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Dr. Bob is Robert Hsiung, MD,
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Posted by AudreyE on November 13, 2004, at 10:15:08
Hello!
I've been taking Parnate for 2 months, and it's effectively ended 15+ years of chronic depression. I've had very few side-effects, compared to those I've experienced on other anti-depressants, *except* that I've had horrible insomnia at night and, oddly enough, terrible sleepiness between 2-6 in the afternoon.
I've read a few posts on other forums that suggest this pattern has happened to others. I am dangerous between the hours of 2-6, and I can barely stay awake on my feet, let alone drive a car. Then, around 10 pm, I'm wide awake until 5 am.
Has anyone else experienced sleep disturbanes with MAOIs, and what has your doctor suggested?
(My doctor is, btw, the worst doc I've ever had, and I get no help from him with anything. I have appointments coming up with new docs, but, of course, I can't get in until January or February.)
Thanks!
Posted by King Vultan on November 13, 2004, at 11:04:06
In reply to Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 13, 2004, at 10:15:08
> Hello!
>
> I've been taking Parnate for 2 months, and it's effectively ended 15+ years of chronic depression. I've had very few side-effects, compared to those I've experienced on other anti-depressants, *except* that I've had horrible insomnia at night and, oddly enough, terrible sleepiness between 2-6 in the afternoon.
>
> I've read a few posts on other forums that suggest this pattern has happened to others. I am dangerous between the hours of 2-6, and I can barely stay awake on my feet, let alone drive a car. Then, around 10 pm, I'm wide awake until 5 am.
>
> Has anyone else experienced sleep disturbanes with MAOIs, and what has your doctor suggested?
>
> (My doctor is, btw, the worst doc I've ever had, and I get no help from him with anything. I have appointments coming up with new docs, but, of course, I can't get in until January or February.)
>
> Thanks!
I'm on Parnate also and was on Nardil before that. Both drugs have given me severe insomnia, with the Parnate being worse. I was experiencing the afternoon sedation you describe while on Nardil until I started using triazolam/Halcion every other night instead of the Benadryl I had been using every night for sleep, and the increased number of hours and improved quality of sleep quickly eliminated the problem. As in some other situations where people are excessively sleepy during the day, sleep apnea being a good example, my opinion is that the notorious MAOI afternoon sedation problem results from either not getting enough sleep or enough quality sleep. However, finding a sleep med or combination of meds that work can still be a problem, given how bad MAOI insomnia can be. What have you tried so far for your insomnia?Todd
Posted by AudreyE on November 13, 2004, at 13:15:10
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by King Vultan on November 13, 2004, at 11:04:06
Hi, and thanks for your reply!
I've tried very little in terms of my insomnia, actually. I've been taking melatonin, which is no longer working. My doctor is very condescending about everything, and he won't prescribe anything. He finally suggested I take Alluna, which is an all natural supplement. I'm concerned, though, since it's not FDA approved, and God only knows how it interacts with Parnate.
Audrey
Posted by Dan Perkins on November 13, 2004, at 13:25:50
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 13, 2004, at 13:15:10
What time of day do you take your Parnate? That can make a bit of a difference sometimes.
Posted by cosis on November 13, 2004, at 14:13:33
In reply to Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 13, 2004, at 10:15:08
> Hello!
>
> I've been taking Parnate for 2 months, and it's effectively ended 15+ years of chronic depression. I've had very few side-effects, compared to those I've experienced on other anti-depressants, *except* that I've had horrible insomnia at night and, oddly enough, terrible sleepiness between 2-6 in the afternoon.
>
> I've read a few posts on other forums that suggest this pattern has happened to others. I am dangerous between the hours of 2-6, and I can barely stay awake on my feet, let alone drive a car. Then, around 10 pm, I'm wide awake until 5 am.
>
> Has anyone else experienced sleep disturbanes with MAOIs, and what has your doctor suggested?
>
> (My doctor is, btw, the worst doc I've ever had, and I get no help from him with anything. I have appointments coming up with new docs, but, of course, I can't get in until January or February.)
>
> Thanks!
