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Dr. Bob is Robert Hsiung, MD,
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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.
Posted by sigismund on March 3, 2012, at 20:29:50
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 3, 2012, at 17:18:59
By which I mean 15% for whatever effort it was back then made me feel I would rather (I don't know) watch TV or stare at the wall.
All I can recall is it was Parnate, probably nortriptylline and a couple of others.
Posted by SLS on March 3, 2012, at 21:26:21
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 3, 2012, at 17:18:59
> >Yay for polypharmacy!
>
> Maybe.
>
> Before the prazosin polypharmacy was not so good, was it?Is that question meant to relate to my condition in particular of to those of everyone else?
Polypharmacy has certainly served me better than all of the monotherapeutic treatments I have tried over the last 30 years.
I recently tried to discontinue Abilify. I relapsed after two weeks. Fortunately, I was able to recapture a response within two days.
Is there something inherently unscientific about using more than one drug at a time to treat an illness? I really don't understand on what basis polypharmacy should be discouraged. CV diseases often require 3 drugs to manage hemodynamics and cardiac conduction. Is there something about the fundamental nature of mental illness that dictates that a single pharmacological action always be sufficient to treat it? Unfortunately, it would seem that the converse is true. Most of the drugs we currently use possess more than one pharmacological property. Perhaps a single biological target will one day emerge as the only site necessary to modulate. But that is not today.
Ed_Uk2010 mentioned that prazosin might work in conjunction with a norandrenergic drug to treat depression. I don't know what condition or symptoms you are trying to treat, though. I have always been unclear on this. It won't hurt to try prazosin as monotherapy, but I wouldn't forever cast the drug aside if it doesn't help treat MDD or BD.
- Scott
Posted by sigismund on March 3, 2012, at 21:42:27
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by SLS on March 3, 2012, at 21:26:21
>Is that question meant to relate to my condition in particular of to those of everyone else?
No, just you.
>Polypharmacy has certainly served me better than all of the monotherapeutic treatments I have tried over the last 30 years.
Yes, but it isn't saying much if it is only 15% hey?
>I recently tried to discontinue Abilify. I relapsed after two weeks. Fortunately, I was able to recapture a response within two days.
I recall you saying that.
>Is there something inherently unscientific about using more than one drug at a time to treat an illness?
No, not unscientific.
>I really don't understand on what basis polypharmacy should be discouraged.
The inadequacy of our knowledge, our ability to get it wrong, the shortcomings of the drugs?
>Is there something about the fundamental nature of mental illness that dictates that a single pharmacological action always be sufficient to treat it? Unfortunately, it would seem that the converse is true.
But how many years had you been on treatment to reach 15% 3 or 4 years ago? You get what I am trying to say? I hope you don't get me wrong. Treatment should have a better outcome than benign neglect
>Ed_Uk2010 mentioned that prazosin might work in conjunction with a norandrenergic drug to treat depression. I don't know what condition or symptoms you are trying to treat, though. I have always been unclear on this. It won't hurt to try prazosin as monotherapy, but I wouldn't forever cast the drug aside if it doesn't help treat MDD or BD.If it could help with sleep I would be happy. People who take it sleep longer. I don't sleep deeply enough to dream or have nightmares. PTSD? Could be.
Please take this the right way. I am just interested.
Posted by papillon2 on March 3, 2012, at 23:07:48
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 3, 2012, at 21:42:27
I'd take 15% over nothing. 15% could be the difference between life and death.
Posted by sigismund on March 3, 2012, at 23:44:12
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by papillon2 on March 3, 2012, at 23:07:48
>I'd take 15% over nothing. 15% could be the difference between life and death.
Yes. But you might wish for more after such a lot of effort.
Still, you should see me with all the stuff I take. There is a rationale. It's not always effective, AFAIK. There's a lot of polypharmacy in it (especially with TCM). When people question it I become quite irritated.
As for Scott's question: what is my problem? Well, you won't get a psych diagnosis from me. And I don't know. Part of me has always hated being alive. Now it is almost over. That's it, really. I can cope.
Drugs that make me feel better rather than worse would interest me. Can't get them.
Posted by ed_uk2010 on March 4, 2012, at 3:45:06
In reply to Re: Adding Parnate and prazosin., posted by sigismund on March 3, 2012, at 23:44:12
Hi Sigi,
>But you might wish for more after such a lot of effort.
You certainly would, but it doesn't always work out that way.
>Part of me has always hated being alive. Now it is almost over.
Nearly over? You're not even old!
>Drugs that make me feel better rather than worse would interest me.
The problem with drugs that make you feel better straight away is that it's rarely long before they make things worse.
