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Dr. Bob is Robert Hsiung, MD,
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Posted by Girlnterrupted78 on February 3, 2010, at 0:42:53
I'm on 80mgs of Parnate + 20mgs Adderall.
This combination started out really well but lost strength after the 2nd week.
Then I was given Nortriptyline and then Lamictal.
Not sure which one did it, but I feel as if one of them, probably Lamictal, weakened Parnate even more. So now that I stopped Lamictal completely, I feel more depressed than before I tried it.
Now my doctor wants to add Lithium. But if this is going to make it even worse and permanently weaken the strength of my Parnate combo, I will end up almost as depressed as I was before I started on Parnate + Adderall.
So I was just wondering if anybody knows what would Lithium do?
I know it would be hard to figure out since every person is so different. While several people here reponded very well to Parnate + Nortriptyline, it did nothing for me except made me more tired and lethargic. Lamictal was even worse.
But I'd still like to hear other's experiences just to see how it's worked for others.
This seems to be the very last med I can add to the combo. After that I only have ECT to try.
Thanks for any info.
Posted by Phillipa on February 3, 2010, at 12:19:18
In reply to Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 3, 2010, at 0:42:53
I don't feel anyone knows but your own body as you say you responded differently than others to same combo. Phillipa
Posted by inanimate peanut on February 3, 2010, at 15:49:31
In reply to Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 3, 2010, at 0:42:53
Maybe it's not the other drugs that are weakening the Parnate. Maybe your body is getting a resistance to it over time. Have you tried increasing the dose of Parnate-- does this help at all? If the lithium doesn't work and the Parnate continually seems to be weakened, perhaps look at switching to another MAOI. My Stanford doc recommended a switch to Marplan in that circumstance or I know many of this board like Nardil. I'm sure you're not completely out of med combos. Have you tried Mirapex or calcium channel blockers (nimedipine). Have you tried all the atypical antipsychotics? Take it from someone who is literally down to their last 5 med combos, there are always some things that you haven't thought of. You can always post the meds you've been on and see if anyone here has any ideas. To me, these just seem to be better options than ECT.
Posted by Girlnterrupted78 on February 3, 2010, at 16:59:32
In reply to Re: Will Lithium augment or weaken Parnate?, posted by inanimate peanut on February 3, 2010, at 15:49:31
(sorry, this might be a little long..)
Thank you so much for the suggestions, inanimate.
> Maybe it's not the other drugs that are weakening the Parnate. Maybe your body is getting a resistance to it over time.
I don't know. All I know is that while on Lamictal, I experienced a lot of lethargy and was pretty much bed-bound. It was impossible to get anything done. Even taking shower seemed like a monumental task, and the more I thought about it, the more depressed I got--I almost cried over it.. I just wanted to avoid doing house chores at all costs, and I wasn't going out at all.
That was a huge contrast with how I felt on Parnate + Adderall alone. Parnate & Adderall made me avoid the bed at all costs, to the point where I went 2 nights in a row without sleep, and in those 48 hours I would not even touch the bed...not even for a couple of minutes. Something about lying down didn't feel right. I was very active during the night time, mostly doing things around the house and online. Of course, by the third night I crashed for 12-20 hours. And I was dead afraid of going to bed after those 2 nights because I knew that when I woke, I'd be more depressed than ever. I called that the "Nightmare on Elm's street" effect. I wanted to avoid it but I had no choice. I'd wake up crying like if somebody had died, and that lasted for 2-3 hours. Sometimes I started crying before I even woke up.. and continued to cry once I was fully awake.. and for hours. One time I woke and felt as if I had been on a comma. Didn't recognize the room, or the stuff I had, and I was crying like crazy.. really weird stuff, but I'd take that over Lamictal any day.
Anyway, by the time I finally got off Lamictal, it took 3 days for the lethargy to start to go away.. however, it did not go away completely. Now I feel some kind of emotional lethargy. Or I guess the word would be depression? I'm less willing to try things, less willing to go out and take risks with people.
That tells me that Lamictal had something to do with the weakening of Parnate. Otherwise, why would it happen right upon discontinuing Lamictal? I get the feeling that medications have an impact on your chemistry, so it might have done something to me..
