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Dr. Bob is Robert Hsiung, MD,
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Posted by Meltingpot on December 10, 2009, at 15:12:18
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
Scott,
I really admire the way you rationalise things and it is hard to believe that you are barely employable when you are quite obviously so brainy.
When you say that you are only about 35% improved, in what way? What are you able to do and feel at 35% that you can't and don't at 0%? What would a 75% improvement be?
I hope this switch you are planning works out for you but you always do improve initially don't you whenever you start a new drug that's effective for you so there is a chance that just the starting of the Effexor will improve your mood.
Just out of interest, why do you think Effexor will be an improvement on Parnate? How did your experience of Effexor differ to your experience of Parnate?
Denise
Posted by linkadge on December 10, 2009, at 17:02:51
In reply to Re: Swapping Parnate for Effexor., posted by Meltingpot on December 10, 2009, at 15:12:18
Effexor might be worth a shot.
Have you ever tried doxapin? It is similar to amitriptyline but I personally found it a bit more hedonically activating.
Nortriptline was definalely cleaner than the other TCA's I have tried, but there was just something missing with it.
Nortriptyline plus dark cholocate was good. Mmm dark chocolate.....caffiene, thebromine, phenylethyamine, MAOi's, SSRIs, anandamine reuptake inhibitors..yes..dark chocolate
Linkadge
Posted by SLS on December 10, 2009, at 17:04:51
In reply to Re: Swapping Parnate for Effexor., posted by Meltingpot on December 10, 2009, at 15:12:18
Hi Denise.
> I really admire the way you rationalise things
I only wish that I admired myself half as much as you do. I don't feel very admirable this week. I look at my lack academic and career accomplishments, and what little self-esteem I have left evaporates.
> When you say that you are only about 35% improved, in what way?
Mental and physical energy, thought speed, memory, flat affect, and anhedonia are the major areas that are most affected.
> What are you able to do and feel at 35% that you can't and don't at 0%?
I acquire some mental energy to interact with my environment and think more clearly. I begin to feel less negative about things. My affect brightens, my memory improves, and I can read a paragraph or so at a time instead of the two sentences I was capable of.
> What would a 75% improvement be?
Orgasmic, but short of nirvana. I am sure that I could go to school and hold a job. It would be great if I could operate at my tested I.Q. I would become very gregarious and self-confident. I would seek out new people and relationships. I think I would become involved in various hobbies. Perhaps music and photography.
> I hope this switch you are planning works out for you
Thanks. I am not expecting nirvana, though.
> but you always do improve initially don't you
That has been my response pattern, yes.
> whenever you start a new drug that's effective for you so there is a chance that just the starting of the Effexor will improve your mood.
> Just out of interest, why do you think Effexor will be an improvement on Parnate?
I recall having passing moments of feeling better on the combination of Effexor and nortriptyline that occurred long after my startup improvement. I was happy with the scope of the improvement, but not the magnitude and consistency. I believe things will be better now that I am taking twice the dosage of nortriptyline as I did then.
> How did your experience of Effexor differ to your experience of Parnate?
For me, Parnate helps more with anergia than it does with anhedonia. It doesn't brighten my mood as much as does Nardil. It really is hard to compare drugs when the effects they have change as do dosages and adjunct drugs. Effexor gave me more of a sense of enjoyment of things and a brighter affect than did Parnate. The last time I read a book cover-to-cover was when I was taking Effexor. Things just seemed to decay over time or I would have continued with it.
We'll see.
I am beginning to feel less well. Things are bound to get worse, but I can't predict just how much worse.
- Scott
Posted by SLS on December 10, 2009, at 17:07:49
In reply to Re: Swapping Parnate for Effexor., posted by linkadge on December 10, 2009, at 17:02:51
> Effexor might be worth a shot.
>
> Have you ever tried doxapin?That is about the only TCA that I haven't tried. I'll file that option away somewhere. Thanks.
