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Dr. Bob is Robert Hsiung, MD,
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Posted by sigismund on February 22, 2012, at 12:20:51
In reply to Re: Adding Parnate and prazosin., posted by sigismund on February 22, 2012, at 0:06:52
>6. Fewer awakenings during the night.
Interesting
Posted by ed_uk2010 on February 22, 2012, at 13:07:08
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on February 22, 2012, at 4:46:48
Hi Scott,
Did you decide to stay at 6mg or are you going to try a higher dose?
Posted by SLS on February 22, 2012, at 13:33:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 22, 2012, at 13:07:08
> Hi Scott,
>
> Did you decide to stay at 6mg or are you going to try a higher dose?Hi Ed.
I have been taking 6 mg for quite a few weeks. I had thought to experiment with higher dosages, but never followed through with it. Perhaps I should try it just to be sure that I am not missing out on anything. What do you think? How do you think I should go about it? I have 1 mg pills to work with. I am currently taking one 2 mg pill t.i.d.
- Scott
Posted by ed_uk2010 on February 22, 2012, at 14:05:00
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 22, 2012, at 13:33:29
>How do you think I should go about it? I have 1 mg pills to work with. I am currently taking one 2 mg pill t.i.d.
Perhaps you could start out by increasing your night time dose. You might sleep better and hopefully 'sleep through' any dizziness (assuming you don't get up for a pee!)
Posted by sigismund on February 22, 2012, at 16:36:16
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 22, 2012, at 14:05:00
Eddy, does Scott's response to prazosin surprise you?
Posted by SLS on February 23, 2012, at 6:37:39
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by sigismund on February 22, 2012, at 16:36:16
> Eddy, does Scott's response to prazosin surprise you?
I don't know if Ed is surprised, but I certainly am. However, there is a reason for everything - we just don't know it yet. I can't be unique. I'm sure others will respond to prazosin as well. I haven't recommended it to anyone yet, though. I am hoping that some people will try prazosin on their own initiative based upon my reporting.
It may be that the antagonism by prazosin of NE alpha-1b receptors reduces neuronal activity in circumscribed areas known to be hyperactive in depression, including subgenual cingulate and nucleus accumbens. These areas just so happen to have populations of these receptors.
Interestingly, prazosin antagonism of NE alpha-1b receptors reduces activity in areas known to be stimulated by amphetamine and cocaine. I bet prazosin can aid in treating addiction to these to stimulants. It is hypothesized that global reduction in 1b receptor activity is partly responsible for producing depression. However, the interactions between circuits is complex. I don't think prazosin will be a successful treatment for everyone. I am interested in characterizing the subtypes or symptomatological profile of people who will respond to prazosin.
For now, I would like to propose the idea that prazosin, in combination with antidepressant medication, will help resolve depressions that evolve due to developmental PTSD wherein the PTSD is occult, operating in the background and driving the depression. This would indicate that people who suffered physical abuse, emotional abuse, or neglect early in life would have a good chance to respond to prazosin.
I am really not terribly interested in performing intense research regarding prazosin and its neurobiology right now. I am too involved in enjoying its results.
- Scott
Posted by SLS on February 23, 2012, at 7:09:03
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 22, 2012, at 14:05:00
> >How do you think I should go about it? I have 1 mg pills to work with. I am currently taking one 2 mg pill t.i.d.
>
> Perhaps you could start out by increasing your night time dose. You might sleep better and hopefully 'sleep through' any dizziness (assuming you don't get up for a pee!)
Okay. That's a good plan. Thanks.I am all but convinced that 6 mg is the optimal dosage for me, but I don't want to miss out on a more robust therapeutic effect and the achievement of remission. Actually, I began to respond to 3 mg, but found that my mood was somewhat variable. I raised the dosage by 100% to 6 mg just to have some headroom. I immediately gleaned an antidepressant response of greater magnitude without mood lability. I might increase the dosage by another 50% to 9 mg. The worst thing that happens is that I get dizzy.
- Scott
Posted by sigismund on February 23, 2012, at 13:24:45
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 23, 2012, at 6:37:39
I will try it at some point.
When it was used as a blood pressure med there must have been some somewhat depressed people who benefited from it?
Posted by SLS on February 23, 2012, at 15:42:42
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on February 23, 2012, at 13:24:45
> I will try it at some point.
>
> When it was used as a blood pressure med there must have been some somewhat depressed people who benefited from it?
I wouldn't know. I guess the effect couldn't have been that robust, or it would have been noticed. Prazosin was found to be effective for PTSD by accident at a VA hospital. It probably does not help with MDD or BD as monotherapy.
- Scott
Posted by phidippus on February 23, 2012, at 17:37:07
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 19, 2012, at 6:53:48
Prazosin works by raising dopamine (DA) levels in the synaptic cleft in the prefrontal cortex and inhibiting extracellular DA concentrations in the nucleus accumbens
Eric
Posted by SLS on February 23, 2012, at 17:42:46
In reply to Re: Adding Parnate and prazosin. » SLS, posted by phidippus on February 23, 2012, at 17:37:07
> Prazosin works by raising dopamine (DA) levels in the synaptic cleft in the prefrontal cortex and inhibiting extracellular DA concentrations in the nucleus accumbens
>
> EricWhere can I find more information about this?