>Have you tried increasing the dose of Parnate-- does this help at all?
No, I haven't. My doctor hasn't suggested it. Parnate was working fantastic when I first made it to 60mgs. Now I'm on 80mg and it's not doing even 1/3 of what it was on 60mgs. Would you recommend going up? I'm afraid about that because of a side effect I have--I'm short of breath most of the time. I don't know how bad it would get, but if you think it might make a difference, I'd try. I'll ask my doctor next time I see him. What about Adderall? Should I raise that? I'm on 20mgs now.
>Have you tried Mirapex or calcium channel blockers (nimedipine). Have you tried all the atypical antipsychotics? Take it from someone who is literally down to their last 5 med combos, there are always some things that you haven't thought of.
No, haven't tried any of those. What kind of depression do you have? In my case I think it's atypical, although my doctor thinks I could be slightly bipolar. I have no idea what it might be. Thanks for suggesting all those combos. Just a question: Where or how do you come up with all those different combinations? I'm getting the feeling that my doctor doesn't have anything else in mind for me. The other day I asked him what else could we try, and he was sort of vague, I think he might have mentioned ECT, but he never mentioned any of the medications that you are talking about.
And I'm surprised because he's a treatment resistant researcher at Columbia Psychiatric Institute, so I'd figure he'd come up with tons of different combos.
Of the different combos that you've tried, would you mind telling me which ones have been the most effective in fighting your depression and whether the effects have lasted? I'm actually going to make a list of things that I could try and take it to him and see what he says. So if you could tell me what exactly have been you combos (and highlight the most effective ones.. ) it would help me a lot.
BTW, I was already on Nardil. I gave it a full year at the maximum dose. It did NOTHING at all for me except made me incredibly dumb (I began to forget words and had to stop a sentence in the middle of it because I arranged the sentence so that it would only work if I used a specific word... and I'd completely forget such word..)
In addition to that, it made me gain like 20 lbs. Once the year was over I gave up. I think it was a fair trial and a failed trial that left me dumber and with 20 extra pounds. But I feel like Parnate sort of did the opposite. It helped me recover my short-term memory and I lost quite a lot of weight.Sorry about the length of this post, and thanks again for the info. Pls don't forget to let me know about the combos you've tried and what's worked for you. I'll write the meds I've tried in my next post..
GI
Posted by floatingbridge on February 3, 2010, at 20:04:21
In reply to Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 3, 2010, at 0:42:53
GI,
Okay, my understanding of lithium is that one can start and end a trial fairly quickly. I was told within two weeks, one could judge it's adjunctive effect. Your question, that whether it will permanently affect parnate's effectiveness, I don't know. My guess is that my own doc would say no--but as wonderful as he is, he's never taken any of the meds he prescribes.
What is your suggested starting dose?
And I agree with peanut that there is more to try before ect. Or TMs.
(I haven't tried lithium yet, but it's likely my next step.)
Good luck!
Posted by inanimate peanut on February 3, 2010, at 21:59:46
In reply to Re: Will Lithium augment or weaken Parnate? » inanimate peanut, posted by Girlnterrupted78 on February 3, 2010, at 16:59:32
I'm glad you found some of the info helpful. My diagnosis is bipolar I, Mixed type, but the mixed states are fairly well controlled by Geodon, so really I'm just left with a very treatment resistant bipolar depression.
I'd ask your doc about increasing the Parnate-- that's the first thing I would try. I don't know whether your shortness of breath is associated with the Parnate or not, but I would definitely keep an eye on it and stop if it gets worse. Your doc may not want to go any higher on the Parnate, as 80mg is a high dose according to the PDR, but it's worth a try to ask. I don't know enough about Adderall to know how high 20mg is, but that might be worth boosting too.
As for combos, I just got back from Stanford who gave me my final 5 or so combos. My best combo was Lithium+Wellbutrin+Lamictal but I don't have any really good combos at the moment. I'm currently on Parnate+Lamictal+Geodon+Mirapex, but I'm still pretty depressed. I definitely encourage you to try Lithium. It was the first thing that got me partially stable and I haven't been stable since going off of it. It should make things better not worse, but of course everyone's brain is different. Lithium actually provides neuroprotection for your brain and helps keep the damage in your brain from getting worse. I would give anything if Lithium still worked for me.
