![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 30 to 54 of 54. Go back in thread:
Posted by Scott L. Schofield on January 8, 2000, at 20:35:29
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 7, 2000, at 8:54:00
> Aha. Okay. I'm still on Marplan right now, but considering returning to good ol' Parnate because of that insidious weight gain.
>
> One thing my therapist suggested when I mentioned this to him was to try adding verapamil or some other Ca++ antagonist to the Parnate to keep my BP stable.
>
> I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)
Do you discontinue MAOIs all at once or do you gradually taper off of them? I know it would protract the time necessary to wait before starting Parnate, but might not weaning prevent any disturbances that would otherwise affect function? I have discontinued MAOIs abruptly many times. Unfortunately, the withdrawal syndrome seems to be less severe now than it was early on. I’m not sure I like the idea of a drug leaving less of an “impression” on the system as to allow for reduced side-effects or a milder withdrawal. Anyway, I am curious as to which withdrawal phenomena bother you most. I no longer seem to experience either the REM suppression during treatment or the REM rebound of withdrawal. I do continue to have the “lightening bolt” type thing going on, though.The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties. There was some thought initially that the L-type calcium-channel blockers, such as nimodipine, might be more effective at regulating mood. The more recent stuff I have come across does not support this contention. What’s more, nimodipine is prohibitively expensive to use on a regular basis. (I believe its primary use is to mitigate the damage that immediately follows a CVA). You may want to look into how ACE-inhibitors compare to CA++ channel blockers regarding their efficacy in counteracting sympathomimetics in general and amphetamines in particular.
My gut feeling is that it might be wise to continue the semester without making any major changes, the results of which, for you, are unpredictable. When I was younger, and a bit more handsome, I was confronted with a similar situation. I began seeing a new doctor about a month before I was to be married. After a battery of psychometric exams (pretty cool stuff) and a detailed review of my history, he wanted to try a combination of Parnate and Norpramin. I was not receiving any treatment at the time. However, I knew that I could count on what little I had to work with to remain available and stable. The wedding went great (unfortunately, the marriage did not), and I waited until I felt the time was right to take the risk of losing some degree of function. I believe it was the right decision for me.
If Marplan has helped you, I imagine you feel smarter because of it. It might be a good idea to use the extra smartness to ace your courses, then wait until summer to lose the extra weight. I dunno. I sure wish I had some extra smartness to work with.
Good Luck !!!
Get Well.
- Scott
Posted by Elizabeth on January 9, 2000, at 5:25:13
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 8, 2000, at 20:35:29
> Do you discontinue MAOIs all at once or do you gradually taper off of them? I know it would protract the time necessary to wait before starting Parnate, but might not weaning prevent any disturbances that would otherwise affect function?
I try to compromise between the above-mentioned rock and hard place by tapering off but not too extremely slowly. (Quitting all at once would just be *bad*.) I've had nasty withdrawal symptoms each time I d/c'd MAOIs nonetheless.
Also, I'm under some time pressure to switch, since the new semester begins in just a few weeks.
> Anyway, I am curious as to which withdrawal phenomena bother you most. I no longer seem to experience either the REM suppression during treatment or the REM rebound of withdrawal. I do continue to have the “lightening bolt” type thing going on, though.
I never got the "lightening bolts." For me it's REM rebound (especially bad because of my sleep disorder), hypersomnia, agitation, panic attacks, and moodiness.
> The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
(Note: I'm not bipolar.)
> You may want to look into how ACE-inhibitors compare to CA++ channel blockers regarding their efficacy in counteracting sympathomimetics in general and amphetamines in particular.
Good plan; the ACE inhibitors also are thought not to cause depression, whereas it is believed that other antihypertensives may.
> My gut feeling is that it might be wise to continue the semester without making any major changes, the results of which, for you, are unpredictable.
They're pretty predictable, both for better and for worse. I really wonder what all this weight yo-yo-ing is doing to me.
