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Dr. Bob is Robert Hsiung, MD,
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Posted by softheprairie on August 29, 2008, at 18:06:18
In reply to Best way to take Parnate?, posted by john51 on August 29, 2008, at 15:01:19
"An altered diurnal sleep cycle is another MAOI-related side effect. Some patients get extremely drowsy in the late afternoon but then may have insomnia at night.26 Attempts to alter this odd cycle by changing the timing of administration have generally not helped." (The authors, psychiatrists experienced in prescribing MAOIs, offer a low dose of a stimulant for the afternoon and a sleep agent for the insomnia. Plus, they prescribe nifedipine to have ready in case of a hypertensive reaction.)
From
MAO inhibitors: An option worth trying in treatment-resistant cases. JO Cole, JA Bodkin - Current Psychiatry, 2002.
The article is not available free from the original publisher, but is posted on another doctor's website: http://www.drtonyromack.com/MAOIs.htmI myself have not taken Parnate, but experienced the odd phenomenon in the quote above while on EMSAM. I hadn't read the article at that time and didn't feel comfortable asking my dr. for the additional prescriptions. If I do go on an MAOI again, I plan to ask for all 3 additional agents at the outset. Currently, I have had a fair bit of improvement on desipramine plus several adjuncts.
Posted by eric wagner on August 30, 2008, at 4:48:45
In reply to Best way to take Parnate?, posted by john51 on August 29, 2008, at 15:01:19
> I just started taking Parnate. My pscript is for 10mg 3 times a day. I have read and heard that Parnate can cause insomnia and that is the last thing that I want to happen. So, normally I would take a 3 a day med every 6-8 hours thinking about the most "even" distribution of the med in my system...right? But, because I don't want to experience insomnia, which I already have problems with and don't want it to get worse, I am wondering what other people taking Parnate do and how important it is to "evenly" spread out the 3 a day dosage.
My Dr. said there are no studies splitting doses is better.
But, I still have yet to have a positive reaction.
I take 70 mgs. in the morning, although the afternoon/evening is even worse depression.
Good Luck,
Eric M. Wagner
Posted by SLS on August 30, 2008, at 5:58:43
In reply to Re: Best way to take Parnate?, posted by eric wagner on August 30, 2008, at 4:48:45
> My Dr. said there are no studies splitting doses is better.
I think it is best to divide the dosage of Parnate into two even doses, morning and midday. The irreversible MAOIs don't have to be maintained to accomplish keeping the blood levels the same throughout the day. Once bound to the enzyme, it attaches indefinitely. All you need to do is to get enough Parnate down your throat to accomplish this permanent blockade. It can be dosed once a day if the side effects are tolerable. I think larger dosages should be divided, though. Maybe 60mg and over should be divided. It is important not to take Parnate any later than 3:00pm to help mitigate insomnia.
- Scott
>
> But, I still have yet to have a positive reaction.
>
> I take 70 mgs. in the morning, although the afternoon/evening is even worse depression.
>
> Good Luck,
> Eric M. Wagner
Posted by john51 on August 30, 2008, at 9:29:47
In reply to Re: Best way to take Parnate? » eric wagner, posted by SLS on August 30, 2008, at 5:58:43
Thanks to everyone for your responses so far!!
I must say that I KNOW that I have just started on this med (today is my third day) but so far I feel WORSE, not that I expected to feel better yet, but I didn't expect to feel worse!! For instance, yesterday, I became so physically fatigued and weak feeling...I couldn't keep from falling asleep for about an hour....then, at night I felt even more fatigued and weak but had quite a bit of trouble sleeping...I maybe slept for 3 or maybe 4 hours.
Right now I feel pretty bad and even though I know better I am thinking that perhaps I shouldn't have even tried this med!!
Posted by mav27 on August 30, 2008, at 9:34:07
In reply to Re: Best way to take Parnate?, posted by john51 on August 30, 2008, at 9:29:47
Is this with you spreading the dose out? For me if i took 10 or 20mg of parnate i would feel just like you described.. i have to take at least 30mg in one go and then it's the total opposite.. 30mg wakes me and energizes me so i kept to taking the dose in one go per day. When i was on less than 30mg i took it before bed..
