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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by AdamCanada2 on February 26, 2009, at 11:37:57
hi. i'm up to 25mg parnate + 5mg ritalin (4 times a day (20mg ritalin)), and some valium, and been trying risperidone 0.5-0.75mg and other times tried seroquel 25-50mg. both seemed to work well initially (except foggy mind, daytime sedation on seroquel) but would wear off quickly and it was around the time of raising from 20mg parnate to 25mg. the parnate increase gave substantial increase in mood very quickly but stronger fierce insomnia crept in.
today it has been 2 days with zero sleep.
my dose has been considered low by some but is due to often sensitivity of meds. i dont weigh a lot and have small frame. i even lost 17 pounds on this parnate + insomnia nonsense.
starting to really rethink what on earth to do.
higher dose parnate may be more benificial for mood/drive etc but this insomnia is unbelievable. never in my life has it been this bad yet the stimulation from parnate keeps me going somehow and my mind would sometimes just flow during the night in bed despite a somewhat dreadful feeling expecailly today.
is benadryl contradicted with parnate? does higher parnate dose trully over time lead to less insomnia. so many people with different theories. i'm strongly considering dropping down to 20mg. i've even tried a glass of wine + valium to attempt drowiness to make me sleep. didn't work one darn bit (even after 30 mins of taking risperidone).
pls offer any advice, any insight, anything at all. i think ill drop to 20mg today heck. and start taking seroquel again and just hope the daytime mind fog (stupidity) and daytime sedation will wear off. first day was easier sleep, quite a bit of daytime sedatin, 2nd day was less daytime sedation a bit but more mind fog.
Posted by AdamCanada2 on February 26, 2009, at 11:39:03
In reply to Parnate Insomnia too severe, Helppp, posted by AdamCanada2 on February 26, 2009, at 11:37:57
nt
Posted by myco on February 26, 2009, at 12:46:42
In reply to Parnate Insomnia too severe, Helppp, posted by AdamCanada2 on February 26, 2009, at 11:37:57
>...is benadryl contradicted with parnate? ne darn bit (even after 30 mins of taking risperidone).
>
> pls offer any advice, any insight, anything at all.
Hey again,Sorry about how you feel, I know the frustration.
OTC antihistamines for sleep are generally safe with maois:
1) DIPHENHYDRAMINE (i.e. benadryl, unisom, nytol)
-ok with maois just don't take massive doses as this antihistamine does have weak serotonagenic effects
2) DOXYLAMINE (i.e. Unisom-2, *Diclectin)
-more desireable than diphenhydramine (no/less seratoninagenic effects)
-studies show much more effective than diphenhydramine for sleep (I can vouch for this)
-unisom-2 is tough to find in Canada but it's here (i'm Canadian also and have bought it)
-if you wanna try it but can't find it, babble mail me
-*Diclectin is also readily available in Canada under rx. It's a med rx'd to pregnant women for morning sickness. Contains only doxylamine and vitamin B6. A dr would easily rx it for you for sleep if you can't find Unisom-2.3) PROMETHAZINE (i.e. *Histantil, Phenergan)
-supposedly (although I haven't tested YET (on the way)) better for sleep than other antihistamines
-very difficult to find in Canada
-phenergan is an old name - pharmacists will say ya thats long gone buddy
-*Histantil is a Canadian brand name of this produced only (in Canada) by a small company "Pharmascience Inc" based out of Montreal. I emailed them...currently sold out in Canada but will be back on March 17, 2009.
(email company for where to buy, cost, etc...Rosella Del Papa (nice lady): rdelpapa@pharmascience.com)
-try ordering through pharmacy also after that date
Other than the OTC antihistamines listed about you could investigate the herbal/supplement route (some are actually good Adam):-scullcap, hops, niacinamide, rhodiola, magnesium
myco
> is benadryl contradicted with parnate? ne darn bit (even after 30 mins of taking risperidone).
>
> pls offer any advice, any insight, anything at all.
Posted by Neal on February 26, 2009, at 19:33:01
In reply to Parnate Insomnia too severe, Helppp, posted by AdamCanada2 on February 26, 2009, at 11:37:57
your on to something with the benedryl, it is a sleep aide, check a good web PDR for any interactions with the parnate.
your also taking two meds that are known insomnia causing drugs, ritalin and respiridone.
Respiridone = Common side effects include akathisia, anxiety, insomnia, low blood pressure, muscle stiffness, muscle pain, sedation, sexual dysfunction, tremors, increased salivation, and stuffy nose.
Ritalin = The most common side effects of taking methylphenidate are nervousness and insomnia.
also ck the thread higher up on gabapentin.
