# Me, Parnate, and MAOIs



## Caedmon (Dec 14, 2003)

I've had some people ask about my experiences with this drug, when I go on it. Right *now* what I have to say is concerning my pre-medication research and findings. I haven't taken it yet, but here is some information on Parnate (tranylcypromine) and on MAOIs in general.

I would encourage people to independently check anything I say about MAOIs. (Or any drug, really.)

First, two relevant abstracts:

_ J Clin Psychopharmacol. 1988 Aug;8(4):279-83. _

* Tranylcypromine in social phobia.*

Versiani M, Mundim FD, Nardi AE, Liebowitz MR.

Department of Psychiatry, Federal University of Rio de Janeiro, Brazil.

Thirty-two patients meeting DSM-III criteria for social phobia entered a 1-year drug treatment with tranylcypromine in dosages between 40 and 60 mg/day. After exclusion of the early dropouts, improvement was rated as marked and moderate in 62% and 17% of the sample (N = 29), respectively. Alcohol abuse was associated with a poor outcome. Side effects were frequent and in some cases delayed the attainment of efficacious dosages until the third month of treatment. No serious adverse reactions occurred. The findings, relative to efficacy, are in accordance with a previous trial with phenelzine but need confirmation in double blind controlled studies.

___________

_ J Psychiatr Res. 1988;22 Suppl 1:87-98. _
*
Monoamine oxidase inhibitors in anxiety disorders.*

Tyrer P, Shawcross C.

Mapperley Hospital, Nottingham, U.K.

Monoamine oxidase inhibitors (MAOI's) have been shown to be significantly superior to placebo in the treatment of some anxiety disorders, particularly agoraphobia and mixed anxiety--depressive states. There is no convincing evidence that MAOI's are effective treatment in pure anxiety states, whether or not panic is present as a major symptom, although they are effective in so-called endogenous anxiety. Many past published studies of MAOI's have yielded poor results because the drugs have been prescribed for insufficient time (less than four weeks) or at too low dosage. There are no important therapeutic differences between the MAOI's apart from the faster speed of response with the nonhydrazine compound, tranylcypromine. Treatment often has to be long-term, and some degree of pharmacological dependence may develop. A few clinical studies have compared the efficacy of MAOI's and tricyclic antidepressants in anxious disorders. There is growing evidence that MAOI's are somewhat more effective than tricyclic antidepressants in the treatment of anxiety disorders and when phobic anxiety is an important component of a depressive disorder.
_______________



apprentice1 said:


> about Thorazine as an anti-dote for hyper-tension. I am sorry, I posted a stupid post, what can I say? I will edit it to at least take out my "doctor myself" remedy. It is just that I was "treated" with thorazine when I was 22. What size tablet did he give you if I can ask? What you said made sense.


I can understand the Thorazine concern - it's definitely a hardcore medication. I don't have a Rx in my hand for Parnate or for Thorazine yet, I have to wash out from the Wellbutrin first and then meet again with my psychiatrist April 11th.


----------



## Caedmon (Dec 14, 2003)

Why Parnate?

I have severe treatment-resistant depression (part of bipolar disorder). I also have a _lot_ of social avoidance behaviors despite *symptomatic* relief from Valium (diazepam) or Topamax (topiramate). I have some cognitive and attentional problems as a result of my depression. (It may be undiagnosed inattentive ADD, but I don't know.) I have compulsive eating problems and chronically low energy. Parnate is a good choice for those symptoms. I am ready for a very effective medication for depression. MAOIs are that.

Nardil is the more common MAOI, although it is not a common medication by any means. I recall reading that somewhere around 10,000-15,000 people worldwide take Nardil (phenelzine). Compare that to over a million people on Prozac. Even fewer people take Parnate - scripts worldwide are about half that of Nardil. Marplan is the least used of all, and the manufacturer was at one point going to stop making it (I believe they still do now, however).

MAOIs have different profiles. While they all work on serotonin, norepinephrine, and dopamine, they have differing degrees on this. Nardil heavily effects serotonin, and does something with GABA although I'm not sure how important that is. Nardil is a good choice for people with really dark moods, and can having a very 'soothing' effect. My intuition is that Nardil is the best choice for severe social anxiety disorder. (One (1991) study found that it was more effective than Xanax or placebo.) Parnate works stronger on norepinephrine and dopamine. It is a good choice for people who have problems with oversleeping and overeating, or concentration problems. 10mg of Parnate is considered to be equal to 1mg dextroamphetamine. Marplan is considered to be sort of an "in-between" of the two, so for many people it's a good compromise drug.

They also have different side effect profiles. All of them can cause insomnia and lowered blood pressure. These tend to go away over time. Nardil tends to cause sexual side effects, although those can go away in some cases over time. Nardil also tends to cause the most weight gain, which is a good or a bad thing depending on your body type. Marplan can do these things too although I am not sure if they tend to be less common or not.

Parnate may or may not cause sexual side effects - I have heard of it actually increasing sex drive in fact. Same with weight gain or loss - many people lose weight on it. Some of that could simply be from dietary restrictions, however. Parnate causes the most insomnia and activation and is a very very *unsubtle* drug for most people. However, if you are very "low-energy" and low motivation and antisocial (like me), this makes it a good choice. Parnate is structurally related to amphetamine, so some people develop an addiction to it, although I suspect this is pretty uncommon. (Euphoria is something that most all the MAOIs can induce, especially in the beginning stages or at high doses. I actually think that the euphoria is better termed 'euthymia' - it's not clear to me that the euphoria is from an inherent property of the medications or if it has more to do with the fact that a depressed or anxious person finally feels dramatic relief.)

More later, when I get time.


----------



## workman (Mar 5, 2004)

I've read websites that say parnate is better for SA. It is more tolerated with less side effects. I think MAOI's raise blood pressure. I think parnate does it more because it works on dopamine and NE more. It is also supposed to have amphetamine metabolites, which makes blood pressure go up. It also makes a reaction more likely since the blood pressure is already raised it doesn't take as much to push the pressure to high(which I believe what a hypersensitive crisis is). It is also more likely to cause dopergenic reactions which pretty much has the same symptoms as a trymane reaction. So things like caffine or foods that have high levels of dopamine are more likely to cause reactions.

Nardil works mostly SE and GABA so things like caffine can enhance it's effects. 

So, parnate is going to give more activating effects, make you more confident and maybe talkative. Similar to the effects of amphetamines. It will probably have less side effects, but be less forgiving on the food/med restrictions.

Nardil will be more soothing giving an anti-anxiety effect. It seems to be more forgiving on the food/med restrictions. It will have more side effects, though.

I don't really know how much MAO Inhibition effects GABA. Nardil has a metabolite that works on GABA through another means than MAO Inhibition. I don't know if parnate works on GABA or not.

Some of that might be wrong, thats just what I remember from a long time ago.
I was going to see about parnate, but I was in a "i don't want to do anything" mood, so I skipped my doc appt. monday.


----------



## UltraShy (Nov 8, 2003)

Caedmon said:


> There is no convincing evidence that MAOI's are effective treatment in pure anxiety states...


That part would concern me, since I think I'd be pretty close to a "pure anxiety state".


----------



## Caedmon (Dec 14, 2003)

workman said:


> It also makes a reaction more likely since the blood pressure is already raised it doesn't take as much to push the pressure to high(which I believe what a hypersensitive crisis is). It is also more likely to cause dopergenic reactions which pretty much has the same symptoms as a trymane reaction. So things like caffine or foods that have high levels of dopamine are more likely to cause reactions.


Parnate is associated (rarely) with 'spontaneous hypertensive reactions'. The theory being that it reacts to its own amphetamine metabolite. I don't know if this happens with Nardil and Marplan or not, but I know it does for Parnate.

I'm not sure if BP is typically raised or not, with MAOIs. I have read that hypotension (lowered BP) is a common side effect. :stu Anyone know?



> It will probably have less side effects, but be less forgiving on the food/med restrictions.


That's my prediction as well.


> I was going to see about parnate, but I was in a "i don't want to do anything" mood, so I skipped my doc appt. monday.


Hope you feel better soon. :rub


----------



## spaceboy (Mar 5, 2006)

Caedmon said:


> Euphoria is something that most all the MAOIs can induce, especially in the beginning stages or at high doses. I actually think that the euphoria is better termed 'euthymia' - it's not clear to me that the euphoria is from an inherent property of the medications or if it has more to do with the fact that a depressed or anxious person finally feels dramatic relief.


There's definitely the aspect of dramatic relief causing a kind of psychological (as opposed to physical, chemically induced) euphoria.

In my experience, however, the MAOIs can indeed produce a degree of physical euphoria - particularly when just starting out. In order to produce a mild euphoria, you have up the dose quite a bit. At higher doses, the MAOIs are increasing your body's "feel good" chemistry. (A drug like cocaine acts primarily on dopamine and norepinephrine - causing it's euphoric effects.) Since these drugs have such a global effect on body chemistry, however, uncomfortable side effects can increase as well. If you really cranked MAOI dosage in an attempt to replicate something even remotely close to a cocaine or amphetamine high - the side effects would probably overwhelm you long before you got "high".

Even still... there are reports like this:



> ABSTRACT: Abuse of monoamine oxidase inhibitors is not common but there are a few cases of addiction in the literature. Most of these patients had an additional diagnosis, either history of past drug abuse or personality disorder and MAOI withdrawal symptoms have been reported. We encountered three patients who received MAOI under psychiatric care. They were all self medicated by increasing the doses on their own, experienced euphoria and visited various physicians to obtain MAOI prescriptions and manifestedtoxic states. One of our patients had a normal, another a schizoid and the third, an addictive personality. Two were addicted in the past to amphetamine. Therefore, it is important not to prescribe MAOI's to patients who have a history of amphetamine andother addictions.


When I first came across this, I was like, you've gotta be kidding.


----------



## Caedmon (Dec 14, 2003)

I have definitely read case reports of euphoria and even addiction to MAOIs. It seems to be a possibility. It makes sense. You're increasing levels of all three 'major' neurotransmitters, not just in the synaptic cleft but extracellular too. I think cocaine does something similar, although certainly to a larger extent.

How do you think that works spaceboy? I understand that, to a certain level you can inhibit MAO but I would guess that higher doses (e.g. 120mg Nardil/phenelzine) aren't inhibiting MAO anymore than lower doses (e.g. 60mg), since your body only makes so much MAO. I think? So, maybe it's an interaction between the MAO inhibition and a metabolite? Interesting to think about.

FDA indication for Parnate is 30-60mg, but I have read about people on as much as 200mg, in combination with stimulants (clinically). Not as abuse - this is for _severe_ low-energy depression and a very skilled doctor. (It may also have to do with people being fast metabolizers.) Hmm, drugs are complicated like that.

I am bipolar. I wondered about MAOI use and mania. It would appear that there is not necessarily a higher incidence of mood destabilization on MAOIs - if anything, perhaps lower, compared to other antidepressants. Emphasis added:

*Tranylcypromine versus imipramine in anergic bipolar depression*
Himmelhoch JM, Thase ME, Mallinger AG, Houck P
Department of Psychiatry,
University of Pittsburgh School of Medicine, PA.
_Am J Psychiatry 1991 Jul; 148(7):910-6_

OBJECTIVE: This investigation compared the efficacy of the monoamine oxidase inhibitor (MAOI) tranylcypromine with that of the tricyclic imipramine in the treatment of anergic bipolar depressive illness. METHOD: A controlled, double-blind comparison was used to study 56 outpatients who met operationalized criteria for anergic bipolar depression. Patients with bipolar I and II depression were equally distributed between comparison groups. Outcome was measured by the patient-rated Beck Depression Inventory and the clinician-rated Hamilton Rating Scale for Depression, Raskin Mania and Depression Scales, Clinical Global Impression Scale, and the Pittsburgh Reversed Vegetative Symptom Scale. Twenty-eight patients were treated with tranylcypromine and 28 with imipramine. Seventy-three percent of bipolar depressive patients screened for the study met criteria for anergic depression, consistent with previous findings from studies in bipolar illness that stretch back over 100 years. RESULTS: Tranylcypromine produced statistically significant superior outcome in terms of lower attrition, greater symptomatic improvement, and higher global response without increased risk of treatment-emergent hypomania or mania. CONCLUSIONS: The authors propose that the apparently superior efficacy of tranylcypromine in bipolar depression is specifically linked to anergia and reversed neurovegetative symptoms. Bipolar I and bipolar II patients had comparable outcomes, but bipolar I patients had a significantly greater risk of treatment-emergent mood swings. Although the relatively poor showing of imipramine warrants close scrutiny, these findings provide further documentation of the utility of MAOIs in patients presenting with anergia, motor retardation, hyperphagia, and/or hypersomnia.

* Antidepressant-associated mania: a controlled comparison with spontaneous mania.*
Stoll AL, Mayer PV, Kolbrener M, Goldstein E, Suplit B, Lucier J, Cohen BM, Tohen M.
Bipolar and Psychotic Disorders Program, Mailman Research Center, McLean Hospital, Belmont, Mass.
_Am J Psychiatry. 1994 Nov;151(11):1642-5. _

OBJECTIVE: Antidepressants have been associated with the induction of mania and rapid cycling. This study examined whether antidepressant-associated manic states differ in any way from spontaneous mania. METHOD: Forty-nine consecutive inpatients with antidepressant-associated manic states were compared with 49 matched inpatients with spontaneous mania in a blind, retrospective chart review. RESULTS: Across virtually every clinical measure examined, the patients with antidepressant-associated manic states experienced milder and more time-limited manic episodes than the patients with spontaneous mania. The patients with antidepressant-associated manic states were subject to frequent checking by nurses and hall restriction for a significantly shorter period of time than the patients with spontaneous mania. The patients with antidepressant-associated manic states also had significantly less severe levels of delusions, hallucinations, psychomotor agitation, and bizarre behavior, according to a standard rating instrument, than the patients with spontaneous mania. For further study the patients with antidepressant-associated mania were divided into subgroups taking four individual classes of antidepressant drugs: tricyclics (N = 19), fluoxetine (N = 13), monoamine oxidase inhibitors (MAOIs) (N = 8 ), and bupropion (N = 6); three patients taking combinations of drugs were not included in these analyses. The patients with MAOI- and bupropion-associated mania had a slightly lower overall rating of severity of psychopathology at admission than the subgroups with fluoxetine- and tricyclic-associated mania. CONCLUSIONS: Antidepressant-associated mania appears to be a milder and more time-limited syndrome than spontaneous mania and may represent a distinct clinical entity. MAOIs and bupropion may be associated with milder manic states than either tricyclic drugs or fluoxetine.