- Scott
Posted by papillon2 on February 24, 2012, at 4:08:54
In reply to Re: Adding Parnate and prazosin., posted by SLS on February 23, 2012, at 17:42:46
> The more I improve, the more I realize how sick I am. In the past, I tended to overrate my partial improvements.
Oh dear, I do this too! My psychiatrist says I am "too optimistic" (LOL) and subconsciously trying to be a perfect patient, but not in a helpful way. Thought I was the only one!
On another note: was your blood pressure high, normal or low to begin with and how has it changed on Prazosin? Do you have dizziness with your other meds? I am interested in Prazosin, but having naturally low-mid blood pressure and dizziness on current meds I think it may be too much.
And do you think a MAOI/Prazosin combo would allow one to consume a less restrictive diet?
Posted by SLS on February 24, 2012, at 5:04:42
In reply to Re: Adding Parnate and prazosin., posted by papillon2 on February 24, 2012, at 4:08:54
> > The more I improve, the more I realize how sick I am. In the past, I tended to overrate my partial improvements.
> Oh dear, I do this too! My psychiatrist says I am "too optimistic" (LOL) and subconsciously trying to be a perfect patient, but not in a helpful way. Thought I was the only one!
>
> On another note: was your blood pressure high, normal or low to beginMy blood pressure was normal. It really wasn't very much lower once prazosin was added. I don't remember the numbers.
> Do you have dizziness with your other meds?
Parnate does cause some dizziness. I have noticed that it is somewhat worse with the prazosin, but not much. I experienced more significant dizziness immediately after starting prazosin, but it very quickly mitigated.
> I am interested in Prazosin, but having naturally low-mid blood pressure and dizziness on current meds I think it may be too much.
You'll never know unless you try it. Dizziness has not been a deal-breaker for me. I do get occasional orthostatic hypotension if I stand up too fast.
What attracts you to prazosin? What is it about your particular case profile and case history that leads you to believe that prazosin is worth trying?
What drugs are you currently taking?
> And do you think a MAOI/Prazosin combo would allow one to consume a less restrictive diet?
I don't have enough information to make an educated guess. I do know that phentolamine (Regitine) is the drug of choice to treat a hypertensive crisis. It is a non-selective NE alpha receptor antagonist (alpha-1 and alpha-2). Prazosin is selective for alpha-1. A few things I found reported that prazosin attenuates the tyramine pressor effect, but I haven't found anything reporting its use in a hypertensive crisis.
I would advise starting prazosin at a dosage of no more than 3 mg/day. I take it 3 times a day because it has such a short half-life, although twice a day should work, too. You could begin treatment with 1 mg at night. 3 mg/day was almost enough for me to glean a stable antidepressant effect from. It was obvious that I would lose the effect at the end of a dosing period, so I increased the dosage to 6 mg/day. This is still a low dosage. People go up to 20 mg/day to treat hypertension. Even 40 mg is considered safe.
- Scott
Posted by papillon2 on February 24, 2012, at 7:28:26
In reply to Re: Adding Parnate and prazosin. » papillon2, posted by SLS on February 24, 2012, at 5:04:42
> What attracts you to prazosin? What is it about your particular case profile and case history that leads you to believe that prazosin is worth trying?
I have bad nightmares and a history of childhood trauma. Also our med combo is kinda similar and from what you've said, it appears to be helping you tremendously. Though come to think of it you've added Parnate as well.
I suspect my psychiatrist is going to want to change a med or two in a couple of months.
> What drugs are you currently taking?
Nortriptyline 100mg
Lamictal 200mg
Lithium 125mg
Melatonin 3mg
Aspirin 100mg for TCA-induced heart issues
The usual supplementsAs an aside, I recently was prescribed a muscular skeletal relaxant called Norflex for short-term treatment of a neck injury. I'm interested in seeing what, if any, effect it has on my depression. Wouldn't mind some "mild euphoria".
> I would advise starting prazosin at a dosage of no more than 3 mg/day. I take it 3 times a day because it has such a short half-life, although twice a day should work, too. You could begin treatment with 1 mg at night. 3 mg/day was almost enough for me to glean a stable antidepressant effect from. It was obvious that I would lose the effect at the end of a dosing period, so I increased the dosage to 6 mg/day. This is still a low dosage. People go up to 20 mg/day to treat hypertension. Even 40 mg is considered safe.
Ah, so we're dealing with a different doseage regime. That should make quite a difference in terms of side effects.
Thanks Scott.
Posted by ed_uk2010 on February 24, 2012, at 13:33:07
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by sigismund on February 22, 2012, at 16:36:16
> Eddy, does Scott's response to prazosin surprise you?
It did initially Sigi, but less so now. I read a bit about how it might augment noradrenergic ADs.
Posted by ed_uk2010 on February 24, 2012, at 13:34:59
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 23, 2012, at 7:09:03
>I am all but convinced that 6 mg is the optimal dosage for me, but I don't want to miss out on a more robust therapeutic effect and the achievement of remission.
