![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 53 to 77 of 106. Go back in thread:
Posted by SLS on December 18, 2008, at 6:37:51
In reply to TRD --SLS, CPTAmerica, posted by desolationrower on December 17, 2008, at 23:01:12
> Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason?
Not really. I just remember that, during the first few days of modafinil treatment (added to imipramine and Lamictal), I felt some pretty good stuff, and just wondered if it might not be a great augmenter of an MAOI. Unfortunately, toward the end of the first week, I deteriorated; an increase in the severity of my depression that lasted for weeks after the discontinuation of modafinil. Was there a glutamatergic antagonism by modafinil of Lamictal that caused this? I can't be sure.
If one really thought they could hand-pick drugs based on their properties, I guess there would be no concrete rationale that I am aware for why there might be a synergistic effect between the two drugs. I am still not convinced that modafinil is fully understood, and that dopamine reuptake inhibition explains its wake-promoting effect. If anything, it might help with vigilance. Wake promotion seems to be the result of orexin (hypocretin) interactions in the hypothalamus and reticular formation. One wouldn't necessarily think of this as being important in the etiology of depression. I have yet to read about just where and how dopaminergic flow is enhanced by modafinil.
- Scott
Posted by desolationrower on December 18, 2008, at 12:01:10
In reply to Re: TRD --SLS, CPTAmerica » desolationrower, posted by SLS on December 18, 2008, at 6:37:51
> > Scott, you've mentioned modafinil+MAOI as synergistic, any particular reason?
>
> Not really. I just remember that, during the first few days of modafinil treatment (added to imipramine and Lamictal), I felt some pretty good stuff, and just wondered if it might not be a great augmenter of an MAOI. Unfortunately, toward the end of the first week, I deteriorated; an increase in the severity of my depression that lasted for weeks after the discontinuation of modafinil. Was there a glutamatergic antagonism by modafinil of Lamictal that caused this? I can't be sure.
>
> If one really thought they could hand-pick drugs based on their properties, I guess there would be no concrete rationale that I am aware for why there might be a synergistic effect between the two drugs. I am still not convinced that modafinil is fully understood, and that dopamine reuptake inhibition explains its wake-promoting effect. If anything, it might help with vigilance. Wake promotion seems to be the result of orexin (hypocretin) interactions in the hypothalamus and reticular formation. One wouldn't necessarily think of this as being important in the etiology of depression. I have yet to read about just where and how dopaminergic flow is enhanced by modafinil.
>
>
> - ScottYeah, it seems to be one of the least understood meds. I think it also increase 5ht efflux in pfc, so that would make it one of the few meds with 5htergic properties that can be taken with an MAoi, although i guess a number have similar downstream effects. Also interesting the 'hibernation' theory of depression vs. antiD effects of sleep deprivation, hypocretin activation.
-d/r
Posted by desolationrower on December 18, 2008, at 12:26:42
In reply to Re: TRD --SLS, CPTAmerica, posted by CaptainAmerica1967 on December 18, 2008, at 4:06:01
> Thanks for your feedback.
>
> I haven't tried buprenorphine, but have been interested in it as I'm interested in almost anything that could bring about a better life. I'm not sure about the drug interaction with Parnate and would have to do some more research on it. I have a gut feeling my depression could be related to some sort of malfuncition with the hypothalamus-pituitary-adrenal axis (hot flashes or feeling warm all the time)-cortisol, endorphins, neurotransmitters. Obviously exercise affects mood as a result from many different physiological mechanisms, but it's only the intense physical exercise that produces the slight euphoria and antidepressant effect I feel which could be attributed to endorphins hence buprenorphine or naltrexone might help. Also, my father got "hooked" on heroin the first time he tried it in 1972 and died from an accidental overdose (sad to know that the following day he was suppose to go in for treatment, but never made it) so this could point to my depression as having some type of opioid dysfunction. Dextromethorphan would be interesting to try too if I weren't on an MAOI.Hm, given the relationship of opiods and your family tradegies i can see it being a complicated subject for you.
