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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by SLS on May 10, 2018, at 5:06:55
The plan is to discontinue Parnate and replace it with Trintellix. I currently take 80 mg/day of Parnate. I should be able to taper the dosage and discontinue it in 7-10 days. I will then allow for a washout of 10-14 days in order to avoid serotonin syndrome. Trinellix, among other things, is a serotonin reuptake inhibitor. MAOIs like Parnate cannot be taken together with drugs that do this or else serotonin syndrome will result.
Trintellix is rather unique as an antidepressant. It potently normalizes or enhances cognitive and memory functions - even in people who do not have mood disorders. Trintellix is now indicated for depression with cognitive impairments. My depression has always expressed itself with major deficits in slow thinking, confusion, processing impairments, and memory difficulties (short-term, and recall). I was forced to drop out of college because of my depressive disorder; not because of negative thinking, but for my inability to read, learn, and remember. Perhaps Trintellix is a good match for this presentation. I have become enthusiastic to begin treatment.
In the meantime, I am performing an experiment. I would like to switch from taking Abilify to Saphris so that I can lose 50 pounds of weight and normalize my very high triglycerides. Saphris is not a dopamine D2/D3 partial agonist as is Abilify. I have always thought that it is this action of Abilify that confered upon it its antidepressant properties. Saprhis does not do this, so my optimism is guarded. However, there is the possibility that there are other properties that they share. Additionally, Saphris does a bunch more things; the importance of which has yet to be determined.
I have decided to wait until I have run the Abilify -> Saprhis experiment before beginning to wean off of Parnate. I should have an answer in 1-2 weeks. When an antipsychotic is to be effective for depression, it will usually demonstrate an improvement in the first 1-2 weeks - sometimes days. Once I have settled on one of these two drugs, I will begin to reduce the dosage of Parnate rather quickly. For me, one of the most difficult withdrawal effects of Parnate discontinuation is profound fatigue. My doctor and I agreed that I can try using methlylphenidate or amphetamine to soften the crash.
I have become more excited to try Trintellix. When I first expressed a desire to come off of Parnate, I had wanted to move to Effexor. I tried it several times in the past, the results of which were partial improvements. However, never have I tried Effexor with the other drugs I'm taking. In my mind, Effexor represented a sure thing to get to at least a 50% improvement. My doctor lobbied instead that I try Trintellix first. He had his reasons, I guess. He tells me everything, generally. However, much of what goes on in his mind is more abstract than verbal. In any event, Trintellix is simply a drug that I have not tried yet, and is different from all the others. For every new antidepressant that becomes available, a certain percentage of previously treatment resistant cases will respond to it. That's why I don't have some sort of disdain for drug companies when they bring a "me too" drug to market. The more the merrier. If a drug is truly worthless, capitalism will remove it from the market.
- Scott
Posted by bleauberry on May 10, 2018, at 5:45:45
In reply to Switching from Parnate to Trintellix, posted by SLS on May 10, 2018, at 5:06:55
Best wishes to you SLS. Every med change brings a renewed hope.
On paper this looks like a promising possibility with the potential to be fruitful.
Transitions were always so hard for me. I was trying to maintain a full time job through it all.
So I sincerely wish you great strength and endurance to get through the weaning/wash-out/titration period as smoothly as possible.
Win.
Posted by linkadge on May 10, 2018, at 7:06:17
In reply to Switching from Parnate to Trintellix, posted by SLS on May 10, 2018, at 5:06:55
Let us know how it goes.
I'm interested in trintillex too, but it not generic at the moment and I don't have an extra $500 a month.
Its good to see more medications with diverse range of targets.
Linkadge
Posted by SLS on May 10, 2018, at 7:19:34
In reply to Re: Switching from Parnate to Trintellix » SLS, posted by bleauberry on May 10, 2018, at 5:45:45
Hi, Bleauberry.
> Transitions were always so hard for me. I was trying to maintain a full time job through it all.