Hi Scott,
I think it's impossible to predict what the optimal dose will be. Prazosin is hardly a standard drug for depression. Perhaps a higher dose might be much better, I really have no idea.
Posted by SLS on February 24, 2012, at 14:31:48
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by ed_uk2010 on February 24, 2012, at 13:33:07
> > Eddy, does Scott's response to prazosin surprise you?
>
> It did initially Sigi, but less so now. I read a bit about how it might augment noradrenergic ADs.
>Ed, if it isn't too big an imposition, could you post a link to anything you find regarding prazosin. I would really like to see the stuff you have found already regarding augmentation of noradrenergic ADs.
Thanks.
If you don't have the time or energy, that's okay.
- Scott
Posted by ed_uk2010 on February 24, 2012, at 16:49:55
In reply to Re: Adding Parnate and prazosin. » ed_uk2010, posted by SLS on February 24, 2012, at 14:31:48
> > > Eddy, does Scott's response to prazosin surprise you?
> >
> > It did initially Sigi, but less so now. I read a bit about how it might augment noradrenergic ADs.
> >
>
> Ed, if it isn't too big an imposition, could you post a link to anything you find regarding prazosin. I would really like to see the stuff you have found already regarding augmentation of noradrenergic ADs.
>
> Thanks.
>
> If you don't have the time or energy, that's okay.
>
>
> - ScottHi Scott,
It was only an animal study - the one that Franz posted a few days ago. Prazosin seemed to augment imipramine and it was hypothesised than it might augment noradrenergic ADs.
Posted by sigismund on February 24, 2012, at 17:07:05
In reply to Re: Adding Parnate and prazosin. » SLS, posted by ed_uk2010 on February 24, 2012, at 16:49:55
> it was hypothesised than it might augment noradrenergic ADs.
Because it acted in a similar way or an opposite way or because it mixed well (and so on and so forth)?
In my simple way I was thinking about how Scott mainlt takes ADs that increase dopamine and NE, and since prazosin blocks NE (this is ridiculous, but anyway) it might be that which helped.
Perhaps someone can amplify.
Posted by Phillipa on February 24, 2012, at 18:19:10
In reply to Re: Adding Parnate and prazosin., posted by sigismund on February 24, 2012, at 17:07:05
I thought the same thing about the norepineprine when googled the med also saw that 40 was was used in hypertension.
Posted by ed_uk2010 on February 25, 2012, at 2:43:14
In reply to Re: Adding Parnate and prazosin., posted by sigismund on February 24, 2012, at 17:07:05
> > it was hypothesised than it might augment noradrenergic ADs.
>
> Because it acted in a similar way or an opposite way or because it mixed well (and so on and so forth)?Prazosin does block the effects at NE, but only at one type of receptor (alpha-1 group). It doesn't block the effects of NE at any other type of receptor. Perhaps it could 'augment' noradrenergic ADs such as nortriptyline by allowing the increased levels of NE to bind to other receptors but not alpha-1?
TCAs also block alpha-1 receptors but like Scott said, they are not very potent at the alpha-1b subtype, which may be the relevant receptor in the brain. TCAs are more active at alpha-1a, which is why they tend to reduce standing BP.
Interestingly, reboxetine, an NRI which does not block alpha-1 receptors at all, does not appear to be such a reliable AD as nortriptyline. Reboxetine is highly selective for the NE transporter whereas nortriptyline also binds to a variety of other receptors. Lack of alpha-1 blockade also means that reboxetine can make it difficult to urinate. This is less of a problem with nortriptyline because it blocks alpha-1a receptors in the prostate and urinary tract.
Posted by SLS on March 2, 2012, at 16:31:25
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Just a quick update:
I am still gradually improving. It never happens fast enough, though. However I am so very grateful for any improvement at all. I don't always see a difference day to day, but I can see a difference week to week. The trend is definitely towards continued improvement. I will have a few days in a row when I feel less well. I lose ground during these times, and it is a little frustrating if not scarey to feel worse. I guess this is the "saw-tooth" effect that Robert Post would tell his patients about. Two steps up and one step down.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mgYay for polypharmacy!
- Scott
Posted by Phillipa on March 2, 2012, at 21:07:03
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 2, 2012, at 16:31:25
Scott I'm impressed for sure. In all the years been here this is the best. And I need to remember two steps forward and back myself. I must say you are the most courageous and positive person and always with hope. And this time is paying off. You finally got a winning combo!!! Phillipa
Posted by Beckett on March 3, 2012, at 14:55:22
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 2, 2012, at 16:31:25
Good news. I was wondering how it was going. Glad to hear it.
:-)
Posted by sigismund on March 3, 2012, at 17:18:59
In reply to Re: Adding Parnate and prazosin., posted by SLS on March 2, 2012, at 16:31:25
>Yay for polypharmacy!
Maybe.
Before the prazosin polypharmacy was not so good, was it?
A pity you could have not tried it first.
I will see if my doc will write a script for it.
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