I have been on Nardil for 3 years and never experienced insomnia. It actually makes me sleep a lot better because I use to worry and think about things too much before going to bed. I can't remember that last night I couldn't sleep...
I wish you luck on finding a good solution
Posted by King Vultan on November 14, 2004, at 0:51:33
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 13, 2004, at 13:15:10
> Hi, and thanks for your reply!
>
> I've tried very little in terms of my insomnia, actually. I've been taking melatonin, which is no longer working. My doctor is very condescending about everything, and he won't prescribe anything. He finally suggested I take Alluna, which is an all natural supplement. I'm concerned, though, since it's not FDA approved, and God only knows how it interacts with Parnate.
>
> Audrey
>
>I never had much luck with melatonin in the past, but I understand this works pretty well for some people. I use diphenhydramine (plain Benadryl) quite often, and it is not great, but it is better than nothing. It is perfectly safe to use with an MAOI, but just be sure you get a version that does not have any decongestants in it. The Simply Sleep product is pure diphenhydramine, and there are also some other products that are equivalent.
Your doctor, however, really should be willing to prescribe some kind of sleep aid, and IMO, it is irresponsible and unconscionable to prescribe a psychiatric med that produces insomnia and then not be willing to prescribe something to help the patient sleep. The most common sleep med to be prescribed is probably Ambien, which is really not strong enough to cope with the insomnia in my particular case, but many doctors will let you use it every night. I use triazolam/Halcion every other night, and this works reasonably well, but it is helped out by the sleep/relaxation CDs that I also use (every night). Trazodone is also commonly used to treat MAOI insomnia, but it keeps me awake, as does hydroxyzine, a prescription antihistamine.
Todd
Posted by Willyee on November 14, 2004, at 7:26:58
In reply to Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 13, 2004, at 10:15:08
I hope this doesent show as a re-post,appearently i had to re-register or confirm my registration.......is this normal,every week?
Anyway to your question,one method of aiding sleep,and i can only speak of this in regards to myself,since im not sure if this method of ingestion is safe,is to take a single parnate tab,let it dissolve in warm water,and sip it.
I have only been doing this a week,but it seems to put me into a nice peaceful sleep,much different from gaba or other sedating substances which knock you out and leave you feeling horrable the next morning,only to have to use parnate from which seems like point A to get you back on track.
The one tab method so far has put me to a nice ease sleep,and i have been waking feel somewhat energized,definatly not horrable as with sleep meds.Its been a short trial,but so far effective.
Posted by AudreyE on November 14, 2004, at 7:52:04
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbanc, posted by Dan Perkins on November 13, 2004, at 13:25:50
> What time of day do you take your Parnate? That can make a bit of a difference sometimes.
Unfortunately, I'd pushed my 3 doses so far into the morning that my Dr. actually scolded me and said I needed to take the last dose later. This was the same visit he told me to take my last dose *earlier* to help with the insomnia. Hence, one of the many reasons I'm looking for a new doc.
Audrey
Posted by AudreyE on November 14, 2004, at 8:03:38
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances » AudreyE, posted by King Vultan on November 14, 2004, at 0:51:33
> I never had much luck with melatonin in the past, but I understand this works pretty well for some people. I use diphenhydramine (plain Benadryl) quite often, and it is not great, but it is better than nothing. It is perfectly safe to use with an MAOI, but just be sure you get a version that does not have any decongestants in it. The Simply Sleep product is pure diphenhydramine, and there are also some other products that are equivalent.
>
> Your doctor, however, really should be willing to prescribe some kind of sleep aid, and IMO, it is irresponsible and unconscionable to prescribe a psychiatric med that produces insomnia and then not be willing to prescribe something to help the patient sleep. The most common sleep med to be prescribed is probably Ambien, which is really not strong enough to cope with the insomnia in my particular case, but many doctors will let you use it every night. I use triazolam/Halcion every other night, and this works reasonably well, but it is helped out by the sleep/relaxation CDs that I also use (every night). Trazodone is also commonly used to treat MAOI insomnia, but it keeps me awake, as does hydroxyzine, a prescription antihistamine.
