# Need advice from MAOI Parnate user



## hensley258 (Apr 24, 2010)

Hello all,
I'm new to the forum and it seems like it's pretty active which is a plus.

I am so desperatly seeking conversation with anyone that uses the MAOI Parnate, but after weeks of searching I have found not one person in the entire world wide web that takes the drug.

I don't want to bore you with my medication past, but may I be very breif as to my condition. I am 40 years old (male) and when I was 23 I was (not sure why) hit with very severe depression and anxiety dissorder (diagnosed as uni-polar). My symptoms were off the chart severe. I was put on my first antidepressant in the hospital (Zoloft) and given my system was new to antidepressant drugs the Zoloft worked like magic at 200Mgs a day after about 4 weeks. My life was restored I was released from the hospital to an outpatient Psychiatrist and I really felt normal again and figured the whole thing was behind me.

I was very wrong about that. 2 years later the Zoloft slowly stopped working and my Depression and anxiety started to return. My Psych doc then switched me to Effexor XR. We had to ramp it up to 300Mgs a day, but after 4 weeks I felt like my old productive self again.

To make a long story short, 4 years and the Effexor slowly stoped working also. Then on to Tri-cyclics and combinations of meds. Some relief here and there but always the drugs would poop out on me.

In 18 years I have been on 17 different meds. Some worked ok and some not at all. Now days most fail to work very well. I get a little relief from them, but not much.

I think after so long taking SSRI's and SNRI's that I have just simply become resistant to any theraputic effect they might offer.

I've seen more than a few Psychiatrist, why would none of them have tried me on MAOI? I don't have social phobia or OCD so I figure Parnate might be a good try.

No doctor ever offered this treatment to me and when I ask them they look at me like I have a death wish. I told one Psychiatrist, " look pal I already have one foot in a coffin so why would I be worried about taking Parnate?"

I have read so many stories of people with the exact same symptoms and exact same story and they are doing great on Parnate. They report feeling normal for the first time in years.

I feel I have done my time with so many meds and failed in the end. Why not MAOI? I told my P-doc if it doesn't work or I get sick then we can go back to the previous drugs that are only working a little even at high dosage.

I am responsable, I diet all the time to keep a 32" waist so any diet restrictions don't bother me. I don't drink and my blood pressure has always been rock solid.

I think I'm a good candidate and my physical health is good, no allergies.
Going on 6 Psychiatrists now and none of them will try me on Parnate even though they admit I am not Bi-polar. If I die from MAOI then so be it, but to live like this is no life anyway.

I am desperate and now may even order MAOI on my own and just spend 10 days flushing my current meds from my system. I feel I have no choice. 

Please help, what can I do to have a psych doc help me with MAOI?
I'm so sick of them giving an ugly face everytime I request Parnate.
I will even buy a portable blood pressure monitor and check my BP 15 times a day. I even agreed to get a Med Alert bracelet that says MAOI on it just in case of an accident.

I feel like I am being very responsible with the prospect of taking Parnate and I even spent week doing research about how to use the dug safely and what precautions to take at all times.

Please help me. I am so desperate and I have suffered so long that even suicide is starting to sound like a real and only option for me.


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## Godber (Apr 17, 2010)

Hi hensley, I am also looking for advice regarding Parnate, I have been on many SSRI's and have found little benefit from them. Like you, no GP or psych has ever offered me an MAOI, so I did some research and found it to have great efficacy for SA and depression.

I realise that there are dietary restrictions and possible hypertensive issues but I would really like to try it as life has become unbearable these last few years and I need some radical change. I can't understand the 'veil of secrecy' attached to this drug and would also like to speak with anyone who has experience with it.

I have an appointment with my psychiatrist next week and it is the first on my list which I want to discuss. I will let you know how I get on.

Here is some info I found:

http://http://www.revolutionhealth.com/drugs-treatments/parnate

http://http://www.dr-bob.org/babble/20090912/msgs/917054.html


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## hensley258 (Apr 24, 2010)

Godd luck Godber. I hope he or she doesn't treat your request the way the last 6 Psychiatrist reacted to my request.

The MAOI club reminds me of a sort of secret society. No one want's say much unless you know the secret pass word at the door.

I did find some documentation that listed there are approx 90,000 people in the United States alone that are taking MAOI. You would think just by pure chance that I would have bumped into one of them by now.

I asked my current Psychiatrist a couple weeks ago and he said no. What pissed me off is that he wouldn't even give me a reason why.

I hope you have better luck than I had. Now (again) I am looking for another Psychiatrist that will help me with MAOI. For me this is no longer a search but a damn quest from hell. I spend half my days on the phone trying to nail down another Psychiatrist to ultimatly ask the BIG question.

They make me feel as if I were going in their office and simply asking for a controled Substance like a powerful Narcotic or mass amounts of Xanax.
I have to remind them that Parnate is not a Controled Substance as listed by the FDA.

Now you know why I am very close to just treating myself. I can get name brand Parnate online with no prescription, but I wanted to do it the right way and do it thru a Psychiatrist.

A word of advice: If your doc says yes then make sure he writes the script for NAME BRAND ONLY. I hear storys about people getting very sick or dead on Generic MAOI so tell the Pharmasist it must be name brand and make them check it.


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## Rasputin_1 (Oct 27, 2008)

I take Parnate and have taken Nardil. If you dont mind the side effects Nardil to me at least was much better. What exactly do you want to know?


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## Rasputin_1 (Oct 27, 2008)

hensley258 said:


> A word of advice: If your doc says yes then make sure he writes the script for NAME BRAND ONLY. I hear storys about people getting very sick or dead on Generic MAOI so tell the Pharmasist it must be name brand and make them check it.


Where did you get this information..... link? source?


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## hensley258 (Apr 24, 2010)

Holy God on earth! We have found a fellow sufferer that managed to get prescribed an MAOI! I found one of the select 90,000 in the United States!

As for the generic Nardil I can not say. My advice was regarding it's sister drug Parnate and NOT to take the generic of Parnate. I accuired this info online while browsing many blogs (not forums) related to Parnate. Seems a good number of people had big time problems with Generic Parnate. At least thats was was written by many users.

You ask what do I want to know first hand about MAOI? More like what don't I want to know. I am a 17 year sufferer of very severe Uni-polar Depression and (GAD) Generalized Anxiety dissorder. In my case Parnate would be a better bet due to the fact that I do not have Social Phobia or OCD which Nardil tends to treat better.

That's why my interest is in Parnate rather than Nardil.
My first question is how in the hell did you even manage to get a Psychiatrist to prescribe the drug? I am a text book candidate for MAOI and when I even mention the word to a Psychiatrist they put on their Gym shoes and run like hell. I mean they don't even want to hear the word much less prescribe it. They love to just keep pumping the same useless SSRI's, SNRI's, and Tricyclics with a dash of lithium and maybe Lamictal. Over and over this goes knowing the result will always be the same. None or little effect for a hardend vetran like me.

Those wimpy SSRI's used to work ok for me years ago, but thay pooped out long ago.

How bad are the food restrictions? Not that I care. I diet all the time anyway to keep a 32 inch waist. I will eat freaking bread and water if it means a lift in my depression. Hell, I even told one Psychiatrist that I would buy a portable blood pressure monitor and check my BP 15 times a day! I will too! I even said I would get a MedAlert bracelet that says MAOI on it in case of emergency.

Can I still take my Klonopin on MAOI? I read you can, but you have to be careful. How are the sexual side effects? You know that "I can perform no problem, but can't finish issue with SSRI's and SNRI's."

About alcohol. I know you can't drink just anything, but can you drink distilled spirits like Vodka or Rum?

Well, that's a lot of questions for me to ask and I hope you can answer them. Thanks for being the only person on any forum in America that takes an MAOI.

A Nardil user is close enough!:yes


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## Rasputin_1 (Oct 27, 2008)

Former Nardil user, I take Parnate now, generic actually. Which is why I am concerned as to what you heard. Can you share those links? As far as your questions.....



hensley258 said:


> My first question is how in the hell did you even manage to get a Psychiatrist to prescribe the drug?


I've been seeing the same doctor for over 5 years. Weve built up a good rapport and he respects me and I respect him. He listens to my ideas but ultimately he decides if I can take a drug or not of course. He thinks MAOI's are very useful in certain situations. Honestly hes just a real smart open-minded guy who thinks outside the box. Hes the only one ive ever been to, guess I got lucky.



> How bad are the food restrictions? Not that I care. I diet all the time anyway to keep a 32 inch waist. I will eat freaking bread and water if it means a lift in my depression. Hell, I even told one Psychiatrist that I would buy a portable blood pressure monitor and check my BP 15 times a day! I will too! I even said I would get a MedAlert bracelet that says MAOI on it in case of emergency.


You shouldnt gain weight on Parnate, if anything it might decrease your appetite a little. The actual food restrictions list they give you is pretty substantial, and your pharmacist will probably want to talk to you the first time you fill it to make sure you understand it. Soy sauce is bad for me. The only time I was actually scared was taking a pre-workout supplement I use to take (NO-Xplode), I took it without thinking stupidly and it reacted poorly. Not go to the hospital poorly, but close. Just test stuff out slowly if you are going to, the BP stuff is worst at first. Im on 40 mg's and I never notice a BP change.



> Can I still take my Klonopin on MAOI? I read you can, but you have to be careful. How are the sexual side effects? You know that "I can perform no problem, but can't finish issue with SSRI's and SNRI's."


I take Klonopin, no problems to report on that front. Also sexually everything is good, might even increase sex drive a bit.....



> About alcohol. I know you can't drink just anything, but can you drink distilled spirits like Vodka or Rum?


You should be fine with that, I drink beer/liquor approx two times a week. Never noticed any problems with that. I think most of the problems come from drinking wine. Again I would just take it slow and be careful. All the info I have is just whats worked for me. Things could be totally different for you.

Also there are many people on the board who have a much more technical knowledge of how these drugs work then I do. So you will probably get some more informative responses.


