![[dr. bob]](/dr-bob-sm.gif)
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 quasimotor on July 30, 2012, at 3:38:21
I'll attempt to brief(ish).
My symptoms would best be described as atypical or agitated depression with GAD, panic disorder and agoraphobia. Definitely not the can't get out of bed depression. Panic attacks, suicidal ideation, anhedonia, etc. but also extremely restless, can't ever sit still, racing thoughts, doing pushups and chainsmoking and walking laps around my house first thing out of bed until three am. Add to that, recovering IV heroin/cocaine addict (two years sober) as well as a recovering bulimic/anorexic (about a year abstinent). I'm a psych dream/nightmare (obviously).
Horrible reactions to meds. Tried all SSRIs and SNRIs; would reduce panic and sometimes depression but would just increase my general level of restlessness and agitation with disastrous consequences. Same with TCAs. Remeron was awesome for anxiety but exacerbated depression and not exactly the best drug to give to a bulimic. APs did nothing more than give me horrifying side effects and make me gain weight with no real reduction in main symptoms. Benzos were okay for agitation and anxiety and I never abused them, but because of past history they are just a bad idea (and klonopin withdrawals pretty much ruined my life a few years ago). Mood stabilizers (depakote, tegretol, lamictal) were useless. I take neurontin (I'm supposed to take 900mg three times a day, usually take a third of that because it seems like a fairly powerful placebo).
I'm about to start taking Parnate (20mg I believe). I am at the tail end of the washout period from Nardil 60mg. It's been a long two weeks. Nardil worked great in a lot of ways. Unlike all other ADs it actually calmed me down a bit and I enjoyed things a lot more, suicidal ideation almost completely disappeared, could focus and interact with people. Very good drug, unfortunate it is rarely prescribed anymore. Most side effects were tolerable and the diet etc was no big deal (I will gladly give up sausage and benadryl to not want to kill myself). The problem was the appetite. Increased appetite sucks for anyone but for a recovering bulimic it's very dangerous.
Thus, the switch to Parnate. I have hopes but honestly the more i read about it the more frightened I get, mainly because it sounds so stimulating. I do not need stimulation. I (sort of) understand the basic psychopharmacology behind the two drugs and their supposed differences, but then again it all seems like alchemy to me sometimes too.
So, has anyone (especially anyone that can identify with my particular set of symptoms) done this switch? Are they really that different? And has anyone who suffers from my particular brand of crazy had luck with any other meds maybe I didn't mention?
Thank you if you took the time to make it this far. I sincerely hope you all find some relief from whatever ails you, however you do it.
Posted by SLS on July 30, 2012, at 4:20:27
In reply to nardil to parnate and general rant, posted by quasimotor on July 30, 2012, at 3:38:21
Everyone reacts differently to Parnate. I have a form of bipolar depression. I have been on Parnate several times and have alternated it with Nardil as you are now. Whatever mild stimulation there was during the first few weeks of Parnate treatment dissipated for me. I believe that Parnate can be effective for GAD and social anxiety disorder. I am hoping that it would also be as useful as Nardil for treating panic disorder. However, Parnate has not been studied as closely for these indications as has Nardil. Parnate is an old drug, and there is very little impetus to continue working with it investigationally. However, I did find one group of investigators who did so.
http://www.ncbi.nlm.nih.gov/pubmed/20036427
In this double-blind study, their conclusions were that Parnate was effective for treating panic disorder and social anxiety disorder, and that 60 mg/day was much more effective than 30 mg/day.
Good luck with Parnate.
- Scott
Posted by SLS on July 30, 2012, at 4:40:29
In reply to nardil to parnate and general rant, posted by quasimotor on July 30, 2012, at 3:38:21
> http://www.ncbi.nlm.nih.gov/pubmed/20036427
>
> In this double-blind study, their conclusions were that Parnate was effective for treating panic disorder and social anxiety disorder, and that 60 mg/day was much more effective than 30 mg/day.
This investigation studied only those people who suffered from panic disorder and social anxiety disorder comorbidly. I should have specified that the superiority of the 60 mg/day dosage over 30 mg/day dosage was seen for the social anxiety component. Otherwise, the difference in efficacy for panic disorder was not as large.You can try 30 mg/day of Parnate first, but I would consider raising the dosage to 60 mg/day if you do not obtain satisfactory results at the lower dosage. I don't think 30 mg/day will be very effective for the depression or the GAD. If you titrate the dosage gradually, you might better tolerate the Parnate. I find that the orthostatic hypotension all but disappears with continued use.
How would you deal with insomnia were it to appear as a side effect?
- Scott
Posted by quasimotor on July 30, 2012, at 5:29:56
In reply to Re: nardil to parnate and general rant » quasimotor, posted by SLS on July 30, 2012, at 4:40:29
Thanks for the information Scott.