One more idea i thought of last night, stimulant-type drugs seem to help, have you ever gotten ahold of an H3 antagonist? Betahistine is the only one i think that is easily availible, its also a H1 agonist i think. Its used for some sort of ear dysfunction i think, but H3 antagonists are being tested for ADHD. Given its rather broad effects (h3 antongoism on heteroreceptors disinhibits a number of neurotransmitters) slow titration since you're on an MAOI would probably be wise although no reactions have been reported. Additionally, betahistine may be metabolised by MAO so much lower doses might be needed. -> THE METABOLISM OF BETAHISTINE IN THE RAT
L. A. STERNSON 1, A. J. TOBIA 1, G. M. WALSH 1, and A. W. STERNSON 1
ABSTRACT
The metabolism of betahistine, 2-(2-methylaminoethyl)pyridine, a bio-isostere of histamine, was studied in the rat. 2-Pyridylacetic acid, which had been previously isolated as a metabolite of betahistine from dog and rabbit urine, was isolated from rat urine as well as from rat liver homogenates. In addition, trace amounts of the N-demethylated product, 2-(2-aminoethyl)pyridine, was isolated from liver homogenates. In vitro studies revealed that the preponderance of betahistine oxidase activity originated in liver mitochondria and was attributable to monoamine oxidase (MAO). The participation of mitochondrial MAO in metabolism was corroborated by inhibiting betahistine oxidation with specific MAO inhibitors. Additional experiments ruled out the involvement of diamine oxidase in betahistine metabolism. The kinetics for the MAO-catalyzed oxidation of betahistine was studied and revealed that betahistine had a greater affinity for mitochondrial MAO (KM = 3.3 x 10-5 M) than did tyramine, serotonin, or benzylamine.Also, read this patent application for betahistine use-> http://www.wipo.int/pctdb/en/wo.jsp?wo=2007076140&IA=US2006049321&DISPLAY=DESC
Lots of stuff in there, they think it normalises HPA same as MAOIs.
Hm, someone else had the same idea, i found this now: ongoing study -> http://clinicaltrials.gov/ct2/show/NCT00585585Quite promising.
-d/r
Posted by JadeKelly on December 18, 2008, at 18:04:23
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 17, 2008, at 21:11:43
Hi Jeff,
This is too long but IM DESPERATE!! I developed a tr/mdd about 3 years ago after a cluster of family tragedies struck in a very short time. It developed into apathy/numbness/not leaving my room/bed. I can't tolerate most a/d's, especially ssri's. I've been on Parnate for ten weeks and have been at 60mg for 3 days, wieght 125lbs. How high should I go? I got a week long reprieve/high following initial dose of 30mg, then 2-3 days of this when I increase dose. I honestly can't tell how well the A/d effect is because I am SO lethargic. It should be working by now, right? Whats the longest Parnate should take to work? I do think my mood is better. If I wasnt lethargic, I think the rest would fall into place. Was this your experience at all?
Our depresions sound similar, except I have never suffered from anxiety but am starting to as I lose hope with this catch 22 I seem to be in. I, too, get pretty intense high when I do a difficult workout. Don't know if thats everyone, or just some. Haven't done it for a while due to fatigue and fear of BP irregularities. I forgot to mention, BP always on the low side, but even when I can get it up to 120/80, I'm still lethargic. I need ritalin for a while as I'm very familiar with it and I can switch or add nortriptyline when fatigue/lethargy wears off.
Right now the only drug I take is 3mg klonopin, been taking it for years for a nerve injury in my neck. REALLY want to stop taking it and see if I still need it. Have no psychological dependence on it but don't want w/d's to interfere with Parnate benefit. Do you think I should taper off now? Or wait?
It makes sense to me, due to my ignorance in this subject, to copy your regimen (one that I was headed towards! I wanted ritalin or nortriptyline) and that advised to you by one of the leading tr/dep PDoc's, Dr. Gordon I think it is, in New york. I took Ritalin for 12 years for ADD, as diagnosed by only PDoc, and I responded to it beautifully. I don't have an addictive personality at all so I was able to go from original dose of 5mg 3x day to 5mg 5xday during those 12 years. (I often wonder if it wasn't working as a mild A/D also) Pdoc made me d/c with MAOI, will not talk about augment to get me up and moving. But no risk to bedridden 24/7??
