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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by uncouth on October 23, 2008, at 10:44:06
Hi, I was advised to ask this question again as I didn't get too many responses when I asked two weeks ago.
I'm currently taking 40mg of Parnate and took Emsam in the past, and did well on Emsam but the anxiety was too much to handle. Anxiety has been better on Parnate and overall I like it better, but I have done lots of research on selegiline and know it to have some very unique neuroprotective and neurotrophic properties, independent of it's MAO-B inhibition, that Parnate may not have.I'd like to add a very low dose of oral selegiline (tablets) to my daily dose of Parnate. Is this is a safe thing to do? I was thinking 2.5mg. I realize I could simply increase my dose of Parnate, but I've had bad orthostatic hypotension on higher doses, and am looking to take the additional selegiline as a neuroprotectant and to improve residual anhedonia.
I'd love feedback on this idea. Is 2.5mg daily enough to make a difference? Is it too much? Is daily dosing necessary? Will this screw with Parnate? If 2.5mg is enough to have an affect on MAO-B, does that mean the dose of Parnate will be more biased towards MAO-A inhibition?
Or is this just a bad idea at any dose?
Would liquid selegiline (cyprenil) be a better choice, as as far as I know, it doesn't convert into amphetamine like oral selegiline does....right?
Posted by uncouth on October 26, 2008, at 10:08:13
In reply to MAOI Experts: Combining Parnate with Selegiline, posted by uncouth on October 23, 2008, at 10:44:06
anyone? bueller????
Posted by Ant-Rock on October 27, 2008, at 20:30:40
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by uncouth on October 26, 2008, at 10:08:13
> anyone? bueller????
I have some info on this for you,
but as i'm falling asleep right now, I'll get back to you as soon as I can.Anthony
Posted by Ant-Rock on October 28, 2008, at 18:59:21
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by uncouth on October 26, 2008, at 10:08:13
> anyone? bueller????
Back in 1999, I corresponded with a woman who finally beat trd with a combination of 30mg parnate and 40mg eldepryl.
The Dr. she worked with was out of Atlanta, Georgia.
I hope this helps.
Anthony
Posted by Questionmark on October 30, 2008, at 15:53:51
In reply to MAOI Experts: Combining Parnate with Selegiline, posted by uncouth on October 23, 2008, at 10:44:06
I'm not sure as to the risk factor. I would say that if you take in a manner that is converted into the amphetamine metabolites it could very well be particularly risky, unless 2.5 mg is too low a dose to be cause problems. Otherwise-- and I'm not sure but-- I would guess that 2.5mg of selegeline, if not converted to amphetamines, would be safe.
Also, I definitely don't think Parnate would be biased toward MAO-A inhibition. You will just have more MAO-B inhibition.
I would also say, from what i remember reading, that 2.5mg selegeline is enough to have some neuroprotective benefit. Whether it will be clinically helpful so to speak you could only know by trying. It could be helpful or it could be , detrimental or increase side-effects.
Needless to say, be very very careful, and if possible get your pdoc's advice on this (though i imagine he or she would just say "don't do it").
> Hi, I was advised to ask this question again as I didn't get too many responses when I asked two weeks ago.
> I'm currently taking 40mg of Parnate and took Emsam in the past, and did well on Emsam but the anxiety was too much to handle. Anxiety has been better on Parnate and overall I like it better, but I have done lots of research on selegiline and know it to have some very unique neuroprotective and neurotrophic properties, independent of it's MAO-B inhibition, that Parnate may not have.
>
> I'd like to add a very low dose of oral selegiline (tablets) to my daily dose of Parnate. Is this is a safe thing to do? I was thinking 2.5mg. I realize I could simply increase my dose of Parnate, but I've had bad orthostatic hypotension on higher doses, and am looking to take the additional selegiline as a neuroprotectant and to improve residual anhedonia.
>
> I'd love feedback on this idea. Is 2.5mg daily enough to make a difference? Is it too much? Is daily dosing necessary? Will this screw with Parnate? If 2.5mg is enough to have an affect on MAO-B, does that mean the dose of Parnate will be more biased towards MAO-A inhibition?
>
> Or is this just a bad idea at any dose?
>
> Would liquid selegiline (cyprenil) be a better choice, as as far as I know, it doesn't convert into amphetamine like oral selegiline does....right?
Posted by JadeKelly on October 31, 2008, at 0:24:39
In reply to Re: MAOI Experts: Combining Parnate with Selegiline » uncouth, posted by Questionmark on October 30, 2008, at 15:53:51
Just a bad idea at any dose, imo. One MAOI seems risky enough, mixing 2 which is a big no-no? I was on the emsam patch, no problems. Switched to Parnate, it works but I doubt it should be played with.
