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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by superman on June 30, 2005, at 5:02:45
Ok, so its I've been on Parnate a month and a half now. I've gotten over the insomnia I think, although the quality is rather sporatic (barely sleeping one night, deep with vivid dreaming another, etc). I feel like I've lost the activating effects I was origionally enjoying (ie. waking up energetic, etc). Do I need to increase the dose?
The major problem now seems to be a daily "slump" of fatigue. I've read of others having this same problem. For me it seems to come 1-3 hours after my morning dose, and I've pretty much noticed it since day one. Not only is this sudden lack of energy I feel everyday unproductive, it nearly always leads me to go lie down, but not to sleep. There I get extremely stuck in my usual dysthymic thoughts, which compounds the depression I've been fighting. Ahhh! I thought this was the one.
Anyway, maybe someone can tell me more about this, or share their experience. Why am I fatigued when plasma levels of the parnate are suppose to be greatest? I thought it was suppose to be stimulating? And why am I not noticing the stimulating effects anymore? Anyone here a biochemist?
Should I see about augmenting with anything to deal with the fatigue? Or will only time help, as people seem to have suggested in the past?
Thanks in advance for any responses.
... Oh, on the psycopharmacolgical tips, DR.Bob suggests benzos and MAois dont mix well (especially Klonolpin). Not contradicted, but apparently its unhelpful with the depression, or perhaps other problems. I wanted to take Klonopin for social anxiety (already take as needed). I've actually already had it perscribed, but am curious about other ppls experiences combining it with a Maoi. Thanks,
-T
PS. Thanks for the advice I've gotten so far here on babble (ie. tazodone as needed for the insomnia, emergency hypertensive med, etc all great advice). I'm going to come here for info from now, since its clear u guys are more knowledgeable than my doctor with the med advice. ha!
Posted by willyee on June 30, 2005, at 7:47:11
In reply to another parnate question... fatigue, posted by superman on June 30, 2005, at 5:02:45
Dr.Bob made a good statment.One would think you have a stimulating med that works on depression(parnate),and you have a semi-sedating med that works on anxiety (klonopin)so togther u have the magic combo.
Well the world is never a convienant place,for whatever reason,and id love a theory the two do not go well together,at least on a daily basis as a protocol.Klonopin works well with parnate when its used very sparingly,i.e when each parnate dose seems to drive you mad.Klonopin as needed is ok.But togther it kills both of the meds effects,least thats what i noticed.
As far as increasing it,honestly if you found an effective dose for depression,id keep it right there for as long as it is just that.With fatigue carefully try one whole vivarin tablet,lay down and let it settle,you should see energy appear.
Now i know u say vivarin uck,but when u have parnate fatigue,vivarin is not likly to behave as it would alone,like incredable rush etc.Instead it is mildly soothing and seems to have a synergy.Id try something as simple as this first,reason being u have a magical thing a med thats working,dont mess with what aint broken lol.One problem u might come across is if uhave ocd tendacies the vivarin might aggravate that.But since vivarin is cheap and right at ur 7-11 id try it personaly.Ive tried many stimulants and most do not go to great with parnate,vivarin simple as it is does.
p.s please come to the conclusion on ur own of course,i just offer my own exper as a possable option,techincaly the two are contradicted,i do not find this to be the case,and quite a few others as well.
DR Bob,thats some great info,i forgot to mention that excessive use of a benzo for SOME can definatly hault of even prevent parnate from showing any anti-depressant effects.
Posted by laurenjb on June 30, 2005, at 20:55:42
In reply to Re: another parnate question... fatigue, posted by willyee on June 30, 2005, at 7:47:11
I have been on 30mg Parnate for around 3 weeks and am having horrible insomnia and resulting fatigue. The only thing that has ever really helped me to sleep was 1-2mg Klonopin, which is not working so well right now, maybe because of what was mentioned in the previous posts. I'm about to try Lunesta (Ambien doesn't work unless I take more than my doctor recommends and leaves me a zombie the next day). Would you please refer me to where Dr. Bob discussed the use of Parnate and benzos? Thanks, Lauren
Posted by superman on July 1, 2005, at 0:52:42
In reply to Re: another parnate question... fatigue, posted by laurenjb on June 30, 2005, at 20:55:42
Hi Lauren. I had the insomnia at first too, but at the time I wasn't feeling tired during the day, I actually felt energetic. That has gone with time tho. I wanted to try lunesta. Very small amounts of trazodone is what I used (12.5mg was plenty), which allowed me to fall asleep quickly and have a deep sleep. Minor headache in the morning, but I've always gotten that with trazodone. Trazodone is suppose to be contradicted with parnate, but thats a conservative recommendation I think.
http://www.dr-bob.org/tips/split/MAOIs-+-benzodiazepines.html --> here is where they discuss the use of maois with benzos. (my mistake, Dr.bob did not take part in the discussion).
Thanks for the response Lauren.