My current problem, I have lost faith in my PDoc, he is not at all creative with despensing of meds, and I realize that he doesn't seem to care much that I've became deeply depressed, then onto apathetic and numb, in front of his very eyes. The only reason I'm on an MAOI is that I was following a poster (before I joined), RobertDavid, who was trying the patch. I took that and had the same immediate reaction (great). When I had to go up to 9mg patch it made sense to switch to Parnate.
So, I need Doc to prescribe first choice, low dose Ritalin (5mg 3-5x day), to get me up and moving, then maybe 2nd choice, nortriptyline or amitriptyline, and I noticed a 3rd you take Li??, would you recommend? It sounds like you are not in full remission, in what way: depression, fatigue, apathy, etc?
Finally, and most importantly, how does one go about getting much needed medication from a PDoc who is experienced enough to not be overly conservative, like the one you consulted with ? This is getting to be an emergency for me as I have to go back to work (not to mention the time of year) Do Docs scribe with phone consult? I've only had the one. ANY help appreciated.
Posted by JadeKelly on December 18, 2008, at 18:23:36
In reply to Re: TRD --SLS, CPTAmerica » desolationrower, posted by SLS on December 18, 2008, at 6:37:51
Hi Scott, Hi d/r,
I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
Thanks for any help with this-Jade
Posted by CaptainAmerica1967 on December 18, 2008, at 19:30:21
In reply to Re: TRD --SLS, CPTAmerica » CaptainAmerica1967, posted by desolationrower on December 18, 2008, at 12:26:42
Wow, interesting...learn something new everyday.
I'm familiar with vertigo and Meniere's Disease, but had never heard of Betahistine. I guess it's not available in the USA, but available mainly in the UK and maybe Canada.
I have to read over the information again, but it sounds like a good med to try. Doesn't specify if there's any drug interaction with an MAOI, but I'll search for some more information on it.
Wikipedia states that "The H3 receptor has also been shown to presynaptically inhibit the release of a number of other neurotransmitters (i.e. it acts as an inhibitory heteroreceptor) including, but probably not limited to dopamine, GABA, acetylcholine, noradrenaline, and serotonin" so betahistine as an H3 receptor antagonist would increase these neurotransmitters.
Thanks for the info...interesting to see that a study is being done on betahistine in relation to atypical depression.
Jeff
Posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by JadeKelly on December 18, 2008, at 18:04:23
Hi,
Sorry to hear you'r not feeling better.
I think dosage is an individual thing. The PI states the normal dose of Parnate is from 20mg-80mg, but I know it can be dosed higher. Dr. Ivan Goldberg, a psychiatrist in the New York City area says that's just an average range and one could go higher. He see severe TRD and has good luck giving an; MAOI+TCA(orpsychostimulant)+Lithium.
If you current psychiatrist isn't willing to work with you (show him some evidence that other psychiatrists use the above combination), fire him and find someone new. If all else fails, order via a mail order pharmacy not requiring a doctor's RX.
A night of sleep deprivation can boost me out of the fatigue and excessive sleepiness I experiencemuch of the time.
Posted by Phillipa on December 18, 2008, at 21:09:30
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
Captain have heard his name come up frequently how would someone contact him? Thanks isn't there a site with send e-mail? Phillipa
Posted by desolationrower on December 18, 2008, at 21:14:30
In reply to TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by JadeKelly on December 18, 2008, at 18:23:36
> Hi Scott, Hi d/r,
>
> I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
>
> Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
>
> Thanks for any help with this-JadeWell, mine said i haven't tried enough things yet for a drastic treatemtn like tca+maoi or stim+maoi.
You just havent earned it yet, baby
You just havent earned it, son
You just havent earned it yet, baby
You must suffer and cry for a longer time
You just havent earned it yet, babyAnyway, if you had read the post i wrote specifically for you in the SAMe thread, i had a suggestion for your fatigue. But you love chatting so i'll tell you again. Go buy some creatine, i think it might help with MAOI induced fatigue independent of hypotension. Also, acetyl l carnitine might help, although i don't think MAOIs create a unique need for it so it'll have hte same effect as if you weren't on one. But it helps some fatigue conditions.
