![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by JadeKelly on January 2, 2009, at 18:29:24
Hi Guys,
It appears I'm a slow learner. I believe there is a Method to Parnate's Madness. I think. Hoping people in the know will explain/explore the stages we MAY go thru, APPROX when, and POSSIBLY what order, and, if the mood strikes, WHY. In addition, if certain medications are better left added when we HIT those stages, helfpul as well, ie melatonin for norep crazies, saved me last night Jay. Scott, I started lithium today, later saw week 6 is the best time. In reading a recent post, it seems Norepiniphrine is the neuro that brings out lots of emotions and sensitivity usually around week 6, in Nortrip I think. I just had an unusually nice 10 days, to enter week 6+ of Parnate with 2-3 days(so far) of extreme frustration, anger, explosiveness, crying, etc. I haven't cried in two years.
I will save the rest of my personal experience and very limited knowledge for a separate post, and hope other user's and past users will post there as well. We may find patterns where none were obvious before.
Thanks!
~Jade
Posted by Phillipa on January 3, 2009, at 0:49:06
In reply to Enlighten Please! PARNATE's Many Moods, posted by JadeKelly on January 2, 2009, at 18:29:24
Jade you started lithium today? Love Phillipa
Posted by jms600 on January 3, 2009, at 8:13:11
In reply to Enlighten Please! PARNATE's Many Moods, posted by JadeKelly on January 2, 2009, at 18:29:24
Hi Jade,
Not sure what your diagnosis is - I guess whatever it is must be fairly severe to be prescribed an MAIO.
I read in the BNF that Parnate is the most hazardous out of all the MAOIs due to it's stimulant effects, and Nardil or Marplan is preferred (although they are still not the first or even second line of defence).
You may very well need an antidepressant which has stimulating properties; however, if not, then maybe you should discuss this choice with your p/doc??
Please please please do not take what I've said as a firm recommendation! You first port of call - if you are concerned - should always be you doctor!
Good luck,
jms
> Hi Guys,
>
> It appears I'm a slow learner. I believe there is a Method to Parnate's Madness. I think. Hoping people in the know will explain/explore the stages we MAY go thru, APPROX when, and POSSIBLY what order, and, if the mood strikes, WHY. In addition, if certain medications are better left added when we HIT those stages, helfpul as well, ie melatonin for norep crazies, saved me last night Jay. Scott, I started lithium today, later saw week 6 is the best time. In reading a recent post, it seems Norepiniphrine is the neuro that brings out lots of emotions and sensitivity usually around week 6, in Nortrip I think. I just had an unusually nice 10 days, to enter week 6+ of Parnate with 2-3 days(so far) of extreme frustration, anger, explosiveness, crying, etc. I haven't cried in two years.
>
> I will save the rest of my personal experience and very limited knowledge for a separate post, and hope other user's and past users will post there as well. We may find patterns where none were obvious before.
>
> Thanks!
>
> ~Jade
Posted by JadeKelly on January 3, 2009, at 10:44:47
In reply to Enlighten Please! PARNATE's Many Moods, posted by JadeKelly on January 2, 2009, at 18:29:24
Hi Guys,
I know everyone means well, however, I want to make clear the purpose of this thread. While on Parnate, I have had 3+ of the best weeks I've had in over 2 years. One week, emotional.
I want first to acknowledge to people ON PARNATE that I believe these stages are normal, and maybe we can get an idea of what we can expect (from each neuro as it is effected)
IF WE STICK TO TOPIC we may get answers FROM PEOPLE WHO KNOW that will save us (parnate users) a lot of time and questions.
There is a thread below for our experiences as we go through this journey. Maybe we can help each other! Thanks-Jade
Posted by SLS on January 4, 2009, at 20:11:08
In reply to Re: Enlighten Please! PARNATE's STAGES, posted by JadeKelly on January 3, 2009, at 10:44:47
Parnate's Stages: Are they universal?
If you cannot answer this question with certainty at this point, you may still find it to your advantage to rely on trial-and-error.
My unsolicited and perhaps unwanted suggestion to you as a concerned comrade is that you might be spending too much time acting as an investigative scientist (a pretty good one, actually) and too little as a patient patient. Besides, you won't really know how your patterns compare to others until after you conclude your treatment trial.
Read. Make observations. Ask questions. Take notes. Ponder associations. Synthesize theories. However, be careful when committing to testing hypotheses. Try to remember to be clinical.