----------



## spaceboy (Mar 5, 2006)

Re: mania and MAOIs - here's a post from these forums related to this:



lostsoul said:


> Can't sleep just thought I'd share my experience with medication. I've tried many over the years finally thought I found one that worked with Nardil.
> 
> It worked very well I felt great, wonderful! My fears begin to vanish, social anxiety became a thing of the past. I thought I was brilliant I was just impressed to hear myself talk and I would never stop moving. Eventually I started to feel like had a mission from god...


Nardil precipitated a manic state in this person. Read the rest at:
http://www.socialanxietysupport.com/vie ... hp?t=33148


----------



## spaceboy (Mar 5, 2006)

Caedmon said:


> I have definitely read case reports of euphoria and even addiction to MAOIs. It seems to be a possibility. It makes sense. You're increasing levels of all three 'major' neurotransmitters, not just in the synaptic cleft but extracellular too. I think cocaine does something similar, although certainly to a larger extent.
> 
> How do you think that works spaceboy? I understand that, to a certain level you can inhibit MAO but I would guess that higher doses (e.g. 120mg Nardil/phenelzine) aren't inhibiting MAO anymore than lower doses (e.g. 60mg), since your body only makes so much MAO. I think? So, maybe it's an interaction between the MAO inhibition and a metabolite? Interesting to think about.


I don't know to what degree you can inhibit MAO, and what effect something close to 100% inhibition would produce.

"Too much of a good thing" ... recently I had read on the internet somewhere, that if MAO is inhibited over 80% by an MAOI, dopamine levels actually begin to drop dramatically. I'm too lazy to go looking for it right now.

I do know that the effects of cocaine are _vastly_ - let me say that again - *vastly* more intense as far as euphoria goes.

This is from a book I have called "Drugs and the Brain" - sort of a layman's guide to various drug actions.



> Apparently the major action of amphetamines is to release dopamine and norepinephrine from the storage vesicles. The amphetamine molecules diffuse into the nerve ending where the neurotransmitter is contained and, because of their close chemical similarity to dopamine and norepinephrine, displace those neurotransmitters from their storage sites. The neurotransmitters are thus pushed out into the synaptic cleft, where they stimulate appropriate receptors.
> 
> Cocaine may behave in exactly the same way, but, to date, scientists have been unable to define its precise molecular action.


This is a very different action from the MAOIs (which inhibit the "janitorial" enzyme that oxidizes excess neurotransmitters [monoamines] after they've been released from their storage sites.) In the case of stimulants like amphetamine and cocaine, their effects are specific to dopamine and norepinephrine - affecting no other neurotransmitters. (the molecules of these stimulants closely resemble DA and NE molecules.) However, by inhibiting MAO, there are going to be increased levels of dopamine and norepinephrine available in the synapses - but it doesn't include only these. It also has an effect on seratonin along with every other neurotransmitter.


----------



## Caedmon (Dec 14, 2003)

I thought cocaine affected SE. :stu I'll admit I don't know very much about the way most recreational drugs work.

More abstracts that I found interesting while doing my daily compulsive medication research:

Bipolar depression: issues in diagnosis and treatment. [Tranylcypromine (Parnate) for refractory bipolar depression]

Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

Metabolism of monoamine oxidase inhibitors. [Tranylcypromine may not metabolize into amphetamine - it's controversial.]

Insight into the mechanisms of action of the MAO inhibitors phenelzine and tranylcypromine: a review. [This is a full-text article, not just an abstract. Fascinating info on MAOIs. I have always been taught in research classes that going off of abstracts is bad form, because the body of the article can be full of ill logic. I mean, it's the best we laymen can do, but I always am pleased if I can read the entire article. *Anyway*, what the article does is point out how MAOIs work very differently than just on SE, NE, and DA. Phenelzine (Nardil) may do a LOT of stuff with GABA, in unique ways - and that GABA action could, indeed, be responsible for some of its antidepressant/ antianxiety efficacy. MAOIs actually cause neurological changes (good ones), contributing to their efficacy, e.g. decreasing 5HT2 receptors. Their action on dopamine has a complex, almost bell-shaped response - robust at mid doses, and like you said spaceboy, lowers again at higher doses.]

Monoamine oxidase inhibitors and weight gain. [Phenelzine (Nardil) causes weight gain, but not as much as TCAs - I didn't know that. Also, isocarboxazid (Marplan) causes less weight gain than phenelzine, and tranylcypromine (Parnate) causes no weight gain based on literature.]

Adverse reactions to monoamine oxidase inhibitors. Part I. A comparative study. [Phenelzine (Nardil) may cause more side effects, BUT it may not necessarily end up being less tolerable than Tranylcypromine (Parnate) or having more dropouts.]

VASCULAR CRISES ASSOCIATED WITH MONOAMINE-OXIDASE INHIBITORS. [I am told that this Bethune 1964 study found that "a retrospective analysis of the incidence of acute hypertensive crisis in 692 patients treated with MAOIs found that the incidence was 8.4% prior to instituting dietary restrictions but 3.3% after dietary restrictions were imposed." I read this somewhere, posted by someone who seemed very knowledgeable. (I was just copying and pasting information into a Word document whilst compiling information on MAOIs.) I can't independently verify that because I can't read it in the non-existent abstract nor do I have the article in front of me. :stu Anyway I thought it was interesting that less than 10% of patients had a hypertensive crisis back in the day, even though they weren't dissuaded from eating certain foods.]

Sorry guys, when I do research I end up using the generic names of the drug because that's what you have to enter in the search parameters. Just remember, Nardil = phenelzine, Parnate = tranylcypromine.


----------



## apprentice1 (Feb 9, 2005)

I am having limited success with tranylcypromine. Within two weeks of starting, I needed to up the dose to keep the energy effects going. I took the first one in the morning around 6:30am and it would wear off by noon, sometimes though coming back later on in the evening...sometimes not. I started Saturday taking one in the morning and another at around 3:30pm. that worked one day and not the next. 
I had my appt. with my psychiatrist today and took along a written request to try Provigil. My problems with sleeping too much are still there, obviously. Unfortunately, it is outrageously expensive and the insurance system won't pay for it. (Something like 128 Euro for 20 pills!!) At this point we talked about upping the dose of tranylcypromine!! I explained that I had had visitors who slept in the same room with me and have told me I should get checked for sleep Apnea, because, they said, I have it...my psych told me if he can prove I have sleep Apnea he can prescribe Provigil under the insurance system so now I have to go to a Pulmonary doc (?). I have no idea how they determine things, if I will have to go to a sleep clinic...yuk...but he said if I have it they will give me a machine and a mask to wear at night that makes you breathe right. Now I have seen these things in action once in a hospital stay and I cannot imagine using such a thing, but when I said that I got a sort of "don't ask, don't tell" look from the psych doc which makes me think the main thing is to get the diagnosis so he can prescribe the Provigil...whether I use the mask is something else...in the meantime, I have taken 30mg. tranylcypromine today and slept most of the afternoon again...it is okay for today, as I am now on vacation and actually have a "date" planned for later this evening. So...the tranylcypromine at least seems to work well, really well for depression...and as for SA, well...the date... It is someone I have only net so far.He seems the complete opposite of me as far as shyness, but very understanding. After me not showing up several times and making excuses for not being able to meet he asked and I told about the SA stuff and he said he thought as much, asked if we could still talk and even offered "other alternatives" that might make meeting more easy. , and so far I haven't backed out from the meeting set for about 3 hours from now...maybe with a xanax or two, I can go through with this...wish me luck. I haven't talked to a stranger in private for I don't know how many years. Another thing! My psych doc that I like so o o much said if I take the tranylcypromine and Provigil, I will have to stop taking the xanax. I have not read any information against a combination of the three, and have read suggestions for the combo at Social Anxiety Disorder (Social Phobia). All in all, I would not give up my tranycypromine for anything else and if I can get the Provigil I would even be willing to give up the xanax...


----------



## Caedmon (Dec 14, 2003)

It doesn't make sense to me why he would want you to stop the Xanax. :stu Maybe he thinks that's too many meds?

I think the rule for Parnate/tranylcypromine (well, a rough rule) is 1 mg/kg of body weight. So if you weigh 80 kg, your dose is 80mg of tranylcypromine. If you weigh 62 kg you'd aim for 60 mg. Something like that. Of course, people are different metabolizers so you may need more or less despite body weight.


----------



## workman (Mar 5, 2004)

the dosing info for parnate says 30 mg is the usual dose and 60 is the max. 60 to 80 sounds more like nardil doses.

I'm going to make an appt. again to see about parnate or trying nardil again. The thing about parnate is that no pharmacy around here carries it.

apprentice1: how is parnate anxiety wise? does it make you more anxious? does it make more confident or talkative? I hope you go on your date. I hope it goes well.


----------



## Caedmon (Dec 14, 2003)

I know that's what the manufacturer says, and the PDR, but I'd say it's conservative (just like some of the food interaction lists are conservative). I think it's too low; I really do think it's 1mg/kg although I can't recall where I read that. Pretty much everyone on dr-bob is on 50-100 mg. People go as high as 200 mg (see above). Parnate seems to have a wider therapeutic window than Nardil. :stu

Example:


Ivan Goldberg said:


> The commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.
> 
> If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.
> 
> ...


Any pharmacy can order the Rx and it's there within a couple of days. Refills should probably be called ahead by a couple of days if you are taking an MAOI.


----------



## apprentice1 (Feb 9, 2005)

Versiani M, Mundim FD, Nardi AE, Liebowitz MR.

Department of Psychiatry, Federal University of Rio de Janeiro, Brazil.

Thirty-two patients meeting DSM-III criteria for social phobia entered a 1-year drug treatment with tranylcypromine in dosages between 40 and 60 mg/day. After exclusion of the early dropouts, improvement was rated as marked and moderate in 62% and 17% of the sample (N = 29), respectively. Alcohol abuse was associated with a poor outcome. Side effects were frequent and in some cases delayed the attainment of efficacious dosages until the third month of treatment. No serious adverse reactions occurred. The findings, relative to efficacy, are in accordance with a previous trial with phenelzine but need confirmation in double blind controlled studies.


This came from an earlier post on this thread, but I thought it was just worth mentioning again.
Parnate doesn't make me anxious at all. Where there was normally fear, there...just isn't now. It is difficult to describe...I think 10mg. one time a day is too little, but to establish a compatability record..okay. I have the go ahead to take one morning and noon and will call and ask if I can take another one, which will simply make my doctor think I am very careful and he will certainly say yes. The half-life of tranylcypromine is very low and that is what I have been noticing. It is not like Prozac where you can take 60mg. all at once in the morning, you have to space tranylcypromide in for example three times a day, because it just wears off. My observation, anyway. I read and get conflicting info as to the half-life of tranylcypromine, but figure 2.5 to 3 hours is about right. I also get conflicting info as to whether you have to spread out the days dose or can take it all at once. The instructions that came with my meds say 1 to 3 tablets a day either all at once or spread out over three doses...If the half-life is so short, an all at once dose doesn't make sense to me...


----------



## apprentice1 (Feb 9, 2005)

Caedmon said:


> It doesn't make sense to me why he would want you to stop the Xanax. :stu Maybe he thinks that's too many meds?
> 
> I think the rule for Parnate/tranylcypromine (well, a rough rule) is 1 mg/kg of body weight. So if you weigh 80 kg, your dose is 80mg of tranylcypromine. If you weigh 62 kg you'd aim for 60 mg. Something like that. Of course, people are different metabolizers so you may need more or less despite body weight.


Any idea where you have that information?

Today I went to the dentist so took my 10mg.Parnate and 1mg. of xanax for obvious reasons (dentist, fear, anxiety). This was about 9:00am. The appointment was for 10:15am. The appointment went great, I was friendly and not uptight at all. Doctor visits are one of the worst things for me as far as anxiety is concerned. (I cut my own hair because I couldn't stand going to a haircutter...the cape, the mirror...the panic.) Anyway, I was great but before I knew it I had missed taking my noontime dose of Parnate and it was about 2:00p.m. I took the Parnate but, again as has happened before, too late and nothing. I was in bed half an hour later having almost fallen asleep at the keyboard. Four hours later, I'm awake again. Maybe there is something to the theory about giving up the xanax. Parnate makes me feel not depressed, but is sort of speedy... I thought it really didn't help my S/A so much. Maybe I was wrong and just didn't trust it, or give it a chance. Maybe I am just on way too little a dosage of the Parnate...tomorrow is a new day...


----------



## Caedmon (Dec 14, 2003)

apprentice1 said:


> Any idea where you have that information?


I don't! And I can't re-discover the source either (stupid Google). It's one of those things that I got into my head, somehow, but I don't know where from or if it's reliable, so I could be very wrong. See the discussion pg. 1, re: dosing.

Actually, I've been thinking about what Dr. Goldberg wrote. I didn't know you could take MAO platelet levels (but I guess, sure, why not?). So that's one way to check on the level of the drug in the bloodstream and therefore, the therapeutic dose. You could always ask for that, I guess. (I try to avoid lab tests when possible because they are not always covered by my insurance.)

I think the Versiani (1988) study is interesting. It's been 18 years and no follow-up study?


----------



## apprentice1 (Feb 9, 2005)

I just posted under the Nine year Nardil thread and couldn't move the post over to here where it belongs...


----------



## Thunder (Nov 5, 2003)

apprentice1 said:


> I just posted under the Nine year Nardil thread and couldn't move the post over to here where it belongs...


Copy & paste


----------



## apprentice1 (Feb 9, 2005)

Thanks, Thunder. I tried that three times and gave up. One more go...your name still scares me, by the way...


