![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Vincent_QC on December 24, 2008, at 18:32:59
Hi everyone!
I know that I ask a lot of questions about the Parnate since 3 weeks, but i'm not feeling very good right now, especially since yesterday afternoon.To do a short story, I beging the parnate at 10mg/day for 1 week, increase it at 20mg/day the week after and I begin the 30mg/day last sunday (or monday, I can't remember well...).
I had only one orthostatic hypotension episode at the 20mg/day dose. Someone here advise me to devide my daily dose and give more space between my doses...so it's what I do...I devided my dose into 10mg AM and 10mg PM...It was ok, I mean not that bad.
Since I increase my dosage to 30mg/day, I feel really strange. In the morning, I take 20mg when I wake up and 10 mg at noon or sometimes just 30mg in one shoot before 8 AM. My afternoons and nights are bad, the good feeling I have in the morning, the good energy feeling and the improve I feel, they all fade away and it's change completly to a BIG lack of energy, and worst of that, I do a LOT of orthostatic hypotension.
I stop the Nardil 90mg/day because of the same problem, the orthostatic hypotension never fade away after 3 months on that dose...Now it's seem that i'm stick with the same problem with the Parnate...
My doctor give to me some Florinef (0.05 mg/day to take with food). It's suppose to help with the orthostatic hypotension but it's worst than ever. Before I had just orthostatic hypotension when I climbing stairs with the common adverses effects (blurred vision, tinnitus, fast pulse, faint and syncope)... but now it's always like that. I sit on the computer chair and when I get up, it's beging and I feel bad for 2-3 minutes...Same thing apply when I just lying in my bed and want to get up...I feel really bad for a couple of minutes, I have to sit again and wait and if I get up again it continue.
The strange thing is that I don't have a low blood pressure. I monitor it more since the orthostatic hypotension begin last monday and it's always at the acceptable limit of 140/90, sometimes 150/95...with a slow pulse rate 40-50. That's really strange...Do you think the Florinef will increase my blood pressure like this and worst it ???
On the Nardil, I never had high blood pressure like this, in fact I had a too low blood pressure and it was probably why I had so much problem with my orthostatic tension, but now that's seem to not be the case...
How I can explain the fact that I have orthostatic hypotension if my BP is high? I don't understand...Is it normal? Maybe i'm wrong, someone know if blood pressure have a link with orthostatic hypotension or you can have high BP and have also orthostatic hypotension at the same time?
I have to say that I respect the diet at 100%...so that's not the cause of the high BP...
That's too bad, I had big hope on the Parnate treatment, and I was feeling good on it also, especially at 30mg/day, but just in the morning. I don't understand why the effect seem to not be stable at all and don't stay all day long (I mean the good feeling of well being and the energy level)?
Do you think return to 20mg for a couple of days can help? I wanted to up my dosage again next week at 40mg, it seem that I will have to forget it!!!
Someone know if I can hope a recovery of my social phobia on only 20mg/day or 30mg/day?
If I devide my dose into 10mg before 8AM, 10mg at noon and 10mg at 3PM, it will reduce my orthostatic hypotension problem?
I have so many questions...but no answer...since it's christmas holidays, I can't reach my doctor or my psychiatrist to help me with that...
And the high blood pressure make me really anxious as well as the orthostatic hypotension. That's sensation scarry me a lot...
Well, thanks in advance for the help...
BTW, I wish to someone on this board a happy Christmas...I hope you will have a great time, even if some people like me feel not a lot in a good mood... ;-)
Posted by Phillipa on December 24, 2008, at 19:34:02
In reply to Parnate + orthostatic hypotension (30mg/day), posted by Vincent_QC on December 24, 2008, at 18:32:59
Hey Vincent know nothing about Parnate unfortunately and besides docs posters aren't posting either. All I know is that orthostatic blood pressure is low blood pressure. Is there an emergency service you can call. That blood pressure is getting high. Don't want to have a hypertensive crisis. Could you use the Dr. Bob side of google and google parnate and blook pressure or just parnate. Let me know how you're doing okay? Love Phillipa
Posted by mav27 on December 24, 2008, at 20:07:33
In reply to Parnate + orthostatic hypotension (30mg/day), posted by Vincent_QC on December 24, 2008, at 18:32:59
Wish i could help, but all i can say is i had the exact same problem with parnate as well as Nardil and nothing i tried could solve the problem. I spent days reading up on it trying to find a way around it.. i even remember reading once that high blood pressure can lead to worse orthostatic hypotension which is a bit strange. I even went to the extent of ordering those stockings you wear to hold the blood out of your legs or something like that... but after too many falls and hitting my head i just had to give up.
Posted by Phillipa on December 24, 2008, at 20:12:17
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Vincent_QC, posted by mav27 on December 24, 2008, at 20:07:33
Oh dear!!!! Got to find some help for you??????Phillipa
Posted by desolationrower on December 25, 2008, at 1:22:24
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » mav27, posted by Phillipa on December 24, 2008, at 20:12:17
Whats your exercise regime look like?
