Shown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by EERRIICC on September 20, 2005, at 13:48:20
I've been augmenting 40mg Parnate t.i.d. now for the past week with 5mg of ritalin t.i.d., it seems to just produce agitation and has a very bad "crash" when
it wears off. 2.5mg t.i.d. did the same thing. What should I do? Anyone augmented MAOIs that aren't working with a DA agonist and had success?Buprenorphine did not work out at all for me either,so I'm feeling very desperate. Does this mean that other opiods will probably not work for me either? Please help.
Posted by lunesta on September 20, 2005, at 13:56:39
In reply to MAOI+Ritalin/Buprenorphine, posted by EERRIICC on September 20, 2005, at 13:48:20
have you tried augmenting with neurontin 2400mgs daily ? that may work. your combo might be askin for a seizure!
Posted by Declan on September 20, 2005, at 14:54:33
In reply to MAOI+Ritalin/Buprenorphine, posted by EERRIICC on September 20, 2005, at 13:48:20
I dunno about opiates with Parnate, but the thing with opiates (the good ones) is they always work, which is why they're used in terminal illness. And then there are the consequences, too well known to repeat.
Sorry you're feeling so awful, my friend.
Declan
Posted by Tom Twilight on September 21, 2005, at 16:14:11
In reply to MAOI+Ritalin/Buprenorphine, posted by EERRIICC on September 20, 2005, at 13:48:20
If you haven't had success augmenting with Ritalin/Methylphenidate then why not try Dexedrine or Adderall (if its available were you live).
As long as your very careful I think you should be OK on this combination
Its best to have a doctor to supervise of course
Posted by Tom Twilight on September 21, 2005, at 16:18:19
In reply to Re: MAOI+Ritalin/Buprenorphine, posted by Declan on September 20, 2005, at 14:54:33
Actually I'm not sure if its a good idea to use stims to treat depression
There's probably more chance of getting addicted, and there's also the crash to deal with.
Have you considered augmenting with Desipramine or Reboxetine?
Posted by Chairman_MAO on September 21, 2005, at 19:36:06
In reply to MAOI+Ritalin/Buprenorphine, posted by EERRIICC on September 20, 2005, at 13:48:20
How much buprenorphine were you on? It seems that for depression, the common dosage 0.3-0.6mg qid sublingually. This is because previous to Suboxone coming onto the US market, the only form of bupe were ampoules for injection. Unfortunately, sublingual bioavailability is only ~15% of IM/IV bioavailability. This could be WAY too little for you.
What your ceiling dose is ultimately depends upon bodyweight, but for most it falls around 16mg sublingually, either taken 4mg qid or 16mg all at once. This will produce FAR stronger effects than what you have likely tried. Unfortunately, getting Suboxone without having a d/x of opioid depndency is next to impossible. One option would be for a close friend or family memeber to write an affadivait asserting that you have had repeated opioid problems--including a recent stint of abuse--and as such need maintenance despite the lack of withdrawal symptoms. Not honest, but remember the reason you're doing it is insane, cruel drug laws ... The other option is to persuade your doctor to let you inject the bupe; whether you want to bang something three-four times daily is up to you, though (in theory one to two times daily might work).
Your parnate + ritalin combination seems all wrong to me. Either up the ritalin dose to something useful (10-20mg tid) or drop the ritalin and increase the tranylcyrpomine to 120-200mg/day (its effect IMO is far superior once 80-90mg is exceeded due to clinically significant concentrations of sympathomimetic metabolites and more robust MAO inhibition). The second option is probably the best idea. Alternatively, you could try phenelzine 1mg/kg and add methylphenidate to that; phenelzine's calming properties would likely bring the agitation down to a manageable level.
I strongly believe, moreoever, the memantine added to an MAOI+buprenorphine combination would potentiate the antidepressant effect and prevent "poop-out". I personally have added cabergoline to phenelzine (for sexual dysfunction) and noticed an antidepressant effect that waned significantly after a month or so, but far from vanished completely. The dose you'll have to work up to is probably around 2.5mg/day; the twice-weekly 0.5-1.5mg dose is for prolactin suppression ONLY.
Cabergoline has an extraordinarily benign side effect profile for a DA agonist; you can self-medicate with it unless you have a psychotic disorder or another contradindication.If I can help you in any way, let me know. Best of luck. And FWIW, I feel d-amphetamine or d-methamphetamine are FAR cleaner, more robust stimulants than methylphenidate.
Posted by cybercafe on September 22, 2005, at 2:06:34
In reply to Re: MAOI+Ritalin/Buprenorphine » EERRIICC, posted by Chairman_MAO on September 21, 2005, at 19:36:06
buprenorphine -- my doc was mentioning that this drug increases stimulation to the hippocampus and for some reason this is not a good thing ...
comments ?
Posted by Chairman_MAO on September 22, 2005, at 10:20:40
In reply to Re: MAOI+Ritalin/Buprenorphine, posted by cybercafe on September 22, 2005, at 2:06:34
I have no idea what this means. This drug is an EXCELLENT treatment for addiction, obsession, craving, and highly treatment-resistant depression and anxiety/phobic disorders. Some fact about hippocampal whatever seems irrelevant when one considers the well-established facts about its psychopharmacological effects. Put simply: so what? I depresses neuronal firing in the LC, which can be a great thing for many people. It also dramatically increases motivation and helps immensely with reward-deficiency-type syndromes, besides killing pain a little, even long-term.
Posted by Declan on September 22, 2005, at 15:15:33
In reply to Re: MAOI+Ritalin/Buprenorphine » cybercafe, posted by Chairman_MAO on September 22, 2005, at 10:20:40
People who have switched (are able to switch) from methadone to buprenorphine report losing a feeling of low grade depression and gaining motivation and clarity of mind.
I think.
I've never done it myself.
Declan (still on the ludicrously low dose of around 0.75mg/d methadone)
Posted by EERRIICC on September 23, 2005, at 20:45:19
In reply to Re: MAOI+Ritalin/Buprenorphine » EERRIICC, posted by Chairman_MAO on September 21, 2005, at 19:36:06
Thank you!
I live in Toronto but my doctor is a depression specialist at MGH in Boston. He will prescribe anything he believes has a chance of helping. I think you're right about the ritalin being too low but wouldn't higher doses just end up creating tolerence, and then the same situation would re-emerge? I'll try some concerta and start at 18mg. If that fails he wants to augment with oxycodone starting at 5mg twice a day and going up to 10mg t.i.d. (and then switching to oxycontin.) Buprenorphine felt bad at 1mg and 2mg, genuinely bad, this scares me does it mean I will not respond to the oxy? I also don't react well to taking a bunch (10-20) of over the counter 8mb codeine plus 15mg caffeine plus aspirin, any idea why? When I go higher than 120mg on parnate I get "weak" its strange, it doesen't feel to good at first either, I've never really given it a good effort though.
Eric
Posted by EERRIICC on September 23, 2005, at 20:53:27
In reply to Re: MAOI+Ritalin/Buprenorphine » cybercafe, posted by Chairman_MAO on September 22, 2005, at 10:20:40
What are you're thoughts on this drug, I've taken 40mg with paxil and nortrip. and it didn't synergise or really do much of anything. Could it really prevent stimulant poop-out or opiod tolerance. Could it synergise with parnate?
Eric
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