# Nardil and Parnate users please help.



## hensley258 (Apr 24, 2010)

Is it just me or is it normal for Parnate to make me feel so weak? It's kind of like a rubber legs lack of physical energy feeling. Kind of like my body feels very weak most of the time. My mind doesn't feel weak or depressed so it's not from my depression or anxiety.

To me it feels like what it feels like if your blood sugar level was low, but I have been checking that and my levels are in normal range.

I can't blame it on the low Blood pressure the drug causes because even when I am at 118 over 82 I still feel very weak.

It's been 4 months on this drug and even going down from 40Mg a day to 20Mg a day has not helped.

Is this some unknown side effect of Parnate or is this one of the side effects?


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## crayzyMed (Nov 2, 2006)

Probably caused by the decrease in NE.


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Probably caused by the decrease in NE.


Decrease in NE? You mean Norephinepherine? How could that be?
The lack of MO that MAOI's cause always bumps up Norephinepherine.

Thats the very mechanism by which it works. More Norephinepherine in the brain and less depression. I don't get it.

I am absolutly positive it's the Parnate. It has to be because I have never felt this kind of body weakness in my life for no reason.

It feels just like your Glucose level is low, yet it's not. If you have ever done wind sprints for an hour after not eating the whole day and your body and legs get all shaky and weak that is exactly what it feels like.

Or if you have ever tried a strict no Carb diet then it feels like that.


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## crayzyMed (Nov 2, 2006)

MAOI's decrease norephinepherine, its the elevated dopamine and serotonine wich probably helps your depression, all MAOI's decrease norephinepherine, because they rease a certain peptide (forgot the name) wich then lowers NE, even tough MAOI's block NE breakdown, they decrease it.

Weve mentioned it several times before in your thread, get a med that increases NE, like wellbutrin.


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## Rasputin_1 (Oct 27, 2008)

I felt really weak and physically slow on them.


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## Area88 (Oct 4, 2010)

So do drugs like wellbutrin counter this by increasing NE again? Can you completly negate this side effect?


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## crayzyMed (Nov 2, 2006)

Area88 said:


> So do drugs like wellbutrin counter this by increasing NE again? Can you completly negate this side effect?


Yeah wellbutrin will work against the fatigue and hypotension caused by MAOI's.


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## Area88 (Oct 4, 2010)

Excellent! Thanks so much for that valuable piece of information crayzyMed. Because I'll be starting Parnate very soon, all this info is really vital.

Last question, can you start Wellbutrin as the same as Parnate? Would it be best to do this right away or wait a week or more?


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## crayzyMed (Nov 2, 2006)

Area88 said:


> Excellent! Thanks so much for that valuable piece of information crayzyMed. Because I'll be starting Parnate very soon, all this info is really vital.
> 
> Last question, can you start Wellbutrin as the same as Parnate? Would it be best to do this right away or wait a week or more?


Yeah you can start them at the same time, officially they are contraindicated but you can safely combine them.


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## Area88 (Oct 4, 2010)

Fantastic! Thanks so much, reading through another topic, Caedmon swore by this combination - http://www.socialanxietysupport.com/forum/f30/nardil-vs-parnate-39068/


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Yeah you can start them at the same time, officially they are contraindicated but you can safely combine them.


crazyMed, can you please find me some (anykind) of supporting medical documentation on what your saying? I know for a fact right now that my P-doc will freak out if I suggest taking Welbutrin with my Parnate. I need to show her something.

She will never do it unless I can find some sort of documentation. I don't want to get off MAOI because it's working so damn well for my depression, but this is the first time in my life that any AD side effect has me thinking about quitting it.

This one and only side effect is kicking my ***. Also, from all that I have read Welbutrin only effects Dopamine and no other neurotransmitting chemicals in the brain.

I must also ask...If Welbutrin is such a good NRI then why is it often combined with SNRI drugs like Effexor? It doesn't make sense. In fact it's not even classified as a Norephinepherine Reuptake inhibitor.

Last I read is that if you combine Welbutrin with MAOI-A then your a dead man. I think my P-doc is also under the same assumption, but if it works to counter the weakness then I can stay on Parnate which would be ideal since nothing else works for my Atypical depression.


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## crayzyMed (Nov 2, 2006)

Wellbutrin does *not* significantly affect dopamine its a basicly just a NRI.



> If Welbutrin is such a good NRI then why is it often combined with SNRI drugs like Effexor?


To further augment the antidepressant effects?



> In fact it's not even classified as a Norephinepherine Reuptake inhibitor.


But it is.



> Last I read is that if you combine Welbutrin with MAOI-A then your a dead man.


Wrong.

Adding a NRI to a MAOI is HIGHLY recommend to counteract the NE related side effects.

I will look for documentation tomorrow (remind me tomorrow send me a pm or something in case i forgot) there's nothing about wellbutrin specifically but that other tricyclic antidepressant wich basicly is a NRI is combined with MAOIs very safely.


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Wellbutrin does *not* significantly affect dopamine its a basicly just a NRI.
> 
> To further augment the antidepressant effects?
> 
> ...


I used to take Welbutrin with the tricyclic Nortriptilyne and I know that is safe to do. I just thought my doctor at the time was trying to use Welbutrin to add a doapamine effect to the NRI properties of Nortriptilyne.

Well, I would appriciate anything you could maybe find about Parnate + Welbutrin as an acceptable counteractant because I am very sure my P-doc is not aware of this and will want some data first.

If I can eliminate this weakness then I can stay on Parnate. If not then I must trade it for the alternate hell of my Depression. This pisses me off because I never complain about side effects, but this one is so strong that I don't know if I can continue with it.


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## crayzyMed (Nov 2, 2006)

Its definatly possible to counteract the weakness mate, its just NE related, i'l see what i can find tomorrow.


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## ambidexter (Jul 17, 2010)

hensley258 said:


> Is it just me or is it normal for Parnate to make me feel so weak? It's kind of like a rubber legs lack of physical energy feeling. Kind of like my body feels very weak most of the time. My mind doesn't feel weak or depressed so it's not from my depression or anxiety.
> 
> To me it feels like what it feels like if your blood sugar level was low, but I have been checking that and my levels are in normal range.
> 
> ...


I haven't been on Nardil that long + my experience on it seems to be atypical, so I'm not sure how helpful it is... But after I got Klonopin down to no more than once a week, the weakness seemed to become much more manageable. I still feel it here and there but it's not all the time like before.

Could just be that the effect happened to subside around the same time, I dunno. And turning down the Klonopin isnt an option for everyone. But yeah.


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## DSTiamat (Sep 14, 2010)

Is Selegiline+Wellbutrin also an good idea? I am on Selegiline for 3 weeks and still feel like I am taking a sugarpill, no energy nothing,except if I drink a big coffe, nice feelings then, so If I take Selegiline at MAOI-B doses and Wellbutrin (at what doses??) am I going to be ok? One inhibits dopamine brakedown and the other dopamine- (to a lesser degree, am I right?) and NE-reuptake, correct? 
DST


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Its definatly possible to counteract the weakness mate, its just NE related, i'l see what i can find tomorrow.


