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Dr. Bob is Robert Hsiung, MD,
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Posted by zonked on June 11, 2011, at 13:37:06
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 13:26:34
> parnate+desipramine+modafinal
>
> -d/rIs this what you're taking now DR?
Modafanil: Very good for ADD-inattentive and a temporary mood lift, but for me was also VERY anxiogenic. I have no idea why. :-)
-z
Posted by floatingbridge on June 11, 2011, at 15:26:16
In reply to Re: my research: parnate vs nardil, posted by zonked on June 11, 2011, at 13:37:06
Thanks d/r. Could you unpack that a bit more?
Provigil. Very dyshoric thinking/mood here. Maybe not with parnate. Could revisit.
Desimpramine--for anxiety? Big anxiety?
What is anixiogenic? (Not your word, I know.)
Posted by zonked on June 11, 2011, at 15:39:05
In reply to Re: my research: parnate vs nardil *for d/r » zonked, posted by floatingbridge on June 11, 2011, at 15:26:16
> Desimpramine--for anxiety? Big anxiety?
I have no experience with TCAs except a brief trial of nortriptyline.> What is anixiogenic? (Not your word, I know.)
Generative of anxiety. :-(
-z
Posted by SLS on June 11, 2011, at 16:17:26
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 13:26:34
> parnate+desipramine+modafinal
>
> -d/rVery interesting choice. If daytime sleepiness were not a problem with Parnate, would you still recommend the modafinil?
- Scott
Posted by desolationrower on June 11, 2011, at 17:26:18
In reply to Re: my research: parnate vs nardil » desolationrower, posted by SLS on June 11, 2011, at 16:17:26
>> parnate+desipramine+modafinal
>>
>> -d/r>Is this what you're taking now DR?
no, but i don't have fatigue.
>Desimpramine--for anxiety? Big anxiety?
well it depends on the anxiety.and not as a monotherapy, no. nortryptaline might be better for some types of anxiety, worse for others.
I did think FB needed something for fatigue, and sleep. i'm not good w/ remembering people's info, but i thought there was mood issues too, and she had tried/trying maois. and taking benzos.
>Very interesting choice. If daytime sleepiness were not a problem with Parnate, would you still recommend the modafinil?
i haven't heard of it being useful beyond energy spectrum issues, like sleepiness, attention, etc. but it could help anxiety if you can take a more effective benzo dose.
-d/r
Posted by floatingbridge on June 11, 2011, at 17:44:31
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 17:26:18
Thanks d/r
Who can keep this all in their head--or want to?
Thanks for your input.
fb
Posted by floatingbridge on June 11, 2011, at 17:48:18
In reply to Re: my research: parnate vs nardil, posted by desolationrower on June 11, 2011, at 17:26:18
Any input on risks? Parnate sounded, granted in my limited reading, to incur more reactions.
I also did not care to read the term 'intercranial bleeding'.
Is that alarmist?
Posted by hyperfocus on June 11, 2011, at 18:03:43
In reply to Re: my research: parnate vs nardil, posted by Christ_empowered on June 11, 2011, at 7:34:04
>I read somewhere that something--low dose elavil, maybe?--can be added to ongoing MAOI therapy to minimize the risk of the "cheese reaction."
http://www.ncbi.nlm.nih.gov/pubmed/6123888
Administration of amitriptyline greatly diminished the pressor response to intravenous tyramine in patients receiving monoamine-oxidase inhibitors (MAOIs). Dothiepin and trimipramine, however, produced little change in sensitivity to tyramine. It is suggested that a combination of amitriptyline and an MAOI, started together in a modest dose that is then increased, may protect patients against the potential dangers of eating tyramine-containing foods. However, because MAOIs allow a high proportion of ingested tyramine to be absorbed into the systemic circulation, patients treated with MAOIs, even in combination with amitriptyline, should not be encouraged to eat foods containing tyramine.There are a couple of studies like this. fb if the EMSAM causes you sleep issues then it's highly likely Parnate would too. So I guess the best tack would be attacking the insomnia before you decide to switch MAOIs. I know I keep banging away at the same drum but there are a lot of reasons why amitrip would be a good match for you. The biggest SE of amitriptyline is sedation, which would be beneficial to you.
Posted by floatingbridge on June 11, 2011, at 19:11:40
In reply to Re: my research: parnate vs nardil, posted by hyperfocus on June 11, 2011, at 18:03:43
Hey, hp, This is good stuff. Thanks
> http://www.ncbi.nlm.nih.gov/pubmed/6123888
> Administration of amitriptyline greatly diminished the pressor response to intravenous tyramine in patients receiving monoamine-oxidase inhibitors (MAOIs). Dothiepin and trimipramine, however, produced little change in
sensitivity to tyramine. It is suggested that a combination of amitriptyline and an MAOI, started together in a modest dose that is then increased, may protect patients against the potential dangers of eating tyramine-containing foods. However, because MAOIs allow a high proportion of ingested tyramine to be absorbed into the systemic circulation,
patients treated with MAOIs, even in combination with amitriptyline, should not be encouraged to eat foods containing tyramine.