I believe you will find enough commonalities in experiences between individuals to come to some interesting, albeit perhaps esoteric conclusions. However, the differences between individual biologies might frustrate any attempt you may make to predict your own future response pattern. I think it would be premature to make treatment decisions based upon the response patterns you see in others. You might be right in the hypotheses you arrive at, but without certainty, I don't think you can justify aborting a drug trial prematurely. Of course, if the drug makes you feel substantially worse, or if the side effects are intolerable, it would not be an easy decision to make to continue treatment.
I hope I haven't insulted you.
You think like a good scientist. You might even make some discoveries along the way. However, if you want to get well, your priority role is that of patient. I believe you will enhance your chances to get well by educating yourself as much as possible, and even suggesting to your doctors treatments that you think might work for you. I don't believe that I would represent a success story had I not helped my doctor in choosing the four drugs I am currently taking.
Don't drive yourself crazy looking for answers to questions that won't enhance your chances of getting well. I am still trying to learn the lesson of patience. It is a difficult one. The wisdom of patience comes in knowing that one must give Time time to work.
I worry that you might ride an emotional roller-coaster by looking at things too microscopically. Don't think in terms of hours and days, but, rather, in terms of weeks and months.
For some reason, I don't think I expressed myself very well here. I tried to be helpful rather than hurtful.
I love your enthusiasm. Your positive attitude and constructive behaviors will lead you to success.
- Scott
Posted by JadeKelly on January 4, 2009, at 23:31:14
In reply to PARNATE's STAGES: Are they universal? » JadeKelly, posted by SLS on January 4, 2009, at 20:11:08
> Parnate's Stages: Are they universal?
>
> If you cannot answer this question with certainty at this point, you may still find it to your advantage to rely on trial-and-error.
>
> My unsolicited and perhaps unwanted suggestion to you as a concerned comrade is that you might be spending too much time acting as an investigative scientist (a pretty good one, actually) and too little as a patient patient. Besides, you won't really know how your patterns compare to others until after you conclude your treatment trial.
>
> Read. Make observations. Ask questions. Take notes. Ponder associations. Synthesize theories. However, be careful when committing to testing hypotheses. Try to remember to be clinical.
>
> I believe you will find enough commonalities in experiences between individuals to come to some interesting, albeit perhaps esoteric conclusions. However, the differences between individual biologies might frustrate any attempt you may make to predict your own future response pattern. I think it would be premature to make treatment decisions based upon the response patterns you see in others. You might be right in the hypotheses you arrive at, but without certainty, I don't think you can justify aborting a drug trial prematurely. Of course, if the drug makes you feel substantially worse, or if the side effects are intolerable, it would not be an easy decision to make to continue treatment.
>
> I hope I haven't insulted you.
>
> You think like a good scientist. You might even make some discoveries along the way. However, if you want to get well, your priority role is that of patient. I believe you will enhance your chances to get well by educating yourself as much as possible, and even suggesting to your doctors treatments that you think might work for you. I don't believe that I would represent a success story had I not helped my doctor in choosing the four drugs I am currently taking.
>
> Don't drive yourself crazy looking for answers to questions that won't enhance your chances of getting well. I am still trying to learn the lesson of patience. It is a difficult one. The wisdom of patience comes in knowing that one must give Time time to work.
>
> I worry that you might ride an emotional roller-coaster by looking at things too microscopically. Don't think in terms of hours and days, but, rather, in terms of weeks and months.
>
> For some reason, I don't think I expressed myself very well here. I tried to be helpful rather than hurtful.
>
> I love your enthusiasm. Your positive attitude and constructive behaviors will lead you to success.
>
>
> - ScottHi Scott,
Not to worry, you FLATTER me with all that projection. I'm blushing!
I hope you will continue to answer other's questions as you can regarding Parnate. You have always been generous with your knowledge (your bedside manner could use a little work-JK).
Thanks for your help at critical junctures, most appreciated. I'm finally at my goal: 3+months, 3weeks @60mg. Whoooh
~Jade
ASK SCOTT ......HE KNOWS ALL ABOUT PARNATE!!!
Posted by SLS on January 5, 2009, at 6:17:44
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 4, 2009, at 23:31:14
Hi Jade.
Were heart palpitations ever a symptom of your illness. Are you experiencing them now, or have they become worse?