Check this out, I found it on a medical site:
*MAOI Method of action:*

_A depressive disorder is believed to be caused by a chemical imbalance in the brain. Monoamine neurotransmitters like serotonin, norepinephrine and dopamine are used to relay signals between nerve cells, and they regulate important functions throughout the body. Once these neurotransmitters have acted by sending a message in the brain, they are absorbed by a protein called monoamine oxidase, which is also referred to as a monoamine transporter. If too many monoamines are absorbed, a chemical imbalance occurs in the brain._

It would appear that Parnate does have NE related action. I'm confused as to how my weakness could be NE related if Parnate has this NE action.
The chemistry regarding it is confusing to me. According to this I have no MO to absorb NE which by my logic would dictate that plenty should be there as no absortion is taking place. Hence plenty of NE and no weakness.

Am I reading this wrong?


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## Area88 (Oct 4, 2010)

hensley258, according to reading round the internet, Parnate does increase all those chemicals, however _norepinephrine _is decreased. Everything crayzyMed has said so far seems be spot on.

Hopefully he can get back to us with some written medical support because I'll probaly be in the same situation as you in a few weeks.


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## crayzyMed (Nov 2, 2006)

MAO does break NE norepinephrine down, and you would expect that a MAOI also raises this chemical, HOWEVER MAOI's also raise a differend chemical wich inhibits NE, so despite blocking breakdown of NE the end result is less norepinephrine.


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## crayzyMed (Nov 2, 2006)

DSTiamat said:


> Is Selegiline+Wellbutrin also an good idea? I am on Selegiline for 3 weeks and still feel like I am taking a sugarpill, no energy nothing,except if I drink a big coffe, nice feelings then, so If I take Selegiline at MAOI-B doses and Wellbutrin (at what doses??) am I going to be ok? One inhibits dopamine brakedown and the other dopamine- (to a lesser degree, am I right?) and NE-reuptake, correct?
> DST


That combo will be ok, but dont be fooled with wellbutrins dopaminergic action, its just overtalked by the company's that sell it, it doesnt effectively raise dopamine in humans. You add an extra NE boost, also NRI's boost dopamine in the prefrontal cortex, so that could be of help too.


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## crayzyMed (Nov 2, 2006)

Increase in octopamine is what lowers NE and causes the fatigue, hypotension, weakness and other side effects, IMO, MAOI's should allways be taking with a NRI to counteract those side effects.


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## crayzyMed (Nov 2, 2006)

Study's and more on MAOI's + a stimulant:



> 1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.
> 
> CNS stimulant potentiation of monoamine oxidase inhibitors in
> treatment-refractory depression.
> ...


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## crayzyMed (Nov 2, 2006)

> From: [email protected] (Joel S Hoffman)
> Date: Sun, 18 Feb 1996 21:43:52 -0500
> Subject: MAOIs with stimulants
> 
> ...


Nortriptyline is a NRI like wellbutrin, and may also be an alternative for wellbutrin.

The ultimumate cocktail for treatment resistant patients is a MAOI + Nortriptyline or another NRI + Amphetamine, this combination is safe when titrated carefully and backed up by the literature.


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## Area88 (Oct 4, 2010)

Fantastic crazyzyMed! You are my hero! I'm printing those pages off as well.

I was about to post this old topic that confirms the same but your evidence is just perfection - http://www.dr-bob.org/babble/20060417/msgs/634992.html


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## crayzyMed (Nov 2, 2006)

Area88 said:


> Fantastic crazyzyMed! You are my hero! I'm printing those pages off as well.
> 
> I was about to post this old topic that confirms the same but your evidence is just perfection - http://www.dr-bob.org/babble/20060417/msgs/634992.html


Hehe thx man, i try to help ppl here as much as possible.

Definatly show all that stuff, hopefully you can get everything you need, all it takes is a open minded PDOC that knows what it takes to fix someone up (and getting completely fixed up is a very real possibility!)


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## DSTiamat (Sep 14, 2010)

crayzyMed said:


> That combo will be ok, but dont be fooled with wellbutrins dopaminergic action, its just overtalked by the company's that sell it, it doesnt effectively raise dopamine in humans. You add an extra NE boost, also NRI's boost dopamine in the prefrontal cortex, so that could be of help too.


TY very much , I will try it, may I know what doses of Wellbutrin are ok? shall I start small? how does it interract with Selegiline, meaning are there risks?And one more question what does this boost of dopamine in the prefrontal cortex effectively mean?
Ty again 
DST


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## wjc75225 (Jul 24, 2010)

Hmm. I haven't looked at this entire thread, but I sifted through it a little bit. Nardil hasn't made me feel weak or caused hypotension for me. I'm still able to have workouts just intense before I started taking it. I guess every medicine effects people differently. This is good info, though. It's good to see how much some people help others on SAS!!


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## crayzyMed (Nov 2, 2006)

DSTiamat said:


> TY very much , I will try it, may I know what doses of Wellbutrin are ok? shall I start small? how does it interract with Selegiline, meaning are there risks?And one more question what does this boost of dopamine in the prefrontal cortex effectively mean?
> Ty again
> DST


All NE reuptake inhibitors increase dopamine in the frontal cortex, because dopamine there is taken up by the NE pumps. This can help things as ADHD or improve cognitition (or feel more alert in social situations) and stuff.

Start with a low dose, but you should be able to go to the normal full dose without a problem.


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## crayzyMed (Nov 2, 2006)

wjc75225 said:


> Hmm. I haven't looked at this entire thread, but I sifted through it a little bit. Nardil hasn't made me feel weak or caused hypotension for me. I'm still able to have workouts just intense before I started taking it. I guess every medicine effects people differently. This is good info, though. It's good to see how much some people help others on SAS!!


Thats good news, hopefully this will continue man!


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## wjc75225 (Jul 24, 2010)

crayzyMed said:


> Thats good news, hopefully this will continue man!


Thanks! I hope so, too! Now it does sometimes cause sedation if I don't stay active .. Like if I'm sitting at my computer, I feel like I need a nap. I sometimes use coffee to counteract this. However, I've found it also motivates me to stay active and get out of the house because if I'm moving around, working out, or am engaged in conversation, I don't get that sedated feeling. Maybe it's half Nardil and half boredom because I know boredom can cause tiredness just by itself. It's not that I'm bored talking to people on SAS, but it doesn't take much energy just to type!


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## crayzyMed (Nov 2, 2006)

wjc75225 said:


> Thanks! I hope so, too! Now it does sometimes cause sedation if I don't stay active .. Like if I'm sitting at my computer, I feel like I need a nap. I sometimes use coffee to counteract this. However, I've found it also motivates me to stay active and get out of the house because if I'm moving around, working out, or am engaged in conversation, I don't get that sedated feeling. Maybe it's half Nardil and half boredom because I know boredom can cause tiredness just by itself. It's not that I'm bored talking to people on SAS, but it doesn't take much energy just to type!


Cool, so yeah if it motivates you it can be a good thing!


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> MAO does break NE norepinephrine down, and you would expect that a MAOI also raises this chemical, HOWEVER MAOI's also raise a differend chemical wich inhibits NE, so despite blocking breakdown of NE the end result is less norepinephrine.