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## hensley258 (Apr 24, 2010)

I will post back later with those reports about Generic Parnate. I found them during random browsing and you know how hard it is to re-trace things your read on the internet over weeks. I will find them though.

That's great your on Parnate. To me it just sounds like your saying, take it slow and be more cautious at first until you know how things effect you. Is that right?

I have been turned down for Parnate by 6 different Psychiatrists since I moved to TN. My old Psych doc in Detroit of 6 years would do it in a second. He knows how long a how many different useless meds I have been on. I wrote him a letter and he agreed to see me to start my MAOI therapy, but that means a 700 mile drive to Detroit. Once on Parnate from a Psychiatrist my GP said he would refill for me, but he said no way to the initial start up on Parnate. I can't bame him, hell I know more about Psychotropic meds than he knows and he even admits that. GP docs just don't know much about Psychotropic meds and the idea of starting me makes him nervous. Cant blame him. Hes a good guy.

Maybe it would be worth the drive to see my old P-doc. I just don't see another way to get prescribed. Unless maybe I just order from an online scource, but they worry me because you never know what your getting.

You made it sound like after adjusting to Parnate that taking it really wasn't like strapping C-4 explosive to your body. That makes me feel so much better.

I have always tolerated medication just fine and my BP is dead normal (always has been)

Here's the wopper that's going to be tough for me, if and when I can get on Parnate. I have to wash out on my current meds with a fast taper.
For me thats Protriptilyne (thats an antidepressant) 600Mgs of Lithium, and 200Mgs of Lamictal.

I hear you have to be clean for ten days before starting any MAOI. That ten days is going to be absolute Hell for me. The withdrawl from Protriptilyne makes Effexor discontinuation look like childs play. Not to mention that although my current meds only work a little, it's that little bit that keeps me going just enough to sleep walk thru a day at work and keep me from falling into massive depression and anxiety. Imagine ten days med free for me. OMG! I will be the walking dead.

I can still keep taking my Klonopin which will help keep me at least relaxed druring the switch, but no question that the transition will take me to a very dark place that scares the hell out of me even thinking about it.

No pain no gain I guess. I will locate that info I found on Generic Parnate and post back to you.

Wish me luck on my quest for Parnate. Thank you so much for helping me! You are my hero! I will keep you posted on my quest to try Parnate.

Regards.


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## hensley258 (Apr 24, 2010)

Damn! I can't find the links to the people that said they had problems with Generic Parnate. As I recall the problems were mostly that it seemed to be less effective than the name brand made by Glaxo-smith Kline.

This may be true because my Psychiatrist once told me that most generic Psychotropic meds do have about 20% less active chemical in them.

Would you believe that our FDA allows Generic drug makers up to a 20 percent variance in active ingredient for the generics they make?
Honest it's true and I was shocked to hear that.

Now that FDA link of Generics I think I can find again. Many people report Generics to be less effective and I don't think they are imagining things.

Here is that artical on FDA approved Generic drugs: Also check out this web site: www.crazymeds.us/ It's a well informed investigative blog by this guy that investigates the FDA's failure to monitor generic drugs. What he finds is scary to say the least. He even takes generics to indipendent labs for testing to find out if they have the same amount of active ingrediant and they almost never do. The whole site is a good read. This article goes on much longer on the topic but I couldn't fit it all in my post to you. Just go to the web site and on the left you will see Generic vs Name brand tab"

It is absolute BULL**** that a generic medication is always the same as the brand name drug! There _can_ be a difference, a big difference for some people. I'm backing up that claim with scientific research as well as personal experiences. We've been told since forever that there is no difference between brand and generic drugs. Once again I'll be exposing the lies of the big pharmaceutical companies (this time the manufacturers of generic drugs) and the FDA.
I provided you with the generic name for each drug, and I list the generic names in the navigation panel of this site for all meds. If a generic version is available, you may not have a choice, that is what your HMO or insurance carrier is going to demand you take. 
The law of the land in the US is there can be a plus or minus 20% bioequivalence of the active ingredient! "FDA still uses the plus-or-minus-twenty percent test to determine _blood serum_ bioavailability (i.e., the amount of active ingredient in the blood) over a period of time has to come within plus-or-minus twenty percent of that which is observed when the innovator's drug is ingested." This is from an overview of the Hatch-Waxman Act of 1999, the last major overhaul to patents involving pharmaceuticals. I've been all over the FDA's Office of Generic Drugs site looking for that 20% figure myself, but all I could find were weasel words. Amidst all of the hard & fast numbers in the FDA's _Guidance for Industry Bioavailability and Bioequivalence_, they're pretty damn vague as to the exact bioequivalence and bioavailability required when comparing "pioneer" drugs with generics! Thanks to the Freedom From Information Act, they don't seem to be keeping it online anywhere.


Hey, this isn't just some rant that I'm just pulling out of my ***. An overall review of this issue found several generic psychoactive medications to be less effective than their brand-name counterparts. Many didn't meet their 20% bioequivalence standard. Does the FDA even monitor for that? No! It's on the freaking honor system!
To make matters worse they just test for the +/- 20% on healthy volunteers! Here's another recent article pointing out that obvious problem. And what do they test for? That everything is absorbed into their bloodstream properly, is metabolized at the same rate, and you piss and/or crap all of the remnants out in the same amount of time. There's not a damn thing evaluated about how well a generic works, because they don't try them on with brain cooties, and certainly not to test for efficacy. They don't even do any freaking brain scans if such are available to compare how the generic hits various parts of one's brain with the brand medication. Maybe later, after the generic is approved (see below for some studies I found for such), but not to get it approved. 
This study found that the easier insurance companies made access to brand-name medications for the consumer, the more likely said people were to keep taking their medications.
Not only that, manufacturing processes can differ. Inactive ingredients (i.e. dyes and fillers) can differ. Mostly the dyes. You can be fine with the coloring used by the original brand, or even used by the manufacturer of one generic, but not those used by another manufacturer. That problem is pointed out all over the place.
Does that mean the brand name is better? Not always. Like everything else with these crazy meds, there are pros and cons with all things. If you started out on a generic and don't have any problems with it, great! Stay with it. Does a change to generic automatically mean you'll have a problem? Nope. At least not if the manufacturer is producing a quality product. Several studies referenced below point out that problem as well. I've gone from brand to generic and with one exception the only times I've had problems are when the manufacturers are making crap products. But if your pills changed color, shape, whatever and the meds don't seem to be working correctly any longer, then head over to the page with links to pill identification sites and see if you can get your pharmacist to order your meds from that same manufacturer, and/or your doctor to prescribe brand only ("Dispense as written").
Some examples from the world of consumer experience and scientific research showing how brand name medications are superior to their generic 'equivalents':


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## hensley258 (Apr 24, 2010)

Thanks maybe they will post on this thread.


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## ThirdEyeGrind (Feb 7, 2006)

Rasputin_1 said:


> Where did you get this information..... link? source?


Can you tell the main differences between Parnate and Nardil? I'm on Nardil and might want to switch to Parnate because of the weight gain but I'm not sure.


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## Rasputin_1 (Oct 27, 2008)

AprilEthereal said:


> Can you tell the main differences between Parnate and Nardil? I'm on Nardil and might want to switch to Parnate because of the weight gain but I'm not sure.


sure. for me, nardil is a much better med. Helped more with motivation and rumination. Depression they both help. Parnate is weird in that it kind of makes my body feel tired, but my mind awake, but in a weird restless leg syndrome kind of way. Thats only when I was taking 50mg though.

Side effects are so much better. No sexual side effects. No weight gain, actually lowered appetite, some insomnia but nothing compared to Nardil.(Note: when I stopped Nardil I lost the 35 pounds like THAT, got a ton of complements lol) Helped just as much with depression, but less with anxiety. I would say Parnate really does not help anxiety nearly to the degree that Nardil does. It still helps some because it gets me out of the house to go do what I have to do.

I dont really know what to say about which is better, without nardil I probably would not have finished college. I let all my group-work/presentation filled classes until the last year, and it got me through it. The best thing about nardil was I didnt spend all the time thinking. I might still get nervous doing a presentation, but I wouldnt be thinking about it 3 months in advance.

Hope that helped, let me know if you have any other questions.


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## meyaj (Sep 5, 2009)

hensley258 said:


> Thanks maybe they will post on this thread.


Hi 

Yes, I post a lot about it, hardly a secret.

The only "trick" I found to getting to try MAOIs is to go through a ton of your pdoc's suggestions first and build a very trusting relationship with them over that period. I basically gave everything else a shot, and nothing worked, so it was really the only other thing that COULD be done (the other option suggested being ECT.)

Also, there are liability issues with a drug like this, and unfortunately many patients are sue-happy. Since I have a very trusting relationship though with my pdoc, she knows I take it VERY seriously. I have a medical info chain/dog-tag and wallet card (kind of like the med-alert you mentioned) as well as a BP monitor because I get paranoid about any sort of headache these days. I'm very careful about the foods I eat and I have a well-above average knowledge of all sorts of medications, which I guess is helpful because it allows me to be vigilant if a doctor is incorrectly prescribing me the wrong thing (which HAS happened), so my pdoc probably feels more comfortable.

Don't get a portable BP monitor though. They are unreliable. You need a good arm-band one, and if it's digital (which is likely), preferably calibrated by testing it against your doc's instruments. The truth is though, since I'm very careful about sticking to the diet, my BP has NEVER shot up in the 4-5 months or so I've been taking it. At 40mg, I'm at a _relatively_ high dose now too. In fact, my blood pressure is consistently DOWN 5 points from what it was. Hypotension is a far more common side effect and can happen to anyone, unlike hypertension which is a result of reckless food/drug ingestion. In fact, the 5 points mine went down is relatively mild compared to most. A lot of people get orthostatic hypotension (extreme hypotension upon standing, sometimes to the point of fainting). I think I'm not as bad because I eat a high-sodium diet and I'm also prescribed Dexedrine (amphetamine) alongside the Parnate, which I'm sure counters it a bit. You think an MAOI is hard to get?! Try getting this combo! One pharmacy I picked up the combo from actually forced my doctor to call me to double-check that I really understood the potential consequences and that she had totally informed consent before they would release the drugs to me...

