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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by cellomoi on April 5, 2009, at 20:14:56
Currently taking 10mg of parnate QID, 75mg of cytomel QD, 10mg of abilify QD, 25mg trazodone QD and 0.5 mg of klonopin PRN. Diagnosed with BP II w/ rapid cycling.
Overall, I am happy with the combination of medications, except for the strength of the parnate. I feel it just is not strong enough to blast through my bipolar depression. A constant lingering lack of motivation remains.
My question is, what can be used to augment parnate? I have read on this forum, that ritalin, adderall, a TCA, and provigil can be used. But at what dosages? From where does one titrate upward from? Also, is it possible to combine selegiline with parnate?
Thank You
Posted by Phillipa on April 5, 2009, at 21:30:53
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
Welcome to babble. I don't believe you can combine seligline with parnate. But of course could be wrong. Love Phillipa
Posted by desolationrower on April 6, 2009, at 2:52:17
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
i kind of forget with the intrinisc activity but the main benefit of selegiline is MAOb inhibitions and parnate does that too, have you tried higher dose parnate
and dose is usually 'low' and increased until it works...
-d/r
Posted by cellomoi on April 6, 2009, at 3:57:35
In reply to Re: Augmenting Parnate w/ low dosage of Selegiline?, posted by desolationrower on April 6, 2009, at 2:52:17
I have not tried a higher dosage of parnate. My psychiatrist will NOT go any higher than 60mg. Are higher doses of parnate more stimulating than the lower doses of it?
Posted by desolationrower on April 6, 2009, at 6:10:56
In reply to Re: Augmenting Parnate w/ low dosage of Selegiline, posted by cellomoi on April 6, 2009, at 3:57:35
some find it so. i didn't personally.
going to 60 might be worth trying.
-d/r
Posted by cellomoi on April 6, 2009, at 6:35:37
In reply to Re: Augmenting Parnate w/ low dosage of Selegiline, posted by desolationrower on April 6, 2009, at 6:10:56
Problem is, my psychiatrist will NOT go any higher at the moment. He is willing to augment it though, hesitant but willing to try. Since no one believes it is possible to augment parnate with selegiline. What should I suggest to him to use to augment the parnate?
My primary issues at the moment are day-time tiredness, lack of motivation, and the frequent long-lasting depressive episode. Cognition is also a bit blunted.
According to him, adding a psycho-stimulant is possible, and he is willing to try. But, he said it is a 50/50 chance. That is, 50% of people find it extremely beneficial, the other 50% have a hypertensive crisis. Does anyone know of any journal articles I can give him to read, to sort of change his mind?
Also, when augmenting parnate, with say ritalin or adderall, what is the starting dosage? 2.5mg? 5mg? Same with a TCA, where does one start from, and which would be the best TCA to try?
Thank You
Posted by desolationrower on April 6, 2009, at 8:48:43
In reply to Re: Augmenting Parnate w/ low dosage of Selegiline, posted by cellomoi on April 6, 2009, at 6:35:37
> Problem is, my psychiatrist will NOT go any higher at the moment. He is willing to augment it though, hesitant but willing to try. Since no one believes it is possible to augment parnate with selegiline. What should I suggest to him to use to augment the parnate?
>
> My primary issues at the moment are day-time tiredness, lack of motivation, and the frequent long-lasting depressive episode. Cognition is also a bit blunted.
>
> According to him, adding a psycho-stimulant is possible, and he is willing to try. But, he said it is a 50/50 chance. That is, 50% of people find it extremely beneficial, the other 50% have a hypertensive crisis. Does anyone know of any journal articles I can give him to read, to sort of change his mind?
>
> Also, when augmenting parnate, with say ritalin or adderall, what is the starting dosage? 2.5mg? 5mg? Same with a TCA, where does one start from, and which would be the best TCA to try?
