Psycho-Babble Medication Thread 1095844

Shown: posts 1 to 11 of 11. This is the beginning of the thread.

 

Residual anhedonia on Parnate

Posted by pedr on November 12, 2017, at 8:30:05

Hi,

did anyone get residual anhedonia when on Parnate? If so, how did they address it?

Parnate is helping my mood and outlook somewhat alone but currently I require Vyvanse to feel human and I'm running out of Vyvanse. My PDoc won't prescribe it with Parnate and I can't find a PDoc who will (and this is in NYC FFS).

Any pointers would be ultra welcome. I'm in the process of trying Bupropion as an adjunct. If that doesn't pan out I'm trying Provigil next. This is off my own bat - my PDoc doesn't know.

Thanks, Pete

 

Re: Residual anhedonia on Parnate

Posted by Lamdage22 on November 12, 2017, at 14:27:50

In reply to Residual anhedonia on Parnate, posted by pedr on November 12, 2017, at 8:30:05

I dont know any doctors in your area. You probably should quit taking it using a taper though not cold turkey. Maybe you can convince the doc to do that?

 

Re: Residual anhedonia on Parnate

Posted by Christ_empowered on November 12, 2017, at 15:38:10

In reply to Re: Residual anhedonia on Parnate, posted by Lamdage22 on November 12, 2017, at 14:27:50

would a different antidepressant selection let you keep the vyvanse? I do not know your history, nor am I any kind of expert, but...there was a small study in which the Effexor+remeron combination did about as well as Parnate in a group of depressed people, w/o the potentially serious adverse effects of the MAOI.

I seem to recall some posters on here taking tramadol "off label" for mood problems. Clearly not an option on an MAOI, but seems like something worth talking to the psychiatrist about, if you feel like it.


 

Re: Residual anhedonia on Parnate pedr

Posted by SLS on November 12, 2017, at 21:06:05

In reply to Residual anhedonia on Parnate, posted by pedr on November 12, 2017, at 8:30:05

My personal experience with MAOIs is that Parnate can leave residual anhedonia, even at high dosages. Nardil is a stronger mood-brightener and is better at treating anhedonia. I found that adding nortriptyline helps with anhedonia when added to Parnate. Desipramine did not. However, it often happens that someone is inadequately treated with Parnate and never reaches a therapeutic level. You will find some variability in the literature, but I would say that the dosage range lies between 40-80 mg/day. You really can't evaluate the amount of residual anhedonia that Parnate leaves until it is titrated to a dosage that gives maximal effect, even if only a partial response. I'm sorry that your doctor is resistant to adding a stimulant. You could try to find literature that suggests that adding either nortriptyline or desipramine is not only safe to add to a MAOI, but might even mitigate the tryramine pressor response. Try Google or PubMed.


- Scott

 

Re: Residual anhedonia on Parnate

Posted by pedr on November 13, 2017, at 10:46:18

In reply to Re: Residual anhedonia on Parnate, posted by Lamdage22 on November 12, 2017, at 14:27:50

> I dont know any doctors in your area. You probably should quit taking it using a taper though not cold turkey. Maybe you can convince the doc to do that?

quit taking the Parnate? I'm really hoping to stay on it. It's better for my mood&outlook than other meds, it just doesn't tackle the anhedonia so far. I should have said that I've been on it for 3 weeks so far so it's very early days. It just struck me how my anhedonia has not been helped so far.

 

Re: Residual anhedonia on Parnate Christ_empowered

Posted by pedr on November 13, 2017, at 10:50:37

In reply to Re: Residual anhedonia on Parnate, posted by Christ_empowered on November 12, 2017, at 15:38:10

> would a different antidepressant selection let you keep the vyvanse? I do not know your history, nor am I any kind of expert, but...there was a small study in which the Effexor+remeron combination did about as well as Parnate in a group of depressed people, w/o the potentially serious adverse effects of the MAOI.
>
> I seem to recall some posters on here taking tramadol "off label" for mood problems. Clearly not an option on an MAOI, but seems like something worth talking to the psychiatrist about, if you feel like it.
>

Hey, yes he let me have vyvanse with Effexor and a few other "main" AD's but they were leaving me pretty depressed and still fairly anhedonic. Vyvanse+Parnate is doing a much better job even though by evening I'm anhedonic again.

I've tried remeron and effexor separately but not together. I didn't do well on remeron but it's worth remembering - thanks.

You're spot-on about tramodol since I recently was on oxycodone for CP and it was, initially especially, very good for my anhedonia. However as we all know the opioid effect lessens over time and thus it's not a good long-term solution. I manage to get by without it now. It was great while it lasted :/


 

Re: Residual anhedonia on Parnate

Posted by pedr on November 13, 2017, at 10:55:01

In reply to Re: Residual anhedonia on Parnate pedr, posted by SLS on November 12, 2017, at 21:06:05

> My personal experience with MAOIs is that Parnate can leave residual anhedonia, even at high dosages. Nardil is a stronger mood-brightener and is better at treating anhedonia. I found that adding nortriptyline helps with anhedonia when added to Parnate. Desipramine did not. However, it often happens that someone is inadequately treated with Parnate and never reaches a therapeutic level. You will find some variability in the literature, but I would say that the dosage range lies between 40-80 mg/day. You really can't evaluate the amount of residual anhedonia that Parnate leaves until it is titrated to a dosage that gives maximal effect, even if only a partial response. I'm sorry that your doctor is resistant to adding a stimulant. You could try to find literature that suggests that adding either nortriptyline or desipramine is not only safe to add to a MAOI, but might even mitigate the tryramine pressor response. Try Google or PubMed.
>
>
> - Scott

Scott, thanks so much for the post. I was on Nardil a few years ago and liked it except for the daytime somnolence that I just couldn't shake. I literally fell asleep at my desk on a number of occasions, even after being on Nardil for over a year.

