Posted by SLS on November 7, 2008, at 0:03:35
In reply to PARNATE POOP-OUT OR NIFEDIPINE INTERFERENCE?, posted by JadeKelly on November 6, 2008, at 17:46:05
> Week and 1/2 with quick great response to Parnate30mg, then subsequent hypertensive crisis. Restart Parnate couple days later with daily Nifedipine 10mg (only way to stop BP spikes). Another week 1/2, now feel worse than before. Any Parnate experts/users,etc. have a couple minutes to answer these questions? Note: had great response on Emsam at 6mg patch for week or so, also, then switched to Parnate.
>
> 1. Is parnate known for early response then gone?No. However, that is how I react to Parnate when it is used as monotherapy. Actually, this pattern of response has been my main problem for 25 years.
> 2. Do MAOI's just have early stim effect?
Parnate does.
> Thought they ruled that out. Didn't feel like stim.
You know your body best.
> 3. Is it likely just a need for dose adjustment?
Some people who experience spontaneous hypertensive reactions to Parnate upon treatment startup have it be only transient. You might want to try slowly lowering the nifedipine if you feel confident that you can monitor your blood pressure accurately. You might want to work with your doctor on this.
> 4. I know 30mg to be standard for Parnate trial, I'm small and fairly sensitive to drugs too. Is it likely that Nifedipine is whats causing lack of response?I wouldn't think so. It is likely that 30mg of Parnate is not enough. Most people need a minimum of 40mg when treating more severe depressions.
> 5. Do most people who respond well in 5-7 days on MAOI tend to respond for long time, given right dose?
I don't know. Sometimes slower is better when it comes to responding long-term. It may depend on how your system may have been "primed" by previous treatment. Your brain is not "drug-naive". In the short-term, it might be more responsive rather than less responsive because of this.
> 6. Is it a general rule, that most have to go up in dose to keep original response?Not with Parnate.
> Thanks to anyone who can answer these questions for me. I'm getting anxious to figure all this out as I feel lethargic and back to depressed state. See PDoc Monday. Atyp/tr MDD.
I bet you need to increase the dosage to >= 40mg. It is my experience that 40-80mg is the effective range, not 30-60mg.
Some people do feel lethargic on Parnate early in treatment. Since I haven't been on nifedipine, I can't attest to its propensity to produce sedation. Maybe a Google search will answer this part of your question.
Why people react to psychotropic drugs in "paradoxical" or "atypical" ways is still a mystery, although I am sure that these questions will eventually be answered.
If I were you, I would first try to taper the nifedipine before increasing the dosage of Parnate, hoping that the hypertensive reaction to Parnate is only transient. If hypertension emerges again, and if you have not yet tried Nardil, I would probably make the switch if I were you. I would be afraid that my system on Parnate is too volatile to rely on nifedipine alone as a fail-safe.
- Scott
poster:SLS
thread:861167
URL: http://www.dr-bob.org/babble/20081106/msgs/861246.html