Posted by uncouth on July 5, 2015, at 16:54:05
In reply to Re: Parnate 100mg what to do from here?!? Help! » Uncouth, posted by Robert_Burton_1621 on June 30, 2015, at 10:06:32
> > Hi
> > I had high hopes from parnate after failing on Nardil and Marplan due to various issues. I've been on it for about 2 months and about two weeks ago just pushed to 100mg.
> >
> > 1) Does parnate have a particular dose/kg target like Nardil supposedly does?
>
> Not that I am aware of. Are you experiencing orthostatic hypotension? That is one indicator that you have reached a therapeutic dose for you.I think so, at...I've read Dr. Gilman's guidelines. But I still feel bad. It's not super noticable orthostasis like i've had when on MAOIs in the past (or when just starting up), like when one gets so dizzy upon standing you need to sit back down. But I do find I get fatigued after sitting or laying down for a long time, then getting up.
> >
> > 2). I still get very fatigued in the morning. When I take my 40mg of parnate, and i feel it kick in, it helps a little bit, but I definitely am getting some amount of orthostatic drop when I stand (though not enough to generate lightheadedness, just fatigue).
>
> At what time do you take your last dose of parnate, and what dose is it?
> >I haven't standardized just yet on a dose. I'm taking either 100 or 110mg / day, usually 4, 4, 3, or sometimes 4, 3, 2, and 2. So my last dose is either 3 pills or 2 pills, usually mid afternoons/early evenings.
> > 3) Fatigue, anhedonia, low motivation is still an issue. Was surprised as thought TCP would be good for this. Still need about 100mg of Armodafinil, sometimes more or sometimes less, to even get basic things done.
> >
>
> Parnate has not assisted my motivation either, not has it improved my cognitive and affective capacities. It has been extraordinarily effective at preventing psychomotor retardation and catatonia.
>
> > 4) Where do I go from here??? I have read Chairman_MAOs posting (ARE YOU STILL HERE?!) about high dose TCP, like 150mg+, working phenomenally well for social phobia and confidence which is really what I need. I may talk to Dr. Gillman but given that I am already at a high dose, my doc doesn't seem to think I will see more benefit increasing but reports to the contrary abound. How does one increase when at already a high dose without promoting fatigue or other side effects?
> >
>
> Can you please explain the symptoms of your fatigue? Do you refer to somnolence? Or muscular weakness? If the later, you may be taking too much all at once. You may need to experiment with dosages. E.g., instead of 40mg in the morning, perhaps take 30mg + 30mg + 30mg + 10mg with 4 hour increments between the big doses. This may assist in preventing the drop in persistent blood pressure which parnate can induce if you take too much all at once.
>Oh, this is interesting, I actually thought it was the opposite. Can you explain more? I thought the BP drop (orthostatic hypotension) was a result of the long term inhibition of MAO enzyme (e.g. not related to dose), and that Parnate's stimulating (and anti-hypotensive, perhaps) effects would come from each individual dose...so that's why I've been lumping in 40 or 30mg doses, so get some added "kick". Are you saying it's the other way around?
> > 5) Finally, what are possible adjuncts if I stay at say 100mg? I have done well for about a year at Atomoxetine but it eventually pooped out. I would prefer to not try a stimulant. Can't take abilify or AAP due to weight gain. Already taking Namenda 21mg XR. I am bipolar so stability is an issue too, also take a few caps of lithium orotate.
> >
>
> Have you tried lamotrigine? Nortriptyline might also be an option.I just started atomoxetine and am ramping up on it, currently at 60mg. Feeling actually a lot worse, but i think it may be the clomiphene my endo has me on to help increase natural testosterone after I stopped testosterone replacement therapy 6 months ago and my levels have been rock bottom since.
>
> > But really looking for something to give me the DESIRE back--motivation, social interest, optimism, libido. (Yes, testosterone is being managed too).
> >
> > Any thoughts on what might work with Parnate? Any recent experiences of people needing to go much much higher than the 40-80mg recommended?
> >
>
> I started parnate in February and am now taking 130 mg / day [40 + 40 + 40 + 10]. It is the most consistent medication I have ever taken, and if i reduce to 80 mg I definitely relapse. It has mostly obliterated anhedonia, though not always anticipatory anhedonia, and I have not had a single episode of retardation since being on it (whereas prior to parnate, such episodes were weekly occurances). However, it has not touched my affective, pre-frontal, capacities; the "lights" have not turned on. Nor has it increased motivation or drive. It has enabled me to keep nearly every appointment I make, however, even in the absence of subjective motivation or energetic interest.
>Hmm, that sounds familiar, and thanks for the info. At what dose did it start "kicking in" and are you planning to go up even higher? I suspect I may need supratherapeutic as I usually need high doses of meds given my weight and comorbid issues.
> > Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
> >
> > Uncouth
>
> That is not good at all. You do certainly seem to be affected seriously by anhedonia. I truly hope you find a solutuion. 8 weeks is not that long on parnate, by the way. You mention that you take lithium. Have you had your thyroid levels checked recently?Yes, thyoid is OK, and I just take lithium orotate, very low dose, so i'm not too worried about thyroid.
poster:uncouth
thread:1079745
URL: http://www.dr-bob.org/babble/20150629/msgs/1080236.html