I see what your saying now. I'm not in denial regarding your theory that this may be why I have this body weakness. I was just confused about how MAOI does one thing with NE and then also does another with NE that causes this problem.

I see my P-doc tomorrow. I just know she is going to think I am out of my mind for even suggesting Welbutrin as a counteractant to this problem.

I am very sure she has never heard of doing such a thing and she will claim if I do that it will raise my blood pressure far too high. Lets just say she is not an "out of the box thinker."


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## crayzyMed (Nov 2, 2006)

Yeah ive read about your doc before, imagine it would be hard to get. Good luck anyway!


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Yeah ive read about your doc before, imagine it would be hard to get. Good luck anyway!


Yea, it really sucks to find an AD that works so well but has just one side effect that is killing you.

Maybe I can find a way to order low dosage Welbutrin online. I just hate those online pharmacies because many just take the money and run or give you a low grade product. Off shore Pharmacies, you can never trust them.


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## crayzyMed (Nov 2, 2006)

hensley258 said:


> Yea, it really sucks to find an AD that works so well but has just one side effect that is killing you.
> 
> Maybe I can find a way to order low dosage Welbutrin online. I just hate those online pharmacies because many just take the money and run or give you a low grade product. Off shore Pharmacies, you can never trust them.


Some can be trusted, generally its a bad idea to self medicatie, but if you know what your doing and its the only thing that can help its an option (and i'l make sure you do nothing wrong).


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## ambidexter (Jul 17, 2010)

wjc75225 said:


> Hmm. I haven't looked at this entire thread, but I sifted through it a little bit. Nardil hasn't made me feel weak or caused hypotension for me. I'm still able to have workouts just intense before I started taking it. I guess every medicine effects people differently. This is good info, though. It's good to see how much some people help others on SAS!!


Working out is probably really helpful for battling side effects too.

I envy your ability to stick with it. I started on nardil with this whole plan for getting to the gym regularly, which lasted for all of two weeks.

Sigh.


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## hensley258 (Apr 24, 2010)

wjc75225 said:


> Hmm. I haven't looked at this entire thread, but I sifted through it a little bit. Nardil hasn't made me feel weak or caused hypotension for me. I'm still able to have workouts just intense before I started taking it. I guess every medicine effects people differently. This is good info, though. It's good to see how much some people help others on SAS!!


Please don't confuse this with Hypotension. I know what that feels like. It's a sleepy, tired, and even dizzy feeling. Last few weeks my BP has been a solid 118 over 82 which is right in the sweet spot.

The Hypotension I used to get from Parnate has stopped. I have also ruled out low blood sugar as the culpret as I have been checking it everyday because I thought that may be the issue.

I've never had a Glucose level problem, but on rare occasion we have all had our blood sugar level drop and you know how weak that makes you feel.

It feels just like low blood sugar, but it's not. If you have ever not eaten for 36 hours and then tried to exersise then that is exactly how it feels.
Like a rubber legs body weakness that is very powerful. I tried backing down to 20Mgs a day, but this did not help. About 1 hour after I take my Parnate this symptom will kick in hard core. I can hardly walk from the car to the door the body weakness is so bad.

No dizziness or sleepiness, just complete body weakness like low blood sugar. My glucose level is just fine though.


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## wjc75225 (Jul 24, 2010)

ambidexter said:


> Working out is probably really helpful for battling side effects too.
> 
> I envy your ability to stick with it. I started on nardil with this whole plan for getting to the gym regularly, which lasted for all of two weeks.
> 
> Sigh.


Thanks! It is hard sometimes to stay motivated, but I just know that it makes me feel good. Also, I'm naturally skinny, so I'm trying to bulk up. I have a good therapist who really motivates me. I know motivation comes from within, and she can't make me do anything that I don't want to do, but it's good to have someone to talk to and motivate me to stick with something that makes me feel better about myself. I mean, you would think that people would naturally stick with something that helps them feel better, but it doesn't always work that way! We all sometimes lose focus of bettering ourselves.

I hope you gain the motivation again because I really think working out (either cardio or lifting weights) boosts mood and an overall sense of well-being!


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## Area88 (Oct 4, 2010)

hensley258 said:


> I see my P-doc tomorrow. I just know she is going to think I am out of my mind for even suggesting Welbutrin as a counteractant to this problem.
> 
> I am very sure she has never heard of doing such a thing and she will claim if I do that it will raise my blood pressure far too high. Lets just say she is not an "out of the box thinker."


 As a person, you are always entitled to a second opinion, you don't even have to disclose this with your current P-doc. I did this to get to where I needed to be. Every psychiatrist has a different opinion, some are quite liberal and others are more conservative. The best ones are the ones that listen to their patient. Treatment should be a partnership, not an dictatorship.

I have used *removed* and they seem to be completly legitimate. No prescription required for anything, they even gave me a free pen with the URL on. Maybe one of the more experienced posters on this board could verify this for me.


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## crayzyMed (Nov 2, 2006)

Your not allowed to post pharmacies on the board, just saying so you can remove before you get an infraction.


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## hensley258 (Apr 24, 2010)

Area88 said:


> As a person, you are always entitled to a second opinion, you don't even have to disclose this with your current P-doc. I did this to get to where I needed to be. Every psychiatrist has a different opinion, some are quite liberal and others are more conservative. The best ones are the ones that listen to their patient. Treatment should be a partnership, not an dictatorship.
> 
> I have used *removed* and they seem to be completly legitimate. No prescription required for anything, they even gave me a free pen with the URL on. Maybe one of the more experienced posters on this board could verify this for me.


I didn't know either. At any rate thanks for the link. I'm sure the Admins will understand you just weren't aware. I guess you can talk about it, but not post links to them or names of them.

As for a second opinion, I agree 100% but unfortunatly I have spent dozens of hours this last couple months trying to find a different P-doc and over and over I get the same thing, "sorry sir but Dr. Jones is not taking new patients." Even my GP couldn't locate me a refferal.

Must be a lot of messed up people like me in this City or something.


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## Area88 (Oct 4, 2010)

crayzyMed said:


> Your not allowed to post pharmacies on the board, just saying so you can remove before you get an infraction.


 No worries, just edited it out now, thanks.



hensley258 said:


> As for a second opinion, I agree 100% but unfortunatly I have spent dozens of hours this last couple months trying to find a different P-doc and over and over I get the same thing, "sorry sir but Dr. Jones is not taking new patients." Even my GP couldn't locate me a refferal.


 Wow, thats unfortunate man. Have you considered going private for a one off consultation? It sucks when the system lets you down but it happens to us all. Everyone on this board is here to help so please keep trying. Your voice is just as important, if not more so, since it's you who has the symptoms and it's you who has to take the medication.


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## DSTiamat (Sep 14, 2010)

crayzyMed said:


> All NE reuptake inhibitors increase dopamine in the frontal cortex, because dopamine there is taken up by the NE pumps. This can help things as ADHD or improve cognitition (or feel more alert in social situations) and stuff.
> 
> Start with a low dose, but you should be able to go to the normal full dose without a problem.