When I was younger, and a bit more handsome, I was confronted with a similar situation. I began seeing a new doctor about a month before I was to be married. After a battery of psychometric exams (pretty cool stuff) and a detailed review of my history, he wanted to try a combination of Parnate and Norpramin. I was not receiving any treatment at the time. However, I knew that I could count on what little I had to work with to remain available and stable. The wedding went great (unfortunately, the marriage did not), and I waited until I felt the time was right to take the risk of losing some degree of function. I believe it was the right decision for me.
> If Marplan has helped you, I imagine you feel smarter because of it. It might be a good idea to use the extra smartness to ace your courses, then wait until summer to lose the extra weight.
Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)
> I dunno. I sure wish I had some extra smartness to work with.
Me too.
> Good Luck !!!
> Get Well.:) Thanks!
Posted by Seamus on January 9, 2000, at 10:39:16
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
Suggs,
On Parnate many years at 30 mg/day.
The cold feet and hands finally bothered me so much that I insisted on adding thyroid to me regime, despite "normal" TSH levels.STarted w/ .5 grain Armour, it helped. Upped it to 1 gr. and am happy as a clam. No gross adverse effects -- dropped a few pounds, but no palps, temp still 97.5.
I would definitely give it a try, the risk/reward ratio is pretty low.
Seamus
Posted by Scott L. Schofield on January 9, 2000, at 10:54:46
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 5:25:13
> > The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
> (Note: I'm not bipolar.)
> Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all. I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy. If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
Sorry, gotta go…
- Scott
Posted by S. Suggs on January 9, 2000, at 19:32:09
In reply to Re: Parnate Update, posted by Seamus on January 9, 2000, at 10:39:16
Hello Seamus: I'll mention this to my doc on my next visit. Thanks and Blessings,
S. Suggs
Posted by Scott L. Schofield on January 9, 2000, at 20:08:55
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 10:54:46
> > > The verapamil sounds pretty good, especially since it may offer some mood-stabilizing properties.
>
> > (Note: I'm not bipolar.)
>
> > Actually I feel smarter since decreasing the lithium to 300mg! (I'm not taking any hard classes this semester, FWIW.)
>
> I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all. I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy. If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
>
> Sorry, gotta go…
>
>
> - Scott
To continue…I imagine if you were bipolar, mania would probably have made an appearance by now. You seem to have challenged the system with enough antidepressants and med-changes to trigger it were you to have that potential. Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin. I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria. I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
I think I mentioned in an earlier post that I came across something on one of the newsgroups that purported to list bipolar subtypes being considered for adding to a future DSM. I think there were five total. One of them described a presentation in which any manias that occur are due to some drug intervention. I think I qualify for that one. The last on the list really surprised me. It described a bipolar subtype in which mania *never* occurs. This actually makes sense to me. Additionally, I think it makes sense to consider some cases as being “soft-bipolar”, a term that I came across recently. Without going back to find the literature, I think I remember cyclothymia as being an example of this. Treating these presentations as if they were bipolar was advocated, as well as the notion that these may represent precursor conditions to “hard” bipolar illness.
I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic. Have you ever been successfully treated? I think that if I were in your position, should I find a treatment that works, I would stick with it indefinitely. Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant. A patient is best maintained at the dosages that got them well in the first place. Dr. Kupfer is one of the few investigators who have studied the course of treatment of his patients longitudinally.
- Scott
Posted by Elizabeth on January 9, 2000, at 20:41:36
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 9, 2000, at 20:08:55
> > I guess my next question is obvious. If you are so convinced that you are not bipolar, why have you been taking lithium at all.
I started it to augment Parnate. I'm pretty sure I've discussed this here before: I was nondepressed but still had anhedonia on Parnate, added 600mg of lithium and suddenly I was enjoying going out, eating, sex, music, etc. again. Now I'm trying tapering off the lithium to see if I can manage without, because of the attention side effect.
There's no evidence that verapamil augments ADs in unipolar depression, some evidence that it doesn't, and I think there have even been reports of it triggering or exacerbating depression. See why I'm a tad concerned?
> I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy.
I'm a walking testament to this!