>
> There are a couple of studies like this.
fb if the EMSAM causes you sleep issues then it's highly likely Parnate would too.
So I guess the best tack would be attacking the insomnia before you decide to switch MAOIs.I'm not rushing any changes. Thanks for asking. I appreciate it. If emsam can work, that's perfect. It's easy. It doesn't quite hit the depression, hence my leg work here. I'm just comparing the maoi's because I am done with snri's.
>I know I keep banging away at the same drum but there are a lot of reasons why amitrip would be a good match for you.You're a good drummer :-) Last talk with pdoc was that ami was still a possibility for me, so no worries. He's just freaked about my fatigue level and insomnia. He doesn't know what to do, and neither do I. My body rejects lots of meds.
>The biggest SE of amitriptyline is sedation, which would be beneficial to you.
It might beat the current Valium.
Thanks for all the good info. You know I'll keep you posted.
Warmly,
fb
Posted by Phillipa on June 11, 2011, at 20:19:14
In reply to Re: my research: parnate vs nardil » hyperfocus, posted by floatingbridge on June 11, 2011, at 19:11:40
The intracranial bleeding can happen anyone remember the name of the poster here who it happened to? Was it Phoenix? Phillipa
Posted by desolationrower on June 11, 2011, at 20:48:00
In reply to Re: my research: parnate vs nardil » floatingbridge, posted by Phillipa on June 11, 2011, at 20:19:14
I think intracranial bleeding is caused by the extreme blood pressure in a tyramine reaction. that is what TCA would prevent.
i can't remember much of what i learn. i should keep a journal or blog or something.
-d/r
Posted by emmanuel98 on June 11, 2011, at 21:26:26
In reply to Re: my research: parnate vs nardil » Christ_empowered, posted by floatingbridge on June 11, 2011, at 12:14:40
I was in a virtually catatonic depression when I started on parnate. Hadn't gotten out of bed in weeks, hadn't showered, washed my hair, wasn't eating. Parnate pulled me right out of that == very quickly, 48 hours. Two years later, I still have problems with depression, but I haven't been sleeping like I did before parnate.
It did cause insomnia, very bad. I take trazadone and lorazapem. My p-doc wants me to stop the lorazapem (I am taking higher and higher doses, it doesn't keep me asleep all night) and switch to very low dose seroquel. Last night I took 25mg seroquel and slept all night. So the insomnia is manageable.
No weight gain with parnate. In fact I have finally lost the weight I gained from taking atypical antipsychotics.
Posted by emmanuel98 on June 11, 2011, at 21:30:30
In reply to Re: my research: parnate vs nardil » desolationrower, posted by floatingbridge on June 11, 2011, at 17:48:18
I don't think parnate is any riskier than any other MAOI. You just have to take a little care. I do eat small amounts of cheese and drink white wine and have never had a problem.
Posted by jedi on June 12, 2011, at 2:59:43
In reply to Re: my research: parnate vs nardil, posted by emmanuel98 on June 11, 2011, at 21:30:30
Hi guys,
As most of you know, I'm a long term Nardil user. I've had a couple of trials of Parnate, mostly because of the weight gain issues and orgasm delay on Nardil. During my last Parnate trial I had a rare spontaneous hypertensive episode. This pretty much put an end to my Parnate trials. Parnate makes me much more anxious, while Nardil decreases anxiety. Parnate causes more severe problems with insomnia. Parnate has less of an issue with weight gain and seems to cause less orgasm delay. I really wanted Parnate to work for me, but the hypertensive episode involved nothing on my part to precipitate it. This type of reaction is rare but it does happen to some people.
Good Luck Guys,
Jedi
http://www.ncbi.nlm.nih.gov/pubmed/8399806
http://www.ncbi.nlm.nih.gov/pubmed/2091623
http://www.ncbi.nlm.nih.gov/pubmed/2486182
Posted by SLS on June 12, 2011, at 6:41:42
In reply to Re: my research: parnate vs nardil, posted by emmanuel98 on June 11, 2011, at 21:30:30
> I don't think parnate is any riskier than any other MAOI. You just have to take a little care. I do eat small amounts of cheese and drink white wine and have never had a problem.
It is probably wise to screen for a spontaneous hypertensive reaction to Parnate while starting treatment and titrating.
- Scott
Posted by SLS on June 12, 2011, at 6:44:37
In reply to Re: my research: parnate vs nardil, posted by jedi on June 12, 2011, at 2:59:43
Sorry, Jedi.
I had posted before reading your post. You are right. Thanks for the links.
