# Nardil vs Parnate (What is the deciding factor for you to pick which one?)



## DeafBoy36 (Dec 12, 2009)

Hey everyone,

Now that I'm done with graduate school. (Woohoo!) My psychiatrist has approved me to get either Nardil or Parnate. I can choose which one I want. That's a nice feeling. I'll start that in few weeks. 

Just curious. What is the deciding factor you decided to choose Nardil over Parnate or Parnate over Nardil? I ask because it would be my first time in taking a MAOIs. So I'm kinda nervous (duh, obviously in this forum).

There are zillions of threads on this subjects, I know, but I'm curious on the deciding factor that you choose one medication over the other.

Thanks.


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## barry1685 (May 25, 2011)

Nardil - because it's the one med that has a good rep. I think either medicine you chose will be fine and work really well.


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## Cascade (Feb 17, 2013)

I chose Nardil first because of its reputation with social anxiety. I then when to Parnate and it made me really anxious and had really bad heart palpitations. I am back on Nardil now.

PS - Congratulations! Tremendous accomplishment.


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## Caedmon (Dec 14, 2003)

In terms of the "odds", they both work equally well for anxiety and depression at their conventional doses. Of course, they may not work equally well for you. I chose Parnate because it has fewer side effects. 

A lot depends on what side effects you can tolerate, and what your "rainbow of symptoms" looks like. I have a million reasons why I think Parnate is a better first choice for most people but it's really a case by case thing.


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## yourfavestoner (Jan 14, 2010)

Parnate doesn't have the unappealing weight gain side effect of Nardil.

They're both great drugs.

Parnate is what I take and it works great for me. Nardil didn't work for me at all, but its record is unquestioned. I'd try Parnate first if I were you but everyone is different and they're both worth trying.


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## Caedmon (Dec 14, 2003)

I found this page while surfing and remembered this thread.

http://www.psychotropical.com/index.php/knowledge-base/97-maois/164-maois-choices

(Parnate = tranylcypromine; Nardil =phenelzine)

Dr. Gillman states:



> _MAOIs - Choices
> 
> Date Created: 27/03/1999 Last Modified: 06/10/2002 Last Checked: 03/12/2002
> 
> ...


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## DeafBoy36 (Dec 12, 2009)

Caedmon said:


> I found this page while surfing and remembered this thread.
> 
> http://www.psychotropical.com/index.php/knowledge-base/97-maois/164-maois-choices
> 
> ...


Sounds like Parnate is a better choice to start with (less side effects) even through it has been said that Nardil is the golden standard for anxiety/depressive disorders. I think it makes sense for me to start with Parnate because I want less side effects.

If Parnate doesn't work, at least I know I have the Nardil option next. If Nardil doesn't work I'd be MORE disappointed and going back to "lesser" gold standard "Parnate"&#8230;&#8230;

So Parnate it is 

Thanks all


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## Captainmycaptain (Sep 23, 2012)

Nardil will give you unbelievable sugar cravings, but I actually didn't gain weight even though I was eating donuts all day.


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## DeafBoy36 (Dec 12, 2009)

DRUGSAREnotGOOD said:


> Nardil will give you unbelievable sugar cravings, but I actually didn't gain weight even though I was eating donuts all day.


I wonder if that's because Wellbutrin counteract the weight gain? wellbutrin is well known for weight loss? That's something to consider when taking Nardil&#8230; hmmmm&#8230;

Another disadvantage on Nardil (Sugar craving)&#8230;. thanks for the info


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## Andre (Feb 27, 2004)

Nardil affects gaba.


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## Caedmon (Dec 14, 2003)

DeafBoy36 said:


> If Parnate doesn't work, at least I know I have the Nardil option next. If Nardil doesn't work I'd be MORE disappointed and going back to "lesser" gold standard "Parnate"&#8230;&#8230;


Oh... I _am _biased... but I have to stick up for my favorite medication of all time.  Parnate is *no *silver medalist. I wrote a long post with references and crap and it disappeared when I navigated away so I will just say stuff uncited, sorry. You should audit anything I say. 

I have not read about a significant difference between Parnate (tranylcypromine) and Nardil (phenelzine) in response rates in the studies. In fact, of the studies I have read, the response rates are fairly similar - right around the 60-80% mark. But this is a broad generalization and just from memory.

For example the Versiani 1988 study (have that date memorized!) had like 75%-ish response for Parnate treating social anxiety. Another 2010 study was double blind for people with social anxiety and panic disorder comorbid with repsonse around 70%, range of 30-60 mg (higher dose lead to better responses). So it should be clear that Parnate can do great things.

People tend to seek out Nardil for social anxiety because they believe it to be better. So the success stories involve anxiety. People seek out Parnate, more often, for depression. Success stories often involve that. But there is crossover of course.

