Psycho-Babble Medication Thread 1093598

Shown: posts 1 to 7 of 7. This is the beginning of the thread.

 

new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by mrSwim on December 21, 2016, at 23:15:06

Hi all
Firstly thanks for this forum and your input. Without it, I don't think I would have come across the experiences, advice, links and references that I had done in order to convince me to try Parnate (MAOI) for my situation. I lost all faith in anti-depressants and the medical system in helping my situation after only being offered SSRIs and SNRI's, (and antihistamines!), all unsuccessfully or making matters worse. I gave up for a long time. Self study led me to discover Parnate, and to push for this medication.

The benefits have been outstanding. My question is relating to the Fatigue being experienced, which I know is a common side effect. (Even with this fatigue/lethargy, I would still continue to take the medication for the time being.)

But I wonder if anyone has any information as to what may be the actual cause of this fatigue and increase in perceived weakness of my body. It's much more a physical lethargy and fatigue, than mental. Mentally there is calm and peace, but definitely not a fogginess I would associate with a mental fatigue.

I'm aware that MAO enzymes may have more functions throughout the body other than just regarding the breakdown of neurotransmitters, with perhaps more roles in the GI tract and Liver and elsewhere to a degree. But I cannot find any information about how inhibition of MAO directly can cause perceived fatigue/weakness, eg regarding muscle function or anything like that.

I have come across information suggesting that Norepinephrine can actually be reduced on MAOI's, due to higher levels of Octopamine displacing NE in synaptic vesicles - an adaption to the tyramine pressor response. So one idea is that lowered Norepinephrine may be the cause of this fatigue, however I do not fully understand the significance of this Octopamine/Norepinephrine relationship or the consequences or magnitude of reduced Norepinephrine - whether incorporating an NRI such as Reboxotine would be of benefit at all or whether this would cause unwanted/unnecessary complications. ---> Either way, I think potentially lowered Norepinephrine levels would be a longer term adaption to MAOI's (if at all) - not applicable to fatigue/lethargy experienced in early use of MAOI's.

I'm wondering about Serotonin. As expressed, I had no beneficial response to SSRI's. So I have an intuitive feeling that increased levels of Dopamine (and possibly NE, and endogenous PEA) are more helpful in this situation, and probably in many other peoples too, particularly those who don't response do SSRI's - a lot of people!) - Thus, my positive response to MAOI's and not to SSRI's. And THIS leads me to wonder whether the MAO Inhibition of the breakdown of Serotonin may be unwanted in this situation, and whether too-high (but within safe levels) of Serotonin may be the cause of fatigue and lethargy. (I don't take any 5-htp or tryptophan.).

If this could be the case, one (uneducated) concern could be the downregulation of serotonin receptors in the longer term, eg receptors adapting to the surplus of Serotonin levels available. I say uneducated, as I don't fully understand this mechanism and I'm not sure it would be guaranteed to occur. But if it is a possible outcome of having too high levels of Serotonin available then it is something I would want to take precautions to prevent.

I will probably in the future transition to L-deprenyl, if this is possible at that point in time, for it's selective MAO-B inhibition, and to explore whether this alone provides the improvements being experienced on non-selective MAOI. For now, I'm very happy to continue with things as they are and let things settle for a while, even with the fatigue and lethargy being experienced.
(I can't imagine it will be of much help, but I should be able to get a script for Modafinil in the new year to explore whether that helps, but I can imagine the benefits of this are more on cognition than on somatic - but worth a shot I reckon!)

So, sorry I wrote a lot there - to boil it down, do you think MAOI's could cause favorable neurotransmitter levels but possibly an excess of Serotonin, and that this could be the cause of fatigue and lethargy?

Thanks for your time in reading this, and for any response too :)

~mrSwim

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by baseball55 on December 22, 2016, at 18:09:04

In reply to new to Parnate (MAOI) - Fatigue (Serotonin?), posted by mrSwim on December 21, 2016, at 23:15:06

While I know virtually nothing about all the various neurochemicals, I do know that parnate helped me a lot and has never made me feel fatigued. Initially, in fact, I felt a bit speedy and couldn't fall asleep.