> It is similar to amitriptyline but I personally found it a bit more hedonically activating.
Hedonism. Mmm.
- Scott
Posted by linkadge on December 10, 2009, at 17:08:32
In reply to Re: Swapping Parnate for Effexor., posted by linkadge on December 10, 2009, at 17:02:51
What about a med washout / detox.
I know I know, I'm not trying to get all naturalistic on you, but coming off meds has sometimes helped me reconsider which directions to take.
Linkadge
Posted by SLS on December 10, 2009, at 18:41:44
In reply to Re: Swapping Parnate for Effexor., posted by linkadge on December 10, 2009, at 17:08:32
> What about a med washout / detox.
>
> I know I know, I'm not trying to get all naturalistic on you, but coming off meds has sometimes helped me reconsider which directions to take.Well, I have discontinued lithium and am reducing my dosage of Lamictal to get a better idea of where I'm at. I know that the nortriptyline and Lamictal will keep me out of the deepest abyss, so I am reluctant to give them up right now. I have a love-hate relationship with lithium. It does flatten my affect and personality. It makes me passive and reduces motivation and drive. Yet, it can have antidepressant effects. I would like to have remained on it, but I really do think I am better off without it in the short-term. If it turns out that it works wonders when combined with Effexor, then I will need to make compromises.
What do you think of coenzyme Q10? I was looking at adding that along with NAC at some point.
- Scott
Posted by linkadge on December 10, 2009, at 20:03:43
In reply to Re: Swapping Parnate for Effexor. » linkadge, posted by SLS on December 10, 2009, at 18:41:44
I feel the same way about lithium. It produces an almost immediate AD effect for me, but after about 2 or 3 days I start to feel more depressed.
I think q10 is a good supplement. It actually helps me sleep and seems to have a positive effect on my short term memory.
Usually (when I can sleep) I take a benzo plus q10 and a bit of creatine. The combination seems to have a synergistic effect on sleep and I seem to have less cognative dysfunction the next day.
Both creatine and q10 are potent antioxidants and have synergistic effects in animal models of neurodegernation.
I don't like NAC as much as it seems to make me more obsessive / agressive feeling. I also havn't been liking alpha-lipoic acid as it seems to make me a little unstable although sometimes it seems to be very useful.
I have been having good effects with theanine lately. I started to have a bad bout of insomnia last week but theanine + melatonin got me back on track fast.
In terms of my depression, somtimes the stimulating AD's make me better but sometimes I need the sedating ones. Sometimes AD stop working and some sort of gabaergic med (epival, benzo, theanine) makes me less depressed.
Have you ever tried gabapentin? Tegretol + TCA combinations have also been good for some.
I think for mood disorders its just balancing the inhibitory and excitory. Too much of either can produce depresison. Having a stimulating med and a more sedating one to play around with can help.
For instance, I did well with effexor plus zyprexa. I could often reduce relapses by altering the dose of one or the other.
Linkadge
Posted by linkadge on December 10, 2009, at 20:05:06
In reply to Re: Swapping Parnate for Effexor. » linkadge, posted by SLS on December 10, 2009, at 18:41:44
Reduce the parnate and add trazone + gabapentin plus amphetamine as needed.
Liinkadge
Posted by Bob on December 11, 2009, at 23:17:34
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
> Is this as good as it gets?
>
> I don't think so. I won't settle for being barely employable and doomed to live an empty life. I want more. Parnate is not making it happen for me. It was nice in the beginning. However, even with the lithium added, I'm stuck. I believe that a greater improvement in the quality of my life is there for me to be had. I am not looking for perfection. Complete remission may not be in my future. However, I do expect to feel greater than a 50% improvement. I am stuck at 35%. That sucks. However, if that indeed is as good as it gets, at least I will have tried to move forward.