> If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
Nope. Depakote didn't do a thing when I took it with Parnate. They're not all identical, and lithium is by far the best-studied.
> I imagine if you were bipolar, mania would probably have made an appearance by now.
It did, when I was taking Effexor, but it was in the context of serotonin syndrome. I think I may have been a tad hypomanic (mixed) on Paxil.
> Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.
What is the "typical bipolar profile?"
> Severe depression began with me when I was 17. My initial diagnosis at age 22 was determined to be atypical unipolar. I tried an awful lot of drugs between then and age 27. As I guess you know by now, my depressed state has been quite severe and unrelenting. During this time, I can count on two hands the number of days in which I experienced a transient improvement. Never did I experience mania. However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin.
How was that combination for you? Any side effects? Do you recall what doses you were on?
> I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria.
Ow. Mixed mania is the most horrible mood state, I think.
> I don’t want to discuss what happened with subsequent therapy, but I think it is important to note that the doctor I was seeing did not perceive this episode as being a diagnostic criterion for bipolar disorder. He continued to treat me as if I were unipolar, and thus I never received any “mood-stabilizers” that now seem necessary if I am to have a chance to get well.
Manic episodes that happen when you're taking antidepressants aren't supposed to count towards a diagnosis of bipolar disorder, no. But some people who don't have spontaneous manic episodes nevertheless become manic on ADs...in these cases ("bipolar III" is a term I've heard used by researchers and clinicians -- I've never heard the list you mention except posted on the internet), a mood stabilizer seems indicated.
> I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic.
Yes, it is.
> Have you ever been successfully treated?
Sure. MAOIs work well for my depression, but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble. I also have some irritating problems with MAOI side effects: Parnate causes spontaneous hypertensive episodes while Nardil and Marplan cause sugar cravings and weight gain!
> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!)
Posted by Seamus on January 10, 2000, at 19:37:32
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 20:41:36
>> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
>Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!) <<
I agree w/ that "old idea". W/ MAOI's, it's been my experience you have to go "up and over" -- _then_ back down to achieve a steady state of "euthymia."
I also think that there's no such thing as a maintenace dose. From Oct. 1st to Feb 1st, I need to up my Parnate dose else I'm susceptible to the weepies. If you're fond of labels, perhaps you might say I have a SADD syndrome. No matter, what I do works, and keeps me working and loving.
The point is, listen to the patient. Balance the risk/reward ratio. Who knows better about my inner state: me or my doctor?
Seamus
Posted by Mrs. G on January 10, 2000, at 21:02:09
In reply to Phillip has a sense of humor!, posted by Noa on January 6, 2000, at 6:17:11
Phillip is truly fascinating. Hey, aren't we all reading and replying to this wonderful site because of our own "psych problems?" I think maybe Phillip is WAY smart. Wish I were so articulate. Tell us a little about yourself. So interesting. To those who can't "take it", don't read it. Simple solution.
Posted by dj on January 10, 2000, at 22:31:37
In reply to Re: Phillip has a sense of humor!, posted by Mrs. G on January 10, 2000, at 21:02:09
What is more fascinating is those who mistake babble for genius. But then again the National Enquirer is one of the most read publications in the world and Elvis and Jim Morrison are alive and living in Kansas with Dorothy, aren't they?
> Phillip is truly fascinating. Hey, aren't we all reading and replying to this wonderful site because of our own "psych problems?" I think maybe Phillip is WAY smart. Wish I were so articulate. Tell us a little about yourself. So interesting. To those who can't "take it", don't read it. Simple solution.
Posted by Scott L. Schofield on January 10, 2000, at 23:36:16
In reply to Re: Parnate "properties" :), posted by Seamus on January 10, 2000, at 19:37:32
> >> Also, I agree with Dr. Kupfer at Western Psychiatric that there is no such thing as a maintenance dose of an antidepressant.