-d/r
Posted by Vincent_QC on December 25, 2008, at 7:15:02
In reply to Re: Parnate + orthostatic hypotension (30mg/day), posted by desolationrower on December 25, 2008, at 1:22:24
> Whats your exercise regime look like?
>
> -d/rThanks everyone four your answers ;-) At least, I feel that i'm not alone in the world with my "little" problems...
To answer to d/r, my exercise regime look like....hummm...nothing...I don't have the energy do to anything, just take a walk make me feel a lot tired. I know that exercise is good to reduce the anxiety, I was use to walk more than 2 hours a day last year...but since my social phobia and general anxiety problem became more difficult to handle, I just stop taking long walk.
For Mav27, thanks for your support ;-) I also read a lot about high BP and orthostatic hypotension and I also found some strange things on that subjects. IF I well understand, you stop the Parnate and the Nardil because of the orthostatic hypotension? For now, which drug you take to help you?
Orthostatic hypotension don't fade away after 3 months on Nardil, so I wonder if it will fade away on Parnate? I try to stay on the Nardil at the time, hoping for that problem to resolve by itself but at the end I was not able to handle the orthostatic hypotension.
Hihg blood pressure is not a big deal for me, I know I will not die if I do 150/90 ...even if it's often like this, sure, that 's not good for the health on a long-term view, but what I can do? ORthostatic hypotension is not tolerable for me...if "Florinef" don't help me and worse my high blood pressure problem, I don't see why I will lost my time again another 3 months on something who I will end up stoping cold turkey...
Anyway, I will give it another chance today and tomorrow, devide my dose in 3 shoots, take only one pill at 10mg AM, 10mg noon and 10mg before 5PM, since the Parnate don't worse the insomnia I had already before.
If the orthostatic hypotension problem don't fade away and become more frequent or worst, I think I will stop the Parnate and ask for something else.
I wonder if Manerix (Moclobemide) is worth the trial? I know it's less powerfull than a regular Maoi and results on social phobia and anxiety look like the ones gets with regular SSRI's... but I read that orthostatic hypotension is less a problem on it...
Maybe I will try the Cymbalta...I don't stand the Effexor-xr so I wonder if it will help me???
Maybe I can also try one of the TCA's I never try (Nortriptyline), my psychiatrist talk to me about it the last time...I don't know if it's worth the trail, tca's don'T help a lot with social phobia directly, they help on panic disorder, anxiety and depression but not on the social phobia...
What I hate the most is that I feel an improve in my social phobia and anxiety in general since the increase at 30mg/day of Parnate, but the side effects are just killing me...
I will post an update soon on my situation...Thanks a lot everyone and happy xmas!!! ;-)
Posted by mav27 on December 25, 2008, at 8:31:46
In reply to Re: Parnate + orthostatic hypotension (30mg/day), posted by Vincent_QC on December 25, 2008, at 7:15:02
Im now taking prozac. volproate and xanax. It's weird in that i have not been able to tolerate the ssri's since starting treatment 8 years ago.. but mid this year after parnate failed again on me i was feeling worse than ever and desperate and took the only AD i had around which was lexapro... you wouldn't believe it... not a single side effect and every suicidal thought went from my head... it made me very tired though so ive switched to prozac. *shrug* it really makes no sense as ive tried every ssri in the past and had all the usual side effects like sexual dysfunction to feeling like a zombie.
The volproate which is usually for bipolar or eppilepy i believe i' jst taking becaue i thought it sounded interesting to see what it did.... it has actually given me a sort of burst of mental energy/motivation... nothing like what was expected.
the xanax i onlu just started a few days ago and it just puts me to sleep =/
Posted by Vincent_QC on December 25, 2008, at 10:06:40
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Vincent_QC, posted by mav27 on December 25, 2008, at 8:31:46
> Im now taking prozac. volproate and xanax. It's weird in that i have not been able to tolerate the ssri's since starting treatment 8 years ago.. but mid this year after parnate failed again on me i was feeling worse than ever and desperate and took the only AD i had around which was lexapro... you wouldn't believe it... not a single side effect and every suicidal thought went from my head... it made me very tired though so ive switched to prozac. *shrug* it really makes no sense as ive tried every ssri in the past and had all the usual side effects like sexual dysfunction to feeling like a zombie.
>
> The volproate which is usually for bipolar or eppilepy i believe i' jst taking becaue i thought it sounded interesting to see what it did.... it has actually given me a sort of burst of mental energy/motivation... nothing like what was expected.
>
> the xanax i onlu just started a few days ago and it just puts me to sleep =/Hi ;-)
Ok...I understand...Yeah, SSRI's worked on me but only 4 years of time...I had a partial answer on the Paxil (50mg/day), I kind of improve over my panic attacks and anxiety, but not the social phobia and depression. I drop it after I gain so much weight on it, more than 100 pounds... I was always on a strict diet, proteine powder, I lost a lot of weight and I gained more and more after...