But actually, even my pdoc was very hesitant to prescribe an MAOI originally. We discussed the possibility, but when it came time to do so, she became really reluctant. Ultimately what happened is she referred me to a consult with somebody who is much more of an expert on mood disorders at a big mental health research facility and hospital here. His strongest recommendation was ECT, but I insisted on trying an MAOI first, so ultimately he wrote back to her with MAOI treatment as the primary recommendation. It was for Nardil though.

And she also insisted on Nardil at first, but I told her I was worried about the potential side effects and would rather try Parnate. We compromised and I agreed to try Parnate if she would follow up in a week with me. Well, the Nardil really sucked, plus the liver issues were a big concern for me (my liver is not 100% healthy), so I was finally put on Parnate...

And yeah, I don't really know what else to say. There were no real tricks here, just building a proper relationship with my pdoc, demonstrating knowledge and the willingness to take it seriously, and always being willing to give her opinion some consideration and compromise. I don't think I ever would have gotten it hopping from doctor to doctor just looking for an MAOI. Of course, that's not really helpful advice if you just happen to get a doctor who will never even consider the possibility. It took a while but I finally got Parnate (the Dexedrine was actually not a concern for her at ALL at this point, as it wasn't prescribed until afterwards, but that's a whole other story.) It might also help that the fact that I live in Canada means my ability to sue her for unfortunate events while taking Parnate (especially since the majority of any adverse effects are REALLY in my control) would be really limited compared to in the US, but there are still plenty of Americans taking it as well. I'd be happy to answer any questions though.


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## hensley258 (Apr 24, 2010)

Thanks for the info. Over 18 years of treatment for depression I have racked up about 18 different medications and combinations for augmentation. In fact I have already been tried and failed on every tricyclic antidepressant that is in existance.

As for SSRI's and SNRI's there are only two currently on the market that I have not tried. Mind you this was all over a long period. I haven't been Willy Nilliy switching from one to another in rapid fire mode. Some worked ok at high dosages, when combined with drugs like Abilify or Lithium to help them work better.

Its been a very long hawl and my count may be off, in fact it may be higher than 25 different meds because many were in combination. No one can say that I didn't give all these safer drugs the best shot I could. I'm so pissed that after all that time and all those meds that not one P-doc said, "hey your chart is thick. we need to go for an MAOI with you."

As for trying to be subtile, yet persuasive with my P-doc, I will make valid points about sufferers just like me with the same exact symptoms that have a life again on Parnate. I bring him current Psychiatric jornols that clearly point out my type of depression should be tried with MAOI. I bring him solid facts. He knows my past and all the failed meds. God damn it I just want to reach across his desk and shake him saying THIS IS MY LIFE YOUR ****ING WITH!:cry Get it thru your head doc, another SSRI isn't going to help me if the last 6 did not. I know that for a fact, Is he too stupid to realize that?

I have moved a lot and thats why my longest P-doc was only 2 years, but still even with that and seeing first hand my decline you would think he would say, "we need to at least try this even though I havent known you that long." I'm not manic I just can't get moving like normal people and I have anxiety. God, I sleep so much because my depression is shutting my brain down.

I cry for hours at a time because I feel so hopeless and useless to my family. The tears just well up from my brain to my eyes and release in a shower of dread and gloom so deep that thoughts of my death make me feel warm and good inside. I can't explain it but, it's an emotional power so profound that I swear it almost feels physical in my head. Like my brain feels like it is vomiting. My head and arms always feel heavy like they have weights on them and when it gets bad I get a strange type of vertigo as I walk, but not like normal inner ear vertigo. It's very odd and I can't describe the feeling very well because it so hard to describe a feeling so strange.

I just want to scream because I know Parnate will help me. I have seen the changes it has made for others just like me, yet I am left out and made to suffer.:cry

I will have to accuire the drug on my own. There are ways. I have done the research and know how to start dosage and how long I will need to be off my current three meds before starting. I printed a very long list of things not to eat and OTC drugs not to take. I will take your advice and get the BP monitor you spoke of. It's a ****ing shame that I must resort to self treatment like this, but the reality is that death is the alternative for me. I'm not killing myself without a fight.

I'm glad you feel ok now and I will give hope that you will continue to stay productive on your MAOI. If You can think of anythin I might need to know, please post back.


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## meyaj (Sep 5, 2009)

hensley258 said:


> Thanks for the info. Over 18 years of treatment for depression I have racked up about 18 different medications and combinations for augmentation. In fact I have already been tried and failed on every tricyclic antidepressant that is in existance.
> 
> ...
> 
> ...


Well, first off, I'm far from okay now :lol Maybe 10% improvement in mood at this point, but I still have yet to hit my target dose of Parnate, so there's still hope. I'm a 220lb guy and generally need high doses of most drugs even considering that fact, but I AM thrilled with the total lack of side effects so far. I'm still one sick guy though and I don't think most people would think it's a stretch to say I'm easily one of the most actually impaired people on this board, unable to really function much at all except make sure my monthly government Disability check ends up in my bank account (when the government here doesn't put up a fight to NOT pay you $1,000/month and define you as disabled, considering that they routinely deny over 95% of eventually SUCCESSFUL applicants just to weed people out through the appeals process, it's not a terrific sign), though it embarrasses me greatly just to admit all that. It's possible that not just the severity of my mental illness but also the extreme degree to which my ability to function like a normal human being is impaired, has played a major role in my doctor's assessment that the risk of MAOIs is justified in my case. I get a sense of the treatment-resistant nature of your illness, but not so much the severity and especially the degree of impairment it causes. Some people on this forum see such comparisons as some form of mental-illness dick-sizing, though I hope you don't take it that way. I just don't know that much about your situation and so it makes it impossible for me to identify factors that may have some influence on your doctors' reasoning. BTW your initial post seems to imply that you think social phobia would make an MAOI harder to get but a) that's not true, it's highly successful for social phobia and the form of depression commonly associated with it (atypical depression) and b) if you don't have social phobia, how'd you end up on this board‽ 

I don't really know if self-medication is appropriate in this case though. With a med where contaminants and precise dosing can be so crucial, I think it's a real gamble trying to get the stuff from less-than-reliable sources. Besides, I've never even seen a non-selective inhibitor like Parnate offered online, the most hardcore MAOI available tends to be at most selegiline. I think even most of these sources know they're REALLY playing with fire if they offer something that irreversibly inhibits MAO-A. There would no doubt be people carelessly using the medication and yet these sources generally prefer staying low-key... anybody actually offering Nardil/Parnate without a prescription would likely be responsible for numerous deaths, be thrust into the national spotlight, and quickly made an example of. So I find it highly likely that if you somehow do find a website that offers it, they're probably just going to take your money and run. I've seen many online pharmacies even legitimately (in a business, not legal sense) offering HEAVY narcotics, and pretty much any non-MAOI antidepressant in existence, but not once have I seen these drugs. So be very careful.

I get the frustration of your situation. Depression already creates severe feelings of helplessness and when the people responsible for caring for you aren't doing what you know to be necessary, it only deepens and legitimizes those feelings. You DON'T want to give up, and you KNOW what the next step should be, but our society doesn't allow us to take control of the medication aspect of our disorders, we HAVE to depend on the knowledge and compassion of physicians, and what are you supposed to do when even they've given up on you or just don't care? It must feel twice as horrible just for the obvious fact that there IS one more VERY OBVIOUS move left in a typical psychiatrist's playbook and they don't even feel it's worth trying.

So I'm really sorry because I don't know what you can do, and nobody really does. Doctors are people too and it's impossible to predict what they'll do on an individual scale. Maybe you can start off by telling us where you live. There's a REMOTE chance that you live close to somewhere where somebody has been able to get this drug prescribed, and can give you the name of a doctor who will obviously at least consider it.



hensley258 said:


> God damn it I just want to reach across his desk and shake him saying THIS IS MY LIFE YOUR ****ING WITH!:cry Get it thru your head doc, another SSRI isn't going to help me if the last 6 did not. I know that for a fact, Is he too stupid to realize that


Why haven't you done this? Aside from the physical assault lol) I've had to do pretty much the same thing sometimes. I'm lucky to have a pdoc that I KNOW genuinely cares about me, but even I know that pdocs sometimes need a reminder that your life DOES exist outside these little half-to-full hour meetings, completely separate from them and their own lives, thoughts, and observations. While they're sitting at the dinner table laughing at their family's stories of earlier in the day, you're probably sitting somewhere in your house, all alone, in an agitated yet quiet despair, eager to move past the miserable day you've had and yet still terrified of the calendar moving forward with nothing to show for it. While they comfortably go to sleep at a reasonable hour, that's probably a luxury you could only ever dream of, but ironically, can't even do that.

When they're working with literally hundreds of individual people, it's easy for a doctor to become emotionally detached from their patients and treat them as a stack of papers, no matter how thick, without realizing that 99% of your life and problems really only exist between the lines of the written records themselves. They only know what you tell them, and it's hard to tell them much at all when visits are so short and become increasingly infrequent and treatment-focused, so they've really only got a tiny window into your life - not even a keyhole to peer through, really - enough to usually stick a diagnostic label on, but unfortunately making it all too easy to forget that you're a real human being, living a 24/7 hell for potentially all the remaining decades (if you don't end it sooner), and that they are the ones responsible for dragging you out of it.

I gave my pdoc a study last week supporting the safety of a possible tricyclic to the MAOI + stimulant I am on. She wanted to add an NRI, but the only relatively pure NRI on the market here is Strattera which is prohibitively expensive for me, so I suggested an NRI-like tricyclic but she was concerned about the fact that even the most selective still had significant (albeit low) serotonin activity. Her initial reaction the study was NO way. After explaining to her that I had only gathered this information in case of the Parnate alone not panning out in the future, something I wasn't even sure of yet, as well as acknowledging the fact that I know she'd be too uncomfortable to prescribe it but that she's never let an ego get in the way of her referring me to somebody with more expertise for a consult, he reaction was a BIT more positive, I guess. She basically said that if I REALLY wanted to do it, it shouldn't be too difficult to find a pdoc who can make knowledgeable recommendations to her and prescribe me the combo as long as I am willing to sign a waiver giving informed consent and acknowledging that I fully understand the risks involved. There's the legal concern again, and perhaps it's something you can offer to do, demonstrating your knowledge and seriousness and lack of ulterior motives, and protecting them from at least some degree of liability should something go wrong.