Ok, you really are some hero ,I think that only a few Shrinks have the knowledge about meds that you have, in my country selfmedication is really my only oprions, Doctors are worthless. One more curiosity, does the Selegiline prevent the Dopamine breakdown (which is taken up by the NE)from the NRI in the frontal cortex, meaning do the 2 meds potentiate each other? I tried Ixel (a SNRI) with Selegiline and did not notice any difference.
Big Thank You


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## crayzyMed (Nov 2, 2006)

There could be some potentiation, but sellegilon does only boost dopamine in certain brainarea's, it skips the mesolimbic area's (important for social anxiety) for example.

You cant really notice dopamine in the frontal cortect, exept increased cognitive abilities, and thats likely what you could notice from the combo.


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## DSTiamat (Sep 14, 2010)

Is there some info about the areas of the brain and what effects certain neurotransmitter have on these areas somewhere on the web?I would need the mentioned combination more for my depression (energy +motivation mostly).What areas of the brain does Selegiline affect then (and how is it possible that if Seleg is an MAOI-B to not affect all the brain ?), by this I mean Seleg destroys the substances that should break down Dopamine, right? how can it do this ONLY in some parts of the brain? Do other MAOI act the same (only on some parts of the brain?like Parnate?or do they affect the whole brain?)
This is getting really interresting, I would like to know more.
TY 
DST


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## crayzyMed (Nov 2, 2006)

DSTiamat said:


> Is there some info about the areas of the brain and what effects certain neurotransmitter have on these areas somewhere on the web?I would need the mentioned combination more for my depression (energy +motivation mostly).What areas of the brain does Selegiline affect then (and how is it possible that if Seleg is an MAOI-B to not affect all the brain ?), by this I mean Seleg destroys the substances that should break down Dopamine, right? how can it do this ONLY in some parts of the brain? Do other MAOI act the same (only on some parts of the brain?like Parnate?or do they affect the whole brain?)
> This is getting really interresting, I would like to know more.
> TY
> DST


I will make a good reply for you tomorrow, feel really tired atm, remind me!


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## mike8803 (Feb 21, 2010)

Would anyone recommend Inderal + Nardil for panic attacks., rapid heart beat?


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## crayzyMed (Nov 2, 2006)

mike8803 said:


> Would anyone recommend Inderal + Nardil for panic attacks., rapid heart beat?


Should be fine mate.


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## wjc75225 (Jul 24, 2010)

hensley258 said:


> Please don't confuse this with Hypotension. I know what that feels like. It's a sleepy, tired, and even dizzy feeling. Last few weeks my BP has been a solid 118 over 82 which is right in the sweet spot.
> 
> The Hypotension I used to get from Parnate has stopped. I have also ruled out low blood sugar as the culpret as I have been checking it everyday because I thought that may be the issue.
> 
> ...


Ah. I think I can think of that feeling. There have been stressful times in my life where I haven't eaten for a long period of time (well, never 36 hours), but I understand what you mean. Like I said, I sometimes feel a little tired from Nardil, but it's nothing like you described. I hope you get it figured out soon!!


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> MAO does break NE norepinephrine down, and you would expect that a MAOI also raises this chemical, HOWEVER MAOI's also raise a differend chemical wich inhibits NE, so despite blocking breakdown of NE the end result is less norepinephrine.


Well, you were right she turned me down on adding Welbutrin to counteract this NE problem. I explained to her exactly what you said and here was her nasty response, "Well I have no clue where you obtained such info but you simply can not ever combine even low dose Welbutrin with Parnate!" Then she said, "if I was to do such a thing then you would have an immidiate and massive Hypertensive reaction resulting in stroke or worse!

Then when I told her that her idea regarding this was out dated and said I will go one further. I told her I have a 6 page documented study on the efficacy and safety of combining Parnate with Nortriptilyne and asked if she would like to see it.

She then said, "Parnate and Nortriptilyne? The whole idea is absurd and dangerous!"

I felt like saying "Ok *****, I come to you with solid studies from respected universities and psychopharmocolgists which PROVE things like this can be done in cases where the patient needs relief from a specific side effect or added antidepressive effect and you stick your ****ing head in a hole?!!!"

WTF? Who made her Hitler? Instead all she drones on about is my freaking Klonopin. "you should get off your 2mg a day klonopin and that will fix the problem." Yea right *****! I know the effects of my benzo and they do not include body weakness which BTW just started only when I started Parnate! Do the math you incompetent Psycho doctor!

She won't even read the studies I bring to her about a therapy I'm interested in. She just changes the subject and pushes my documentation aside. I ****ING HATE MY P-DOC! I'm stuck with here too which sucks even worse because this hick *** city I live in has no psychitrist that are taking new patients. If I were still in Detroit I could have a new P-doc by Monday.

damn it! I just want a P-doc that listens to new and well educated ideas. One that is open to trying new and different things. I could understand her reaction if i came to her with some crazy idea like, "hey lets mix Parnate with Nardil and stick an Emsam patch on me too!" I'm not doing that, but rather giving her solid data with fact to back it up.

I will never find a new P-doc. I'm doomed


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## crayzyMed (Nov 2, 2006)

Then its time to order online.


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Then its time to order online.


In theory that sounds like a good idea, but after some research I have discovered that the only places I could order Welbutrin from (Without a prescription) are very non-reputable off shore 3rd world based countries.

They only offer Generic Welbutrin and are based in places like Uganda, Mexico, and other undesirable localaties. The quality of the product these places sell is questionable at best.

They do have some reputable UK and Canadian Pharmacies, but they all require a doctors prescription to place an order.

As for the others.....I'm not sure I want to swollow a pill that came from Colombia or Mexico with no regulations.


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## crayzyMed (Nov 2, 2006)

DSTiamat said:


> Is there some info about the areas of the brain and what effects certain neurotransmitter have on these areas somewhere on the web?I would need the mentioned combination more for my depression (energy +motivation mostly).What areas of the brain does Selegiline affect then (and how is it possible that if Seleg is an MAOI-B to not affect all the brain ?), by this I mean Seleg destroys the substances that should break down Dopamine, right? how can it do this ONLY in some parts of the brain? Do other MAOI act the same (only on some parts of the brain?like Parnate?or do they affect the whole brain?)
> This is getting really interresting, I would like to know more.
> TY
> DST


MAOB enzym's arent spread all around the brain, we also have MAOA enzymes wich break down dopamine, if you take a dosage that is selective for MAOB your doing nothing to elevate dopamine in the mesolimbic area's.

If your taking high doses it also inhibits MAOA and you should raise dopamine in every brainarea, HOWEVER many ppl have comorbid ADHD here, and ADHD patients have excess dopamine transporters, so even if dopamine breakdown is stopped the DAT's would quickly move it away, hence why MAOI's dont work for ADHD and amphetamine works for alot more ppl then MAOI's regarding social anxiety.


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## Area88 (Oct 4, 2010)

You really are one of the most valuable posters on these forums crazyMed. I hope you never stop posting, your knowledge astounds me and your research skills are simply incredible. Thanks to your input, I favourited this thread a week ago.


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## crayzyMed (Nov 2, 2006)

Area88 said:


> You really are one of the most valuable posters on these forums crazyMed. I hope you never stop posting, your knowledge astounds me and your research skills are simply incredible. Thanks to your input, I favourited this thread a week ago.


lol thx

If you have any more questions you can allways pm me btw.


