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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by floatingbridge on June 11, 2011, at 2:54:54
Parnate is actually a form of amphetamine (or a close cousin).
Parnate has anixoltic qualities, but not as great as nardil.
Parnate carries a higher risk factor (intercranial bleeding)?
Nardil has a less direct amphetamine like effect. Will it always be more sedating? 24/7?
Parnate insomnia is more intractable than nardil insomnia.
Anyone can pick anything to comment on.
Personally, my fatigue is disabling. But so are my sleep issues. Anxiety is also an issue.
There is no hurry whatsoever to
comment. I expect no changes for a while in my treatment. This is for my contemplation only.Thank you.
fb
Posted by Christ_empowered on June 11, 2011, at 7:34:04
In reply to my research: parnate vs nardil, posted by floatingbridge on June 11, 2011, at 2:54:54
I've thought about the MAOIs before, not so much because I don't respond to other "antidepressants" as I just don't like them. I've always thought I'd try to make a case for Parnate, since it seems like it could cause fewer problems as long as you threw in some other meds to keep everything steady (polypharmacy is the name of the game these days, anyway).
I read somewhere that something--low dose elavil, maybe?--can be added to ongoing MAOI therapy to minimize the risk of the "cheese reaction." SLS will probably know more.
MAOIs just seem like such a commitment, though. Can you not go back on Dexedrine or some other stimulant? Like I've mentioned before, one of my friends loves the combo of seroquel plus adderall, both at full therapeutic doses. I guess its like a modern goofball.
Good luck!
Posted by jms600 on June 11, 2011, at 11:16:22
In reply to my research: parnate vs nardil, posted by floatingbridge on June 11, 2011, at 2:54:54
> Parnate is actually a form of amphetamine (or a close cousin).
>
> Parnate has anixoltic qualities, but not as great as nardil.
>
> Parnate carries a higher risk factor (intercranial bleeding)?
>
> Nardil has a less direct amphetamine like effect. Will it always be more sedating? 24/7?
>
> Parnate insomnia is more intractable than nardil insomnia.
>
> Anyone can pick anything to comment on.
>
> Personally, my fatigue is disabling. But so are my sleep issues. Anxiety is also an issue.
>
> There is no hurry whatsoever to
> comment. I expect no changes for a while in my treatment. This is for my contemplation only.
>
> Thank you.
>
> fb
?Doesn't Nardil cause more weight gain than Parnate?
Posted by Phillipa on June 11, 2011, at 11:30:34
In reply to Re: my research: parnate vs nardil, posted by jms600 on June 11, 2011, at 11:16:22
From my reading on here seems to cause huge weight gain. Phillipa
Posted by floatingbridge on June 11, 2011, at 12:14:40
In reply to Re: my research: parnate vs nardil, posted by Christ_empowered on June 11, 2011, at 7:34:04
A poster I knew here did really well on parnate w/a side of elavil until she had an immune reaction to parnate. Something about making her RA worse.
CE, I've done the speedball thing. No more dex for me.
If maoi's are for the more treatment resistant, so be it. I don't have lots of
trials left in me. Feels that way.I had read that parnate had more risks, more hypertensive episodes, and because of a closer kinship to amphetamine, I might be that closer to that the speedball (my pdoc despised that term). Especially if insomnia is tougher. Does anyone know? I mean I'm 3/4 of the day in bed these days.
I just want to feel like getting up. I fear parnate might have me running around too much.
I don't know. Parnate might have been better when I was younger or before the darn dex thing. Oh well. Hitting the pavement here, and gathering that info.
Thanks,
fb
Posted by floatingbridge on June 11, 2011, at 12:52:12
In reply to Re: my research: parnate vs nardil, posted by jms600 on June 11, 2011, at 11:16:22
JMS & Phillipa,
The weight gain issues, well who would choose to be fat in the United States? However, is the weight gain like abilify? Because that 'felt' very unhealthy. I think abilify weight is different that Nardil weight.
In the realm of thought, parnate 'looks' good. But it seems to have more incident of reaction. What do I know?
I could handle being overweight if I felt like a more normal person.
Thanks Phillipa & JMS.
fb
Posted by zonked on June 11, 2011, at 13:23:32
In reply to Re: my research: parnate vs nardily, posted by floatingbridge on June 11, 2011, at 12:52:12
> I could handle being overweight if I felt like a more normal person.Discontinuing Nardil in 2008 due to weight gain is
probably the reason I am sitting here today posting this, rather than at a desk doing a job. (Although today *is* Saturday.) I didn't know doing so would basically kill a remission (although I should have!). If you and your provider chose Nardil, and you gain some weight, remember my words about this. I don't want what happened to me to happen to anyone else.I would much rather be fat than depressed. :-)
-z
Posted by desolationrower on June 11, 2011, at 13:26:34
In reply to Re: my research: parnate vs nardil » Christ_empowered, posted by floatingbridge on June 11, 2011, at 12:14:40
parnate+desipramine+modafinal
-d/r
Posted by zonked on June 11, 2011, at 13:37:06
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 13:26:34
> parnate+desipramine+modafinal
>
> -d/rIs this what you're taking now DR?
