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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by rose45 on May 9, 2019, at 15:54:02
Has this happened to anyone else? Has anyone waited a while and then gone back on to one of them. Parnate didnt exactly stop working .... I just lowered the dose as I was feeling a but 'high' on it and then even after increasing the dose, it stopped working. I went up to 40 mg, and it used to work perfectly well on 30 mg.... I dont tolerate high doses in any meds.... The NHS in the UK dont know what to do with me, and will not take me off the parnate...HELP after waiting 3 months for an appointment, this is what they tell me. The UK NHS is just not working. I would pay for a private doctor, but dont know who to trust or what to do..... any ideas besides upping the dosage of parnate, would be very much appreciated.
Posted by TH on May 10, 2019, at 8:13:02
In reply to nardil and parnate have both pooped out on me, posted by rose45 on May 9, 2019, at 15:54:02
I'm not sure there is any obvious course of action to take here, but I just want to say I'm sorry to hear that you're struggling so much with this issue, and I hope you can find something that helps.
It would pay to take a step back here and think about the whole picture; about what ways other medications, and your life circumstances, could also be affecting how you're feeling.
It sounds like trying to experiment with any changes in medication / dose is likely to make things worse rather than better in the short term, and I can understand why a doctor would be hesitant to make any changes; it's one thing to experiment with your own medication, but it's another thing to experiment with someone else's.
I'd like to remind you too that if things do get to the point where you are a danger to yourself, visiting the Emergency Room is appropriate. While I can't in good conscience suggest that you seek hospitalisation unless it is absolutely necessary, a presentation to the ER is a strong sign to your doctor that the status quo is not working.
Posted by rose45 on May 10, 2019, at 17:13:27
In reply to Re: nardil and parnate have both pooped out on me, posted by TH on May 10, 2019, at 8:13:02
thank you TH for your kind and intelligent response. Of course, you are right in everything you say. I just cant see a way out at the moment.
Posted by SLS on May 11, 2019, at 11:38:36
In reply to nardil and parnate have both pooped out on me, posted by rose45 on May 9, 2019, at 15:54:02
> Has this happened to anyone else? Has anyone waited a while and then gone back on to one of them. Parnate didnt exactly stop working .... I just lowered the dose as I was feeling a but 'high' on it and then even after increasing the dose, it stopped working. I went up to 40 mg, and it used to work perfectly well on 30 mg.... I dont tolerate high doses in any meds.... The NHS in the UK dont know what to do with me, and will not take me off the parnate...HELP after waiting 3 months for an appointment, this is what they tell me. The UK NHS is just not working. I would pay for a private doctor, but dont know who to trust or what to do..... any ideas besides upping the dosage of parnate, would be very much appreciated.
What dosage of Parnate are you on now?
What happened when you raised the dosage to 40 mg/day?
What is the longest period of time that you have taken 40 mg/day of Parnate?
What is the maximum dosage that you are allowed to take?I see more people respond to 40 mg/day than 30 mg/day.
Is there any family history of bipolar disorder? If so, it might be worth trying a relatively low dosage of lithium - 300-600 mg/day. You can also try adding Abilify 5-10 mg/day and/or lamotrigine 150-300 mg/day.
Has any other drug or substance given you some kind of improvement?
- Scoty
Posted by rose45 on May 12, 2019, at 6:45:35
In reply to Re: nardil and parnate have both pooped out on me » rose45, posted by SLS on May 11, 2019, at 11:38:36
Hi SLS,
Im now on 40 mg, and completely constipated, whereas 30 mg worked fine for 5 yrs. Ive been on 40 mg for 3.5 months and the doctors here in the uk dont want me to go up higher. I actually couldnt stand going higher myself, as it is really unhealthy being as constipated as I am now. Am feeling totally suicidal as I cant see any way out. The only drugs that have helped me are nardil and parnate, and the doctors on the nhs here are so conservative.I have no insurance as this is a long standing pre-condition. I must say that when the meds did work, I did become quite over-convident, arrogant, and a different personality in many ways. Ive seen many people say similar things. My mother was on parnate also, and used to gamble a lot. I really dont think this is bipolar, but the result of the meds. Ive read several people say similar things and also that the maois can ruin you. The following article is extremely frightening:
Major depression induced or exacerbated by a substance/medicationHas anyone here ever encountered a significant and long-term increase in the severity of their depression after taking a medication or other substance?