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## hensley258 (Apr 24, 2010)

Crazymed knows more about Psychopharmocology than my current Psychiatrist. It's because crazymed keeps up to date on new discoveries regarding brain function as it relates to Psychiatric medications.

On the other end of the spectrum we have my Psychiatrist that is stuck in 1980 and only practices what was taught to her in the books of that time.

I tried to welcome her to 2010, but she is obviously too smart for that.
Crazymed, your pretty young and seriously should consider getting your degree in Psychopharmocology. Even if SA keeps you from classes you can accuire such degrees at top rated online universities.

You could be the next person to develop a new and better class of antidepressant drug. It's still not too late for you.


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## crayzyMed (Nov 2, 2006)

hensley258 said:


> Crazymed knows more about Psychopharmocology than my current Psychiatrist. It's because crazymed keeps up to date on new discoveries regarding brain function as it relates to Psychiatric medications.
> 
> On the other end of the spectrum we have my Psychiatrist that is stuck in 1980 and only practices what was taught to her in the books of that time.
> 
> ...


I even failed highschool, allways been the worst studen of the class, i have a terrible ADHD and cant learn the most simple things, somehow i do want a degree but it takes hard work and i'm a guy that rather goes partying all the time, it will take massive efford in changing me.


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## crayzyMed (Nov 2, 2006)

hensley258 said:


> You could be the next person to develop a new and better class of antidepressant drug. It's still not too late for you.


All the compounds to fix up everyone are allready out there, all it takes is winning the retarded war on drugs, before that we wont see any good antidepressants.


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> I even failed highschool, allways been the worst studen of the class, i have a terrible ADHD and cant learn the most simple things, somehow i do want a degree but it takes hard work and i'm a guy that rather goes partying all the time, it will take massive efford in changing me.


I was the same way at 22. I did poor in High School and was too busy partying all the time for any further education. Because of this I had assumed that I just had a low IQ but when I was 37 my wife (who happens to have a masters) pressured me to take an IQ test and much to my shock I scored a 131 which really blew me away. Thats just shy of the gifted catagory.

I think my head was just too full of Bong smoke and alcohol during High school for me to realize my potential. They say Einstein also had ADHD. Some of the most brilliant minds are those that are disturbed.

If you pick something that really interest you like Pharmocology or Psychiatry then it's easier to focus on the study it takes. I wasted my gift and now at 41 It's too late for me. My domestic responsabilities are to high now and to get an advanced degree....LOL I would be 50 before I was done.

You could do it now, but you have to really want it bad. Pleanty of time to party when the work is done. As for better treatments, I dissagree. There will be more effective antidepressants developed in the future that don't use controled substances. You might as well be the one that discovers them. They say the brain has a ton of neurotransmitters that relate to depression that have yet to be isolated and fully understood.


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## crayzyMed (Nov 2, 2006)

Yeah i know i really need motivation, right now i managed to fix my ADHD with my current regime so with some efford it should be possible... i may go to university next year.



> Pleanty of time to party when the work is done.


I need my MDMA twice a week, so much for the "etard" nonsense haha.

The biggest reason i want to go to university next year is the social life, i'm a social freak and huge extrovert haha, just my SA was inhibiting it, but thats fixed now!



> There will be more effective antidepressants developed in the future that don't use controled substances.


We dont need them, everything is allready out there to fix everyone up for 100% haha.

Another problem is the retarded drug company's that only come up with isomers to be able to repatent the same old drug, they arent motivated to do somthing innovative.

If there's something i want to achieve in my life its to legalize most drugs and put all the compounds that are allready out there in clinical trials, so we can truly help ppl.


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Yeah i know i really need motivation, right now i managed to fix my ADHD with my current regime so with some efford it should be possible... i may go to university next year.
> 
> I need my MDMA twice a week, so much for the "etard" nonsense haha.
> 
> ...


That may not be as far off as you think. You have to understand that people of your age have a completly different mindset when it comes to the use of controled substances for mental illness and other things.

The day will come when your age group will be the ones in power positions in areas of science and government regulation. The current old goats will be long gone by then and you will see a shift in thinking.

It could also be you that helps make that change in idiology. I remember smoking MJ 15 years ago and if a person told me that some states would start allowing people cultivation permits I would have said they were crazy. It's already starting to happen and more will happen in every area of drugs when todays youth takes power. It's just a matter of time.

I was and am also very social. I have GAD not SA. GAD is weird because I have the same anxiety as SA, but it's not elevated or triggered by social situations.


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## crayzyMed (Nov 2, 2006)

Yeah you have a point there.

I'm a big extrovert, i was just trapped in SA wich made me feel extremely bad in social situations, MDMA removed that barrier and suddenly i could be myself, even the day after MDMA (so when the drug were off and i was sober) i was SA free and made TONS of friends and build tons of confidence.

Also a reason why i say that having SA means having low confidence is absolutely bollucks, and why i try to convince ppl of the dopaminergic implications of SA, and that for some drugs are the absolute key (not for everyone as low confidence CAN be the biggest issue that causes SA).


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## hensley258 (Apr 24, 2010)

I very seldom meet anyone with SA or GAD that do not have some form of Depressive dissorder. I find that they sort of run together like two peas in a pod.

As far as SA or GAD, I don't think in most cases it's caused by a low self esteem or lack of confidence. This is the assumption made by most non-sufferers that do not have the capacity to understand.

It's the same as saying that if a person like me who has severe Atypical depression is of low intellect. Actually the opposite has been proven to be the case. People with depression are heavy thinkers and my theory is that because we are always thinking, and evaluating the world around us that we actually cause our own chemical malfunction without even realizing it.

I know so many people with low intellect that have never had a mental illness, but it's very rare for me to find a person with severe depression that is not very intelligent.

I don't know what or why that is, but there is something to it.


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## wjc75225 (Jul 24, 2010)

hensley258 said:


> I very seldom meet anyone with SA or GAD that do not have some form of Depressive dissorder. I find that they sort of run together like two peas in a pod.
> 
> As far as SA or GAD, I don't think in most cases it's caused by a low self esteem or lack of confidence. This is the assumption made by most non-sufferers that do not have the capacity to understand.
> 
> ...


I have SA, but depression isn't really part of my life much anymore. I've had it in the past. Right now, I'd say that I feel lonely sometimes, but that's not really depression. Plus, I've been doing things with more people recently, so that loneliness has gone away some!  I've never just had tons of friends. I would say a lack of confidence is MY main cause of SA. I care too much what people think of me, but I'm getting better at not thinking about it too much. It's just that irrational thought pattern and why I use a CBT therapist. 
I wouldn't say I've ever had severe depression. The worst it's gotten is moderate .. like a 5-6/10. Also, I would consider myself intellectual :boogie.


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## hensley258 (Apr 24, 2010)

That's a good thing. Trust me you don't want Severe Depression. It's like Herpies....You never get rid of it. It will seriously make your head feel like it will go insane and explode.

To me it feels like you just lost your whole family in a plane crash, lost your home, and your job all in one day, yet nothing bad has really happened to feel that horrible. It's like the area of your brain that controls emotion just goes completly haywire. Crushing and dibilitating is a mild way to describe the feeling.