- Scott
Posted by floatingbridge on June 12, 2011, at 14:37:13
In reply to Re: my research: parnate vs nardil, posted by jedi on June 12, 2011, at 2:59:43
Jedi, thank you for these links. I can more fully imagine why my pdoc has avoided the maoi topic for so long.
Myself, yes, parnate sounds good. Like I previously wrote, who wants to be overweight? Or have difficulty achieving orgasm? But I have complicated (read weird) health issues and such a long standing insomnia issue. I *want* parnate, but if my pdoc and I come to this discussion, I feel I'll have greater acceptance of his refusal to risk a trial.
Tell me, would you? Does the weight gain on Nardil compare to the type of weight gain on abilify (if you have ever
experienced it)?Once again, if we can get emsam to do the work, I'm sticking with it.
Thanks,
fb
Posted by jedi on June 12, 2011, at 15:24:44
In reply to Re: my research: parnate vs nardil » jedi, posted by floatingbridge on June 12, 2011, at 14:37:13
Hi fb,
The weight gain I experienced from major atypical depression and treatment with Nardil was beyond terrible. I went from a 205 pound athlete; running-biking-skiing-endurance races-hiking-etc. to a 310 pound Pillsbury Dough Boy! Some was Nardil and some was the atypical depression. I am a carbohydrate addict anyway but Nardil makes this worse. It somehow shuts down the feedback mechanism that lets you know that you are full. Since mostly recovering from the major atypical depression, I have taken off more than half of the gained weight. I have done this through intensive outdoor exercise and a low carbohydrate diet. By eating very minimal carbohydrates, my body shuts down those terrible carbohydrate cravings. I don't really like the diet, but for me it is necessary. If I would have known what I know now, I never would have gained the weight on Nardil. Ironically, one of the major Nardil side effects - overeating, is one of the symptoms of atypical depression. I believe, Nardil is still the gold standard for treating this type of depression. When absolutely nothing else works, Nardil often will.I only tried Abilify once, and was not able to tolerate it. It was the only medication that has ever given me akathisia. If you have ever had this kind of inner restlessness, you would recognize it as one of the worst experiences of your life. It is just a terrible feeling; I discontinued the medication immediately.
I wish I could get something like Emsam to work for me. Though, with my present insurance, I could never afford it. Before Gavis came up with the generic phenelzine last December, my brand Nardil cost over $150 per month. Now, with the generic, I pay $15.
Good luck fb, I wish you the best. If the other meds do not work, don't look past Nardil. The weight gain can be controlled. I'm not sure how the orgasm delay would affect females. I can't imagine it being much worse than the SSRIs, but I don't know. Most of the Nardil users I've seen posting are males, and the orgasm delay is a side effect that decreases with time. Besides, for many males, a little orgasm delay isn't really a problem! LOL
Be well,
Jedi
Posted by europerep on June 12, 2011, at 16:13:27
In reply to my research: parnate vs nardil, posted by floatingbridge on June 11, 2011, at 2:54:54
Hey FB...
> Parnate is actually a form of amphetamine (or a close cousin).
True. It is structurally related, and it has about 1/10th of the potency of amphetamine as a dopamine and norepinephrine releasing agent. This makes that, especially in the beginning, Parnate has a mild stimulant-like effect.
This probably accounts for some of the "Parnate insomnia", though I guess that insomnia is also partially caused by the same mechanism as insomnia in SSRIs, i.e. more serotonin stimulation.
> Parnate has anixoltic qualities, but not as great as nardil.True.
> Parnate carries a higher risk factor (intercranial bleeding)?
Parnate does appear to be slightly more dangerous, yeah. I've been told by an "MAOI expert" that Parnate is the most dangerous of MAOIs, though, absolutely speaking, it is still a safe drug. Part of the risk is due to spontaneous hypertensive episodes, as jedi mentioned.
As for the intracranial bleeding: there must be (at least) two factors for it, a predisposition for it and a sharp rise in blood pressure. Predisposition in the sense that a vein or a blood vessel in the head is "faulty". In case of a sudden rise in blood pressure, that vein or blood vessel may pop and then lead to a bleeding. I'd think this can happen anywhere in the body, but in the brain it's a big problem. However, this is rare and it can't happen to everyone.
> Nardil has a less direct amphetamine like effect. Will it always be more sedating? 24/7?
I think Nardil is structurally very different, and does not have any amphetamine-like qualities, though I may be wrong.
> Parnate insomnia is more intractable than nardil insomnia.
Parnate insomnia is definitely more frequent, and probably more difficult to treat. Taking doses early in the day helps for some, but not for all.
Trazodone is what they usually use in the US to deal with it, as far as I have heard.Looking back, to me, Parnate was just like any other drug. Yes, also in the sense that it didn't work, but you forget that you're on an MAOI after a few weeks. Well, not totally forget, but you're no longer scared or afraid or something might happen. I checked my BP often in the first weeks, but when I noticed that it never rose I limited it to "after eating something I hadn't eaten the weeks before".