> >Yeah, I think that is an old idea that has since been discarded. (Some older books I've seen recommend going down to 15mg of Nardil once you've responded!) I agree w/ that "old idea". W/ MAOI's, it's been my experience you have to go "up and over" -- _then_ back down to achieve a steady state of "euthymia."A doctor told me quite a while ago that it sometimes takes “extra” MAOI to establish the therapeutic percentage of inhibition required to achieve an antidepressant effect. Thereafter, this percentage of MAO inhibition can be maintained using a somewhat lower dose.
- Scott
Posted by Scott L. Schofield on January 11, 2000, at 13:32:09
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 9, 2000, at 20:41:36
> There's no evidence that verapamil augments ADs in unipolar depression, some evidence that it doesn't, and I think there have even been reports of it triggering or exacerbating depression. See why I'm a tad concerned?
I’ve seen similar reports regarding verapamil as well. I don ‘t think that this phenomenon is exceedingly rare. Several years ago, I read an anecdote describing a woman who had been depression-free for several years while taking a tricyclic (desipramine I think). When she developed cardiac trouble, she was given verapamil. She immediately relapsed into depression, and adjusting the dosage of the tricyclic had no positive effect. It was decided to discontinue the verapamil to see what would happen. The depression lifted quickly. The doctor thought it was worthwhile to try adding back the verapamil to make certain that her relapse was indeed induced by the verapamil and not by some fluke coincidence. Again she relapsed. Lucky for her, the antidepressant effect was recaptured.
I don’t recall if there was a discussion in the article regarding the possible mechanisms by which this reaction occurs. I guess one obvious possibility is that verapamil blocks the calcium channels located at the terminal of the neuron, thereby inhibiting the vesicular release of neurotransmitter.
> > I am *sure* that using lithium to augment antidepressants in unipolar depression is often a successful strategy.
> I'm a walking testament to this!
> > If this has been the rationale for using it, would not this rationale also apply to other “mood-stabilizers”?
> Nope. Depakote didn't do a thing when I took it with Parnate. They're not all identical, and lithium is by far the best-studied.Hooray for Cabe!
It’s a good thing that they are not all alike. I doubt as many people would get well if they were.
> > I imagine if you were bipolar, mania would probably have made an appearance by now.> It did, when I was taking Effexor, but it was in the context of serotonin syndrome. I think I may have been a tad hypomanic (mixed) on Paxil.
My personal impression of Effexor is that its effects on dopaminergic pathways have been underestimated.
If this is true, I can see how this drug may be capable of producing mania in vulnerable individuals. It is also my guess that the DA thing is responsible for its reputation of inducing a more rapid onset of an antidepressant response. Early on, many of the investigators of Effexor touted it as being a “non-MAOI MAOI”. I have seen this drug often chosen before others as a therapy for treatment-resistant bipolar depression.I guess whether or not you were hypomanic must be a tough call. Would the word “excitability” apply at all? What was it about your experience that suggests that hypomania may have been involved rather than any other phenomenon?
I’m probably asking too many questions, but I am interested to know what caused the serotonin syndrome and how it manifested. Can serotonin syndrome produce a manic-like state?
> > Also, your presentation of depressive vegetative symptoms doesn’t seem to fit very well into the typical bipolar profile.> What is the "typical bipolar profile?"
I was under the impression that bipolar depression tends to resemble atypical unipolar depression in most cases. The symptoms usually include psychomotor retardation, anergia, hyperphagia, and hypersomnia
> > However, I experienced a robust and steady remission of depression brought about by a combination of Parnate with Norpramin.
> How was that combination for you?The combination at that point in time got me as well as I could ask for, although I subsequently realized that there were things missing in retrospect. I would be very glad to accept it back, though – no questions asked. I definitely felt smarter. I know doctors don’t like to say that intelligence is affected during depression, but I would have to argue that, in my case anyway, “functional intelligence” is definitely reduced.
> Do you recall what doses you were on?
Parnate 60 mg/day and Norpramin 150 mg/day.
> Any side effects?