- Scott
Posted by JadeKelly on January 5, 2009, at 21:02:06
In reply to Re: PARNATE's STAGES: Are they universal? » JadeKelly, posted by SLS on January 5, 2009, at 6:17:44
> Hi Jade.
>
> Were heart palpitations ever a symptom of your illness. Are you experiencing them now, or have they become worse?
>
>
> - Scott
Only early on, none now, why?~Jade
Posted by Phillipa on January 5, 2009, at 23:59:20
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 5, 2009, at 21:02:06
Just a guess maybe to assess for taking a TCA as some can effect heartrate? Love Phillipa
Posted by SLS on January 6, 2009, at 10:21:59
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 5, 2009, at 21:02:06
> > Hi Jade.
> >
> > Were heart palpitations ever a symptom of your illness. Are you experiencing them now, or have they become worse?
> >
> >
> > - Scott
>
>
> Only early on, none now, why?I usually experience palpitations during a short period of time while taking Parnate as I approach an improvement response. Many people mistake this for some sort of cardiotoxicity, but it is probably a time when the autonomic nervous system in the midst of change. If these palpitations linger for too long at a particular dosage, I know it is time to increase it. This is one of MY stages of a response pattern to Parnate.
I am not recommending to anyone that they conclude that heart palpitations are a part of a normal response pattern to an antidepressant. They could be the symptom of another pathology that your doctor should be made aware of.
What improvements have you experienced so far?
- Scott
Posted by JadeKelly on January 6, 2009, at 10:53:24
In reply to Re: PARNATE's STAGES: Are they universal? » JadeKelly, posted by SLS on January 6, 2009, at 10:21:59
> > > Hi Jade.
> > >
> > > Were heart palpitations ever a symptom of your illness. Are you experiencing them now, or have they become worse?
> > >
> > >
> > > - Scott
> >
> >
> > Only early on, none now, why?
>
> I usually experience palpitations during a short period of time while taking Parnate as I approach an improvement response. Many people mistake this for some sort of cardiotoxicity, but it is probably a time when the autonomic nervous system in the midst of change. If these palpitations linger for too long at a particular dosage, I know it is time to increase it. This is one of MY stages of a response pattern to Parnate.
>
> I am not recommending to anyone that they conclude that heart palpitations are a part of a normal response pattern to an antidepressant. They could be the symptom of another pathology that your doctor should be made aware of.
>
> What improvements have you experienced so far?
>
>
> - ScottThe biggest improvement, and seems this follows your line of thought, came a day after I added ritalin. That "remission" lasted 10 days and was NOT that little high you get when increasing dose, or in my case, 5-6 days "a bit" high 2nd week on Parnate. I was just myself. I took ritalin for over 10 years for ADD but I was taking 25mg at end. I only took 5mg 1st day with parnate, and same 2nd day, around noon it hit me. Someone said thats not good, its usually gradual. But 10 days? Seems remission started, then stopped. I increased ritalin to 10mg for a couple days, nothing.
60mg parnate
3mg klonopin
3days 450 lithium, cut in half day four
no ritalin last couple days
(afraid to increase)
6mg melatoninMaybe increase parnate and ritalin? 70mgP + 15mg Ritalin?
Posted by SLS on January 6, 2009, at 11:42:49
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 6, 2009, at 10:53:24
> I only took 5mg 1st day with parnate, and same 2nd day, around noon it hit me. Someone said thats not good,
What were this person's reasons for making such a statement? Was he certain? Are his observations universal and repeatable? Are you willing to make a treatment decision based upon this person's perceived level of certainty? I remember when Quitkin et al. concluded that such a response pattern was that of a placebo response. Before he died, Fred Quitkin made a 180° turn and stated that many people who do begin to respond early in the first two weeks of treatment are indeed responding to the drug. He got away from black-and-white thinking on this issue.
> But 10 days? Seems remission started, then stopped.
It may have.
I guess it depends on what you consider to be a remission.
Obviously, there was a short-lived change in the way you felt. For you, my guess is that this reflects a change in the way your brain operated as a result of drug exposure. This is about the most anyone can say. What has your brain been doing since then, hidden within the secrecy of its black box? Who knows what changes will occur if the brain is allowed to continue along its current path? You could attain a long-term remission without having to change your treatment at all.
> I increased ritalin to 10mg for a couple days, nothing.