Hope this helps!
ER
Posted by floatingbridge on June 12, 2011, at 17:10:38
In reply to Re: my research: parnate vs nardil » floatingbridge, posted by jedi on June 12, 2011, at 15:24:44
Thanks for your helpful input.
I have experienced abilify and discontinued for the reasons you stated: akinesia (sp?). It is awful, truly. I had that on seroquel as well.
On abilify (I hung in there until my dose was pushed to 10mg) the weight gain was very odd. What stayed 'on' did not
in anyway equal what went in. I didn't binge on carbrohydrates. I still did my brisk, near daily walks. The abilify weight, no matter what anyone says, felt so different.Once, someone here posted how abilify did something in the endocrine (I think?) system that made weight accumulate beyond the usual calorie ratio. I read something similar about depakote and women and increased belly fat (just what a depressed woman needs!).
I really appreciate how you answer my questions so directly and with such level cheer. Thank you.
fb
Posted by floatingbridge on June 12, 2011, at 17:14:20
In reply to Re: my research: parnate vs nardil » floatingbridge, posted by europerep on June 12, 2011, at 16:13:27
It does help ER. And thank you!
I hope your new treatment is going as you like.
Warm regards,
fb
Posted by floatingbridge on June 12, 2011, at 17:19:19
In reply to Re: my research: parnate vs nardil » europerep, posted by floatingbridge on June 12, 2011, at 17:14:20
to everyone for fielding so many questions for me. The help is enormous and greatly appreciated.
If I make any changes, trust me, I'll post. Besides being so darned chatty, this board is far and away the best.
Off course, that's determined in large (very large) part by the posters.
:-)
Thanks.
fb
Posted by zonked on June 12, 2011, at 17:41:41
In reply to thank you » floatingbridge, posted by floatingbridge on June 12, 2011, at 17:19:19
> to everyone for fielding so many questions for me. The help is enormous and greatly appreciated.
BTW, while it's sensible to be careful with the dietary restrictions -at first - I encourage you not to freak out about them.
The most important thing is that you might have stumbled upon two of psychiatry's most effective (and tragically underused) treatments for depression, and be on your way to healing.
The University of Toronto's revised guidelines are probably the most sensible, a quick Google search turned them up here:
http://www.drtonyromack.com/MAOIs.htm
That said, I have never had a hypertensive reaction, spontaneous or otherwise, on any MAOI and I was on a VERY high dose of Parnate.
One thing I would add is that, for me, Parnate worked much quicker than Nardil. (But that's just me.)
The best time of my 20s, and the longest lasting without symptoms, was due to Nardil.
The ONLY reason that remission stopped is because I discontinued it, due to weight gain. I strongly advise you do not do this if Nardil provides you relief.
> If I make any changes, trust me, I'll post. Besides being so darned chatty, this board is far and away the best.
>
> Off course, that's determined in large (very large) part by the posters.Agreed 100%. Really, what would some of us have done without PB and the Internet? I shudder to think. This is my favorite mental health forum on the Internet. Isn't a shame we don't have Star Trek transporters? We'd make one hell of a face to face support group. :-)
-z
Posted by jono_in_adelaide on June 12, 2011, at 18:12:26
In reply to Re: thank you » floatingbridge, posted by zonked on June 12, 2011, at 17:41:41
I'd argue that Nardil and Parnate are the best treatments for depression out there - they suit some people very well, but nortriptylein and zoloft and effexor suit some people extremely well also.
This board tends to attract the dregs who have failed multiple treatments, we arnt a true reflection of the average depressed patient.
Nardil and Parnate can be life changing for some patients where nothing else has worked, but they arnt the magic bullet for all depressions, unfortunatly that drug is yet to be discovered.
Posted by desolationrower on June 13, 2011, at 17:47:01
In reply to Re: my research: parnate vs nardil, posted by SLS on June 12, 2011, at 6:41:42
> > I don't think parnate is any riskier than any other MAOI. You just have to take a little care. I do eat small amounts of cheese and drink white wine and have never had a problem.
>
> It is probably wise to screen for a spontaneous hypertensive reaction to Parnate while starting treatment and titrating.
>
>
> - Scott
by 'screen' do you mean give a small amount of tyramine to test one's reaction? I bought a can of tyramine when i started MAOIs but never bothered.>This probably accounts for some of the "Parnate insomnia", though I guess that insomnia is also partially caused by the same mechanism as insomnia in SSRIs, i.e. more serotonin stimulation.
i think increased melatonin levels may also play a role.I agree w/ whoever said that carb restriction is probably the easiest way to deal wiht phenelzine wieght gain.
-d/r
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