I'm not an expert, but I was great on Parnate (alone) for 11 days, full response. 11th day bad hypertensive crisis out of nowhere. I'm anal about the food/drug restricts. I, too, had low BP until "the spike".
After that, went back on assuming it was random food mistake. I had BP up to 190 after every dose.
I took 30mg in morn. When I split them, spike after 3rd dose.My point is, Parnate isnt a drug to mess around with. I read somewhere that not only could small amount of amphetimine cause HT crisis, but also bleeding in the skull. Ouch. Even just the mix of 2 MAOI's could cause HT crisis. I can tell you likely havent had one...scary and dangerous.
If you do this, please do it with close supervision, get antidote ready, and get BP cuff. Now I take nifedipine before my 30mg dose, and no more spikes. Not sure I can stay on it more than 10 days. Up to pdoc as I don't know anything about the antidotes out there. I'd hate to give Parnate up but may have to.
Be careful and good luck. Post re: your decision, and results if you go with it!
Jade
Posted by uncouth on October 31, 2008, at 6:55:39
In reply to Re: MAOI Experts: Combining Parnate with Selegiline, posted by JadeKelly on October 31, 2008, at 0:24:39
been testing this out. no problems at 2.5mg, no problems at 5mg. this is with 40-50mg of parnate, for a 200lb male.
however, did feel a little too overdriven at 5mg, so likely would rather increase my parnate and take 0mg of selegiline than combine the two, although i may try even a lower dose for neuroprotection, 1.25mg daily. 5mg was definitely too much.
Posted by JadeKelly on October 31, 2008, at 10:22:31
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by uncouth on October 31, 2008, at 6:55:39
> been testing this out. no problems at 2.5mg, no problems at 5mg. this is with 40-50mg of parnate, for a 200lb male.
>
> however, did feel a little too overdriven at 5mg, so likely would rather increase my parnate and take 0mg of selegiline than combine the two, although i may try even a lower dose for neuroprotection, 1.25mg daily. 5mg was definitely too much.Wow, you already did it! Probably no precautions (or permission) either! Men. If I did that I'd be dead.
So do you think wieght makes difference? 125lbs and 30mg Parnate did a number on me. I thought it had more to do with the interactions tho. I'm stickin with it, as pdoc added the antidote.
If your lookin for augmentation, I'd stick with Parnate and increase dose. My reaction to Parnate started on 11th day, and didnt stop till "Nifedipine". I'm feeling the Parnate again.
Oh, btw, You didn't feel any "benefit" to adding seleligine? I agree it'd be nice to have that protection and longer life, but I've read that the dose has to be low, there's a bell curve at which it can actually shorten your life span. I believe the studies were done with mice and another with dogs. Sorry I don't have the info. It was very low dose at any rate.
If you don't mind, how long have you been on Parnate, how many increases, is it losing its effect?
Hope to hear from you and good luck with those "trials"!
Jade
Posted by uncouth on October 31, 2008, at 10:27:59
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by JadeKelly on October 31, 2008, at 10:22:31
Well, I've been on parnate for two months. I moved to 40mg of parnate from 90 mg of Nardil which wasn't working (though I only gave the nardil 90mg for about a week and a half). I had bad side effects on Nardil. however, my pdoc did a overnight switch to 40mg of parnate, so I think the nardil effects were still somehow in my system for a week or two, as I had really bad side effects (orthostatic hypotension) at 40mg. That eventually went away after about three weeks, though I admit my mood was the best when i had the physical side effects.
Thats why i'm going back up to 50mg of parnate, and maybe 60. I think at 40 i definitely feel something and it is helpful, but it is only partial, i do feel a bit of a poop out.
I'm also on abilify and lithium. The abilify did help with the obsessive thoughts when i added it to parnate. I'm taking it at 5mg which seems to be the standard for a/d augmentation, though 10mg and 2mg are also used. It's a weird drug but I think it's worth every penny.
Posted by JadeKelly on October 31, 2008, at 11:51:29
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by uncouth on October 31, 2008, at 10:27:59
> Well, I've been on parnate for two months. I moved to 40mg of parnate from 90 mg of Nardil which wasn't working (though I only gave the nardil 90mg for about a week and a half). I had bad side effects on Nardil. however, my pdoc did a overnight switch to 40mg of parnate, so I think the nardil effects were still somehow in my system for a week or two, as I had really bad side effects (orthostatic hypotension) at 40mg. That eventually went away after about three weeks, though I admit my mood was the best when i had the physical side effects.