Your remaining employed while being so severely ill is a genuine accomplishment.
> So I sincerely wish you great strength and endurance to get through the weaning/wash-out/titration period as smoothly as possible.Thank you. I really am afraid as to how difficult this will be for me. Maybe I'll feel as bad as my untreated baseline state leaves me and no longer be able to function. I'm taking 5 other drugs, though. I hope they break the free-fall into the abyss. I'll keep posting as long as I have the energy and focus.
- Scott
Posted by PeterMartin on May 10, 2018, at 11:42:29
In reply to Re: Switching from Parnate to Trintellix, posted by SLS on May 10, 2018, at 7:19:34
Good luck on Trintellix it seems hit or miss but if it's a hit it can be exceptional.
Did you ask your doctor about Metformin (Re: weight gain)? That lowers blood cholesterol and triglycerides.
Posted by SLS on May 10, 2018, at 13:48:03
In reply to Re: Switching from Parnate to Trintellix, posted by PeterMartin on May 10, 2018, at 11:42:29
> Good luck on Trintellix it seems hit or miss but if it's a hit it can be exceptional.
Thanks.
> Did you ask your doctor about Metformin (Re: weight gain)? That lowers blood cholesterol and triglycerides.
He prefers that I have my primary care physician manage metformin. Before starting to take metformin, I will try to switch from Abilify to Saphris. If Saphris proves to be a good substitute for Abilify as an augmenting agent for treating my depression, I may not need metformin.
- Scott
Posted by PeterMartin on May 10, 2018, at 14:32:22
In reply to Re: Switching from Parnate to Trintellix » PeterMartin, posted by SLS on May 10, 2018, at 13:48:03
>
> > Did you ask your doctor about Metformin (Re: weight gain)? That lowers blood cholesterol and triglycerides.
>
> He prefers that I have my primary care physician manage metformin.
>That's how my last pdoc felt about it (he retired end of 2017). At least he wasnt against it. It is a fairly easy unscheduled medicine to find for sale online. I think it's available over the counter in many countries.
Better if you can do w.o. but just an option if seeing a GP is a pain.
Posted by bleauberry on May 11, 2018, at 10:52:08
In reply to Re: Switching from Parnate to Trintellix, posted by SLS on May 10, 2018, at 7:19:34
I used to employ 'life preservers' or 'stepping stones' to help me survive rocky transitions.
I had a rule that I obeyed - no more than 3 doses in a single day, and no more than 3 days per week - to avoid addiction - my best life preserver was Vicadin! It was an amazing antidepressant of me. It lifted me out of the dungeon in about an hour. No long wait. And even after it wore off, the effects of whatever it did at the synapses lasted into the next day or two - I still felt bad but not nearly as bad as I had.
Another tool was Ritalin, prior to when I was on it regularly.
Those 2 substances helped me so much. Establishment would totally disagree with the purpose I used them for. But if you think about it, establishment is just flat wrong - my life matters - my mood matters - surviving a transition matters - stupid rules by bureaucrats of what is appropriate for me or not is ridiculous. So I said screw it, I will take Ritalin 1-3 times per week if I need a lift - went weeks without it usually - and I will take Vicodin 1-3 times per week, though I went weeks without needing any at all.
So I am just wondering if you are aware of any 'life preservers' that can rescue your mood quickly, whether they are politically correct or not. ???
> Hi, Bleauberry.
>
> > Transitions were always so hard for me. I was trying to maintain a full time job through it all.
>
> Your remaining employed while being so severely ill is a genuine accomplishment.
>
> > So I sincerely wish you great strength and endurance to get through the weaning/wash-out/titration period as smoothly as possible.
>
> Thank you. I really am afraid as to how difficult this will be for me. Maybe I'll feel as bad as my untreated baseline state leaves me and no longer be able to function. I'm taking 5 other drugs, though. I hope they break the free-fall into the abyss. I'll keep posting as long as I have the energy and focus.