I bring this all up for another reason too though... the study itself which had a BRILLIANT opening line that I thought I should share and that every doctor should really consider every time they are reluctant to take treatment to the next level (whether it's a situation like yours or simply an ER doc refusing a kidney stone patient more morphine):



Combined MAOI said:


> Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a *moral and legitimate right* to innovative therapy.


They would do well to take heed!


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## ThirdEyeGrind (Feb 7, 2006)

Rasputin_1 said:


> sure. for me, nardil is a much better med. Helped more with motivation and rumination. Depression they both help. Parnate is weird in that it kind of makes my body feel tired, but my mind awake, but in a weird restless leg syndrome kind of way. Thats only when I was taking 50mg though.
> 
> Side effects are so much better. No sexual side effects. No weight gain, actually lowered appetite, some insomnia but nothing compared to Nardil.(Note: when I stopped Nardil I lost the 35 pounds like THAT, got a ton of complements lol) Helped just as much with depression, but less with anxiety. I would say Parnate really does not help anxiety nearly to the degree that Nardil does. It still helps some because it gets me out of the house to go do what I have to do.
> 
> ...


Thanks alot! Very Helpful!:yes


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## hensley258 (Apr 24, 2010)

meyaj said:


> Well, first off, I'm far from okay now :lol Maybe 10% improvement in mood at this point, but I still have yet to hit my target dose of Parnate, so there's still hope. I'm a 220lb guy and generally need high doses of most drugs even considering that fact, but I AM thrilled with the total lack of side effects so far. I'm still one sick guy though and I don't think most people would think it's a stretch to say I'm easily one of the most actually impaired people on this board, unable to really function much at all except make sure my monthly government Disability check ends up in my bank account (when the government here doesn't put up a fight to NOT pay you $1,000/month and define you as disabled, considering that they routinely deny over 95% of eventually SUCCESSFUL applicants just to weed people out through the appeals process, it's not a terrific sign), though it embarrasses me greatly just to admit all that. It's possible that not just the severity of my mental illness but also the extreme degree to which my ability to function like a normal human being is impaired, has played a major role in my doctor's assessment that the risk of MAOIs is justified in my case. I get a sense of the treatment-resistant nature of your illness, but not so much the severity and especially the degree of impairment it causes. Some people on this forum see such comparisons as some form of mental-illness dick-sizing, though I hope you don't take it that way. I just don't know that much about your situation and so it makes it impossible for me to identify factors that may have some influence on your doctors' reasoning. BTW your initial post seems to imply that you think social phobia would make an MAOI harder to get but a) that's not true, it's highly successful for social phobia and the form of depression commonly associated with it (atypical depression) and b) if you don't have social phobia, how'd you end up on this board‽
> 
> I don't really know if self-medication is appropriate in this case though. With a med where contaminants and precise dosing can be so crucial, I think it's a real gamble trying to get the stuff from less-than-reliable sources. Besides, I've never even seen a non-selective inhibitor like Parnate offered online, the most hardcore MAOI available tends to be at most selegiline. I think even most of these sources know they're REALLY playing with fire if they offer something that irreversibly inhibits MAO-A. There would no doubt be people carelessly using the medication and yet these sources generally prefer staying low-key... anybody actually offering Nardil/Parnate without a prescription would likely be responsible for numerous deaths, be thrust into the national spotlight, and quickly made an example of. So I find it highly likely that if you somehow do find a website that offers it, they're probably just going to take your money and run. I've seen many online pharmacies even legitimately (in a business, not legal sense) offering HEAVY narcotics, and pretty much any non-MAOI antidepressant in existence, but not once have I seen these drugs. So be very careful.
> 
> ...


You mentioned NRI, what about Reboxitine? If I failed to be descriptive with my exact symptoms that would be my fault. Some are easy to descibe and some are very odd and hard to put into any words the English launguage has. I will post back with those symptoms and try my best to describe them. They are very bad. I know even people with Mild depression think their symptoms are bad, but mine are morbid and that is putting it lightly. Luckily I don't see things or hear things that are not there and I don't have paranoia.

I did say I don't have social Phobia. I really don't. I meet new people no problem. Ican go into a crowded bar with no problem and even talk to strangers. In fact I hide my symptoms so well that most can not detect it except for the hand and arm tremors.

I must strongly dissagree that a person can not have Severe Chronic Depression unless they also have social phobia. I think the text books would back me up on that fact also.


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## meyaj (Sep 5, 2009)

hensley258 said:


> You mentioned NRI, what about Reboxitine?


Not available in Canada.



hensley258 said:


> I must strongly dissagree that a person can not have Severe Chronic Depression unless they also have social phobia. I think the text books would back me up on that fact also.


Whoa hold on a second. I don't remember saying that, though my post is too long for me to check. If I did, it was fueled by serious sleep deprivation, but that's such a ridiculous statement that I doubt I'd even murmur it in my sleep. What exactly did I say that made you think I even loosely implied that severe chronic depression requires social phobia?

The only thing I could possibly imagine causing such a misunderstanding is the following:


meyaj said:


> BTW your initial post seems to imply that you think social phobia would make an MAOI harder to get but a) that's not true, it's highly successful for social phobia and the form of depression commonly associated with it (atypical depression) and b) if you don't have social phobia, how'd you end up on this board‽


I don't see anything wrong with those statements considering you said:


hensley258 said:


> I don't have social phobia ... so I figure Parnate might be a good try.


What I meant by point "a)" is that, contrary to your implication that not having social phobia somehow makes you a better candidate for Parnate, when the truth reality is that social phobia is one of the strongest indications for the use of MAOIs; it would, if anything, likely help your case, so saying that Parnate "might be a good try" specifically because you DON'T have social phobia was understandably confusing to me, the statement doesn't make much sense. And saying that *atypical* depression is strongly associated with it wasn't at all off the mark either. About 30% of people with atypical depression have comorbid social phobia, with up to 50% comorbidity when looked at the other way around. This is very significant because MAOIs are most strongly indicated in atypical depression and have been repeatedly demonstrated to have much better rates and degrees of success compared to other subtypes of depression (in fact, they hardly stand out if at all in the treatment of other MDD subtypes), and for atypical depression specifically, compared to any other class of antidepressants. There is significant overlap between the disorders in the first place, and social phobia/agoraphobia are the next biggest indications for MAOIs by far, which is hardly surprising. Also noteworthy is the fact that the degree of impairment in people with BOTH disorders tends to be far greater than the sum of its parts. But while there's undoubtedly high comorbidity and many overlapping aspects of both disorders, I never made the claim that serious depression is only possible when paired with social phobia. Depression is depression, applying a descriptive label like "serious" or "severe" doesn't require anything else to be taken into account. What's undeniable though is that the level of impairment is _statistically_ much higher in people with the combination of disorders (though this doesn't mean an _individual_ with only one can't be severely impaired.)

The only other part I could see you being confused is part "b)", if you somehow thought this was a depression forum and not a social anxiety forum :lol


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## hensley258 (Apr 24, 2010)

meyaj said:


> Not available in Canada.
> 
> Whoa hold on a second. I don't remember saying that, though my post is too long for me to check. If I did, it was fueled by serious sleep deprivation, but that's such a ridiculous statement that I doubt I'd even murmur it in my sleep. What exactly did I say that made you think I even loosely implied that severe chronic depression requires social phobia?
> 
> ...


LOL! I would also have to read thru your entire post, but in a half a sleep daze I could swear you had said That Severe depression always has components of social Phobia. Maybe I read that wrong or you had a word out of place by accident.

I thought something was wrong when I thought I read that because you obviously know your ****.

What you said in relation to a persons severity of condition is open to a lot of factors and also an individuals ability to endure pain. Some of us have a higher tolerance to the kind of pain depression causes.

One could say that because I still hold a job that my condition can't be that bad. What they don't know is how I manage to hold that job. I sneek in late because I can't wake in the morning. I have found a way to make it appear as if I am productive when I am really not. I take 2 hour lunches so I can pass out as my depression demands almost constant sleep. I sneak out early because I don't punch a clock.

I have to work. It's simply not an option. Dissability wouldn't even cover my Gas and light bill much less the banks house payment and food for a wife and child. I still am amazed at how people survive on Dissability pay.
The payments are so low they really wouldn't even cover food for a month.

Then again my dad makes it on only $2000 a month so perhaps it can be done.
Oh about a person like me without social Phobia spending time on the forum. Because many of you take MAOI and people that take MAOI are nearly impossible to find much less ask questions to. So I came here and I found MAOI users.

No I don't have social phobia, but I do have very severe depressive dissorder with Anxiety dissorder. In the end they are both mental illnesses and even share some traits. Social Phobia brings on anxiety and panic attacks. I know what both are like even though social settings are not a trigger for me. I have no triggers. My anxiety is a constant and only lowers with use of a benzo.


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## odspot (Sep 1, 2009)

i'm curious whether anyone on Parnate found that the insomnia disappated? that was my biggest problem with it


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## peace (Apr 27, 2010)

Hi, I'm new to the board/thread. I'm on Day 4 of taking parnate for SA and depression. This is the second time I've been prescribed it, the first about 5 years ago from another psych but I had to stop because I went travelling and it was too hard to stick to the diet. Plus I thought I was better, of course .

I'm in Australia so maybe it's viewed with slightly less fear than in the US. Basically it seemed clear that SSRIs and SNRIs weren't working, side effects too debilitating, so my psych suggested parnate because I've been on it before. Problem is, I can't really remember much about taking it back then.