>
> Thats why i'm going back up to 50mg of parnate, and maybe 60. I think at 40 i definitely feel something and it is helpful, but it is only partial, i do feel a bit of a poop out.
>
> I'm also on abilify and lithium. The abilify did help with the obsessive thoughts when i added it to parnate. I'm taking it at 5mg which seems to be the standard for a/d augmentation, though 10mg and 2mg are also used. It's a weird drug but I think it's worth every penny.Its always strange what pdocs will do. Seems its way over the top, or their stingy to the point of not being effective. I've only had one but I've read a lot of stories here. How strange that he would switch you overnight.
Like you, some of my best days on Parnate are full of side effects! Ex: I've been up all night and here I am, babbling on...:). Insomnia plagued me the first time around but only for a few days. I suspect it will be gone soon. I always have to laugh when I see a poster who ditches an effective dose of MAOI because of the diet! Maybe its just me, but I'd eat blueberries all day if this depression would go away!
Well I'm sorry to hear your Nardil & Parnate aren't what they were, but you got me thinking about weight. Do you know if MAOI dose is at all based on that? Because if it is, I started at 30mg, and you're only at 40? Seems you may have plenty of room to go up.
I know someone who was on abilify for Bi-Polar, his dose would have been much larger than yours but he was a walking zombie on that stuff. He went from slim to a 25lb weight gain. He's great now, on 30mg of seraquel, he lost about 1/2 the weight and acts like himself.
I have to say I'm surprised that Abilify would enhance an AD. Doesnt it block dopamine, especially for mania? Maybe its the low dose?
Sorry for the lengthy post. I blame it ALL on Parnate. Good luck to us, heh?!
Jade
Posted by Questionmark on October 31, 2008, at 17:31:41
In reply to Re: MAOI Experts: Combining Parnate with Selegilin, posted by JadeKelly on October 31, 2008, at 11:51:29
"Its always strange what pdocs will do. Seems its way over the top, or their stingy to the point of not being effective."
Hah, well said. That So often seems to be the case. Yeah, going from Nardil straight to Parnate the very next day is Not a good idea, even only being on it for a week and a half. They are entirely different drugs. But of course i'm sure the dr just assumed (note: change dialect) "Well this hEre's an MAOI, and this HERE's an MAOI, so it must be fine to switch the two right away." I mean, i'm glad s/he's willing to use MAOIs, but come on.
And why the h*ll would s/he start uncouth on 90mg of Nardil within the first two weeks?? Of COURSE a person's gonna have bad side effects!! You know, i swear to god there are a number of PsychoBabble posters here who would be better psychiatrists than the average one out there-- including myself, i believe (maybe not w/ all the paperwork and all the other b.s. that probably goes with it, but in terms of helping people better their lives and their psychological well-being, absolutely). Where do these guys come from?? What do they actually Learn in Medical School for !@#$'s sake?
I guess it just illustrates how there's only so much you can learn conceptually compared to experientially.
Well, real quick, all you current or future psychiatrists out there (and other medical doctors for that matter), lesson #1 in Questionmark's "Clinical Psychiatry" course: *Always remember that whatever you have read or been taught about a drug's effects only goes so far without actually having had experienced the effects first-hand.*
Okay that's not exactly completely relevant to the example here with uncouth's pdoc, but, it is very very often relevant. .. Ok i'm an idiot. Sorry for ranting.
Anyway, uncouth, best of luck with the Parnate, but if it happens to not work for you, please don't hesitate to try Nardil once again except at a lower dose-- like 45 or 60mg. I would say everyone should always start with a maintained dose of 45mg for at least a month, with Nardil, until trying to determine if you might need a higher dose.
Be well.
> > Well, I've been on parnate for two months. I moved to 40mg of parnate from 90 mg of Nardil which wasn't working (though I only gave the nardil 90mg for about a week and a half). I had bad side effects on Nardil. however, my pdoc did a overnight switch to 40mg of parnate, so I think the nardil effects were still somehow in my system for a week or two, as I had really bad side effects (orthostatic hypotension) at 40mg. That eventually went away after about three weeks, though I admit my mood was the best when i had the physical side effects.
> >
> > Thats why i'm going back up to 50mg of parnate, and maybe 60. I think at 40 i definitely feel something and it is helpful, but it is only partial, i do feel a bit of a poop out.
> >
> > I'm also on abilify and lithium. The abilify did help with the obsessive thoughts when i added it to parnate. I'm taking it at 5mg which seems to be the standard for a/d augmentation, though 10mg and 2mg are also used. It's a weird drug but I think it's worth every penny.
>
> Its always strange what pdocs will do. Seems its way over the top, or their stingy to the point of not being effective. I've only had one but I've read a lot of stories here. How strange that he would switch you overnight.
