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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 g_g_g_unit on April 3, 2012, at 8:51:04
I'd really like to try adding Memantine to Parnate - a) to help with anxiety (which it did, rather tremendously, from memory, but I think I just dosed too high), b) to alleviate tolerance to the stimulant aspect (helpful for ADHD), c) for extra focus benefits.
My psychiatrist won't prescribe it. I know I'm taking a risk, the responsibility is mine etc. I think my biggest fear is its potential to trigger psychosis, which I worry might be exacerbated by the Parnate insomnia. Is this a reasonable fear?
I'm not sure the best way to go about this and am trying not to be impulsive. One thing at a time, i.e. reach a therapeutic Parnate dose, try get sleep under control, then see if Memantine helps?
My only concern is growing tolerant to the stimulation before that point.
Posted by 757tech on April 3, 2012, at 11:15:35
In reply to self-medicating, posted by g_g_g_unit on April 3, 2012, at 8:51:04
Im right with ya,from my experiance and reading,parnate has a initial effect then poops out.
Chairman maoi told me in detail about parnate via some email discussions,and his answer to me was,Like nardil PARNATE MUS BE TAKEN at higher doses for those who dont have any response.
Its documented that high doses of the range,60-120 mg of parnate work well.
As far as augmenting it,i found it goes well with many drugs,most stimulants went fine with my parnate,i use now vyanese my girlfriends stimulant
i take all the time.So in final,both the things u mentioned are ducumented,PARNATE AT HIGH DOSE.,....PARNATE AUGMENTED BY STIMS.
Just be safe and good luck.
Posted by phidippus on April 3, 2012, at 19:36:23
In reply to self-medicating, posted by g_g_g_unit on April 3, 2012, at 8:51:04
Your pdoc is too conservative.
You're not not going to trigger any psychosis with Memantine.
Its a D2 agonist, which isn't going to help all that much with focus.
You might just be able to use it as an anti-emetic.
Eric
Posted by g_g_g_unit on April 3, 2012, at 20:27:18
In reply to Re: self-medicating » g_g_g_unit, posted by phidippus on April 3, 2012, at 19:36:23
> Your pdoc is too conservative.
Sadly, I've yet to meet an Australian p-doc who isn't.
> You're not not going to trigger any psychosis with Memantine.
Okay. If you google Memantine + psychosis, there are several isolated reports of it developing. I just didn't want to do anything radically stupid, especially when my sleep is currently not-that-great. Have you found Memantine to worsen insomnia?
>
> Its a D2 agonist, which isn't going to help all that much with focus.
>Well, it is being trialed as an independent treatment for ADHD. I do find Parnate alone somewhat helpful in that respect, so even if I could just prevent tolerance, I'd be happy.
I also know you referred to it as a weak anxiolytic it an earlier thread, but I recall it being profoundly calming.
Posted by sigismund on April 3, 2012, at 21:56:04
In reply to Re: self-medicating » phidippus, posted by g_g_g_unit on April 3, 2012, at 20:27:18
>Have you found Memantine to worsen insomnia?
Slightly, but I only took a small dose of it once.
Posted by bleauberry on April 5, 2012, at 5:44:06
In reply to self-medicating, posted by g_g_g_unit on April 3, 2012, at 8:51:04
Everyone has a different journey. For those people who have spent years, decades, thousands of dollars, on doctors and not gotten any improvement out of it, self medication is a logical next step for thousands or millions of people. Happens all the time in psychiatry, lyme, fibromyalgia, CFS, and other diseases. By the time someone decides to self medicate, they have usually become enough of an expert at that time to know how to responsibly do it. I am not in support of it or against, just saying.....reality is what it is, life is what it is, each person has to do what feels right to them in their own journey. Me, I've been a self medicator for a long time, sometimes recruit the help of my nurse for ideas and scripts, and honestly I've made way more progress over the years that way than I ever did with an army of MD specialists.
Posted by SLS on April 5, 2012, at 6:13:41
In reply to Re: self-medicating » g_g_g_unit, posted by phidippus on April 3, 2012, at 19:36:23
> Your pdoc is too conservative.