----------



## apprentice1 (Feb 9, 2005)

I am remembering what my psychiatrist said about Parnate being what they used to call "mother's little helpers" and I said I came from that time and thought he meant to be talking about "black beauties"...speed. Mild, but effective. He also made it sound attractive by saying it is a lot like cocaine...now, my observations after a couple or three weeks...it is speed. For me it has made my depression go away, thank god. It doesn't have a long half-life, disputably between 2.5 and four hours and I would say three to four for the first dose is about right. I seem to have a hypotension reaction then, after the first dose wears off and need to sleep for about three to four hours in the afternoon...not good.. No matter how much, okay, one or two, that I take at this time helps...I have to, if I can, lie down. I think if I checked my blood pressure, it would be the cause. I checked it at the doctor's on my last visit after one 10mg. of Parnate and 1mg. of xanax and it was 115 over something quite reasonable...my doctor said I would live a long life...I see staggering differences in the dosages people take and when and have come to the conclusion that this drug is like cocaine, used to be called "mother's little helper", will bring you up when you want to be up and it doesn't last very long, so it lets you down...but then you can take the next dose after awhile and come right back up...I am packing for Brussels for the week-end from Munich, it is ten pm. and I have been out to drinks (white wine mixed with perrier, not a wine-spritzer) and dinner with my long-time (23 years) friend, during which, after sleeping (I just have to lie down and shut off, I don't sleep the whole time... two hours or so), took a half a xanax, a bit later with dinner a Parnate and another half a xanax and now I am home happily packing away, doing my e-mails, laundry etc., without the faintest apprehension or anxiety about the trip alone to Brussels tomorrow in the morning...I say, take 'em when you need 'em, leave 'em when you don't...for me taking more at one time (meaning two instead of one) made absolutely no difference...I got buzzed and came down and crashed. Crashing could be because of eating a pizza with the little crushed red peppers and having a hypo-tension reaction...I don't know. I am also being checked in a couple of weeks for sleep apnea which could lead to the need for sleeping in the afternoon around 2:00pm for a couple of hours and feeling tired in the evening. At least Parnate helps everything except the nap in the afternoon...I am happy to have come across it and be allowed to try it.


----------



## apprentice1 (Feb 9, 2005)

I want to put a disclaimer in here, right now...what I say today may not be what I say tomorrow about my experiences with Parnate...the directions that came with the package said one to three weeks to notice the mood elevation and anti-depression effects...I noticed them right away. I am into my third week...


----------



## PBNC (Mar 4, 2006)

What about SA? Noticing any improvements or changes there?


----------



## apprentice1 (Feb 9, 2005)

slowly, yes, but it is hard to tell, I still use the xanax for that, but notice I only need .5mg instead of 1.mg. and then a booster maybe, later when I notice it coming back. I am using less xanax though for sure. I think all the warnings about all the different things that you can eat, drink, other medications, etc., definitely have an effect on your blood pressure...it is so hard to judge right now, you have so little infos to go on..one sources says causes hyper the other hypo tension for the same things..I guess everyone has to figure out for themselves what what does...again, so far, I see it as a mild speed. The first dose in the morning with a cup of cappucino is a real WAKE UP for most of the morning...so much so that I haven't tried upping the dose in the morning to 20mg. maybe I should. I am not as afraid of the dosage as I was. As said, the only problem I see, is that in the afternoon, no matter if I take 10 or 20mg. more and drink coffee, it is crash. Later, after a nap, it all comes back nicely, though. That's why I say I don't notice great results for S/A. I go to bed in the daytime to hide, not to sleep...did before, still do. Am anxious to see about the sleep apnea and possible addition of Provigil to the Parnate.


----------



## PBNC (Mar 4, 2006)

I didn't know Parnate and Provigil could be taken together? I'd be interested in that, since Provigil shows some promise for ADHD, and if I went on Parnate I'd have to stop the dexedrine I take for my ADHD now.


----------



## Caedmon (Dec 14, 2003)

Yeah, Provigil (modafinil) + Parnate (tranylcypromine) is something I'd like to try. Provigil becomes generic here in the U.S. in June, I think. The manufacturer is trying to hold onto the patent under some stupid argument about particle size, but they are going to market the metabolite of modafinil anyway so I fail to see the point.

Provigil got approval for pediatric (kids) ADD, so I would assume it could do something for adults too. This is especially something I'd like to try if I find that the Parnate doesn't help my focus or energy as much as I'd want to.

BTW you can take dexedrine with Parnate. Cautiously. Dr. Stahl's "Essential Pharmacology" lists "augmentation with dextroamphetamine or methylphenidate" as a way of treating people who only partially respond to Parnate. I am pretty sure it's something you would only want to do with very close supervision and all prudence. And sloowwwwwly. Ivan Goldberg, in an above post, talks about people "in the old days" being treated simultaneously with Parnate and a stimulant.

(I have heard rumors about the combo of MAOI + TCA (usually amitriptyline or amoxapine) + stimulant. Supposedly an option for those who do not respond to anything, even to ECT, for depression.)

Other augmenting agents (for depression):
- Lithium
- anticonvulsants
- TCAs and tetracyclics esp. amoxapine - but NOT clomipramine
- antipsychotics e.g. Risperdal
- benzodiazepines

Augmenting agents (for anxiety):
- anticonvulsants
- benzodiazepines (see above)
- antipsychotics (in certain cases)

Insomnia can be treated with anything GABAergic like Lunesta or Neurontin or a benzo. Also trazodone. For a mood stabilizer, I think most of them are okay except Tegretol or Trileptal.

I ordered a home blood pressure monitor and a medicalert bracelet. The BP monitor should be here soon; I can take some baseline readings. (Yeah, I am a cautious person.)


----------



## PBNC (Mar 4, 2006)

Caedmon, I think a medicalert bracelet is a great idea. I don't think you're being overly cautious at all. As I've considered MAOIs, I've questioned whether I'd want to wear one, because I know people would ask questions about it, and I'm hyper-sensitive about...well, I don't know how to explain this exactly, but I've known people who like to make a big deal out of any medical problems they have and use it as a way to get attention, and I'm just the opposite - I keep that stuff very private. Hardly anyone outside of my husband knows about most of the mental health stuff I'm dealing with. So, I'd worried that by wearing a medicalert bracelet I'd look like I was trying to get attention or wanted people to ask me about it, if that makes any sense. However, I gave that worry up, because the possible benefits of having one on if it was ever needed far outweigh any minor embarassments it causes.

I've looked at some of the studies you've provided re: taking dexedrine while on an MAOI and will show them to my doctor if I ever do start an MAOI. Offhand, I know it's not an idea she'll be thrilled with, but if I felt I needed it, maybe I could convince her. 

The only thing that makes me hesitate to give up the dexedrine is the awesome appetite suppression. I've effortlessly lost eight pounds since I started taking it. 

I know MAOIs are considered a last resort, something to try if other stuff doesn't work, but I feel that what I've tried so far (Zoloft, Wellbutrin, Klonopin, and now dexedrine and Xanax) have fallen so short of getting me where I want to be that I don't want to mess around anymore. MAOIs are the big guns. They work. Period. I just don't know that I want to spend months and months doing the runaround with Effexor and Paxil and trying to rule everything else out before I try what we know is very likely to work. I don't drink alcohol at all, don't use OTC meds except maybe three times a year, and don't even LIKE most of the foods on the restricted list. Cheese is truly the only thing I'd find hard to give up. 

Sigh.


----------



## Caedmon (Dec 14, 2003)

Re: medicalert bracelet. I plan on telling people that I have a food allergy (except of course, close friends and family). :stu


----------



## Caedmon (Dec 14, 2003)

^ it also takes care of the dietary concerns if that's my cover story. If I'm in a restaurant with someone and I have to ask about the type of cheese on something, or whatever circumstance it might come up in, I can explain that I have a food allergy.

I ordered 2 medicalert bracelets. One of them looks like a sportswatch band, but with a metal plate where a watch face would go. I will wear that one most of the time. I also ordered a second, ordinary stainless steel one. The company I ordered it from threw it in for $10, I figured it was a good idea since I can have a backup in case I lose or can't find my other one. There are a couple of companies that sell these bracelets but I got mine for $35 for the both + shipping, a fair deal. The plate will say:

Christopher [Lastname]
Asthma, Contact Lenses
Meds: MAOI Tranylcypromine

Blood pressure monitor came today; unfortunately, I was at work when the UPS guy came by so I couldn't sign for the package. That's okay, I'll get it tomorrow.

apprentice1, I understand that some people are sedated by Parnate instead of activated. So, it could be that, or it could be the blood pressure.


----------



## workman (Mar 5, 2004)

Well, tomorrow is my pdoc appt. I'm still deciding on parnate or nardil. I might end up getting either, though. We shall see.


----------



## Caedmon (Dec 14, 2003)

I'm bored, as you will soon tell from reading this post:

Interesting link regarding MAOI toxicity resulting from overdose, drug or food interactions, and how it's treated. (Kind of technical.):

http://www.emedicine.com/emerg/topic318.htm

So, just how dangerous _are_ MAOIs?

This letter from the Canadian Journal of Psychiatry says that:



> Hypertensive crisis with monoamine oxidase inhibitor (MAOI) use has been reported in the literature and carries an overall risk of less than 1%. The reported reactions were triggered by diet noncompliance or by the use of concomitant medications. Specific agents responsible for these crises include tricyclic antidepressants (TCAs), meperidine, levodopa, and hay fever and cold remedies.


I am not sure, but I think that when they say "hypertensive crisis", they mean at any given time or per year or whatever (not lifetime incidence). They are probably only addressing hypertensive episodes requiring some type of medical attention. Let's go with that assumption, and look more closely at that first article from eMedicine. It says that



> In the US: In 2003, the American Association of Poison Control Centers' Toxic Exposure Surveillance System (AAPCC-TESS) reported 285 MAOI exposures in the United States. This is compared with 463 MAOI exposures in 1997, which was an increase from the 451 exposures reported in 1996 but a significant drop compared with the 618 cases reported in 1990.
> 
> Of the toxic exposures reported in 2003, 32 occurred in children younger than 6 years and 244 occurred in those older than 19 years. The data from 2003 also showed that 157 of the toxic exposures were unintentional and 74 were intentional. In 2003, of those who ingested MAOIs, 2 died and 20 had severe clinical manifestations.


Let's go with the most recent data. This is a crude analysis, but we have 285 reported hypertensive crises. 2 died, and 20 had "severe clinical manifestations". (I'm not sure what that is, but I would assume it indicates something like a stroke or heart problems.) So, 22/285 = 7.7% are serious. We don't know from this data how much of an impact intentional toxicity has (e.g. taking Demerol in an effort to kill yourself).

So - again, this is all crude, but it gives one an idea - less than 1% of people on MAOIs experience hypertensive crisis. (Let's round up to 1%.) 7.7% of the folks who do, will have serious complications.

.01 x .077 = .00077 or ~.08% of the people taking MAOIs will experience really bad problems. That's 8 out of every 10,000 people. This doesn't differentiate suicides (which I'm sure inflate these statistics somewhat).

To contrast that, your odds of being injured in a car crash in the United States are .8% according to the Department of Transportation. (http://www-fars.nhtsa.dot.gov/) .8% for car injuries, if you drive a car. >1% if you take an MAOI. So, the rates are roughly the same. (Note that I'm not sure what the DOT would consider a "car injury", if this includes something like scrapes and bruises or something more serious; nevertheless, it does involve car _crashes_.) BTW your odds of getting in a car crash of any kind are ~1.8% in the U.S.

Bottomline: Can you be injured or killed from taking MAOIs? Yes, absolutely. Can you be injured or killed in a car crash from driving a car? Yes, absolutely. _The rates are about the same._

Just thought it kind of puts things in perspective. I drive a car about 4 times a week. BTW if any of my math is wrong, or could be, _please _point it out, it would not be the first time.


----------



## Caedmon (Dec 14, 2003)

PBNC said:


> Caedmon, I think a medicalert bracelet is a great idea. I don't think you're being overly cautious at all. As I've considered MAOIs, I've questioned whether I'd want to wear one, because I know people would ask questions about it, and I'm hyper-sensitive about...well, I don't know how to explain this exactly, but I've known people who like to make a big deal out of any medical problems they have and use it as a way to get attention, and I'm just the opposite - I keep that stuff very private.


BTW there are lots of options besides the bracelets. You can get necklaces, dogtags, watchbands, actual _watches_, charm bracelets, and probably some other stuff too.


----------



## apprentice1 (Feb 9, 2005)

Chris said
"I ordered a home blood pressure monitor and a medicalert bracelet. The BP monitor should be here soon; I can take some baseline readings. (Yeah, I am a cautious person."
I think that is a great idea, how much does one cost in the real world?
good luck, workman!
I think the coffee with the Parnate is not good. I 
Accidentally got de-caf this morning and the "rush" from the Pqrnate was not there, but the effects were there. It makes me sweat (Parnate) and I don't like that, otherwise great results.
_________________


----------



## Caedmon (Dec 14, 2003)

I paid $35 for the bracelets and $60 for the blood pressure monitor. So that's about 28 €and 50 €, respectively?

The BP monitor is made by Omron, which is (I hear) a reliable manufacturer. It's automatic inflatable (which is nice if you're having a hypertensive crisis and are too sick or out of it to inflate it yourself) and measures systolic, diastolic pressure as well as heart rate.

It is not exactly _cheap_, but it's less than the cost of an emergency room visit.


----------



## Caedmon (Dec 14, 2003)

I got my blood pressure monitor. It's nice and compact, very easy to use. BP is 103/69. Pulse of 79 bpm.


----------



## rice (Sep 5, 2005)

caedman
Sorry if i missed it. Are you currently on nardil or parnate? How long? If so, how are you finding it?


----------



## apprentice1 (Feb 9, 2005)

Caedmon first posted,
"Post Posted: Thu Mar 30, 2006 7:33 pm Post subject: Me, Parnate, and MAOIs 
I've had some people ask about my experiences with this drug, when I go on it. Right *now* what I have to say is concerning my pre-medication research and findings. I haven't taken it yet, but here is some information on Parnate (tranylcypromine) and on MAOIs in general."

I think Caedmon is using me as his guinea pig while "washing out" of other medication before deciding whether to proceed with one of the MAOIs Parnate or Nardil. If I don't croak, I think he may give one or the other a go...(just kidding)...I take Parnate as Nardil is not offered in Germany any longer. I think it works great for depression...Great! for other things like social anxiety I am not thrilled, but seem to be the exception to the rule. I still take xanax for that. I really like the Parnate though. I am, after about a month of taking it, taking 10mg. about 11:00a.m. and another 10mg. about 3:00p.m. It has a short half-life and therefore harder (for me, at least) to determine what the right dosage is and how often to take it...


----------



## Caedmon (Dec 14, 2003)

LOL! Yes, he is my lab rat. :b

Pdoc visit today... I walked out with a Rx for Valium, nifedipine (emergency antihypertensive - he changed his mind and chose this over thorazine), also Ambien (meh, okay) and... Parnate 10mg x 90, 3 refills! And I get to start very soon!