Anyway, I suppose you'll just be trying a small dose of prazosin at night? You could try 0.5mg before bed, increasing to 1mg then 2mg if necessary.
Posted by SLS on March 4, 2012, at 6:10:33
In reply to Re: Adding Parnate and prazosin. » SLS, posted by sigismund on March 3, 2012, at 21:42:27
Hi Sigi.
15% is better than zero, I'm sure we could both agree. It allowed me to live independently instead of with my parents or a supportive residence. That 15% was primarily the product of combining nortriptyline and Lamictal. Everything else that I took at any one time was for the purpose of experimentation rather than as a treatment to commit to. Bringing in Abilify helped a bit - enough for me to choose to remain on it while searching for other things. Adding an MAOI to a TCA is what got me well the first time in 1987. So adding Nardil or Parnate to the nortriptyline was a no brainer unless I wanted to try something novel. For me, novel meant anything different than I had thusfar tried. For instance, I tried Lexapro. It didn't help. However, Celexa remains novel to me as my brain has never seen it before, despite the molecular similarities. Anyway, I brought lithium on board for its neurogenesis and neuroprotection. Unexpectedly, in combination with Parnate, it helped to smooth out "mood drift". It helped stabilize me and enhanced the antidepressant effects to the other drugs I was taking. That's five drugs. I added prazosin. That's six.
When I remove ANY ONE of the drugs I take, I relapse.
This logical progression of determining drug treatment is more than just a haphazard throwing of enough sh*t against the wall to see how much would stick. I hope you can understand why I felt somewhat insulted by your words. In a way, they were an insult to my intelligence and that of my doctors as well. I guess that is really my problem and not yours.
My sleep is significantly smoother for having added prazosin. I experience fewer awakenings. Experiments have shown that prazosin and clonidine each increase the spectral power of delta-wave (slow-wave) sleep as seen on an EEG. This should produce a greater period of time spent in deep sleep. I hope prazosin helps you.
- Scott
Posted by SLS on March 4, 2012, at 6:15:02
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by ed_uk2010 on March 4, 2012, at 3:45:06
> Hi Sigi,
>
> >But you might wish for more after such a lot of effort.
>
> You certainly would, but it doesn't always work out that way.
>
> >Part of me has always hated being alive. Now it is almost over.
>
> Nearly over? You're not even old!
>
> >Drugs that make me feel better rather than worse would interest me.
>
> The problem with drugs that make you feel better straight away is that it's rarely long before they make things worse.
>
> Anyway, I suppose you'll just be trying a small dose of prazosin at night? You could try 0.5mg before bed, increasing to 1mg then 2mg if necessary.You should really take prazosin 3 times a day if you want to glean an anxiolytic effect during the day. I started at 1 mg t.i.d. Dizziness was a problem at first, but it mitigated within a week. I am now taking 6 mg/day. It is a very clean drug.
- Scott
Posted by SLS on March 4, 2012, at 6:40:19
In reply to Re: Adding Parnate and prazosin. » sigismund, posted by ed_uk2010 on March 4, 2012, at 3:45:06
Hi Ed.
I checked out a few studies on Google.
You are right. Some people respond well to dosages as low as 1 mg h.s. I wouldn't have thought so. Some people go to 6 mg and higher, though.
I don't know how you do it. I really don't.
You are amazing. I don't know how you can keep all of this important information and wonderful insights in your head.
- Scott
Posted by SLS on March 4, 2012, at 7:24:29
In reply to Re: Adding Parnate and prazosin., posted by sigismund on March 3, 2012, at 23:44:12
> My sleep is significantly smoother for having added prazosin. I experience fewer awakenings. Experiments have shown that prazosin and clonidine each increase the spectral power of delta-wave (slow-wave) sleep as seen on an EEG. This should produce a greater period of time spent in deep sleep. I hope prazosin helps you.
Speaking of polypharmacy, if prazosin helps, but is not wholly adequate, you can add clonidine to augment the prazosin. I don't know if anyone has tried this for PTSD, but it makes sense to me. If taken at night along with prazosin, any tendency towards dizziness might dissipate by morning. I'm not sure. Both clonidine and prazosin are used to treat hypertension. I don't know if the two drugs are synergistic with respect to lowering blood pressure. By the way, at 6 mg/day of prazosin, my blood pressure while seated is normal (120/76). I experience some mild to moderate orthostatic hypotension. Note that I am taking Parnate at the same time, which, itself, causes dizziness.
Topamax is also good for treating PTSD, just in case you are thinking along those lines. I don't know if it affects sleep architecture at all.
- Scott
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