A gentle reminder:
"I worry that you might ride an emotional roller-coaster by looking at things too microscopically. Don't think in terms of hours and days, but, rather, in terms of weeks and months."
http://www.dr-bob.org/babble/20090104/msgs/872290.html
I guess riding an emotional rollercoaster is not terribly dangerous in and of itself, as long as it doesn't translate into a treatment rollercoaster.
> 60mg parnate
> 3mg klonopin
> 3days 450 lithium, cut in half day four
> no ritalin last couple days
> (afraid to increase)
> 6mg melatonin> Maybe increase parnate and ritalin? 70mgP + 15mg Ritalin?
Maybe...
- Scott
Posted by JadeKelly on January 6, 2009, at 14:28:21
In reply to Re: PARNATE's STAGES: Are they universal? » JadeKelly, posted by SLS on January 6, 2009, at 11:42:49
> > I only took 5mg 1st day with parnate, and same 2nd day, around noon it hit me. Someone said thats not good,
>
> What were this person's reasons for making such a statement? Was he certain? Are his observations universal and repeatable? Are you willing to make a treatment decision based upon this person's perceived level of certainty? I remember when Quitkin et al. concluded that such a response pattern was that of a placebo response. Before he died, Fred Quitkin made a 180° turn and stated that many people who do begin to respond early in the first two weeks of treatment are indeed responding to the drug. He got away from black-and-white thinking on this issue.
>
> > But 10 days? Seems remission started, then stopped.
>
> It may have.
>
> I guess it depends on what you consider to be a remission.
>
> Obviously, there was a short-lived change in the way you felt. For you, my guess is that this reflects a change in the way your brain operated as a result of drug exposure. This is about the most anyone can say. What has your brain been doing since then, hidden within the secrecy of its black box? Who knows what changes will occur if the brain is allowed to continue along its current path? You could attain a long-term remission without having to change your treatment at all.
>
> > I increased ritalin to 10mg for a couple days, nothing.
>
> A gentle reminder:
>
> "I worry that you might ride an emotional roller-coaster by looking at things too microscopically. Don't think in terms of hours and days, but, rather, in terms of weeks and months."
>
> http://www.dr-bob.org/babble/20090104/msgs/872290.html
>
> I guess riding an emotional rollercoaster is not terribly dangerous in and of itself, as long as it doesn't translate into a treatment rollercoaster.
>
>
> > 60mg parnate
> > 3mg klonopin
> > 3days 450 lithium, cut in half day four
> > no ritalin last couple days
> > (afraid to increase)
> > 6mg melatonin
>
> > Maybe increase parnate and ritalin? 70mgP + 15mg Ritalin?
>
> Maybe...
>
>
> - Scott
With all due respect, I'm not one of those placebo types. I know what I felt. I know it ended. I know it was drug related. OK, I see where we're going.Some smart guy, you wouldn't know him, told me once to look at what worked and go from there.
I'll buy that.
He also said when I got to "60mg for 3 weeks, damn."> "What were this person's reasons for making such a statement? Was he certain? Are his observations universal and repeatabable? Are you willing to make a treatment decision based upon this person's perceived level of certainty?"
Actually, no!
So I know I need to either increase Parnate, Ritalin, or both. OR be patient, yuk, and give lithium a chance to work, then Lamictal. OR if those don't work, add tca. OR, if the mood strikes, small dose A/P.
Excuse me while I go scream.
Posted by SLS on January 6, 2009, at 16:15:11
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 6, 2009, at 14:28:21
> With all due respect, I'm not one of those placebo types.
I never said anything remotely similar to that.
> I know what I felt. I know it ended. I know it was drug related. OK, I see where we're going.
I think you misunderstood me. I questioned whether or not what you experienced was a true remission or, rather, a brief drug-induced improvement that does not reflect the ultimate state of homeostasis that the brain eventually settles down into that is a true and stable remission. There is no doubt in my mind that what you experienced was a true biological event that made you feel better. This is a good thing, I believe. Since I am not absolutely sure about that, you might entertain the suggestion offered to you by someone else that this is a bad thing and abort your treatment now. You will get quite a variety of opinions and suggestions I should think.
I wrote, "I guess it depends on what you consider to be a remission."
If feeling good for a total time period not exceeding 10 days is a remission for you, then you had a remission. No questions asked. Your depression remitted and you felt better.
You can do what you like to try to make it last for more than 10 days. Quite frankly, I don't care if you take my suggestions or not. If the decisions you make lead you to an indefinite remission, then you accomplished the mission. Kudos to the person who hits the bullseye.