T
> I have been on 30mg Parnate for around 3 weeks and am having horrible insomnia and resulting fatigue. The only thing that has ever really helped me to sleep was 1-2mg Klonopin, which is not working so well right now, maybe because of what was mentioned in the previous posts. I'm about to try Lunesta (Ambien doesn't work unless I take more than my doctor recommends and leaves me a zombie the next day). Would you please refer me to where Dr. Bob discussed the use of Parnate and benzos? Thanks, Lauren
Posted by superman on July 1, 2005, at 1:09:57
In reply to Re: another parnate question... fatigue, posted by willyee on June 30, 2005, at 7:47:11
Thanks willyee,
I'm going to stick with taking klonopin only as needed for now then.
I was fairly sure I found a med that worked when I tried parnate at first, but now I'm not so sure. It's like I had 2 or 3 weeks of energy and optimism, and then I fell back into my normal (depressed) self. And the fatigue definitely isn't helping.
I'm going to try the caffeine thing. Vivarin?? I've actually never heard of that. Any caffeine pills will do tho, right? Thanks for that advice. I know they are technically contradicted, so I'll be careful when experimenting with this.
I'm also going to try playing with the timing of the dose. Taking the largest dose in the morning seems to be terrible timing considering how the fatigue always hits me about 2 hours after the dose. I wonder if my sleep would suffer too greatly if I took it later in the day.
Anyway, thanks again.
> Dr.Bob made a good statment.One would think you have a stimulating med that works on depression(parnate),and you have a semi-sedating med that works on anxiety (klonopin)so togther u have the magic combo.
>
> Well the world is never a convienant place,for whatever reason,and id love a theory the two do not go well together,at least on a daily basis as a protocol.Klonopin works well with parnate when its used very sparingly,i.e when each parnate dose seems to drive you mad.Klonopin as needed is ok.But togther it kills both of the meds effects,least thats what i noticed.
>
> As far as increasing it,honestly if you found an effective dose for depression,id keep it right there for as long as it is just that.With fatigue carefully try one whole vivarin tablet,lay down and let it settle,you should see energy appear.
>
> Now i know u say vivarin uck,but when u have parnate fatigue,vivarin is not likly to behave as it would alone,like incredable rush etc.Instead it is mildly soothing and seems to have a synergy.Id try something as simple as this first,reason being u have a magical thing a med thats working,dont mess with what aint broken lol.One problem u might come across is if uhave ocd tendacies the vivarin might aggravate that.But since vivarin is cheap and right at ur 7-11 id try it personaly.Ive tried many stimulants and most do not go to great with parnate,vivarin simple as it is does.
>
> p.s please come to the conclusion on ur own of course,i just offer my own exper as a possable option,techincaly the two are contradicted,i do not find this to be the case,and quite a few others as well.
>
> DR Bob,thats some great info,i forgot to mention that excessive use of a benzo for SOME can definatly hault of even prevent parnate from showing any anti-depressant effects.
Posted by laurenjb on July 1, 2005, at 5:05:02
In reply to Re: another parnate question... fatigue, posted by superman on July 1, 2005, at 0:52:42
Hi T: Thanks for the link and your response. I get that overwhelming fatigue during the day, too, though I think mine might have more to do with the insomnia. I try not to sleep during the day so I can sleep at night but it doesn't seem to matter. I'm also feeling pretty down, but it's all relative -- I feel better than 6 weeks ago when I was going through Effexor withdrawal. I am hoping the Parnate just needs some more time to kick in or that I need the dose increased. What dose are you on?
As for Lunesta, tonight is the first time I've taken it. I slept for about an hour and it's now 3am and I'm wide awake and have the NASTIEST taste in my mouth. Of course, this doesn't mean it won't work for you -- I truly hope it or something else does -- let me know! Lauren
> Hi Lauren. I had the insomnia at first too, but at the time I wasn't feeling tired during the day, I actually felt energetic. That has gone with time tho. I wanted to try lunesta. Very small amounts of trazodone is what I used (12.5mg was plenty), which allowed me to fall asleep quickly and have a deep sleep. Minor headache in the morning, but I've always gotten that with trazodone. Trazodone is suppose to be contradicted with parnate, but thats a conservative recommendation I think.
>
> http://www.dr-bob.org/tips/split/MAOIs-+-benzodiazepines.html --> here is where they discuss the use of maois with benzos. (my mistake, Dr.bob did not take part in the discussion).
>
> Thanks for the response Lauren.
>
> T
>
> > I have been on 30mg Parnate for around 3 weeks and am having horrible insomnia and resulting fatigue. The only thing that has ever really helped me to sleep was 1-2mg Klonopin, which is not working so well right now, maybe because of what was mentioned in the previous posts. I'm about to try Lunesta (Ambien doesn't work unless I take more than my doctor recommends and leaves me a zombie the next day). Would you please refer me to where Dr. Bob discussed the use of Parnate and benzos? Thanks, Lauren
>
>
Posted by willyee on July 1, 2005, at 7:33:54
In reply to Re: another parnate question... fatigue » willyee, posted by superman on July 1, 2005, at 1:09:57
Yess sir i forget how widespread the net is,i guess i live in my little box.Vivarin is pure caffiene,250 mg,which has many other brands,just make sure it isnt combined with any weird herb or anything as you have a lot of those quick energy packs in stores that just combine a bunch of CRAP.