> Thanks to everyone for your responses so far!!
>
> I must say that I KNOW that I have just started on this med (today is my third day) but so far I feel WORSE, not that I expected to feel better yet, but I didn't expect to feel worse!! For instance, yesterday, I became so physically fatigued and weak feeling...I couldn't keep from falling asleep for about an hour....then, at night I felt even more fatigued and weak but had quite a bit of trouble sleeping...I maybe slept for 3 or maybe 4 hours.
>
> Right now I feel pretty bad and even though I know better I am thinking that perhaps I shouldn't have even tried this med!!
Posted by john51 on August 30, 2008, at 9:39:39
In reply to Re: Best way to take Parnate? » john51, posted by mav27 on August 30, 2008, at 9:34:07
> Is this with you spreading the dose out? For me if i took 10 or 20mg of parnate i would feel just like you described.. i have to take at least 30mg in one go and then it's the total opposite.. 30mg wakes me and energizes me so i kept to taking the dose in one go per day. When i was on less than 30mg i took it before bed.. <
Thanks for the advice. To answer your question..YES I have been dividing the dose!! Sounds like that may be a mistake!! I will try taking the 30mg all at once and see what happens!! Thanks again!!
Posted by mav27 on August 30, 2008, at 10:02:14
In reply to Re: Best way to take Parnate? » mav27, posted by john51 on August 30, 2008, at 9:39:39
1 thing i forgot to mention.. although most people don't seem to have this problem but just incase you do.. when i took 30mg i got really bad orthostatic hypotension.. that was the only downside for me taking it in 1 go compared to spacing it out.
>
> Thanks for the advice. To answer your question..YES I have been dividing the dose!! Sounds like that may be a mistake!! I will try taking the 30mg all at once and see what happens!! Thanks again!!
>
>
Posted by john51 on August 30, 2008, at 10:05:29
In reply to Re: Best way to take Parnate? » john51, posted by mav27 on August 30, 2008, at 10:02:14
> 1 thing i forgot to mention.. although most people don't seem to have this problem but just incase you do.. when i took 30mg i got really bad orthostatic hypotension.. that was the only downside for me taking it in 1 go compared to spacing it out.
>
> >
> > Thanks for the advice. To answer your question..YES I have been dividing the dose!! Sounds like that may be a mistake!! I will try taking the 30mg all at once and see what happens!! Thanks again!!
> >
> >
>
>
Ok MAV, I will watch out for that too!! Thank you!
Posted by satsumas on August 30, 2008, at 12:22:39
In reply to Re: Best way to take Parnate? » mav27, posted by john51 on August 30, 2008, at 10:05:29
I'm surprised at the advice here...i think it's better to split the dose as much as possible, not for the MAOI effect, but for the amphetamine-like action of parnate. Parnate I believe has a pretty short half life so ideally 2-3 times a day spaced out (last dose taken mid afternoon if you have trouble sleeping) seems to be best...right?
Of course everyone is different.
Posted by john51 on August 30, 2008, at 12:31:07
In reply to Re: Best way to take Parnate?, posted by satsumas on August 30, 2008, at 12:22:39
> I'm surprised at the advice here...i think it's better to split the dose as much as possible, not for the MAOI effect, but for the amphetamine-like action of parnate. Parnate I believe has a pretty short half life so ideally 2-3 times a day spaced out (last dose taken mid afternoon if you have trouble sleeping) seems to be best...right?
>
> Of course everyone is different.
Okay, I am getting confused now....like I said before, I realize that I am only on day 3 taking Parnate but, I can't believe how awful I feel! I mean really weak, no energy at all, but not like I could sleep...not that I want to sleep during the day as that would increase the probablility of insomnia at night.....
Posted by mav27 on August 30, 2008, at 23:58:51
In reply to Re: Best way to take Parnate?, posted by satsumas on August 30, 2008, at 12:22:39
Not everyone gets that amphetamine type feeling from parnate.. for me (and it seems the OP) it can really sap the energy right out of you and make you feel crap at low doses.
When i went into hospital they decided to lower my dose to 10 mg.. it would put me to sleep for hours.