>
> Like you, some of my best days on Parnate are full of side effects! Ex: I've been up all night and here I am, babbling on...:). Insomnia plagued me the first time around but only for a few days. I suspect it will be gone soon. I always have to laugh when I see a poster who ditches an effective dose of MAOI because of the diet! Maybe its just me, but I'd eat blueberries all day if this depression would go away!
>
> Well I'm sorry to hear your Nardil & Parnate aren't what they were, but you got me thinking about weight. Do you know if MAOI dose is at all based on that? Because if it is, I started at 30mg, and you're only at 40? Seems you may have plenty of room to go up.
>
> I know someone who was on abilify for Bi-Polar, his dose would have been much larger than yours but he was a walking zombie on that stuff. He went from slim to a 25lb weight gain. He's great now, on 30mg of seraquel, he lost about 1/2 the weight and acts like himself.
>
> I have to say I'm surprised that Abilify would enhance an AD. Doesnt it block dopamine, especially for mania? Maybe its the low dose?
>
> Sorry for the lengthy post. I blame it ALL on Parnate. Good luck to us, heh?!
>
> Jade
Posted by JadeKelly on November 1, 2008, at 11:30:08
In reply to MAOIs, and PDoc Rant » JadeKelly, posted by Questionmark on October 31, 2008, at 17:31:41
Haha,
So true. Sad but true. Every med my pdoc has prescribed for me over the past few years, that was at ALL effective, I asked for. Geuss how I knew to ask for it. This sight! I'm not an idiot, I always check other sources, but c'mon...If my symptoms match someone elses, and they suddenly have great success, I'm gonna be asking a lot of questions. I cant take ssri's, or any other AD's for that matter, except for MAOI's, and I'm onto MAOI's ONLY because I insisted from pdoc. They worked almost immediately. Emsam & Parnate (not together). Now, even if Parnate poops out, seems at least I have more insight re: my condition.Btw, anyone else ever tempted to become a pdoc, just so we can make sense of all this? Mine sees me for 15 minutes and has more than once messed up script instructions. Was not too careful with handing out the MAOI's either. I know, I asked for them, but would have been nice to get the food list, what to do in case of HT crisis, etc. In hind sight, 15 minutes is not long enough to instruct a first time user regarding safety issues, etc. Geuss I should should be glad he was willing to prescribe them.
How's that for a rant??? Sorry to hi-jack your post uncouth. Good luck!
Posted by uncouth on November 2, 2008, at 9:53:33
In reply to MAOIs, and PDoc Rant » JadeKelly, posted by Questionmark on October 31, 2008, at 17:31:41
just want to make clear that my pdoc didn't start me on nardil at 90mg within two weeks. i believe i started at 30 and went up to 60 for a few weeks before going to 90 for 1.5 weeks.
i do think the switchover was potentially not the best idea in terms of side effects, but i'm guessing i gave up on nardil probably just as it was kicking in, because when i went to parnate, i felt the response within a day or two. i likely was probably getting near 100% MAO inhibition for a while due to the high dose of nardil, then switching to parnate, and over time, the lower equivalent dose of parnate (40mg equates to 60mg of nardil) likely caused teh % inhibition to actually go down, so side effects went away, but mood also wasn't as great as it was when the side effects were in full force.
i'm planning on going back up to 60mg of parnate which equates to 90mg of nardil, so hopefully this time i'll get the mood benefits without the major side effects.
nardil would have been fine long term, except for the terrible side effects. i'm happy with parnate, it feels much better than emsam did. emsam was far too speedy and anxiety inducing, but who knows perhaps if parnate ever poops out i'd consider emsam again, this time with some abilify to help with the anxiety.
all i know is, these MAOIs are great. i feel closer to well than i ever have, and feel like the only thing that's left int erms of mood and behavior and life are things that can be done with psychotherapy and behavioral changes. rejection sensitivity is still pretty bad, but i'm guessing that's more of a learned behavior from years of depression, and i'm hoping that now that i'm on a solid a/d regime, i won't be as sensitive to rejection. at least that's the theory.
compared to effexor and cymbalta, parnate and the MAOIs have given me far more self control, they have helped attention and motivation an anhedonia, they haven't exacerbated cravings for alcohol and carbs and obsessively using the internet like effexor did. it's a shame more doctor's don't prescribe MAOIs, and parnate and nardil should really come in a patch form too, as i think they are superior meds to selegiline.
all i know is i never ever want to go back on an SSRI. i have bp2 tendencies and while I felt great on effexor for a few weeks, the compulsiveness and acting without thinking and feeling of bliss seemed extremely artificial. the MAOIs feel much more natural, and ironically although parnate has some stimulant properties, in terms of speed and expansiveness of thought, is far less 'speedy' in that sense than effexor was.
i just wish i could sleep well :(
and wasn't so hungry. parnate (or abilify, i dont know which) makes me hungry.anyway, hope this helps. i decided not to do the selegiline thing. probably too dangerous. maybe will try a tiny dose every few days for neuroprotection and antioxidant benefits. seems like even 1mg daily can work, and at that dose i won't likely feel anything.
