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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Nohope on September 15, 2004, at 4:23:10
Hi everyone.
I've been on Parnate for 6 weeks now - I'd like to say how it is going but my condition is changing all the time. Here is a summary of my experience so far:
WEEK 1
Started on 30mg/day; 20mg upon awakening, 10mg at lunch time. By day 3, I am experiencing enormous relief from my anxiety. Insomnia starts to set in a little too, but I lie blissfully in bed like a sunbather, thanks to this new found calm. No change in depression, fatigue or any other aspect, but more wakefulness.WEEK 2
Getting temporary bursts of energy that helps me a lot at work. Still feeling calm, although maybe not as much as in week 1. Insomnia definitely prominent, but at least it is dream- free (I hate dreaming), unlike SSRI type insomnia where it is like a TV left on in my head. Notice some improvement in depression towards the end of the week. Erectile and anorgasmia problems become quite bad, but libido good. Appetite much less (excellent) but very strong craving for sugars (strange).WEEK 3
Outstanding mood - sometimes even a little calm euphoria. I haven't felt like this for a long time. Feeling very sharp and energetic at work. Insomnia still a problem. Sexual problems abating. I feel like a turning point has been reached in my life.WEEK 4
Unexpected return of significant anxiety and depression. Sleep improved. Still wakeful and energetic, but starting to feel periods of fatigue. Strong urges to sleep hit me between 4-6 pm, but then go again. Libido starts to wane. No other sexual problems. Appetite remains low (by that I mean excellent).WEEK 5
I increase dose to 40 mg/day. A few days later there is a definite improvement in anxiety; insomnia worsens but is still not bad. Towards the end of the week, mood improves again, but no really strong antidepressant effect or euphoria. Libido temporarily increases then wanes again. No other sexual problems. Start to crave sugars again, but still gradually losing weight.WEEK 6
All anxiety and depression benefit gained from upping dose is lost. Feeling quite anxious and mildly depressed. Quite irritable. Libido almost non-existant. Insomnia not too bad. Feeling wakeful but fatigued all day. Still strong urges to sleep between 4 - 6pm.In summary, I've never had a roller coaster ride like this. I've never been on a medication where I gained such tolerance to both the good and bad effects. It was extremely cruel to get to such an excellent state in week 3, then to feel it slip away.
My pdoc has given me the freedom to go as high as 60mg/day if I feel the need. My current plan is to go to this dose then stay there for about 4 weeks to see what happens. However, if people have any other suggestions or comments, *please* let me know. I'm disappointed and perplexed, but I'm not ready to give up on Parnate yet.Nohope
Posted by Piquet on September 15, 2004, at 5:43:31
In reply to 6 Weeks on Parnate - Advice Sought, posted by Nohope on September 15, 2004, at 4:23:10
> Hi everyone.
>
> I've been on Parnate for 6 weeks now - I'd like to say how it is going but my condition is changing all the time. Here is a summary of my experience so far:
>
> WEEK 1
> Started on 30mg/day; 20mg upon awakening, 10mg at lunch time. By day 3, I am experiencing enormous relief from my anxiety. Insomnia starts to set in a little too, but I lie blissfully in bed like a sunbather, thanks to this new found calm. No change in depression, fatigue or any other aspect, but more wakefulness.
>
> WEEK 2
> Getting temporary bursts of energy that helps me a lot at work. Still feeling calm, although maybe not as much as in week 1. Insomnia definitely prominent, but at least it is dream- free (I hate dreaming), unlike SSRI type insomnia where it is like a TV left on in my head. Notice some improvement in depression towards the end of the week. Erectile and anorgasmia problems become quite bad, but libido good. Appetite much less (excellent) but very strong craving for sugars (strange).
>
> WEEK 3
> Outstanding mood - sometimes even a little calm euphoria. I haven't felt like this for a long time. Feeling very sharp and energetic at work. Insomnia still a problem. Sexual problems abating. I feel like a turning point has been reached in my life.
