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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by g_g_g_unit on June 12, 2012, at 7:36:34
So I increased my Parnate to 60mg a few days ago. I take 15mg four times a day. Today was one of the first days in a while where I felt 'okay', mood-wise. I could tolerate my family, noticed an absence of dysphoria, etc. etc. Also less panicky.
Only problems are:
a) blood pressure, especially on standing, is pretty low. It came out as (68/50) when measured a few hours after my last dose.
b) I still feel quite empty, bored and demotivated. No real ADD benefits anymore. I don't know how much the Klonopin (1mg at night) is contributing to this, but it's frustrating. I'm more naturally tired at night lately though, so maybe I can wean off it at some point.
Still, is this the best I have to look forward to mood-wise? Or should there be more gains over the next few weeks? I know that Parnate isn't known for being mood-lifting, but I was expecting something more .. I donno .. at this point it feels like a cleaner SSRI.
c) I guess this goes with b), but I'm pretty spacey. Again, not sure if it's the Klonopin or Parnate.
My psychiatrist has little experience using Parnate, and no experience prescribing it above 30mg (the recommended limit in Australia). He said he knows some psychiatrists who use it, but never at the dose I'm on. I did e-mail one professor here who said that, despite 60mg being the maximum in the UK and US, "progressive benefits are noted with higher doses", so I don't know if that means he's willing to go above 60mg. He said he won't prescribe a stimulant with an MAOI, though. My psychiatrist was thinking of referring me to him for advice on Parnate maintenance.
Maybe I should wait it out at 60mg for longer, though?
Posted by SLS on June 12, 2012, at 14:28:26
In reply to doing a little better ..Parnate (60mg), posted by g_g_g_unit on June 12, 2012, at 7:36:34
> So I increased my Parnate to 60mg a few days ago. I take 15mg four times a day. Today was one of the first days in a while where I felt 'okay', mood-wise. I could tolerate my family, noticed an absence of dysphoria, etc. etc. Also less panicky.
>
> Only problems are:
>
> a) blood pressure, especially on standing, is pretty low. It came out as (68/50) when measured a few hours after my last dose.BP tends to recover with continued treatment.
> b) I still feel quite empty, bored and demotivated.Parnate is not as much of a "mood-brightener" as is Nardil. However, when the true antidepressant response appears, I doubt that you will be disappointed.
> No real ADD benefits anymore.
It would be an ideal answer to add amphetamine at some point. It would help with The ADD and give you more energy throughout the day.
Feeling "spaced-out" is usually only a temporary side effect. I tend to think that it is a good sign.
Klonopin can be depressing.
There is an art to using MAOIs. In some cases, you need to go above the dosage that will eventually be adequate for maintenance so that sufficient MAO inhibition can be established. However, the difference in these two dosages is not very large. For instance, going to 70 mg of Parnate for a few days might be necessary to establish enough MAO inhibition so as to maintain it at a dosage of 60 mg.
> Maybe I should wait it out at 60mg for longer, though?
Yup - at least 3 weeks. But you already know that. It is hard to be patient. I am not as patient as I could be. My impatience has led me to prematurely increase the dosage of medications on more than one occasion.
- Scott
Posted by g_g_g_unit on June 13, 2012, at 4:50:57
In reply to Re: doing a little better ..Parnate (60mg) » g_g_g_unit, posted by SLS on June 12, 2012, at 14:28:26
> > a) blood pressure, especially on standing, is pretty low. It came out as (68/50) when measured a few hours after my last dose.
>
> BP tends to recover with continued treatment.Good to know. I'm experiencing a lot of physical weakness.
>
> > b) I still feel quite empty, bored and demotivated.
>
> Parnate is not as much of a "mood-brightener" as is Nardil. However, when the true antidepressant response appears, I doubt that you will be disappointed.Thanks. This has given me something to look forward to. I kind of figured this was it as far as the mood benefit goes, but I'll continue to hold out.
>
> > No real ADD benefits anymore.
>
> It would be an ideal answer to add amphetamine at some point. It would help with The ADD and give you more energy throughout the day.Maybe I can convince someone to if I have a robust-enough anti-depressant response, since I know my psychiatrist feels a little despondent about seeing me fail trial after trial. Otherwise, I'm aware that there's off-label options like Memantine, or OTC ones like Nicotine.
>
> Feeling "spaced-out" is usually only a temporary side effect. I tend to think that it is a good sign.
>
> Klonopin can be depressing.Yeah, I'm trying to lower my Klonopin dose.
>
> There is an art to using MAOIs. In some cases, you need to go above the dosage that will eventually be adequate for maintenance so that sufficient MAO inhibition can be established. However, the difference in these two dosages is not very large. For instance, going to 70 mg of Parnate for a few days might be necessary to establish enough MAO inhibition so as to maintain it at a dosage of 60 mg.Thanks for the tip; I'll keep that strategy in mind if I don't see results at 60mg.
>
> > Maybe I should wait it out at 60mg for longer, though?
>
> Yup - at least 3 weeks. But you already know that. It is hard to be patient. I am not as patient as I could be. My impatience has led me to prematurely increase the dosage of medications on more than one occasion.
>Yeah, I realize anymore at this stage would be counterproductive, since even moving from 50 to 60mg in the space of a week produced quite a significant drop in BP.
This is the end of the thread.
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