Posted by john51 on August 31, 2008, at 9:02:07
In reply to Re: Best way to take Parnate? » satsumas, posted by mav27 on August 30, 2008, at 23:58:51
> Not everyone gets that amphetamine type feeling from parnate.. for me (and it seems the OP) it can really sap the energy right out of you and make you feel crap at low doses.
>
> When i went into hospital they decided to lower my dose to 10 mg.. it would put me to sleep for hours.At the risk of seeming ignorant, what is "the OP"?
Posted by Quintal on August 31, 2008, at 10:21:12
In reply to Re: Best way to take Parnate?, posted by john51 on August 30, 2008, at 12:31:07
John, Parnate made me feel terrible at low doses. I became suicidal during the first week at 30mg, and very tired too. I only felt the amphetamine-like effects when I raised the dose to 40mg and then I started to feel better. My therapeutic dose was 80-120mg and at that range it was one of the best antidepressants I've ever taken. I would have had a very poor view of Parnate if I'd stopped at 30mg.
I used to take it in divded doses of about 30mg at a time throughout the day. The afternoon sleepiness is known as the 'parnate slump' among veterans of the drug. I found the best way around it was to take about three 30mg doses, one at breakfast, one at lunch and the third at about 5:00PM, or sometimes later. I found that intense fatigue and sleepiness set in about three or four hours after a 30mg dose, so I would take my last dose about four hours before I planned on going to bed. I had no trouble falling asleep using Parnate this way, although I was taking 4mg clonazepam with it.
Q
Posted by john51 on August 31, 2008, at 10:30:46
In reply to Re: Best way to take Parnate? » john51, posted by Quintal on August 31, 2008, at 10:21:12
> John, Parnate made me feel terrible at low doses. I became suicidal during the first week at 30mg, and very tired too. I only felt the amphetamine-like effects when I raised the dose to 40mg and then I started to feel better. My therapeutic dose was 80-120mg and at that range it was one of the best antidepressants I've ever taken. I would have had a very poor view of Parnate if I'd stopped at 30mg.
>
> I used to take it in divded doses of about 30mg at a time throughout the day. The afternoon sleepiness is known as the 'parnate slump' among veterans of the drug. I found the best way around it was to take about three 30mg doses, one at breakfast, one at lunch and the third at about 5:00PM, or sometimes later. I found that intense fatigue and sleepiness set in about three or four hours after a 30mg dose, so I would take my last dose about four hours before I planned on going to bed. I had no trouble falling asleep using Parnate this way, although I was taking 4mg clonazepam with it.
>
> QThanks Q, I am currnetly taking only 30mgs and I DO FEEL AWFUL!! I can't even get dressed, let alone leave my home. I felt that way often before I began the Parnate but it is MUCH WORSE now!! Granted, I have only been taking it for 5 days now but this is not at all what I expected!!
I got the impression from your response that you are no longer taking Parnate. Is that true and if you don't mind me asking, why?
John
Posted by Quintal on August 31, 2008, at 12:04:21
In reply to Re: Best way to take Parnate? » Quintal, posted by john51 on August 31, 2008, at 10:30:46
My pdoc would only prescribe 30mg as that's the upper recommended limit for Parnate here. I'm not a very obedient person... in the end I had to come off it because I kept running out and the dose he was willing to give me only made me feel worse. I hope your pdoc is more sympathetic than mine. I can't guanruntee that higher doses will be any different for you, but I hope you can give them a try before switching to something else. It's a very effective drug, when it works.
Q
Posted by john51 on August 31, 2008, at 12:47:52
In reply to Re: Best way to take Parnate? » john51, posted by Quintal on August 31, 2008, at 12:04:21
> My pdoc would only prescribe 30mg as that's the upper recommended limit for Parnate here. I'm not a very obedient person... in the end I had to come off it because I kept running out and the dose he was willing to give me only made me feel worse. I hope your pdoc is more sympathetic than mine. I can't guanruntee that higher doses will be any different for you, but I hope you can give them a try before switching to something else. It's a very effective drug, when it works.