TL;DR: I once had mild depression that was very responsive to treatments. After a 10-month course of phenelzine/Nardil, I was left with severe depression that basically responds to nothing, forcing me to line up for ECT. I feel very strongly the phenelzine caused this increased symptom severity and medication-refractory status, especially after reading a journal article that records this phenomenon has happened in the past (https://www.ncbi.nlm.nih.gov/pubmed/2910838).
________________________________________________________________________________________________________________________________
My major depression originally started because of stress caused by my mild-moderate social anxiety. However, the depression was only mild-moderate in severity and quite treatment-responsive: 100 mg/day of sertraline eradicated the symptoms by about 75%. I went on and off sertraline for years, and it never stopped working for my depression during this time.
The sertraline didn't do much for my social anxiety though, so I eventually got fed up and decided to try the gold standard treatment for it: phenelzine. I worked my way up to 75 mg/day. The therapeutic effect was astounding: after three weeks on the medication my major depression went into complete remission, and social anxiety was reduced by 4/5.
However, over the months the anti-depression efficacy of the phenelzine slowly waned (its anti-social-anxiety effect remained constant, though). By about 10 months in it was less effective than sertraline had been for my depression. I went off the phenelzine and went back on the sertraline. When I came off the phenelzine, I found my depression was far more severe than before I began, especially when it came to fatigue and cognition (e.g. word-finding).
Moreover, sertraline no longer worked! Over the next two years I tried just about every medication in the book:
SSRIs and/or NRIs
Tranylcypromine (including high dose 120+ mg/day)
T3 augmentation
Ketamine infusions
Scopolamine [hydrobromide] infusions
Psilocin (i.e. Magic Mushrooms)
Methoxetamine (an NMDA-antagonist dissociative hallucinogen)
Buprenorphine
CERC-501 (a selective kappa-opioid antagonist)
Melanocyte-inhibiting-factor-1 (MIF-1)
Sarcosine (an NMDA modulator)
Tianeptine
Course of rTMS
Of the above, I get partial responses (~25% symptom relief) from tranylcypromine, scopolamine, buprenorphine, and once briefly from MIF-1. Nothing else touches me. I'm in line for ECT now.
There are currently no 'stress' factors in my life - my social anxiety problems are long gone. (I inadvertently learned while injecting testosterone for bodybuilding that keeping my T in the upper end of the normal range 100% obliterates my social anxiety. This was by far the biggest break of my life). My depression is purely 'biological' in nature, and without these depressive symptoms I would be problem-free and happy.
And so I am forced to conclude that a single 10-month course of phenelzine turned my case of mild treatment-responsive depression to a monster case of severe refractory depression that may not even respond to ECT. Although I can't find any anecdotal cases on the internet resembling mine with respect to MAOIs, I did find an academic article describing three patient cases which have a striking similarity to my own case:
The Journal of Clinical Psychiatry. (1989). Tolerance to phenelzine and subsequent refractory depression: three cases. 50(1), 33-35.
PubMed link: https://www.ncbi.nlm.nih.gov/pubmed/2910838
Abstract: Three patients with major depression superimposed on chronic dysthymia were treated with phenelzine. After an initial excellent response, each patient relapsed and developed a severe chronic depression that was refractory to other treatments. The implications for the long-term effects of phenelzine treatment are considered.
By the way, I don't wish to turn anyone off phenelzine. If it did indeed cause this, then it must have been an extraordinarily rare genetic reaction. I think phenelzine is still a fantastic medication (after the first few months I had less side effects on phenelzine than sertraline, believe it or not) for social anxiety and depression.
13 commentsand also:https://www.wallowinmaya.com/tranylcypromine-the-most-powerful-antidepressant-ever/#com
Posted by rose45 on May 12, 2019, at 7:07:28
In reply to Re: nardil and parnate have both pooped out on me, posted by rose45 on May 12, 2019, at 6:45:35
Has anyone taken any of the maois for any length of time, and then been able to live med free, or been ok on any other med subsequently?
I would really appreciate knowing, as the above article as well as what Peter Kramer mentions in his book Listening to Prozac which I have mentioned in an earlier article, have really scared me about having taken maois. I am having severe cognitive difficulties and can barely function at the moment.
Posted by sigismund on June 18, 2019, at 3:13:36
In reply to Re: nardil and parnate have both pooped out on me, posted by rose45 on May 12, 2019, at 7:07:28
https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/
Thanks.
This is the end of the thread.
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