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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ColoradoSnowflake on August 1, 2009, at 22:02:15
Hi Scott:
I'm really happy you are feeling so well!! It's a good thing especially since so many of us on PB are needing your input and support!!First, I'm really liking Parnate! I'm so glad to have gotten over my fears and gone for it!! It works better than any of the tons of other ADs I've tried. Thanks so much to you and other PBers.
OK, I'm having a few problems: fatigue, insatiable carb hunger and poor sleep.
It was amazing..the Parnate and the Amytriptyline together took away my hunger!! I'm not kidding!! even though I was really really tired (which usually kicks in my emotional eating) I was rarely hungry. Yay yay! and the sleep was great. Yay yay
But now on the Nortriptyline (12 1/2mg) I am FAMISHED constantly for carbohydrates. Yuk. That's why I didn't stay on the nortrip the last time. I have a lot of self discipline, but this is awful. I feel like I could eat my own arm. Help!
I stopped the Provigil for 5 days to see how much fatigue was strictly from the Parnate itself since I wasn't taking any amytriptyline any more. Well, I'm fairly tired. Not NEARLY as bad as on the amytrip. Taking the Provigil should pretty much take care of the Parnate fatigue. (I was hoping I could do without it since it's so pricey). So I will take the Provigil.
Hunger. Could I take even less Nortriptyline? Or, what would taking more Parnate do? I'm at 50mg/day. When I went to 60mg several weeks ago it was really too much. Now that I've been on the 50mg for several weeks maybe I could go up to 60mg if you think that would be beneficial? Do you think more Parnate would counteract the Nortrip hunger?
Sleep. I miss that wonderful amytriptyline sleep!! It's the best! But not worth the hangover fatigue. Off of it, at first I didn't sleep at all, but now I do sleep. I wake up a time or two but I can go back to sleep. But, I'm still tired in the morning even after 7 hours sleep. I don't think I sleep deeply nor do I dream. Would more Parnate give me insomnia which I really don't have now?? I've tried Ambien (hangover), Ativan (hangover) and klonipin (no sleep, just depression). Help! Please don't tell me that sleep deprivation is part of Parnate's power!!
Another thing. Do you find Parnate to be inconsistent? Like a couple of days its working real well, then a day not? for no apparent reason? Just wondering.
So Scott, what do you think? You really know what you're talking about with these drugs (most docs don't) and I greatly appreciate your time, attention and expertise!! Any comments, experience, suggestions, hunches etc. would be greatly appreciated!! I think I could feel quite a bit better.
Thank you, thank you!!!
gayle50mg Parnate
200mg Provigil
12 1/2mg Nortriptyline
Posted by Phillipa on August 2, 2009, at 0:06:57
In reply to Scott - More help with Parnate + Augmentation, posted by ColoradoSnowflake on August 1, 2009, at 22:02:15
Just wanted to say so glad your're doing so well congrat!!!! Phillipa
Posted by SLS on August 2, 2009, at 6:41:13
In reply to Scott - More help with Parnate + Augmentation, posted by ColoradoSnowflake on August 1, 2009, at 22:02:15
Hi Gayle
> OK, I'm having a few problems: fatigue, insatiable carb hunger and poor sleep.I don't think you ought to try to correct all of these problems at once. The Provigil might help with the daytime sleepiness. You can keep that. However, you might find that this problem mitigates over time. On the flip side, you might find that Provigil helps the depression, too. Either way, you might want to try coming off the Provigil at some point as an experiment. Regarding the insatiable hunger, that might dissipate a great deal once you begin to titrate the nortriptyline closer to a therapeutic dosage, which can be 50-100mg. Most people end up at 75mg. At too low a dosage, the antihistamine (H1) properties probably predominate over the NE reuptake inhibition. Try going up to 25mg. It might even help with sleep.
> Please don't tell me that sleep deprivation is part of Parnate's power!!
I am quite sure that it is not. Although I usually look at insomnia as a good prognosis phenemonon, it does not have to be present for Parnate to work. You might need to take a sleep aid at some point. Chronic sleep deprivation is counterproductive, I believe. You might catch a buzz after a single night's sleep deprivation, but that trick doesn't work on consecutive nights. The thing that might contribute to the therapeutic effect is the suppression of REM sleep.
> Another thing. Do you find Parnate to be inconsistent? Like a couple of days its working real well, then a day not? for no apparent reason? Just wondering.Your recovery from depression will not be a steady one. Expect periodic worsenings. However, the goal is to establish a trend towards further improvement. Going up to 60mg of Parnate sounds good to me. I'm just not sure when would be the best time to attempt this. You probably will have no problem handling the higher dosage, but you might as wait awhile so you can see what the higher dosages of nortriptyline do for you.