>
> Q
I don't think that I could describe my pdoc as sympathetic. In fact, because I would not go for ECT treatment he told me that he wouldn't treat me any longer. It took a call from another doctor that wasn't comfortable prescribing Parnate (or any MAOI) to get him to "take me back". I do think he will be willing to raise the dosage above 30mg, possibly up to 60, but he doesn't have me scheduled to return for an entire month. I can't imagine feeling this way for a whole month!!john
Posted by Quintal on August 31, 2008, at 13:33:47
In reply to Re: Best way to take Parnate? » Quintal, posted by john51 on August 31, 2008, at 12:47:52
>In fact, because I would not go for ECT treatment he told me that he wouldn't treat me any longer.
That is awful.
Parnate made me very unwell during the first week or so, so I understand what you're going through. Can you call his office and ask for an emergency appointment?
Q
Posted by john51 on August 31, 2008, at 16:06:44
In reply to Re: Best way to take Parnate?, posted by Quintal on August 31, 2008, at 13:33:47
> >In fact, because I would not go for ECT treatment he told me that he wouldn't treat me any longer.
>
> That is awful.
>
> Parnate made me very unwell during the first week or so, so I understand what you're going through. Can you call his office and ask for an emergency appointment?
>
> QOh, I suppose that I could call and ask for an emergency appointment but I really hesitate because this doctor actually intimidates me..makes me feel defensive....makes me feel like a fool...I swear, I have never met another pdoc like him. When I am in his office, he doesn't even look at me he never asks me about my depression and how it manifests itself. I am afraid that if I called it would only irritate him. I know that this is NOT the way things should be...but he is the only pdoc that I know of that is willing to prescribe MAOIs....and I felt that I needed to try an MAOI again because years ago I did have some success with Nardil...but Nardil is different now (there's a whole web community about it) and the last time I tried it, it didn't work. So..I thought I would try Parnate....
I wish this could all be over...I wish I could just be normal and handle my life without these problems!!
john
Posted by Quintal on August 31, 2008, at 16:26:07
In reply to Re: Best way to take Parnate? » Quintal, posted by john51 on August 31, 2008, at 16:06:44
That sounds pretty much like my last pdoc. I'm still sure he's the closest thing to high functioning psychopath I've ever encountered! I always left feeling like a peice of sh*t he just wiped off his shoe. I don't know what to say because there doesn't seem an easy way out of that. I feel your pain. I only hope Parnate turns round and starts working for you at this lower dose.
Q
Posted by john51 on August 31, 2008, at 16:30:13
In reply to Re: Best way to take Parnate? » john51, posted by Quintal on August 31, 2008, at 16:26:07
> That sounds pretty much like my last pdoc. I'm still sure he's the closest thing to high functioning psychopath I've ever encountered! I always left feeling like a peice of sh*t he just wiped off his shoe. I don't know what to say because there doesn't seem an easy way out of that. I feel your pain. I only hope Parnate turns round and starts working for you at this lower dose.
>
> Q
You described the experience better than I did...that is how I feel after I see this doctor. I think that he has so much business that he could care less about one individual!!Thanks Q!
Posted by Nadezda on August 31, 2008, at 17:59:47
In reply to Re: Best way to take Parnate? » Quintal, posted by john51 on August 31, 2008, at 16:30:13
Good grief! Get a new pdoc. That sounds awful.
Parnate totally knocked me out, too. I don't think I got anything resembling a serious AD effect until I hit about 80 mg a day. At lower doses, I was so exhausted I didn't feel so bad- probably just never more than semi-awake. But I never really had much energy on the stuff. It was noticably better at higher doses-- I didn't fall asleep every few hours, for an hour or so-- but I never had anything like full alertness either.
The AD effect was enough to keep me on it-- at my Ts and friends' insistance-- but it was pretty awful.
I hope it works a lot better for you. But still, isn't there anyone in your area who prescribes Maois except this guy? Couldn't he consult with someone else, whom you could use as your primary pdoc. A pdoc who insists on ECT is dangerous.
Nadezda
Posted by john51 on August 31, 2008, at 19:29:43
In reply to Re: Best way to take Parnate? » john51, posted by Nadezda on August 31, 2008, at 17:59:47
> Good grief! Get a new pdoc. That sounds awful.