I always fail to answer to regular SSRI's or SRNI's, as well as Wellbutrin or Remeron or Trazodone as well as Buspar or any anticonvulsives (Gabapentin, Lyrica...) and i'm addict to benzo drugs since 2005. Now on 20mg/day of valium...a pretty low dose if you compare it to the newer more powerfull benzo drugs (Rivotril, Lorazepam or Xanax). They don't help me anymore, I can take the 20mg of Valium in one take and I will not feel tired at all or I will not feel less anxious as well...I take it because I don't want to have a seizure if I stop them completly...That's one of my biggest fear also for now cause my psychiatrist want to withdraw me of them as soon as I will be stable on the Parnate.
After my Nardil fail in 2007, I return to SSRI and I switch to Prozac also, it was the only one SSRI I never try. I had no improve at 20mg after 3 months, we up the dosage to 30mg and it was crazy as hell. I was so nervous, worst than ever. You are lucky to be able to tolerate it. IT take a lot of time to work on your body...and it cause more anxiety than the others SSRI's in general.
I remember the day when I quit it cold turkey, it was my birthday and I was in a restaurant and I do a major panic attack...the biggest I do in my life...I said never again, no SSRI...and you know what...I return to Zoloft...3 months on it, at the highest dose...nothing at all except a major gain weight. Zoloft do nothing on me, I don't feel side-effects or improve on it. It's like I take a placebo...Celexa is the same, nothing on it...no side-effect but no improve also.
I return to Effexor-Xr in april 2008...up the dose to 300mg day...no improve also, just worst anxiety and worse my bad habits(Smooke more cigarettes, drink more coffee)...I augmented my daily dosage of benzo drugs to calm me down and I ended up at the hospital with a high addiction to Xanax (12mg/day and more sometimes...). I return home and withdraw the Xanax by switching it with Valium, like I always do...Take 3 months to recover from the Xanax addiction and abuse...
After this, I take a vacation of any drug (except the valium)...Last october my psychiatrist put me on Lexapro (Cipralex in Canada), that's not cover by insurrance here and it's expensive, I had to pay for it and I paid the price in all the way you want. Worse condition again, migraines everyday, tired from the morning to the night, no motivation, no energy, major gain weight again, more than 40 pounds... I had to begin to take a Stimulant (Ritalin) with it to be able to stay awake more than 3 hours in a row...After I add Wellbutrin on the top of it, I was on 20mg/day of Lexapro at the time...I don't increase my benzo drug intake on it and I had no sexual side effect also...but well I quit it cold turkey also because I was tired to be tired...the blend of the Stimulant drug with the AD's make me feel worst than ever. I know I always tell this but that's true...After each try of a drug, I feel worse...I just think I don't answer well to all the SE effects of the SSRI's in general.
The only one category that I never explore with my doctor is TCA's, since he find them not effective at all for social phobia, that's my main problem. I think they also cause otrhostatic hyppotension as a side-effect no?... I only take a small amount of Elavil for my migraine prevention but that never work really...it was suppose to help me to sleep at night also but it was not the case...Impramine seem to be too sedating and weight gainer for me, I don't want to try it. Weight is important for me, since it's a part of my social phobia problem.
In fact, i'm tired to switch from one drug to another. It's worsing my condition every time. So now i'm a lot anxious about my situation.
So like I write more sooner, I will stay on 30mg/day of Parnate, devide in 3 doses with a minimum of 4 hours between each doses. I will see if the orthostatic hypotension fade away or reduce a little bit...and I will wait for my psychiatrist appointment the 14th january to talk with him about all of this. I stop the Florinef also, since I read it can high the blood pressure.
I think I increase maybe the dose too fast, as usual. The general anxiety make me a lot anxious about the situation, about my blood pressure, and everything else I feel from this drug. I'm the kind of guy who react strongly to all the drugs he try, I always get the rarest side-effects...like the Tinnitus I have when I do otrhostatic hypontension.
For the lack of energy I feel in the afternoon and at night, I will talk about it to my psychiatrist also. Adding coffee to my daily regiment was my trick until yesterday, but I think this is maybe why my BP is high. I should stop drinking it. Maybe adding something like you take will help, lamictal or valporate acid or Lithium...I seem not very stable and maybe it will help on me to feel a more stable effect of the Parnate.
You see, this morning, I wake up early like always and I was ok...I don't have high blood pressure or low blood pressure and I don't have orthostatic hypotension when I climb the stair of just sit and get up of the computer chair or my bed. I just have a small headache, probably because I had a migraine last night and I don't sleep a long time... So I wonder why yesterday i was not ok??? Maybe it was the familly dinner who put me in a anxious mood and a more pre-disposed to BP problem.
I had a crazy night, a familly dinner for Christmas and I was so tired, I think I said 3 words in all the night. I was feeling a lot detachead from the rest of my familly. They all had fun last night except me. I was not able to eat the food they eat because of the diet...everything was in the gravy (powder) so I was not allowed to eat the good food my mom do, I had no patience at all, and I got one of the bigest migraine since a while...it was not very pleasant or fun...
Another thing, the blood pressure seem also to be not stable. I take it last evening and I do low blood pressure, 90/50...but all the morning and the afternoon I was at 140/90-150/90...Strange...that's not constant at all.
