pick the wrong medication?
Perhaps.
It does happen that someone will respond to one MAOI and not another.
I am still curious as to why Parnate was chosen in place of Nardil.
- Scott
Posted by Phillipa on October 2, 2013, at 18:38:44
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 1, 2013, at 22:59:57
I'm glad I could help a bit. Did you get ahold of your doc today? And I would also be very anxious and when anxious talk a lot!!!! Phillipa
Posted by baseball55 on October 2, 2013, at 19:15:49
In reply to My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 1, 2013, at 22:05:06
He seems excessively cautious. The side effects of parnate are not so severe that you need to titrate to minimum therapeutic dose. I started on 30mg and found that worked for me and have stayed on 30mg. I had side effects -- mostly insomnia and postural hypotension, that's pretty much it -- and I don't think they could have been avoided by triturating. Parnate is not like lamictal, where the possibility of a serious rash needs to be carefully monitored over a few weeks.
Also, feeling short of breath is likely not due to parnate, but to your anxiety. At the dose you're at, I don't imagine parnate is doing anything, good or bad.
I can't speak to whether parnate helps anxiety. Perhaps others can.
Good luck.
Posted by Rahilka on October 3, 2013, at 10:07:20
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by SLS on October 2, 2013, at 7:44:50
> >
>
> What other drugs are you currently taking?Hi Scott! Thanks for taking the time to read my thread and help me with my dilemma. I am currently only taking the Parnate and Klonopin when I am feeling extremely anxious, have to go out to a friends house (very bad social anxiety,) or have to go to work (which is not often; I only go once or twice a week so I can have some money to pay hospital bills.)
> What is your doctor's rationale for titrating so slowly?
I don't really know what his rationale was; I believe he just wanted to see if I would have any adverse reactions to the medication. He knows from my past AD trials that I am very sensitive to medications and how much they increase my anxiety (whether this is real or just imagined anxiety) so I am sure that was a big part of his decision too.
> Why was Parnate chosen instead of Nardil?
We decided on Parnate because I suffer from a very bad energy deficit and have for years. I lack a lot of motivation and initiative, although this could also be due to anxiety. I'm assuming that if it is my GAD/OCD making me exhausted, then we might have chosen the wrong medication. But it's so hard to tell because I have a lot of trouble thinking straight (like right now.)
>
> Historically, I have needed a minimum dosage of 40 mg/day.This relieves me because going any higher would be extremely expensive for me. I always assumed in general that most people needed to take much more. I've also heard that how much you need to take is sometimes dependent on your body weight - .8 mg/kg. In this case I would only need a small dose (around 40 mg I believe) because I am 110 pounds. Have you heard this theory?
> Yup. However, it has been my experience that taking lower dosages of Parnate "set up" for a quicker response once the minimum effective dosage is reached. You might not have to wait a full 3 weeks at 30 mg/day for it to work.
Thanks Scott!! Reading this ^^ in particular has brought me a lot of relief! I would have to agree with you, now that I think about it, because the same thing happened when I titrated up on Effexor, although it was a much quicker titration.
> >
>
> Perhaps it depends on which anxiety disorder is being treated.
>
> http://www.ncbi.nlm.nih.gov/pubmed/20036427
>
> Notice how 30 mg/day of Parnate was ineffective while 60 mg/day produced a clinical improvements.Thanks for the study information, Scott. I do suffer from the occasional panic attack and pretty major social anxiety. I am good at "casual conversation" but talking about myself or things happening in my life (AKA nothing) causes me to go blank and my thoughts to race. Hopefully if I can stay on the Parnate it will address this.
It would be very beneficial, though, if it could treat Generalized Anxiety Disorder. I feel like I am in a rush all the time and get nervous and scared about EVERYTHING. I am scared of life in general. Every day feels like impending doom.
It's hard to separate out my symptoms into the different diagnoses because I have been to so many doctors and they all had different ideas of what "affliction" I have (for lack of a better term.)
>
> I can't speak from experience regarding Parnate in the treatment of GAD. However, I have seen Nardil bring about a remission in a woman who suffered from depression, GAD, and panic disorder. When I take Nardil, I find that it produces an anxiolytic effect early in treatment, often before the antidepressant effects emerge.I thought Nardil sounded like a promising drug, too, but have read online how much sedation and lethargy it has the potential of causing, how people have had to stop exercising due to the hypotension, etc. I know it's unfair to judge a drug without trying it but the side effects of Nardil sound horrendous! Or, rather, the severity of the SEs.
Have you run into trouble with the SEs of Nardil?
>
> Can you describe this depression?Well, when I take my Klonopin now, the next day after waking up I just feel even more tired, foggy, lethargic, and just in general very low mood. It doesn't happen all the time but it does happen most of the time.
>
> Which benzodiazepines cause depression for you?I have tried Klonopin, Xanax, and Valium. The only one I have taken for over a year (now PRN,) is Klonopin. Xanax knocks me OUT and would be completely useless to me in social situations. Valium hardly touches my social anxiety. Klonopin seems "sharp" enough to address the SA but not so much that it makes me dysfunctional.
>
> The breathing thing may be temporary and is sometimes referred to "air hunger". It can appear as a side effect of drug treatment and even as a symptom of the depression itself. Air hunger appeared in me before I was ever treated.This is really good to know, thanks Scott. I really hope it is temporary because I had high hopes for Parnate. Today will be the 3rd day in a row where the breathing has been an issue, whether I am actively anxious or not. Yesterday at a friend's house I was standing outside and it was MILDLY hot outside and I felt like I was going to stop breathing. My friend who is a pharmacist told me to have my blood pressure checked today due to difficulty breathing being a symptom of hypertension and call my doctor.
