![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 57 to 81 of 82. Go back in thread:
Posted by Lamdage22 on April 4, 2022, at 12:35:49
In reply to Re: combining nardil and parnate ) SLS, posted by Lamdage22 on April 4, 2022, at 12:32:43
Is there any history of psychosis or mania? If so, caution with psychedelics or stimulants. Thats just my cents.
Posted by Lamdage22 on April 4, 2022, at 12:42:04
In reply to Re: combining nardil and parnate ) SLS, posted by undopaminergic on April 4, 2022, at 12:33:50
> > What is tcp?
>
> TranylCyPromine. Or Transmission Control Protocol (which gets used every time you access a web site).
>
> -undopaminergicProbably the former in this context.
Posted by SLS on April 4, 2022, at 13:22:53
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 4, 2022, at 9:54:26
Hi, Rose.
> >
> > I don't think I ever asked you how you were feeling.
> >
> > Don't worry, I won't start now...
> >
> > Silliness aside, are you hanging in there?
> >
> >
> > - Scott> Im hanging in there but in a very bad way. The NHS want to add lithium. From what I gather from your posts, lithium is not an essential part of your recovery ?
.
No!
Lithium *is* essential for me!
However, lithium produces an antidepressant effect for me *only* at 300 mg/day. Once I increase the dosage to 450 mg/day, I begin to deteriorate. It's amazing. I found some literature that suggests an explanation for this. Lithium demonstrates a bimodal effect on both glutamate neurotransmission and clinical response.
> Do you think it can kick-start the tcp which is no longer working ? Lamotrigine did kick start it many months ago, but then stopped working and has now completely destroyed my memory and Im finding it very hard to come off it. In fact, Im finding it impossible to come off tcp, or lamotrigine or olanzapine. Just dont know what to do.
I have responded best to Parnate when it was combined with either desipramine or nortriptyline.- Scott
Posted by SLS on April 4, 2022, at 13:27:01
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 4, 2022, at 9:54:26
Hi, Rose.
> >
> > I don't think I ever asked you how you were feeling.
> >
> > Don't worry, I won't start now...
> >
> > Silliness aside, are you hanging in there?
> >
> >
> > - Scott> Im hanging in there but in a very bad way. The NHS want to add lithium. From what I gather from your posts, lithium is not an essential part of your recovery ?
.
No!
Lithium *is* essential for me!
However, lithium produces an antidepressant effect for me *only* at 300 mg/day. Once I increase the dosage to 450 mg/day, I begin to deteriorate. It's amazing. I found some literature that suggests an explanation for this. Lithium demonstrates a bimodal effect on both glutamate neurotransmission and clinical response.
> Do you think it can kick-start the tcp which is no longer working ? Lamotrigine did kick start it many months ago, but then stopped working and has now completely destroyed my memory and Im finding it very hard to come off it. In fact, Im finding it impossible to come off tcp, or lamotrigine or olanzapine. Just dont know what to do.
I have responded best to Parnate when it was combined with either desipramine or nortriptyline.If you have never tried Nardil, I strongly encourage you to do so. It is much better for anxiety than is Parnate. For me, Nardil makes me feel much "brighter" than Parnate. Nardil is also "pro-social". I did not find Parnate capable of doing this, even when it produced a remission of depression.
- Scott
Posted by Lamdage22 on April 4, 2022, at 13:36:59
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 4, 2022, at 13:27:01
I can second that.
> If you have never tried Nardil, I strongly encourage you to do so. It is much better for anxiety than is Parnate. For me, Nardil makes me feel much "brighter" than Parnate. Nardil is also "pro-social". I did not find Parnate capable of doing this, even when it produced a remission of depression.
Posted by Lamdage22 on April 4, 2022, at 13:53:48
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 4, 2022, at 13:27:01
It has cool pro GABA effects. In a way that is more sustainable and less addicting than Benzos.
Posted by Lamdage22 on April 4, 2022, at 13:56:17
In reply to Re: combining nardil and parnate ) SLS, posted by Lamdage22 on April 4, 2022, at 13:53:48
If I could, Id like just the GABAergic effect and not the MAO Inhibition. That got me in a problematic state.
Posted by rose45 on April 4, 2022, at 17:42:26
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 4, 2022, at 13:27:01
> Hi, Rose.