I felt great on day 1 (10mg) and day 2 (20mg), day 3 (30mgs) didn't really feel much emotion and didn't have much to say, terrible afternoon fatigue, and today still a bit of brain fog and heart beating fast. It has disrupted my sleep, which was already disrupted.

How long does it usually take to kick in? And I have the same question, do the s/e's like insomnia, rapid heart beat etc wear off after a while? I really just want to get my concentration back - happiness and less fear of people would be a bonus!

Thanks.


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## odspot (Sep 1, 2009)

peace, did your psych discuss a maximum dose with you? just curious 'cos in new zealand, where i was originally prescribed parnate, the literature stated that the maximum dose was 30mgs (though in the USA i believe psychs are safely allowed to go to 60-80mgs, and often go higher for treatment-resistant cases) ..

i'm in australia (melbourne) now and wondering if its the same case re: the 30mg limit


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## hensley258 (Apr 24, 2010)

Maybe I need to move to Austrailia. 6 P-docs and counting and not one will let me try MAOI even though I am very treatment resistant and have dozens of AD drugs under my belt. (I'm a black belt in AD's and mood stabilizers)LOL!

There are some on this forum from the States like me that have managed to get MAOI. Even then I think it took them a long time to get their P-doc to agree to do it.

I heard Parnate can keep you awake like nothing else. In my case I can't stay awake but for about 6 hours a day so maybe that would even me out perfect. No use wondering. The drug is off limits where I live.

Have you tried 1 mg of klonopin before bed to sleep. I think I read that you can take Klonopin with Parnate as long as you don't chomp down 5 Mgs of it. I think that might help.


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## peace (Apr 27, 2010)

Odspot - no, he didn't say about increasing it if the effect is not significant. But in the paperwork that came with the meds it does say that the usual dose is 20mgs a day. I plan to speak with him tomorrow or the day after over the phone, depending on when he has time. 

Do s/e's go over time or do they mean that it's not the right drug for me? For eg, I have severe chills, too cold to do much else other than sit in front of the heater wrapped in layers, and my pupils are so dilated I look like I'm high. Sydney's heading in to winter so being cold-sensitive isn't going to be great 

Hensley, no, haven't tried Klonopin but it's a good suggestion. I'll mention it when I speak with him. 
Thanks


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## hensley258 (Apr 24, 2010)

peace said:


> Odspot - no, he didn't say about increasing it if the effect is not significant. But in the paperwork that came with the meds it does say that the usual dose is 20mgs a day. I plan to speak with him tomorrow or the day after over the phone, depending on when he has time.
> 
> Do s/e's go over time or do they mean that it's not the right drug for me? For eg, I have severe chills, too cold to do much else other than sit in front of the heater wrapped in layers, and my pupils are so dilated I look like I'm high. Sydney's heading in to winter so being cold-sensitive isn't going to be great
> 
> ...


The parnate is giving you the chills? Like fever chills? That's a side effect I have not read about. Maybe one of the guys that take it would be familiar with such an odd side effect. Either way I would call you doctor and tell him about the chills. That don't sound right.


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## meyaj (Sep 5, 2009)

As far as Parnate keeping you awake... I find it's a stimulant more maybe an hour and a half at most. The stimulant effects are generally while people spread their dose throughout the day, I can't take more than 2 at once. It's like an amphetamine, and causes dopamine and norepinephrine release in a similar way, but the norepinephrine seems to be way more prominent meaning it tends to be more anxiogenic than amphetamine itself, though like I said the effects are VERY short lived.

And every time I increase my dose, I actually have a hard time staying AWAKE, it makes me feel exhausted. I haven't noticed that in general Parnate helps me stay very awake though... hell, I take Dexedrine with it. If you just switched Nardil (or certain other antidepressants), then I can see how one might think that though. Nardil (and oddly, Effexor for me though people say its stimulating) had me so exhausted that all I wanted to do was lie in bed all day. Parnate DOESN'T do that, which is a big part of why I'm on it instead. What use is getting rid of my SA and depression and anxiety if I'm too worn out and exhausted to do anything with my new-found mental health?

As far as insomnia issues, I wouldn't know, as I have very bad, very chronic insomnia issues and so I'm just at the point where I take zopiclone every night to get to sleep which seems to be a bit stronger and last a lot longer since I've been on MAOIs. Narcotic painkillers are also stronger and seem to have a FAR longer duration. And Dexedrine is the most notable of all. I can only really tolerate a quarter of my original dose, and it lasts for the better part of the day, when it should be only about 4 hours in duration.


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## peace (Apr 27, 2010)

hensley258 said:


> The parnate is giving you the chills? Like fever chills? That's a side effect I have not read about. Maybe one of the guys that take it would be familiar with such an odd side effect. Either way I would call you doctor and tell him about the chills. That don't sound right.


Yes, I'm sitting at the computer in a singlet, T-shirt, thermal hiking top, fleece sweater and fleece vest with the central air on warm AND it's warm outside AND I'm still cold. It's not like fever chills, though - I'm not shivering to the bone, it's more of an upper layer skin chill.

I took a calcium supp and a painkiller last night, slept a lot better. Maybe not as much brain fog today as yesterday. I'm also taking fish oil. Is anyone else taking it? I'm assuming it's ok to take with ADs??

Also, my psych told me to take 3 parnates in the morning (30mg) but I didn't like the effect of that. I felt that anxious, heart-thumping feeling like I was about to give a speech all day, so by 3pm I was so exhausted I fell asleep. Much better on 20mgs in morning and 10mgs at lunch.


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## hensley258 (Apr 24, 2010)

With luck I'm going on Parnate soon. I hope I don't get such bad side effects. Every one else here that I talked to has not had that side effect. What about that fish oil? You sure there's nothing in that is interacting with the Parnate? You sure the fish oil has no Tayamine (or whatever that amino is you can't have) Test by droping the fish oil for a week. You never know.

Also, maybe you should have started slower at first. Like 10Mgs the first week then 20Mgs the second week and so on. That way your body would have more time to adjust. I think maybe that doctor increased dosage on you too fast. Some people need to start slow and easy with any antidepressant. Just a few thoughts.
Either way that side effect is not normal and I woul call your P-doc right away. How is your BP?


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## meyaj (Sep 5, 2009)

peace said:


> Yes, I'm sitting at the computer in a singlet, T-shirt, thermal hiking top, fleece sweater and fleece vest with the central air on warm AND it's warm outside AND I'm still cold. It's not like fever chills, though - I'm not shivering to the bone, it's more of an upper layer skin chill.
> 
> I took a calcium supp and a painkiller last night, slept a lot better. Maybe not as much brain fog today as yesterday. I'm also taking fish oil. Is anyone else taking it? I'm assuming it's ok to take with ADs??
> 
> Also, my psych told me to take 3 parnates in the morning (30mg) but I didn't like the effect of that. I felt that anxious, heart-thumping feeling like I was about to give a speech all day, so by 3pm I was so exhausted I fell asleep. Much better on 20mgs in morning and 10mgs at lunch.


I don't get chills at all, I'm actually feeling a bit too warm right now, even with my window open here in the Canadian nighttime at a balmy 6°C / 41°F

Can I ask why you're specifically taking calcium supps? Calcium is important and all but magnesium is probably even more vital, deficiencies are far more common, and actually really hard to detect. Magnesium is vital for nerve transmission, acting almost like a natural benzo because it's generally inhibitory, and especially crucial for muscle relaxation. It also is very tightly associated with anxiety, mood, and fatigue problems. When beginning to take a good dose of a good magnesium supplement, many people actually notice within a matter of days how much better they feel, which also probably has a lot to do with the fact that it's closely tied to overactive immune function producing things like allergies, low-grade inflammation (very common in depressed people, and part of what antidepressants do, surprisingly, is dealing with this) and, in more severe cases, has been linked to outright autoimmune diseases, including the development of diabetes (the evidence for which is remarkably strong at this point, though we are still unable to explain why.) It's also great for lowering high blood pressure, even to the point where (along with a few other supps, but magnesium glycinate was the cornerstone) over the span of a few months I was able to lower his hypertension so much that the family doctor no longer wanted to put him on an anti-hypertensive or any kind of medication at all, whereas before he was insisting on it and so concerned that he said my dad was a ticking time bomb and was at very high risk for a stroke.

But a lot of people take calcium to help fight against (or prevent) osteoporosis. If that's the case, you ought to know that magnesium is absolutely critical in its prevention, particularly women after (eventual) menopause.

It may seem strange why I'm talking about magnesium at such length, but the thing is, calcium and magnesium are direct competitors in the body, and, calcium generally being excitatory, is responsible for many of the problems I mentioned. Even some things people frequently worry about on these forums, ie neurotoxicity, tolerance, etc are actually at their core a direct result of calcium's involvement. Calcium is important for a number of reasons, but it really should be balanced out. I would NEVER recommend taking a calcium supplement without also taking a good magnesium supplement, and if you notice, they often even come as a pair in a supplement (ie Cal-Mag.) And the likelihood of you seeing benefits beyond the balancing out of calcium is very, very high.

Oh, and fish oil is perfectly okay to take with ADs, though I prefer higher doses of Omega 3's in a molecularly distilled form. But it's one of the few supplements I think just about anybody SHOULD be taking. Coincidentally, this is another "balancing" issue, as omega 6's can cause serious problems if not balanced out by an adequate ratio of o3's. The modern diet is EXTREMELY poorly balanced for these fatty acids, I think the average person gets 1:30 when it should be pretty much a minimum of 1:4. The other supplement I think just about everyone should take is - big surprise - magnesium, in chelated form. Other supplements are good too, but I think these two are practically essentially and can produce some degree of benefit for just about everybody.


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## peace (Apr 27, 2010)

hensley, I think you're right about starting slower. I thought it was strange when he told me I could start at 30mgs in the morning, but dr's are meant to know best, right?! Anyway, when I took 30mgs I felt like c**p, so today I might just take 20mgs in two doses and see how that feels. I'll be talking to him in a few hours though. 