I dropped everything off at the pharmacy and my MAOI will be here on Wednesday (tomorrow). But, I'm not going to take the Parnate until Thursday because I have to drive down to my folks' house in So. Utah that day, and I don't want to end up with weird side effects before I drive.

He said that I don't really need to wash out any more. It's a good precaution but that there is such a small blood level of Wellbutrin that will be in my system, and my initial starting dose of 10 mg is small enough, that there isn't likely to be any interactions. He's more worried about the consequences of me slumping into depression, which I already have been. So, it'll be just a 4 day washout and slow dose titration. 

I move up to 30mg over time and stay there. Depending on my response we may or may not monkey around with the other meds. Well, the pharmacist knows my name now.


----------



## apprentice1 (Feb 9, 2005)

good luck, Chris. Other than the green skin color and the extra fingers and toes I've grown since starting Parnate, everything is "go".!! Truthfully, though, good luck with no chocolate over the easter holidays, for example and the other diet "suggestions". My experience tells me breaking diet doesn't kill you, but the things that used to taste so good, don't necessarily seem to agree with us so well anymore, maybe that is all psycho-somatic because we know we aren't suppossed to be enjoying these foods, but whatever, I am convinced now that letting the Parnate work successfully means sticking as close to the diet suggestions as possible. Let me know if a chocolate easter egg makes you croak, I'll put out a disclaimer right away!


----------



## Caedmon (Dec 14, 2003)

Day 1: took 10mg in the afternoon. My baseline BP is 106/67; it rose slightly to 125/81. (It has since stabilized to about 105/78.) No noticeable effects or side effects. 

Day 2: took 10mg in the afternoon. No change in BP. No effects or side effects. I did seem to "crash" and get sleepy about 3 hours later, but I have had allergies lately and took some chlorpheniramine also, and that is as likely as anything to have caused it.

Tomorrow the dose jumps up to 10mg taken in the morning and afternoon (20mg total), to be taken for a week. I have not died yet, as you can plainly see.

Foods I've eaten and "wondered" about: breakfast sausage (the kind that's uncooked when you buy it, I figured it was not aged so it was okay, and it was). Caffeine - I continue to consume about 200mg per day with no ill effects. I have not taken enough Parnate, for long enough, for sufficient MAO inhibition to take place so these results may not be representative of what I will ultimately experience.

Parnate comes in little red round pills with the words "Parnate SB" written on them, in a way that makes them look a bit like a smiley face. They are my smile pills.


----------



## workman (Mar 5, 2004)

Well, my school pdoc didn't want to prescribe nardil again. She might give in on the next appointment, though. I asked my brother, and he wouldn't even write me a script for it. On friday I'm going to try one last doctor who prescribed it for me before my school doc did. I'll have to come up with a story why I didn't take it the first time. Hopefully, she will prescribe it again. I have been taking 30 mg of some I had left over the last few days and I do feel calmer than I have been.


----------



## Caedmon (Dec 14, 2003)

*20mg* dose update:

No effects, no side effects. Where are the stupid "stimulant" effects of this drug? I still feel pretty tired and stupid.

Good things: no sexual side effects (libido increased steadily since stopping SSRIs). Chocolate seems to be okay in the small quantities I've eaten it; so is caffeine but I hesitate to take more than 300mg per day. I ate out at a mexican restaurant, just had to ask for no cheese. I didn't die or even feel ill.

My BP has stabilized at about 110/80 which is, like, optimal (if anything).


----------



## apprentice1 (Feb 9, 2005)

Dang, I was just sure the tacos were gonna get ya, too...well, try uh...no, just kidding. Glad to hear things are going without incident. I think it was about at this point where I noticed myself shaking hands with like a cashier or something. I do notice myself talking more and longer with people, but then I start to 'freak out' because I don't have the skills to keep it up so long so I just stop, even though I am still standing there, the people I was talking to are gone and I am like, "that was that Parnate I'm taking." I find I am more social, just not less afraid of it. xanax.


----------



## PBNC (Mar 4, 2006)

I know what you mean, apprentice. Effexor is making me less anxious about talking to people, but I've had such stunted social skills for so long that I still don't always know what to say to people.


----------



## Caedmon (Dec 14, 2003)

PBNC said:


> I know what you mean, apprentice. Effexor is making me less anxious about talking to people, but I've had such stunted social skills for so long that I still don't always know what to say to people.


I had this experience yesterday. I was filling my car up at a gas station and a work acquaintence pulled up behind me and talked to me. I felt surprisingly calm and unalarmed (this normally would shoot my anxiety through the roof). But, I still didn't have much to say. I just kind of smiled and nodded at what she said and then drove off. :stu Don't know if that means the Parnate is starting to do something or if I just had a good day where the anxiety is concerned.


----------



## nickguy (Feb 14, 2006)

When you get up to the max/right dosage, how many times a day do you have to take an MAOI (any of them as an example)


----------



## apprentice1 (Feb 9, 2005)

I think when I reached the max/right dosage it was 40mg. spread out strategically during the day. One in the morning with coffee, early, 5:30 or 6:00a.m. then again not until about 10:00 or 10:30a.m. the third one at about 1:00p.m. the fourth at about 3:00p.m. to 4:00p.m. That seemed to get me through the afternoon crash I was having. I am really not sure how it should go from here. One school says go back down to 10mg. a day and others say up and down it as you see fit, I plan to try the one a day until I notice it going back to the afternoon crash and if that happens, I will probably start taking more again. They seem to have a short half-life and there are few sources for information as to what works best. That makes it a difficult question to answer for me. I guess one way of knowing if you are taking too much is when you notice you can't fall asleep at your normal or wanted time at night. Anyway, my two cents worth, others?


----------



## Caedmon (Dec 14, 2003)

The short half-life is curious. I should think that once MAO is inhibited, that that is where the therapeutic effect comes in, rather than something to do with the active presence of the drug in your system. I may be misunderstanding how this works. But, it could also be that tranylcypromine has that amphetamine-like quality which has some amount of psychotherapeutic effects as well. So the halflife becomes an issue once again. I think most people will end up doing best with doses spread out in 2-4 times a day.

So apprentice you're doing well on 40 mg? That's encouraging. Maybe when I get to 30 things will really start firing...

I'm having intensely vivid dreams on Parnate, unlike anything I've had before. Last night I slept through two alarm clocks because I was trying to figure out a nightmare in which my dad accused me of credit card fraud.


----------



## PBNC (Mar 4, 2006)

Caedmon, I'm curious, are you noticing any effects of Parnate on your appetite? How about sleep?


----------



## Caedmon (Dec 14, 2003)

Yeah, my sleep is just plain irregular. If anything I take more naps nowadays. Times like this I wish I had lots of Provigil to get things regulated. But no insomnia, no shorter length of sleep. Actually the nap thing, that could be anything, sometimes my sleep schedule just gets off like this and then it takes a while to get back to normal. So I'm not sure that's the Parnate.

I've seen no effect (no increase/decrease) in my appetite. Today I took 30 mg for the first time (tried 20 in the morning at 10 at noon; I'll try it 3x a day as well and compare). 

No blood pressure weirdness. It did raise my BP the first few days but now it's back to normal. No side effects, no effects. I've now eaten chocolate (LOTS), ham and olive pizza, guacamole, and had more caffeine than is good for me, since starting Parnate. None of them has caused any adverse effects or raised BP (I did have a lot of caffeine yesterday and my heart rate went up... of course. But no hypertension. In fact, it was weird to see a reading of 104/61 and 95 bpm!) I had to turn down cheese on a salad at a Mexican restaurant, and I had to turn down some suspicious generic macaroni and cheese, that's it.


----------



## apprentice1 (Feb 9, 2005)

I would have turned down the 'suspicious generic mac and cheese' anyway...good for you. I am noticing that after reaching 40mg. for just a day or two, that I get along just fine on one a day again. Like you said, there may be lots of reasons for this...but I am, after a long time noticing the SA deterrant (sp?). And I notice that a half a valium (half of a 10mg.) helps tremendously. The effects of the valium seem to be increased by the Parnate and the Parnate seems to give me a queesy (sp?) stomach sometimes. Today I had one 10mg. dose of Parnate, a half a valium and another half a short time later, so, altogether 10mg. of valium. "Something's happening here. What it is ain't exactly clear..." (from either Crosby Stills Nash and Young or Neal Young, I'm not sure..." I seem to have a craving for chocolate pudding with whipped cream lately, so I guess binge eating can go on the negatives list, but again, that has happened before...I still do not have enough experience to say one way or the other about this med. I have been on it for what, five weeks or so. The little instruction sheet that came with the med says the retreat of the problems is usually at least 4-6 weeks. We shall see.


----------



## workman (Mar 5, 2004)

Well, I got a doc to write me a script for nardil again. She is referening(sp) me to a pdoc, though, but wants me to come back and see her in two weeks. I don't know why I need to see her if I'm getting shipped off to a pdoc. Knowing my luck the pdoc won't want to prescribe the nardil and I will only be on it for a month or so. Also, insurance won't pay for pdoc, so that will be expensive.


----------



## Caedmon (Dec 14, 2003)

Good luck on the Nardil!


----------



## apprentice1 (Feb 9, 2005)

Yeah, workman, good luck. I don't understand either why she would prescribe Nardil for you herself and THEN refer you to a pdoc...if I were the pdoc that would automatically make me feel compromised im my competence and uncomfortable...and you end up having to pay for the bill if she says she doesn't want to be the responsible party and disagrees??? I wouldn't go. It's your money. Is your doctor competent or not seems to be the issue here and if she doesn't feel competent she should have referred in the first place and not in the second...just my opinion.


----------



## Caedmon (Dec 14, 2003)

Well, I'm fine to take Hormel brand pepperoni (which is probably processed, and that's why). So I can now include *some* pepperoni back into my diet. I did slow BP assays yesterday, and ended up eating an entire package! My final BP was 106/60, which is LOW, not high.


----------



## apprentice1 (Feb 9, 2005)

Howdy. I was just wondering what dose you were taking now? I am moving up and down, at the moment back up. I am also moving up with my irregular doses of xanax and taking them together, 10mg. Parnate and 1mg. xanax. That seems to work really well. I got so much propaganda from my first house doc about getting addicted, I find myself not taking it when I need it, still, now that I have a doctor who is willing to give it to me. I have to change my attitude. Are you noticing any effects one way or the other, yet?


----------



## Caedmon (Dec 14, 2003)

On 30 mg for a few days and I'm finally noticing a change.

1) I'm less anxious around other people. It's a different quality from benzos, which sort of sedate me but don't make me want to socialize. It's more of a pro-social, "I'm happy to talk to you now" sort of thing.

2) I feel like I can think better. Not so much cloudy thinking as I've had in the past. I have some definite ADD tendencies and these are clearing up. I can follow conversations somewhat better.

3) Enjoying things I used to enjoy. This is a nice change. I'm actually engaging in certain activities, and wanting to, because they are FUN. I've been so apathetic towards everything that this is a nice change for me.

It's not a tremendous, "boom!" type of change, but it is noticeable. I like it.


----------



## PBNC (Mar 4, 2006)

Hehehehe, just ignore my question on your blog, since you answered the questions here. I'm really glad this is working for you.


----------



## workman (Mar 5, 2004)

I don't know if I should be posting here or in the nardil thread, but oh well.

So far I'm feeling more confident on nardil. I'm also getting very sleepy, but every once in awhile I get a nice burst of energy. Overall, it seems good so far, but I don't like the sleepiness. I still haven't got the liver tests the doc that prescribed them wants me to get. I still don't know what I'm going to do about going back and seeing her and then seeing a pdoc. I wish my school pdoc would prescribe it or I could get my brother to prescribe it. It would be much cheaper.


----------



## apprentice1 (Feb 9, 2005)

maybe if you go back to your brother and explain to him that it is important enough to you to have gone on your own and taken a stash you had and that you have not had any problems, etc, he will give in. Personally, I would not doctor my own family, though, so I understand his position. I would go back to the doc who gave you this prescription and explain the finances involved in you having to go to another doctor, tell of your success and ask if she can't just drop it. The liver tests she should be able to do, too, or, I mean it is just a matter of drawing blood and sending it to a lab...? I am glad you are feeling more confident, hope you don't start drinking again as you mentioned, I fight against it, too. I know having friends means drinking but coming up with your own non-alcoholic beverages is not a bad idea. Drinking of all the addiction fears we talk about on this forum with things like benzos and even parnate, is still the number one addictive drug and we just don't think twice about that and should. Sorry didn't mean to evangelise there, I am sure you mean the mildest joy in enjoying a cold Bud here and there...


----------



## Caedmon (Dec 14, 2003)

Yeah, the costs suck! I would go back to your GP and explain that you've been on it before and have considerable knowledge of the medication. See if you can work things out.


----------



## apprentice1 (Feb 9, 2005)

These are the words to Mother's Little Helper from Mick Jagger and Keith Richards, I mentioned in an earlier post. I just thought I would throw it in here for entertainment's sake. Sounds like mom had more than one little helper, or?! When you think about it, these are most likely you guys' grandmothers!! I know my aunts were always trading their drugs back and forth with "here, try these!...oh, hon', I take these, they're great, take some..." They made great cakes, though.

Mother's Little Helper

What a drag it is getting old
"Kids are different today,"
I hear ev'ry mother say
Mother needs something today to calm her down
And though she's not really ill
There's a little yellow pill
She goes running for the shelter of a mother's little helper
And it helps her on her way, gets her through her busy day

"Things are different today,"
I hear ev'ry mother say
Cooking fresh food for a husband's just a drag
So she buys an instant cake and she burns her frozen steak
And goes running for the shelter of a mother's little helper

And two help her on her way, get her through her busy day
Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

"Men just aren't the same today"
I hear ev'ry mother say
They just don't appreciate that you get tired
They're so hard to satisfy, You can tranquilize your mind
So go running for the shelter of a mother's little helper
And four help you through the night, help to minimize your plight

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

"Life's just much too hard today,"
I hear ev'ry mother say
The pusuit of happiness just seems a bore
And if you take more of those, you will get an overdose
No more running for the shelter of a mother's little helper

They just helped you on your way, through your busy dying day.


----------



## Caedmon (Dec 14, 2003)

I've had some reduction in depression and a surprising reduction in anxiety so far. Kind of like you said apprentice, I can talk to people and I don't freak out about it. It's very very weird to begin to feel normal...