>
> Thank Youhaha. my pdoc let me go as high with the parnate as i wanted (or, could afford at any rate), but nothing augmenting.
the 50/50 thing, who knows where he came up with that.
if $ isn't an obsticle, modafinal might be a good choice, since it won't have the risk of interaction, and could help with tiredness and the other symptoms, and is probably lower risk of triggering mania. otherwise, i suppose desipramine/reboxetine sine you still have depression, but not anxiety/insomnia stuff (i guess.).
i don't have any articles saved on that specifically (i mean, the evidence is quite clear. i'm interested in hard topics. i don'to have a good feel for what pdocs learn in residency. maybe i should try to find out.), i'd look on scholar.google.com com, for recent review articles. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2014120 has some stuff on tca interactions with MAOIs which would probably be a start.
the other thing is, what about your other medications? the abilify, do you think it is helping? i know when i took it, it sucked any remaining motivation out of me. maybe if you were on a different mood stabilizer or a lower dose of abilify you'd feel back to 100%.
-d/r
Posted by ParnateStarted2008 on April 6, 2009, at 15:30:19
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
Provigil, Ritalin, Adderall are all good choices. Like d/r I would first try Provigil because of its low side effect profile and very little, to no chance of hypertensive crisis. Try 50mg am(you'll need a pill cutter) and 50mg at noon. If you need more you can raise it as needed. I find 150mg Provigil bid works the best with Parnate for me, actually awsome in my case. 10mg Parnate is a very low dose. USUALLY it can become stimulating between 20-90mg/day. Then once you pass 100mg/day the stimulation seems to disipate and it becomes much stronger towards antianxiety. 30-60 is usually the sweet spot as an AD. Mixing with Selegiline is totally against the book, but so is everything else with maoi's ha.
Posted by HyperFocus on April 6, 2009, at 17:10:06
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
A poster here called JadeKelly had a lot of success augmenting Parnate with Ritalin. Hopefully she'll see this thread and stop-by.
Posted by shasling on April 7, 2009, at 10:14:26
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
> Currently taking 10mg of parnate QID, 75mg of cytomel QD, 10mg of abilify QD, 25mg trazodone QD and 0.5 mg of klonopin PRN. Diagnosed with BP II w/ rapid cycling.
>
> Overall, I am happy with the combination of medications, except for the strength of the parnate. I feel it just is not strong enough to blast through my bipolar depression. A constant lingering lack of motivation remains.
>
> My question is, what can be used to augment parnate? I have read on this forum, that ritalin, adderall, a TCA, and provigil can be used. But at what dosages? From where does one titrate upward from? Also, is it possible to combine selegiline with parnate?
>
> Thank YouThere are abstracts where klonopin was used with both tcas and stimulants as well as wellbutrin.
I will say these are not your average augmets and they really require lots of work,meaning please play attention to your mood and keep a strong benzo handy,i personaly went pyshotic after the benifit of parnate plus ritalin,there was first a improve in mood,but parnate caused ritalin to accumlate faster and i ended up spending several hours on insginificant tasks which to me all seemed very important,the combo made any project i started to be very important regardless of how insignificant.
What would be a nice combo is if xyrem...GHB was legal again and added with a stimulant to parnate a three way PARNATE-GHB-STIM-OCCASIONAL BENZO combo.
Posted by cellomoi on April 8, 2009, at 11:14:28
In reply to Augmenting Parnate w/ low dosage of Selegiline?, posted by cellomoi on April 5, 2009, at 20:14:56
Thank You ALL!
I think I will speak to my psychiatrist about the provigil first. Since it has a lower side-effect profile.
Question, when taking wellbutrin with parnate... what form does one take, IR, SR, or XL? Also, what is the starting dosage? 150mg? Since I have been on parnate for about 7 months, can I start the wellbutrin, or would I have a hypertensive crisis?
The "PARNATE-GHB-STIM-OCCASIONAL BENZO combo" sounds interesting. Though, I personally HATE benzos, I find them dulling.
I normally monitor my mood closely, but while augmenting, etc. I will definitely pay more attention.
This is the end of the thread.
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