I will try and get Nortriptyline added. This will mean finding a new PDoc as there's zero chance my current one will see past his "MAOI+TCA=instant death" mantra. I've shown him the psychotropical.info literature and he's not budging. Sigh.

Pete

 

Re: Residual anhedonia on Parnate

Posted by Christ_empowered on November 13, 2017, at 12:47:44

In reply to Re: Residual anhedonia on Parnate Christ_empowered, posted by pedr on November 13, 2017, at 10:50:37

hi. me, again. some people take...suboxone, I think it is....for treatment-resistant depression. I think its a Schedule III drug, so not -as- regulated as the amphetamines. I think some uses require the prescriber to have special training, licensing, etc. I don't know what the rules are for use in mood disorders.

have you tried a tca+amphetamine? not the easiest thing to tolerate, but its an old school combination that does help some people, some times (reassuring, I know). I did OK on Adderall and Tofranil-PM (I think its just a modified version of Tofranil).

would your doctor consider a milder stimulant w/ the maoi? I seem to recall Ritalin and focalin finding their way into some peoples' treatment plans on here, but I could be wrong.

hope things get better in your world.

 

Re: Residual anhedonia on Parnate Christ_empowered

Posted by pedr on November 14, 2017, at 10:40:06

In reply to Re: Residual anhedonia on Parnate, posted by Christ_empowered on November 13, 2017, at 12:47:44

> hi. me, again. some people take...suboxone, I think it is....for treatment-resistant depression. I think its a Schedule III drug, so not -as- regulated as the amphetamines. I think some uses require the prescriber to have special training, licensing, etc. I don't know what the rules are for use in mood disorders.
>
> have you tried a tca+amphetamine? not the easiest thing to tolerate, but its an old school combination that does help some people, some times (reassuring, I know). I did OK on Adderall and Tofranil-PM (I think its just a modified version of Tofranil).
>
> would your doctor consider a milder stimulant w/ the maoi? I seem to recall Ritalin and focalin finding their way into some peoples' treatment plans on here, but I could be wrong.
>
> hope things get better in your world.

thanks! Suboxone is an opioid replacement therapy drug (I'm sure that's not the right phrase). Ironically I was offered it to get off of oxycodone but apparently it's as difficult if not more difficult to quit! And yes, the prescriber has to be have specific accreditation, there's not many of them around.

Haven't tried TCA+amphetamine, mainly because TCA's just zombify me. I've tried 4 or 5 and never any success. It's worth bearing in mind though, thanks.

He won't consider anything off label. He's sadly not interested in off-label stuff at all. I need to find a new PDoc but finding progressive one with MAOI experience is very, very hard even in NYC.

 

Re: Residual anhedonia on Parnate

Posted by Christ_empowered on November 15, 2017, at 7:50:05

In reply to Re: Residual anhedonia on Parnate Christ_empowered, posted by pedr on November 14, 2017, at 10:40:06

ugh. sorry about your situation. have you ever tried EMSAM? I didn't know they still made it, until somebody at another forum posted about her love her EMSAM. maybe a psychiatrist might be more willing to keep an amphetamine in the mix w/ that instead of a more traditional MAOI?

Other than that, I have 0 ideas, lol. sorry. its crazy...for all this talk of "progress" in the "treatment of mental illness," it really seems that the drugs are more or less the same, although some of the newer options do have different adverse effect profiles, which I suppose is "progress," right?

I hope you can find something that helps, even if you need to get a new shrink to make it happen.

 

Re: Residual anhedonia on Parnate Christ_empowered

Posted by pedr on November 17, 2017, at 7:49:54

In reply to Re: Residual anhedonia on Parnate, posted by Christ_empowered on November 15, 2017, at 7:50:05

> ugh. sorry about your situation. have you ever tried EMSAM? I didn't know they still made it, until somebody at another forum posted about her love her EMSAM. maybe a psychiatrist might be more willing to keep an amphetamine in the mix w/ that instead of a more traditional MAOI?
>
> Other than that, I have 0 ideas, lol. sorry. its crazy...for all this talk of "progress" in the "treatment of mental illness," it really seems that the drugs are more or less the same, although some of the newer options do have different adverse effect profiles, which I suppose is "progress," right?
>
> I hope you can find something that helps, even if you need to get a new shrink to make it happen.

Yeah I thought of Emsam but I it has the same meds restrictions as other MAOI's. It's only the dietary (tyramine) restrictions at 6mg or lower that are lighter/lifted. It's a bummer.

Thanks man, me too. The last 3 days my mood has completely crashed unfortunately. From "meh" to scared. It happens to coincide with my going up to 60mg Parnate which seems over-simplistic but either way I'm going down in dose to see if that helps. I've no idea why 60mg would potentially cause this severe crash.


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