There have been questions about contraindicated meds. Here is a list that I butchered from http://www.rxlist.com:

Edit: I took out what I felt was not evidence-based. Just to keep things simple.

CONTRAINDICATED MEDICATIONS

- *MAO inhibitors* or dibenzazepine-related entities *[mainly certain TCAs esp. clomipramine; don't combine w/out doctor supervision]* 
- In combination with *dexfenfluramine* hydrochloride
- In combination with selective serotonin reuptake inhibitors *(SSRIs)*
- In combination with *buspirone [Buspar]*
- In combination with *sympathomimetics* ... such as cold, hay fever or weight-reducing preparations that contain vasoconstrictors. [Me: this is where people get confused. DIRECT-ACTING sympathomimetics such as ephedrine or pseudoephedrine are bad. INDIRECT-ACTING sympathomimetics such as albuterol or hypodermic epinephrine are okay although caution is prudent. Amphetamines are usually okay w/ doctor supervision.]
- *guanethidine* [Me: this is not used in the U.S.], *methyldopa, reserpine, dopamine, levodopa and tryptophan* with PARNATE may precipitate hypertension, headache and related symptoms. 
- In combination with *meperidine [Demerol]* This is perhaps the biggest one.
- In combination with *dextromethorphan [OTC cough suppressant]*, although it rarely works better than placebo so you're no worse for the wear.
- *Anti-parkinsonism drugs *
- _Excessive _use of *caffeine *in any form [Me: Really, it's fine to have caffeine in small amounts. I think it depends on your tolerance as well. I have the equivalent of 2-3 cups coffee a day with no problems.]

Added by me
- *tramadol [Ultram], SNRIs, sibutramine [Meridia], atypical antidepressants [e.g. mirtazapine (Remeron)]*
- *hypoglycemics* may be potentiated, for anyone diabetic
- Be careful with *OTC herbal supplements*; ask the pharmacist
- *anticholinergics* such as diphenhydramine (Benadryl) or IBS medications may be potentiated, and the dose may need adjustment
- Some central nervous system depressants such as *narcotics *and *alcohol*, or with hypotensive agents. A marked potentiating effect on these classes of drugs has been reported. [Me: you may need to simply adjust the dose to work around side effects of narcotics. Alcohol, just use it in moderation and avoid tap beer and really old wines.]

If it's not on this list, then I believe it's fine. Ask the pharmacist.


----------



## Caedmon (Dec 14, 2003)

http://www.acnp.org/G4/GN401000046/CH046.html
^ This website is very interesting. It states that:



> The actual morbidity associated with administration of the irreversible MAOIs is difficult to determine. However, it has been estimated that, of the 3.5 million patients that had used tranylcypromine by 1970, about 50 persons reportedly had cerebrovascular accidents and 15 of these individuals died.


That means you have a 1.4 x 10^-5 % (or 0.000014 %) chance of suffering a serious hypertensive reaction, at least on Parnate. That is not very high.

More interesting stuff:



> *Anxiety Disorders*
> 
> The biological mechanism of antipanic and antiphobic action remains unclear. MAOIs have potent effects on noradrenergic as well as serotonergic function, both of which have been implicated in the etiology of panic symptoms (21,98,135). In support of an antipanic effect mediated by noradrenergic mechanisms, MAOIs have been shown to diminish the output of central and peripheral noradrenergic metabolites. MAOIs downregulate b1, a1 and a2 receptors and suppress neuronal firing in the locus coeruleus (21,93). In support of a serotonergic mechanism of an antipanic effect, MAOIs have been shown to increase brain 5-HT levels (12), decrease cerebrospinal fluid (CSF) levels of 5-hydroxyindoleacetic acid (5-HIAA), downregulate 5-HT1 and 5-HT2 receptors, and decrease the firing rate of serotonergic neurons in the raphe nucleus (93). To what extent these observations are mere associations versus direct causations of the antipanic effects of MAOIs remains to be clarified.
> 
> The apparent advantage of MAOIs over TCAs in the treatment of panic and phobic symptoms has prompted speculation that anxiolysis may be related to differences in the pharmacological effects of these agents. Antipanic and antiphobic effects have been linked to changes in dopaminergic function, insofar as administration of MAOIs results in a moderate reduction of dopamine metabolites, whereas TCAs have little or no effect (64). Others have suggested that the antipanic effects may be linked to changes in PEA, whose levels are sensitive to the nonspecific MAOIs but not the TCAs (85)). Alternatively, the ability of phenelzine to increase brain levels of g-aminobutyric acid (GABA) may contribute to the anxiolytic effects of the MAOIs (1). More research is needed to evaluate these hypotheses.


And finally, today's tidbit:
these guys state that: "Structurally, tranylcypromine [Parnate] is amphetamine with the side chain cyclized. It is a mixture of enantiomers, one of which is a good MAOI, while the other is a good norepinephrine reuptake inhibitor."


----------



## apprentice1 (Feb 9, 2005)

well, my update...going down from 40mg. a day didn't work, so I just wanted to say that I am currently using more...50-60mg. at least, and the only thing I did one time notice as a side-effect was feeling a bit light-headed after sitting for a long time and then standing up and I just felt a bit faint, which was quickly solved by bending over like I was going to tie my shoe-strings. That took care of the problem real fast, it really wasn't so bad, I just remembered reading it could happen and it didn't scare me or anything. I start the day with one 10mg. with my coffee and that wakes me up and gets me going, then I wait and take the rest at a faster rate, (every couple of hours in the afternoon and stop at the latest at six p.m. so I can go to sleep at a normal time. I have done the "sleep test" and will find out the next time if I can get a script for Provigil on the insurance. I think I could reduce the amount of Parnate in the afternoon if I was taking the Provigil. I am reducing the xanax drastically, only taking about .50mg. twice a day mostly, sometimes more, sometimes less. Does anyone else though notice 'drymouth' from Parnate? The metallic taste seems to be gone, but the dry mouth still bugs me.


----------



## Caedmon (Dec 14, 2003)

Question: can stimulants (e.g. Ritalin (methylphenidate), Dexedrine (dextroamphetamine) be combined with MAOIs?

Answer: apparently, yes.

Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.

CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.


----------



## PBNC (Mar 4, 2006)

Thanks for posting, Caedmon. If I do end up going the MAOI route and decide that I also want to continue dexedrine, I will print this out for my doctor.


----------



## nickguy (Feb 14, 2006)

With regards to social anxiety, whats the advantages/disadvantages of nardil vs parnate?


----------



## apprentice1 (Feb 9, 2005)

Dr. Caedmon! How about some progress notes? How is it going with you? We are starting to miss you around the lab. sincerely, your lab rat and Apprentice.


----------



## nickguy (Feb 14, 2006)

apprentice1 said:


> Dr. Caedmon! How about some progress notes? How is it going with you? We are starting to miss you around the lab. sincerely, your lab rat, Apprentice.


How is everybody taking MAOI's doing? I'm debating trying to obtain a prescription for nardil or parnate. (I probably could get it seeing all the other meds i've failed on)


----------



## Caedmon (Dec 14, 2003)

I believe there is some information in this thread on the evidentiary status of Nardil and Parnate. 

My response to Parnate is... nil at this point. I feel depressed and avoidant as ever. I hit a bad patch over the weekend. I don't think 30mg is going to do it. The only benefit so far is less apathy and fewer side effects vs. other antidepressants. I'm losing weight (appetite is decreased).


----------



## PBNC (Mar 4, 2006)

Hang in there, Caedmon. Remember, spaceboy said it took six weeks to feel a golden bath of neurotransmitters. (That description always stuck with me!) You'll get there, it just takes time.


----------



## workman (Mar 5, 2004)

Well, I'm going good on nardil so far. I'm going to get the liver tests done tomorrow. On friday, I'm going to see my school pdoc aand try one last time for has to prescribe me nardil again. If not, I'm going back to the GP on the 11th and the new pdoc at on the 11th. I don't know if I am going to go to the new pdoc, I might just cancel.


----------



## Caedmon (Dec 14, 2003)

I have recently read that it is okay to combine carbamazepine (Tegretol) with MAOIs. Edit, edit, snip snip.


----------



## Caedmon (Dec 14, 2003)

Well, I get to go up on Parnate in two-week steps. 40mg, then 50mg. I'd have liked to move faster than that but I guess it's probably just as well go go slow - no reason to take more than I need. 

Weirdly, he gave me some EMSAM samples so I could look at those in case I want to try that next if Parnate doesn't work. I've got 5 of the 6mg patches sitting on my desk right now. I'll try one on one of these days and let you know how it feels. (I'll have to take it off right after though, because you can't really take it with Parnate.)

Well okay, let's give this next step a go!


----------



## Caedmon (Dec 14, 2003)

Wow. 40mg is cool, I've been on that for two days now. It's starting to really work. Kind of "spotty" - it comes and goes - but _I felt undepressed in a way I haven't felt since I was a kid_. I felt a sort of calm motivation, sociability, and sense of well-being that is nearly miraculous.

It's not placebo. It's not, "hmm I believe I notice a slight improvement." It's like, "I! Am! In! Remission!". Like I say, it was spotty, it'd come for about an hour and then leave again. I think it's a good sign of things to come however.


----------



## nickguy (Feb 14, 2006)

that's awesome. I know from reading your posts that you've tried a lot of meds and I'm glad that one is finally helping.


----------



## PBNC (Mar 4, 2006)

Wow, Caedmon, that is so great to hear. Wait until that feeling is 24/7!


----------



## Caedmon (Dec 14, 2003)

Today was a great day. 

It doesn't even feel like a drug. It's a completely non-chemical-seeming improvement. It's also completely unmistakably _whole_... Almost as if I were suddenly waking from a life-long nightmare of anxiety and depression, nothing more. And realizing it was all just a dream.

My only side effect is that tendency towards afternoon naps. This is dissipating at the higher dose, I've noticed. Also, my binge eating is going down and so is my appetite (these are good things). My pants are beginning to feel looser round the waist; my lovehandles don't pinch quite as much. My ADD symptoms persist in the afternoon concomitant with the sleepiness (obviously!). It's actually gone in the mornings. My guess is that with time and a higher dose the afternoon ADD/narcolepsy stuff will also clear up.

Good grief WHY didn't I just go on Parnate earlier?!


----------



## PBNC (Mar 4, 2006)

Wow, Caedmon, this is inspiring to read. I am so happy you're feeling better and have possibly found that magic bullet.


----------



## apprentice1 (Feb 9, 2005)

I have been away on vacation, so am slowly catching up. When do you take your doses, Chris?


----------



## Caedmon (Dec 14, 2003)

Welcome back! I take 10mg of tranylcypromine in the morning (first wake up), ~ noon, ~ 4 p.m., and at night. So, they're all spread out. 

I should try some different patterns to see if I get less of that afternoon nap phenomenon. Insomnia has not been a problem.

New side effect that I'm noticing: heart palpitations. Very mild, occurring at night when I'm laying down. They usually go away if I just lay on my right side. It's independent of any blood pressure or heart rate changes (I've checked). My guess is that it's something to do with the fact that tranylcyp. lowers my blood pressure.

I've had more depression/anxiety yesterday and today than I did during the week. I think this is because I'm trying to quit caffeine. I drink too much, and it's really not preventing the naps, but it does pose a potential interaction in high quantities. So I'm going to take a vacation from it. As a result, I feel pretty sluggish today. :troll


----------



## apprentice1 (Feb 9, 2005)

I was interested in what you know about a 'maintenance dose' of going back to 10mg. only per day. I have my next pdoc appt. this week, so will talk to him. I have done my own experimenting, taking it when I feel like I need it and not taking it when I don't, but then, always the one-a-day at least thing. Also no more than 5-6 tablets a day... I can't say what is best just now, but I think I am going to go back to a more regular dosing plan. You take one at night?! My instructions are to not take it after three in the afternoon in order to prevent sleep problems. I have taken it at 4pm,6pm and did have trouble sleeping without a sleeping tablet.


----------



## Caedmon (Dec 14, 2003)

I don't find it activating at all! I really thought I would, but I don't. I fall asleep very easily.

I believe the current line of thinking with antidepressants is to continue taking the dose that facilitated remission of symptoms. It used to be, you'd take it at a regular dose for a while and then reduce to a "maintenence dose", but I think that this is no longer accepted. Of course it's always possible that some people end up doing well with this type of dosing. I *do* know that, regardless of whether you end up trying a maintenence dose, one is supposed to stay at the initial therapeutic dose for at least 12 months. (Unless other things happen of course, like toxicity or the med stops working.)

My latest thinking is that it's best to evaluate MAOIs in at least 2-week dose intervals. Slowly increase the dose until you get to remission. I think it's a good idea to try the Goldberg Depression Scale and/or the Leibowitz Social Anxiety Scale at the end of every two weeks and use that to help figure out how much response you're getting.


----------



## apprentice1 (Feb 9, 2005)

Interesting! I find a 'build-up' effect throughout the day to a point where it will keep me buzzing for about six hours without taking any in the evening, but by then I am so awake I can't sleep. (That's doing the 6a.m., 11a.m., 1p.m. 3p.m., 6p.m., routine). That works good on week-ends when I have to work and still want to do something besides go to the 'safe place' for the rest of the time. But day after day it is too much. I just haven't found the right timing/dosage yet for a daily routine. I will keep trying. The side effects are lessening more all the time..ie; dry mouth, sweating, metallic taste...and the bennies are so far too good to stop taking it. On vacation, I noticed that sometimes, it was my avoidant personality behaviors and not my social anxiety that were an issue. Sometimes I just WANT to be left alone.


----------



## Caedmon (Dec 14, 2003)

I have been reading about MAOI withdrawals, especially from tranylcypromine. Some of the stories about Parnate withdrawal remind me of horror stories about Effexor.

Here are two letters in the J Psychiatry Neurosci. 1994 November; 19(5): 382-384. The reply concerns both Parnate and Nardil. I would encourage anyone interested in MAOIs to read them.


----------



## apprentice1 (Feb 9, 2005)

So, I just came back from the pdoc. Hmmm. Not too much luck. My sleeping problems are not bad enough to warrant Provigil and even though we agreed that I would have to drastically reduce my xanax if I could have gotten it, which I said I already had...also two other things he said were in the way. One is that it increases the risk of (here we go again) addiction to Parnate, and or Alprazolam, and as a professional he couldn't justify it because Provigil is suppossed to be bad for Ängste...so, I left with my usual Tranylcypromine and Alpralozam 1,mg. (100 tablets which brings my stash up to 160..) and 180 tablets of Tranylcypromine. Maybe next time he will be more willing. Oh, yeah, I told him I was up to taking 4-5 tablets of Tranycylpromine and he said that was too much and I shoulc bring it back down to 3 a day because of the 'addiction' issues....