Maybe I don't react well to the epinephrine effect of Parnate and all the maoi's drugs. Don't know...
Like I write before, so much question and so less answer...I think my brains are just f*ck up...One thing is sure, i'm tired to be always an exception. My sister have the same problems than me and she answer very well to newer AD's, she's now on the Cymbalta, since this drug don't make you gain weight...and she feel ok...not always, she have her bad day, like everyone, but she feel fine...She also answer well to Celexa before, but just switch because of the weight gain... But me, nothing seem to work and that's suck... (Sorry for my bad language....)...
Well that's all for now folk's...thanks again ;-)
Posted by Vincent_QC on December 25, 2008, at 14:37:34
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » mav27, posted by Vincent_QC on December 25, 2008, at 10:06:40
Well, that's really weird. I try to eleminate all the possibilities that something in my daily life can make my BP to get high or too LOW and make me do orthostatic hypotension and I found no explanation at all.
Since this morning, I monitor my blood pressure 3 times and each time it's NORMAL... 110/50 for me is what I call a normal blood pressure. I just take it 3 minutes ago and It was at 115/53. So I'm looking for what wrong I do yesterday to reach the level of high blood pressure I had and I don't find anything wrong.
Since this morning I had:
4 cups (big cup) of coffee (usual for me)/don't high my BP...
3 Tylenols x-strong for my headache and 2 aspirins x-strong (I usually change every week, one week on Tylenols, one on advils, the other one on aspirins). /Never had any high BP before because of them.
Eat 3 sliced of bread with "false cheese" cheese wizz on it for breakfast and a big piece of meat pie with green salad and vinaigrette for lunch time. /No diet interraction here...so no HBP...
I drink another cup of coffee right now. (My usual afternoon coffee). /No HBP from it also.
I just up from the basement of the house to the first floor, 4 times in a row because I had a lot of things to bring at the first floor and I NEVER had another orthostatic hyptension episode.
I don't take the Florinef pills today. / I read that it can cause hypertension.
Take all my vitamins that I usually take in one day (I had a gastric by-pass in 2001, not a restrictive one like they do in the USA, mine is a malabsorbtion kind of, I have a short intestine, 1 meter long, the rest is by-pass, so I don't absorb fat-solubes vitamins and proteine very well so the list is there, some vitamins amount can be seem very high but I need them in order to stay in shape and avoid blood disorder deficiencies:
1 B6 pill / no HBP potency here.
3 iron pills - 300mg. / no HBP potency here.
Vit A - 30 000 units. / no HBP potency here.
Vit D - 50 000 units. / no HBP potency here. High amount of units but necessary...
2 centrums strong. / no HBP potency here.
1 pill call "Cotazim 20" to help me to digest what I eat). / no HBP potency here.
2.5mg/Valium. / Hypotensor sometimes, normally I take more than this, but today I don't feel the need to take all my 20mg of Valium...it's like this since I begin the Parnate treatment, I don't feel the craving for my benzo pills, I take them just to prevent seizure...that's a major improve for me.I devide my dose of Parnate like this:
10mg - 8AM
10mg - 1PM
10mg - 5PMYesterday, I had the same vitamins pills...but I devided my dose of Parnate differently:
30mg of Parnate at 8 AM. 4 valium 5 mg pills like usual, I was feeling a lot more anxious for no apparent reason, my familly dinner was not the problem cause I love them and I never had a problem with them. I eat less, 2 eggs and 2 slices of bread in the morning, and nothing before 9 PM cause I was not feeling very well...and I take the 0.1mg of Florinef for the orthostatic hypotension.
Strangely, my blood pressure was high and I had a lot of orthostatic hypotension...I wonder why?
I can't find the main problem...maybe devide my dose of Parnate into 3 doses will help...I hope it will stay like this for now. I don't feel super energic, and I probably will not go dancing all night long cause my headache is still strong, but I feel a LOT less anxious and I don't experience other orthostatic hypotension episode and that's a great thing...
Maybe I miss something on my list of all the pills I take...but for what I know, nothing I take can make my blood pressure so high and at the same time cause orthostatic hypotension.
For d/r, I forget to mention that I know exercise is good for mental health. I do a CTB before where I had to respect a strict schedule and I had to do exercices every day and get active a lot but I don't improve of it. I was just more and more tired.
Like I trying to explain several times to my psychologist at the time was the fact that to be able to do exercices, you need energy...and I don't have it.
Try to go outside and walk for 1 hour or go to the gym when you sleep only 2-3 hours by night and when you feel already exhausted when you wake up in the morning...that's not easy...add on the top of this the frequent migraines, my severe anemia (that I try to control, I receive monthly one treatment of I.V. iron "venofer", it's iron sucrose)...You will see that's not easy to be active when you feel like this.
I want to be in a more great shape...Yes, I really do...I try several times to stop smooking, 3 times this year, but that's another point, quit smooking when you are in depression, that's not easy at all, even with nicotine patch... To be able to get in shape and move your *ss and do some exercices, you need energy, and I don't have it for now...
