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Dr. Bob is Robert Hsiung, MD,
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Posted by AdamCanada2 on January 23, 2009, at 16:40:30
I take currently 15mg parnate divided 10mg early in day and 5mg later on. I also take Valium 5mg twice a day.
I may try 20mg Parnate as I have in the past but at those doses I begin to have a lot of hypotension/dizziness and cloudy mind... not to mention increased insomnia.
I notice after 2-3 weeks on 15mg parnate I am starting to sleep better (maybe 6-7 hours) on average instead of 4-6 yet still difficult to initially fall asleep. But also seems the positive effects are a bit diminished for my depression + social anxiety compared to earlier on.
What augmentations would people suggest? Please try to offer more than one suggestion as some meds are not available in Canada.
Posted by desolationrower on January 23, 2009, at 18:06:36
In reply to How to Augment Parnate for social-anx + anhedonia?, posted by AdamCanada2 on January 23, 2009, at 16:40:30
First get to an adequate dose of parnate before trying to augment it. 40-60.
-d/r
Posted by AdamCanada2 on January 23, 2009, at 19:16:51
In reply to Re: How to Augment Parnate for social-anx + anhedonia?, posted by desolationrower on January 23, 2009, at 18:06:36
> First get to an adequate dose of parnate before trying to augment it. 40-60.
>
> -d/rI've tried up to 40mg and I am sensitive to most meds. at 30 and 40mg I would get extremely dizzy extremely often. I reach down for 3 seconds to find the shampoo and guess what... by the time I stand up my vision is all yellow for about 1 minute, my hearing becoming subdued, and I am trying to balance myself against the clear glass in the shower so I dont fall over. Not to mention my ability to think/concentrate would be very compromised.
I cannot handle a higher dose of Parnate except possibly 25mg without huge side effects. Just like I cannot handle over 12mg Paxil (in the past) without feeling tremendously sleepy all the time.
Posted by Phillipa on January 24, 2009, at 0:00:03
In reply to Re: How to Augment Parnate for social-anx + anhedonia? » desolationrower, posted by AdamCanada2 on January 23, 2009, at 19:16:51
Please consult your pdoc before adding anything agree with antidote. And don't raise dose without doc's authoration. Phillipa
Posted by shasling on January 24, 2009, at 4:16:50
In reply to How to Augment Parnate for social-anx + anhedonia?, posted by AdamCanada2 on January 23, 2009, at 16:40:30
> I take currently 15mg parnate divided 10mg early in day and 5mg later on. I also take Valium 5mg twice a day.
>
> I may try 20mg Parnate as I have in the past but at those doses I begin to have a lot of hypotension/dizziness and cloudy mind... not to mention increased insomnia.
>
> I notice after 2-3 weeks on 15mg parnate I am starting to sleep better (maybe 6-7 hours) on average instead of 4-6 yet still difficult to initially fall asleep. But also seems the positive effects are a bit diminished for my depression + social anxiety compared to earlier on.
>
> What augmentations would people suggest? Please try to offer more than one suggestion as some meds are not available in Canada.
>
>Well most people will suggest you wait and see how a increased dose works out as your dose is pretty low and commonly produces short term benifits that dont seem to last very long which is why for most common stay put doses usualy range arange 40-60 mg.
If how for reasons you may have,you are firm in your dose your at now,Klonopin would ge the way to go for all day anxiety,...HOWEVER too add a more social aspect very small doses of xanax through the day with parnate should provide a much more roboust social effect.
You also have many other gaba meds such as low dose Gabapentin,gabitril,and some other gaba meds you can try,only problem there is unlike xanax which would require very small doses to help,most other softer types like gabpentin would require higher doses and Parnate is known and said right on its data sheet to potenatiate other meds,so adding these in sight of better social effect might end up ruining the parnate effects your getting.
In all honesty parnate/xanax would have to your most soical combo as xanax will work with the parnate and you can use very low doses.As far as sexual issues go,all ive ever known parnate to do was increase libido.
Any google with keyword social anxiety network and i think there is a page that recomends meds for social anxiety.