-d/r
Posted by CaptainAmerica1967 on December 18, 2008, at 21:28:01
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by Phillipa on December 18, 2008, at 21:09:30
Do you mean Ivan Goldberg, M.D.?
Posted by CaptainAmerica1967 on December 18, 2008, at 21:31:44
In reply to Re: Treatment Resistant (Refractory) Depression » CaptainAmerica1967, posted by JadeKelly on December 18, 2008, at 18:04:23
You might also try cold showers. Takes a little bit of getting used to but it's stimulating (enhances endorphins and norepinephrine) and helps with fatigue.
Posted by JadeKelly on December 18, 2008, at 21:41:19
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
Posted by JadeKelly on December 18, 2008, at 21:47:02
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » JadeKelly, posted by desolationrower on December 18, 2008, at 21:14:30
Posted by CaptainAmerica1967 on December 18, 2008, at 22:10:55
In reply to TRD/PARNATE LETHARGY Thanks d/r, Jade (nm) » desolationrower, posted by JadeKelly on December 18, 2008, at 21:47:02
From PubMed Adpated cold shower for treatment of depression
Depression is a debilitating mood disorder that is among the top causes of disability worldwide. It can be characterized by a set of somatic, emotional, and behavioral symptoms, one of which is a high risk of suicide. This work presents a hypothesis that depression may be caused by the convergence of two factors: (A) A lifestyle that lacks certain physiological stressors that have been experienced by primates through millions of years of evolution, such as brief changes in body temperature (e.g. cold swim), and this lack of "thermal exercise" may cause inadequate functioning of the brain. (B) Genetic makeup that predisposes an individual to be affected by the above condition more seriously than other people. To test the hypothesis, an approach to treating depression is proposed that consists of adapted cold showers (20 degrees C, 2-3 min, preceded by a 5-min gradual adaptation to make the procedure less shocking) performed once or twice daily. The proposed duration of treatment is several weeks to several months. The following evidence appears to support the hypothesis: Exposure to cold is known to activate the sympathetic nervous system and increase the blood level of beta-endorphin and noradrenaline and to increase synaptic release of noradrenaline in the brain as well. Additionally, due to the high density of cold receptors in the skin, a cold shower is expected to send an overwhelming amount of electrical impulses from peripheral nerve endings to the brain, which could result in an anti-depressive effect. Practical testing by a statistically insignificant number of people, who did not have sufficient symptoms to be diagnosed with depression, showed that the cold hydrotherapy can relieve depressive symptoms rather effectively. The therapy was also found to have a significant analgesic effect and it does not appear to have noticeable side effects or cause dependence. In conclusion, wider and more rigorous studies would be needed to test the validity of the hypothesis.
PMID: 17993252 [PubMed - indexed for MEDLINE]
Posted by SLS on December 18, 2008, at 23:50:46
In reply to TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by JadeKelly on December 18, 2008, at 18:23:36
> I'm at 10 weeks of Parnate, 3 days at 60mg.
Try to stick with it. Caffeine helps. Eventually, this side effect will pass. I used caffeine pills just like any other drug. Use as little as will produce the desired effect so as not to grow tolerant of stimulation. 100-200mg taken in late morning is all I usually need to get a kick that lasts the whole day.
See if Robert Post, MD still has a private practice in Chevy Chase. Also, I would highly recommend Kay Redfield Jameson, MD, PhD. at Johns Hopkins University. Even if these people are unable to take you on as a patient, I am sure they will direct you to ones that will. Impress upon them your desire to combine Parnate with nortriptyline or desipramine. That should be the "litmus test" for finding a doctor.
- Scott
Posted by JadeKelly on December 19, 2008, at 21:49:14
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » JadeKelly, posted by desolationrower on December 18, 2008, at 21:14:30
> > Hi Scott, Hi d/r,
> >
> > I'm at 10 weeks of Parnate, 3 days at 60mg. Whole post is above to Jeff. My immediate problem is My PDoc (the only one I've had) is unwilling to add anything to Parnate. So here I am completely lethargic, I mean can hardly get out of bed kind, and I have to go back to work, my life, etc. He's not gonna budge, so new PDoc. How does everyone find Pdocs that are current enough to prescribe things like Ritalin w/MAOI? Or Nortriptyline?
