Posted by Robert_Burton_1621 on July 6, 2015, at 8:56:30
In reply to Re: Parnate 100mg what to do from here?!? Help! » Robert_Burton_1621, posted by uncouth on July 5, 2015, at 16:54:05
> Oh, this is interesting, I actually thought it was the opposite. Can you explain more? I thought the BP drop (orthostatic hypotension) was a result of the long term inhibition of MAO enzyme (e.g. not related to dose), and that Parnate's stimulating (and anti-hypotensive, perhaps) effects would come from each individual dose...so that's why I've been lumping in 40 or 30mg doses, so get some added "kick". Are you saying it's the other way around?
>I wouldn't wish to generate the misapprehension of an expertise I in no sense possess. And, in any case, the mechanisms by which MAOIs affect many aspects of blood pressure are not fully understood. There is, however, some correlation between *peak* plasma MAOI levels and hypotension, so that minimising these levels by smaller dosages might assist you in avoiding the lethargy and muscular fatigue induced (hypothetcially) by hypotensive effects. While taking a big dose all at once may *initially* generate a stimulating effect, in an hour or so when plasma levels rise the physiological effect may be the exact opposite. This is what I experienced. And it was easily solved by reducing my doses and taking them more frequently during the day, leaving an interval of 3-4 hours. In fact, my fatigue and weakness disappeared in one day after I modified my dosage regime. Sorry I can't explain the mechanism by which this occured. But it may be worth your while just to experiment with dosing and see if your side-effects are also remedied.
> I just started atomoxetine and am ramping up on it, currently at 60mg. Feeling actually a lot worse, but i think it may be the clomiphene my endo has me on to help increase natural testosterone after I stopped testosterone replacement therapy 6 months ago and my levels have been rock bottom since.
>I wonder whether a more potent NRI might be helpful? Nortriptyline?
> Hmm, that sounds familiar, and thanks for the info. At what dose did it start "kicking in" and are you planning to go up even higher? I suspect I may need supratherapeutic as I usually need high doses of meds given my weight and comorbid issues.
>Parnate "kicked in" relatively quickly - within one week. However it was also accompanied by side-effects (related to sleeping, weakness, appetitie) which did not resolve for a month. When I say "kicked in" I refer only to its remarkably positive effect on my psychomotor retardation. It has not "kicked in" when it comes to more subjective symptoms like attention, motivation, interest (although it has also prevented any recurrence of nauseating and alienating anhedonia). The studies I have read on "supra-therapeutic" doses involved 120 - 170 mgs. I am now on 140 mgs. There is a slight improvement in cognitive interest and attentive capacities, and a slight improvement in motivation and future-directed thought. Early days I think.
Before I do augment (I have augmented with Lithium 750mg but it did not work; made me worse because it increased by TSH dramatically even though I only took lithium for a month) I wish to give parnate on its own its best chance of working (in my case). My doctor has recommended lamotrigine as the next augmentation strategy if high-dose parnate does not fully work. He is very hesitant for me to go beyond 130 mg because he thinks it could kill me because I have already experienced two hypertensive crises. It appears I am in that 5% of people who are very sensitive to tyramine.
I must confess that you ought read my personal report on my experience on parnate in light of the fact that I have difficulty in stopping alcohol consumption. Such consumption both acts as a CNS depressant in its own right and affects the efficiacy of medication. I have tried a number of strategies to stop but it is difficult because it does provide me relief at night time.
I should be dry for three months before I can evaluate parante truly on its own terms. This is what I am aiming for now.
We also ought be mindful of the fact that chronic depressive illnesses shrink the hippocampus, and that reparative neurogenesis induced by the administration of (the right class of) anti-depressants takes a lot of time.
> > > Sorry for lots of questions but I am desperate. It's a beautiful sunny day outside and i don't even feel like being in the sun or going for a walk or swimming, i'm just staring at the wall or my phone or my pill/supplement cabinent :-/
> > >
> > > Uncouth
> >
> > That is not good at all. You do certainly seem to be affected seriously by anhedonia. I truly hope you find a solutuion. 8 weeks is not that long on parnate, by the way. You mention that you take lithium. Have you had your thyroid levels checked recently?
>
> Yes, thyoid is OK, and I just take lithium orotate, very low dose, so i'm not too worried about thyroid.
>May I ask why you are taking this lithium compound which is, insofar as I am aware, not usually recommended as a therapeutic agent?
poster:Robert_Burton_1621
thread:1079745
URL: http://www.dr-bob.org/babble/20150629/msgs/1080255.html