I have been trying to get well for 25 years. I was first diagnosed and treated in 1982. I have seen quite a few changes in the paradigms with which psychiatry operates clinically and investigationally. I have also witnessed quite a few paradigm shifts in my own belief system and resulting behaviors, which included some very reckless and dangerous self-medicating. But that is me, and not you. 25 years doesn't guarantee wisdom or expert marksmanship. I shall leave it at that.
- Scott
Posted by JadeKelly on January 6, 2009, at 17:23:37
In reply to Re: PARNATE's STAGES: Are they universal?, posted by SLS on January 6, 2009, at 16:15:11
> > With all due respect, I'm not one of those placebo types.
>
> I never said anything remotely similar to that.Scott, I was just trying to tell you that I'm NOT going to follow that persons advice, and that my "remission" or "partial remission" I believe means something. Whatever its called.
>
> > I know what I felt. I know it ended. I know it was drug related. OK, I see where we're going.
Here, definately a misunderstanding. I felt you were leading me in a direction to sort out my own care, as a teacher would a student. You were telling me (I thought) to look at all the things that worked, and the things that didn't and figure it out, as you felt I could.I wasn't for two seconds worried about convincing you of whatever I felt. Remission/partial remission. Its done and time to move on. I think all we have here are semantics. Its done, whatever we want to call it. Doesn't matter does it? Besides, I trust that you would believe me.
>
> I think you misunderstood me. I questioned whether or not what you experienced was a true remission or, rather, a brief drug-induced improvement that does not reflect the ultimate state of homeostasis that the brain eventually settles down into that is a true and stable remission. There is no doubt in my mind that what you experienced was a true biological event that made you feel better. This is a good thing, I believe. Since I am not absolutely sure about that, you might entertain the suggestion offered to you by someone else that this is a bad thing and abort your treatment now. You will get quite a variety of opinions and suggestions I should think.Are we absolutely sure about anything? Well, I think I'll go with yours if you don't mind. Even if you do mind.
>
> I wrote, "I guess it depends on what you consider to be a remission."
>
> If feeling good for a total time period not exceeding 10 days is a remission for you, then you had a remission. No questions asked. Your depression remitted and you felt better.
>
> You can do what you like to try to make it last for more than 10 days. Quite frankly, I don't care if you take my suggestions or not. If the decisions you make lead you to an indefinite remission, then you accomplished the mission. Kudos to the person who hits the bullseye.Well, that hurt.
>
> I have been trying to get well for 25 years. I was first diagnosed and treated in 1982. I have seen quite a few changes in the paradigms with which psychiatry operates clinically and investigationally. I have also witnessed quite a few paradigm shifts in my own belief system and resulting behaviors, which included some very reckless and dangerous self-medicating. But that is me, and not you. 25 years doesn't guarantee wisdom or expert marksmanship. I shall leave it at that.Maybe not, but probably comes close if patience is involved. Its a model that most on this board would emulate or take advice from. I think you know that though.
And I would hope that if you see me do something that seems reckless or dangerous you would let me know.
I don't know what else to say Scott. I was following your advice, and thought you'd actually be proud of my decision to stick with it and I even worked up choices based on what you've taught me. I've learned life can be a lot easier if you have a task that is outside your realm expertise, and you have the good fortune to find someone with 25 years experience, AND they are willing to share it. I geuss I'm confused as to why you are angry, I apologize if I wasn't clear. Again, thank you for the help you've given me these past months. I hope we are still on friendly terms.
>
>~Jade
>
- Scott
>
Posted by SLS on January 6, 2009, at 17:47:38
In reply to Re: PARNATE's STAGES: Are they universal? » SLS, posted by JadeKelly on January 6, 2009, at 17:23:37
> I hope we are still on friendly terms.
Most definitely.
:-)
- Scott
Posted by JadeKelly on January 16, 2009, at 22:00:02
In reply to Re: PARNATE's STAGES: Are they universal? » JadeKelly, posted by Phillipa on January 5, 2009, at 23:59:20
> Just a guess maybe to assess for taking a TCA as some can effect heartrate? Love Phillipa
Oh, I'm sorry Phillipa. I thought that post was addressed to me. Oh, wait! It was! Silly you. Answering before other people have a chance to. Your a quick one, haha!! ;-)
Love, Jade
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.