But again a low dose xanax for social ehnancment would be just what you need.Thats of course my opinion.
Posted by Vincent_QC on January 24, 2009, at 16:48:43
In reply to How to Augment Parnate for social-anx + anhedonia?, posted by AdamCanada2 on January 23, 2009, at 16:40:30
> I take currently 15mg parnate divided 10mg early in day and 5mg later on. I also take Valium 5mg twice a day.
>
> I may try 20mg Parnate as I have in the past but at those doses I begin to have a lot of hypotension/dizziness and cloudy mind... not to mention increased insomnia.
>
> I notice after 2-3 weeks on 15mg parnate I am starting to sleep better (maybe 6-7 hours) on average instead of 4-6 yet still difficult to initially fall asleep. But also seems the positive effects are a bit diminished for my depression + social anxiety compared to earlier on.
>
> What augmentations would people suggest? Please try to offer more than one suggestion as some meds are not available in Canada.
>
>Hi AdamCanada2!!!
Well, it seem that we have the same problem....very sensible to side-effects of drugs. I also live in the Canada and here, the choice of drugs are more limited than in the States...I also try the Parnate in November and December 2008...I wrote severals posts here about my experience... At a dose higher than 20mg, it was almost intolerable...a lot of dizness, orthostatic hypotension, strange noisein my ears when I climbing the stairs, lost of vision, change in my vision, increase blood pressure...
Like you, I had a partial reduction on my social phobia...but i'm not sure if it was because my "focus" was more in the side-effects of the Parnate and cause a reduction in my thoughts about the others when I Was in a social situation...
Sometimes I can tolerate high dose if a drug without encounter any intolerable side-effects (Zoloft, Cipralex, Celexa), and sometimes I can't tolerate a drug at all (Parnate, Prozac, Effexor-XR, Wellbutrin-SR or XR, Risperdal, Zyprexa...). I don't know why...but I really think that social anxiety is the most hard disease to treat...
I recommend to you maybe to switch to the Nardil, since I was able to tolerate it at 75mg/day...a normal dosage for almost everyone... I had a partial answer on it as well...I was able to reduce my intake of Rivotril on it at the time...but I up my dosage at 90mg for 2 weeks and I had episodes of orthostatic hypotension that freaking me out, so I just stop the Nardil cold turkey because I Was affraid...but now that I experienced more hard side-effects from the Parnate, i'm ready to give to the Nardil another try...
IF you decide to up your dosage of the Parnate and want something to avoid orthostatic hypotension and dizness like you experience at 20 mg of PArnate, ask your Doctor about a drug call Florinef...it's suppose to help to reduce the hypotension effect of the Parnate...
For the Valium, 5 mg X 2 /day is ok...but it's a low dosage... if you never had addiction to benzo drugs, I suggest to you maybe to switch to the Rivotril, since it have a more long half-life than the Xanax...The Xanax is more for panic attack...Rivotril work more on social anxiety...(In my case I become addicted to it so I had to withdraw it and change for the Valium, i'm now at 20mg/day).
For the insomnia, you can ask for a low dose of Seroquel...but the REGULAR formulation...you take it 30minutes before the bedtime (25mg) and you will fall asleep fast and you will avoid early wake up or insomnia in the middle of the night...since I take this, I sleep 6 hours and more by night...
I think for now, just focus on one drug at the time, and get a dosage you will be able to tolerate will be the main goal to achieve...the addition of an extra drug to the Parnate seem a little bit early as a solution in your case...
One thing is sure, the Nardil have less side-effect...and is more easy to tolerate than the Parnate...who can stimulate you at first but become more and more sedating with time...also avoid to up your dose like I do too fast...it's probably why I had so many side-effects on the Parnate...I wanted to see results in 1 week but it also make the experience very hard to tolerate in my case...
For now, I see my PDoc in 1 1//2 weeks, he put me on the Manerix temporary...I had an extreme intolerance to it....big headache and migraine that never fade away and an increase of anxiety...so I just stop it...We will try me and my PDoc to have some Marplan (another MAOI only avaible in the USA) and try it...but I will ask before to return on the Nardil, since it's cover by insurrance and avaible in the Canada...For now, I only survive with my Valium pills...I double the dose because I Feel nervous...I know it's not good for me do to it because i'm addicted to benzo drugs but I have no choice...