>
> Five or six years ago, I had been taking a combination of Effexor 300mg and nortriptyline 75mg. It helped, but was inadequate. The doctor should have tested my blood level of nortriptyline. He did not. In retrospect, we now know that I was significantly underdosed with nortriptyline. I predict that I will do better with the 150mg that I am currently taking when we combine it with the Effexor.
>
> I know that I can always go back to an MAOI if my planned treatment changes do not produce adequate results. Although making these changes is a gamble of sorts, I think it is a good investment of time to look for a better quality of life.
>
>
> - ScottI had good luck with Effexor about 15 years ago for maybe two months. I got up to maybe 225mg, and then it degenerated into hypersomnolence during the day followed by insomnia at night. I had nasty bruxism, even when awake and completely numb genitals. Then the anger set it and I decided it was time to get off. At the time it was by FAR the worst withdrawl I ever had, and possibly still is to this day. I have had some other bad withdrawls though. I promised myself I would never go there again because I'm not sure I'd survive it this time. I wonder if I'll be able to keep that promise?
Posted by SLS on December 12, 2009, at 5:37:07
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by Bob on December 11, 2009, at 23:17:34
> I had good luck with Effexor about 15 years ago for maybe two months. I got up to maybe 225mg, and then it degenerated into hypersomnolence during the day followed by insomnia at night. I had nasty bruxism, even when awake and completely numb genitals. Then the anger set it and I decided it was time to get off. At the time it was by FAR the worst withdrawl I ever had, and possibly still is to this day. I have had some other bad withdrawls though. I promised myself I would never go there again because I'm not sure I'd survive it this time. I wonder if I'll be able to keep that promise?
I understand your predicament. At some point, you will do anything to escape the crushing suffocation that is depression, even if it means returning to a drug that you were sure was counterproductive at the time you were taking it. You ask yourself, "will it work better this time?" What makes things particularly problematic in making a decision is that it is difficult to remember exactly how it felt to be taking the drug in comparison to the way you feel now. If you could flick a switch between the two states, it would be easier to compare them. As it is, choosing to return to a failed drug is an act of desparation, especially when one is willing to neglect the difficulty in discontinuing that drug should it fail again.
So far, life sucks.
- Scott
Posted by Bob on December 12, 2009, at 10:50:24
In reply to Re: Swapping Parnate for Effexor. » Bob, posted by SLS on December 12, 2009, at 5:37:07
> > I had good luck with Effexor about 15 years ago for maybe two months. I got up to maybe 225mg, and then it degenerated into hypersomnolence during the day followed by insomnia at night. I had nasty bruxism, even when awake and completely numb genitals. Then the anger set it and I decided it was time to get off. At the time it was by FAR the worst withdrawl I ever had, and possibly still is to this day. I have had some other bad withdrawls though. I promised myself I would never go there again because I'm not sure I'd survive it this time. I wonder if I'll be able to keep that promise?
>
> I understand your predicament. At some point, you will do anything to escape the crushing suffocation that is depression, even if it means returning to a drug that you were sure was counterproductive at the time you were taking it. You ask yourself, "will it work better this time?" What makes things particularly problematic in making a decision is that it is difficult to remember exactly how it felt to be taking the drug in comparison to the way you feel now. If you could flick a switch between the two states, it would be easier to compare them. As it is, choosing to return to a failed drug is an act of desparation, especially when one is willing to neglect the difficulty in discontinuing that drug should it fail again.
>
> So far, life sucks.
>
>
> - ScottYes, what you have described is my experience exactly. Sometimes when I'm trying to think of a drug that will be better I will think for days about one I might have already taken and only after much reflection remember some very unpleasant aspect of it that made me discontinue.
You're not alone in even some of the more obscure aspects of your suffering, I assure you.