Posted by JadeKelly on February 27, 2009, at 1:48:20
In reply to Parnate Insomnia too severe, Helppp, posted by AdamCanada2 on February 26, 2009, at 11:37:57
Seroquel. If that doesn't work, I'm gonna come and find you and knock you out myself.
Seriously tho, ask your PDoc about Seraquel. Its an atyp a/p but a lot of people are taking small doses, 25mg or so, for insomnia.
Don't quit!!! I am out of depression, Parnate and Ritalin. And yes a couple of sleepless nights. That will be over when you get to a therapeutic dose.
Good luck....don't quit now!!!
~Jade
Posted by desolationrower on February 27, 2009, at 3:13:35
In reply to Re: Parnate Insomnia too severe, Helppp » AdamCanada2, posted by Neal on February 26, 2009, at 19:33:01
i'd pick a short half life antihistamine, a long one you're just going to be tired all day, and get tolerance to the effect right quick.
-d/r
Posted by diego on February 27, 2009, at 10:35:06
In reply to Parnate Insomnia too severe, Helppp, posted by AdamCanada2 on February 26, 2009, at 11:37:57
I've had the same problem w/ Parnate. One obvious suggestion is taking your second dose no later than noon.
I used to take Xanax .5 mg for insomnia but the doc recommended temazepam (Restoril). I LOVE it!
30 mg doesn't knock you out, but allows for a full night's sleep w/ no fuzzy head the next morning like the Xanax did.I'm on 20 mg Parnate per day and may up to 30 mg. I'm wondering if that in itself will help with the insomnia? Seems counteruntuitive, but who knows?
Posted by Neal on February 27, 2009, at 16:51:36
In reply to Re: Parnate Insomnia too severe, Helppp, posted by diego on February 27, 2009, at 10:35:06
________________________
Diego;
Good to hear about your success with Restoril.
for others reading: It is in the benzo class of drugs. Meaning it can be hard to get off of for some.
Restoril (temazepam) should not be used by those with severe depression accompanied by suicidal tendencies, according to this info gleaned from the web:
(Quote)
"Use of temazepam should be avoided, when possible, in individuals with the following conditions:
* Ataxia
* Severe hypoventilation
* Acute narrow-angle glaucoma
* Severe hepatic deficiencies (hepatitis and liver cirrhosis decrease elimination by a factor of 2)
* Severe renal deficiencies (e.g. patients on dialysis)
* Severe sleep apnea
* Severe depression, particularly when accompanied by suicidal tendencies
* Acute intoxication with alcohol, narcotics, or other psychoactive substances
* Myasthenia gravis
* Hypersensitivity or allergy to any drug in the benzodiazepine class"
___________________________
Posted by AdamCanada2 on February 27, 2009, at 17:54:02
In reply to Re: Parnate Insomnia too severe, Helppp, posted by JadeKelly on February 27, 2009, at 1:48:20
Is Seroquel 25mg suppossed to better somehow for sleep than say 50mg.... 75mg... etc?
How long does it take for Parnate Insomnia on an increased dose to diminish? (I plan to go up again probably, this time even higher)
Today i slept maybe 11 hours after 2 days of zero sleep. I took risperidone for sleep and still have seroquel if that option is necessary and I imagine it will have to be if I go up to 30mg parnate.
Maybe this is just some withdrawl, maybe it was the longer than average amount of sleep but something is not right today. I dropped from 25mg parnate to this 20mg dose and after getting out of bed a sign of usually worsened mood for me is lack of color in my surroundings. Everything appears less colorful also I find it more difficult to talk to people. Anxiety over calling someone over the phone and so forth where before even during days of zero sleep and cognition compromised I would ''Want'' to actually speak to people. Also I feel less inclined, less motivated/interested in doing things generally.
This is not entirely unexpected. Going up to 25mg previously from 20mg gave me an extra boost in mood very swiftly but also a swift boost in insomnia. If I move up to 30mg Parnate or even higher how long should this ''therapeutic'' dose take? For me any time I raise a dose I notice improvement within the first day then it starts to level off.
But if I raise my dose the insomnia will be in full force again for someone whom has had pre-existing insomnia for over a decade.
Posted by diego on February 27, 2009, at 19:53:59
In reply to 20mg parnate, Dont feel the same, Update People, » JadeKelly, posted by AdamCanada2 on February 27, 2009, at 17:54:02
We're in the same boat as to whether an increase in dosage will diminish insomnia.
Prior to taking the Parnate I took part in a Phase II trial of a reversible MAOI. It had many of the same side effects as the Parnate, agitation chief among them. Helped with the depression, too. I think the dose was too high, but I wasn't allowed to lower it. Point is that it really helped with the insomnia, even though it had no sedative effect whatsoever.
So that's one reason to suspect that raising the dose of the Parnate may paradoxically decrease the insomnia.