>
>
> - Scott
Posted by ed_uk2010 on May 12, 2018, at 16:13:26
In reply to Re: Switching from Parnate to Trintellix, posted by linkadge on May 10, 2018, at 7:06:17
>I'm interested in trintillex too, but it not generic at the moment and I don't have an extra $500 a month.
500 dollars?! It's not used much here, and if it was it would be covered on the National Health Service, so would be free or costing the usual fixed prescription charge. Even so, the actual cost of the med to the NHS is only £27 per month. That still makes it one the most expensive antidepressants here though. Sertraline 50mg currently costs the NHS £0.67 per month, for example. Escitalopram 10mg costs £1.
Posted by linkadge on May 16, 2018, at 18:09:53
In reply to Re: Switching from Parnate to Trintellix » linkadge, posted by ed_uk2010 on May 12, 2018, at 16:13:26
Hi Ed.
Wow that's an eye opener.
We don't have national or provincial pharmacare coverage. In my province we are nearing an election where a populist leader is looking to take the leadership, which will make this an even more remote likelihood.
No without work coverage (which I don't have), I pay 100%.
Canada's health care system is a bit misunderstood. Free doctors visits, not free treatments.
Linkadge
Posted by ed_uk2010 on May 20, 2018, at 10:20:22
In reply to Re: Switching from Parnate to Trintellix » ed_uk2010, posted by linkadge on May 16, 2018, at 18:09:53
Hi Link,
The thing is, if a manufacturer wanted to charge a lot for a new antidepressant in the UK, doctors would be told not to prescribe it. Manufacturers of new products are well aware of this. Price competition is high for this type of product (general low level of uniqueness). To charge a large amount, the product would need to offer something very unique or have few alternatives.
The health service gets considerable value for most medications used in primary care. A few examples of prices paid by the NHS for this month:
Venlafaxine 75mg tablets - £1.94 for 56.
Risperidone 2mg tablets - £1.36 for 60.
Aripiprazole 10mg tablets - £1.99 for 28.Now imagine a company trying to sell a new antidepressant for £500....
Even if you were visiting the UK from Canada and got a private/non-NHS prescription for one of the above three products, you'd probably only pay about £4.50 at the pharmacy.
A non-NHS prescription for a box of 28 vortioxetine would cost you around £35 at an average high street pharmacy. Most European countries have restrictions on branded medicines prices, with the system varying according to the country.
Posted by linkadge on May 20, 2018, at 15:02:38
In reply to Re: Switching from Parnate to Trintellix » linkadge, posted by ed_uk2010 on May 20, 2018, at 10:20:22
Hi Ed,
It works a bit differently here, with private insurance paying drug costs for a sizable (but shrinking) number of people.
Some coverage requires trials of certain generic medications before the new-fangled drug can be tried. After that (or for more comprehensive plans) the insurance company pays the outrageous price.
I remember reading the cost for my mothers brand name lyrica (50mg) when she first took it. It was a few hundred dollars. She was also taking brand name seroquel which was over a hundred a month as well.
Linkadge
Posted by linkadge on May 20, 2018, at 15:04:07
In reply to Re: Switching from Parnate to Trintellix » linkadge, posted by ed_uk2010 on May 20, 2018, at 10:20:22
In theory, Trintillix could offer advantages (i.e. for cognition) in the treatment of depression. I don't know if this will prove meaningful over time.
I always feel a bit wonkey on Effexor, and remeron definitely produces some cognitive impairment.
Linkadge
Posted by SLS on June 10, 2018, at 13:22:47
In reply to Switching from Parnate to Trintellix, posted by SLS on May 10, 2018, at 5:06:55
Not fun.
Rapid taper of Parnate.
1. Rebound depression with anxiety. Battling thoughts of suicide.
2. Profound fatigue separate from depression.I went from 80 mg/day to 40 mg/day in 6 days. I am able to offset much of the fatigue using amphetamine. However, this does not reduce the depression. I plan to decrease the dosage to 30 mg/day today.
