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Dr. Bob is Robert Hsiung, MD,
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Posted by g_g_g_unit on April 7, 2012, at 8:34:27
In reply to Re: Adding Parnate and prazosin. » g_g_g_unit, posted by SLS on April 7, 2012, at 6:18:13
> Do you suspect that the choppy sleep will improve the longer you stay on Parnate?
>
> Perhaps. I am not sure how things will play out at this point.
>
> When I was younger, I experienced total sleep deprivation when Parnate was combined with desipramine, but not when taking Parnate alone. For me, insomnia has been a good prognosticator of positive response to treatment. For the entire time I was on combination treatment, I don't think that the insomnia mitigated over time. However, it would be difficult for me to know for sure because the treatment of my insomnia was so effective.
>
> triazolam (Halcion) 1.0 mg
> lorazepam (Ativan) 4.0 mg
>
> Later in my treatment history, the Parnate + desipramine combination treatment no longer produced insomnia. It also never worked again. Now, if I am losing too much sleep, I will take a combination of zaleplon (Sonata) and lorazepam (Ativan). If initiating sleep were to be refractory to this treatment, I would have to convince my doctor to use triazolam in place of zaleplon. Doctors are squeamish about prescribing triazolam. The drug got developed a reputation for having amnestic effects. However, I think zolpidem (Ambien) is just as bad as triazolam with respect to producing amnesia.
>
>
> - Scott
>Right now, I'm able to fall (and stay) asleep with 0.3mg of Clonidine and 5mg of Valium. But I just raised my Parnate dose to 30mg (finally) and things are a little worse now. One of my hobbies involves niggling over every prospective thing that could go wrong with a med trial, and reading through the archives, it seems like there are very few people who've managed to successfully remain on Parnate without an adjunctive sleep aid. It's a pity there isn't much available that actually preserves sleep architecture (aside from Xyrem and Trimipramine?). I know it's a bridge I'll have to cross when I get to it, but I'm just a little concerned about the long term effects of benzodiazepines on sleep and health. I know Zolpidem is less intrusive, and can supposedly be used in the long-run without rebound insomnia, but I suffer terrible withdrawal anxiety/depression on it. However, I've wondered if - pending I respond to Parnate - it might mitigate the next-day withdrawal.
Posted by michael on April 9, 2012, at 10:25:05
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
> I added prazosin (Minipress) 30 mg last week as a treatment for residual PTSD, if it even exists in me. I thought it was worth a shot. Certainly, childhood abuse and neglect contributed to the evolution of my depressive illness.
>
> I added Parnate on Monday. I am titrating as quickly as I can while avoiding the development of hypotension. The prazosin might work synergistically with Parnate to significantly reduce my blood pressure. We'll have to see. 30 mg is a small dose of prazosin. There is room to increase it.
>
> So...
>
> I'm feeling better than I should be. Yesterday, I met some family and friends at a hotel bar. I was comfortable, gregarious, and talkative. My mind was very active. I really enjoyed myself for the first time in many years.
>
> Two things are different about my current regime compared to the last time I took Parnate lithium and prazosin. I wonder
>
> Currently:
>
> Parnate 40 mg (titrating rapidly)
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 30 mg
>
> Wish me luck! I could sure use it.
>
>
> - ScottHey Scott,
Don't know if you remember me, I haven't been around for years... But I was just responding to a question someone asked me from an ancient thread...
In any case, I appreciate the feedback, suggestions, etc. that you've given me over the years, and wanted to say that I'm glad to hear that you're finding some relief, and sound optimistic! I hope that continues, and continues to improve!
Thanks again, and GOOD LUCK!
michael
p.s. still love that medication chart that you put online long ago! Is that still up?
Posted by SLS on April 12, 2012, at 15:54:31
In reply to Re: Adding Parnate and prazosin., posted by michael on April 9, 2012, at 10:25:05
> Hey Scott,
>
> Don't know if you remember me, I haven't been around for years... But I was just responding to a question someone asked me from an ancient thread...
>
> In any case, I appreciate the feedback, suggestions, etc. that you've given me over the years, and wanted to say that I'm glad to hear that you're finding some relief, and sound optimistic! I hope that continues, and continues to improve!
>
> Thanks again, and GOOD LUCK!
Thank you, Michael. You are kind.