>
> Todd
Thank you, Todd! I was wondering about Benadryl.My doc has a real chip on his shoulder about the Parnate. He didn't want to prescribe it, but I kept bringing in the research about it working for treatment-resistance cases, and he finally gave in. (I'm 28 years old, and I'd gone 15 without any significant remission from depression.) The Parnate works for me, and he's not very happy about it. He's always implying it's either a placebo effect, or my fault for not trying to get over my depression faster myself.
Of course, he's always started every session by saying depression is just "mental," and I would be exercising, avoiding alcohol, and "thinking more positively," etc., if I really wanted to get better. Then, I tell him, for the 1000th time, that I exercise 6 days a week, haven't drank anything in years, and practice cognitive therapy...
This is, btw, one of the most well-respected docs in my state, so you never know...
Audrey
Posted by Dan Perkins on November 14, 2004, at 10:41:35
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbanc, posted by AudreyE on November 14, 2004, at 7:52:04
You could try gradually combining all your doses into one, and taking that dose in the morning. I was on 70mg of Parnate and was taking pills in two doses/day. I gradually combined that into one dose and found that over time my side effects decreased and sleep came a bit easier (though I still needed to take Trazodone for sleep occasionally).
> Unfortunately, I'd pushed my 3 doses so far into the morning that my Dr. actually scolded me and said I needed to take the last dose later. This was the same visit he told me to take my last dose *earlier* to help with the insomnia. Hence, one of the many reasons I'm looking for a new doc.
>
> Audrey
Posted by King Vultan on November 14, 2004, at 11:03:28
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 14, 2004, at 8:03:38
So is this a general practicioner or a psychiatrist? If he's a psychiatrist, he would appear to be about the worst one in existence. I'm thinking that he's probably a GP, who do tend to have more prejudices when it comes to psychotropic drugs. My own GP very much looks down even on Ambien, which is part of the reason I avoided sleep meds for so long. However, he is very good otherwise and certainly doesn't have the incredibly ignorant and narrow minded view your doctor unfortunately appears to have about depression. I'm curious as to what state you are from?
As for when people take their doses of MAOIs during the day, I happen to share my pdoc's philosophy that spreading them throughout the day is the optimum, unless it causes other problems. I found the Parnate somewhat stimulating when I first started it and skewed the dosing towards the first half of the day. Now that I've been on it a while, there is no longer any overt stimulating effect, and when I recently went up to 6 pills a day, I actually added one at bedtime, so my dose timing is now 7 AM, 11 AM, 2 PM, 5 PM, 8 PM, and 11 or 12 PM.
I've experimented some with different dosage timings, and it just doesn't seem to have any effect on the degree of insomnia in my case, other than perhaps taking the last pill at bedtime may actually help a little bit, but I am not 100% positive of that. However, most people do take their Parnate earlier in the day; if they take 60 mg, they might take 30 mg in the morning and 30 in the early or mid-afternoon. The dosage should be divided into at least two parts, but as for the timing, you have to look at what works best for a particular individual.
Todd
Posted by AudreyE on November 14, 2004, at 11:20:38
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances » AudreyE, posted by King Vultan on November 14, 2004, at 11:03:28
Thank you guys so much for the advice!
Unfortunately, I'm not seeing a GP. My pdoc is one of the most well-respected psychiatrists in my state, in terms of his peers. I believe he's exceptionally well-published on one particular topic, and this is where the admiration comes from, but I've never had a worse doctor in terms of prescribing.
It's been very difficult to explain as I've looked for a new doc. You know..."What? You're seeing so-and-so, and you want to change? What's the problem?" I certainly can't say, "He's the worst psychiatrist I've had in 15 years," so I usually babble something about changing insurance.
My husband often comes to my appointments with me when I'm doing really poorly, and he is equally dismayed by this guy. So, at least, I know it's not just me. Sometimes, it's hard to see *yourself* as credible, when you're depressed, and, God knows, nobody else who knows about your condition will.
I think I'm going to try benadryl, and moving my doses about. I'm also going to talk to my GP about a prescription for the insomnia. Perhaps, he will listen...
I'm glad to hear there's at least some hope the afternoon drowsiness will clear up, if the nighttime sleeplessness gets taken care of. I haven't experienced any side-effects beyond these, but I pick up my son up from daycare at 3pm, and it almost feels dangerous these days!