I know by experience that going outside and do 1 hour of walk, will not help me at all, I will be more exhausted, I will get a more big migraine, and I will not sleep more the night after. I understand the principle of the secretion of endorphins produce by regular exercices and it's important role in the reduction of the pain, stress and anxiety, but again, to be able to change something, I need to feel more well and have more energy, and it's what I try to do now with AD treatment.
I also do right now another cognitive therapy who will help me this time to reduce my social anxiety level and my general anxiety...After that, I will be able to move more easily my *ss to the gym, or just take a walk, without being embarrassed in front ot the others persons... that's another point...if I take a walk, I will see people on the street and I have a lot of difficulties to deal with the stress causing by this situation. At the gym it will be the same...shy in front of the others people, especially muscles guys or people in a more well shape than me...
So you see, i'm not trying to find "bad" excuses and to stay sit on my chair...I just need to feel more good with myself and have a more high level of energy before being able to think about doing some exercise.
For now, i'm doing some exercise with my fingers...on the keyboard! lol
Well, again, thanks...that's all for now...And again, have fun tonight, it's Christmas after all ;-)
Posted by Phillipa on December 25, 2008, at 23:16:12
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Vincent_QC, posted by mav27 on December 25, 2008, at 8:31:46
Mav don't know age of you but did you happen to go through menopause and when tried SSRI's peri? d/r I thinks thinks may be a correlation with chemical body changes. Just wondering and sure don't want to insult a 20 year old. Love Phillipa
Posted by mav27 on December 25, 2008, at 23:53:13
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » mav27, posted by Phillipa on December 25, 2008, at 23:16:12
Im 28... and male so i'm hoping never to go through menopause :)
Posted by desolationrower on December 26, 2008, at 0:47:02
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Phillipa, posted by mav27 on December 25, 2008, at 23:53:13
hey vincent. I know its tough to get stuf done with these kind of issues, i bring up excercise because i think poor toleration of blood pressure side effects is more likely if cardiovascular system is out of shape. obviously its got other upsides as well. getting stuff wokring can feel like a rubicks cube, get one thing fixed and another slips out of control. merry xmas.
-d/r
Posted by Vincent_QC on December 26, 2008, at 8:02:23
In reply to Re: Parnate + orthostatic hypotension (30mg/day), posted by desolationrower on December 26, 2008, at 0:47:02
> hey vincent. I know its tough to get stuf done with these kind of issues, i bring up excercise because i think poor toleration of blood pressure side effects is more likely if cardiovascular system is out of shape. obviously its got other upsides as well. getting stuff wokring can feel like a rubicks cube, get one thing fixed and another slips out of control. merry xmas.
>
> -d/rHi d/r ;-)
Yeah I understand very well what you mean...I totally agree with you about the "cardiovascular system out of shape" and the facility to make more high blood pressure...as far as I know, i'm not in good shape...lolI apply the "one thing done at the time" technique, at least I try...I think I understand now that I can't fix everything in my life in 2 weeks...humm well i'm in the same state since 2 years now so it's about time that I realize this!!! lol
I have a big tendancy to always want to go more fast. Up my dosage, without advise my psychiatrist, is something I do often...who's too blame here? I just want to feel good...but if I think about it, I never felt good in my life, even as a kid, I was always anxious and I always avoid public place and the others childrens...so I don't really know what's mean "feeling normal or good"... I also forget often than the others "normal" people have also their problems, they just have a better method to deal with them...but are they feel "normal" themself? Who know... I can't answer to this...
I always think that one day I will find the "magic" pill, the one who make me feel like the others people, but I realize that the "magic" pill don't exist, and I will have to work probably all my life around my well being and the fact that I have to deal with the normal stress of everyday life.
This time, I will stick at the 30mg/day for a couple of weeks, devide in 3 doses of 10mg, even if I don't find it to be very high or effective for now, maybe it will begin to work on me one of these day, at least help me to fight my social phobia problem and feel less anxious in my global life...For now, I only see one difference, and it's the fact that I tend to not take all the benzo pills i'm suppose to take at daytime...and it's a good point.
I think I know what happen with the orthostatic hypotension problem 2 days ago. I really think my benzo intake (VALIUM) make the orthostatic hypotension worst.
Yesterday, I take only 2.5 mg of Valium, devide in 2 doses (5mg in my entire day) and I don'T experience a orthostatic hypotension attack. Two days ago, I take all the 20mg at daytime, and I had all day long orthostatic hypotension attacks...
Last night, I go to the bed around 12AM...I was not able to sleep, so I get up and take 10mg of Valium as a sleep aid since I had nothing else to help me...and guess what...I get up at 4AM and I climb the stairs to go to the kitchen and take a glass of water...and I had a BIG orthostatic hypotension attack ( I will call them like this now...lol). I had the same when I get up from my bed this morning, and also when I get up from the computer chair...
So Valium make my orthostatic hypotension worst and it's seem to be a good explanation cause my psychiatrist told me last month the benzo drugs have a big potential effect to be hypotensor for the cardio system.