>
> > >
> > > I don't think I ever asked you how you were feeling.
> > >
> > > Don't worry, I won't start now...
> > >
> > > Silliness aside, are you hanging in there?
> > >
> > >
> > > - Scott
>
> > Im hanging in there but in a very bad way. The NHS want to add lithium. From what I gather from your posts, lithium is not an essential part of your recovery ?
>
> .
>
> No!
>
> Lithium *is* essential for me!
>
> However, lithium produces an antidepressant effect for me *only* at 300 mg/day. Once I increase the dosage to 450 mg/day, I begin to deteriorate. It's amazing. I found some literature that suggests an explanation for this. Lithium demonstrates a bimodal effect on both glutamate neurotransmission and clinical response.
>
> > Do you think it can kick-start the tcp which is no longer working ? Lamotrigine did kick start it many months ago, but then stopped working and has now completely destroyed my memory and Im finding it very hard to come off it. In fact, Im finding it impossible to come off tcp, or lamotrigine or olanzapine. Just dont know what to do.
>
>
> I have responded best to Parnate when it was combined with either desipramine or nortriptyline.
>
> If you have never tried Nardil, I strongly encourage you to do so. It is much better for anxiety than is Parnate. For me, Nardil makes me feel much "brighter" than Parnate. Nardil is also "pro-social". I did not find Parnate capable of doing this, even when it produced a remission of depression.
>
>
> - Scott
>
>
> I thought you said that you take lithium now mainly to stave off Alzheimers.... maybe i misunderstood.Nardil was the first med I was ever put on, and it lasted 22 years before it stopped working. I then went on to parnate which I preferred. It suited me very well and had less side effects than nardil. But it stopped working after I reduced it, and now I am unable to come off it, even though it is no longer totally working. The pain is too great. Same is true for lamotrigine.
Re.lithium, do you do the blood tests regularly... or did you just take 300 mg from the start, without the blood tests?
Lithium doesnt really help with anxiety does it?
Posted by Lamdage22 on April 4, 2022, at 23:56:31
In reply to Re: combining nardil and parnate ) SLS, posted by rose45 on April 4, 2022, at 17:42:26
> Lithium doesnt really help with anxiety does it?
Maybe a little bit. Everyone is different. Are you not interested in reducing suicidality?
Posted by rose45 on April 5, 2022, at 6:13:03
In reply to Re: combining nardil and parnate ) SLS, posted by Lamdage22 on April 4, 2022, at 23:56:31
> > Lithium doesnt really help with anxiety does it?
>
> Maybe a little bit. Everyone is different. Are you not interested in reducing suicidality?
My feeling of suicidality comes from not being able to accept that I have to live from now on as I am now. Its more from an intellectual understanding, if that makes sense.I asked Scott this same question, but do you have regular blood tests for lithium, or did you just decide to stay on a low dose, and do not need blood tests?
>
>
Posted by Lamdage22 on April 5, 2022, at 6:15:57
In reply to Re: combining nardil and parnate ) SLS, posted by rose45 on April 5, 2022, at 6:13:03
> I asked Scott this same question, but do you have regular blood tests for lithium, or did you just decide to stay on a low dose, and do not need blood tests?
I had a blood test once and my doctor said: At that dosage and that blood level, Lithium is extremely unlikely to get toxic.
Posted by SLS on April 5, 2022, at 8:39:01
In reply to Re: combining nardil and parnate ) SLS, posted by rose45 on April 4, 2022, at 17:42:26
> > Hi, Rose.
> >
> > > >
> > > > I don't think I ever asked you how you were feeling.
> > > >
> > > > Don't worry, I won't start now...
> > > >
> > > > Silliness aside, are you hanging in there?
> > > >
> > > >
> > > > - Scott
> >
> > > Im hanging in there but in a very bad way. The NHS want to add lithium. From what I gather from your posts, lithium is not an essential part of your recovery ?
> >
> > .
> >
> > No!
> >
> > Lithium *is* essential for me!
> >
> > However, lithium produces an antidepressant effect for me *only* at 300 mg/day. Once I increase the dosage to 450 mg/day, I begin to deteriorate. It's amazing. I found some literature that suggests an explanation for this. Lithium demonstrates a bimodal effect on both glutamate neurotransmission and clinical response.