-uncouth
Posted by JadeKelly on November 2, 2008, at 14:06:42
In reply to Re: MAOIs, and PDoc Rant, posted by uncouth on November 2, 2008, at 9:53:33
> just want to make clear that my pdoc didn't start me on nardil at 90mg within two weeks. i believe i started at 30 and went up to 60 for a few weeks before going to 90 for 1.5 weeks.
Hi Uncouth!
Don't know anything about Nardil starting dose, just sounded a little reckless to switch MAOI's overnight. But sounds like your getting thru it.
>
> i do think the switchover was potentially not the best idea in terms of side effects, but i'm guessing i gave up on nardil probably just as it was kicking in, because when i went to parnate, i felt the response within a day or two. i likely was probably getting near 100% MAO inhibition for a while due to the high dose of nardil, then switching to parnate, and over time, the lower equivalent dose of parnate (40mg equates to 60mg of nardil) likely caused teh % inhibition to actually go down, so side effects went away, but mood also wasn't as great as it was when the side effects were in full force.Is the idea to reach 100% MAO inhibition? or no?
>
> i'm planning on going back up to 60mg of parnate which equates to 90mg of nardil, so hopefully this time i'll get the mood benefits without the major side effects.Parnate side effects were very tolerable for me, other than HT episode. Got that under control now.
>
> nardil would have been fine long term, except for the terrible side effects. i'm happy with parnate, it feels much better than emsam did. emsam was far too speedy and anxiety inducing, but who knows perhaps if parnate ever poops out i'd consider emsam again, this time with some abilify to help with the anxiety.Don't know if I mentioned before, I was on Emsam and responded just like Parnate. No anxiety. I have to say, it felt safer to me also. But since I had to go to 9mg anyway, it semed a good choice to switch to Parnate, $10 a month!!
>
> all i know is, these MAOIs are great. i feel closer to well than i ever have, and feel like the only thing that's left int erms of mood and behavior and life are things that can be done with psychotherapy and behavioral changes. rejection sensitivity is still pretty bad, but i'm guessing that's more of a learned behavior from years of depression, and i'm hoping that now that i'm on a solid a/d regime, i won't be as sensitive to rejection. at least that's the theory.I'm really happy for you! Hope you can stay on Parnate, if not there are other choices at least. Did you say how long you've been responding to MAOI(s)? I'm always afraid it will stop working.
Or in my case, not start again.
>
> compared to effexor and cymbalta, parnate and the MAOIs have given me far more self control, they have helped attention and motivation an anhedonia, they haven't exacerbated cravings for alcohol and carbs and obsessively using the internet like effexor did. it's a shame more doctor's don't prescribe MAOIs, and parnate and nardil should really come in a patch form too, as i think they are superior meds to selegiline.You are probably right, depending on the person.
>
> all i know is i never ever want to go back on an SSRI. i have bp2 tendencies and while I felt great on effexor for a few weeks, the compulsiveness and acting without thinking and feeling of bliss seemed extremely artificial. the MAOIs feel much more natural, and ironically although parnate has some stimulant properties, in terms of speed and expansiveness of thought, is far less 'speedy' in that sense than effexor was.Surprised Parnate doesn't activate mania. I'm with you re: the ssri's. 3-4 days and they make me feel crazy. No extra seratonin need here please!
>
> i just wish i could sleep well :(
> and wasn't so hungry. parnate (or abilify, i dont know which) makes me hungry.I can almost say with certianty its the Abilfy. Known for weight gain. Be careful with that, I've seen it happen twice, very quickly (weight Gain). Parnate is known for weight loss, typically.
>
> anyway, hope this helps. i decided not to do the selegiline thing. probably too dangerous. maybe will try a tiny dose every few days for neuroprotection and antioxidant benefits. seems like even 1mg daily can work, and at that dose i won't likely feel anything.I believe you can just take a drop daily, liquid form, I'd ask Pdoc 1st of course. I don't think it would be safe to take enough to augment Parnate, and it may lose its neuroprotective properties at that dose.
> -uncouth
Be well! Jade
This is the end of the thread.
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