>
> You're not not going to trigger any psychosis with Memantine.
>
> Its a D2 agonist, which isn't going to help all that much with focus.
>
> You might just be able to use it as an anti-emetic.
>
> EricI don't know these things. I was under the impression that memantine was a NMDA antagonist and did not bind to the DA receptor at all. Perhaps this is a new finding.
Anti-emetic? A DA agonist would be a pro-emetic?
- Scott
Posted by SLS on April 5, 2012, at 6:24:25
In reply to Re: self-medicating » phidippus, posted by g_g_g_unit on April 3, 2012, at 20:27:18
> Well, it is being trialed as an independent treatment for ADHD. I do find Parnate alone somewhat helpful in that respect
Yes. Parnate was studied long ago for ADHD and showed a modest therapeutic effect.
Thanks, Phidippus. I found an article that indicated that memantine was indeed a D2 receptor agonist.
- Scott
Posted by g_g_g_unit on April 5, 2012, at 8:58:36
In reply to Re: self-medicating, posted by SLS on April 5, 2012, at 6:24:25
> Yes. Parnate was studied long ago for ADHD and showed a modest therapeutic effect.
>Do you know if it showed results in the long-term? I know my p-doc wouldn't augment Parnate with a stimulant. I'm beginning to grow a little bit concerned that I'm devoting a lot of time and pain and effort to a medication that won't sufficiently improve my ADHD (once the stimulant effect poops out). Attentional problems contribute a lot to my depression.
Posted by SLS on April 5, 2012, at 10:02:14
In reply to Re: self-medicating » SLS, posted by g_g_g_unit on April 5, 2012, at 8:58:36
> > Yes. Parnate was studied long ago for ADHD and showed a modest therapeutic effect.
> Do you know if it showed results in the long-term?In the past, most investigations lasted for 8 weeks or less. I guess things haven't changed that much.
> I know my p-doc wouldn't augment Parnate with a stimulant.
That's too bad. It is generally safe to do this, provided that you start with a low dosage and, perhaps, monitor blood pressure immediately after the first dose. However, in your case, it might lead to a worsening of your untoward reaction to Parnate.
> I'm beginning to grow a little bit concerned that I'm devoting a lot of time and pain and effort to a medication that won't sufficiently improve my ADHD (once the stimulant effect poops out).
Without more information, I would say that this is a legitimate concern.
> Attentional problems contribute a lot to my depression.
http://www.ncbi.nlm.nih.gov/pubmed/15554766
- Scott
Posted by phidippus on April 5, 2012, at 16:09:53
In reply to Re: self-medicating » phidippus, posted by g_g_g_unit on April 3, 2012, at 20:27:18
I believe those memantine + psychosis reports involved elderly patients with dementia.
I've taken Memantine for weeks on end and found no impact on my cognitive abilities. Nor did I find it profoundly calming, even at high doses (40 mg).
Eric
Posted by phidippus on April 5, 2012, at 16:16:44
In reply to Re: self-medicating » g_g_g_unit, posted by sigismund on April 3, 2012, at 21:56:04
Memantine gave me terrible insomnia.
Eric
Posted by phidippus on April 5, 2012, at 16:20:18
In reply to Re: self-medicating, posted by bleauberry on April 5, 2012, at 5:44:06
I self medicate. The only drugs I leave in the hands of my pdoc are mood stabilizers and SSRIs.
Eric
Posted by phidippus on April 5, 2012, at 16:21:50
In reply to Re: self-medicating » phidippus, posted by SLS on April 5, 2012, at 6:13:41
>Anti-emetic? A DA agonist would be a pro-emetic?
LOL, no. Memantine is a 5ht3 antagonist just like Ondansetron.
Eric
Posted by phidippus on April 5, 2012, at 16:25:51
In reply to Re: self-medicating, posted by SLS on April 5, 2012, at 6:24:25
Memantine is a low-affinity voltage-dependent uncompetitive antagonist at glutamatergic NMDA receptors.