> >
> > > Do you think it can kick-start the tcp which is no longer working ? Lamotrigine did kick start it many months ago, but then stopped working and has now completely destroyed my memory and Im finding it very hard to come off it. In fact, Im finding it impossible to come off tcp, or lamotrigine or olanzapine. Just dont know what to do.
> >
> >
> > I have responded best to Parnate when it was combined with either desipramine or nortriptyline.
> >
> > If you have never tried Nardil, I strongly encourage you to do so. It is much better for anxiety than is Parnate. For me, Nardil makes me feel much "brighter" than Parnate. Nardil is also "pro-social". I did not find Parnate capable of doing this, even when it produced a remission of depression.
> >
> >
> > - Scott
> >
> >
> > I thought you said that you take lithium now mainly to stave off Alzheimers.... maybe i misunderstood.
>
> Nardil was the first med I was ever put on, and it lasted 22 years before it stopped working. I then went on to parnate which I preferred. It suited me very well and had less side effects than nardil. But it stopped working after I reduced it, and now I am unable to come off it, even though it is no longer totally working. The pain is too great. Same is true for lamotrigine..
First of all, why do you want to stop taking Parnate? You know that you are most likely a "lifer", right?. The next time you find something that works, don't rock the boat.
How much Parnate were you taking when it worked best? How would you describe the amount of improvement it produced?
As best as I can estimate from my knowledge of the real-life clinical effective dosage range for Parnate is 40-80 mg/day. A special "high dosage" Parnate begins at 120 mg/day.
I have taken 120 mg/day of Parnate in combination with 300 mg/day of desipramine and some Ritalin. Thyroxine (T4) was added at some point. That is, of course, very aggressive.
One strategy for "recapturing" the antidepressant response when you relapse on Nardil is to discontinue it for three months, and then restart it. One of my doctors had a patient who he had to switch back and forth between Nardil and Parnate.
With lamotrigine (Lamictal), not going up to a minimum of 200 mg is usually optimally effective. Lamotrigine is not an all-or-nothing drug. At 200 mg/day, I glean a partial, although significant response. At 300 mg/day, I experience full remission AND the side-effect of memory impairment disappears, and my memory actually improves as the depression is reduced.
In my estimation, the effective dosage range of lamotrigine to treat bipolar depression is 200-300 mg/day.
You never know.
What are your plans at this point?
- Scott>
> Re.lithium, do you do the blood tests regularly... or did you just take 300 mg from the start, without the blood tests?
>
> Lithium doesnt really help with anxiety does it?
Posted by SLS on April 5, 2022, at 8:49:43
In reply to Re: combining nardil and parnate ) SLS, posted by rose45 on April 5, 2022, at 6:13:03
> > > Lithium doesnt really help with anxiety does it?
> >
> > Maybe a little bit. Everyone is different. Are you not interested in reducing suicidality?
>
>
>
>
> My feeling of suicidality comes from not being able to accept that I have to live from now on as I am now. Its more from an intellectual understanding, if that makes sense.
>
> I asked Scott this same question, but do you have regular blood tests for lithium, or did you just decide to stay on a low dose, and do not need blood tests?
Lithium blood levels are irrelevant when using lithium as a low-dosage treatment for depression. The level might not exceed 0.2.mEq/L. You really have to establish the right dosage clinically - trial and error in this case.You simply start at 150 mg/day and go no higher than 600 mg/day. I think that you should stay on each dosage for 2-3 weeks before increasing another 150 mg/day.
I find that taking too much (450 mg/day) lithium exacerbates my depression, and makes me feel flat, apathetic, less creative and generally unmotivated. For me, 300 mg/day of lithium is optimal. Another advantage of using low dosages of lithium is that there is almost no liability for thyroid or kidney dysfunction.
- Scott
Posted by rose45 on April 5, 2022, at 10:58:48
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 5, 2022, at 8:39:01
> > > Hi, Rose.
> > >
> > > > >
> > > > > I don't think I ever asked you how you were feeling.
> > > > >
> > > > > Don't worry, I won't start now...
> > > > >
> > > > > Silliness aside, are you hanging in there?
> > > > >
> > > > >
> > > > > - Scott
> > >
> > > > Im hanging in there but in a very bad way. The NHS want to add lithium. From what I gather from your posts, lithium is not an essential part of your recovery ?