Anyway, do post your prior and current meds and see if anyone has any suggestions. I would say definitely try the Lithium and then if that makes you feel bad try increasing the Parnate and the Adderall. I really hope some of that helps and you start feeling better.
Posted by Maxime on February 4, 2010, at 8:40:22
In reply to Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 3, 2010, at 0:42:53
I'm in the same place you are. Depressed and on 100 mg of Parnate and 75 mg of Nortrip. I see my pdoc on Friday and I am going to ask him to add Lithium. When SLS - Scott used it with the Parnate and found that it helped.
I will be looking to see how people respond to this thread.
Posted by Girlnterrupted78 on February 6, 2010, at 9:18:10
In reply to Re: Will Lithium augment or weaken Parnate? » Girlnterrupted78, posted by inanimate peanut on February 3, 2010, at 21:59:46
Thanks for the information. I know Lithium, along with all the other meds that function as "mood stabilizers" are good for those diagnosed with bipolar. I haven't been formally diagnosed with it. My doctor simply has a slight suspicion I could be mildly bipolar, but that's about it. I don't ever go manic. He sometimes thinks that just because I responded exceptionally well to Celexa 7 years ago, that I was in fact "hypomanic" rather than simply free from depressive symptoms. I've grown tired of explaining to him that I just felt no depression--I felt freedom and happiness. But he claims that how I felt "sounds 'too good'" I guess normalcy should have some slight depressive symptoms for it to not be hypomania? If I had said "I was ok, but still slightly depressed" maybe he might have been more satisfied.
But anyway, I said I'd write down what I've tried, so here it goes:
*Paxil : no results, lethargy.
*Celexa: Outstanding AD effects for 1 year, zero side effects, stopped working after 1 year.
*Zoloft : Sexual side effects, Mild positive results on OCD. No anxiety or depression relief.
*Lithium (w/Celexa) No difference.
*Abilify (w/Celexa + w/Paxil) Horrible lethargy in both cases. Zero AD effects.
*Wellbutrin (taken w/Adderal): No AD effects at all.
*Buspar: No results.
*Effexor: No results.
*Nardil: No results. Decreased cognitive function, weight gain. Fair 1 year trial at highest dose.
*Adderall: Outstanding AD & Cognitive effects lasting less than a week. Tolerance built incredidibly fast.
*Ritalin: Mild positive effects on cognitive function. Lasted less than a month.
*Lexapro: Worst nightmare. Taken to replace Celexa. Undid all the AD effects of Celexa and took me back to point zero.
*Parnate: Taken in conjunction with Adderall. Excellent AD effect at 60mgs. Effects began to diminish after 2-3 weeks from 80% to about 50%.
*Lamictal (w/Parnate): Horrible. Caused lethargy and depression.
*Nortriptyline: (w/Parnate): Caused lethargy and no AD relief.I think this might be all. I don't believe going through every single SSRI will make a difference. I tried 3 of them, only 1 worked.
I refuse to try anything that will cause weight gain, as that would make me more depressed. So I'm not trying Remeron or any other med with such side effects. Nardil was enough of a nightmare.
Even if something worked, I would discontinued it if it made me gain weight. So I'm not sure what else could I possibly try at this point. Not even my doctor knows.. He suggested Abilify last time.. I refused immediately, since I have tried it twice and both times it was a nightmare. So we might go for Lithium, which I tried already with Celexa and did nothing, but I'll do it just for the sake of "trying something else.."
I still have the fear, though, that it will make things worse. As you can see, it's been other meds that have normally offset the positive results of the successful meds. Like in the case of Celexa. It worked outstandingly well for a year. When my doctor ran out of Celexa samples (which I was getting for free) he began giving me Lexapro samples, thinking they'd be the same thing. Within a week, I was back to point zero--horribly depressed after a successful year on Celexa. When I went back on Celexa it was never the same. Now it only gave me 40% relief, as opposed to a 90% I had experienced in the first year.
I suspect I need stimulant meds more than anything. Adderal alone (when I first took it, probably while on Celexa at the point where Celexa was no longer working at its fullest) gave me a great AD boost for a couple of days, but I built tolerance immediately.