> p.s. still love that medication chart that you put online long ago! Is that still up?Yes. I still have it up, but have not been diligent in keeping it up to date. I get to it occasionally, but I'm about six months behind.
http://www.slschofield.com/medicine/psychiatric_drugs_chart.html
- Scott
Posted by SLS on April 12, 2012, at 16:17:58
In reply to Adding Parnate and prazosin., posted by SLS on December 29, 2011, at 6:55:56
Hi.
I am still improving - I think.
I have been in a slump for the past week. I have not felt as well as I had two weeks ago. This is the second week-long slump that I have experienced since beginning to respond to treatment in late December. In addition, my mood has been variable during the day. I have experienced significant episodic dips that can last for 3 - 6 hours and then disappear. It has been a bumpy ride.
Periodic worsenings are to be expected in my case. I am becoming less and less concerned when they occur, but I still worry that the beast may be lurking.
I feel better today.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 6 mg
- Scott
Posted by SLS on April 16, 2012, at 5:12:32
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 12, 2012, at 16:17:58
> Hi.
>
> I am still improving - I think.
>
> I have been in a slump for the past week. I have not felt as well as I had two weeks ago. This is the second week-long slump that I have experienced since beginning to respond to treatment in late December. In addition, my mood has been variable during the day. I have experienced significant episodic dips that can last for 3 - 6 hours and then disappear. It has been a bumpy ride.
>
> Periodic worsenings are to be expected in my case. I am becoming less and less concerned when they occur, but I still worry that the beast may be lurking.
I became suspicious. Through a bit of experimentation, I discovered that I had beem underdosing prazosin. I have increased my dosage from 6 to 12 mg. 20 mg is the maximum recommended. The dosages currently used for PTSD are between 12 - 15 mg. Within 48 hours of my doubling the doses, I was amazingly improved. It has been 25 years since I felt this well. I think this shall be the last of the treatment adjustments necessary for me to achieve remission.Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg
- Scott
Posted by Tomatheus on April 16, 2012, at 10:45:34
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 16, 2012, at 5:12:32
Wow, Scott, it's great to hear that you've been feeling really well, and I certainly hope that your response continues. Feeling the best that you've felt in 25 years is quite a feat, and I think it's something to be excited about. Let's hope that you're right about not needing any more medication adjustments to achieve remission.
Tomatheus
Posted by SLS on April 16, 2012, at 13:11:47
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Tomatheus on April 16, 2012, at 10:45:34
> Wow, Scott, it's great to hear that you've been feeling really well, and I certainly hope that your response continues. Feeling the best that you've felt in 25 years is quite a feat, and I think it's something to be excited about. Let's hope that you're right about not needing any more medication adjustments to achieve remission.
>
> Tomatheus
Thanks!:-)
- Scott
Posted by uncouth on April 16, 2012, at 15:11:20
In reply to Re: Adding Parnate and prazosin. » Tomatheus, posted by SLS on April 16, 2012, at 13:11:47
Scott what is your dosing schedule. I am taking 5-10mg at night for sleep, but it's not doing anything and I might try 15mg at night, or another dosing schedule, like starting with 5mg earlier in the day. What have you found works best for you? Do you feel any immediate effects...does it cause fatigue or sleepiness during the day?
Posted by SLS on April 16, 2012, at 19:56:07
In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 16, 2012, at 15:11:20
> Scott what is your dosing schedule.
4 mg 3 times a day.
> I am taking 5-10mg at night for sleep, but it's not doing anything and I might try 15mg at night, or another dosing schedule, like starting with 5mg earlier in the day.
Prazosin is not improving my sleep at all. My sleep is disturbed by the other drugs I am taking. However, my main motivation for taking prazosin is to treat bipolar depression. For this purpose, it is working wonderfully.
I have not heard of anyone using prazosin to treat disturbed sleep except for in PTSD. If you are looking for a sympatholytic to be used for improving sleep, clonidine seems to be a better choice. You just need to be wary of clonidine producing depression as a side effect.
> What have you found works best for you? Do you feel any immediate effects...
I felt an improvement in depression within a 12 hours of increasing my dosage of prazosin from 6 mg to 12 mg.
> does it cause fatigue or sleepiness during the day?
I did experience sleepiness and fatigue for the first day after the dosage increase.
What conditions are you treating? What is the nature of your sleep disturbances?