>
> Parnate is stimulating and can display amphetamine-like effects. You might be experiencing autonomic dysregulation - even at 5.0 mg/day - as a side effect. This is usually not dangerous. However, I would ask your doctor about it. With me, these things eventually disappear with continued treatment.Good to know. I will ask him today. I have heard the amphetamine-like effects wear off once the body becomes adjusted. Has this been the case for you? Amphetamines make my focus amazing and give me more energy but they also make me more irritable and want to be alone. Some people are helped by amphetamines for social anxiety and I am absolutely NOT one of those people! I hope since Parnate is an analog of amphetamine that it will not cause me to have the same side effects of the stimulants I have tried.
>
> For now, there might be a synergism between a Parnate-induced dysautonomia and your anxiety. This will be uncomfortable, but you might be able to minimize the severity of this anxiety psychologically knowing that you are safe and that others have experienced side effects similar to yours. I have. I would say that there is a chance that Parnate can work in your case, but you are going to need to be patient and titrate the dosage at a rate that avoids the exacerbation of your anxiety.That does make me feel better to know that I am not the only one who has had these SEs before - I hope they go away! I do also think that titrating this slowly is causing me to have more anxiety - I will ask my doctor today if we can pick up the pace. I don't want to insult him as I think he is a very brilliant doctor and I know he just wants me to be safe but the waiting game is just driving me crazy. I haven't had an HC and it's been 6 doses so come on! LOL.
>
> I am still curious as to why Parnate was chosen in place of Nardil.
Constant fatigue and exhaustion, cognitive dysfunction/"brain fog", lethargy. Also, according to studies and anecdotes, fewer side effects/less intense side effects (other than higher chance of HC.)
>Thanks again, Scott! Nice to meet you :)
Posted by Rahilka on October 3, 2013, at 10:10:21
In reply to Re: My doc is titrating up my Parnate dose v. slowly? » Rahilka, posted by Phillipa on October 2, 2013, at 18:38:44
> I'm glad I could help a bit. Did you get ahold of your doc today? And I would also be very anxious and when anxious talk a lot!!!! Phillipa
Hi again Phillipa! Glad to know I'm not the only one in that boat (talking a lot when anxious) LOL! I didn't get a hold of him yesterday because I REALLY want this Parnate to work out so I decided I would give it one more day and see if the breathing problems/anxiety/overstimulation would calm down. Today it seems the breathing issue is still there so I am getting my blood pressure checked at the pharmacy and calling him to ask if it could be a sign of prehypertension.
Thanks for the follow-up, Phillipa! PS I love your name!
Posted by Rahilka on October 3, 2013, at 10:12:35
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by baseball55 on October 2, 2013, at 19:15:49
> He seems excessively cautious. The side effects of parnate are not so severe that you need to titrate to minimum therapeutic dose. I started on 30mg and found that worked for me and have stayed on 30mg. I had side effects -- mostly insomnia and postural hypotension, that's pretty much it -- and I don't think they could have been avoided by triturating. Parnate is not like lamictal, where the possibility of a serious rash needs to be carefully monitored over a few weeks.
>
> Also, feeling short of breath is likely not due to parnate, but to your anxiety. At the dose you're at, I don't imagine parnate is doing anything, good or bad.
>
> I can't speak to whether parnate helps anxiety. Perhaps others can.
>
> Good luck.Thanks so much for responding to my thread! May I ask what you are taking Parnate for? I'm assuming it has been helping you since you are still on it. If it is helping, congrats! I know finding the right med is so difficult but beyond rewarding in the end.
Posted by baseball55 on October 3, 2013, at 19:21:29
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by Rahilka on October 3, 2013, at 10:12:35
> Thanks so much for responding to my thread! May I ask what you are taking Parnate for? I'm assuming it has been helping you since you are still on it. If it is helping, congrats! I know finding the right med is so difficult but beyond rewarding in the end.
>
I went on parnate for severe depression. It worked very fast for me. I felt noticeably better within a few days. I was started on 30mg after two weeks washout. I'm now slowly titrating off of it after over three years, since I have been consistently good for a year and still have parnate side effects - insomnia and postural hypotension.But I have never suffered from anxiety, so I don't know how parnate would work with that. It does tend to be stimulating, especially initially and that might be hard with anxiety.
Posted by Rahilka on October 19, 2013, at 23:38:38
In reply to Re: My doc is titrating up my Parnate dose v. slowly?, posted by baseball55 on October 3, 2013, at 19:21:29
> I went on parnate for severe depression. It worked very fast for me. I felt noticeably better within a few days. I was started on 30mg after two weeks washout. I'm now slowly titrating off of it after over three years, since I have been consistently good for a year and still have parnate side effects - insomnia and postural hypotension.
>
> But I have never suffered from anxiety, so I don't know how parnate would work with that. It does tend to be stimulating, especially initially and that might be hard with anxiety.
>
>Thanks for responding! I am glad to hear that Parnate worked for you and in such a short amount of time. Congrats on now officially being depression-free!! That is inspirational news to me since it feels like, as of now, that I will always be like this :( Although I am trying to remain positive.
PS - If anyone is reading this, I discontinued the Parnate. I didn't find it very helpful for my anxiety and if anything it possibly made it worse. I wasn't willing to take a benzo as an anxiolytic so I have gone back to my familiar SSRIs/SNRIs and plan on augmentation.
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.