He point out the fact that my nardil experience fail back in 2007 at 90mg/day with 8mg of Rivotril probably because of the high amount of Rivotril I taken each day. Like he said, they are not good to use everyday, they are good to use on purpose or as needed only...He want them to be out of my life soon...And me too anyway...but one thing at the time for now. The improvement I Feel now with the Parnate, about the fact that I don'T feel the need to take my Valium pills at daytime is more than welcome...I should keep them only for bedtime and withdraw them slowly when I will be stable on Parnate.
For the high blood pressure, I can't tell you what happen 2 days ago...I eat a lot of eggs recently, maybe it's the explanation, I don't eat a lof of meat, except for chicken... I don't eat egg yesterday and had no high blood pressure...so who know??? Eggs are not on the diet list...Maybe it was just the normal stress, christmas thing and everything else...
I also forget to mention the fact that when I move my face muscles, especially when I do rotation with my eyes and move at the same time the muscles in my forehead, I feel the same strange sensation that I experience when I do orthostatic hypotension... blurred vision, change in my vision, tinnitus, increase of my heart beat, dizziness...
That's weird no? I notice this last night when I wake up at 4AM...I was in front of the mirror and I feel a pain behind my eyes (I use more my laptop since a couple of days, maybe it's related)...so I move my eyes and they other muscles of the face and I feel the same sensations I get when I do orthostatic hypotension. So I think I will do some exercices with those muscles...move them the more often I can...it seem to help me to get use to the orthostatic hypotension side-effects.
The panic disorder make me more focus on this problem since 2 days so I will work it out a little bit and try to desensitize me on these strange effects I can feel sometimes.
Well, I just write another novel...sorry!!! lol
I think write a lot like this help me to feel relieve of a part of my stress...but I don't want to become an embarrass to the others members of this website...
You're very nice d/r and thanks for you help and support ;-)
I wish you a good day and take care of you ok ;-)
Ciao!!!
Vincent ;-)
Posted by SLS on December 26, 2008, at 16:24:09
In reply to Parnate + orthostatic hypotension (30mg/day), posted by Vincent_QC on December 24, 2008, at 18:32:59
I found that the hypotension produced by Parnate resolved with the passage of time. The first time I tried it, I began nearly fainting once I reached 60mg. It mitigated after a few days and then resolved almost entirely after a few weeks. In the more recent past, I have been able to progress to 150mg without experiencing hypotension at all. I now take 80mg.
Just one stubborn person...
- Scott
Posted by Phillipa on December 26, 2008, at 19:11:49
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Phillipa, posted by mav27 on December 25, 2008, at 23:53:13
Oh that's funny think you're safe on that one!!!! Love Phillipa
Posted by Vincent_QC on December 26, 2008, at 21:38:01
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Vincent_QC, posted by SLS on December 26, 2008, at 16:24:09
> I found that the hypotension produced by Parnate resolved with the passage of time. The first time I tried it, I began nearly fainting once I reached 60mg. It mitigated after a few days and then resolved almost entirely after a few weeks. In the more recent past, I have been able to progress to 150mg without experiencing hypotension at all. I now take 80mg.
>
> Just one stubborn person...
>
>
> - ScottHi Scoot ;-)
So you din't experienced orthostatic hypotension before 60mg? I had a lot of hypotension on Nadil back in 2007,only at 90mg, the recommended dosage I think...and it never fade away with time (3 months)...so I guess i'm more predisposed to do ortho hypo than you...I'm just at 30mg of Parnate, so it's why I found it to be a very low dosage to experience orthostatic hypotension no? On other hands, it's write in the official facts sheet .pdf document from GSK website for the parnate that orthostatic hypotension is a MAJOR side-effect, with 30mg dose and more...
I also found that this side-effect is on and off and it tend to decrease a little bit day after day. The weird thing with the Parnate is that one day I feel really tired and I experience a lot of orthostatic hypotension and high blood pressure and the day after I feel in great shape...That's strange no?
I hope the Ortho Hypo will fade away with times, like you experienced ;-) I feel this time I will be able to do something with my social phobia.
Yeah, the Parnate have a lot of side-effects (Less than all SSRI's...), well on me, I found it to be very sedating, except if I take the whole 30mg dose in one shoot but if I do this it worse my orthostatic hypotension. I also eat more on it so I gain weight as usual...and my eyes burn... I have to buy some eyes drops I think...but again that's only me, I always have differents side-effects, at least differents than the ones on the official list.
No, i'm not feeling a lot of benefits from the Parnate already, I don't feel more energic and I don't get more motivation to do things or going outside, in fact, I have to deal with extreme "fatigue" and I have to get motivated a lot to just do my regular routine (take my shower, clean my room and the house, do some laundry and go take a coffe with a friend at night...), most of the time, I just wait at the evening to take my shower, put some clean clothes and go out with my friend...during the day, I return often in my bed and i'm very lazy...
For now, the Parnate help me to reduce my intake of valium, I feel less the "craving" for benzo drugs on the Parnate so it make it a good potential medecine of choice for a long term treatment.
Ok, I continue to take my Valium, because if I don't do it, I have this fraking sensation inside my head, like I will do a seizure...but I reduce my intake of 5mg in 6 days...I was on 20mg/day of Valium before, now i'm only at 15mg.
