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Dr. Bob is Robert Hsiung, MD,
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Posted by TH on April 12, 2019, at 7:38:50
Like what seems to be so many other people, I have had a wonderful honeymoon period with Tranylcypromine, lasting several months, however over the past few weeks this has sharply dropped off, leaving me to suspect the dreaded "poop-out".
Does anyone have any experience, or opinions on the best course of action?
Current dose is 30mg Tranylcypromine daily (monotherapy).
Posted by Christ_empowered on April 12, 2019, at 10:29:03
In reply to Tranylcypromine Tachyphylaxis, posted by TH on April 12, 2019, at 7:38:50
the late Dr.Ivan Goldberg had a website about his tips on managing mood problems. Maybe its still out there, somewhere? Anyway...
he seemed to be big on adding amphetamine to Parnate. i think lithium can be used to augment, also, but...wow. lithium. both carry risks, of course.a former shrink told me that "california rocket fuel" works as well as parnate. that's remeron plus effexor. that's based on a very small study, but....maybe worth considering (?).
given the popularity of the 'atypicals,' maybe adding one of those might help?
Posted by TH on April 12, 2019, at 16:17:42
In reply to Re: Tranylcypromine Tachyphylaxis, posted by Christ_empowered on April 12, 2019, at 10:29:03
Thank you for your reply.
I can see the potential value in augnenting with a stimulant (methylphenidate seems to be the most appropriate), however I would certainly still have some reservations about the strategy.
I would be worried that if down-regulation of receptors is the cause of ADT tachyphylaxis, that adding extra dopamine may only exacerbate the problem.
In addition, going in search of a stimulant prescription is no easy task, and a good way to get yourself labeled as a drug-seeker. To prevent abuse, our medical system only allows such a prescription can only be made by a qualified specialist, and only with a diagnosis of ADHD or narcolepsy. While I do have a friend who had been prescribed methylphenidate off-label for a mood disorder, and it did appear to help, it was only prescribed having exhausted all other options.
Having already been prescribed atypical psychotics, I do not see any further value in attempting to augment with them. In regards to "Californian rocket fuel", I had previously spent quite a period on a similar combination already with no positive effect.
The idea of adding lithium is possibly worth exploring, I have seen it suggested that any value as an augmenting agent should be apparent within four weeks, else it would be wise to discontinue. At the very least, this fixed time period makes it a more attractive option. I had also seen suggestions of using lamotrigine in a similar manner.
Another set of very unproven suggestions seem to target the glutamate system. Anecdotally I have read of sarcosine being useful as an augmenting agent, as well as memantine being used specifically in the hopes of preventing ADT tachyphylaxis. As best I can understand, this theory suggests that glutemic overactivation of the dorsal raphe causes down-regulation of other receptors. Another unrelated suggestion involved using kappa opioid agonists regularly to induce down-regulation of that receptor, as kappa opioid activation is believed to cause dopamine receptor down-regulation. Does anything have any input on any of these theories?
I would be inclined to first try blindly increasing my dose of tranylcypromine to 40mg daily in the hope that a solution could be that simple, but is this overly naïve?
Posted by SLS on April 13, 2019, at 8:20:26
In reply to Tranylcypromine Tachyphylaxis, posted by TH on April 12, 2019, at 7:38:50
> Like what seems to be so many other people, I have had a wonderful honeymoon period with Tranylcypromine, lasting several months, however over the past few weeks this has sharply dropped off, leaving me to suspect the dreaded "poop-out".
>
> Does anyone have any experience, or opinions on the best course of action?
>
> Current dose is 30mg Tranylcypromine daily (monotherapy).It is my observation than most people don't get durable results with Parnate until they reach a minimum of 40 mg/day. My ideal dosage seems to be 80 mg/day. I have been up to 150 mg/day. Many others have been over 100 mg/day. I think it makes more sense to increase the dosage of Parnate than to add a second drug. Is there anything preventing you from doing this?
- Scott
Posted by Christ_empowered on April 13, 2019, at 10:42:16
In reply to Tranylcypromine Tachyphylaxis, posted by TH on April 12, 2019, at 7:38:50
hi. i dont know where you live or anything...here in the US, -some- doctors are more accomodating with using uppers in bad cases of depression, when appropriate. then -some- doctors will Rx a stimulant and say 'oh, wow...you must have ADHD!,' which...strikes me as ridiculous. some just don't, ever...and then you have drug dealers with MDs, they'll prescribe whatever, if you can put $$$ on the table. -sigh- what a mess...
anyway, if you're not experiencing adverse effects, I would think talking to the prescriber about a dosage increase would be the logical 1st step. i seem to recall reading about tca augmentation of maoi treatment. id be scared, personally, but...i think its nortrip that's supposed to be both safe and effective, maybe? one psychopharmacologist's stuff i read even indicated that he's under the impression that the combination is actually safer (for hypertensive episodes) than the maoi alone...i forget why, exactly.
other than that...i dont have any ideas to offer, just...sorry about this.