Parnate + Adderal was once again a great combo that managed to control my depression very well. But again, it lasted 2-3 weeks.
Nothing else has worked. And what works never lasts. I think I'm doomed. I've always suspected that my problem is Dopamine, and my doctor mentioned the same thing. But what is going to fix that problem without building tolerance? I have no clue..
Thanks again for the info,
GI-----------------------------------o----------------------
> I'm glad you found some of the info helpful. My diagnosis is bipolar I, Mixed type, but the mixed states are fairly well controlled by Geodon, so really I'm just left with a very treatment resistant bipolar depression.
>
> I'd ask your doc about increasing the Parnate-- that's the first thing I would try. I don't know whether your shortness of breath is associated with the Parnate or not, but I would definitely keep an eye on it and stop if it gets worse. Your doc may not want to go any higher on the Parnate, as 80mg is a high dose according to the PDR, but it's worth a try to ask. I don't know enough about Adderall to know how high 20mg is, but that might be worth boosting too.
>
> As for combos, I just got back from Stanford who gave me my final 5 or so combos. My best combo was Lithium+Wellbutrin+Lamictal but I don't have any really good combos at the moment. I'm currently on Parnate+Lamictal+Geodon+Mirapex, but I'm still pretty depressed. I definitely encourage you to try Lithium. It was the first thing that got me partially stable and I haven't been stable since going off of it. It should make things better not worse, but of course everyone's brain is different. Lithium actually provides neuroprotection for your brain and helps keep the damage in your brain from getting worse. I would give anything if Lithium still worked for me.
>
> Anyway, do post your prior and current meds and see if anyone has any suggestions. I would say definitely try the Lithium and then if that makes you feel bad try increasing the Parnate and the Adderall. I really hope some of that helps and you start feeling better.
Posted by desolationrower on February 7, 2010, at 11:27:21
In reply to Re: Will Lithium augment or weaken Parnate? » inanimate peanut, posted by Girlnterrupted78 on February 6, 2010, at 9:18:10
have you tried/had levels done for thyroid hormone?
for bipolar, lamotragine can be worth a try
-d/r
Posted by Girlnterrupted78 on February 8, 2010, at 14:35:43
In reply to Re: Will Lithium augment or weaken Parnate?, posted by desolationrower on February 7, 2010, at 11:27:21
Yes, yes, I forgot to mention that. I also tried thyroid hormones along with Celexa. No results either.
Isn't lamotrigine the same as Lamictal? I tried it very recently with awful results..
Posted by desolationrower on February 11, 2010, at 12:27:17
In reply to Re: Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 8, 2010, at 14:35:43
the most likely way thyroid hormones work is interacting with adrenoceptors so it might be worth trying with a drug like desipramine
-d/r
Posted by Meltingpot on February 14, 2010, at 11:54:43
In reply to Re: Will Lithium augment or weaken Parnate?, posted by Girlnterrupted78 on February 8, 2010, at 14:35:43
Give Zyprexa a try. It is the only thing that has given me relief when I've been at my complete wits end.
I'm not saying that Zyprexa will make you feel like skipping down the road, it doesn't work for me in the way an antidepressant does when it actually works but it seems to help me think more rationally and it actually gives me more physical energy.
Then again you don't want anything that will make you put on weight and there is a good chance you might do with Zyprexa. I just take Zyprexa now and again and I'm still slim but then I smoke which keeps the weight down but not a good idea.
Perhaps if you tried Zyprexa and then if it helps keep up a strict exercise regime.
It does sound to me like you might be slightly bipolar simply because you seem to sometimes have initial success and then it wears off (Scott has that problem) also your reaction to Lamictal seems so extreme. I felt nothing on Lamictal apart from more tired. Then again you could be atypical like you say. It's just all of the crying seems to me more symptomatic of bipolar than unipolar. But then what do I know, I just rarely cry when I'm depressed, I cry more when I'm not depressed strangely enough.
Denise
Posted by Phillipa on February 14, 2010, at 19:28:29
In reply to Re: Will Lithium augment or weaken Parnate?, posted by Meltingpot on February 14, 2010, at 11:54:43
Denise me also crying when not depressed strange? I didn't know crying was a sign of bipolar? Love Phillipa
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