I don't know what others' experiences have been.

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by pontormo on December 25, 2016, at 10:55:56

In reply to new to Parnate (MAOI) - Fatigue (Serotonin?), posted by mrSwim on December 21, 2016, at 23:15:06

I experienced fatigue with parnate, but it was mental as well as physical. I wondered how well you're sleeping, whether it seems to be deep sleep, and whether you're having any sort of dreams, or dream-like states.

Also, if serotonin bothered you in the past, what symptoms or effects did you have then? It's possible if the physical fatigue is a new symptom, it might be due to some other phenomenon.

Also, what dose of parnate are you taking, and when do you take it?

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?) pontormo

Posted by baseball55 on December 28, 2016, at 20:07:48

In reply to Re: new to Parnate (MAOI) - Fatigue (Serotonin?), posted by pontormo on December 25, 2016, at 10:55:56

I take 40mg/day. At the beginning, I had terrible, up-all-night insomnia and eventually started taking ativan and trazadone for sleep, but after a time the insomnia went away along with all of the other side-effects (except dry mouth). My dreams are no different from the way I dreamed before and most of my life.

SSRIs never did much for depression but I didn't really have any side effects after the start-up period (initially had nausea and insomnia). The only AD that wiped me out and made me fatigued was, paradoxically, wellbutrin.

> I experienced fatigue with parnate, but it was mental as well as physical. I wondered how well you're sleeping, whether it seems to be deep sleep, and whether you're having any sort of dreams, or dream-like states.
>
> Also, if serotonin bothered you in the past, what symptoms or effects did you have then? It's possible if the physical fatigue is a new symptom, it might be due to some other phenomenon.
>
> Also, what dose of parnate are you taking, and when do you take it?
>
>

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by mrSwim on December 29, 2016, at 0:50:14

In reply to Re: new to Parnate (MAOI) - Fatigue (Serotonin?), posted by pontormo on December 25, 2016, at 10:55:56

Hi, thank you everyone for getting back.
I've just found out how to post a follow up message on this thread (first time using this forum) :)

My first week on Parnate I had a lot of energy (possible initial reaction to amphetamine effects, or a response to my uplifted mood, optimistic thoughts etc) and this energy also manifested at night, several nights were pretty sleepless but I was very content and relaxed just lying there. After the first week, my sleep returned to pretty much normal,

Right now I must be about 4 or 5 weeks in, and my sleep is really good actually. I'm generally sleeping for 8 solid hours straight if I go to bed early enough (9/10pm). I never used to recall my dreams that much, but at the moment I'm recalling one or two fairly detailed dreams on about 3 or 4 nights a week. Seems to be like a good sleeping pattern.

I'm actually on a 30mg dose which i can know be relatively low, compared to what's possible. (I would love to get MAO levels tested - will need to look more into this, to see the actual effects of 30mg daily). I tend now to take all 30mg in the morning, say, 10am. This way, I'm exhausted at around 11.30-3pm but then energy tends to pick up for the later afternoon and evening. I found if i spread the dose, it just spreads the fatigue effects too.

I have heard that Nardil can generally be more 'sedating' and Parnate more activating, but I've also heard of people who get a lot of fatigue from Parnate, doing much better on Nardil. I'm reluctant to change right now, because of the improvements I've been experiencing on Parnate.

I did skip my dose yesterday to experiment, and I had more energy throughout the day, definitely not that super heavy slump that kicks in. So, my thoughts are maybe that the fatigue isn't related to MAOI or any neurotransmitter effects (as respective levels of MAO are inhibited for about 2 weeks, until levels are replaced - so missing one dose, shouldn't affect this immediately) - so it seems to be the assimilation of the actual Parnate tablets which seem to cause the fatigue, (for me!)

Relating to Serotonin - I've actually not experienced anything noticeable - just that for example supplementing with L-tryptophan or 5-HTP, and all relevant cofactors for their conversion to Serotonin, didn't seem to have any effect on mood, nor did taking SSRI medications, and this was at a critical time, but things remained critical whilst on the SSRI's for a substantial period of time, so I eventually withdrew from taking these.