- Scott
Posted by uncouth on April 16, 2012, at 20:01:08
In reply to Re: Adding Parnate and prazosin. » uncouth, posted by SLS on April 16, 2012, at 19:56:07
I'm using prazosin for sleep, both sleep initiation and sleep maintenance, right now I cannot initiate sleep without saphris or seroquel, which i'm trying to get off of. And for the past 9 months i've been getting up at 3-4am and am not able to get back to sleep. We tried clonidine, but it didn't really work. Nothing else I have tried works, especially for maintenance. Seroquel makes me super depressed and groggy next day. Saphris unfortunately seems to be the best option right now, but i have to redoes it at 3am, and even then it's iffy if it works or not.
I will try a higher dose of prazosin at night. I am also BP2, so I definitely am watching your response with interest. I'm on a high dose of wellbutrin 600mg and vyvanse so i may just be antagonizing the NE with prazosin so who knows.
Posted by Bob on April 16, 2012, at 21:41:06
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 16, 2012, at 5:12:32
> > Hi.
> >
> > I am still improving - I think.
> >
> > I have been in a slump for the past week. I have not felt as well as I had two weeks ago. This is the second week-long slump that I have experienced since beginning to respond to treatment in late December. In addition, my mood has been variable during the day. I have experienced significant episodic dips that can last for 3 - 6 hours and then disappear. It has been a bumpy ride.
> >
> > Periodic worsenings are to be expected in my case. I am becoming less and less concerned when they occur, but I still worry that the beast may be lurking.
>
>
> I became suspicious. Through a bit of experimentation, I discovered that I had beem underdosing prazosin. I have increased my dosage from 6 to 12 mg. 20 mg is the maximum recommended. The dosages currently used for PTSD are between 12 - 15 mg. Within 48 hours of my doubling the doses, I was amazingly improved. It has been 25 years since I felt this well. I think this shall be the last of the treatment adjustments necessary for me to achieve remission.
>
> Currently:
>
> Parnate 80 mg
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 12 mg
>
>
> - Scott
Scott,What is the current status of you sexual side effects?
Bob
Posted by SLS on April 17, 2012, at 6:57:03
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Bob on April 16, 2012, at 21:41:06
Hi Bob.
> What is the current status of you sexual side effects?
My libido is very much suppressed by prazosin. However, this is being offset by the return of some of the libido that was stripped away by the depression. Unfortunately, the net effect still leaves me disappointed. I don't seem to have lost very much capacity to maintain an erection and reaching orgasm. Since it has been only three days since increasing my dosage of prazosin, I don't know where things will end up. My guess is that reduced libido will continue to be a problem. It really isn't such a bad trade-off for being free of depression and starting a new life. I did have a very successful and satisfying experience two days ago.
- Scott
Posted by Bob on April 17, 2012, at 11:58:49
In reply to Re: Adding Parnate and prazosin. » Bob, posted by SLS on April 17, 2012, at 6:57:03
> Hi Bob.
>
> > What is the current status of you sexual side effects?
>
> My libido is very much suppressed by prazosin. However, this is being offset by the return of some of the libido that was stripped away by the depression. Unfortunately, the net effect still leaves me disappointed. I don't seem to have lost very much capacity to maintain an erection and reaching orgasm. Since it has been only three days since increasing my dosage of prazosin, I don't know where things will end up. My guess is that reduced libido will continue to be a problem. It really isn't such a bad trade-off for being free of depression and starting a new life. I did have a very successful and satisfying experience two days ago.
>
>
> - Scott
Hey Scott,Maybe you'll find that the higher dose eventually ups the dopamine a little more or whatever, thus bringing it back in line.
I'm pulling for you.
Bob
Posted by Alexei on April 19, 2012, at 14:46:50
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 7, 2012, at 6:23:20
> I continue to improve, albeit gradually and with some occasional dips. These brief worsenings can last for a few hours or a few days. I usually emerge from these dips feeling better than I did prior to the dip.
>
> I still like my chances of achieving remission with this treatment:
>
> Parnate 80 mg
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 6mg
>
>
> - Scott
Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.May I ask your opinion on Parnate? How would you rate its efficacy compared with ssri & snri meds? Does it have any merit for OCD? I'm finding venlafaxine to be merely average.
Do you prefer nortriptyline to desipramine? If so, why?
Also, you've spoken of some type of synergy between abilify and lamictal. Could you elaborate a bit on this? I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.
Thank you for reading ...