With a good PDoc, i'm sure you will be able to find a solution to your problem...Some people like me need only small dose of a drug to help them...others will need higher dose...I think we are all different...and we react all differently to drugs...
Don't give up ...you are not alone in the same boat!!! ;-)Take care of you and if you want to ask more questions, my babblemail is on!!!
Bye!
Vincent ;-)
Posted by desolationrower on January 25, 2009, at 2:09:56
In reply to Re: How to Augment Parnate for social-anx + anhedonia? » desolationrower, posted by AdamCanada2 on January 23, 2009, at 19:16:51
> > First get to an adequate dose of parnate before trying to augment it. 40-60.
> >
> > -d/r
>
> I've tried up to 40mg and I am sensitive to most meds. at 30 and 40mg I would get extremely dizzy extremely often. I reach down for 3 seconds to find the shampoo and guess what... by the time I stand up my vision is all yellow for about 1 minute, my hearing becoming subdued, and I am trying to balance myself against the clear glass in the shower so I dont fall over. Not to mention my ability to think/concentrate would be very compromised.
>
> I cannot handle a higher dose of Parnate except possibly 25mg without huge side effects. Just like I cannot handle over 12mg Paxil (in the past) without feeling tremendously sleepy all the time.how long were you at that dose? it might be an indication that you were finally reaching an effective dose. If you didn't before, i'd go back to 30 and wait a few weeks for the side effects to dissipate. then to 40, etc.
-d/r
Posted by Vincent_QC on January 25, 2009, at 9:37:36
In reply to Re: How to Augment Parnate for social-anx + anhedonia?, posted by desolationrower on January 25, 2009, at 2:09:56
> > > First get to an adequate dose of parnate before trying to augment it. 40-60.
> > >
> > > -d/r
> >
> > I've tried up to 40mg and I am sensitive to most meds. at 30 and 40mg I would get extremely dizzy extremely often. I reach down for 3 seconds to find the shampoo and guess what... by the time I stand up my vision is all yellow for about 1 minute, my hearing becoming subdued, and I am trying to balance myself against the clear glass in the shower so I dont fall over. Not to mention my ability to think/concentrate would be very compromised.
> >
> > I cannot handle a higher dose of Parnate except possibly 25mg without huge side effects. Just like I cannot handle over 12mg Paxil (in the past) without feeling tremendously sleepy all the time.
>
> how long were you at that dose? it might be an indication that you were finally reaching an effective dose. If you didn't before, i'd go back to 30 and wait a few weeks for the side effects to dissipate. then to 40, etc.
>
> -d/rLike I wrote yesterday, some "Florinef: fludrocortisone acetate" pills can help to resolve the dizness, the tinnitus and the concentration problems. The anhedonia is typical of the depressive symptoms...i'm like this also and nothing succeed to help me in that field. I think I never enjoy life at all...maybe just when I was drunk 4 nights/week...but it was an artificial pleasure effects...anyway...I'm sure the anhedonia will fade away when you will find the good drug for you...everything is connected together...and since it's better to focus on one problem at the time, you should ask yourself witch disorder make your life the worst...Social anxiety, depression, general anxiety...??? Work on the primary problem, not the second one... For now forget the combo option or the augmentation with another drug...who will just add more stress and negatives thoughts in your head and your life...
Some people are more sensible to the side-effects of a drug, other people can take a higher dose without noticing any side-effect at all... If your heart don't go crazy and if you didn't have any high blood pressure problem, I think the best solution is maybe to up the dosage by 5mg each 2 weeks...until you reach at least 30mg, the minimum effective dosage for the Parnate...if you can't have the Florinef pills, take some salt with water when you feel like you will fainted or weak...it will help to make your blood pressure normal, not low...and prevent the dizness and others problems connected with the orthostatic hypotension....
In the social anxiety field, if nothing improve more in 1 month, (since the Parnate often do some good effects at start and they fade away fast), I think up the dosage will be unnecessary and wait for a partial answer or relief will be unnecessary also...I'm sure you don't want to loose your time on something who will not work for you...that's my guess...