I hope you can try them. Obviously there are side effects so don't be disillusioned too quickly if you get any. I think one thing we tend to do is think that the grass is always greener with something else, but if SSRIs just aren't working for you then I think you have a pretty good argument to try them.

Re the calcium - someone suggested it cause I can't handle that much dairy and also because it comes with Vit D, which he thought I might be lacking, esp now as Australia is heading in to winter. But now that you mention the magnesium i remember a friend telling me about that fine balance. Thanks for the info meyaj, how do you know all that stuff? 

Do you know why my doc would not recommend spacing out the parnates? It seems that everyone here spaces them out during the day. He said something out them not being time-released??


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## meyaj (Sep 5, 2009)

they are not time-released, but with MAOIs specifically that kind of think doesn't matter. It PERMANENTLY blocks the MAO enzyme until it gets recycled in up to two week's time. Parnate can leave the blood almost completely and you'll still have the effect until the MAO replenishes fully. So you could technically take a week's dose, all at once, and have a similar effect, though it wouldn't be nearly as smooth. And of course, it's be freaking uncomfortable. 

But since the effect permanent disables the enzyme, the best dosing strategy would be to take it evenly throughout the day is AS MANY doses as possible, so after about 2-weeks when you've reached a steady-state of enzyme replenishment, it happens as smoothly as possible with only VERY minor fluctuations of functional enzyme levels. So people taking say, 90mg Nardil/day, or 60mg Parnate/day, would technically be best off taking it in six separate doses, adjusting of course the times of day depending on how tired/stimulated it makes them. The downside is that patient compliance with such a strategy is EXTREMELY low, not many people are going to remember to take all six of their doses per day on time. I have enough trouble with two! So a doctor has to balance the technically ideal dosing strategy with realistic expectations that the patient will be taking all their meds, and it's easiest with a single dose. The interesting about MAOIs is, unlike most meds which say that if you miss a dose you should skip it if it's almost time to take the next one, and it probably SAYS the same things for MAOIs as well, taking a double dose can actually be justifiably done IF you can tolerate it.

Another reason your doc probably didn't recommend t because most docs these days just don't have a ton of experience with it. All the older studies I've read have shown people typically dosing Parnate like 4 time a day, and with good reason. I've been upping my dosage VERY slowly and cannot tolerate more than 20mg at once, the stimulation is way too anxiety-provoking. So I take my 40mg in two seperate doses. When that gets bumped to 50mg (and it will), there's no doubt I will start having to take it 3 times a day.

Damn, it's hard enough to remember to take it twice as it is D:


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## Weston (Sep 23, 2006)

hensley258 said:


> I heard Parnate can keep you awake like nothing else. In my case I can't stay awake but for about 6 hours a day so maybe that would even me out perfect. No use wondering. The drug is off limits where I live.


Too bad you can't get prescribed a MAOI. You have at least two symptoms of Atypical Depression. MAIO's are the most effective treatment for Atypical Depression.
Symptoms are:

*sleeping too much (hypersomnia)*
eating too much (hyperphagia), resulting in weight gain
*having a more intense reaction or increased sensitivity to rejection, resulting in problems with social and work relationships*
having a feeling of being weighed down, paralyzed, or "leaden"


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## hensley258 (Apr 24, 2010)

Weston said:


> Too bad you can't get prescribed a MAOI. You have at least two symptoms of Atypical Depression. MAIO's are the most effective treatment for Atypical Depression.
> Symptoms are:
> 
> *sleeping too much (hypersomnia)*
> ...


I swear those are my exact symptoms to the tee.
I have talked to a couple people on this site that have my exact symptoms and the same long story of failed treatments. They started on parnate and they are so glad they did. A few side effects (big deal) but they report such positive things about how well they are responding to it.

I just really think it's what my brain needs. I just know if I could be treated with this drug that I could bounce back to life. Even if I only got 50% effectivnes out of the drug then that would be a huge victory for me and my wife and child.

This is why I just feel so hopeless and just want to end it all. I feel like a suffering donkey with a carrot hung in front of his face that is just out of reach.

I feel so paralized when I wake that I swear for a couple minutes I honestly don't feel as if I can stand. When I do I get dissoriented and often off balance for the first 30 minutes after waking. It's so disturbing and makes me just want to curl up in a ball and cry all day then sleep more.

In the last year i have been to several diferent Psychiatrist. I presented my past with meds and my sympoms, but when I pull the trigger and ask for just a 90 day trial on parnate they all shy away. they will turn their chair around and then change the subject fast. Like I just asked to have sex with their daughter! When I demand that thay tell me why not, they push away from the subject and tell me it's an old non-effective drug that is too dangerous. One P-doc even told me that Parnate has been completly discontinued due to lack of any need for it! I told this P-doc "that's simply not true doctor." he became upset with me and said, "you see all those books on that wall? I have the knowledge of them all in my head so do not question my expertice!" I have never had a doctor bark at me like that in my life. He was so angry.

What can you say to that? I just said our appointment is over mail me my co-pay and I left. I slamed that ****ing door so hard I busted the hinges.

This goes against everything I'm reading in psychiatric jornols and from other sufferers.

I suspect maybe this resistance is due to my location. I live smack in the middle of the Bible Belt. For reasons unknown maybe they have a thing against MAOI treatment. My old P-doc in Detroit would have had me on parnate after my 7th failed med combination. I have no doubt about it. In fact after my 5th failed med combination he made a mention of parnate as a back up plan.

Maybe i will call him In detroit. It's been 8 yeras since I have seen him, but just maybe he would see me about parnate. I would have to drive 700 Miles, but 700 miles to save my life isn't that far.

I know he's still in practice in Royal oak. I think I will try to call him or send him a letter. he was nice and would remember me because my depression was a tough nut for him to crack.


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## ThirdEyeGrind (Feb 7, 2006)

Do you get that really nice euphoria when starting Parnate? I'm talking about the euphoria that you experience after starting Nardil for 3 or so weeks? I think atleast some people here know what I mean. After starting Nardil for like 2 or 3 weeks, there was all the sudden this amazing euphoria where I felt amazing and could take on anything but that feeling slowly fades away. Anyway, does anyone know if Parnate causes that as well? Because I'm on Nardil now and am thinking of switching to Parnate and was just wondering if the same euphoric feeling would start again after being on Parnate for the first couple weeks.


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## hensley258 (Apr 24, 2010)

AprilEthereal said:


> Do you get that really nice euphoria when starting Parnate? I'm talking about the euphoria that you experience after starting Nardil for 3 or so weeks? I think atleast some people here know what I mean. After starting Nardil for like 2 or 3 weeks, there was all the sudden this amazing euphoria where I felt amazing and could take on anything but that feeling slowly fades away. Anyway, does anyone know if Parnate causes that as well? Because I'm on Nardil now and am thinking of switching to Parnate and was just wondering if the same euphoric feeling would start again after being on Parnate for the first couple weeks.


I wouldn't know because as you can see from my post above, no P-doc will prescribe me Parnate. Euporic feeling? That's interesting because I have never had a feeling of euporia in my entire life. Just once I would like to see what that feels like.

I used to experiment with drugs for a while back in High school, but even then no Euporic feeling. Some people get that Euporic feeling from taking a lot of Oxycodone or Vicotin. I tried that once and did get high, but not a euporic high.


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## Weston (Sep 23, 2006)

hensley258 said:


> I
> In the last year i have been to several diferent Psychiatrist. I presented my past with meds and my sympoms, but when I pull the trigger and ask for just a 90 day trial on parnate they all shy away. they will turn their chair around and then change the subject fast. Like I just asked to have sex with their daughter! When I demand that thay tell me why not, they push away from the subject and tell me it's an old non-effective drug that is too dangerous. One P-doc even told me that Parnate has been completly discontinued due to lack of any need for it! I told this P-doc "that's simply not true doctor." he became upset with me and said, "you see all those books on that wall? I have the knowledge of them all in my head so do not question my expertice!" I have never had a doctor bark at me like that in my life. He was so angry.


If that were true Par Pharma wouldn't have started making it generically mid decade.
(Second from Bottom on link) Evidentally there is demand or Par would have never bothered with FDA approval and manufacturing. There are studies from around 2002 or so that you could print and bring to a doctor. How about telling them that you were prescribed Parnate in Detroit and it's the only thing that worked for you. I got prescribed by my GP based on the fact that I was prescribed Parnate in another state.

http://parpharm.com/generics/index.php?option=com_products&view=default&article_id=46&Itemid=79


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## meyaj (Sep 5, 2009)

No, I got a bit euphoric on Nardil at first, walking around everywhere with a really stupid grin on my face, like I was constantly in a state of just-about-to-bust-out-laughing. I'm pretty sure I looked really good on it but it made me so exhausted all the time that it just wasn't compatible with my goals. I want a drug to allow me to be FUNCTIONAL. And the effects it can have on the liver were definitely a problem IMO.

Parnate didn't have that initial euphoria for me, but it's possible that this could just be due to the fact that I switched straight from Nardil to Parnate. Literally one day Nardil, the next day Parnate (just in case it isn't obvious, you DON'T need a wash-out period to go from one MAOI to another.) So if MAOIs in general cause it, I had already gone through that phase.

However, my guess would be that Parnate probably doesn't do it to any degree close to the way that Nardil does, probably as a result of a different mechanism than actual MAO inhibition. You might be able to get a better answer from somebody who started on Parnate and switched to Nardil, but I don't see that happen very often.


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## hensley258 (Apr 24, 2010)

Weston said:


> If that were true Par Pharma wouldn't have started making it generically mid decade.
> (Second from Bottom on link) Evidentally there is demand or Par would have never bothered with FDA approval and manufacturing. There are studies from around 2002 or so that you could print and bring to a doctor. How about telling them that you were prescribed Parnate in Detroit and it's the only thing that worked for you. I got prescribed by my GP based on the fact that I was prescribed Parnate in another state.
> 
> http://parpharm.com/generics/index.php?option=com_products&view=default&article_id=46&Itemid=79


Wow you got lucky. Last week I went to My GP who is just the greatist guy. He's only 38 and I think it's kind of cool to have a doctor my age.
I presented my delema to him and he understood 100% but he said, "I just can't do this Bob. Your under the care of a Psychiatrist and this would be me over riding his current treatment for you. Not only that even if you were not under care of a psychiatrist I couldn't do it. I'm just a GP and when it comes to Psychotropic meds you probably know more than I know about them."