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## crayzyMed (Nov 2, 2006)

Never had problems with depression fortunalle


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## crayzyMed (Nov 2, 2006)

hensley258 said:


> That's a good thing. Trust me you don't want Severe Depression. It's like Herpies....You never get rid of it. It will seriously make your head feel like it will go insane and explode.
> 
> To me it feels like you just lost your whole family in a plane crash, lost your home, and your job all in one day, yet nothing bad has really happened to feel that horrible. It's like the area of your brain that controls emotion just goes completly haywire. Crushing and dibilitating is a mild way to describe the feeling.


Yeah its terrible, ive had intense depressive episodes, never long tough around 2 weeks, its horrible and i feel for ppl suffering from that on a daily basis.


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## hensley258 (Apr 24, 2010)

At this level it really sucks because even when it's under control with meds you can still tell it's there just hanging around waiting for your meds to fail so it can unleash it's horror on you.

Once a medication fails it will grow worse and never stop until you find a med combo that puts it back down. The feeling is so bad that you go beyond suicidal to the point where causing your death makes you feel warm and good inside. Anything even death to escape it seems a viable solution.

It hit's my body too and makes my extremities feel like they have heavy weights on them. Makes you dizzy and for me even effects my vision to where the world actually looks black and white only and the world takes on a kind of skewed sort of unreality feel to it.

In a way it kind of feels like a really bad LSD trip that never ends. I make up only 2% of depressed people with what they call Intractable treatment resistant depression with a HAM-D score that is off the chart.

It seems to get worse with age too because when I was in my 20's it was much more controlable.


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## crayzyMed (Nov 2, 2006)

Sounds horrible


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Sounds horrible


Oh dude, there are no words in the English lauguage to even describe it.
It's a pain so bad that I swear if God came to me now and said "I will abolish this disease from you forever if you let me take your right foot."

I swear I would jump at the chance and do it in a second. I don't care, I will walk around with a stump to be rid of this chronic illness.

That's no joke, I would really make that trade.


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## crayzyMed (Nov 2, 2006)

Dude i hope you find long term relief, i'm sure you will tough


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## hensley258 (Apr 24, 2010)

crayzyMed said:


> Dude i hope you find long term relief, i'm sure you will tough


I think I can get a very good long period of remission, but as we talked about before It requires a P-doc that is willing to let me try some things that are a little off lable or that old data says you can't do.

Parnate puts it down to about 60% but I know if I were allowed to experiment with some rare forms of augmentation such as Welbutrin that I just might get 95% relief.

Currently I have a 3 page study conducted at a top University that shows huge improvement in Refractory patients like me when they combine Nortriptilyne with Parnate. The data shows no major rise in BP and marked improvement. Long ago I was on just Nortriptilyne and it didn't help that much, but when combined with MAOI the result might be completly different. Same with Welbutrin. Alone it does little for me, but with Parnate it may be just the right thing.

My current P-doc will not allow such augmentation with Parnate because she says it could kill me.
Well, I have data that shows otherwise and she will not read it. Obviously I would not advocate such a treatment for a person with Mild or moderate depression, but she fails to understand that I'm not the average patient.

Do you know of anyone on the forum that has tried low dosage welbutrin with Parnate? If so how many and what was their response? I'm looking to just eliminate the NE weakness from Parnate, but this could also give me added AD benifit too.


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## Area88 (Oct 4, 2010)

Yeah, there are a few threads on Parnate and Welbutrin, including the doseage. If no one finds them, I'll post them tomorrow when I have time. I have one bookmarked somewhere.


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## i_against_i (Nov 29, 2007)

What dosage o Parnate you at?


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## jim_morrison (Aug 17, 2008)

hensley258 said:


> I very seldom meet anyone with SA or GAD that do not have some form of Depressive dissorder. I find that they sort of run together like two peas in a pod.


Yeah I think you have a good point, my depression and SA have always felt very closely intertwined. I think perhaps because my SA limits me from going out into the world and doing tasks that I enjoy, and as a result I end up feeling like a prisoner confined to my own home and that makes me feel depressed.


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## crayzyMed (Nov 2, 2006)

Its weird, i allways felt really happy, despite my SA being very severe in the past, gues the difference was that i allways KNEW that i was gonna be fixed one day, and never even tought that i would stay like that forever.


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## hensley258 (Apr 24, 2010)

Area88 said:


> Yeah, there are a few threads on Parnate and Welbutrin, including the doseage. If no one finds them, I'll post them tomorrow when I have time. I have one bookmarked somewhere.


Huge favor....Do that if you can. I would really like more first hand info about combining the two drugs.

"I_against" you asked my Parnate dosage? It was 40Mgs a day, but I had to back it down to 25Mgs a day because of only one side effect which is a severe body weakness from the drug. Even lowering the dosage didn't help much. It's not caused by Low BP because I hang steady at 118 over and my Glucose levels are also spot on perfect.

Crazymed has a solid theory it may be NE depletion caused by a chemical that the drug releases which in the end game causes Inhibition of NE.
Thinking maybe augmentation with low dose Welbutrin might counteract this side effect.

It's at least worth a try I figure. I would at first probably cut the Welbutrin into very low dosage sections just as a start point to see how it effects my BP with the Parnate.


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## jim_morrison (Aug 17, 2008)

Nortriptyline has other properties which lower blood pressure. Perhaps this makes it safer than other NRI's like wellbutrin when added to parnate :stu.


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## hensley258 (Apr 24, 2010)

jim_morrison said:


> Nortriptyline has other properties which lower blood pressure. Perhaps this makes it safer than other NRI's like wellbutrin when added to parnate :stu.


Could be. Long ago when I was taking Nortrip I never checked my BP so I wouldn't know how it was effecting my BP.

Not trying to compare Nortrip to Welbutrin because they are worlds apart. Even if low dose Welbutrin with Parnate bumps my BP up to 125 to 135 I'm not going to panic.

I took some radings from a few people I work with and my God some of them are walking around at 160 to 180 over and they don't even care. If I saw a 180 reading on my monitor I would freak out and run to the hospital.


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## i_against_i (Nov 29, 2007)

Hmmm... that's unfortunate! You're stuck in the middle ground. Not sure how bad the weakness was, but if you could push past into 60-80's you ought to notice the side effect subside, and knock back that depression 90+%. Parnate dosage is kinda paradoxical.. the higher you go, supposedly the less side effects you incur..except insomnia.

Too bad your pdoc is a retard and wont supplement you with low dose ritalin or dexadrine to help with energy as you try to raise dosage.


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## mike8803 (Feb 21, 2010)

i_against_i said:


> Hmmm... that's unfortunate! You're stuck in the middle ground. Not sure how bad the weakness was, but if you could push past into 60-80's you ought to notice the side effect subside, and knock back that depression 90+%. Parnate dosage is kinda paradoxical.. the higher you go, supposedly the less side effects you incur..except insomnia.
> 
> Too bad your pdoc is a retard and wont supplement you with low dose ritalin or dexadrine to help with energy as you try to raise dosage.