Posted by TH on April 13, 2019, at 16:24:31
In reply to Re: Tranylcypromine Tachyphylaxis » TH, posted by SLS on April 13, 2019, at 8:20:26
Our official government source (New Zealand, medsafe.govt.nz) recommends the extremely conservative dose of 10 - 20mg daily.
Ken Gillman's website suggests that a minimum effective dose is likely to be between 30 - 50mg daily.
As I initially got a good response from 30mg it led me to believe that the dosage was sufficient. However, given the suggested ranges from other sources, it doesn't seem unreasonable at all to increase the dosage. If you have tended to notice a better response from 40mg, it certainly does strengthen the case for increasing.
I will bring up a new dosage with my doctor next week.
Thanks for your input.
Posted by SLS on April 13, 2019, at 17:20:37
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 13, 2019, at 16:24:31
> Our official government source (New Zealand, medsafe.govt.nz) recommends the extremely conservative dose of 10 - 20mg daily.
>
> Ken Gillman's website suggests that a minimum effective dose is likely to be between 30 - 50mg daily.
>
> As I initially got a good response from 30mg it led me to believe that the dosage was sufficient. However, given the suggested ranges from other sources, it doesn't seem unreasonable at all to increase the dosage. If you have tended to notice a better response from 40mg, it certainly does strengthen the case for increasing.
>
> I will bring up a new dosage with my doctor next week.
>
> Thanks for your input.
>Good luck, TH.
- Scott
Posted by rose45 on April 14, 2019, at 5:01:03
In reply to Re: Tranylcypromine Tachyphylaxis » TH, posted by SLS on April 13, 2019, at 8:20:26
Hope its not discourteous to butt into this conversation, but the same thing happened to me, after 20 years on Nardil, and now after 5 years on parnate after mistakenly lowering the dose (discussed on thread called 'Parnate has anyone stopped and restarted..)
Does anyone know whether the maoia are more prone to Tachyphylaxis than other meds, or does it just depend on the person? I become suicidal off meds, as Ive been on maois for so long, and pretty desperate for suggestions. I just cant bear Parnate above 40mg. I know Dr. Gillman and many people on here take very high doses, but we are all different and in the UK, they wont let you go higher anyway.
TH I do hope you dont mind me adding this on your thread, but it is relevant, as it is the same subject and Im very desperate for any information, as Im getting very little help here in the UK. Thank you.
Posted by TH on April 14, 2019, at 5:16:30
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on April 14, 2019, at 5:01:03
Have you considered switching to Isocarboxazid? It appears to be available in the UK and is a lot more similar to Nardil than Parnate is.
Posted by rose45 on April 14, 2019, at 15:01:23
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 14, 2019, at 5:16:30
both nardil and parnate have made me manic..... I myself feel happy but dont realise how aggressive I am being and over talkative I become. Did parnate have that effect on you? One sometimes doesnt even reaiise it oneself.
And Marplan was taken off the market recently. Even parnate is not that easy to come by now...... so i think its a risk being on maois in the uk at the moment. They are also very expensive.. so the nhs may well refuse them. Thanks for the suggestion.....I dont want to become a guinea pig for psychiatrists. Im afraid if 2 maois have pooped out on me, maybe there is something in my genes that makes that happen. I am really scared -
Posted by TH on April 15, 2019, at 5:26:36
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on April 14, 2019, at 15:01:23
I have noticed that I can be over-talkative, however this had always been one of my personality traits. As far as aggressive behaviour, possibly a very slight increase, but overall my temperament has improved due to the great reduction in irritability. I haven't found either aspect to be concerning.
You mentioned you can't bear to raise the dosage, is that because of the mania or because of uncomfortable physical side effects? How long did you maintain the higher dose for? Over a period of weeks many people seem to report unpleasant side effects easing.
I know it's a long shot, but ensuring the dose is taken on an empty stomach seems to help in my personal experience. If you don't already do this it could be worth a try to see if it changes anything?
You also mentioned your struggles seeing a psychiatrist through the NHS. I'm not sure how things are in the UK, but I know here that a GP is allowed to prescribe almost any medication that they are comfortable with. If you can make a strong case and find a sympathetic GP you may have more luck there?
Posted by rose45 on April 15, 2019, at 7:09:11
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 15, 2019, at 5:26:36
Ive been on parnate for 5 years,at 30mg and the prescription is just automatically renewed electronically.