Posted by JadeKelly on February 27, 2009, at 20:44:39
In reply to 20mg parnate, Dont feel the same, Update People, » JadeKelly, posted by AdamCanada2 on February 27, 2009, at 17:54:02
I started at 30mg. Had a nice euphoric 2nd week. Yes, there is insomnia on and off. The higher you go, the less insomnia. Mostly just at dosing time. 25mg seraquel should do it but see what your Doc says. You should treat insomnia aggresively. I've heard that over and over. Its not a free ride on your way out of depression. You just really have to find what works for insomnia. I got a new PDoc and then rapidly titrated to 80mg Parnate and 60mg Ritalin. I no longer have any insomnia.
Good Luck!
~Jade
Posted by myco on February 28, 2009, at 11:05:53
In reply to Re: 20mg parnate, Dont feel the same, Update People, » AdamCanada2, posted by JadeKelly on February 27, 2009, at 20:44:39
Hey Jade,
What dose did you see the insomnia start to really diminish?
Is the therpeutic dose max (if it is a max?) 30mg? and some of you par-na-teers are on 80?...what I mean is: is it acceptable to go way above 30mg in a dr's eyes? Partnate is in the relatively near future for me I think.thanks,
myco
> I started at 30mg. Had a nice euphoric 2nd week. Yes, there is insomnia on and off. The higher you go, the less insomnia. Mostly just at dosing time. 25mg seraquel should do it but see what your Doc says. You should treat insomnia aggresively. I've heard that over and over. Its not a free ride on your way out of depression. You just really have to find what works for insomnia. I got a new PDoc and then rapidly titrated to 80mg Parnate and 60mg Ritalin. I no longer have any insomnia.
>
> Good Luck!
>
> ~Jade
Posted by JadeKelly on February 28, 2009, at 16:46:11
In reply to Re: 20mg parnate...is 80mg ok? » JadeKelly, posted by myco on February 28, 2009, at 11:05:53
> Hey Jade,
>
> What dose did you see the insomnia start to really diminish?
> Is the therpeutic dose max (if it is a max?) 30mg? and some of you par-na-teers are on 80?...what I mean is: is it acceptable to go way above 30mg in a dr's eyes? Partnate is in the relatively near future for me I think.
>
> thanks,
> myco
>
>
> > I started at 30mg. Had a nice euphoric 2nd week. Yes, there is insomnia on and off. The higher you go, the less insomnia. Mostly just at dosing time. 25mg seraquel should do it but see what your Doc says. You should treat insomnia aggresively. I've heard that over and over. Its not a free ride on your way out of depression. You just really have to find what works for insomnia. I got a new PDoc and then rapidly titrated to 80mg Parnate and 60mg Ritalin. I no longer have any insomnia.
> >
> > Good Luck!
> >
> > ~Jade
>
>The old therapeutic range for Parnate was 30mg to 60mg. For many PDocs, a higher dose is used, and I believe the new recommended range is 40mg-80mg,
however, PDocs specializing in MAOI's can go much higher. In addition, they should be familiar with augmunting with Stims, and certain tca's. This is something I would NEVER try to do on my own or with an inexperienced PDoc. In answer to your question, paradoxicaly, I think it was around 50mg Parnate that not only did I not have insomnia, my head hit the pillow and I was gone. That was around the time my PDoc added ritalin also. Now, like today I slept in by accident, I didn't take my first dose of 40P and 30R until 11:30am, 2nd dose 4:30pm. I'm expecting I'll be up till 2am unless I intervene. I'm a night person anyway.It is not only expected to go above 30mg Parnate its likely. Maybe your one of the very few that will respond to a small dose. Don't count on it. I wouldn't be on Parnate if I had to stay at 30mg.
Some PDocs are afraid of MAOI's. I looked carefully in my area for a well know PDoc who specialized in MAOI's and the experience to augment with stims or tca's if needed. If your PDoc doesn't have these qualifications, or you are uncomfortable sticking with such a program until remission, I would say this is not the med for you. What concerns me is that insomnia, etc seems to the deciding factor. I was so deeply depressed, I would have put up with just about any side effect to get to remission, if I believed it was waiting if I was patient. And it was. You're going to have s/e's with any a/d. How depressed are you? Parnate is the kind of med that you just have to decide. Am I going to do this or not. You can't keep questioning yourself or you'll go nuts. Why are you taking risperidone?
I would strongly advise waiting for a higher dose, 40-50mg before augmenting.As an aside: Insomnia is such a non-issue for me that I'm tapering off Klonopin and don't even notice. In the last few weeks I've gone from 3mg day to 1.5 mg per day. This was my idea not PDoc's.
Good luck!
~Jade
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