> > >
> > > .
> > >
> > > No!
> > >
> > > Lithium *is* essential for me!
> > >
> > > However, lithium produces an antidepressant effect for me *only* at 300 mg/day. Once I increase the dosage to 450 mg/day, I begin to deteriorate. It's amazing. I found some literature that suggests an explanation for this. Lithium demonstrates a bimodal effect on both glutamate neurotransmission and clinical response.
> > >
> > > > Do you think it can kick-start the tcp which is no longer working ? Lamotrigine did kick start it many months ago, but then stopped working and has now completely destroyed my memory and Im finding it very hard to come off it. In fact, Im finding it impossible to come off tcp, or lamotrigine or olanzapine. Just dont know what to do.
> > >
> > >
> > > I have responded best to Parnate when it was combined with either desipramine or nortriptyline.
> > >
> > > If you have never tried Nardil, I strongly encourage you to do so. It is much better for anxiety than is Parnate. For me, Nardil makes me feel much "brighter" than Parnate. Nardil is also "pro-social". I did not find Parnate capable of doing this, even when it produced a remission of depression.
> > >
> > >
> > > - Scott
> > >
> > >
> > > I thought you said that you take lithium now mainly to stave off Alzheimers.... maybe i misunderstood.
> >
> > Nardil was the first med I was ever put on, and it lasted 22 years before it stopped working. I then went on to parnate which I preferred. It suited me very well and had less side effects than nardil. But it stopped working after I reduced it, and now I am unable to come off it, even though it is no longer totally working. The pain is too great. Same is true for lamotrigine.
>
> .
>
> First of all, why do you want to stop taking Parnate? You know that you are most likely a "lifer", right?. The next time you find something that works, don't rock the boat.
>
> How much Parnate were you taking when it worked best? How would you describe the amount of improvement it produced?
>
> As best as I can estimate from my knowledge of the real-life clinical effective dosage range for Parnate is 40-80 mg/day. A special "high dosage" Parnate begins at 120 mg/day.
>
> I have taken 120 mg/day of Parnate in combination with 300 mg/day of desipramine and some Ritalin. Thyroxine (T4) was added at some point. That is, of course, very aggressive.
>
> One strategy for "recapturing" the antidepressant response when you relapse on Nardil is to discontinue it for three months, and then restart it. One of my doctors had a patient who he had to switch back and forth between Nardil and Parnate.
>
> With lamotrigine (Lamictal), not going up to a minimum of 200 mg is usually optimally effective. Lamotrigine is not an all-or-nothing drug. At 200 mg/day, I glean a partial, although significant response. At 300 mg/day, I experience full remission AND the side-effect of memory impairment disappears, and my memory actually improves as the depression is reduced.
>
> In my estimation, the effective dosage range of lamotrigine to treat bipolar depression is 200-300 mg/day.
>
> You never know.
>
> What are your plans at this point?
>
>
> - Scott
>
> >
> > Re.lithium, do you do the blood tests regularly... or did you just take 300 mg from the start, without the blood tests?
> >
> > Lithium doesnt really help with anxiety does it?
>
>
> Scott,
You may not remember as there have been so many posts on here, but I did mention in an earlier post thatparnate on its own was perfect for me at 30mg. I was on it happily for 6 years,But I went slightly high on it, after a meditation retreat, and so reduced the dose and it stopped working altogether, and the unbearable anxiety which it had been masking came out with a vengeance.
I increased it to 40 mg but it made no difference, and just cannot tolerate it any higher. Same thing happened to me when Nardil stopped working.
In hindsight it was a terrible mistake to lower the dose, but I never imagined it would just stop working altogether.
It is still active at some level and lamotrigine did 'jump start' it but that only lasted for 4 months, and then stopped working altogether. The
lamotrigine has ruined my memory and ability to communicate as I used to- And now im finding it is excessively difficult to come off it also. So now there are 3 meds that I cannot come off : Parnate, Lamotrigine and Olanzapine.
I am in a terrible state, with no memory and anxiety which is so crippling, I dont dare go out on my own further than just my neighbourhood. Ive lost the ability to think things out in my own mind....this is a little worse than the state I was in when I first went on meds - Both nardil and parnate worked for me, but nardil did make me go 'high' and very aggressive.