Ive now upped the dose to 40 mg, but 50 mg gives me too many horrible side effects. This all happened because I was getting 'high' on 30 mg, beginning to spend more money than I should, imagining someone was my guru etc....so I reduced the med, which in hindsight, was a mistake.
I shouldnt have reduced it on my own, but i can now see that on 30 mg, I was behaving rather like a drug addict, and not thinking things out properly at all. It was like I was on a drug 'high'.
Cant sleep at all now and taking too much benzo to sleep, and cant really think straight or work , serious cognitive problems etc and have so much fear and anxiety. Dont know whether starting it from scratch again would work, but just ramping up has not worked and it just feels wrong to ramp up any higher.
I think this must be tachyphylaxis. Similar symptoms to when nardil stopped working.
Posted by TH on April 15, 2019, at 15:36:10
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on April 15, 2019, at 7:09:11
I'm not a doctor and really have no place making suggestions, but if it were me in that position here's what I would be considering:
I would either take a higher dosage of an MAOI, and tolerate the side effects for the adjustment period in the hopes that they lessen with time, adding lithium / lamotrigine if that "high" feeling started to return;
Or I would be considering looking for a new antidepressant medication regime that didn't act on dopamine. The dopamine receptors certainly are known for being involved with things like reward seeking and risk taking so it doesn't seem too far-fetched of an idea. Maybe Clomipramine, as a potent SNRI, would be an appropriate choice? It also has a non-narcotic sedative effect so taking the dose at night could help with sleep.
Posted by rose45 on April 15, 2019, at 16:46:09
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 15, 2019, at 15:36:10
Thank you for your suggestions. Have you taken clomipramine and did it work for you ? I read that it has some unpleasant side effects - not too sure what they are.
I really dont think I am bipolar, but the maois do
seem have this effect on many people from what I have read on these boards.
Posted by TH on April 15, 2019, at 16:59:19
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on April 15, 2019, at 16:46:09
Side effects for a lot of these medications do decrease after an initial adjustment period, as long as you can tough it out.
I personally haven't tried Clomipramine, but is supposedly is one of the more effective antidepressants for Treatment Resistant Depression.
As for using bipolar medications, I was under the impression that as long as the symptoms are there, they could be of useful effect, even if you do not have a bipolar diagnosis. Someone else on the boards would likely have more knowledge on the subject that me however?
Posted by Lamdage22 on April 16, 2019, at 3:01:06
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 15, 2019, at 16:59:19
Dopamine is very dangerous to tamper with.
Posted by rose45 on April 16, 2019, at 3:54:11
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on April 15, 2019, at 16:59:19
i have now realised what happened. I think I have become addicted to the benzos I was taking with parnate. I took them very sparingly before, but when parnate began to stop working, I increased them and now if I dont take them, I get unbearably anxious. Will have to try to taper them slowly and I know it will be hell.
Would anyone know whether Parnate is a gaba receptor down regulator, as it seems that affects the tapering process - acc. to a video ive been listening to re coming off benzos.... what a nightmare.... Any help much appreciated, although I realise this is changing the original question on this thread. Thank you.
Posted by rose45 on May 3, 2019, at 5:12:12
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on April 16, 2019, at 3:54:11
TH Please let us know how you are doing now.
Im still waiting for an appointment with the nhs psychiatrist. Things are really terrrible in mental health in the UK.
I would also be interested to know how old time posters who initially did well on MAOIs are doing now and whether they have had success with anything else..... if any of you feel like posting, it would be appreciated.... I am hoping to make suggestions to the psychiatrist, and only maois have ever helped me. marplan not available here. So theres nothing left I can think of. Thank you.
Posted by TH on May 3, 2019, at 5:15:36
In reply to Re: Tranylcypromine Tachyphylaxis, posted by rose45 on May 3, 2019, at 5:12:12
> TH Please let us know how you are doing now.
>
> Im still waiting for an appointment with the nhs psychiatrist. Things are really terrrible in mental health in the UK.
>
> I would also be interested to know how old time posters who initially did well on MAOIs are doing now and whether they have had success with anything else..... if any of you feel like posting, it would be appreciated.... I am hoping to make suggestions to the psychiatrist, and only maois have ever helped me. marplan not available here. So theres nothing left I can think of. Thank you.Increasing the dose to 40mg seems to have helped, but it's still too early to comment on whether this will be a long term solution or only provide a short window of relief.
Posted by rose45 on May 3, 2019, at 5:47:32
In reply to Re: Tranylcypromine Tachyphylaxis, posted by TH on May 3, 2019, at 5:15:36
The above post was written by me, Rose 45.... sorry im so unwell, it got posted as if it was written by TH by mistake.
This is the end of the thread.
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