One theoretical benefit for Nardil is a GABA increase. This _might _help anxiety but then it might also simply worsen side effects. It seems to be a high maintenance method of increasing GABAergic transmission, considering how much more tolerable benzos are. Other medications are also GABAergic yet get little attention and lukewarm reception (i.e. Depakote, Gabatril, Topamax). It is probably more complicated than "GABA=good" when evaluating these MAOIs.

Re: depression, if I were to give either a "gold standard" badge, I would not hesitate to give it to Parnate. It is the medication chosen by researchers for the STAR*D depression trials. In a 2014 trial it was first line treatment-resistant medication. Parnate gets used and referenced for depression because it *works*. One advantage is dose-dependent effects. Parnate has NDRI properties which increase with higher doses. It can be used in high doses (ie 120 mg) to produce a response even where lower doses may fail. However, usually a "regular" dose will work.

Results may vary! Everyone is different.


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## praytopesci (Jul 28, 2014)

Caedmon, can you explain how Parnate differs from high dose Emsam? I've been on 12mg Emsam for several months. It has pretty much zapped my depression but I feel no help for SA symptoms at all. I'm wondering if Parnate would be similar for me.


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## DeafBoy36 (Dec 12, 2009)

Caedmon said:


> Oh... I _am _biased... but I have to stick up for my favorite medication of all time.  Parnate is *no *silver medalist. I wrote a long post with references and crap and it disappeared when I navigated away so I will just say stuff uncited, sorry. You should audit anything I say.
> 
> I have not read about a significant difference between Parnate (tranylcypromine) and Nardil (phenelzine) in response rates in the studies. In fact, of the studies I have read, the response rates are fairly similar - right around the 60-80% mark. But this is a broad generalization and just from memory.
> 
> ...


Speaking of GABA, Klonopin, as I am aware of, increases GABA, which always pretty much controls my anxiety. So I know that my brain needs more GABA. So Nardil does the same thing to GABA, that's why it's one of my options.

My issues are much more with anxiety than depression, but as you said both medications have crossovers, so for time being, I'll do Parnate first. Too bad Parnate doesn't do much with GABA. If so, that'll be probably the BEST medication.

Klonopin does control my anxiety far more than Effexor (the next best medication) has ever did. It has to be the GABA issue in my brain.


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## Caedmon (Dec 14, 2003)

praytopesci said:


> Caedmon, can you explain how Parnate differs from high dose Emsam? I've been on 12mg Emsam for several months. It has pretty much zapped my depression but I feel no help for SA symptoms at all. I'm wondering if Parnate would be similar for me.


On Dr Bob, the user Chairman MAO pretty much nailed it to the wall.

My own opinion is that Parnate is more effective than Emsam for anxiety, particularly social anxiety (though there is clear evidence for panic disorder as well). Selegiline/Emsam isn't bad per se but my _uncited intuition _is that it does not work as well for depression, and that it probably isn't better than placebo for anxiety. Again, I have no sources for this statement and results may vary.

I only speak broadly. If you like Emsam and do well on it, *who cares* - what matters is if it works for _you_! 

Long and short of it is that it works differently. Parnate is a completely unique medication and I don't think it's very well understood, neither is Nardil. The most in depth most descriptions go is that "MAOIs increase neurotransmitter levels" and leave it at that but there seem to be many complex aspects to the older ones - effects due to being a hydrazine (Nardil) or amphetamine (Parnate).

Parnate has stronger effects on the big three neurotransmitters vs selegiline (and other of the newer MAOIs). Being in the amphetamine family it has some of the pro-social and mood improvement properties found in those drugs (i.e. Dexedrine, MDMA). (A side note that I've found that some low doses or unusual dose increases _can_ actually reverse this and I think related to paradoxical norepinephrine signaling. I've heard of people feeling totally wiped out from it. It varies.)

The feeling Parnate exerts on social anxiety is not like regular amphetamine (which folds social zest into a generally speediness). Just my experience though. I find Parnate to provide a jaunty relaxed sensation of *confidence *and eagerness. Sometimes for big meetings where a warm affect is required, I prefer to take extra Parnate, instead of Xanax. Instead of a tired sluggy relaxation it feels like total control. You don't talk fast and think faster, or get drowsy and forgetful, or anything. It's like the world turns into positive possibilities.

It literally changes _how _and _what _I think, and I begin to believe that I can do things. I _can_ talk to the cashier and I _can _make a phone call and I will be _okay_. Not hypomania. Just calm and positive.

Maybe it's like this: You're trying to watch a video about something beautiful, but you can't see it. There is interference [anxiety/depression]. The image is disorted or destroyed. Then suddenly the TV tunes in (or the streaming video stops being a stupid pixel-y mess, for you kids). In full HD. There it is! Oh, so *that's *what Patagonia looks like. (Or whatever.) For _me_, that is what happens. Trading depression/anxiety for clarity and possibility. I don't become an extrovert but I do see clearly, and with *confidence*. This is the opposite of social anxiety.