The NHS (UK free medical) are now suggesting lithium and I have no choice but to agree, otherwise they will discharge me. I cant see how lithium will help the anxiety or give me my memory back....I dont know how I can ever get out of this hell that I am living.
Thank you for all your responses to my posts. You are very kind.
Posted by SLS on April 5, 2022, at 14:22:57
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 5, 2022, at 10:58:48
Hi, Rose.
Can you describe what are the obstacles that prevent you from discontinuing each drug?
Did what I wrote change anything about the way you plan to move forward?
- Scott
Posted by rose45 on April 5, 2022, at 17:15:45
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 5, 2022, at 14:22:57
> Hi, Rose.
>
> Can you describe what are the obstacles that prevent you from discontinuing each drug?
>
> Did what I wrote change anything about the way you plan to move forward?
>
>
> - ScottScott, I try to reduce the parnate by one 10 mg pill and the pain is excruciating - dont know how to describe it, mental and psychic crippling pain.. I cant tolerate it, and that is just 10mg out of a 40 mg dose. Strange thing is that when I was high on the parnate, I reduced without any problem, but now i just cannot tolerate the pain.
It is similar with lamotrigine - I tried to reduce by 25 mg and the depression and anxiety were unbearable. I have discovered a lamotrigine withdrawal group on facebook, and the people on there suggest reducing very gradually, using a syringe, and lamotrigine dissolved in water. They say its harder to come of f it than benzos - Not everyone experiences it that way, and not everyone has the horrible side effects of memory loss and loss of communication ability, finding the right word etc..I dont know whether managing to come off lamotrigine would bring back my memory or not, or would it make my mental state even worse.
Obviously lamotrigine has worked for you, but it has been terrible for me, except for the 4 months when I was ok.I dont have much choice re. moving forward do I? Adding lithium is the only thing that the NHS can offer. You have told me what works for you
but what options do I have ?I dont think that adding lithium will be a magic cure. But I am depending on a useless mental health dept. What options do I have, if I cannot even get off my meds.
Posted by SLS on April 5, 2022, at 23:26:32
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 5, 2022, at 17:15:45
Hi, Rose.
Don't try to swallow all of this at once.
Back in the early 1980s, the Columbia Presbyterian depression research unit found that lithium augmentation was particularly effective when lithium was added. Since you get "high", I would consider you to fall somewhere along the bipolar spectrum. Start treating your illness as if it were bipolar depression, and alter your treatment strategies. Although you and I both suffer predominantly from depression with only rare drug-induced manias, I would say that your depression has a bipolar diathesis. (I couldn't find a better word). Concentrate on treatments for bipolar depression from now on.
You could try:
1. Bring the lamotrigine to 300 mg/day for maybe five days to see if your thinking and memory impairments clear up.
2. Start Nardil very low an very slow. I played out a hunch I had. I had thought that a gradual titration beginning at 7.5 mg/day might prevent *triggering* side effects. I had guessed that if you can prevent the triggering of Nardil side effects in the first place, they may never emerge or be much milder. Having initiated Nardil treatment this say prevented or mitigated all autonomic side effects, including hypotensive dizziness and difficulties with initiating urination (delayed micturition).
Beginning Nardil Treatment:You might begin at 7.5 mg/day (1/2 pill) for 5-7 days, and then to 15 mg/day (whole pill) for another 7-10 days. From there, you might increase the dosage to 30 mg/day for 10 days. Next, move up to 45 mg/day for no longer than 2 weeks. mg/day-2 weeks. Once you get to 60 mg/day, it's time to find the lowest effective dosage. You might think to give each dosage increase 2-3 weeks to evaluate your response to it. Continue this process until you reach 90 mg/day if necessary. If, at 90 mg/day, you are tolerating Nardil side effects, you might then allow another 2-3 months for Nardil to begin working. Be careful once you get to the higher dosages. A dosage that is too high can allow for a relapse and the appearance of "brain fog" and a difficult to describe zombie-like state. not begin responding for a few months. At this point, returning to 75 mg/day might not settle in for a week or so.
I have been encouraged lately by the potential for asenapine (Saphris) to augment a drug treatment by adding it to everything you are taking.