> >
> > Anybody consult with more liberal docs by phone? I can't believe he's left me in this position. Sucks. ANY advise/help most appreciated. I'm in Maryland, btw, 45 minutes from NIH. Scott?
> >
> > Thanks for any help with this-Jade
>
> Well, mine said i haven't tried enough things yet for a drastic treatemtn like tca+maoi or stim+maoi.
>
> You just havent earned it yet, baby
> You just havent earned it, son
> You just havent earned it yet, baby
> You must suffer and cry for a longer time
> You just havent earned it yet, baby
>
> Anyway, if you had read the post i wrote specifically for you in the SAMe thread, i had a suggestion for your fatigue. But you love chatting so i'll tell you again. Go buy some creatine, i think it might help with MAOI induced fatigue independent of hypotension. Also, acetyl l carnitine might help, although i don't think MAOIs create a unique need for it so it'll have hte same effect as if you weren't on one. But it helps some fatigue conditions.
>
> -d/rI've suffered plenty thank you and I've earned some normalcy as well IMHO. I'm not cognitively functioning as it is d/r, how am I supposed to find a post "specifically for me" if you don't put my name on it? Please stay out of that "box" under the sink. I know you like to play under there (oops, sorry, chatting again). Well, geuss what I got in one day? 120 5mg Ritalin. I'll give you a moment to be jealous........OK, took one didn't feel it at all???? Why?? Also, I've probably asked this a hundred times but if Parnate is going to work for me, how much longer for significant improvement?? Isn't 10 weeks long enough for ANYONE???? I hate to even ask this, but when do ya call it a day? When is Parnate screaming I WILL NEVER HELP YOU!!!
Thanks, I'll keep ya posted on the ritalin.
~Jade-day 4 on 60mg Parnate/over 10 wks...ugghh
Posted by JadeKelly on December 19, 2008, at 23:38:33
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by SLS on December 18, 2008, at 23:50:46
> > I'm at 10 weeks of Parnate, 3 days at 60mg.
>
> Try to stick with it. Caffeine helps. Eventually, this side effect will pass. I used caffeine pills just like any other drug. Use as little as will produce the desired effect so as not to grow tolerant of stimulation. 100-200mg taken in late morning is all I usually need to get a kick that lasts the whole day.
>
> See if Robert Post, MD still has a private practice in Chevy Chase. Also, I would highly recommend Kay Redfield Jameson, MD, PhD. at Johns Hopkins University. Even if these people are unable to take you on as a patient, I am sure they will direct you to ones that will. Impress upon them your desire to combine Parnate with nortriptyline or desipramine. That should be the "litmus test" for finding a doctor.
>
>
> - ScottScott, thanks for the names, my son sees a neurologist at Hopkins, my family goes there for everything, so I'll start there. I was able to get 120 5mg ritalin today. Strange, I took one and didn't really feel it. Walgreens, so I'm sure its ok. But no adverse reaction so I'll stick with the program for now. I am getting really worried that this fatigue/lethargy isn't going away. BE HONEST: when is it time to say this isn't going to work? I have the best combo (according to that NY DOC): Parnate, Ritalin, and I even found a script for lithium Carb ER, 450mg. Should I take it? how much? Especially want to know when a Parnate trial is officially over.
Hope to hear from you,
~Jade-i'm an idiot, I just realized it was Jeff's Doc in New York. Just need dosages from him, unless you know them. Also have months supply of Lamictal.
Posted by desolationrower on December 20, 2008, at 0:49:34
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » desolationrower, posted by JadeKelly on December 19, 2008, at 21:49:14
> I've suffered plenty thank you and I've earned some normalcy as well IMHO. I'm not cognitively functioning as it is d/r, how am I supposed to find a post "specifically for me" if you don't put my name on it? Please stay out of that "box" under the sink. I know you like to play under there (oops, sorry, chatting again). Well, geuss what I got in one day? 120 5mg Ritalin. I'll give you a moment to be jealous........OK, took one didn't feel it at all???? Why?? Also, I've probably asked this a hundred times but if Parnate is going to work for me, how much longer for significant improvement?? Isn't 10 weeks long enough for ANYONE???? I hate to even ask this, but when do ya call it a day? When is Parnate screaming I WILL NEVER HELP YOU!!!