The usual, I guess. Postural hypotension was definitely “irritating”. I don’t think that Parnate contributed to the anticholinergic side-effects that I experienced. If it did, it was minimal. Desipramine was more the culprit, but its effects definitely mitigated over time. Also, Parnate caused retrograde ejaculation along with a change in the experience of orgasm, and perhaps even a bit of difficulty reaching it. These effects also seemed to disappear. Oh yeah, one more. I could have a woody all day long if I wanted to (not priapism).
> > I spent about six months in a state of euthymia, or something close to it, after which things began to change. Hypomania appeared and later blossomed into a psychotic manic dysphoria.
> Ow. Mixed mania is the most horrible mood state, I think.It’s hard to say. It sure is draining, or at least it feels that way. I know that the grass always looks greener,… yadda, yadda, yadda, but at least I didn’t feel like I was chained to the bottom of some deep, murky sea.
> Manic episodes that happen when you're taking antidepressants aren't supposed to count towards a diagnosis of bipolar disorder, no.
I guess this is the crux of the issue. My case definitely presents this way. WZ Potter diagnosed me as being bipolar. He was the first clinician to do so. I’m sure he was right.
> But some people who don't have spontaneous manic episodes nevertheless become manic on ADs...in these cases, a mood stabilizer seems indicated.
That sounds about right to me.
Do you treat a syndrome, or do you treat a biological entity? If the biology of a “unipolar with drug-induced mania” turns out to be quite similar to that of bipolar, but significantly different from “unipolar without mania”, I think the identification of the biological etiology would better serve to choose treatments. This would be extremely important early in the course of affective-illness, and I think it should be the first step in treating the index episode.
I guess we’re not there yet. Nevertheless, you may want to keep the possibility of extant bipolarity somewhere in your unipolar mind. :-)
("bipolar III" is a term I've heard used by researchers and clinicians -- I've never heard the list you mention except posted on the internet)
Yeah, I tried to search the newsgroup archives using Deja News, but couldn’t find it. I’m quite sure it was posted and I do remember who posted it. However, I don’t know what source he got the information from.
> > I have no reason to believe, and certainly don’t suggest that you are in any way bipolar. I know very little about your treatment history, but I get the impression that your depression is quite episodic.
> Yes, it is.You know the rapid-cyclicity deal, as arbitrary as it may be, can be a good index for deciding how to attack the illness. Does your “episodic” course resemble rapid-cyclicity?
If it does, you may want to stuff that fact somewhere too. (you probably have a place picked out already) ;-)
> > Have you ever been successfully treated?
> Sure. MAOIs work well for my depression…Another correlative fact.
> …but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble.
???
> I also have some irritating problems with MAOI side effects: Parnate causes spontaneous hypertensive episodes while Nardil and Marplan cause sugar cravings and weight gain!
To describe this stuff as being nothing more than “irritating” shows that your sense of humor may still be intact.
Later…
- Scott
Posted by Elizabeth on January 11, 2000, at 19:29:50
In reply to Re: Parnate "properties" :), posted by Scott L. Schofield on January 11, 2000, at 13:32:09
Hi Scott.
> I guess whether or not you were hypomanic must be a tough call. Would the word “excitability” apply at all? What was it about your experience that suggests that hypomania may have been involved rather than any other phenomenon?
Okay, so what was going on (when I took Paxil) was this: I got irritable in an "excitable" way, as you say. I tended to be less easy-going than usual, picking fights with people over relatively minor things and being generally defiant. I was also hypersexual, having fantasies about lots of different people who I was seeing day to day. (I was in control enough not to act on them, though!) I was no longer feeling tired, even though I was not sleeping.
> I’m probably asking too many questions, but I am interested to know what caused the serotonin syndrome and how it manifested. Can serotonin syndrome produce a manic-like state?
Hell yeah. In this case, it was a mixed episode with psychotic features (at some point I just blacked out and woke up in restraints feeling strangely serene and unbothered by said restraints).
> I was under the impression that bipolar depression tends to resemble atypical unipolar depression in most cases. The symptoms usually include psychomotor retardation, anergia, hyperphagia, and hypersomnia
I think it's the other way around: bipolar disorder is more common in atypical depression than in "typical" depression, but atypical features have not clearly been shown to be more common in bipolar depressions than unipolar ones.