- Bob
Posted by bulldog2 on December 12, 2009, at 11:08:42
In reply to Re: Swapping Parnate for Effexor. » Bob, posted by SLS on December 12, 2009, at 5:37:07
I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
Posted by SLS on December 12, 2009, at 11:48:07
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by bulldog2 on December 12, 2009, at 11:08:42
> I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
- Scott
Posted by bulldog2 on December 12, 2009, at 13:21:19
In reply to Re: Swapping Parnate for Effexor. » bulldog2, posted by SLS on December 12, 2009, at 11:48:07
> > I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
>
> There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
>
>
> - ScottLet's examine the idea. There are four irreversible maois currently on the market(nardil,marplan,parnate,emsam). Each one has cases where one has worked where the others have not. So each maoi while in theory boosts neurotransmitters also has something unique. Now there are supposed to be cases where nardil and parnate have been blended to yield a new blend that has worked.
I would search for these cases or studies and see wether this has actually occurred. What doses were used and were there specific ratios that were used such as 50 to 50 . Were there any cases of serotonin syndrome? How safe is this method when certain controls are in place.The following has always baffled me. Nardil appears to hit serotonin more strongly than parnate. Does one get serotonin syndrome when the dose of nardil goes to high? So why does parnate which seems more norepinephrine oriented precipitate serotonin crisis if used in low doses with nardil?
Posted by SLS on December 12, 2009, at 15:10:37
In reply to Re: Swapping Parnate for Effexor., posted by bulldog2 on December 12, 2009, at 13:21:19
> > > I've read of pdocs who combine nardil with parnate. Obviously lower doses of both would be required. Each drug has its own neurotransmitters ratios and maybe when combined you have the potential to hit that elusive sweet spot called remission.
> >
> > There was one person on PB that I remember trying it, but he never followed up to tell us what happened. Although the thought of combining the two MAOIs has occurred to me, a doctor at NYU pretty much scared me out of giving it further consideration. He said that his staff had seen strokes result from an inadequate washout period when switching from one drug to the other. I know that my current doctor would not entertain the idea.
> >
> >
> > - Scott
>
> Let's examine the idea. There are four irreversible maois currently on the market(nardil,marplan,parnate,emsam). Each one has cases where one has worked where the others have not. So each maoi while in theory boosts neurotransmitters also has something unique. Now there are supposed to be cases where nardil and parnate have been blended to yield a new blend that has worked.
> I would search for these cases or studies and see wether this has actually occurred. What doses were used and were there specific ratios that were used such as 50 to 50 . Were there any cases of serotonin syndrome? How safe is this method when certain controls are in place.
>
> The following has always baffled me. Nardil appears to hit serotonin more strongly than parnate.I can attest to that. I twice experienced a mild-to-moderate serotonin syndrome when I combined Nardil with imipramine, a drug with significant serotonin reuptake inhibition. I had no such problem when combining Parnate with imipramine.
> Does one get serotonin syndrome when the dose of nardil goes to high? So why does parnate which seems more norepinephrine oriented precipitate serotonin crisis if used in low doses with nardil?
If stroke is the sequalae of combining the two drugs, I would think it be the result of some sort of catecholaminergic reaction.
- Scott
Posted by RocketMan on December 12, 2009, at 16:39:36
In reply to Re: Swapping Parnate for Effexor., posted by SLS on December 12, 2009, at 15:10:37
Hi Scott,
I hope you are feeling well during your transition. Do you have a date in mind for starting effexor?
Take care,
Rocket
Posted by uncouth on December 12, 2009, at 17:09:53
In reply to Re: Swapping Parnate for Effexor., posted by SLS on December 12, 2009, at 15:10:37
Scott did you ever decide to try Zyprexa at any point?
Good luck with teh parnate -> effexor experience. I think i said it in another post but that transition is what caused me to end up getting ECT as the suicidal thoughts came on strong after a few weeks on effexor and off of parnate. I wish I had known about Zyprexa's effectiveness then, however.
Posted by West on December 16, 2009, at 11:36:29
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
Good luck Scott. Make it happen.
W
Posted by SLS on December 16, 2009, at 12:59:40
In reply to Re: Swapping Parnate for Effexor., posted by West on December 16, 2009, at 11:36:29
> Good luck Scott. Make it happen.