>
> Thanks, I'll keep ya posted on the ritalin.
>
> ~Jade-day 4 on 60mg Parnate/over 10 wks...ugghh
>
>ha, you always want something from me...now its for me to be jealous....sure didn't take you long to get your drug...people with fatigue usually takea while to accomplish things...whats going on
what sleep drug are you using? maybe you're not actually getting restful sleep at night.
Make sure you get outside when the high or if you're in a dreary area of the world, buy some super high intensity lamps.
and weird AD response often = bipoalr
might want to add that lamotrigine-d/r
Posted by SLS on December 20, 2008, at 6:49:17
In reply to Lithium. ritalin, Parnate-have it-SCOTT » SLS, posted by JadeKelly on December 19, 2008, at 23:38:33
Before the age of Lamictal, lithium was considered the augmenter of choice for Parnate. If it doesn't work within 2 weeks, it is probably not going to. It usually works within a week. Of course, it will be necessary to have established a dosage of Parnate that is going to be high enough for this strategy to work. What is that dosage? Odds are, 60mg for 2 weeks should be enough - ideally, 3 weeks. The dosage of lithium when used as an augmenter has been established by Harvard to be 300-600mg.
It is important to note that Lamictal is not lithium and lithium is not Lamictal. Lithium might work where Lamictal may not. It makes sense to try the lithium first and get it over with within 1-2 weeks. Establishing a therapeutic level of Lamictal will take a minimum of 6 weeks.
One step at a time.
Did you try caffeine yet? For some people, it is more effective than Dexedrine or Ritalin.
- Scott
Posted by JadeKelly on December 20, 2008, at 12:58:52
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by desolationrower on December 20, 2008, at 0:49:34
Hey d/r,
So many people say that to me, I always assume that when you don't respond the way the Doc wants you to its automatically BiPolar. I don't feel bi-polar, never been manic, tried lithium once, must not have liked it, still have it. I dont know. Do I seem bi-polar to you? This is also my first real depression. I geuss I'll keep trying and add the lithium or lamictal. Believe it or not, my local GP gave the R to me, 3 minutes from me. I was practically falling asleep in her office. I don't sleep all day, I'm just too lethargic to do anything. That doesn't happen to you? LUCKY!
~Jade
Posted by JadeKelly on December 20, 2008, at 13:11:57
In reply to Re: Lithium. ritalin, Parnate-have it-SCOTT » JadeKelly, posted by SLS on December 20, 2008, at 6:49:17
> Before the age of Lamictal, lithium was considered the augmenter of choice for Parnate. If it doesn't work within 2 weeks, it is probably not going to. It usually works within a week. Of course, it will be necessary to have established a dosage of Parnate that is going to be high enough for this strategy to work. What is that dosage? Odds are, 60mg for 2 weeks should be enough - ideally, 3 weeks. The dosage of lithium when used as an augmenter has been established by Harvard to be 300-600mg.
>
> It is important to note that Lamictal is not lithium and lithium is not Lamictal. Lithium might work where Lamictal may not. It makes sense to try the lithium first and get it over with within 1-2 weeks. Establishing a therapeutic level of Lamictal will take a minimum of 6 weeks.
>
> One step at a time.
>
> Did you try caffeine yet? For some people, it is more effective than Dexedrine or Ritalin.
>
>
> - ScottHey Scott,
Thanks for the quick response. Today is my 6th day on 60mg Parnate. So I geuss I'll know soon. I've always gotten that occasional high with dose increase, but thats all I've noticed. I've also wondered if I would notice as lethargic as I am. I do drink coffee, always have. it helps a little, not much. I'm now trying ritalin, but I took one yesterday, barely noticed it if at all. This fatigue is like nothing I've ever felt. So, I'll give it a couple more weeks then. Add the lithium and ritalin.Thanks-Jade
>
>
>
>
Posted by Vincent_QC on December 21, 2008, at 11:22:11
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R, posted by desolationrower on December 20, 2008, at 0:49:34
> ha, you always want something from me...now its for me to be jealous....sure didn't take you long to get your drug...people with fatigue usually takea while to accomplish things...whats going on
>
> what sleep drug are you using? maybe you're not actually getting restful sleep at night.