Modafanil: Very good for ADD-inattentive and a temporary mood lift, but for me was also VERY anxiogenic. I have no idea why. :-)
-z
Posted by floatingbridge on June 11, 2011, at 15:26:16
In reply to Re: my research: parnate vs nardil, posted by zonked on June 11, 2011, at 13:37:06
Thanks d/r. Could you unpack that a bit more?
Provigil. Very dyshoric thinking/mood here. Maybe not with parnate. Could revisit.
Desimpramine--for anxiety? Big anxiety?
What is anixiogenic? (Not your word, I know.)
Posted by zonked on June 11, 2011, at 15:39:05
In reply to Re: my research: parnate vs nardil *for d/r » zonked, posted by floatingbridge on June 11, 2011, at 15:26:16
> Desimpramine--for anxiety? Big anxiety?
I have no experience with TCAs except a brief trial of nortriptyline.> What is anixiogenic? (Not your word, I know.)
Generative of anxiety. :-(
-z
Posted by SLS on June 11, 2011, at 16:17:26
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 13:26:34
> parnate+desipramine+modafinal
>
> -d/rVery interesting choice. If daytime sleepiness were not a problem with Parnate, would you still recommend the modafinil?
- Scott
Posted by desolationrower on June 11, 2011, at 17:26:18
In reply to Re: my research: parnate vs nardil » desolationrower, posted by SLS on June 11, 2011, at 16:17:26
>> parnate+desipramine+modafinal
>>
>> -d/r>Is this what you're taking now DR?
no, but i don't have fatigue.
>Desimpramine--for anxiety? Big anxiety?
well it depends on the anxiety.and not as a monotherapy, no. nortryptaline might be better for some types of anxiety, worse for others.
I did think FB needed something for fatigue, and sleep. i'm not good w/ remembering people's info, but i thought there was mood issues too, and she had tried/trying maois. and taking benzos.
>Very interesting choice. If daytime sleepiness were not a problem with Parnate, would you still recommend the modafinil?
i haven't heard of it being useful beyond energy spectrum issues, like sleepiness, attention, etc. but it could help anxiety if you can take a more effective benzo dose.
-d/r
Posted by floatingbridge on June 11, 2011, at 17:44:31
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 17:26:18
Thanks d/r
Who can keep this all in their head--or want to?
Thanks for your input.
fb
Posted by floatingbridge on June 11, 2011, at 17:48:18
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 17:26:18
Any input on risks? Parnate sounded, granted in my limited reading, to incur more reactions.
I also did not care to read the term 'intercranial bleeding'.
Is that alarmist?
Posted by hyperfocus on June 11, 2011, at 18:03:43
In reply to Re: my research: parnate vs nardil, posted by Christ_empowered on June 11, 2011, at 7:34:04
>I read somewhere that something--low dose elavil, maybe?--can be added to ongoing MAOI therapy to minimize the risk of the "cheese reaction."
http://www.ncbi.nlm.nih.gov/pubmed/6123888
Administration of amitriptyline greatly diminished the pressor response to intravenous tyramine in patients receiving monoamine-oxidase inhibitors (MAOIs). Dothiepin and trimipramine, however, produced little change in sensitivity to tyramine. It is suggested that a combination of amitriptyline and an MAOI, started together in a modest dose that is then increased, may protect patients against the potential dangers of eating tyramine-containing foods. However, because MAOIs allow a high proportion of ingested tyramine to be absorbed into the systemic circulation, patients treated with MAOIs, even in combination with amitriptyline, should not be encouraged to eat foods containing tyramine.There are a couple of studies like this. fb if the EMSAM causes you sleep issues then it's highly likely Parnate would too. So I guess the best tack would be attacking the insomnia before you decide to switch MAOIs. I know I keep banging away at the same drum but there are a lot of reasons why amitrip would be a good match for you. The biggest SE of amitriptyline is sedation, which would be beneficial to you.
Posted by floatingbridge on June 11, 2011, at 19:11:40
In reply to Re: my research: parnate vs nardil, posted by hyperfocus on June 11, 2011, at 18:03:43
Hey, hp, This is good stuff. Thanks
> http://www.ncbi.nlm.nih.gov/pubmed/6123888
> Administration of amitriptyline greatly diminished the pressor response to intravenous tyramine in patients receiving monoamine-oxidase inhibitors (MAOIs). Dothiepin and trimipramine, however, produced little change in
sensitivity to tyramine. It is suggested that a combination of amitriptyline and an MAOI, started together in a modest dose that is then increased, may protect patients against the potential dangers of eating tyramine-containing foods. However, because MAOIs allow a high proportion of ingested tyramine to be absorbed into the systemic circulation,
patients treated with MAOIs, even in combination with amitriptyline, should not be encouraged to eat foods containing tyramine.
>
> There are a couple of studies like this.
fb if the EMSAM causes you sleep issues then it's highly likely Parnate would too.