Again there is that ~25% who won't do well on Parnate for social anxiety. This is often because of a dose that is too low! However even so, sometimes it just doesn't provide broad enough coverage and needs augmentation. This is true for probably the majority of people on MAOIs simply because they (we) often have complex, resistant neurological issues and it requires team coverage with different meds. I take a combo of Parnate w/ Lamictal and Adderall, and occasional Xanax to cover nighttime anxiety. Parnate is still my star player though. (Even Lebron James or Michael Jordan need their teammates.)

*TLDR*: Link posted, Parnate is stronger and I like it.


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## praytopesci (Jul 28, 2014)

Great write up, thanks a lot.

One question I have about your experience on Parnate. You say, "I don't become an extrovert but I do see clearly, and with *confidence*." So would you say that you're still introverted, in that you still only get energized when you're alone and that social interaction is somewhat draining? I'm finding that socializing, especially for extended periods of time, is completely exhausting. I don't want to knock Emsam, because it's been a powerful mood regulator for me and my depression is 95% gone, but I experience zero pro-social effects on it. I'd like to be able to spend hours around people without feeling drained.

Same question for anyone taking Nardil.


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## Caedmon (Dec 14, 2003)

No i feel tired from socializing,and i have to be alone to recharge my batteries. I think that is just inherent to being introverted though. When the workday is done I am out in my garden or at home, because i like it more than going out to a bar for drinks. Socializing is less draining on Parnate because there is less effort involved, less anxiety, but it is still effortful. Adderall provides some coverage in this area too - energy and focus, and augments antidepressant effects. I do much better with the two meds combined.


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## ChopSuey (Nov 5, 2012)

I simply picked Nardil because there had been done more studies on social phobia in combination with it. As well as the huge amount of successful anecdotal reports. I decided i wanted the best and most effective treatment, and at the time it was quite clear what that was. Le Nardilé.


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## viper1431 (Jun 6, 2012)

I've been on both many times.
parnate makes me too sleepy, so I choose to stay on nardil now, it gives me heaps of energy and motivation, stops me sleeping too much and stops me eating a lot.


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## SplendidBob (May 28, 2014)

If I were to go on one, it would be Parnate first. Without question. Simply because of a better side effect profile and it is more activating.


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## UKguy (Sep 30, 2013)

Lets be honest here, most people just want to go on the most 'hardcore' med they can get, almost like it is a badge of honor. So on that basis I would have to say Nardil. 

Based on the reviews and feedback seen on this forum I'm not convinced MAOI are the magic bullet people are looking for but I wish anyone who wants to give them a go the best of luck. I might consider Parnate myself....... if there was ever a hope in hell that I would be offered it.


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## DeafBoy36 (Dec 12, 2009)

UKguy,

Then what's the magic bullet for you? I'm curious to know.


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## watertouch (Nov 4, 2013)

Parnate for me, mostly because Depression and fatiuge is my main probs.

Nardil im afraid of the weightgain, im not fancy but i gained some on prev meds and comfort eating...+ the effect, ive tried Benzo work on GABA and training supplements containing PEA+boosters and for me i didn't find it that stimulating.


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## UKguy (Sep 30, 2013)

DeafBoy36 said:


> UKguy,
> 
> Then what's the magic bullet for you? I'm curious to know.


I haven't found one yet, I don't think there is one really - that was my point. I don't think anybody on this forum has found a magic bullet...... some people find medications that work for a while but almost invariably they return with the same complaints X number of months down the line.

I think for most of us SA is deep routed in the personality and psychological make up. I suspect only prolonged therapy with an experienced therapist can even come close to 'curing' people. Unfortunately that kind of thing isn't available to 99% of us, so drugs are the next best option.

Recently Ativan has helped me get through some tough situations, but it doesn't fix the underlying issues. Moclobemide is a medication that I rate reasonably highly as well - being a RIMA it is safer than the older MAOIs but not as potent maybe.

However as I said, with the choice between nardil and parnate I would take the parnate; less side effects, more stimulating, etc.


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## Bill McGarr (Oct 2, 2021)

SplendidBob said:


> If I were to go on one, it would be Parnate first. Without question. Simply because of a better side effect profile and it is more activating.


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## jtd1974 (Jan 13, 2015)

One aspect that hasn't been mentioned here is insomnia. 

Parnate is generally considered to have a more favourable overall side-effect profile than Nardil. 

But I've heard from people on Parnate, and one who actually went from Nardil onto Parnate, that Parnate can cause fairly brutal insomnia, worse than Nardil. 

To those here who take Parnate, is a sleep med a necessity, or are you able to manage without?


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