Today, I had a family dinner for Christmas with a lot of uncles, aunts, cousins, cousines and childs and I take only 2.5mg before I go there. Last year I didn't go at all because I didn't had the courage to do it... Yeah, I was a lot shy, I just sit a a table with my sisters, I don't say hi at first to the people there, I wait after my sister to go take a plate of foods on the buffet , I don't talk a lot to my cousins and cousines...or play with childs...but I go there and it was a kind of improve for me... Anyway, out of subject again...sorry...
Can I ask you a question? Why you taked a high amount of Parnate like this? 150mg for me, it seem to be a high dose...80mg seem to be a more normal dose now...I hope you're feeling ok now ;-)
I plan to up the dose to a maximum of 60mg...cause my psychiatrist is very reticent about a more high dose than this, and also because it's too soon to see if 30 mg will be enought for me, i'm on 30mg only since 6 days.
Well thanks for your answer and the fact that you share your experience with me ;-) You give me some hope ;-)
Posted by SLS on December 27, 2008, at 8:13:48
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » SLS, posted by Vincent_QC on December 26, 2008, at 21:38:01
Hi.
I believe that there is still a good chance that your body will accommodate to the hypotensive effects of Parnate. It may take several weeks once you reach 60mg for it to mitigate. As you point out, you and I have different biologies, so there are no guarantees that you will respond the same way I have.
It is too bad that the GSK and PDR literature recommend 60mg as the maximum dosage of Parnate. I have found that many of the doctors who have the most experience with Parnate suggest that the true dosage range for efficacy is 40-80mg.
There is clinical and pharmacological evidence that Parnate at dosages above 100mg exerts effects not seen at the lower dosages. I found 150mg very tolerable. It was more helpful to me at that time than were the lower dosages.
- Scott
Posted by Vincent_QC on December 27, 2008, at 10:28:57
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » Vincent_QC, posted by SLS on December 27, 2008, at 8:13:48
> Hi.
>
> I believe that there is still a good chance that your body will accommodate to the hypotensive effects of Parnate. It may take several weeks once you reach 60mg for it to mitigate. As you point out, you and I have different biologies, so there are no guarantees that you will respond the same way I have.
>
> It is too bad that the GSK and PDR literature recommend 60mg as the maximum dosage of Parnate. I have found that many of the doctors who have the most experience with Parnate suggest that the true dosage range for efficacy is 40-80mg.
>
> There is clinical and pharmacological evidence that Parnate at dosages above 100mg exerts effects not seen at the lower dosages. I found 150mg very tolerable. It was more helpful to me at that time than were the lower dosages.
>
>
> - Scott
>Hi Scoot ;-)
I totally agree with you again. I'm maybe less tolerant with the orthostatic hypo effect provocated with the old MAOI's, but you know what, I begin already to get use to it. I mean that I know I will not die of it. So having less anxiety in face of that problem make it to became not a problem, I don't know if you understand what I mean? My english is not at is best...sorry...If I feel dizness and a change of my vision with tinnitus, I try to think about something else and my heart pulse slow down immediately and everything return to the normal after 3 minutes... But like you write, it tend to fade away with time, that less bad than what I experienced 3 days ago...I still have some orthostatic hypotension, but less frequently...I think higher dosage than the one recommend by the official compagny who make the parnate (GSK) will be more efficient. The only recommend a dose of 30 MG by day!!! And it's write in capital letters that's a dose above 30 mg is not necessary and cause more orthostatic hypotension and more side-effects.
The main problem with MAOI's is that little to no NEW studies are made on them, since the compagny don't do money with them, they don't invest money on research about them...I'm sure a good study between an old MAOI and the newer SSRI's or SRNI's will show a higher rate of success with MAOI than SSRI'S or SRNI's... I found one study about MAOI's and TCA'S showing a highest success rate and the superiority of MAOI's, I think it was the doulbe success rate with the MAOI's... Why do you think they don't investigate more in that kind of research....just because of the money...
Since Effexor-XR patented expire, I know that a new drug will come soon in the States...FAD approve already a new drug made with a metabolite of venlafaxine(Effexor). I guess it will be exactly the same level of sucess rate...
Cymbalta was suppose to be superior to Effexor-xr and "supposedly" but is it really more good than Effexor-Xr ? I can tell you that no.My family doctor is a lot involved in research about drugs and anxiety problems and he assist to the launch of the Cymbalta in Canada...a conference made by the compagny who fabric Cymbalta. To be accepted by health Canada, the compagny had to show some studies about the fact that Cymbalta is equal than effexor-xr...nothing more...and they succedd to do it...but that doesn't make it a more good drug than Effexor-XR.
The same happen in Canada and in the States also, when the Celexa(Citalopram) became not patented and generic version begin to surface, the compagny put some money in the developpement of a new drug made with the pure enantiomer of racemic citalopram. It's the same ingredients but they remove all the inactive ingredients inside the Citalopram, made a pure version and sell it under the name Cipralex(Escitalopram).
It's a good example of pharmaceutical companies who want to extend the lifetime of a drugs...A very popular strategy in this industry.