>
> Parnate totally knocked me out, too. I don't think I got anything resembling a serious AD effect until I hit about 80 mg a day. At lower doses, I was so exhausted I didn't feel so bad- probably just never more than semi-awake. But I never really had much energy on the stuff. It was noticably better at higher doses-- I didn't fall asleep every few hours, for an hour or so-- but I never had anything like full alertness either.
>
> The AD effect was enough to keep me on it-- at my Ts and friends' insistance-- but it was pretty awful.
>
> I hope it works a lot better for you. But still, isn't there anyone in your area who prescribes Maois except this guy? Couldn't he consult with someone else, whom you could use as your primary pdoc. A pdoc who insists on ECT is dangerous.
>
> NadezdaThank you for your reply Nadezda!
Believe me, if I can find a new pdoc, I WILL!!
I realize that if I can hang in there long enough to reach a therapeutic dose on the Parnate it could work and end up being worth it...I just don't know if I can stand feeling this weak and exhausted and "out of it" for that long!!
John
Posted by djmmm on August 31, 2008, at 19:42:22
In reply to Best way to take Parnate?, posted by john51 on August 29, 2008, at 15:01:19
> I just started taking Parnate. My pscript is for 10mg 3 times a day. I have read and heard that Parnate can cause insomnia and that is the last thing that I want to happen. So, normally I would take a 3 a day med every 6-8 hours thinking about the most "even" distribution of the med in my system...right? But, because I don't want to experience insomnia, which I already have problems with and don't want it to get worse, I am wondering what other people taking Parnate do and how important it is to "evenly" spread out the 3 a day dosage.
I take 20mg in the morning (6 or 7am) and another 30mg at noon...I have found that your body will pretty much adjust to any dosage schedule over time. I think most people agree that you should not take it in the evening.
Posted by eric wagner on August 31, 2008, at 22:49:10
In reply to Re: Best way to take Parnate? » Quintal, posted by john51 on August 31, 2008, at 16:06:44
> > >In fact, because I would not go for ECT treatment he told me that he wouldn't treat me any longer.
> >
> > That is awful.
> >
> > Parnate made me very unwell during the first week or so, so I understand what you're going through. Can you call his office and ask for an emergency appointment?
> >
> > Q
>
> Oh, I suppose that I could call and ask for an emergency appointment but I really hesitate because this doctor actually intimidates me..makes me feel defensive....makes me feel like a fool...I swear, I have never met another pdoc like him. When I am in his office, he doesn't even look at me he never asks me about my depression and how it manifests itself. I am afraid that if I called it would only irritate him. I know that this is NOT the way things should be...but he is the only pdoc that I know of that is willing to prescribe MAOIs....and I felt that I needed to try an MAOI again because years ago I did have some success with Nardil...but Nardil is different now (there's a whole web community about it) and the last time I tried it, it didn't work. So..I thought I would try Parnate....
>
> I wish this could all be over...I wish I could just be normal and handle my life without these problems!!
>
> john
>I am really scared what I might do to my PDoc b/c of the same issues.
I'm still young & stupid
Posted by eric wagner on August 31, 2008, at 22:52:10
In reply to Re: Best way to take Parnate? » john51, posted by Nadezda on August 31, 2008, at 17:59:47
> Good grief! Get a new pdoc. That sounds awful.
>
> Parnate totally knocked me out, too. I don't think I got anything resembling a serious AD effect until I hit about 80 mg a day. At lower doses, I was so exhausted I didn't feel so bad- probably just never more than semi-awake. But I never really had much energy on the stuff. It was noticably better at higher doses-- I didn't fall asleep every few hours, for an hour or so-- but I never had anything like full alertness either.
>
> The AD effect was enough to keep me on it-- at my Ts and friends' insistance-- but it was pretty awful.
>
> I hope it works a lot better for you. But still, isn't there anyone in your area who prescribes Maois except this guy? Couldn't he consult with someone else, whom you could use as your primary pdoc. A pdoc who insists on ECT is dangerous.
>
> NadezdaPeople like me have been to every PDoc in the area
Wish it was as easy as switching Dr's.
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