How can I argue with his logic. I don't blame him. Now if I were already prescribed them like you said then no question he would refill me. It's that initial script that is a *****. Once I get that initial script it so easy from that point.

My GP did work to find me another P-doc. He said he's not sure, but given my past she may agree to Parnate for me. This is on May 10th and I am crossing my fingers. Can you think of anything I can take to that appointment which will up my chances of getting agreement with her on MAOI?

I sound like I'm on some mad quest for a drug, but the reality is that I was never Willie Nillie with my past meds. I always gave them months to work. some did. in fact some worked for a good few years. Unfortunatly they no longer are and even my current Psych is out of ideas (less MAOI)

Whats so wrong with me just trying to get better so I can be productive? I just want a shot at a drug that I really think might work for me. I don't know why, but I really think Parnate will work. It's a damn good match for my symptoms and dissorder type. If it fails to work after a couple months then so be it. I move on to something else. Maybe Reboxatine with Zyprexa or something even newer than Reboxatine.


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## peace (Apr 27, 2010)

When I saw my new psych last week i told him that I was put on parnate 5 years ago by another doc and that it worked well for me, i just went off it because i went travelling and i thought i was better! That was all true, but no questions, he just went right ahead and prescribed it to me. He said it was a fantastic drug. But when i went to get it filled at the pharmacy the old guy whistled and said, "Jeez, we haven't given that out in years!" Obviously not many people are taking it, but some in the medical community think it's one of the best out there. 

Having said that it's just not working for me yet. I've been on it a week and the only time I felt good was the second day - I noticed colours, shapes, movements, and Yes, I got things done! I know what you mean about wanting to be functional. I have things to do and I want to get them done! It's definitely reduced my compulsive tendencies and thoughts, which in themselves are debilitating, but I went out to lunch today and I still really had nothing to say and just wanted to be at home. 

Because of my physical symptoms - freezing cold, dilated pupils, rash on face and chest, pounding heart - my doc said it sounds like I'm reacting to the noradrenaline. I don't know if that means it's a slight allergy to the drug? Obviously 5 years ago i took it fine, 30-40mg, but now i'm on 20mg a day and still getting a rash. He said he was really hesitant to drop it yet because if it works it can be great, but i'm to speak with him in a few days. 

I hope the new doc listens to you. Maybe sit yourself down in her room and say you're not leaving until she prescribes it for you. What's the use of doing the same old stuff if they haven't worked for years?? Reassure her that you can cope with the diet.


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## meyaj (Sep 5, 2009)

peace said:


> When I saw my new psych last week i told him that I was put on parnate 5 years ago by another doc and that it worked well for me, i just went off it because i went travelling and i thought i was better! That was all true, but no questions, he just went right ahead and prescribed it to me. He said it was a fantastic drug. But when i went to get it filled at the pharmacy the old guy whistled and said, "Jeez, we haven't given that out in years!" Obviously not many people are taking it, but some in the medical community think it's one of the best out there.


One of the pharmacists I priced it out at was CONVINCED the medication had been discontinued, lol


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## Weston (Sep 23, 2006)

hensley258 said:


> My GP did work to find me another P-doc. He said he's not sure, but given my past she may agree to Parnate for me. This is on May 10th and I am crossing my fingers. Can you think of anything I can take to that appointment which will up my chances of getting agreement with her on MAOI?


You can do a search for atypical depression and print out the symptom list. They also document MAOI's use in treatment if you look around. I was originally prescribed by Quitkin who I believe defined Atypical Depressions symptoms. This abstract may be what you need.

http://www.psychiatrist.com/pcc/pccpdf/v04n03/v04n0302.pdf

Some of his obituaries described him as the Nardil King.


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## hensley258 (Apr 24, 2010)

Weston said:


> You can do a search for atypical depression and print out the symptom list. They also document MAOI's use in treatment if you look around. I was originally prescribed by Quitkin who I believe defined Atypical Depressions symptoms. This abstract may be what you need.
> 
> http://www.psychiatrist.com/pcc/pccpdf/v04n03/v04n0302.pdf
> 
> Some of his obituaries described him as the Nardil King.


That's Golden info. Yes my symptoms are like a spot on match for Atypical depression. Why all these damn years of visiting Psychiatrist would none of them Mention Atypical depression to me? I was very clear about my symptoms. Now their all on this big Bi-polar click. I swear to God if you have a pulse and walk in the door of a Psychiatrist now they will immidiatly slap a Bi-polar 1 2 or NOS patch on you. I guess it's the "new wave sheek in Psychiatry." I call it the everyones Bi-polar movement.
I only wish I hade some Hypo-Mania. At least then I could change the oil and fix the garrage door.


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## peace (Apr 27, 2010)

hensley258 said:


> That's Golden info. Yes my symptoms are like a spot on match for Atypical depression. Why all these damn years of visiting Psychiatrist would none of them Mention Atypical depression to me? I was very clear about my symptoms. Now their all on this big Bi-polar click. I swear to God if you have a pulse and walk in the door of a Psychiatrist now they will immidiatly slap a Bi-polar 1 2 or NOS patch on you. I guess it's the "new wave sheek in Psychiatry." I call it the everyones Bi-polar movement.
> I only wish I hade some Hypo-Mania. At least then I could change the oil and fix the garrage door.


Ha ha! - and wash the towels and sheets that have been in the basket for months, and open my mail, and pay my bills, and clean out the fridge...

Snap on the bipolar diagnosis. Though I did read somewhere that a hypomania episode can happen as rarely as once every 5 years! Fortunately I'm able to do laundry a bit more often than that.

And thanks for the article Weston, v. interesting.


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## Weston (Sep 23, 2006)

The reason I found that document intersting was the one symptom that they call "rejection sensitivity" that it says is the most common symptom (over 70%). I would think that means that 70% of those people have some form of social anxiety. Hope you have luck getting a script from your new doc.


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## hensley258 (Apr 24, 2010)

peace said:


> Ha ha! - and wash the towels and sheets that have been in the basket for months, and open my mail, and pay my bills, and clean out the fridge...
> 
> Snap on the bipolar diagnosis. Though I did read somewhere that a hypomania episode can happen as rarely as once every 5 years! Fortunately I'm able to do laundry a bit more often than that.
> 
> And thanks for the article Weston, v. interesting.


Hell, I would be happy with once every 5 years so I could paint the house.
For a while I thought it was just me perhaps not realizing that I'm Bi-polar so I started asking my family and friends, "do I seem talkative, or even a little hyper or agitated or manic in any way? Their response, "LOL! Hell no you can't even walk from the bedroom to the garrage and back and you seldom even talk unless forced!"

I do have Generalized anxiety too, but it's not an energizing anxiety or phobic anxiety. For a while I thought I might have Depression with Narcolepsy because I sleep so much, so I went to see my GP. He said I can send you to a neurologist but from my examination your symptoms are not conducive with Narcolepsy. He said his bet is on the Severe Depression.

I need to read that artical Weston sent if I can get up enough energy.


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## meyaj (Sep 5, 2009)

Weston said:


> The reason I found that document intersting was the one symptom that they call "rejection sensitivity" that it says is the most common symptom (over 70%). I would think that means that 70% of those people have some form of social anxiety. Hope you have luck getting a script from your new doc.


Yeah, there's definitely a lot of overlap between the two, and it hasn't exactly gone unnoticed, though I wouldn't go as far as to say 70% of them have social anxiety, they each have exclusive criteria. Many people DO have both however. Though don't let the name fool you, "Atypical" depression is by far the most common subtype of depression. People would think that mood reactivity makes it less serious than melancholic depression, but it's shown people with atypical depression, in general, tend to have a lot more functional impairment in their lives as a result of this disorder, almost certainly because of that sensitivity to rejection.

What I found more interesting about the document that it was done in the last decade. It's hard to come across even semi-recent literature regarding the usefulness of MAOIs.


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## hensley258 (Apr 24, 2010)

Weston said:


> You can do a search for atypical depression and print out the symptom list. They also document MAOI's use in treatment if you look around. I was originally prescribed by Quitkin who I believe defined Atypical Depressions symptoms. This abstract may be what you need.
> 
> http://www.psychiatrist.com/pcc/pccpdf/v04n03/v04n0302.pdf
> 
> Some of his obituaries described him as the Nardil King.


Read the report you posted by Dr. Quitkin.

One question I don't understand.... Yes I have every symptom listed in the Atypical specifier, but I also have many of the symptoms in the Criteria for Major Deprssive Episode. I must have missed something. Does it say you can have both? The Atypical symptoms list is like reading a book of myself. This could explain why I get little relief from SSRI's and SNRI's and only mild relief from Tricyclics.

17 years with this illness and I feel like I'm getting closer to an answer.
My only concern is that this documentation is several years old and you know how Psychiatrists like to dismiss any data that is not ultra current.


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## meyaj (Sep 5, 2009)

hensley258 said:


> Read the report you posted by Dr. Quitkin.
> 
> One question I don't understand.... Yes I have every symptom listed in the Atypical specifier, but I also have many of the symptoms in the Criteria for Major Deprssive Episode. I must have missed something. Does it say you can have both? The Atypical symptoms list is like reading a book of myself. This could explain why I get little relief from SSRI's and SNRI's and only mild relief from Tricyclics.
> 
> ...


The Atypical specifier is FOR Major Depressive Disorder. The two are not exclusive. Or do you mean melancholic? Because most of the symptoms of that tend to not be compatible with atypical symptoms at all. Diminished appetite vs hyperphagia, mood reactivity vs a pemanently depressed affect.