- Scott
Posted by bulldog2 on August 2, 2009, at 12:49:02
In reply to Scott - More help with Parnate + Augmentation, posted by ColoradoSnowflake on August 1, 2009, at 22:02:15
> Hi Scott:
> I'm really happy you are feeling so well!! It's a good thing especially since so many of us on PB are needing your input and support!!
>
> First, I'm really liking Parnate! I'm so glad to have gotten over my fears and gone for it!! It works better than any of the tons of other ADs I've tried. Thanks so much to you and other PBers.
>
> OK, I'm having a few problems: fatigue, insatiable carb hunger and poor sleep.
>
> It was amazing..the Parnate and the Amytriptyline together took away my hunger!! I'm not kidding!! even though I was really really tired (which usually kicks in my emotional eating) I was rarely hungry. Yay yay! and the sleep was great. Yay yay
>
> But now on the Nortriptyline (12 1/2mg) I am FAMISHED constantly for carbohydrates. Yuk. That's why I didn't stay on the nortrip the last time. I have a lot of self discipline, but this is awful. I feel like I could eat my own arm. Help!
>
> I stopped the Provigil for 5 days to see how much fatigue was strictly from the Parnate itself since I wasn't taking any amytriptyline any more. Well, I'm fairly tired. Not NEARLY as bad as on the amytrip. Taking the Provigil should pretty much take care of the Parnate fatigue. (I was hoping I could do without it since it's so pricey). So I will take the Provigil.
>
> Hunger. Could I take even less Nortriptyline? Or, what would taking more Parnate do? I'm at 50mg/day. When I went to 60mg several weeks ago it was really too much. Now that I've been on the 50mg for several weeks maybe I could go up to 60mg if you think that would be beneficial? Do you think more Parnate would counteract the Nortrip hunger?
>
> Sleep. I miss that wonderful amytriptyline sleep!! It's the best! But not worth the hangover fatigue. Off of it, at first I didn't sleep at all, but now I do sleep. I wake up a time or two but I can go back to sleep. But, I'm still tired in the morning even after 7 hours sleep. I don't think I sleep deeply nor do I dream. Would more Parnate give me insomnia which I really don't have now?? I've tried Ambien (hangover), Ativan (hangover) and klonipin (no sleep, just depression). Help! Please don't tell me that sleep deprivation is part of Parnate's power!!
>
> Another thing. Do you find Parnate to be inconsistent? Like a couple of days its working real well, then a day not? for no apparent reason? Just wondering.
>
> So Scott, what do you think? You really know what you're talking about with these drugs (most docs don't) and I greatly appreciate your time, attention and expertise!! Any comments, experience, suggestions, hunches etc. would be greatly appreciated!! I think I could feel quite a bit better.
>
> Thank you, thank you!!!
> gayle
>
> 50mg Parnate
> 200mg Provigil
> 12 1/2mg Nortriptyline
>
>I'm not Scott but one poster who was held in high esteem here for her parnate knowledge used ritalin as a supreme augmentor. However that would not solve your sleep problems but would solve your hunger problems.
There's another tca desipramine that is very good at blocking reuptake of norepinephrine and will not give you carb craving. Will not help with sleep.
Seroquel helps some with parnate sleep problems. I did not like it personally because it seemed to block the ad effects of parnate for me. However some love it.
Now there's strattera that works on norepinephrine. However not sure if it can be used with parnate.
Good luck and may God be with you on your journey to happiness.
Posted by SLS on August 2, 2009, at 14:33:04
In reply to Re: Scott - More help with Parnate + Augmentation, posted by bulldog2 on August 2, 2009, at 12:49:02
It is unfortunate that we don't all respond to the same drugs. For me, Parnate + Ritalin did absolutely nothing except to make me a little irritable. Dexedrine had a much more pronounced antidepressant effect.
I had more of a problem with Parnate + desipramine as far as disturbed sleep is concerned. Unfortunately, that is no longer the case. The stuff would probably work again if it did. It doesn't even prevent me from dreaming any more.
I think Strattera is almost worthless for depression unless the depression is comorbid with ADD. It just doesn't hit the right targets.
- Scott
Posted by ColoradoSnowflake on August 2, 2009, at 16:09:42
In reply to Re: Scott - More help with Parnate + Augmentation » ColoradoSnowflake, posted by SLS on August 2, 2009, at 6:41:13
> Hi Gayle
>
> > OK, I'm having a few problems: fatigue, insatiable carb hunger and poor sleep.