> Do you treat a syndrome, or do you treat a biological entity? If the biology of a “unipolar with drug-induced mania” turns out to be quite similar to that of bipolar, but significantly different from “unipolar without mania”, I think the identification of the biological etiology would better serve to choose treatments.
Yeah, this is true, I suppose; I think it depends if the patient continues having manic episodes on ADs or if it's an isolated thing...is there a latent bipolar disorder that is expressed by the addition of ADs, or is it truly "drug-induced?" The latter seems to be true in my case, as it turns out.
> You know the rapid-cyclicity deal, as arbitrary as it may be, can be a good index for deciding how to attack the illness. Does your “episodic” course resemble rapid-cyclicity?
In what sense?
> > Sure. MAOIs work well for my depression…
>
> Another correlative fact.Correlative with...?
> > …but I also have what my pdoc describes as "ADD spectrum disorder" and that has been causing me a lot of trouble.
>
> ???What is the ??? ? :-)
> To describe this stuff as being nothing more than “irritating” shows that your sense of humor may still be intact.
Okay, the spontaneous hypertension was more than irritating. :-} The weight gain is just irritating, I'd say, though (so far anyway).
(Yeah, I think I've got a sense of humor somewhere.)
Posted by Elizabeth on January 13, 2000, at 7:01:50
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 11, 2000, at 19:29:50
Hey Scott,
I hope you'll have a chance to answer my 1/11 post on this thread. It's back in the "00 January 1" message listings. Thanks. :)
Posted by Scott L. Schofield on January 13, 2000, at 7:41:50
In reply to Re: Parnate "properties" :) -- Scott, posted by Elizabeth on January 13, 2000, at 7:01:50
> Hey Scott,
>
> I hope you'll have a chance to answer my 1/11 post on this thread. It's back in the "00 January 1" message listings. Thanks. :)I haven’t forgotten about you. It’s on it’s way.
- Scott
Posted by Elizabeth on January 13, 2000, at 16:45:43
In reply to Re: Parnate "properties" :) -- Scott, posted by Scott L. Schofield on January 13, 2000, at 7:41:50
> > Hey Scott,
> >
> > I hope you'll have a chance to answer my 1/11 post on this thread. It's back in the "00 January 1" message listings. Thanks. :)
>
> I haven’t forgotten about you. It’s on it’s way.Thanks. :) (Sometimes threads die when the slate gets wiped clean.)
Posted by Michael on January 15, 2000, at 22:04:31
In reply to Re: Parnate Update-to Michael, posted by S. Suggs on January 5, 2000, at 6:15:20
> Michael, thanks for the reply. The cold intolerance is a minor side effect that I can put up with. What I've also noticed is a huge improvement in the social aspect. For ex. while at Home Depot (wood worker and tool freek) I,m talking briefly to strangers and just being plain nice. Also, when the Parnate wears off, I do crash (get sleepy), this is fine since I end up getting a full and restful nights sleep. For years I never slept well. It's good (I've tried so many AD's).
>
> My main question to you is what is your dose of Parnate, I'm at 60?
>
> Blessings,
>
> S. SuggsSorry for the delay in answering. I'm glad you sleep well on Parnate. I've had to take Trazodone for sleep for quite awhile. I'm at 70 mg per day. Am contemplating increase to 80. I had a heart attack in late October and coronary meds have kind of messed up my routine. If any has any experience with Lopressor and/or Lipotor and its effect on Parnate or depression in general, would love some feedback.
Michael
Posted by Michael on January 15, 2000, at 22:22:37
In reply to Re: Parnate "properties" :), posted by Elizabeth on January 7, 2000, at 8:54:00
> > Sure. If I remember correctly, one of the difficultites you had with Parnate was recurrent spontaneous hypertensive crisis at a relatively low (but promisingly therapeutic) dose. I assume "cowboy psychopharmacology" might refer to creative, perhaps unorthodox, strategies to increase Parnate dosage while minimizing or eliminating ill effects. If the above is true and you are comfortable discussing, I would be interested in hearing what you are trying and how it is working.