Why would he want to increase energy if parnate is suppose to act as a stimulant?


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## i_against_i (Nov 29, 2007)

Same thing happens with Nardil.. until it actually kicks in at adequate dosage/length of time, you're stuck in this limbo fatigue zone. Maois are reorganzing your whole neurotransmitter system, lol.


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## hensley258 (Apr 24, 2010)

i_against_i said:


> Hmmm... that's unfortunate! You're stuck in the middle ground. Not sure how bad the weakness was, but if you could push past into 60-80's you ought to notice the side effect subside, and knock back that depression 90+%. Parnate dosage is kinda paradoxical.. the higher you go, supposedly the less side effects you incur..except insomnia.
> 
> Too bad your pdoc is a retard and wont supplement you with low dose ritalin or dexadrine to help with energy as you try to raise dosage.


I made it to 40mgs and was pushing for 50Mgs, but I just had to back off. I was fine in every area except the damn body weakness. It's a rubber legs feeling and feels exactly like your blood glucose level just droped like a rock, yet my Blood sugar readings are fine and my BP readings are fine.

You think if I could push above 60Mgs the side effect may go away? I would have liked to stay at 40Mgs because at that dosage my depression was very manageable and I felt near remissive. It's just a body thing.

Maybe this side effect will go away. I already have 3 other Parnate side effects that went away.

Either way giving up is not an option. Over my dead body am I going back to the black hole that is my severe Depression. I will freaking crawl to my car in the morning if I must, but I'm not going back to that dark place. My severe depression scares me more than any horror in the world and I intend to keep that beast locked up as long as I can.


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## hensley258 (Apr 24, 2010)

mike8803 said:


> Why would he want to increase energy if parnate is suppose to act as a stimulant?


It's just a weird drug. On one hand I find Parnate Stimulating, but othertimes it can make you sleepy. It's all dosage and time.

Parnate just does some weird things to you sometimes. It will take you in one direction and then a week later it has you in the opposite direction. By far the most unusual AD I have ever taken. It almost will Morph and change on you at will.

Something I have never experienced on any other AD in my life and trust me I have taken so many different ones.


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## i_against_i (Nov 29, 2007)

Personally I would get a pair of crutches and try to push for 50 or 60, lol. But only you know what you are capable of and how bad you felt. I think effects will get better.

Pharmacopsychiatry. 1989 Jan;22(1):21-5.
*High dose tranylcypromine therapy for refractory depression.*

Amsterdam JD, Berwish NJ.
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
*Abstract*

A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.

*MAOIs in high doses and with stimulants*

Date: Sat, 1 Apr 1995 13:33:03 -0800 (PST)
From: Ivan Goldberg <[email protected]>
Subject: Non-response to tranylcypromine
The commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.

Date: Fri, 14 Apr 1995 15:06:15 -0700 (PDT)
From: Ivan Goldberg <[email protected]>
Subject: MAOIs in high doses and with stimulants
There are recently been a number of warnings posted there that MAOIs should not be prescribed together with psychostimulants. While that is the conventional wisdom, if universally implemented, it would deprive many severely and intractably depressed people from relief.
In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Until it was recently withdrawn, a 60ish year old patient of mine was only able to continue in his professional work by taking 170 mg/day of isocarboxazid + 5 mg of dextroamphetamine t.i.d. Since the isocarboxazid became unavailable, he has been doing almost as well on phenelzine 135 mg/day + the dextroamphetamine.
When treating patients with unusually hard to treat syndromes it is often necessary to use combinations [and doses] of medication that are conventionally considered to be contraindicated.


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## hensley258 (Apr 24, 2010)

i_against_i said:


> Personally I would get a pair of crutches and try to push for 50 or 60, lol. But only you know what you are capable of and how bad you felt. I think effects will get better.
> 
> Pharmacopsychiatry. 1989 Jan;22(1):21-5.
> *High dose tranylcypromine therapy for refractory depression.*
> ...


Where are the Psychiatrists that are open to unconventonal treatments like this? I can't find one in my city. They all are very strict about sticking with the old school standard treatment approach.

They know full well that my Depression is very treatment resistant and has been for 20 years. They know most classes of AD's do not work for me, yet they don't take a shot at something such as what you found above. I just don't get it. I have provided two of them with much simmilar documentation, but they push it aside as if what these other doctors are doing is non-sense.

Most people with depression do not warrent such augmentation, but I have proven to them that I do, yet they turn their back on me as if I'm crazy for even bringing up such ideas for relief.

Where are these out of the box thinking Psychiatrist because I need one so bad. My current P-doc is the worst. She thinks our doctor patient relationship is a dictatorship of which I have no say in my treatment. She looks down on my ideas like I am beneith her intelect, yet she fails to read the written findings and studies from other P-docs that are helping their patients by treating them in a creative manner.

She just locks up when I mention such things as if they have no fact to back them up. I bring her university studies and peer reviewed reports for her to read so she can understand and she pushes them aside and they go right in the shredder.

Memphis is a pretty big city and you would think my several year quest to find a P-doc with balls would have turned up at least one by now.


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## jim_morrison (Aug 17, 2008)

http://www.psychotropical.com/maois_full.shtml



> Combinations of MAOIs and TCAs may occasionally be used in specialist practice; but not all specialists have sufficient knowledge or experience to do this safely; it is uncertain how much is to be gained from the technique. The main danger is serotonin syndrome which can be fatal. This is likely to be caused by:-- MAOIs (including RIMAs such as moclobemide) when they are combined with 'SSRIs', or any TCA which is also a serotonin reuptake inhibitor (SRI) i.e. clomipramine and imipramine. Dual action drugs are also dangerous viz. venlafaxine, sibutramine or milnacipran (see other serotonin toxicity notes for details). *TCAs that are essentially only noradrenaline reuptake inhibitors, which is in fact most of them-- see (5) are quite safe when combined with MAOIs. So adding a small dose of amitriptyline, nortriptyline or doxepin to improve sleep (via H1 blockade, and perhaps 5-HT2A/C blockade) in a patient on MAOIs is most unlikely to cause any major side effect problems and does not give rise to any risk of serotonin syndrome.*
> 
> Combinations of MAOIs and TCAs got a bad name in the sixties because imipramine was used. It occasionally proved to have enough activity as an serotonin reuptake inhibitor to cause serotonin toxicity (serotonin syndrome). Such reactions were not then understood. Serotonin toxicity reactions were sometimes wrongly interpreted as 'hypertensive' reactions. Many current pharmacological texts still get all this wrong by mixing up serotonin syndrome and tyramine induced hypertension. *The irony is that mixing a TCA (one which is not also an SRI) with an MAOI makes it safer! This is because the 'cheese' reaction (potentially catastrophic hypertension) requires that the provoking dietary component (the amino acid tyramine) must first enter the pre-synaptic nerve, from whence it displaces noradrenaline which then mediates the hypertension. Tyramine is actively moved into the pre-synaptic nerve by the very same 'reuptake' mechanism that is blocked by TCAs, which are 'NRIs'.*


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## hensley258 (Apr 24, 2010)

jim_morrison said:


> http://www.psychotropical.com/maois_full.shtml


I'm actually not interested in combining a tricyclic with my Parnate, but was rather using that combination as an example that it can be done with little risk of Serotonin Syndrome.