Posted by SLS on April 20, 2012, at 7:22:30
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Alexei on April 19, 2012, at 14:46:50
> Hi, this is my first post on this forum. I'm amazed with your med regime... fascinated. I have so many questions. Thank you for your information.
>
> May I ask your opinion on Parnate?I like Parnate more than Nardil because it has milder side effects. In addition, I find that Nardil produces a euphoric effect that I would prefer to do without. Everyone reacts to these two drugs differently. Some people do not respond to Parnate who do respond to Nardil. In my experience as a TRD patient, I have found it necessary to take a MAOI in order to respond well to treatment. I have always had to combine a MAOI with a tricyclic in order to glean a lasting improvement in depression.
> How would you rate its efficacy compared with ssri & snri meds?
MAOI > SNRI > SSRI
> Does it have any merit for OCD?
There are several anecdotal reports for success in treating OCD using either Parnate or Nardil. These drugs have not been the focus of study in this disorder. One study of Nardil (phenelzine) reported negative results, but its design had some significant flaws.
Study:
http://www.ncbi.nlm.nih.gov/pubmed/9286186Rebuttal:
http://ajp.psychiatryonline.org/article.aspx?Volume=156&page=159&journalID=13Do you have any other types of anxiety disorder?
> I'm finding venlafaxine to be merely average.
There are plenty of studies demonstrating the efficacy of clomipramine, fluoxetine, and fluvoxamine. Only a few studies exist using venlafaxine or paroxetine.
> Do you prefer nortriptyline to desipramine? If so, why?
I have used both drugs, and while I find them both effective in my case, nortriptyline produces better results. The autonomic side effects tend to be milder with nortriptyline. I experience a greater elevation of heart rate and palpitations with desipramine. I also get more dry mouth and blurred vision with desipramine. Sometimes you don't have a choice between the two. There are people who respond only to desipramine just as there are people who respond only to nortriptyine.
> Also, you've spoken of some type of synergy between abilify and lamictal.
I do better when I take both drugs together than when I take either one alone. I also know someone with depression who takes only these two drugs. She does not take any of the standard antidepressants, although she has tried most of them. Her system needs both drugs for her to feel well.
> Could you elaborate a bit on this?
I am going to have to disappoint you on demonstrating an explanation for the mechanics of interaction of the two drugs to produce a synergy. I don't know of any scientific studies investigating this. I have proposed my own pet theory which might explain a dopaminergic synergy between of these two drugs. Abilify seems to increase DA tone in neurons that are hypoactive in the nucleus accumbens via D2/D3 partial agonism. I think that Abilify is more of a modulator than it is a stimulant. Lamictal might produce an increase in DA activity in the nucleus accumbens via disinhibition. Lamictal reduces glutamate release in the thalamus. These glutamate circuits normally travel to the nucleus accumbens whereupon they act to reduce DA activity when activated. Lamictal reduces GLU activity in the thalamus and thus allows for increased DA activity in the the nucleus accumbens.
> I have just begun abilify, and am struggling with it ... anxiety, nervousness, zoned out, insomnia, blunted mind. I sure hope this goes away.
These things are very ofen startup side effects that disappear within a week or two. However, there are enough people who continue to react badly to Abilify that aborting a trial is necessary.
What dosage of Ability did you start at?
It may be that people with unipolar depression are more sensitive to Abilify than those with bipolar disorder. I had no problem treating my bipolar depression with a starting dosage of 20 mg. People with unipolar depression often respond to dosages of 5 mg and lower. Some respond well at 2.5 mg, but suffer intolerable side effects at 5 mg.
So, what's your plan?
- Scott
Posted by uncouth on April 20, 2012, at 8:07:50
In reply to Re: Adding Parnate and prazosin. » Alexei, posted by SLS on April 20, 2012, at 7:22:30
Scott, quick question...have you ever tried much higher dose lamictal? Or memantine added on, at like 40mg? I know you're seeing great results with prazosin now and don't need/want to screw with anything, but i'm just curious...namenda is seeming to become really popular in a lot of treatment resistant mental health cases...may require higher dosages than the 20mg used in studies though. Same deal with lamictal, i think i posted to you a few months ago that in the rehab i went to two years ago, they said thy were seeing really great things happen with lamictal at 400-600-even 800 mg. I think going up on lamictal is probably a really easy thing to try and one can just back off if cognitive issues arise. Seems like there is definitely some magic pushing up dosages.