- Scott
Posted by Lamdage22 on April 6, 2022, at 1:31:19
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 5, 2022, at 17:15:45
> Adding lithium is the only thing that the NHS can offer. You have told me what works for you
> but what options do I have ?I dont think that adding lithium will be a magic cure. But I am depending on a useless mental health dept. What options do I have, if I cannot even get off my meds.
>It likely doesn't impact your anxiety in a major way, but at least your anxiety might not lead to suicidal thoughts anymore. That is better than nothing.
Can Buspar be taken with her medicaction mix? It doesn't work for everyone, but when it works the reviews sound cool.
Posted by rose45 on April 6, 2022, at 4:32:22
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 5, 2022, at 23:26:32
Scott,
Once again, I am so grateful to you for giving me so much of your time and thoughtfulness to me. I am truly desperate and not getting the help I need from mental health services.I think because we have had so many messages to and fro, there are some details you forget:
1. I was on nardil for 22 years and it then entirely stopped working. So there is no guarantee that it would work again.
Parnate has worked much better for me than Nardil, and unfortunately I am unable to come off it - I did describe the difficulty I have in my previous post...
so to remind you, I am still taking parnate because I cannot come off it.Re. Lamotrigine, I am on 125 mg, having reduced from 200 mg. I never noticed much difference when increasing from 100-200 mg, and it did work for 4 months at 200 mg,
but then stopped working and the memory loss and inability to communicate is so severe and totally caused by lamotrigine, as I did not have it that badly before. It would take a while to increase to 300 mg at 25 mg every 2 weeks and hesitate to increase it at this point - just because it worked for you - You did not have the horrible side effects that I got.I truly dont want to negate everything you suggest, although it may sound like it. I think it may be hard for you to get my whole picture as you have other things to do besides re-reading my posts - eg I took nardil for probably longer than you have- so I did become familiar with how to increase, and was on a dose of 45 mg for all that time.
Posted by rose45 on April 6, 2022, at 5:43:47
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 5, 2022, at 23:26:32
Scott,
Just to remind you also, as I mentioned in another earlier post, that 2 years ago, i added 25mg olanzapine to the parnate, and it miraculously made the parnate work again. However again, stupidly I slowly decreased the olanzapine, and it stopped working altogether,and would not work even after increasing again. I have made so many mistakes, but other people decrease and increase their meds without having them stop working.
Posted by SLS on April 6, 2022, at 12:24:57
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 5, 2022, at 23:26:32
Sorry for the confusion. This is what I had wanted to write:
"Back in the early 1980s, the Columbia Presbyterian depression research unit found that lithium augmentation to Parnate was particularly effective."
- Scott
Posted by rose45 on April 6, 2022, at 12:58:07
In reply to Oops..Parnate + Lithium is particularly effective., posted by SLS on April 6, 2022, at 12:24:57
> Sorry for the confusion. This is what I had wanted to write:
>
>
> "Back in the early 1980s, the Columbia Presbyterian depression research unit found that lithium augmentation to Parnate was particularly effective."
>Scott,
> Ah yes, I was told this by a professor here in UK, who I emailed in desperation
> - He said:'
> Yes the action of lithium is to boost the Parnate and the two were often used together in severe depression. You just add the lithium and if its going to help it should be effective in a couple of weeks. The blood level of lithium can be quite modest (about 0.5mmol/l 12 hours after the last dose). As I mentioned, low dose aripiprazole can also be helpful when added to Parnate.He is a professor at Oxford University, but unfortunately does not see patients.
Do you think that means that possibly the lithium may kick start the parnate ? Otherwise I cant see the point of taking lithium as it apparently doesnt do much for anxiety or depression.
Posted by SLS on April 6, 2022, at 14:17:15
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 6, 2022, at 4:32:22
> Scott,
> Once again, I am so grateful to you for giving me so much of your time and thoughtfulness to me. I am truly desperate and not getting the help I need from mental health services.
>
> I think because we have had so many messages to and fro, there are some details you forget:
>
> 1. I was on nardil for 22 years and it then entirely stopped working. So there is no guarantee that it would work again.
> Parnate has worked much better for me than Nardil, and unfortunately I am unable to come off it - I did describe the difficulty I have in my previous post...
> so to remind you, I am still taking parnate because I cannot come off it.