Also i know insomnia is terrable,but i do personaly think what u take the night before for sleep,how u wake,does effect parnate dose.Elavil is one thing i can vouche for that is pretty effective for insomnia.
I personaly took lunesta,and what happened is it got me to sleep,not easly i might add,BUT perhaps the maoi action prolonged it,but the next day i was a mess,i could not do anything but lay down,i hardly had energy to get up to eat,and would have ate in my bed and just rolled over again if i had the choice,so lunesta was quickly cut.Now i use elavil which seems to be fine.
Maoi affect other drugs,potentiate them,make sure other drugs u take arent doing this,again i can personaly say this of lunesta,it hid parnates benifits.
Another good option is either ambein or klonopin,however to keep both at a min try pouring a portion of l-theanine a natural amino acid under ur tongue,l theanine seems to have a sedating synergy with most gaba meds.Try very small amounts of various gaba meds rather than say popping a second or third ambien or klonopin,hit the brain with different mechanicms.Parnate seems to work ok with ambien for me,but i usualy take half a pill with say a small pieace of neurontion,or l theanine,or even taurine,however luckly ive been sleeping on nothing latly,knock on wood.
As for parnate poopout,unfortunatly this is one of ur better meds,someone just posted that a article stated parnate was considered the best option for major depression,once on parnate,i believe it said to then throw everything but the kitchen sink at it.
Try ur doses in increments,and try various increment times.Good luck
Posted by Declan on July 1, 2005, at 14:34:47
In reply to Re: another parnate question... fatigue, posted by willyee on July 1, 2005, at 7:33:54
Hi everyone
On 10 mg my sleep is shortened and made lighter. If I took 30mg I wouldn't sleep much at all. So the 'side effect' of insomnia is the limiting factor. The sleep med options are not attractive, although I take some herbs which are OK. But I take that 10mg when I wake up, maybe 4am. I assume that's the best time. The line seems to be, Take the last dose by lunch.
Declan
Posted by superman on July 2, 2005, at 5:25:06
In reply to Re: another parnate question... fatigue » superman, posted by laurenjb on July 1, 2005, at 5:05:02
Hello again Lauren. You sound much like how I felt the first few weeks on parnate. I took 20mg the first week, and have been taking 30mg ever since. From about weeks 3-5 I hardly slept at all. And oh yea, I started parnate right after going through that horrible effexor withdrawl as well.
Hmmmm. I think parnate is an excellent drug for stimulating and increasing motivation. That's what I noticed. I used to be a hypersomniac depressive, who would lie in bed all day and dwell on sadness. This is where parnate helped I think. I'm not sure if it neccissarily helps my mood directly, but the fact I wouldn't sleep all day and that I'd actually start doing a few things helped with my depression, although not perfectly.
I'm sorry you're feeling down. Yea, you'll have to try playing with the dose. I read a study where extremely high doses (about 120mg) were found most effective for refractory depression. Of course a lot of guides suggest 30 or 40mg is all thats needed if there is to be any effect from parnate. It seems most people on this board take quite a bit more than that tho. It's interesting to note that relatively little MAO inhibition actually occurs at a 30mg dose( http://www.vh.org/adult/provider/psychiatry/CPS/17Figure2.html ), so if that is its mechanism of action, something closer to the 120mg would probably make some sense (or perhaps just 50-80mg). I'm going to hold steady at 30mg for a while, since I'm fairly sure I am at least somewhat more optimistic, motivated, and energetic in everyday life with it, compared to the pessimistic, apathetic, reactive person I was. Does this sound a little like you?? If it does, perhaps you just need some time for the drug to translate into some improvement in mood. Or perhaps you're feeling down goes a little deeper, and you would benefit from a higher dose. I think parnate has a tendency to have dramatically different effects at a higher dose. But 3 weeks isn't very long anyway is it?? so maybe you do just need some more time.
Anyway, I know insomnia is no fun. But I do think that's something that gets better with time. I had an incredible sleep last night, without any meds. I hope you find something that helps tho. Hey, thanks for sharing Lauren, and good luck.
T
> Hi T: Thanks for the link and your response. I get that overwhelming fatigue during the day, too, though I think mine might have more to do with the insomnia. I try not to sleep during the day so I can sleep at night but it doesn't seem to matter. I'm also feeling pretty down, but it's all relative -- I feel better than 6 weeks ago when I was going through Effexor withdrawal. I am hoping the Parnate just needs some more time to kick in or that I need the dose increased. What dose are you on?
>
> As for Lunesta, tonight is the first time I've taken it. I slept for about an hour and it's now 3am and I'm wide awake and have the NASTIEST taste in my mouth. Of course, this doesn't mean it won't work for you -- I truly hope it or something else does -- let me know! Lauren
>
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