Posted by SLS on April 20, 2012, at 14:10:55
In reply to Re: Adding Parnate and prazosin. » SLS, posted by uncouth on April 20, 2012, at 8:07:50
> Scott, quick question...have you ever tried much higher dose lamictal?
I went up to 450 mg once. I couldn't remember my own name. I spent several years at 300 mg. I had constant brain-fog along with profound impairments in short-term memory. It wasn't until I tried reducing the dosage as an experiment that I discovered that 200 mg was the highest dosage I could take without cognitive side effects.
> Or memantine added on,
I tried adding 20 mg to Lamictal. Nothing. When I increased the dosage of memantine to 40 mg, I felt drunk and got scared. I stopped taking it. Perhaps the drunkeness would have disappeared if I stuck with it.
I came upon this not too long ago:
Original listing:
http://clinicaltrials.gov/ct2/show/NCT00305578
Results:
http://www.ncbi.nlm.nih.gov/pubmed/22329473
I'll keep memantine on hand, just in case.
Thanks for the suggestion.
- Scott
Posted by uncouth on April 20, 2012, at 16:52:29
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 20, 2012, at 14:10:55
Yes that is typical memantine reaction, and does go away. If your depression gets bad again, try 40mg on top of your lamictal. High dose namenda is going to change psychiatry.
Posted by g_g_g_unit on April 21, 2012, at 10:27:51
In reply to Re: Adding Parnate and prazosin., posted by uncouth on April 20, 2012, at 16:52:29
are you on Namenda at the moment uncouth? I wanna add it to Parnate for OCD, ADHD, impulse control issues ..
any problems with insomnia, dissociation etc.?
Posted by SLS on April 24, 2012, at 18:51:05
In reply to Re: Adding Parnate and prazosin. » uncouth, posted by g_g_g_unit on April 21, 2012, at 10:27:51
Best day yet!
Woohoo!
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 12 mg
- Scott
Posted by Phillipa on April 24, 2012, at 21:30:59
In reply to Re: Adding Parnate and prazosin., posted by SLS on April 24, 2012, at 18:51:05
Congrats sounds excellent. That's 12mg of prazosin now right? Phillipa
Posted by Twinleaf on April 25, 2012, at 5:58:29
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Phillipa on April 24, 2012, at 21:30:59
This is the best news ever. It seems as though right from the beginning there has been something about Prazosin's effect on you which made you very hopeful about it. Do you think it's the effect it may be having on the traumatic component of your depression? Or is it more its synergy with the other medications? In any event, it's wonderful to hear.
Posted by SLS on April 25, 2012, at 21:43:34
In reply to Re: Adding Parnate and prazosin., posted by Twinleaf on April 25, 2012, at 5:58:29
> This is the best news ever. It seems as though right from the beginning there has been something about Prazosin's effect on you which made you very hopeful about it. Do you think it's the effect it may be having on the traumatic component of your depression? Or is it more its synergy with the other medications? In any event, it's wonderful to hear.
Thanks, Twinleaf!
I'll give your excellent questions some more time to consider.
I have a few ideas, but nothing definite. I think the mind/brain gets into the habit of dissociating in response to trauma, both external and internal. Once established, the dissociative processes in the brain might remain active, even after the traumas are resolved. The brain gets "stuck" in a dissociative, vegetative depressive state.
The addition of prazosin felt like I had added a robustly effective antidepressant that produced greater clarity of thought. It is very "clean" cognitively. The only two side effects I have is mild orthostatic hypotension and a loss of libido.
- Scott
Posted by Ron Hill on April 27, 2012, at 3:56:59
In reply to Re: Adding Parnate and prazosin. » Twinleaf, posted by SLS on April 25, 2012, at 21:43:34
> and a loss of libido.
-----------
Scott,Loss of sexual desire only, or ED plus lack of sexual desire?
-- Ron
Posted by SLS on April 27, 2012, at 13:44:37
In reply to Re: Adding Parnate and prazosin. » SLS, posted by Ron Hill on April 27, 2012, at 3:56:59
> > and a loss of libido.
> -----------
> Scott,
>
> Loss of sexual desire only, or ED plus lack of sexual desire?
>
> -- Ron
Prazosin has reduced my sexual desire. This is not an uncommon side effect with this drug. I have no problems with erection and orgasm. The hardware works just fine.
- Scott
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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
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