>
> Aha. Okay. I'm still on Marplan right now, but considering returning to good ol' Parnate because of that insidious weight gain.
>
> One thing my therapist suggested when I mentioned this to him was to try adding verapamil or some other Ca++ antagonist to the Parnate to keep my BP stable.
>
> I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)My experience with MAOI is abrupt cessation is better than tapering unlike most AD. At least, this is true with Parnate. Otherwise, it's like cutting off your arm an inch at a time. Since you are getting ready to start a new semester, use of a stimulant such as ritalin can help you during the transition if your doctor recognizes that therapy. If not, as you probably know, Parnate is much faster acting than Nardil or Marplan.
Posted by S. Suggs on January 16, 2000, at 5:24:16
In reply to Re: Parnate Update-S. Suggs, posted by Michael on January 15, 2000, at 22:04:31
Michael, sorry to hear about the heart attack. Lipotor, I would think would be safe, Lopressor (for bp I think) might pose a problem.
I myself took trazadone for sleep once. Great drug. I was taking 200 mg, but during the med change to med change to med change, it was taken out and to be honest, I cannot remember why.
You should get some good responses from some other posters, blessings,
S. Suggs
Posted by Scott L. Schofield on January 16, 2000, at 20:33:40
In reply to Re: In reply to Elizabeth-Parnate "properties" :), posted by Michael on January 15, 2000, at 22:22:37
> > I'm ambivalent about switching -- like anybody, I don't relish the idea of ballooning like I did on Nardil, but at the same time, switching MAOIs is truly painful due to withdrawal symptoms and that pesky waiting period (I thought those were for handguns!). I can't decide whether it's worth the risk, especially since the spring semester begins in a couple weeks. (I *don't* want to have to go to the hospital right now!)There is a much more important issue to be considered here. An antidepressant that works for you today may not work the next time you try it. I know this to be very true of Nardil. Someone can take an antidepressant for many years and remain free of depression. However, once the drug is discontinued - because they have been on it "long enough" - they can relapse quickly. When the drug is restarted, oops.
After reading some of your posts, Elizabeth, I suggest that it might be wise to continue on Nardil or Marplan if they work for you, at least until some substantial inroads are made in neuroscience that will offer better, more accurately targeted treatments. Pardon my terseness, but fuck the weight gain.
> My experience with MAOI is abrupt cessation is better than tapering unlike most AD. At least, this is true with Parnate. Otherwise, it's like cutting off your arm an inch at a time. Since you are getting ready to start a new semester, use of a stimulant such as ritalin can help you during the transition if your doctor recognizes that therapy. If not, as you probably know, Parnate is much faster acting than Nardil or Marplan.
It has been my experience with MAOIs, Parnate in particular, that a rapid taper is preferable to an abrupt discontinuation.
- Scott
Posted by Annie on January 19, 2000, at 21:59:30
In reply to Re: Parnate Update-S. Suggs, posted by Michael on January 15, 2000, at 22:04:31
Michael, I had been on Lipitor and also, Dyazide and Covera for hypertension for over a year when I started Parnate in November. I was also taking 1200 mg of Neurontin. I was feeling a lot better until the Parnate was raised to 30mg and the Lipitor was raised to 20mg. I started to backslide. My motivation and energy are down again and I can fall asleep sitting up, not long after awakening from a 12 hour sleep. I never napped previously and usually slept about 7 hours.I'm not sure if the change is due to an increase in Parnate, Lipitor, a combination of the two or something else unrelated. My Pdoc has raised me to 40mg Parnate and said this may help the daytime sleeping. He did not seem overly concerned. Annie
>I had a heart attack in late October and coronary meds have kind of messed up my routine. If any has any experience with Lopressor and/or Lipotor and its effect on Parnate or depression in general, would love some feedback.