As to potential insomnia (which I have anyway to varying degrees), I've found that it's not as difficult to cope with when the depression and anxiety are more under control. When sleep is the only relief I get and I can't sleep, it's horrible. But when I can actually enjoy things and calm down a bit, it isn't nearly as problematic. So it would be acceptable. I also will occasionally take a minute dose of Seroquel if I need to (like 10-25mg) and it knocks me out. I looked pretty thoroughly and I did not see any potential interactions with Seroquel and MAOIs.
Posted by papillon2 on July 30, 2012, at 12:02:11
In reply to Re: nardil to parnate and general rant, posted by quasimotor on July 30, 2012, at 5:29:56
Hello Quasi,
I have been recovered/in remission from restrictive anorexia for about 9 years, never had b/p issues, but I also found Remeron and AAPs a nightmare when I trialled (sp?) them last year. I didn't eat any more than usual, but the insatiable hunger and uncontrollable weight gain despite this and copious amounts of exercise was EXTREMELY distressing, triggering and anxiety provoking (despite not being sick with AN for many years!). The mental bashing I was getting from ED thoughts was unbelievable. So I understand your quandary from this perspective!!!
Scott would know more about it than me, but I am wondering if one of the more sedating tricyclic anti-depressants might be an option for you? You don't seem to have tried meds in this class. TCAs can cause appetite and weight disturbances, how bad compared with MAOIs I'm not sure. Still, you might not get those side effects. I have had no problems on Nortriptyline, but I suspect it's one of the more activating TCAs since psychomotor retardation plays a big part in my depression, unlike agitation for you. So it may not be suitable.
I hope this helps. More than anything I wanted to reach out to you and say, I get it. A lot of doctors don't understand EDs. IMO, some of their med suggestions are just plain dangerous in this context. It's like they forget that eating disorders can kill, too.
Oh, one last thing, I've found DBT and CBT really useful for distress tolerance, anxiety and suicidal ideation (doesn't make me less suicidal but has so far stopped me from making further attempts). I understand they are indicated for bulimia too. Might want to check them out if you haven't done these types of therapy before.
Hang in there!! And let us know how things go, ok?
Posted by quasimotor on August 3, 2012, at 18:52:58
In reply to Re: nardil to parnate and general rant, posted by papillon2 on July 30, 2012, at 12:02:11
Thank you Papillon. It sounds like you understand exactly what the issue is as far as meds and appetite disturbances while dealing with ED. I was on Desipramine briefly; not a very good reaction to it, although it tends to be a more stimulating TCA. Might have been on some others; can't remember. It does seem, however, that anything with potent serotonin reuptake inhibition causes more harm than good with me. Nardil did not, but perhaps the GABA effect counteracted it. I have been in CBT for years. It definitely has a positive effect, but my therapist (as well as my friends and family and pretty much anyone that comes in contact with me) agrees that there is just a certain level of mental illness that cannot be touched without medication. I hate it and I wish it weren't so but I've come to accept it as the years have gone on.
At any rate, the Parnate has been a nightmare so far. The simulating effect has been intolerable (as I was afraid of) and has basically worsened all the symptoms that returned when I quit the Nardil. Because the Nardil was so slow to kick in, I did not realize what a profound effect it was having on my anxiety and depression, especially the physical symptoms which have plagued me for so long.
So I'm stuck, as usual. I may have to bite the bullet and just go back on the Nardil, maybe a lower dosage. Is there anything that can help with the appetite increase (besides stimulants)? I read that Nardil can lower thyroid activity and relatively high doses of iodine can counteract this, but perhaps this is just anecdotal. I'd go back on Topamax but my doc is opposed to it because of the potential side effects (kidney damage, memory loss, etc.).
Thanks again, Scott and Papillon
Sincerely,
Adrian
Posted by papillon2 on August 4, 2012, at 1:15:03
In reply to Re: nardil to parnate and general rant: follow-up, posted by quasimotor on August 3, 2012, at 18:52:58
Hi Adrian,
I think Metformin is sometimes used off label for appetite/weight issues in people taking psych meds. A potential problem, however, is that an appetite suppressant might play into your eating disorder/make it really hard to manage your appetite is suppressed too much. I can see Ed having a field day -- and this is assuming you could find someone willing to prescribe it to someone with an ED history!
You might be interested in reading the following blog post on seretonin, anti-depressants and eating disorders:
http://feastingonresearch.blogspot.com.au/2010/01/serotonin-antidepressants-and-eating.html?m=
It contains links to the studies being discussed.Papillon
Posted by quasimotor on August 4, 2012, at 2:50:18
In reply to Re: nardil to parnate and general rant: follow-up, posted by papillon2 on August 4, 2012, at 1:15:03
Thank you Papillion for the feedback and support. I know serotonergic pathways are often thought to be the root of ED. What you may find interesting is that my bulimia actually presented itself a year after I was first put on antidepressants (Paxil). I actually stopped taking Paxil two years later and for a time the bulimia stopped but I became severely anorexic (easily the most disturbing year of my life). I went back on Paxil and the anorexia stopped but I soon became bulimic again. Since then there have been so many meds and my ED has taken so many forms that it's hard to say what's what. But I always found it curious that my bulimia began on a class of drug that is generally used to treat it, even if it is just purely coincidental.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.