>
> Re. Lamotrigine, I am on 125 mg, having reduced from 200 mg. I never noticed much difference when increasing from 100-200 mg, and it did work for 4 months at 200 mg,
> but then stopped working and the memory loss and inability to communicate is so severe and totally caused by lamotrigine, as I did not have it that badly before. It would take a while to increase to 300 mg at 25 mg every 2 weeks and hesitate to increase it at this point - just because it worked for you - You did not have the horrible side effects that I got.
>
> I truly dont want to negate everything you suggest, although it may sound like it. I think it may be hard for you to get my whole picture as you have other things to do besides re-reading my posts - eg I took nardil for probably longer than you have- so I did become familiar with how to increase, and was on a dose of 45 mg for all that time.
I think you'll find that Nardil at 45 mg/day is usually too low. Like I said, my impression is that the effective range of Nardil for treating severe depression or anxiety disorders is 60-90 mg/day. You are unusual in this regard. Your doctor may have made a grievous error in not increasing your dosage of Nardil to 60 mg/day.My memory is still terrible. I find it difficult to remember everyone's treatment history. I wish I did. Memory seems to be the last part of my depression to recover. Short-term memory is still particularly affected.
In any event, if you are ever to return to Nardil, my current beliefs include:1. Know that the range for MOST people is 60-90 mg/day.
2. Starting at 7.5 mg/day and increasingly gradually can reduce the risk of experiencing significant side-effects.
- Scott
Posted by rose45 on April 6, 2022, at 14:31:58
In reply to Re: combining nardil and parnate ) SLS » rose45, posted by SLS on April 6, 2022, at 14:17:15
Scott, i was on nardil for 22 years , that is a long time.
The dose would be slowly increased to 60 mg, and once I felt better it would be brought down to 45 mg which was my maintenance dose. It was NOT too low, it was just right.
I always take low doses of meds. On parnate it was 30 mg.And I simply cannot tolerate higher than 40 mg.
I think its important to remember that we are all different.
Posted by SLS on April 7, 2022, at 8:07:45
In reply to Re: combining nardil and parnate ) SLS » SLS, posted by rose45 on April 6, 2022, at 14:31:58
Hi, Rose.
> Scott, i was on nardil for 22 years , that is a long time.
> The dose would be slowly increased to 60 mg, and once I felt better it would be brought down to 45 mg which was my maintenance dose.How could 45 mg/day of Nardil be your maintenance dosage if you relapsed on a regular basis and then had to raise it to 60 mg/day to "recapture" your antidepressant response? I would strongly recommend that you remain at 60 mg/day next time.
Regarding lithium at low dosages (150-450 mg/day), why would you resist such a simple and innocuous treatment?
> I always take low doses of meds. On parnate it was 30 mg.And I simply cannot tolerate higher than 40 mg.
> I think its important to remember that we are all different.
Yeah. Go back and reread everything I have posted to you. I made that quite clear several times.
Discovering what drugs do what for you is still an empirical endeavor. You can either try what worked before or try other things. If you are suicidal, and you tolerated 60 mg/day of Nardil, I think your best choice for the moment is clear.What other treatments do you have lined up to try next?
You have been very somewhat resistant to everything I wrote, so I'm sure this post is going to piss you off. If it does, then wait until you are no longer pissed off at me, and then go back and read all of my posts to you. You may have been on Nardil for 22 years, but I have been on and off of it for 40 years (1982), and treated by one of the most expert teams using Nardil. In fact, the syndrome known as "atypical depression" was coined there, and Nardil had shown itself to be the best drug to combat that syndrome and also anxiety disorders. I picked a lot of brains, most of which have authored articles in the medical literature for years. Maybe that's worth something. Maybe it's not. That is for you to decide.
My recommendation is that if you are so depressed, anxious, and suicidal, just go back to Nardil and remain on it at 60 mg/day indefinitely. You were so close. And yes, Zyprexa can give one hell of a boost to Nardil, but my guess is that it is usually temporary. I would look at asenapine or lumateperone if you are looking at "antipsychotics" as augmenters.
What are the obstacles that prevent you from returning to Nardil?
As I mentioned in a previous post to you, a strategy used in the past to remedy a relapse on Nardil after years of remission is to stop taking it for three months, and then restarting it. Just a little brain picking...
Good luck.
- Scott
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