Thanks.:-)
- Scott
Posted by floatingbridge on December 21, 2009, at 2:19:47
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
Scott,
How are you doing?
fb
Posted by SLS on December 21, 2009, at 6:41:56
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by floatingbridge on December 21, 2009, at 2:19:47
> Scott,
>
> How are you doing?Thanks for asking. I really appreciate it.
So far, I have not plunged into the abyss. I discontinued taking Parnate 7 days ago. I am grateful that I am not feeling worse. We'll see what happens over the next week as MAO activity continues to recover.
I am going through an emotional crisis right now, so I am experiencing anxiety along with the depression. It has been difficult.
- Scott
Posted by mtdewcmu on December 21, 2009, at 11:03:54
In reply to Re: Swapping Parnate for Effexor. » linkadge, posted by SLS on December 10, 2009, at 18:41:44
> What do you think of coenzyme Q10? I was looking at adding that along with NAC at some point.
>
>
> - ScottIf you want to go the "alternative" route, you ought to try SAMe if you haven't. I gave it a try years ago and it was definitely more than mere placebo. It made everything look super-bright. I did not stay on it, though, for reasons I can't remember, and since then I have gone the mainstream medicine route.
Posted by mtdewcmu on December 21, 2009, at 11:12:02
In reply to Swapping Parnate for Effexor., posted by SLS on December 8, 2009, at 10:29:39
> Is this as good as it gets?
>
> I don't think so. I won't settle for being barely employable and doomed to live an empty life. I want more. Parnate is not making it happen for me. It was nice in the beginning. However, even with the lithium added, I'm stuck. I believe that a greater improvement in the quality of my life is there for me to be had. I am not looking for perfection. Complete remission may not be in my future. However, I do expect to feel greater than a 50% improvement. I am stuck at 35%. That sucks. However, if that indeed is as good as it gets, at least I will have tried to move forward.
>
> Five or six years ago, I had been taking a combination of Effexor 300mg and nortriptyline 75mg. It helped, but was inadequate. The doctor should have tested my blood level of nortriptyline. He did not. In retrospect, we now know that I was significantly underdosed with nortriptyline. I predict that I will do better with the 150mg that I am currently taking when we combine it with the Effexor.
>
> I know that I can always go back to an MAOI if my planned treatment changes do not produce adequate results. Although making these changes is a gamble of sorts, I think it is a good investment of time to look for a better quality of life.
>
>
> - ScottAs long as you are piling on the meds, you might as well add a drug like Remeron, which will synergistically enhance the effects of the Effexor and Nortriptyline. Adding Serzone or an atypical would be other options for adding 5-HT2 inhibition. Why stop at only 2 or 3 meds?
Posted by SLS on December 21, 2009, at 11:18:57
In reply to Re: Swapping Parnate for Effexor. » SLS, posted by mtdewcmu on December 21, 2009, at 11:12:02
> As long as you are piling on the meds, you might as well add a drug like Remeron, which will synergistically enhance the effects of the Effexor and Nortriptyline. Adding Serzone or an atypical would be other options for adding 5-HT2 inhibition. Why stop at only 2 or 3 meds?
Remeron seemed to exacerbate my depression, although I didn't stay on it for more than a week. I guess I could try it again. I am taking Abilify.
Currently:
nortriptyline 150mg
Lamictal 150mg
Abilify 10mgI still need to wait another week before starting the Effexor.
Still hanging in there...
- Scott
Posted by West on December 21, 2009, at 11:58:18
In reply to Re: Swapping Parnate for Effexor. » mtdewcmu, posted by SLS on December 21, 2009, at 11:18:57
I would not give this advice to anyyone but given the outstanding circumstances, get hold of some ketamine.
It will relieve suffering acutely and provide a buffer between your med trials. I'm sure you know the rap anyway. Rooting for you.
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