----------



## Caedmon (Dec 14, 2003)

I got my first cold on Parnate. I was doing tremendous, and my depression was really receeding. Now I just feel feverish and awful! I have been taking 10mg loratidine twice a day as well as 4mg chlorpheniramine a few times a day. For the aches and pains, acetominophen + ibuprofen. I do have nasal congestion, and I've been trying out saline spray (which does nothing!) and l-methamphetamine [Vick's inhalers] (which is marginally helpful). I am also sucking down lemon totties and cough drops like there is no tomorrow. I have a doc's appointment tomorrow so I'll see if I should get a steroid nasal spray. So far it's really not been that hard to deal with compared to prior colds/flus, it's just tricky dealing with the short-term nasal congestion.

I've reduced the amount of fish oil I'm consuming to see if that helps my heart palpitations; I'm also on very little or no caffeine. The two things in concert seem to be helping. Going off caffeine was rough. I've had a rough week; I had caffeine withdrawals for a few days and then a cold. Next week should be better.

I can relate to what apprentice said, I still feel introverted. Despite feeling more relaxed, calm, and confident, I still _prefer _many solitary pursuits. I doubt there is a pill that is going to magically change my personality!


----------



## jealibeanz (Oct 1, 2005)

Ask for Flonase. It's amazing for my allergies and congestion. I've used it for 7 years. It's much better than Nasonex or and OTC spray.


----------



## apprentice1 (Feb 9, 2005)

Sorry to hear your are sick, Chris. Gute Besserung! (get well, soon!, in german). I bet you miss the nasal sprays we are not suppossed to use. It is pollen season here and I woke up with a stuffed up nose and almost hit the (what is it called?) Afrin or something that I bought in the states last time I was there. I guess that's what we're not suppossed to use, or? I just looked and can't find it, anyway to see what is in it, so will do without, anyway. I wanted to ask your opinion, I have done some checking, not quite enough yet, maybe, but everything I find so far says that I can take Trazadone with Parnate. I wonder though why I had to 'wash out' from it before I started my Parnate. Granted, it was a short wash-out period, but still, why? Any comments? I found my left-overs here and may well try it out this afternoon. My pdoc is on vacation so I can't ask there.


----------



## UltraShy (Nov 8, 2003)

jealibeanz said:


> Ask for Flonase. It's amazing for my allergies and congestion. I've used it for 7 years.


I've been using Flonase daily for a few years myself. I'd rate it as marginal. Better than nothing, but hardly impressive IMO. It helps some with congestion. Allergies don't bother me unless I'm around cats or doing something that stirs up a lot of dust. I seem to have non-allergic vasomotor rhinitis, or fancy way of saying I'm stuffed and runny but not due to allergies.

Flonase does zip to stop the endless flow of snot. For that I use ipratropium (Atrovent) nasal spray. That's probably the only drug that really does it's job and does it well. It really stops the snot.

Flonase recently went generic, so I'll do a dance of joy as executives at GSK cry.

I sometimes use pseudoephedrine, which you are now treated like a criminal when you dare to purchase. Of course, you know that's on the forbidden list when you're on any MAOI.


----------



## Caedmon (Dec 14, 2003)

Rather than raise my Parnate dose to 50mg like I had planned, I will stay at 40mg to wait out some of the side effects. Instead, to help with depression and inattentiveness, I have decided to add L-tyrosine to promote dopamine. I am surprised I didn't think of this earlier. This is a very effective, cheap therapy for MAOIs given how they work, although it should really be done slowly and in a specific manner to avoid acute hypertension. Specifically, tyrosine taken in the morning is best, starting with lowest doses. L-tyrosine converts to NE and DA, and with less MAO to break those down, the neurotransmitters stick around longer. My understanding is that amino acids in conjuction with MAOIs are exponentially more potent than when they are added to reputake inhibitors.

Well I got back from the reg. doctor. I had him check out my arrythmias and got input on my cold management. My heart is fine, he listened and ordered an EKG which were normal. Also labs for TSH, basic metabolic panel (electrolytes), and magnesium. This was all just to rule things out, which is good because that's precisely what I was hoping for. At this point it just appears to be a side effect of the Parnate. 

For the cold, I asked about a steroid nasal spray but he said it would probably not be that helpful, since it tends to work more on inflammation than mucous congestion. He suggested OTC guafenisen. I have been taking that, it does make it easier to blow my nose but not necessarily clearer. Anyway it's day 3 of my cold, and the aches and grogginess are clearing up so it would appear that it's possible to survive a cold and still take an MAOI. I may have to look at getting on intranasal fluticasone this summer when my allergies are at their worst.

The doc didn't know what Parnate was, which I can't say was too surprising, I told him it was an MAOI and he underlined those letters about 4 times on his notepad. He asked a pharmacist about the possible interaction between oxymetazoline (in Afrin nasal spray) and MAOIs, although I already had read up on it. So I can't say he was that helpful for my cold symptoms, but the guafenisen was probably a helpful idea. 

I suppose if there is one thing that is frustrating about MAOIs, it is the considerable amount of ignorance and paranoia - probably understandable to some extent - among medical professionals regarding these medications. We have benzophobia, opiophobia, etc. We need a name for MAOIs. MAOIphobia? It doesn't have the same cachet. Ideas people?!

Edit: I don't know if tyrosine is a DA agonist or not. That is what I wrote before but I think it merely can increase DA reserves, I don't know if it affects anything else. I got confused because I thought L-Dopa was a DA agonist but I don't believe it is. Mea culpa.


----------



## apprentice1 (Feb 9, 2005)

goood idea, but MAOIphobia? They might think we are talking chinese revolution....I, too, am astounded at what you hear from one doc to the next. I have gotten to a stage where I can easily take Parnate, 5-6 times one day, and just one or two the next. sometimes two at a time and then still go to sleep. the buzz is gone, but the S/A improvement at the higer dose is definitely noticeable...and way cool. I can see how space boy was up to 90mg. on Nardil. The side effects go away, leaving me feeling more 'normal' than I ever have. Now it is the same problem...convincing the new pdoc that all this makes sense, that I don't need to take so much xanax all the time, etc., but can use the up and down dosing with parnate effectively.


----------



## Nae (Nov 10, 2003)

> I suppose if there is one thing that is frustrating about MAOIs, it is the considerable amount of ignorance and paranoia - probably understandable to some extent - among medical professionals regarding these medications. We have benzophobia, opiophobia, etc. We need a name for MAOIs. MAOIphobia? It doesn't have the same cachet. Ideas people?!


What should happen is group the symptoms of benzophobia, opioiphobia and maoiphobia under the umbrella of Clueless Doctor Syndrome

thanks to Ultrashy, I believe it was, for the phrase "clueless doctor"


----------



## Caedmon (Dec 14, 2003)

:lol @ chinese ideology and clueless doctors.


----------



## apprentice1 (Feb 9, 2005)

Clueless Doctor Syndrome CDS ! love it! I should add that to my list of problems.


----------



## apprentice1 (Feb 9, 2005)

Chris wrote, "I have decided to add L-tyrosine as a dopamine agonist. I am surprised I didn't think of this earlier. This is a very effective, cheap therapy for MAOIs given how they work, although it should really be done slowly and in a specific manner to avoid acute hypertension. Specifically, tyrosine taken in the morning is best, starting with lowest doses. L-tyrosine converts to NE and DA, and with less MAO to break those down, the neurotransmitters stick around longer. My understanding is that amino acids in conjuction with MAOIs are exponentially more potent than when they are added to reputake inhibitors. "

Okay, doc Caedmon, no idea what you were saying here but, as usual coming from you, it sounds good and I shall start researching tyrosine and see if I can figure out on my own what the heck you are talking about! (I need things that six year olds can understand...)regards, comrade, MAO the lab rat.


----------



## Caedmon (Dec 14, 2003)

Sorry. Tyrosine is the precursor to norepinephrine and dopamine. (Skipping over some stuff.) MAOIs keep you from "losing" neurotransmitters, amino acids plump up the supply chain to make them.


----------



## apprentice1 (Feb 9, 2005)

Any evidence that it is or is not compatable with Parmate? This is something you don't need a prescription for, right? It sounds good, have you already started? cold all gone?


----------



## workman (Mar 5, 2004)

Does Tyrosine make more NE or just DA? you kind of confused me? I think more NE would just raise my anxiety, but I'm always up for more DA.

I'm using nasal spray for sinuses. oxymetazoline is in it. probably contradicted, but hasn't killed me yet. I should probably watch out for contradictions more, but I just try things and if nothing happens I figure it is fine. Not smart on my part.


----------



## Caedmon (Dec 14, 2003)

Yeah I just started the tyrosine. Actually I'm gonna go every other day for now, it's very stimulating. You can buy it OTC at least here, it's a supplement.

Tyrosine is officially contraindicated with an MAOI on a lot of lists I've read. The tricky thing is that everyone consumes tyrosine, it's not contraindicated on MAOIs as part of your diet. I can find basically no studies on tyrosine interactions with MAOIs. I think the idea is that tyrosine has the potential to convert to tyramine in people with insufficient stomach acid production - which, if so, can cause hypertension. So it may depend on that. I would say to be very careful. I have excess acidity, barely controlled with famotidine, so I'm less worried but still being cautious. I am taking 500mg, and it is very stimulating, but my blood pressure is unchanged. (Check that BP!)



workman said:


> Does Tyrosine make more NE or just DA? you kind of confused me? I think more NE would just raise my anxiety, but I'm always up for more DA.


It does both as far as I know. But I think it primarily converts to L-Dopa which converts to DA. I don't know, it's hard to separate the two because when you raise one you often raise the other.



> oxymetazoline is in it. probably contradicted, but hasn't killed me yet. I should probably watch out for contradictions more, but I just try things and if nothing happens I figure it is fine. Not smart on my part.


I used l-methamphetamine for my nasal congestion and it was fine. I think oxymetazoline is okay. Direct acting sympathomimetics are usually okay, not much gets into the bloodstream. I guess you should be careful though to use it sparingly in case some is. The thing to really avoid is of course pseudoephedrine or ephedrine, both of which are quite dangerous. P.S. my cold is mostly gone. I found that menthol cough drops worked better than anything.

Do you have chronic sinus problems? If so I would get on a steroid spray, it's completely safe and you'd never have to worry about using it.


----------



## Caedmon (Dec 14, 2003)

Well, there is no interaction between tranylcypromine and albuterol. I had a nasty cough today, just out of nowhere from my cold! I took many many (probably a dozen) puffs on my albuterol inhaler. So I could breathe, you know. It didn't affect my blood pressure hardly at all. My systolic BP went up about 5 points is all.


----------



## Caedmon (Dec 14, 2003)

Turns out, there is a handy formula for calculating Parnate dosage in most people. It's .7 mg per kg of body weight.

http://www.tu.edu/user_files/10/17.html

Those higher doses used in Tx-resistant depression probably work because of the slightly elevated MAO inhibition as well as the SNRI component. But the .7 mg/kg rule will get most people to 80% MAO inhibition.


----------



## Caedmon (Dec 14, 2003)

Parnate. 40 mg. It's been a few weeks now on this dose. I would say that, so far, it's the best medication I've ever been on for reducing my anxiety and depression.

Parnate kicks *** in a way that no other drug ever has. My Goldberg Depression Scale score is lower than it's ever been since I became severely depressed 4 years ago. It's now at a 31 and I would consider myself "mildly" depressed, primarily a result of symptoms which may actually be clinical or subclinical ADD.

My compulsions, such as trichotillomania, vocal tics, etc. Gone.

My binge eating is&#8230; gone.

Hypomania/ mixed states? Nah. None. I've never felt more stable.

Apathy? Lack of motivation? Gone. (This has been a pleasant change from SSRIs.) I care about things again. I am very motivated. I exercise regularly now. I've taken up jogging.

My addictive behaviors to too much junk food, internet, tv&#8230; going going gone. I set the timer when I'm online, and I do well. It's manageable again.

Sadness? No, not really. I get sad, but I'm not defined by sadness. Hostility? No way&#8230; I feel so much more secure in the world. I feel healthy again. I feel like people are good again. Hypersomnia? It's completely gone&#8230; I just sleep normal hours now, 7-8 per night and I'm good. When I wake up in the morning I'm ready to do something with my day!

What are its limitations? My inattentive symptoms have gotten better, but they are still there. I still feel spacey sometimes. I am still low energy, although this is lessened. I still am a completely disorganized mess. (Will that one _ever _change? Heh.) I continue to forget things. This has improved since the Parnate, but it is still around. However, I'm not bored anymore.

What else? It's very anxiolytic. I feel less anxious on Parnate than I do on alcohol. But, I'm still me, which means I'm still shy and introverted, still pensive, still have the same body which gives me insecurities (even if I'm losing weight), still have the same life "issues" which no pill is going to magically cure. My LSAS continues to hover around the pathological range (71 last time, which is "marked social phobia"). It is mostly that high because of avoidance. I have very little "fear" at all. I believe my avoidance is part of old patterns and general introversion at this point. I don't think anything is going to change my ingrained personality. I'm not sure it's really healthy to pursue such a drug anyway.

I had a cold recently, and I felt crummy. I felt crummy because I had a cold! I thought I had lost some response, but I didn't. I had a cold. If you feel stuffed up, achy, tired, and you're coughing, you tend to feel worse. It's normal. BTW it was well-managed despite the drug interactions.

Side effects? Well, I get tired in the afternoons, and often take a nap. I had some issues with heart palpitations but this has subsided with the addition of an antihistamine at night (chlorpheniramine). Medications are potentiated. (Ambien now knocks me out, and I could take as little as 2.5-5mg of Valium in the a.m. on difficult days and be good for the day. I've reduced my Topamax to 75 mg as a result of all this.)

My next step? Probably a dose increase. I haven't noticed a relationship between dose and side effects, and for my body weight, 60 mg is probably closest to the ideal 80% MAO inhibition. A higher dose will allow more wiggle room for Parnate to close the gaps around remaining symptoms, reduce anxiety and depression more, and possibly help out more with those ADD symptoms. If, at that time, I still need something else, then I will look into it. The tiredness is quite tolerable now, and is no worse than the normal "it's a Sunday afternoon, time for a nap" -sort of reaction. Two thumbs up.