That's my point of view...Personnaly, I didn't like my Parnate experience. The promising effects when you up the dosage (The untolerable side-effects was also more and more present at each increase) and the pop up (fade away) after a couple of days make me feel irritable + side-effecst on my heart was untolerable... I really find the Parnate "unstable". That's maybe why they don't know in witch category of MAOI it goes (Reversible, irreversible), the short half-life in the blood of the Parnate, and the fact that he have a rapid onset of action and the fast time the regeneration of the MAO enzymes take to reform, make this drug less suitable for the "Stability" of is effect.
I know one thing, I care a lot about my health and I don't want to die of a heart attack or something like this...I always prefer to have low blood pressure than high BP...The Parnate was not for me....BUT maybe it's the good choice for you.
The Nardil or the Marplan seem to be a more good choice if you are sensible to the Parnate. Maybe they take more time to work for social anxiety, some people will claim it have more side-effects (weight gain, sedation, insomnia) but it will maybe not be the same on you... At least when the Nardil kick in, it's stay at the same level. Like all the others drugs, with the TIME, maybe he will loose some effects...but I never take a drug who stay effective for years and years without some loose of power... (Paxil was effective at 50mg for 4 years on me, after, nothing...it just stop working...)...
That's another time my point of view...
It seem that on this board, people get more and more into the Parnate and push the Nardil or the Marplan out of option...I still don't know why... I know that my first try of Nardil was so so, but I also know that I never give it the time to do his action...since no other medication help me before for my social anxiety (PArtial answer to the PAxil for 4 years and rivotril maybe on the first month), I think I should try it again, up the dose at the maximum and wait...even if it's more than 3 months of waiting at the 90mg dosage... I don't think I will improve more (on another drugs) ...and it's better than nothing at all. The magic pill don't exist...I always had social anxiety, even as a kid and I have an avoindance personnality..i'm like this and I have to accept it...Now, I can change my thoughts and try some options to help me to be someone who his interact more with the others people and who will feel more well in a social event or anyplace with a lot of people...Every little improve I will get on a drug I will take it...
Well...I write and write and write...I tend to repeat myself, sorry !!! lol I just sleep 8 hours in a row because I double my dose of Seroquel before bedtime (50mg)...and I have some dizness this morning...my laptop screen move a little bit...hahaha, but at least I sleep ! lol I don't sleep like this since years and years...Well, I don't feel more energized this morning, I will probably return in my bed in the afternoon, but at least, I know I sleep the 8 hours(magic number in my head), make me think that i'm not doing insomnia and I will have a good day ... Well that's it...Bye for now and take care ok!!!
Posted by ParnateStarted2008 on February 5, 2009, at 4:15:00
In reply to How to Augment Parnate for social-anx + anhedonia?, posted by AdamCanada2 on January 23, 2009, at 16:40:30
Alertec is quite amazing with Parnate.. often makes a person very sociable with lots of energy and focus. some people get agitated and anxiety becomes worse.. Its very individualized... I dgive it a try if I were you.. anywhere from 100mgs - 400.. 150 works best for me. Alertec has a fairly long half life so you might get away with a single dose in the morning..
Posted by JadeKelly on February 8, 2009, at 15:54:18
In reply to Re: How to Augment Parnate for social-anx + anhedonia?, posted by ParnateStarted2008 on February 5, 2009, at 4:15:00
> Alertec is quite amazing with Parnate.. often makes a person very sociable with lots of energy and focus. some people get agitated and anxiety becomes worse.. Its very individualized... I dgive it a try if I were you.. anywhere from 100mgs - 400.. 150 works best for me. Alertec has a fairly long half life so you might get away with a single dose in the morning..
Hi Phillipe!Fancy finding you here, haha. I had to answer some mail. Brings back memeories of our obscenely long threads. Well, can't think of anything that needs to be said here! I believe its me that owes you an email. I'll get right on that, today ;-)
Good you are passing on your extensive knowledge to others.
Talk to ya soon,
~Jade
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