>
> Make sure you get outside when the high or if you're in a dreary area of the world, buy some super high intensity lamps.
>
> and weird AD response often = bipoalr
> might want to add that lamotrigine
>
> -d/rHumm I totally disagree with that statement. That's doesn't mean your BP at all, that just your brains who are differents than the others people. Lamictal can be add only if your AD treatment is not stable, mean that if you feel good mosttly of the time but sometimes you get down, like everyone in the world who don't take AD drugs, the Lamictal will make your AD treatment more stable...
d/r is prorably right a bout the fact that people who are tired take a lot of time to accomplish things...I have something like 5 appointments to take and I never call...I have a lot of things left aside that need to be done but I can't find the energy to do it.
I searching for 14 years a good drug for depression and social phobia without finding one and I can really say that i'm not BP...
I'm also on Parnate since 3 weeks now, and I have big hope on it, even if at 30mg/day since today, I feel like my heart do a racing and that I just do a marathon ...lol I'm also often cold...I mean that even if the heat is turn on , i'm always frozen...normally I always sleep with the window open a little bit, even if it's minus 10 celsius outside...now forget this...
But you're probably right about the fact that maybe JadeKelly are not actually getting restful sleep at night...That's what happen with me right now and my day are not very productive, I often lying in my bed all the afternoon...
Parnate seem to be stimulant at first, maybe 2 or 3 hours of time after you take your doses...but after it's seem to leave you without energy. I guess the body will adjust to that side-effect with time.
I add coffee in my daily regiment. I had some Wake-up pills but I react badly with chimical caffein...SO i just drink maybe 5 cups maximum by day, without drinking coffee after 3 pm to avoid insmonia...I try at least to avoir it after 3 PM...lol
I never find Riatlin to be very stimulating or effective for a long time...you need more than 15 mg to feel something...5 mg do less effect than a cup of coffee...but in contrast, if you take more than 15mg, in my case, you can have a LOT anxiety...it's why I never really wanted to ask for Adderall-Xr...that's seem to be too strong for me...and on MAOI's I don't think it's very safe anyway...Ritalin seem to be less dangerous and powerfull.
And in my case again, I find the Parnate to be LESS sedating than all the newer SSRI'S or SRNI'S...even the Wellbutrin-xr. I don't feel LAZY on Parnate, I just feel tired because I don't sleep well at night...On newer AD drug, I feel totally pass out and in the fog all day long, I don't want to do anything, i'm just lazy and apathic. So in that case, a more stimulating drug is a good choice and Parnate seem to be the one to get...since Wellbutrin-xr don't have this stimulant effect even if it work on DA and NE...That drug just want make you cry all day long.
TAke fresh air and a lot of sun light is also good...luminotheraphy is very popular...but the lamp is at a high price. I like to go to the tanning....I know that's not very good for the skin, but 15 minutes of hot feeling on the skin make me more relax...especially in the winter.
Well, another time, it was just my point of view, i'm not a psychiatrist or a doctor, so I can't say if you are BP or not...but I just don'T think because someone don't react well to a lot of drugs that it mean this person is BP...
Have a good day JadeKElly and I hope everything is fine now ;-)
Posted by elanor roosevelt on December 21, 2008, at 12:24:31
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » desolationrower, posted by Vincent_QC on December 21, 2008, at 11:22:11
it might be the parnate is not a good fit
that lethargy did me in to the point of self-loathing
that said, i've had few successes
do you see a therapist to talk?