>
> WEEK 4
> Unexpected return of significant anxiety and depression. Sleep improved. Still wakeful and energetic, but starting to feel periods of fatigue. Strong urges to sleep hit me between 4-6 pm, but then go again. Libido starts to wane. No other sexual problems. Appetite remains low (by that I mean excellent).
>
> WEEK 5
> I increase dose to 40 mg/day. A few days later there is a definite improvement in anxiety; insomnia worsens but is still not bad. Towards the end of the week, mood improves again, but no really strong antidepressant effect or euphoria. Libido temporarily increases then wanes again. No other sexual problems. Start to crave sugars again, but still gradually losing weight.
>
> WEEK 6
> All anxiety and depression benefit gained from upping dose is lost. Feeling quite anxious and mildly depressed. Quite irritable. Libido almost non-existant. Insomnia not too bad. Feeling wakeful but fatigued all day. Still strong urges to sleep between 4 - 6pm.
>
> In summary, I've never had a roller coaster ride like this. I've never been on a medication where I gained such tolerance to both the good and bad effects. It was extremely cruel to get to such an excellent state in week 3, then to feel it slip away.
> My pdoc has given me the freedom to go as high as 60mg/day if I feel the need. My current plan is to go to this dose then stay there for about 4 weeks to see what happens. However, if people have any other suggestions or comments, *please* let me know. I'm disappointed and perplexed, but I'm not ready to give up on Parnate yet.
>
> Nohope
>
Hi Nohope.I started on Parnate at 40 mg and went to 60 mg after six weeks. At the end of my fourth week on 60 mg I'm on a bit of a plateau, but I've improved a lot overall. My dx is major depression, atypical & treatment resistant. My doc told me that therapeutic results generally can't be confirmed until after being on a given dosage for at least 6 weeks for most people. That gives me another 2 weeks to see if there's more to be had from 60 mg, and he is willing to go to 90 mg. To give an idea of my progress, I started at 25-30 per cent, I'm currently at around 70 plus percent and I want (of course) to get to 100 per cent. So I'm glad you're not ready to washout Parnate yet, as you may just need more time, higher dosage or -- most likely -- both. Nearly all my side effects diminish to near zero within about 3 weeks of startup or dose increase. Like you, I'm sorry that my appetite came back, but it's still more controllable than before Parnate. I get urges to eat cookies etc., but I'm gradually losing my excess weight anyhow. I'm in this for the long haul as I think it may well turn out to be worth it. Hope this helps you, and I wish you the best.
Piquet.
Posted by King Vultan on September 15, 2004, at 11:05:46
In reply to 6 Weeks on Parnate - Advice Sought, posted by Nohope on September 15, 2004, at 4:23:10
I've been on 30 mg/day for two weeks and was on 20 mg for a week before that. I'm also seeing my pdoc today about going up to 40 mg/day. I've been on the stuff for a shorter period of time than you but have also experienced some ups and downs. I can't say this has ever really happened on any of the 10 or so other meds I've tried, but I don't think it necessarily portends badly. The hypothesis I would suggest is that the dual effects of MAO inhibition + its effects as a stimulant are kicking in at different times and interacting in such a way that it's taking longer to come to equilibrium. If you can imagine putting something on a balance beam scale and then adding another item before the scale has come to rest from weighing the first one, there is likely to be some unpredictability as to exactly what it does next, along with some more ups and downs. Honestly, I don't know if that's what's going on, but it sure sounds good.
Todd
Posted by yznhymer on September 15, 2004, at 17:28:47
In reply to Re: 6 Weeks on Parnate - Advice Sought » Nohope, posted by King Vultan on September 15, 2004, at 11:05:46
> I've been on 30 mg/day for two weeks and was on 20 mg for a week before that. I'm also seeing my pdoc today about going up to 40 mg/day. I've been on the stuff for a shorter period of time than you but have also experienced some ups and downs. I can't say this has ever really happened on any of the 10 or so other meds I've tried, but I don't think it necessarily portends badly. The hypothesis I would suggest is that the dual effects of MAO inhibition + its effects as a stimulant are kicking in at different times and interacting in such a way that it's taking longer to come to equilibrium. If you can imagine putting something on a balance beam scale and then adding another item before the scale has come to rest from weighing the first one, there is likely to be some unpredictability as to exactly what it does next, along with some more ups and downs. Honestly, I don't know if that's what's going on, but it sure sounds good.
