![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 57 to 81 of 106. Go back in thread:
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
Posted by desolationrower on December 21, 2008, at 15:22:00
In reply to Re: Parnate Lethargy Jade to D/R, posted by desolationrower on December 21, 2008, at 15:13:34
My guess is it would cost an arm and a leg, but ever try growth hormone? especially since MAOIs, excersise helps you the most. and i think you said GHB did as well. i think GH->igf-1
Running exercise- and antidepressant-induced increases in growth and survival-associated signaling molecules are IGF-dependent.
Chen MJ, Russo-Neustadt AA.Department of Biological Sciences, California State University, 5151 State University Drive, Los Angeles, CA 90032, USA. mchen@calstatela.edu
It is known that physical exercise increases hippocampal brain-derived neurotrophic factor (BDNF) mRNA and protein, as well as the expression of several pro-survival signaling proteins and that many of these effects depend on the uptake of peripheral insulin-like growth factor-1 (IGF-1) into the CNS. Because treatment with antidepressants has similar effects upon neurotrophin expression, we investigated whether antidepressant-induced BDNF changes also depend on IGF-1 uptake, as well as whether IGF-1 plays a role in the exercise/antidepressant-induced expression of molecules associated with plasticity/growth (GAP-43, SCG-10) and the intracellular activation of molecules associated with neuronal survival (Akt, ERK1/2). We evaluated the effects of a well known monoamine oxidase inhibitor, tranylcypromine, on BDNF mRNA and protein levels and phospho-Akt and phospho-ERK1/2 immunoreactivity, both with and without systemic blockade of IGF-1 uptake through the use of an antiserum raised against IGF-1. Anti-IGF-1 reversed the increase in BDNF mRNA and protein elicited by exercise as well as tranylcypromine. Exercise also significantly enhanced transcription of axon growth protein, GAP-43, an effect that was also evidenced to be IGF-1-dependent. The combination of exercise-plus-tranylcypromine also increased several cell survival signaling measures, but the BDNF changes associated with the combination treatment appeared to be independent of IGF-1 uptake. Together, these results indicate that the uptake of peripheral IGF-1 in the CNS is essential for antidepressant- as well as exercise-induced enhancement in hippocampal BDNF expression and thus, enhanced hippocampal neuronal survival and plasticity.PMID: 17852404 [PubMed - indexed for MEDLINE]-d/r
Posted by JadeKelly on December 23, 2008, at 10:15:09
In reply to Re: Parnate Lethargy Jade to D/R, posted by desolationrower on December 21, 2008, at 15:13:34
>
> >>
> 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/rIt isn't clear except I'm only taking 1-5mg tab a day (nothing) and I wondered how that could make a difference, so more research, it seems at least at this one source, that the MAOI potentiates the Ritalin, not the other way around. Maybe then you feel more ritalin? Works with MAOI? Not sure. If you recall my biggest problem had become incapacitating lethargy. So. Its been 5 days, not at all like that feeling you get after dosing. (I wish) I'd say full remission, except I'll need to go slowly, as I'm finding after 10 weeks of laying around, I'm a little slow cognitively and physically. So at the gym I'll do half the work out I normally did and work up, I take longer at the grocery store, and a dinner party I had (thats right, I said Jade had a dinner party) well, lets just say everyone had a great time but it was far from my usually organized get togethers. But...WHO CARES!!!! I just wanted to feel like myself again and I do. What more could a girl ask for? (course, santas on his way)
As for the creatine, (thats whats in No-Xplode, right?) I took it once before a work-out and I felt mild lift and a bit more energy. My nephew took too much one time, and had an anxiety attack after a workout. I called the company about it, but I'm sure you know all about its properties, etc. I'd say the equivalent of 5mg ritalin, but I had tolerance to ritalin also. So its been 5 days, I think I'm there, I'm gonna try to jump back into my old routine as soon as possible so I don't back slide.
Okay, so where are you with everything? Change anything? You been staying out of that kitchen sink? Dumb question. Let me know whats up and I'll keep you posted. If I didn't say this before, thanks for ALL your help. Even tho I confuse you with my niceness, haha, you are a funny guy! Oh, Phillipa and I are placing bets on your age....care to cheat and accidentally hide it in a post?
Okay then, don't know where you are but Happy Holidays, in case I don't catch up with you by the wknd *<((: ^ )>>
~Jade
Posted by JadeKelly on December 23, 2008, at 10:47:25
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.
>
>
> - Scott
>
>
>
>
Hi Scott,I must say you know your Parnate! Day 5 or 6 on 60mg Parnate + 1-5mg ritalin and I'm in full remission. Its unbelievable. It took 10 weeks. Some not so fun s/e's and family telling me to stop. But you guys said keep going and here I am! While 10 weeks sucks, and is a long time to be lethargic, I'm SO glad I stuck with it. Thank you for the encouragement and info. You really do help people when you offer up your experience.I owe several people on the board thanks for the "keep on going" you are one. I have my life back, just like that. So wierd. So again, for your files, hah, I'm on 60mg Parnate, at remission was 5 days?, 1mg 3x day Klonopin (don't need this but I'm not changing a THING right now), and 1-5mg ritalin. No insomnia at all, a little slow physically and cognitively when I go out, but I blame that on 10 weeks of laying around. I'll get buzy at a reasonable pace and I think that'll do it. No where near as tired but still have small amount of fatigue I think will disipate when I get back to the Gym.
Again, thanks, and I'll be around if I forgot something.
~Jade
Posted by JadeKelly on December 23, 2008, at 11:32:58
In reply to Re: Treatment Resistant (Refractory) Depression, posted by CaptainAmerica1967 on December 18, 2008, at 19:55:23
> 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.Hi Captain,
Hope you are still around. Wanted to thank you for your answers to my questions. Its the little things sometimes. For example, you posted that a well known Doc for trd has success with either Parnate + stim + Lithium (or tca I think instead of stim) Well it was a long shot but my GP gave me ritalin (I took it for 12 years for ADD (5mg 3xday) So that day added 1-5mg Ritalin, the timing for remission matched what Scott predicted, and I've been in full remission for I think 4 days maybe? It happened suddenly that day at lunchtime. After 10 "unpleasant" weeks on Parnate, in bed most of the time, I am now myself again. Not Like when first started or little high after each dose. Its just me and I'm grateful for your help. Btw-wondered how 1-5mg ritalin could even make a difference, I found a sit that said the MAOI potentiates the Ritalin. I'm sure you already knew that. I have Lithium, but wont take that unless needed. Thanks again!!
~Jade
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