Posted by JadeKelly on December 21, 2008, at 12:35:33
In reply to Re: TRD/PARNATE LETHARGY HELP!!!! SCOTT + D/R » desolationrower, posted by JadeKelly on December 20, 2008, at 12:58:52
D/R,
Don't want to jinx myself but I gotta tell someone on this board, and YOUR IT! Not to make you jealous but to share what I did and hopefully this continues! Oh, I did tell Phillipa. She'd find out anyway. Day before yesterday, I took one 5mg Ritalin and felt nothing. I figured all the stim action in the Parnate canceled it out or something. But yesterday, it hit me around lunch time and hasn't stopped since. I feel like a normal human being! Like I did before depression! So I kept watch of my BP, it went up for small amount of time, then normal again. I was outa bed, cooked dinner, watched TV, haven't done that forever, spent time with my son and dogs. I'm on my 7th day of 60mg, and damn if that isn't when Scott said that it should kick in recently. And I forgot that till just now. No, I'm not imagining it. I asked him when to give it up and he said in one to three weeks after you hit your dose, for me he said 60mg (I would have gone to 70). So there it is! Ritalin (only one 5mg a day!) and 60mg of Parnate. Total time, 10 weeks. I've told you this but I took Ritalin for 12 years for ADD, and stopped a few months ago to try a/d's. Felt no withdrawal. My dose started at 5mg 3x day, then ended at 5mg 5x day, 12 years later. Never abused it. So there it is! I'll keep you posted, but if this continues, I highly recommed it. Oh, also taking klonopin 1mg 3x day. Don't need it but I'm not changing anything right now. If I start feeling tired again, I'll taper off the klon. And maybe add Lithium.
~Jade -
Btw-Thnx d/r for your help, hopefully all my pestering will help us both! This was one of two combos that PDoc in New york recommeneded for tr/dep: Parnate + stim + lithium. I have lithium so if I start goin south, I'll add that. Other was what we considered anyway: Parnate + Nort + ?
Posted by desolationrower on December 21, 2008, at 15:13:34
In reply to Re: Parnate Lethargy Jade to D/R » JadeKelly, posted by JadeKelly on December 21, 2008, at 12:35:33
> D/R,
>
> Don't want to jinx myself but I gotta tell someone on this board, and YOUR IT! Not to make you jealous but to share what I did and hopefully this continues! Oh, I did tell Phillipa. She'd find out anyway. Day before yesterday, I took one 5mg Ritalin and felt nothing. I figured all the stim action in the Parnate canceled it out or something. But yesterday, it hit me around lunch time and hasn't stopped since. I feel like a normal human being! Like I did before depression! So I kept watch of my BP, it went up for small amount of time, then normal again. I was outa bed, cooked dinner, watched TV, haven't done that forever, spent time with my son and dogs. I'm on my 7th day of 60mg, and damn if that isn't when Scott said that it should kick in recently. And I forgot that till just now. No, I'm not imagining it. I asked him when to give it up and he said in one to three weeks after you hit your dose, for me he said 60mg (I would have gone to 70). So there it is! Ritalin (only one 5mg a day!) and 60mg of Parnate. Total time, 10 weeks. I've told you this but I took Ritalin for 12 years for ADD, and stopped a few months ago to try a/d's. Felt no withdrawal. My dose started at 5mg 3x day, then ended at 5mg 5x day, 12 years later. Never abused it. So there it is! I'll keep you posted, but if this continues, I highly recommed it. Oh, also taking klonopin 1mg 3x day. Don't need it but I'm not changing anything right now. If I start feeling tired again, I'll taper off the klon. And maybe add Lithium.
>
> ~Jade -
>
> Btw-Thnx d/r for your help, hopefully all my pestering will help us both! This was one of two combos that PDoc in New york recommeneded for tr/dep: Parnate + stim + lithium. I have lithium so if I start goin south, I'll add that. Other was what we considered anyway: Parnate + Nort + ?Hey now how am i going to figure out if creatine has anti-fatigue effects in MAOI takers? Sounds like you found a good combination though. keep me updated. oh and promise you'll be carful if you notice signs of hypomania. not sure what i'll do, if the klonopin helps my anxiety i gues i'll have to stick with the pdoc, maybe i'll ask about guanfacine for days i am studying. if not i might go rogue again and try reboxetine or nortriptiline.
so is the ritalin what helped or is the parnate just kicking in on its own? maybe its not clear.
-d/r
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