Who suffer from this? The patients only !!! I can write others example, Paxil CR...Luvox XR...they all have an ideal half-life in the blood in the regular form, why they need to do extended version ??? That's wasn't necessary but their patented expired so it's the way the companies find to make more money!
Anyway my family doctor don't recommend Cymbalta or newer version of Paxil CR or Luvox XR as well and prefer to prescribe older drugs like MAOI's when the regular SSRI's, Wellbutrin or Effexor-Xr don't work, since TCA's don't work for social phobia and have a more high profile of side-effects than old MAOI's in general, that's the way he work...
I think that completely uncessary to have more AD on the market for now...since the more specific they seem to work on the brains, and the worst they are...My Cipralex experience was a disaster, it's almost killed me...
So no more newer drug for me, until they will found something that really work for social phobia...and something NEW also, not an old metabolite drug modified!!!
Anyway, out of subject again...lol Too much coffee I think...I can't stop my fingers! ;-)
Well, like I write before, I plan to up my dosage to 60mg...and stay at this state and wait to see what happen...I think it will be a slow process...cause my new psychiatrist have a slow approach...i'm suppose to be only at 20mg now and I already up the dose to 30mg...he will not be happy for sure but I don't care, i'm the one who suffer from 14 years of social phobia, panic disorder, general anxiety and depresison, that's not him and it's normal that I want to feel and see some improve soon...I understand also that I have to not go too fast, but I don't think up my dosage of 10mg every 2 weeks is what you can call going too fast no???
Well that's enough for now, have a great day and take care of you ok ;-)
Posted by SLS on December 27, 2008, at 11:35:27
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » SLS, posted by Vincent_QC on December 27, 2008, at 10:28:57
Hi.
:-)
> I understand also that I have to not go too fast, but I don't think up my dosage of 10mg every 2 weeks is what you can call going too fast no???
That is a great strategy. It is not too fast at all. If fact, it is rather conservative, but you will avoid triggering too much hypotension and other side effects.
> Well that's enough for now, have a great day and take care of you ok ;-)
Ok.
:-)
- Scott
Posted by dscb on January 2, 2009, at 21:00:07
In reply to Parnate + orthostatic hypotension (30mg/day), posted by Vincent_QC on December 24, 2008, at 18:32:59
Hello.
If you're on other medications, the Parnate may be interacting with them and causing the hypotension. Definitely ask your doctor. I was on Parnate and didn't have problems with hypotension until I added Lamictal and then had some really scary episodes with blacking out. I wish you the best.
Posted by Vincent_QC on January 3, 2009, at 7:21:27
In reply to Re: Parnate + orthostatic hypotension (30mg/day), posted by dscb on January 2, 2009, at 21:00:07
> Hello.
> If you're on other medications, the Parnate may be interacting with them and causing the hypotension. Definitely ask your doctor. I was on Parnate and didn't have problems with hypotension until I added Lamictal and then had some really scary episodes with blacking out. I wish you the best.Hi ;-)
Well, I will tell my doctor about it for sure, I see him next week. Orthostatic hypotension seem to fade away with time, more fast than the hypertension I have since I increase my dosage to 40mg/day.
I know that Valium can worse the hypotensive symptoms and cause more orthostatic hypotension but since i'm on the Parnate, I take less Valium than before, it's like I don't need it anymore...I just continue because I don't want to withdraw too fast of it and make me feel worse in general.
A lot of others factors seem to contribute a lot to the hyper-hypotension comming from the Parnate. The general physical health of the person who take the Parnate is another factor. I don't exercise a lot, I definitly need to be in a more good shape and I know it. I also need to stop smooking, but since cigarette have a AD effect, I doubt it's a good time to stop smooking.
Bur for now everything is ok. I mean, I see better days and worse also. Every time I increase my dose, I seem to react badly, but everything seem to fade away in 6 or 7 days...I suppose it's the time my body need to adjust to the new dose.
So thanks for your encouragement, you are very nice ;-) I wish you the best also!!!
Posted by Cseagraves on January 6, 2009, at 21:55:01
In reply to Re: Parnate + orthostatic hypotension (30mg/day) » dscb, posted by Vincent_QC on January 3, 2009, at 7:21:27
Hi there! My name is Courtney and i'm new here. My pdoc wants to start me on Parnate in a couple of weeks after trying every other SSRI out there. Have read through tons of stuff in internet about MAOIs and it sounds a little scary. Not so much worried about diet. I'm a vegetarian, so I will have to do some adjustments, never ate soy products much anyway. Love chocolate, so that will be a biggie. My major concern after reading everyones posts are about high blood pressure. If I already have high blood pressure, does that mean that I don't take BP meds while on parnate? The BP med I take is Benazapril, which is on the list of no-no's. So I'm confused. Is it while taking parnate that you don't need BP meds? Also, I don't understand what you mean by having hypertension and hypotension at the same time. Could someone please explain to me. Also too, when you do get a cold, all I have been able to find is what you can't take. Could someone tell me what you can take thats safe?
Thanks so much for the help!
CS
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