- Scott
Posted by ed_uk2010 on June 10, 2018, at 16:39:01
In reply to Re: Switching from Parnate to Trintellix, posted by SLS on June 10, 2018, at 13:22:47
How awful. Going to be difficult over the next few days but you will make it through. You're really strong.
I know it might make you too drowsy, but would it help to have a small dose of olanzapine on hand in case you feel agitated or suicidal? Maybe 5mg.
Posted by SLS on June 10, 2018, at 20:09:42
In reply to Re: Switching from Parnate to Trintellix » SLS, posted by ed_uk2010 on June 10, 2018, at 16:39:01
> How awful. Going to be difficult over the next few days but you will make it through. You're really strong.
>
> I know it might make you too drowsy, but would it help to have a small dose of olanzapine on hand in case you feel agitated or suicidal? Maybe 5mg.That's an excellent idea.
Thanks, Ed.
- Scott
Posted by pedr on June 21, 2018, at 11:27:35
In reply to Re: Switching from Parnate to Trintellix, posted by SLS on June 10, 2018, at 13:22:47
> Not fun.
>
> Rapid taper of Parnate.
>
> 1. Rebound depression with anxiety. Battling thoughts of suicide.
> 2. Profound fatigue separate from depression.
>
> I went from 80 mg/day to 40 mg/day in 6 days. I am able to offset much of the fatigue using amphetamine. However, this does not reduce the depression. I plan to decrease the dosage to 30 mg/day today.
>
>
> - Scott
>
>Scott, can I ask why the fast taper? I go to pieces when I reduce my Nardil 60mg dose by even 1/2 a tablet. I assume you've heard of the 10% taper theory/movement/group? : https://www.survivingantidepressants.org/topic/1024-why-taper-by-10-of-my-dosage/
Tapering - if you're suffering on your current med - is a nightmare. The longer you take, the more you suffer "as is". The faster you go, the more likely you'll suffer withdrawal. Rock, hard place etc.
Pete
Posted by SLS on July 3, 2018, at 18:31:49
In reply to Re: Switching from Parnate to Trintellix » SLS, posted by pedr on June 21, 2018, at 11:27:35
I've been on Trintellix for over a week. I'm taking 10 mg/day. I don't like the way I feel. I do nothing but sleep all day. I'm not really sleepy, though. I experience anxiety throughout the day and get nothing done. My mind feels somehow muddy. I feel dazed. I sleep because I have no desire to do anything else.
Any suggestions?
- Scott
Posted by ed_uk2010 on July 4, 2018, at 15:51:18
In reply to Re: Switching from Parnate to Trintellix, posted by SLS on July 3, 2018, at 18:31:49
> I've been on Trintellix for over a week. I'm taking 10 mg/day. I don't like the way I feel. I do nothing but sleep all day. I'm not really sleepy, though. I experience anxiety throughout the day and get nothing done. My mind feels somehow muddy. I feel dazed. I sleep because I have no desire to do anything else.
>
> Any suggestions?You feel this is Trintellix rather than stopping previous meds?
>
>
> - Scott
Posted by SLS on July 15, 2018, at 8:23:59
In reply to Re: Switching from Parnate to Trintellix » SLS, posted by ed_uk2010 on July 4, 2018, at 15:51:18
> > I've been on Trintellix for over a week. I'm taking 10 mg/day. I don't like the way I feel. I do nothing but sleep all day. I'm not really sleepy, though. I experience anxiety throughout the day and get nothing done. My mind feels somehow muddy. I feel dazed. I sleep because I have no desire to do anything else.
> >
> > Any suggestions?
>
> You feel this is Trintellix rather than stopping previous meds?That's a great question. I don't know the answer to it. The thought had occurred to me.
- Scott
This is the end of the thread.
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