The sleep issues are somewhat exclusive though even many psychiatrists just take it at face value and refuse to acknowledge you can have both insomnia AND hypersomnia. Anxiety can cause worry and racing thoughts when you're trying to sleep, giving you possibly very severe sleep-onset insomnia, where it can take absolutely forever get to sleep. That's how it was for me before I started zopiclone. But I also had clear hypersomnia, regularly sleeping 12+ hours a day AFTER finally getting to sleep. One psychiatrist tried to tell me that insomnia and hyperinsomnia can't co-exist, but is a clear example of how it can, and every other psychiatrist I've talked to disagrees. Though for both to exist in somebody who leads a very functional life is unusual, finally getting to sleep at 6am after trying since 1am because of the onset insomnia, and then hypersomnia having you sleep past 6pm - well, it clearly would be hard to lead a functional life living like this, it can get a bit extreme.

Though keep in mind, onset insomnia is generally a feature of ANXIETY disorders. Insomnia is a feature of melancholic depression as well, but far more often it's what is called terminal insomnia. They regularly wake up far too early and then can never get back to sleep, sometimes only get a few hours of sleep every night. THIS kind of insomnia is indeed pretty incompatible with the hypersomnia features of atypical depression, it's just a logical impossibility to have them occur at the same time. But if your problem is mostly just falling asleep in the first place, it is not at all a strong indicator of melancholic depression and, in the presence of hypersomnia as well, becomes almost completely unimportant in identifying subtypes of depression, though is still a valuable indicator of a possible anxiety disorder. It's really important to stay on top of these signs of anxiety disorder because the research shows mostly that, while patients are usually pretty spot on in identifying themselves as depressed, generally even more proficient then psychiatrists, this tends to be the other way around with anxiety disorders - while people can indeed tell when they're FEELING anxious, they tend to be absolutely lousy in identifying when it becomes clinically significant.

So for the most part, the subtypes have symptoms that are pretty mutually exclusive, so I'm not sure what you mean. Maybe you could elaborate on the symptoms you feel may be contradicting each other. It's also possible to have atypical depression (which is often a very chronic, persisting form), with occasional episodes of melancholic depression, where the symptoms seem to totally change, though in this case I'd really look at whether it's just double depression (chronic dysthmia with more severe episodes of MDD). From the way you worded it though, I somehow doubt that's what you meant.


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## hensley258 (Apr 24, 2010)

meyaj said:


> The Atypical specifier is FOR Major Depressive Disorder. The two are not exclusive. Or do you mean melancholic? Because most of the symptoms of that tend to not be compatible with atypical symptoms at all. Diminished appetite vs hyperphagia, mood reactivity vs a pemanently depressed affect.
> 
> The sleep issues are somewhat exclusive though even many psychiatrists just take it at face value and refuse to acknowledge you can have both insomnia AND hypersomnia. Anxiety can cause worry and racing thoughts when you're trying to sleep, giving you possibly very severe sleep-onset insomnia, where it can take absolutely forever get to sleep. That's how it was for me before I started zopiclone. But I also had clear hypersomnia, regularly sleeping 12+ hours a day AFTER finally getting to sleep. One psychiatrist tried to tell me that insomnia and hyperinsomnia can't co-exist, but is a clear example of how it can, and every other psychiatrist I've talked to disagrees. Though for both to exist in somebody who leads a very functional life is unusual, finally getting to sleep at 6am after trying since 1am because of the onset insomnia, and then hypersomnia having you sleep past 6pm - well, it clearly would be hard to lead a functional life living like this, it can get a bit extreme.
> 
> ...


I get the same as you said you get. Hypersomnia, but will have periods of insomnia. Usually late at night and mixed with anxiety. Problem is when I do sleep I can't get up. I feel paralized.

I didn't see anything in the report about Melencholia. But I do see the Criteria for Major Depression and I have about 90% of those symptoms also.

I always thought Melencholia was simply just mild depression. Mine is far from mild and very chronic. I'm sorry if I am not digesting everything written in the report (my depression is bad and it often impares my level of concentration. That of course being one major depression symptoms. My focus is not always normal.) Not to mention I am getting sleepy again and I have only been awake for 2 hours.


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## meyaj (Sep 5, 2009)

hensley258 said:


> I get the same as you said you get. Hypersomnia, but will have periods of insomnia. Usually late at night and mixed with anxiety. Problem is when I do sleep I can't get up. I feel paralized.
> 
> I didn't see anything in the report about Melencholia. But I do see the Criteria for Major Depression and I have about 90% of those symptoms also.
> 
> I always thought Melencholia was simply just mild depression. Mine is far from mild and very chronic. I'm sorry if I am not digesting everything written in the report (my depression is bad and it often impares my level of concentration. That of course being one major depression symptoms. My focus is not always normal.) Not to mention I am getting sleepy again and I have only been awake for 2 hours.


I haven't read the entire report, but Major Depressive Disorder can have many different and even opposing features, usually seen grouped together in certain combinations, and is generally broken down into these subtypes:
- Melancholic depression (NOT melancholia, which is totally outdated as a medical term, and typically has a mood that cannot brighten in response to positive external events, lack of appetite, and decreased sleep)
- Atypical depression (mood CAN brighten in response to positive effects, increased appetite, increased sleep, sensitivity to rejection, and for some a persistent "heavy, leaden feeling".)
- Depression with psychotic features (kind of self-explanatory)

and some also include seasonal affective disorder and postpartum depression.

I think that what you are thinking of as melancholia is clinically termed Dysthmia, which is a mild but chronic form of depression. And I think you're confusing Major Depression (which is comprised of all the above subtypes) with the melancholic subtype of Major Depression.


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## jennifervescent (Aug 15, 2010)

I think having documentation that you took SSRIs unsuccessfully (assures doc that trials and strengths were adequate), list of "atypical depression" symptoms along with up-to-date articles that discuss MAOIs greater efficacy with that type of depression helps- 

But the best way to get your foot into the MAOI door is to suggest the EMSAM patch. It is very expensive (even with insurance) and you will probably need your insurance company's approval. HOWEVER, the docs are more likely to go for it because it does not have the deadly interactions with tyramine that oral MAOIs have.

Docs don't want to prescribe MAOIs because you can kill yourself by eating cheese on the stuff. I asked for Parnate first too and my doc said no because a) I was suicidal and b)although very responsible, often forgetful and flighty because of the depression- both things that could be potentially dangerous.

Also most docs have the SSRIs are newer and therefore better than MAOIs- and for many people they are better- effective with less side effects and less danger. So it makes sense to them to make sure you are truly treatment resistant to the newer stuff before going to the dangerous stuff.

EMSAM was the only thing that had ever worked in 20 years of trial after unsuccessful (long) trial of the newer drugs. Unfortunately, it pooped out after a year and did not respond to augmentation. Once EMSAM was SO successful- it made sense to the doc to go MAOI oral.

I, too, hoped that Parnate would be my "hero" drug based on SO MANY good reviews by people taking it- people who had been successful with it for many years.

I've only been on Parnate for 2 weeks. Day 3 I felt better but around day 6 ALL of the listed side effects started to kick in (I'd been lucky not to have many side effects before) and I'm miserably tired, weak, dizzy, sweaty/chilly, and constipated. Around day 6-7 I had to pee every hour on the hour at night, but luckily that's gone away. From what I read from other people, these symptoms may persist for 4-6 MONTHS. I've been sleeping all weekend every weekend, nodding off at work, nodding off while driving, while trying to watch movies I'm very interested in, etc... I feel more useless now than when unmedicated but don't really feel SAD. I'm not sleeping to escape- I'm sleeping because I feel exhausted. It's a nice distinction but just as debilitating. 

I hope you get to try it and that you don't have these awful side effects but I'd caution about expecting anything to be the magic bullet. It's certainly a tempting feeling but can be very disappointing.


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## mike8803 (Feb 21, 2010)

Sorry to hear that Jennifer. I heard Parnate can be pretty sedating. You should keep in mind...I believe 2 Nardil tablets = 1 Parnate tablet, so depending on your dosage, if it is too high, you might want to lower it. But fatigue is common at first with any MAOI. I had it with Nardil, and it past in a couple weeks. The worst side effect was weight gain which I did not manage properly.

I also heard that Parnate has a higher rate of interaction to tyramine than does nardil? Not sure about that, but thats what i've heard. In which case, you need to be double double extra careful!


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## Medline (Sep 23, 2008)

When I started Parnate I was also very tired, but just for the first few weeks. That side effect can definitely vanish over time, though it does not for everyone. Sometimes it's related to low blood pressure and drinking more water & eating more salt can help. Spreading Parnate doses throughout the day or taking it before bedtime works for some people. If the antidepressant / anxiolytic effect is really good, but sedation continues to be a problem, augmenting with stimulants is an option (if the Pdoc is experienced and open-mindend enough).


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## jim_morrison (Aug 17, 2008)

meyaj said:


> The sleep issues are somewhat exclusive though even many psychiatrists just take it at face value and refuse to acknowledge you can have both insomnia AND hypersomnia. Anxiety can cause worry and racing thoughts when you're trying to sleep, giving you possibly very severe sleep-onset insomnia, where it can take absolutely forever get to sleep. That's how it was for me before I started zopiclone. But I also had clear hypersomnia, regularly sleeping 12+ hours a day AFTER finally getting to sleep. One psychiatrist tried to tell me that insomnia and hyperinsomnia can't co-exist, but is a clear example of how it can, and every other psychiatrist I've talked to disagrees. Though for both to exist in somebody who leads a very functional life is unusual, finally getting to sleep at 6am after trying since 1am because of the onset insomnia, and then hypersomnia having you sleep past 6pm - well, it clearly would be hard to lead a functional life living like this, it can get a bit extreme.


I suffer from this type of insomnia too; sleep onset insomnia, where in it typically takes me a long time to fall asleep, but once I do finally fall asleep I would fall more into the category of hypersomnia since I can't feel rested unless I've had a full 10-12 hours or so of sleep per night.

I agree that it's ridiculous that a doctor told you that insomnia and hyperinsomnia can't co-exist, since chronic fatigue syndrome for example is usually characterized with both insomnia and hypersomnia being prevalent symptoms.


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