----------



## Caedmon (Dec 14, 2003)

P.S. my inattentiveness _has_ gone down, just not as much as I was hoping. I wanted to clarify that.

P.P.S. 500mg tyrosine has no appreciable effects. On this either.


----------



## seattleguy35 (Dec 14, 2005)

Chris,

wow... sounds like Parnate has been the BEST medication for you so far......Congratulations!!!

SeattleGuy35


----------



## Caedmon (Dec 14, 2003)

Thanks!  I am pretty pleased with how things are evolving.

BTW for fellow MAOers (lol, like we're Chinese ideologists) I looked into oxymetazoline. It doesn't look like it's been systematically studied, but it also doesn't look like very much (if any) of it is absorbed into the bloodstream from intranasal application. It is recommended as a decongestant in pregnancy as a result. If you're on an MAOI and taking it, I would be cautious and use low doses just in case. My doctor recommended against it "just in case" but I felt okay trying it under controlled circumstances with 10mg nifedipine at my side.

I tried it. Just one spray of oxymetazoline (generic version of Afrin nasal spray - $2 at my local pharmacy) into each nostril, worked like a charm for my congestion. I checked my blood pressure before and after and there was no change in that or in my heart rate. So, sniff sniff! :yay Actually I can't believe I've never used it before, I always used pseudoephedrine or ephedrine, but this stuff works better for me with no side effects.


----------



## Redefine (Jan 11, 2005)

yea, afrin is great but don't use for more than three days straight or the congestion will come back alot worse than before.


----------



## GraceLikeRain (Nov 9, 2003)

seattleguy35 said:


> wow... sounds like Parnate has been the BEST medication for you so far......Congratulations!!!


 :agree :squeeze


----------



## Caedmon (Dec 14, 2003)

It's nice not to feel like crap.


----------



## apprentice1 (Feb 9, 2005)

I am so happy for you, boss!


----------



## UltraShy (Nov 8, 2003)

drive-to-the-hoop said:


> yea, afrin is great but don't use for more than three days straight or the congestion will come back alot worse than before.


 :agree Oxymetazoline is the ultimate in rapid action and efficacy. It will get you very unstuffed within 5 minutes. Only problem: rebound congestion from hell.

I've probably used more of this stuff in my life than almost anybody on this board. I used it on a daily basis for something like 8 years, because nothing else really solved my congestion problem.

I stopped several years ago and you end up with your nose totally plugged for about a week or more after it. Hold your nose shut with your fingers and you get an idea of what I mean.

Flonsase works to some extent. Psuedoephedrine works a bit too I guess. Neither is very impressive even when I use both at the same time, but it seems to be as good as one can get. At least it avoids the rebound congestion problem.


----------



## workman (Mar 5, 2004)

If you want something great for opening up your sinuses(and pretty much all your airways) you can get ephedrine from a store like CVS. I think it is called bronkaid or something. It is over the counter for asthma. It opens up everything. It feels completely different when you breath. It is a strong stimulant, though. So you get all those side effects. And, of course, you can't take it while on an maoi.


----------



## Redefine (Jan 11, 2005)

Sometimes I use Breathe-right strips. They fit around your nose and open the nasal passages. A lot of times you see football players wearing them. They work pretty well, especially when you have a cold or sinus infection. 

Of course it would probably be weird walking around with a strip on your nose during the daytime, so I use them at night when I go to bed.


----------



## Caedmon (Dec 14, 2003)

WOW! Yesterday and the day before have been weird. Something is changing - the sedation is giving way to _intense _energy and focus. Yesterday I literally felt like I was on speed. No joke. I spent 7 hours after work designing mood charts. Then I cleaned the whole frickin' living room. I wasn't more anxious - if anything, less so - but I was a LOT less anergic/ unmotivated. There have been no med changes or significant variations in sleep or diet to explain it. (Amazingly, I still took my afternoon nap.) I'm just trying to figure out who is slipping Ritalin into my pill organizer!

:hyper


----------



## korey (Apr 25, 2006)

Congratulations on your success, Caedmon! :hs :squeeze


----------



## SpringViolet (Oct 23, 2005)

Man, it's good to see you having some success! I hope the hyperness is transient and you settle in at a good energy level.


----------



## ZeitGuest (May 17, 2006)

*Caedmon: Parnate update?*

Caedmon,

How is the Parnate trial coming along? I haven't seen a post from you on your progress in a while. Are you still getting beneficial effects? Has Parnate knocked down your social anxiety? Any negative side effects, such as weight gain or sexual dysfunction?

I've been on Emsam now for nearly six weeks, and it just isn't working for my atypical depression and social anxiety. So, I'm considering switching over to either Nardil or Parnate. Nardil's GABA-boosting quality makes it my first choice, but I'm curious to hear more about your Parnate trial....

I hope it's still working for you.

Thanks for any info you can share!


----------



## apprentice1 (Feb 9, 2005)

Hi, Zeit Guest. encouraging to see interest...are you trying meds for the first time? It would be nice to hear a bit about who you are, etc.


----------



## ZeitGuest (May 17, 2006)

apprentice1 said:


> Hi, Zeit Guest. encouraging to see interest...are you trying meds for the first time? It would be nice to hear a bit about who you are, etc.


Apprentice1,

This is my first encounter with an MAOI, but I've been an unhappy rider of the SSRI/SNRI train for nearly a decade.

Well, not entirely unhappy. I got a big bang from Prozac (my first head med) when I first started on it. It took about five weeks to kick in, and only did so after I upped the dose from 20mg/day to 40mg/day. It really worked well for my atypical depression and social anxiety. I daresay it made me something close to outgoing -- for the year and a half that it worked. After that it began to be less effective, and eventually petered out. Speaking of petering out, my only complaint against Prozac while it was working was that it really dampened my libido and saddled me with anorgasmia. I tried all the usual augmentation tricks (Wellbutrin, amantadine, buspar, and others that I can no longer recall), but nothing reversed that side effect. Initially, I found the Prozac activating and I lost a lot weight on it. Later, I felt that it was making me gain weight. Insomnia was always an issue on the higher dose, but it was worth it while the med was working to reverse my depression and extreme shyness.

Over the years, I've tried various other SSRIs -- Paxil, Zoloft, and Lexapro -- but they were either too sedating or just didn't work like Prozac Year 1. I've also tried assorted other meds, including serzone and donepezil, but found them to be of no use, and worse, side-effect-filled. Provigil has been a bit more helpful, but only as a means of giving me a slight energy boost (and therefore a slightly easier time of socializing) when on sedating meds.

I've been on Emsam now (smallest patch) for 39 days, and so far it has only made me more irritable. I haven't felt any mood elevation, depression leavening, or social anxiety relief whatsoever. I think six weeks is a long enough trial, and now I'm casting about for the next med candidate.

I'm to see my Pdoc in a few days, and maybe I'll ask about augmenting the emsam with something else. Klonopin is a possibility (although my pdoc is reluctant to prescribe it), but I am worried about the sedating effect and the mental cloudiness, which is precisely what i do NOT want in a social anxiety treatmet. My goal is to become more sociable and assertive (as I was on Prozac early on), not to become a contented wallflower -- and I am afraid that when people speak of Klonopin as social anxiety treatment, the are really talking about merely eliminating the fear response, rather than becoming active, assertive participants capable of successfully engaging in the back and forth of social communication.

I may attempt to increase the dose of Emsam, but while lurking here and over at the Psychobabble BBS, I haven't seen any instances of Emsam early adopters getting a substantially better result after upping the dose.

OK this has been a real windy introduction, but that's my story and unfortunately for now I'm stickin' to it.

If any of you out there in SAS-land have advice for me, I'm very eager to receive it.


----------



## Caedmon (Dec 14, 2003)

*Re: Caedmon: Parnate update?*

Parnate's been good to me. I'm still on 40mg. I probably won't go any higher for some time, due to some concern of arrhythmias and the fact that it's done quite a lot as it is. I'll keep trying some other things for my depression like my running program, some supplements, CBT, etc. P.S. ginkgo biloba does not go well with this medication! (for me). P.P.S. I have motivation/ energy to go running again! 

By far, it's the best antidepressant I've taken. By far.

My social phobia is still there, I guess. I sort of have good days and bad days. I have less problems with it than I've ever had before... but I still feel "shy". There isn't much to say there, as I am not really _nervous_ anymore, but I do lack confidence, which I'm finally in a position to start to gain. In a way it is encouraging that I have not gone slingshot into hypomania and a social butterfly... it wouldn't last, probably not for me anyway.

My most significant side effect was the sinus arrhythmia. It was almost entirely likely to be an interaction between Parnate and caffeine. I stopped the caffeine (ironically it wasn't helping anyway) and now I'm fine. In other words, it's mainly gone. (Technically speaking, if I lay flat on my back and pay attention, I can feel my heartbeat. Does that count as a side effect?) No sexual dysfunction, no weight gain, I eat less than in the past, I exercise better, I feel healthier, etc.

I also felt tired in afternoons... this too is subsiding with time. I have times in the afternoon when I'd like a nap, and usually I can take it or leave it. It helps a lot if I can get regular sleep, e.g. 7-9 hours per night. The sleep meds and good sleep hygeine are helpful to minimize this.

It's been such a good medication for the "brain fog" that had settled in. I was so tremendously worried for a while about some kind of neurological impairment, tumors (seriously!), or just undiagnosed ADD. Perhaps it's because of dopamine release, but with Parnate on board I don't have any brain fog. I feel so much more able to _think _now, and it's wonderful. I have tons more energy, more initiative, finally I'm enjoying things. It's a nice change!

All of my graphs have been trending down and I'm optimistic this will continue, as I work on more cognitive and behavioral techniques and keep getting myself healthier overall.

I really wasn't at all sure what med changes to make, if any. I met with Dr. C today and we're adding gabapentin to augment the Parnate. I've read a couple of accounts that it goes well with Parnate. It might help me sleep and do something with anxiety/ inhibition. Another reason it was on my list of "things to ask about" was the nerve-ending analgesia could help my dermatotillomania. There may be mood-stabilizing properties as well. So now I'm on:

Parnate 40mg
Topamax 75mg 
Valium ~5-10mg (past 2 weeks averaging 4.1 mg per day)
Neurontin 300 -->900mg


----------



## Caedmon (Dec 14, 2003)

You could certainly give Nardil a try. Nardil wasn't my first choice, the weight gain and liver toxicity from Nardil and Marplan still freak me out. I will save those honors for a possible Depakote trial. :lol


----------



## seattleguy35 (Dec 14, 2005)

*Re: Caedmon: Parnate update?*

Caedmon,

Congratulations on your getting better with Parnate!!

I have few questions....

1) Do you feel that your anxiety is now in remission? I ask because is that POSSIBLE having remission after taking an Antidepressant or MAOI?

My doctor (he takes Cymbalta) said that his anxiety is in remission....my friend also said that his anxiety/depression is in remission.... To be honest, I find that very hard to believe perhaps in part because I haven't had any remission of anxiety since I was 15...

One of the biggest issues (I'm sure that others have been through that).... I have been so anxious for so long and so many years and when I'm taking antidepressant, all of sudden my anxiety level goes down significantly... that made me feel "weird" because it's not a state that I'm familiar with... being less anxious...

Do you and others feel the same thing?

Seattleguy35


----------



## Caedmon (Dec 14, 2003)

If I take the Liebowitz Social Anxiety Scale then I will still score in the range for "moderate social anxiety". Most of it is avoidance. I am just not used to talking to strangers, going to parties, etc. It's not really what I am used to. Part of it too is that I do not have opportunities for everything right now - it takes time to make social connections and so on. So it has some limitations as far as how well it measures things. To a great extent I now need to work on goal-setting and exposure therapy.

If I take other psychiatric scales used to measure anxiety, I don't score as clinically anxious anymore. So, anxiety is in remission. It's just that my social life is still kind of "budding", shall we say. :lol

I do think it's weird not to feel anxious. I first noticed this with Lexapro, which I felt was my best SSRI for anxiety. It was like, "I feel so much better! I'm still not going to talk to anybody!" LOL. Some of my motivation to interact was due to fear of looking like a dunce. I don't know if that's in line with what you're talking about, but it was just something I experienced.

I believe remission is always possible.


----------



## ZeitGuest (May 17, 2006)

Thanks for the update on your Parnate trial, Caedmon. I think that before I take the Nardil plunge, I'll try adding Klonopin to my Emsam regime, and also upping my Emsam dose in an effort to get some MAO-A action going.


----------



## Caedmon (Dec 14, 2003)

Oh yeah, I could post this here!:

I eat cheese if it is mozzarella, parmesan, american/ "processed", cream cheese, or sour cream. I haven't tried Swiss yet but I suspect it is also okay. There are a bunch of other types of cheese out there but I rarely encounter them, as an American, so I just refrain from mystery cheese. Cheddar is just a no-no for me, I've given it up.


----------



## Caedmon (Dec 14, 2003)

This weekend I need to try nifedipine and see how it affects me. I never did get a chance to do that. My BP went low for a while just from Parnate, but it's back to normal now.

I went to the regular doc yesterday and got weighed like a cow at the state fair, like they always do. I've lost 5 pounds on Parnate. :yay


----------



## incubusfan (May 13, 2006)

Caedmon said:


> This weekend I need to try nifedipine and see how it affects me. I never did get a chance to do that. My BP went low for a while just from Parnate, but it's back to normal now.
> 
> I went to the regular doc yesterday and got weighed like a cow at the state fair, like they always do. I've lost 5 pounds on Parnate. :yay


Good news! I'm afraid of Nardil because of the weight gain. I porked up 50 pounds when I took Paxil, a little less on Zoloft. EMSAM caused me to shed a few pounds. I don't need to lose any weight(I'm 5'11", 147 pounds, and I've been lifting weights for a year and running for almost 2 years), but I'm just paranoid about gaining weight again.

Hopefully the Parnate doesn't affect my weight at all. My pdoc also prescribed nifedipine for me in case of a hypertensive crisis. I'm still waiting till next week before I start the Parnate. I plan on testing some of the taboo foods, mostly pizza to see if it gives me a reaction. I don't drink, and I don't eat aged meats, so I shouldn't have to alter my diet much at all.