>
> ToddLOL Todd, it sure does sound good! You could have a bright future writing for one of the political campaigns! Wanna take a stab at explaining John Kerry's Iraq votes or GWB's assertion that we're safer today than we were 3 years ago? They could both use your clarity. Thanks for the chuckle. :)
Mark
Posted by Nohope on September 16, 2004, at 3:35:30
In reply to Re: 6 Weeks on Parnate - Advice Sought, posted by Piquet on September 15, 2004, at 5:43:31
> I started on Parnate at 40 mg and went to 60 mg after six weeks. At the end of my fourth week on 60 mg I'm on a bit of a plateau, but I've improved a lot overall. My dx is major depression, atypical & treatment resistant. My doc told me that therapeutic results generally can't be confirmed until after being on a given dosage for at least 6 weeks for most people. That gives me another 2 weeks to see if there's more to be had from 60 mg, and he is willing to go to 90 mg. To give an idea of my progress, I started at 25-30 per cent, I'm currently at around 70 plus percent and I want (of course) to get to 100 per cent. So I'm glad you're not ready to washout Parnate yet, as you may just need more time, higher dosage or -- most likely -- both. Nearly all my side effects diminish to near zero within about 3 weeks of startup or dose increase. Like you, I'm sorry that my appetite came back, but it's still more controllable than before Parnate. I get urges to eat cookies etc., but I'm gradually losing my excess weight anyhow. I'm in this for the long haul as I think it may well turn out to be worth it. Hope this helps you, and I wish you the best.
>
> Piquet.Hi Piquet,
Thanks for that. I'm starting to get the feeling that one has to be very patient with MAOIs. Quite a few posters here seem to respond quickly, but almost as many have had to wait many weeks before feeling benefit. They certainly are unique drugs. I will be patient, and up my dose as well, I think.
With regards to appetite, I agree that it has been *much* more controllable on Parnate - a very pleasant change.
I hope you get to 100% soon, though 70% dosen't sound too bad either (congratulations!)
Nohope
Posted by Nohope on September 16, 2004, at 3:49:59
In reply to Re: 6 Weeks on Parnate - Advice Sought » Nohope, posted by King Vultan on September 15, 2004, at 11:05:46
Hi King Vultan,
You may be right about the dual effects of MAOIs. I searched the archives, and actually found others (e.g. cybercafe) who had the early euphoria (stimulant induced), followed by a worsening of symptoms, followed by a final improvement (MAO inhibition). I hope that's what is happening to me...
Certainly it has inspired me to be patient.I hope you do well on Parnate.
Nohope
Posted by Piquet on September 16, 2004, at 4:11:53
In reply to Re: 6 Weeks on Parnate - Advice Sought » Piquet, posted by Nohope on September 16, 2004, at 3:35:30
> Hi Piquet,
>
> Thanks for that. I'm starting to get the feeling that one has to be very patient with MAOIs. Quite a few posters here seem to respond quickly, but almost as many have had to wait many weeks before feeling benefit. They certainly are unique drugs. I will be patient, and up my dose as well, I think.
>
> With regards to appetite, I agree that it has been *much* more controllable on Parnate - a very pleasant change.
>
> I hope you get to 100% soon, though 70% dosen't sound too bad either (congratulations!)
>
> Nohope
>
Hi Nohope,It sounds like you have a good (ie, reasonable) attitude to the process. That'll be of great benefit to you in the long run. I hope things settle down and move ahead for you soon. Thanks for the good wishes.
Piquet.
This is the end of the thread.
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