My next steps are to see if I can try Modafinil along with the Parnate on a few days a week to see if that helps, or alternatively to gradually transition over to a low dose of a MAO-B specific inhibitor, if doctor is willing to prescribe, and encourage natural Dopamine and PEA pathways, and to see if this helps as much as the Parnate. Time shall tell :)

Anyways hope this helps to answer your questions sorry I tend to write so much, feel free to throw any more ideas this way if you have any insight :)

I hope things are continuing to be well for you,

Best wishes for the new year from mrSwim

> I experienced fatigue with parnate, but it was mental as well as physical. I wondered how well you're sleeping, whether it seems to be deep sleep, and whether you're having any sort of dreams, or dream-like states.
>
> Also, if serotonin bothered you in the past, what symptoms or effects did you have then? It's possible if the physical fatigue is a new symptom, it might be due to some other phenomenon.
>
> Also, what dose of parnate are you taking, and when do you take it?
>
>

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by pontormo on December 31, 2016, at 10:14:15

In reply to Re: new to Parnate (MAOI) - Fatigue (Serotonin?), posted by mrSwim on December 29, 2016, at 0:50:14

It can't hurt to see if modafinil helps. I've found it to be a mildly activating substance and I do take it along with emsam, which I'm taking now.

I'm glad to hear both of you can sleep with parnate, I really never felt alert, at any dose, starting with 60 and going up to 100 mg a day. Maybe it was too stimulating of serotonin, which I react to very badly. I finally had to give it up anyway for other reasons. For me it wasn't really the right med, and I do much better on emsam.

I had very strange dreams, or quasi-dreams on parnate, which very repeititive, and had sort of dark and limited imagery, where I was walking either uphill or over a long dark highway, or over heavy snow., I used to wake up every morning exhausted as if I had really been make a huge effort while I was asleep. It made me wonder if my muscles weren't entirely paralyzed. The other strange thing was that they seemed much more prolonged than normal dreams, and seemed to go for long periods of time, Toward the end, I would wake up directly from dreaming and sometimes would feel that I was partly woken up but not entirely and would try to get myself to wake up all the way, but that it a great struggle to do so.

I haven't had any of those problems on emsam.

 

Re: new to Parnate (MAOI) - Fatigue (Serotonin?)

Posted by mrSwim on December 31, 2016, at 16:13:08

In reply to Re: new to Parnate (MAOI) - Fatigue (Serotonin?), posted by pontormo on December 31, 2016, at 10:14:15

Hi pontormo,

Thanks for keeping in touch,

It's great to hear you have good success with Emsam. I would love to try it too (with an interest in L-deprenyl/selegeline, as previously mentioned).

Would you be able to tell me a little more about how it works, in terms of dose (I recall a 6mg patch is quite standard) but for example how long this patch lasts for, etc. I know orally the dose can be low at 2.5mg, or up to 5mg, 10mg, then possibly breaching into MAO-A inhibiting effects. Is the purpose of the EMSAM patch also to cross over into MAO-A inhibiting non-selective territory when it is used for depression, or is the dose sometimes maintained low enough for only MAO-B selective inhibition - even when it is used for depression?

Would love also to find out how, even if EMSAM does cross over into MAO-A inhibiting effects, how this may also be safer - being transdermal administration - than through ingesting a non-seletive MAOI... I have a vague memory that MAO-A may still be active in the GI tract when using EMSAM, as it bypasses the GI tract entirely during it's administration, thus the usual deactivation of tyramine and other amines takes place making it safer than ingested MAOI's - OR, is MAO-A still inhibited in the GI tract, even with transdermal EMSAM, once it crosses the threshold of non-selective MAO-B to MAO-A+MAO-B inhibition, regardless of transdermal administration?

Hope this all makes sense,
I'm sure I could google it all so no pressure to respond but if you'd like to share your knowledge and experiences with EMSAM I'd be very interested - thank you :)

Wishing you all the Best for the New Year ahead too :)

~mrSwim


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