----------



## nickguy (Feb 14, 2006)

do you drink caedmon? For me, giving up beer would blow. Drinking is a fun part of my life. I wouldn't care about giving up tap beers, but my doctor said you can't drink any at all.


----------



## seattleguy35 (Dec 14, 2005)

Nickguy,

In theory, all people who are taking ADs shouldn't be drinking because taking AD and drinking at the same time is doubly hard on the liver for it to be processing.

However, lot of people can drink while on they are on ADs as long as the taking of AD medication and drinking are hours apart. That's what my pharmacist said. 

Wellbutrin users are the ones that should avoid alcohol the most because of the risk it can cause seizures. Other ADs aren't bad as long as it is done in moderation. 

I drink 3 beers only once a month and that's all on same day.... 

Correct me if I'm wrong guys? Any thoughts?

SeattleGuy35


----------



## Caedmon (Dec 14, 2003)

nickguy said:


> do you drink caedmon? For me, giving up beer would blow. Drinking is a fun part of my life. I wouldn't care about giving up tap beers, but my doctor said you can't drink any at all.


Tap beer is discouraged. Other beer is fine in moderation.

~~~
J Clin Psychiatry. 1996 Mar;57(3):99-104.

The making of a user friendly MAOI diet.

Gardner DM, Shulman KI, Walker SE, Tailor SA.

Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

BACKGROUND: Many monoamine oxidase inhibitor (MAOI) diets are considered to be excessively restrictive and founded on poor scientific evidence. We present a safe and practical MAOI diet based on the related clinical and analytic data. METHOD: We used a critical review of the literature and our own tyramine assay results to categorize foods to be restricted absolutely, taken in moderation only, or unrestricted. RESULTS: We recommend that users avoid aged cheese; aged or cured meats (e.g., air-dried sausage); any potentially spoiled meat, poultry, or fish; broad (fava) bean pods; Marmite concentrated yeast extract; sauerkraut; soy sauce and soy bean condiments; and tap beer. *Wine and domestic bottled or canned beer are considered safe when consumed in moderation.* Other foods not mentioned are considered unrestricted. CONCLUSION: The concerns about perpetuating an overly restrictive MAOI diet include the avoidance by prescribers of a potentially useful treatment option, excessive limitations on lifestyle for patients, and increased risk to patients secondary to noncompliance with the diet. We propose an MAOI diet that has a solid scientific and clinical basis and that is, above all, practical.

PMID: 8617704


----------



## nickguy (Feb 14, 2006)

Thanks. Still, not very encouraging for me because ocassionally I like to drink in large amounts. I'm on desipramine right now, I'll see how it works out. If it doesn't, than giving up binge drinking won't be that big of a deal weighed against any anti-depressant gains.


----------



## apprentice1 (Feb 9, 2005)

Hi, Caedmon, just wondering if you are still at the 4 level with Parnate. It seems to be a good number. I was having trouble taking one so often durning the day and have gone to taking two in the morning with 1mg. xanax and later in the day, around one o'clock two more with a second xanax and at the moment, that works really well with me. Sometimes I do a third round if needed...
I must admit though, I find paradoxes with Parnate. I feel well enough to do something like get out and ride my bike to work in the morning...(it takes about an hour, so good exercise suggested by my med doc,) but after a couple of times, I had a major panic attack in rush hour traffic and just stopped my bike, got off, was totally confused, didn't know where I was, cars were not coming forward and normal anymore but like from an elevated level and toward me. (I was safe on the bike path.) People were bigger than life and noise unbearable. I reached for my xanax and took one or two, I don't know which and began to calm down a little. I walked my bike to the subway down a quiet street but couldn't get myself to go down into the subway, either. I called in sick to work, walked my bike all the way back home, taking another xanax along the way, and went to 'the safe place'. I haven't tried that again since. I don't have trouble riding my bike for fun and pleasure, but in rush hour traffic to get to work on time was just 'way' too much for me. Too much, too fast. But overall, this seems to be the best combination I can find. By the way, the combination I am talking about is since the panic attack. I had started lowering the dosages of xanax because I felt I didn't need it...back on it, now.!


----------



## Caedmon (Dec 14, 2003)

Yep I'm still on 10 mg four times a day. Yours is a good dosing pattern though, my pdoc suggested 2 pills twice a day in fact.

I want to try Parnate at 50 or 60 mg, eventually maybe, but I'm trying gabapentin right now instead. Which, is, okay. It definitely helps take the edge off anxiety and depression, and it's been good at keeping my sleep-wake cycles more regular. It makes me a bit uncoordinated though. I walked into a lamp yesterday morning. <thud> I don't think the 900 is quite enough, I will probably try 1200.

P. S. just in time, because I've started a holiday off of Valium. I'm 4 days in, with no trouble.

I went down, and then up, on my fish oil dose. Now I'm settling in at 2700 mg. I think I responded better at about 2100 though. We'll see.


----------



## apprentice1 (Feb 9, 2005)

Caedmon said:


> Yep I'm still on 10 mg four times a day. Yours is a good dosing pattern though, my pdoc suggested 2 pills twice a day in fact.
> 
> I want to try Parnate at 50 or 60 mg, eventually maybe, but I'm trying gabapentin right now instead. Which, is, okay. It definitely helps take the edge off anxiety and depression, and it's been good at keeping my sleep-wake cycles more regular. It makes me a bit uncoordinated though. I walked into a lamp yesterday morning. <thud> I don't think the 900 is quite enough, I will probably try 1200.
> 
> ...


What is gabapentin????? I just never took enough Benzo/xanax because of the fear of 'addiction'. Even when my doc prescribed it in larger doses, I kept it down. Wrong decision. I just need to get over the sleepy part and understand that takes some time.

A wierd thing. I take my Parnate during the day and it helps me stay awake. Then it wears off and then, without taking more, it comes back around bedtime and keeps me awake and hyper. I would like to drop the sleeping pill, instead it has increased...I am thinking about taking one at bedtime with half a sleeper which will put me asleep, and maybe as long as the Parnate needs to work I can sleep and wake up more clear-headed and energetic...right now it takes me about two hours to get ready to head out to work and that is anouther hours public transportation...
I have heard using Tranylcypromide 'brings back your old self'....well, in my case and at my age, that isn't my goal...I want MORE AND BETTER.!
My last visit to the psych he just said something about 'you take what did you say the last time 50 or 60 mg.? And with no further addiction talk he gave me double prescriptions on both Jatrosom and xanax! and another visit in about 6 weeks...He knows I fool around with the dosing and respects what I say works the best. (My pharmacy asked why he was ordering two of each script and I told him my next appt. was not for a long time...!!!!!!!!!!!!!


----------



## Caedmon (Dec 14, 2003)

Hey that's great!! I'm glad you got onto the higher dosage, it's just silly to putz around with the lower dose and be only half-miserable.

Gabapentin is the generic name for Neurontin. Not sure what they would call it in Germany. It's an anticonvulsant that is sometimes used for anxiety or bipolar disorder. It has the benefit of very few side effects in most people. I read several people on another website had success with tranylcypromine + gabapentin so I thought I'd try it out myself. So far, I like it. Not as much as valium though. I'm on a "med holiday" from Valium but will try all three together later and see how that goes. 

My doc gave me samples of a new sleeping pill that is from Japan, called Rozerem. It works but it is too sedating with tranylcypromine. The whole next day all I want to do is sleep. 

From what I've read the daytime sedation will wear off over time but not the insomnia. That is just part of the MAOI game. I dont' like taking sleeping pills either, I have been taking Ambien as-needed and sometimes promethazine. It's okay that way. I love Ambien but don't want to take it constantly.

P.S. a friend of mine is in Heidelberg right now.


----------



## Nae (Nov 10, 2003)

> My doc gave me samples of a new sleeping pill that is from Japan, called Rozerem. It works but it is too sedating with tranylcypromine. The whole next day all I want to do is sleep.


Heh! While I was waiting in my doctor's office I saw a pamphlet advertising Rozerem. The front cover consisted of just this:

*ZERO*
Evidence of abuse or dependence in clinical studies. 
Now, that's a good night's sleep.

Then, inside the booklet point #5 Explains how the DEA closely regulates controlled substances and how great it is that Rozerem isn't classified as one and thus doesn't suffer how & for how long it is allowed to be prescribed.

uke

Ok, Ok, with that out of the way, I am interested in how this drug works. I haven't read much of the PI sheet yet but apparently it hits the melatonin receptors.


----------



## Caedmon (Dec 14, 2003)

Rozerem feels just like a way-too-long acting version of OTC melatonin. I just want to sleep the entire next day. I am not interested in it for future use when I can take OTC stuff for a fraction of the cost!


----------



## Caedmon (Dec 14, 2003)

I am going to increase the dosage of Topamax to 100mg (beginning to get into a lessened sleep phase) and then the Parnate to 50mg (anxiety has been getting a little worse, probably my summertime fluctuation).

I haven't had any arrhythmias or daytime tiredness in a few weeks. It seems to be gone.


----------



## apprentice1 (Feb 9, 2005)

The time between 0500 and 0630 is generally the only time of the day I have to use a computer. In a couple of hours I will be at work with no contact to the outside world except the telephone...no net, no computer, no radio or television...these are the hours which determine my day, where it goes and why or why not. The rest of the day, on workdays, depends on now, the hours after I wake up. Would work function without me? (I know I can call in sick without giving any further reason...I ask myself, am I needed? Can they get along without me? Will I be okay if I go in?..... 
My update. I take 3x10mg. Parnate and 01mg. xanax now with my coffee around 0530 to 0600 hours. I take the same amount sometime in the afternoon around four o'clock and that is it. I do not at this time deviate from the dosage and schedule, as I found that trying to take less leads to disaster... It is the week-ends that I have to work so I am already in conflict with my room-mates and friends who have every week-end free and think I do, too. Living with room-mates is preferred to living totally by myself. I have my own separate two rooms where I can close myself off if I want/need to, otherwise I share the space with a business and friends and 'society' instead of living separated in a small space which makes me feel more socially-impaired and completely lonely. These are the only hours I have to myself. Me, my coffee and you. I go to work...force myself, because I know there will be social problems or situations to deal with whatever I do..unless I just stay home and hide under the covers. Everyday is a new challenge. I amaze myself that I, after all the problems my work has brought about think twice about whether they will get along without me today and let that influence whether I go in or not. I am naturally a reliable worker. I shall take a break and go take my meds now. 
0545am...Living with other people and their own problems is not easy. They are alcoholics who function quite well on a day to day basis...to the point where if they didn't drink, things would not be okay and I play along, longing for that glass of white wine at the end of the work day and the beginning of the 'social evening'...the others coming in slightly ahead of me at this time of the year (summer) where I don't come home until around 7pm...I am so happy to have people around me I am pretty much willing to keep up the drinking when offered by the 'company' at home. I have, for the most part, no will of my own to keep to myself. I feel if I do that, I am making myself appear conceited and as though I am not trying to fight my SA when my friends and acquaintances are there and want to see me...they say, and I let myself, out of need, believe them. When I 'do not have to work I am onthe computer until at least 11:00am. or so...no shower, no change of clothes... I just wanted to say here that I am finding my dose and timing adequate and correct and even though I sometimes feel I don't 'need' the xanax, I tend to take it these days on a regular basis after the panic attack I had, partly due to the fact that with the parnate, I felt I didn't need the xanax. Wrong. I do not have a health-program like jogging or anything and am putting that on the list of priorities. I need to lose weight and get back to 'normal'. I feel lonely during these hours, I have become so accustumed to sacrificing my own thoughts for the thoughts of others, to the activities of others, than when I am here, alone, while others sleep that I feel weak and compromising. I hear I need therapy that makes me believe in myself more, but when you are like me, you just don't get far enough to do that, go there. It is just easier to adjust and fit in to the ideas and thoughts of others. This is, I guess, what I mean when I talk about a drug 'working'. I basically have tried them all and find I just get back to where I started...a part-time poet, a loner, someone who is more prepared to stand up for the rights of others than for myself and as my psychologist says, in the end I don't really help anyone and I should mind my own business. I am like super-man or Under-dog (in case anyone remembers that show)...I fight against injustices for others and basically just make everyone more unhappy. I am not really depressed at this time, though it sounds like it...I have always felt this way. More from my meds I don't expect. Some people don't want to post here and make the younger members realize that many of them are not going to get better, more like maintaining the place we are in is about the best we are likely to do. Not to be negative, (of course that leads to nothing), but just to be still around at my age amazes me sometimes. Life is worth living...the colors, the friends, the experiences both positive and negative make life worth experiencing and sharing with a new generation of similar people, some of whom will give up, some who will conquer their fears and go on to live a healthy life, some who just are sometimes better, sometimes worse...I want to be one who says, "keep trying".....don't give up". We are as much a part of the universe as the confident and aggressive, the strong of mind and the movers and shakers' of our generations and centuries. Others consider us seriously in their thoughts and decisions and I for one am grateful for the friends I have that put up with me the way I am. 
This was all just to report how much meds I am taking and that I am satisfied with the results. Sorry. p.s. we worry more about having a hyper- tension attack than what I experience which is hypo-tension. I get such low blood pressure that I cannot stand up alone sometimes. I recognize what it is, but don't have anything with me as far as a med that can bring me out of it faster than a couple of hours lying with my feet up...any suggesstions?


----------



## apprentice1 (Feb 9, 2005)

I am just taking a bit more time to say that life is not always ruled or governed by SA, I had many years where I was self-confident and I have always managed to find work. I have had fine friends and teachers who coaxed the best out of me and got it. SA may return every once in awhile, but it does not always rule our lives. We do. Go for it, whatever it is that you want. Maybe you don't get just that, but something close or just something that allows you to feel good about yourself for awhile. Never give up. fight when you can. Know yourself. Trust yourself. Always give your best at whatever you do, life will reward you when you at least try no matter how hard it is. Okay, now I am late for the bus. Fick it! frank


----------



## Caedmon (Dec 14, 2003)

Frank, I'm the same way. I recently moved back in with my parents, and I wasn't sure if I would like it, but I do. I like having people around. I am nervous around them a lot, but I feel much less isolated. I plan to have roomates or a family for the rest of my life if it is at all possible. I lived a year alone before this, it was not for me, I really began to feel very alone.


----------



## Narparit (Dec 2, 2014)

In this topic, Caedmon doesn't explained his social anxiety status enough, he mostly talked about its stimulation and anxiolitic effect. Socializing effect needs to be described, and update after 10 years will be great what he accomplished on Parnate.


----------