Audrey
Posted by djmmm on November 14, 2004, at 18:16:48
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 14, 2004, at 11:20:38
Try melatonin..it has worked when other sleep meds havent (myself included)
Posted by Tepiaca on November 14, 2004, at 22:09:51
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by djmmm on November 14, 2004, at 18:16:48
> Try melatonin..it has worked when other sleep meds havent (myself included)
did you tried with a MAOI?
I saw the bottle of Melatonine in the pharmacy and it says it can not be taken with a MAOI
Posted by Willyee on November 14, 2004, at 22:15:30
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances » djmmm, posted by Tepiaca on November 14, 2004, at 22:09:51
> > Try melatonin..it has worked when other sleep meds havent (myself included)
>
> did you tried with a MAOI?
>
> I saw the bottle of Melatonine in the pharmacy and it says it can not be taken with a MAOI
>
>
Yeah good question,i took melatonine once with my Maoi and it was not nice.As for the orginal posters problems with her doc,id shop for a new one,the best day of my life was when i came to the conclusion these docters werent chemists and really werent worth relying on,i know some value theres,but one statement i say with all my heart,after years of suffering,thousands upon thousands of wasted dollers,voice messages unanswered etc,that i NOW value only my p-docs signature,i do the research,and as much as one might find it irresponsable,truth is the day i stopped relying on my doc to save me was the day i began to improve at all.
Posted by AudreyE on November 14, 2004, at 22:21:09
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by djmmm on November 14, 2004, at 18:16:48
Oh, my! I've been sucking the Melatonin down at night. I take the max dose of 3 mg, for sure. Sometimes I take it twice!
Audrey
Posted by gromit on November 15, 2004, at 7:03:28
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances, posted by AudreyE on November 14, 2004, at 22:21:09
> Oh, my! I've been sucking the Melatonin down at night. I take the max dose of 3 mg, for sure. Sometimes I take it twice!
I used to do that too, and it would stop working within a few days. Try stopping for a little while then try .5 mg or even less maybe and see how that goes. Larry had the explanation but I can't remember exactly what it was. Lower doses work better for me though.
Rick
Posted by King Vultan on November 15, 2004, at 8:04:03
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbances » djmmm, posted by Tepiaca on November 14, 2004, at 22:09:51
> > Try melatonin..it has worked when other sleep meds havent (myself included)
>
> did you tried with a MAOI?
>
> I saw the bottle of Melatonine in the pharmacy and it says it can not be taken with a MAOI
>
>I believe the reason is that melatonin is some kind of serotonin precursor, so theoretically, it might be able to cause serotonin syndrome. I haven't done any research on whether there have been any case reports, though.
Todd
Posted by dove on November 15, 2004, at 9:31:19
In reply to Re: Parnate (or other MAOI's) and melatonin, posted by King Vultan on November 15, 2004, at 8:04:03
Have you tried sublingual melatonin (melts under the tongue). My husband and I both suffer from severe sleep disorders (Trazadone didn't even work for him) and we had tried regular melatonin, along with prescript-only meds with mixed results until we found sublingual melatonin. It takes effect very rapidly compared to regular melatonin, you can take less, and doesn't leave the morning grogginess one sometimes contracts when ingesting 5 mgs of regular melatonin.
Just a thought. (I also had good results with Remeron (mirtazapine) but I think its contraindicated with Parnate.)
dove
Posted by AudreyE on November 15, 2004, at 14:21:49
In reply to Re: Parnate (or other MAOI's) and Sleep Disturbanc » AudreyE, posted by gromit on November 15, 2004, at 7:03:28
> > Oh, my! I've been sucking the Melatonin down at night. I take the max dose of 3 mg, for sure. Sometimes I take it twice!
>
> I used to do that too, and it would stop working within a few days. Try stopping for a little while then try .5 mg or even less maybe and see how that goes. Larry had the explanation but I can't remember exactly what it was. Lower doses work better for me though.
>
>
> Rick
>That's interesting, because I've noticed that I used to get good results with 1 mg, and now 3mg does nothing at all.
Thanks!
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