So I guess the best tack would be attacking the insomnia before you decide to switch MAOIs.I'm not rushing any changes. Thanks for asking. I appreciate it. If emsam can work, that's perfect. It's easy. It doesn't quite hit the depression, hence my leg work here. I'm just comparing the maoi's because I am done with snri's.
>I know I keep banging away at the same drum but there are a lot of reasons why amitrip would be a good match for you.You're a good drummer :-) Last talk with pdoc was that ami was still a possibility for me, so no worries. He's just freaked about my fatigue level and insomnia. He doesn't know what to do, and neither do I. My body rejects lots of meds.
>The biggest SE of amitriptyline is sedation, which would be beneficial to you.
It might beat the current Valium.
Thanks for all the good info. You know I'll keep you posted.
Warmly,
fb
Posted by Phillipa on June 11, 2011, at 20:19:14
In reply to Re: my research: parnate vs nardil » hyperfocus, posted by floatingbridge on June 11, 2011, at 19:11:40
The intracranial bleeding can happen anyone remember the name of the poster here who it happened to? Was it Phoenix? Phillipa
Posted by desolationrower on June 11, 2011, at 20:48:00
In reply to Re: my research: parnate vs nardil » floatingbridge, posted by Phillipa on June 11, 2011, at 20:19:14
I think intracranial bleeding is caused by the extreme blood pressure in a tyramine reaction. that is what TCA would prevent.
i can't remember much of what i learn. i should keep a journal or blog or something.
-d/r
Posted by emmanuel98 on June 11, 2011, at 21:26:26
In reply to Re: my research: parnate vs nardil » Christ_empowered, posted by floatingbridge on June 11, 2011, at 12:14:40
I was in a virtually catatonic depression when I started on parnate. Hadn't gotten out of bed in weeks, hadn't showered, washed my hair, wasn't eating. Parnate pulled me right out of that == very quickly, 48 hours. Two years later, I still have problems with depression, but I haven't been sleeping like I did before parnate.
It did cause insomnia, very bad. I take trazadone and lorazapem. My p-doc wants me to stop the lorazapem (I am taking higher and higher doses, it doesn't keep me asleep all night) and switch to very low dose seroquel. Last night I took 25mg seroquel and slept all night. So the insomnia is manageable.
No weight gain with parnate. In fact I have finally lost the weight I gained from taking atypical antipsychotics.
Posted by emmanuel98 on June 11, 2011, at 21:30:30
In reply to Re: my research: parnate vs nardil » desolationrower, posted by floatingbridge on June 11, 2011, at 17:48:18
I don't think parnate is any riskier than any other MAOI. You just have to take a little care. I do eat small amounts of cheese and drink white wine and have never had a problem.
Posted by jedi on June 12, 2011, at 2:59:43
In reply to Re: my research: parnate vs nardil, posted by emmanuel98 on June 11, 2011, at 21:30:30
Hi guys,
As most of you know, I'm a long term Nardil user. I've had a couple of trials of Parnate, mostly because of the weight gain issues and orgasm delay on Nardil. During my last Parnate trial I had a rare spontaneous hypertensive episode. This pretty much put an end to my Parnate trials. Parnate makes me much more anxious, while Nardil decreases anxiety. Parnate causes more severe problems with insomnia. Parnate has less of an issue with weight gain and seems to cause less orgasm delay. I really wanted Parnate to work for me, but the hypertensive episode involved nothing on my part to precipitate it. This type of reaction is rare but it does happen to some people.
Good Luck Guys,
Jedi
http://www.ncbi.nlm.nih.gov/pubmed/8399806
http://www.ncbi.nlm.nih.gov/pubmed/2091623
http://www.ncbi.nlm.nih.gov/pubmed/2486182
Posted by SLS on June 12, 2011, at 6:41:42
In reply to Re: my research: parnate vs nardil, posted by emmanuel98 on June 11, 2011, at 21:30:30
> I don't think parnate is any riskier than any other MAOI. You just have to take a little care. I do eat small amounts of cheese and drink white wine and have never had a problem.
It is probably wise to screen for a spontaneous hypertensive reaction to Parnate while starting treatment and titrating.
- Scott
Posted by SLS on June 12, 2011, at 6:44:37
In reply to Re: my research: parnate vs nardil, posted by jedi on June 12, 2011, at 2:59:43
Sorry, Jedi.
I had posted before reading your post. You are right. Thanks for the links.
- Scott
Posted by floatingbridge on June 12, 2011, at 14:37:13
In reply to Re: my research: parnate vs nardil, posted by jedi on June 12, 2011, at 2:59:43
Jedi, thank you for these links. I can more fully imagine why my pdoc has avoided the maoi topic for so long.
Myself, yes, parnate sounds good. Like I previously wrote, who wants to be overweight? Or have difficulty achieving orgasm? But I have complicated (read weird) health issues and such a long standing insomnia issue. I *want* parnate, but if my pdoc and I come to this discussion, I feel I'll have greater acceptance of his refusal to risk a trial.
Tell me, would you? Does the weight gain on Nardil compare to the type of weight gain on abilify (if you have ever
experienced it)?Once again, if we can get emsam to do the work, I'm sticking with it.
Thanks,
fb
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