Posted by Robert_Burton_1621 on August 20, 2016, at 9:42:44
In reply to Ultra high dose parnate (tranylcypromine), posted by Uncouth on August 2, 2016, at 21:25:53
> I have suffered a relapse last few months despite taking a high dose of parnate (140mg) along with various NRIs (currently strattera 160mg--i am 125kg)). I have been on parnate for over a year and it has never really done the job alone. Social anxiety, motivation, a hedonistic, ocd still an issue. I have recently stopped a number of supplements that could.have been confounding results (though that alone hasn't helped) and am lowering my dose of memantine to 14mg.
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> I would like to get any insight, experiences, or even thoughts or second hand stories of what significantly pushing my parnate dose up over 200mg might accomplish. I also take bydureon AND victoza for weight loss, which delay gastric emptying....i've always been a bit paranoid the parnate is not absorbing correctly or completely also.
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> I am looking for full resolution of social phobia, motivation, and mood (especially self esteem/ optimism) and want to try pushing parnate as high as necessary before asking my pdox to add a stimulant or switch to emsam.
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> Please let me know if you have any insight or recall stories of people only finding full remission at 200mg+
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> UncouthI'm sorry to hear of your residual symptoms. Parnate is an excellent medication. I have taken it (120 - 140mg) - and wish to take it again - but also experienced residual challenges (which were essentially remedied by lamotrigine 300mg, until I confronted serious side-effects and had, alas, to withdraw it).
I would echo Scott's suggestion regarding nortriptyline augmentation. Strattera is not a particularly potent NRI and is scheduled for the treatment of ADHD; I do not think it is indicated for depressive conditions, though I could be wrong.
Have you trialed Lithium augmentation of parnate? This can be a very effective combination. It is important to monitor your thyroid hormones while on lithium treatment.
There is a case report of tranylcypromine with successful bupropion augmentation, too. However, should have thought the first augmentation strategy would involve lithium.
While expert psychopharmacologists would concede - and even openly acknowledge - that the dose of tranyclypromine used in the putatively authoritative STAR*D trials was woefully inadequate, I have never come across a study which assessed the efficacy and tolerability of tranylcypromine 200mg/day. I have read a study which used 170mg. And there is a well-known study which used 120mg (and various augmentation strategies, including with dextroamphetamine).
I do wonder whether increasing your dose to 200mg when 140mg itself has proven inadequate would deliver you significant clinical benefits.
Best of luck.
poster:Robert_Burton_1621
thread:1091116
URL: http://www.dr-bob.org/babble/20160819/msgs/1091467.html