>
> Michael
Posted by Michael on January 20, 2000, at 20:55:30
In reply to Re: Parnate & Lipitor-Michael, posted by Annie on January 19, 2000, at 21:59:30
> Michael, I had been on Lipitor and also, Dyazide and Covera for hypertension for over a year when I started Parnate in November. I was also taking 1200 mg of Neurontin. I was feeling a lot better until the Parnate was raised to 30mg and the Lipitor was raised to 20mg. I started to backslide. My motivation and energy are down again and I can fall asleep sitting up, not long after awakening from a 12 hour sleep. I never napped previously and usually slept about 7 hours.I'm not sure if the change is due to an increase in Parnate, Lipitor, a combination of the two or something else unrelated. My Pdoc has raised me to 40mg Parnate and said this may help the daytime sleeping. He did not seem overly concerned. Annie
>
> >I had a heart attack in late October and coronary meds have kind of messed up my routine. If any has any experience with Lopressor and/or Lipotor and its effect on Parnate or depression in general, would love some feedback.
> >
> > MichaelAnnie, thanks for the info. After suffering low energy and borderline depression that was affecting my work, I unilaterally discontinued the lipitor and lopressor. I decided I would rather risk another heart attack than be depressed. I will see my cardiologist in 2 weeks to get his take on this. Both the lipitor and lopressor were prescribed for their ancillary benefits of strengthening a damaged heart muscle rather the usual reasons.
Posted by Cynthia on April 12, 2000, at 7:29:52
In reply to Parnate Update, posted by S. Suggs on January 1, 2000, at 7:05:26
> I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
>
> S. SuggsMy daughter has been on Parnate for 5 months. It did relieve an awful, 2 year depression, but she has symptoms that I have never observed before. Paranoia, compulsions, delusions, disturbed sleep, loss of hair, and many physical complaints. This has even led to a hospitalization. Two doctors told me it was not the Parnate, but, like I said, this is just not my daughter. Has anyone experienced these symptoms?
Thanks, Cynthia
Posted by Michael on April 13, 2000, at 20:40:11
In reply to Re: Parnate Update, posted by Cynthia on April 12, 2000, at 7:29:52
> > I've Been on Parnate for about 2 months. Without a doubt, there has been a very positive response. Some strange things have happened (I must mention that I take lithium 900 mg, and started at 600 mg around 3 1/2 years ago). What I have noticed are: Increased thirst (never before with the lithium) and therefore increased urination. Early evening becomming very sleepy, and therefore having no trouble with sleep, whatsoever. Here is the strang one: Very intense cold intolerance (Columbia, SC). I wonder if this one is related to thyroid, so I had my doc run a tsh, which came back "normal", which we all know my not mean anything at all. These are in my opinion small side effects which by far outweigh the depression. I have a better outlook on life, more energy etc... It's the cold intolerence thing that is really strange, what do my fellow babblers in their fountain of knowledge think? happy new year blessings,
> >
> > S. Suggs
>
> My daughter has been on Parnate for 5 months. It did relieve an awful, 2 year depression, but she has symptoms that I have never observed before. Paranoia, compulsions, delusions, disturbed sleep, loss of hair, and many physical complaints. This has even led to a hospitalization. Two doctors told me it was not the Parnate, but, like I said, this is just not my daughter. Has anyone experienced these symptoms?
> Thanks, CynthiaIn response to Cynthia:
I have been on Parnate on and off (mostly on) for 12 years. I have also had the cold intolerance since day one. The doctor said it wasn't the Parnate, but too many others have experienced it. Anyway, as you said, it's a small price to pay since most of the side effects are relatively minor. Just be glad you are in SC instead of Maryland.
Michael
PS The cold intolerance is somewhat of an advantage in the summertime.
Posted by sophia04 on June 17, 2007, at 2:07:09
In reply to Re: Parnate Update, posted by Michael on April 13, 2000, at 20:40:11
I too had the cold intolerance. It would feel like someone dropped a bucket of ice water on me and nothing I did could warm me up. It was brief though and went away after a few weeks - or when I raised the dose to 50mg +.
This is the end of the thread.
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