>
> I don't think you ought to try to correct all of these problems at once. The Provigil might help with the daytime sleepiness. You can keep that. However, you might find that this problem mitigates over time. On the flip side, you might find that Provigil helps the depression, too. Either way, you might want to try coming off the Provigil at some point as an experiment. Regarding the insatiable hunger, that might dissipate a great deal once you begin to titrate the nortriptyline closer to a therapeutic dosage, which can be 50-100mg. Most people end up at 75mg. At too low a dosage, the antihistamine (H1) properties probably predominate over the NE reuptake inhibition. Try going up to 25mg. It might even help with sleep.
>
> > Please don't tell me that sleep deprivation is part of Parnate's power!!
>
> I am quite sure that it is not. Although I usually look at insomnia as a good prognosis phenemonon, it does not have to be present for Parnate to work. You might need to take a sleep aid at some point. Chronic sleep deprivation is counterproductive, I believe. You might catch a buzz after a single night's sleep deprivation, but that trick doesn't work on consecutive nights. The thing that might contribute to the therapeutic effect is the suppression of REM sleep.
>
> > Another thing. Do you find Parnate to be inconsistent? Like a couple of days its working real well, then a day not? for no apparent reason? Just wondering.
>
> Your recovery from depression will not be a steady one. Expect periodic worsenings. However, the goal is to establish a trend towards further improvement. Going up to 60mg of Parnate sounds good to me. I'm just not sure when would be the best time to attempt this. You probably will have no problem handling the higher dosage, but you might as wait awhile so you can see what the higher dosages of nortriptyline do for you.
>
>
> - Scott
>Hi Scott:
Thanks so much for the ideas, explanations and suggestions! It all makes a lot of sense. I am always trying too many things at once, too soon, too much, and then don't have a clue!
The Provigil works very well. Today I am trying the Nuvigil and can already see it doesn't last as long for starters. But for free, I'm happy to have it. I do think the Provigil augments the Parnate's AD qualities! So that's good! And I'm not tired on it, until the end of the day when I really drag, but that's OK.
I'll up the Nortriptyline to 25mg tonight. What a relief that will be not having to cut those little capsules full of powder in half! I pray it doesn't double my carb hunger!! It would be great if it helps me sleep. It will be interesting to see. Should I take it at bedtime or a little earlier? How long is the half life?
I'll stick with 50mg Parnate. I'm confused about when to take it. Does it matter? I've been taking 30mg a.m., then 20mg about 2pm. I tried all 50mg. in the a.m. and that was a BAD idea to do that and then exercise. I fell down once (a little fall) and scared my classmates. I was dizzy a lot because of leaning over so much as part of the exercises. I did fall out my backdoor but don't know if it was the Parnate or the thongs. I'm not getting rid of either one!
Do you think that dosing is ok? I like the 30mg. in the morning because that plus coffee plus Provigil gets me going!Thanks for the reminder that I wont be 100% overnight. I'm like Lucy (Peanuts) and want "Ups and ups and more ups!" Right now!
I really am very grateful to feel as much better as I do!Thanks again Scott!! It is so great to have your experience, expertise and willingness to help us on this forum!!
gayle
Posted by ColoradoSnowflake on August 2, 2009, at 16:56:34
In reply to Re: Scott - More help with Parnate + Augmentation, posted by bulldog2 on August 2, 2009, at 12:49:02
Hi Bulldog2:
Thanks so much for sharing your ideas! I really appreciate it.
Ritalin and I don't get along. It makes me tired and depressed. Too bad because I have a bunch of it and that darn Provigil is SO expensive!
I think I'll stick with the three things I'm on now: Parnate, Nortriptyline and Provigil until I've given them a good run.
If the Nortriptyline helps me sleep I'll be in good shape I think, as long as the carb craving isn't too bad.Thanks again,
gayle
Posted by bulldog2 on August 2, 2009, at 17:28:31
In reply to Re: Scott - More help with Parnate + Augmentation » bulldog2, posted by ColoradoSnowflake on August 2, 2009, at 16:56:34
> Hi Bulldog2:
>
> Thanks so much for sharing your ideas! I really appreciate it.
>
> Ritalin and I don't get along. It makes me tired and depressed. Too bad because I have a bunch of it and that darn Provigil is SO expensive!
>
> I think I'll stick with the three things I'm on now: Parnate, Nortriptyline and Provigil until I've given them a good run.
> If the Nortriptyline helps me sleep I'll be in good shape I think, as long as the carb craving isn't too bad.
>
> Thanks again,
> gayleI never had carb craving with nortriptyline. Also as my nortriptyline doses increased it did help improve my sleep. Low doses of amitriptyine help my sleep without hangover but I seem to grow tolerant to that effect and the sleep effect seems to wear off.
You could try some benadryl for seem. Other than your sleep issues the regemin sounds excellent.
This is the end of the thread.
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