My main interest was in combining Welbutrin with my Parnate. Logic would dictate that since Welbutrin has no Serotonin inhibition properties that it would make well for augmentation with Parnate to provide added energy.

Looking into Welbutrin I discovered that it doesn't effect Dopamine to a level which most people think. In fact it hardly effects Doapamine at all, but rather more Norephinepherine only.

By this logic I would imagine adding low dosage Welbutrin with Parnate would be safe if done correctly and could also eliminate the weakness I am experiencing with Parnate.

I have found plenty regarding Parnate with TCA's, but nothing about Parnate with Welbutrin. I would imagine someone out there must have tried this at some point and hope to hear from them.


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## Area88 (Oct 4, 2010)

A long time poster called Caedmon on Wellbutrin and Parnate, although it's not the exact thread I was looking for, here it is as proof: http://www.socialanxietysupport.com/forum/f30/parnate-klonopin-med-adventure-20461/


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## wjc75225 (Jul 24, 2010)

Yeah, good luck finding a pdoc to prescribe that combination! I'm not being sarcastic (hard to tell on the internet I know). Let us know if you convince him/her!


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## hensley258 (Apr 24, 2010)

Area88 said:


> A long time poster called Caedmon on Wellbutrin and Parnate, although it's not the exact thread I was looking for, here it is as proof: http://www.socialanxietysupport.com/forum/f30/parnate-klonopin-med-adventure-20461/


Looks like the one person was taking just 10Mgs Parnate with Welbutrin. 10Mgs to me seems like a very low dosage, but perhaps when taking Welbutrin you have to keep the Parnate low.


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## Area88 (Oct 4, 2010)

He reduced it over time because he's trying to get off the medication, he was taking higher doses at one point. I'll try and find the topics if I can.


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## DSTiamat (Sep 14, 2010)

http://www.socialanxietysupport.com/forum/f30/nardil-vs-parnate-39068/
hope that helps


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## donk (Aug 2, 2009)

crayzyMed said:


> Increase in octopamine is what lowers NE and causes the fatigue, hypotension, weakness and other side effects, IMO, MAOI's should allways be taking with a NRI to counteract those side effects.


Fantastic thread. I too was under the assumption that Parnate would elevate NE levels. This is important to me because I suffer from SA first and ADD second in importance. I have used and abused stimulants to the point where I am overly sensitive to anything NE related. I suspect adrenal fatigue. Taking Wellbutrin, Dexedrine, even L-tyrosine and I get a negative reaction physically and mentally. This Parnate/Stimulant combo sounds tailor made for me. I have just started Cognitive Behavioural Therapy and the Dr. said adding medication might be necessary. Really helpful thanks much.


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## crayzyMed (Nov 2, 2006)

If you do want to add a stim to nardil at some point, look into nebivilol and candesartan, the combo abolished amp's NE related anxiety for me.


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## donk (Aug 2, 2009)

crayzyMed said:


> If you do want to add a stim to nardil at some point, look into nebivilol and candesartan, the combo abolished amp's NE related anxiety for me.


Curious if Moclobemide works the same as Parnate in decreasing NE overtime?
I have been on Moclobemide for a short while. They warn of occipital headaches as a side effect. I got just that and decided to get off it thinking it was blood pressure related


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## vinny (Oct 20, 2010)

I finally quit Nardil recently, I've never felt better.
The fact of the matter is, Nardil works for the two months and then just poops out. Don't get your hopes up. The reforumation they did in 2003, really messed up this drug, not to mention all you do is gain weight from this medication and wind up with a big belly no matter how hard you work out at the gym.

Nardil is junk. Trust me, i've taken it for a year. Finally moving on to a different medication.


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## donk (Aug 2, 2009)

yeah that blows. I was getting my hopes up. The gaba connection and the absence of NE potentiation seemed right for me. I've tried ghb and the results were remarkable.....others I know don't enjoy ghb, so I'm thinking there must be a relationship with gaba levels and social phobia....did you try Parnate?


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## crayzyMed (Nov 2, 2006)

vinny said:


> I finally quit Nardil recently, I've never felt better.
> The fact of the matter is, Nardil works for the two months and then just poops out. Don't get your hopes up. The reforumation they did in 2003, really messed up this drug, not to mention all you do is gain weight from this medication and wind up with a big belly no matter how hard you work out at the gym.
> 
> Nardil is junk. Trust me, i've taken it for a year. Finally moving on to a different medication.


I'm wondering wheter poop out can be prevented with a NMDA antagonist.


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## metamorphosis (Dec 18, 2008)

Yeah, but it wasn't just effectiveness vinny was complaining about. It was also the side-effects like weight gain that seems almost impossible to get rid of. Than your dealing with metabolism,food and carb cravings, unnatural sleep cycles and on and on...I've often said to others that if I didn't know it was a 24 yr old complaining about all of these physical issues. I would swear I was reading about a 70 yr old!!! Fluid retention, constipation, lack of sleep.Witch is critical for your mental and physical health.

I guess it comes down to the scale of checks and balances. Serious personal questions need to be asked. How bad is my SAD? Have I used up all other options including med. combos,cbt etc.? Is it worth a trial run? You can always stop the med. Better sooner than later.

I would rather use up all other rationale possibilities but my SAD does respond pretty good for what I take. Oh yeah, I forgot. You need a blood pressure cuff, you can't get it up and you have to be very,very careful about food and meds. oc or otherwise.Because then you can have a hypertensive crisis leading up to a heart attack. I swear. Just like the issues of a 70 yr old. 

Weigh your options!!!!


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## rm123 (Mar 21, 2016)

Sorry for posting on such an old thread, dno if I can even expect a reply lol, but will bupoprion also remove the effects of muscle weakness with Nardil?


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## Gillman fan (Sep 24, 2016)

Yes. I have used this combo with Parnate personally, but I prefer Noritryptiline because the NRI blocks dietary reactions.


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## rm123 (Mar 21, 2016)

Gillman fan said:


> Yes. I have used this combo with Parnate personally, but I prefer Noritryptiline because the NRI blocks dietary reactions.


Ok thanks. I just imagine a TCA would increase my fatigue tho


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## Gillman fan (Sep 24, 2016)

Desipramine will allow you to eat anything and it is not at all sedating. Just something to consider.

Also it has like 0 serotonin reuptake potency, lowest of all tricyclics IIRC, so if your doctor is afraid of the MAOI + TCA combo you can mention this.

My current psychiatrist used Nardil + Desipramine "back in the day" before doctors panicked about MAOIs.


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## rm123 (Mar 21, 2016)

Gillman fan said:


> Desipramine will allow you to eat anything and it is not at all sedating. Just something to consider.
> 
> Also it has like 0 serotonin reuptake potency, lowest of all tricyclics IIRC, so if your doctor is afraid of the MAOI + TCA combo you can mention this.
> 
> My current psychiatrist used Nardil + Desipramine "back in the day" before doctors panicked about MAOIs.


My pdoc knows nothing about maoi's & is too scared to prescribe anything on it. He's currently trying to persuade me to switch to Effexor augmented with abilify


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