Memantine acts as a non-competitive antagonist at different neuronal nicotinic acetylcholine receptors (nAChRs)
Memantine acts as an agonist at the dopamine D2 receptor.
Memantine acts as a non-competitive antagonist at the 5-HT3 receptor
Memantine does all these things, however it doesn't seem to treat anything reliably.
Eric
Posted by phidippus on April 5, 2012, at 16:26:36
In reply to Re: self-medicating » SLS, posted by g_g_g_unit on April 5, 2012, at 8:58:36
Do they have Vyvanse available out there?
Eric
Posted by SLS on April 5, 2012, at 18:37:59
In reply to Re: self-medicating » SLS, posted by phidippus on April 5, 2012, at 16:25:51
Nice synopsis, Eric. Thanks.
How do "competitive" and "non-competitive" drugs differ?
- Scott----------------------------------------------
> Memantine is a low-affinity voltage-dependent uncompetitive antagonist at glutamatergic NMDA receptors.
>
> Memantine acts as a non-competitive antagonist at different neuronal nicotinic acetylcholine receptors (nAChRs)
>
> Memantine acts as an agonist at the dopamine D2 receptor.
>
> Memantine acts as a non-competitive antagonist at the 5-HT3 receptor
>
> Memantine does all these things, however it doesn't seem to treat anything reliably.
>
> Eric
Posted by SLS on April 5, 2012, at 18:40:44
In reply to Re: self-medicating » g_g_g_unit, posted by phidippus on April 5, 2012, at 16:09:53
> I believe those memantine + psychosis reports involved elderly patients with dementia.
>
> I've taken Memantine for weeks on end and found no impact on my cognitive abilities. Nor did I find it profoundly calming, even at high doses (40 mg).I tried 40 mg of memantine for one day. I felt drunk. I was afraid to continue with it. Perhaps this would have dissipated with time.
- Scott
Posted by g_g_g_unit on April 5, 2012, at 20:22:31
In reply to Re: self-medicating » sigismund, posted by phidippus on April 5, 2012, at 16:16:44
> Memantine gave me terrible insomnia.
>
> EricProbably not a good idea to take with Parnate then.
Posted by g_g_g_unit on April 5, 2012, at 20:25:16
In reply to Re: self-medicating » g_g_g_unit, posted by phidippus on April 5, 2012, at 16:26:36
> Do they have Vyvanse available out there?
>
> EricNo, I wish. Just Dexamphetamine IR, Ritalin, Ritalin LA, Concerta, Strattera and Reboxetine.
I haven't tried Concerta or Reboxetine. I know Dexamphetamine should technically be ideal (for ADHD + OCD), but I found it overstimulating. I still suspect I could be Bipolar, but failing that, my psychiatrist has said he's started prescribing benzos for people who can't tolerate Dexamphetamine alone, so that's always an option I suppose.
Posted by TiredofChemicals on April 6, 2012, at 19:22:40
In reply to Re: self-medicating, posted by bleauberry on April 5, 2012, at 5:44:06
> Everyone has a different journey. For those people who have spent years, decades, thousands of dollars, on doctors and not gotten any improvement out of it, self medication is a logical next step for thousands or millions of people. Happens all the time in psychiatry, lyme, fibromyalgia, CFS, and other diseases. By the time someone decides to self medicate, they have usually become enough of an expert at that time to know how to responsibly do it. I am not in support of it or against, just saying.....reality is what it is, life is what it is, each person has to do what feels right to them in their own journey. Me, I've been a self medicator for a long time, sometimes recruit the help of my nurse for ideas and scripts, and honestly I've made way more progress over the years that way than I ever did with an army of MD specialists.
^^^^
Got any tips? I've covered abuse pretty good.
I guess moderation wouldn't be all that bad if I could swing it.
Posted by phidippus on April 8, 2012, at 17:41:14
In reply to Re: self-medicating » phidippus, posted by SLS on April 5, 2012, at 18:37:59
Non competetive means it doesn't lock down the synapse.
Eric
This is the end of the thread.
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