# Parnate Anyone?



## bluebird274 (Dec 1, 2008)

Hi, I'm on week three now of the MAOI Parnate. I'm wondering if there's anyone out there who can share their experiences, good and not so good with this medication. I began at 20mg for the first two weeks, and now I've been 30mg for about five days. 
I'm definitely experiencing an anti-depressant effect and some increased confidence/motivation. For example, I haven't been able to get a haircut for months because of my anxiety, but this week I was able to do it. I've had a few other little successes this week too that lead me to believe this may turn out to be an effective medication. Which would be a godsend since I've tried about every psychiatric med on the market and there was nothing but the MAOIs left to try. 
Wish me luck!


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## dss (Oct 28, 2008)

Well I hope you do well on it. I've recently started it myself but have only been taking it for a few days now. No real side effects for me yet other then some minor insomnia last night. Haven't noticed any real changes yet but it's very early so I'm sure around the 2 week mark or so I'll pick up some.


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## No Limit (Dec 6, 2005)

It's been the most successful drug for my SA, but I've been slowly reducing my maintenance dosage from 40mg per day to 20mg. I've been on MAOIs for more than 2-3 years now (currently on Parnate, but tried Nardil for awhile). Insomnia and sometimes constipation are the only annoying side-effects that stick out for me. Good luck with it though. And you're lucky to have found a doc who would prescribe it to you. There are docs out there that are scared silly about MOAIs and are sold on SSRIs being the god send for all those who suffer SA.


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## Vincent_32 (Dec 17, 2008)

I also begin the Parnate, i'm on 20mg/day since 3 days, I was at 10mg/day at week first...

All I can say is that I try everything before, and by everything I mean every new drugs...like all the newer SSRI's, SNRI's, anticonvulsives (Neurontin, Lyrica...), antipsychotics, and the list goes on...

I'm also a benzo addict...Thanks to an excellent family doctor, who decide to put me on Rivotril (Clonazepam) back in 2005, begin at 2 mg/day, increase after 3 months to 4 mg/day and increase again to 8 mg/day after another 3 months... All I can say is that benzo drugs destroy my gaba receptors, so now I don't react to them. 

Since then, I succed to reduce my daily dosage of benzo drugs, I was at 8mg/day of Rivotril until may 2007, i'm now only at 20mg/day of Valium since june 2007. I had 2 periods after who I sak to be put back on Rivotril and Xanax, because I was a lot overstress and I was thinking it will be helpfull again after a couple of months without taking powerfull anxiolytics drugs...but I Was wrong..they don'T help me at all, I ended up at the hospital last summer for a Xanax deppendency...12mg/day...it was crazy at hell...I succed to return to my normal 20mg of valium day since then...I do a rapid withdrawl of the Xanax at home, since I was not able to stay at the hospital...

The valium stayt more longer in the blood, you don't feel the craving effect or the need of it after 4 hours...like on the Rivotril or the Xanax. I plan to quit the Valium after I Will be stable on THE drug who will help me with my social phobia and anxiety.

To do a short story, the MAOI's was my last ressort. I try the Nardil first, in the begining of 2007. I was taking 90mg/day for 3 months and I never feel any improve for my social phobia or my anxiety on it. In fact, I was feeling nothing except a lot of hypotension problems, having difficulties to climb the stairs without having blindness for a couple of seconds, seing stars and things like that...My family doctor at the time say these side effects will disepear with time, but they never fade away. So I just stop after 3 months and I was a lot frustrated...because I heard so much succes stories about the Nardil...

After I go from one drug to another. Like I write before, I switched from the Rivotril to Valium, since the Rivotril was getting me more depress and I it was not helpfull with my social phobia or anxiety at all , at the end...I don't feel the effect of valium for my social phobia or my anxiety, I just need to take it because if I don't do it, I have a lot of anxiety rebounds, I feel like I will have a seizure, unpleseant feeling inside my head, vertigo...things like that.

Anyway's, I meet a new psychiatrist in october 2007, he prescribed to me the Prozac, it was the only one SSRI I never try...I was a disaster, so much overstress and tired at the same time, it was killing me...I try for the second time the Zoloft...I never felt anything on it except a big weight gain...I was at the most highest dose, more than the FDA approval I think...After, we try the Cipralex (Lexapro)...OMG, it was another disaster. I had the more terrible 2 months of my life, at 20mg/day it was a LOT difficult to support. I was so TIRED and I gain another 40 pounds...Do nothing for my social phobia or my general anxiety and worsed my depression problem as well...

So here I'm now... I meet a new psychiatrist in november 2008, we decide to try the Parnate, since it was the only one drug I never try. The new psychiatrist have a slow approach, since he know the Parnate is more activiting than the Nardil or others SSRI's, except the Prozac... he prefer to go slow on the dose and prevent more anxiety problem...He don't want also to augment my dayli dose of valium...he said that all the benzos drugs are not helping at all...yes they work for a couple of months, but after they leave you with a more important problem. He said also that they block the good effects of the AD drugs... The AD drugs boost the chemicals transmissions in the brain...the benzo drugs slow down this process...

For now, the parnate don't worse my anxiety and my social phobia, I mean I don't feel a worse condition in my anxiety or anything else. I just feel tired as usual and my insomnia problem is worst than ever.

When I up my dose to 20mg/day last monday, I had a terrible day, a lot of anxiety and panic attacks...So tuesday I decide to not devide my dose and I take the whole 20mg in the morning and it was more tolerable. At day 3 on 20mg, I feel A LOT TIRED. When I take the 20mg in the morning, I get the stimulation effect, I'm full of energy, I can do 5 things at the same time...but after 3 hours everything return to the normal and I feel tired again. I plan to devide my dose again this weekend. I just have to let my body adjust to the drug. I also begin to do hypotension, like on the Nardil, but i'm only at 20mg/day...so I already have a prescription of a drug to encounter the hypotension effect, if it will get worse when I Will be at 30mg next week, I will begin to take it. The goal to reach is 60mg...maybe more if I can tolerate it. That's what my psychiatrist want...he say that more than 60mg is not necessary...but we will see...

One thing I Can say is that the Nardil maybe seem to be a better choice because of the Gaba (type B) effect. Most of the AD drugs play a role on the Gaba...but the Nardil activate the Gaba type B effect...and it's the only one to do it. But like I Write before, I don't see a difference on it, since a lot of drugs like the benzos or the anticonvulsives drugs play a role also on the Gaba (type A)...since I have an addiction to the benzo pills, my Gaba receptors are probably not working normally now and it's probably will never reverse to the state it was before I begin to take the benzos drugs back in 2005, so The Nardil don't seem a SO good idea for someone who take already a benzo drug like Rivotril or Xanax or Ativan...

I have a lot of hope on the Parnate. I read a lot of good review about it on books and on the Internet. I don't find a lot of studies about is effectiveness for social phobia or anxiety...but one particular study show an effective rate similar to the Nardil... And the Parnate is by far more effective than any newer drugs, even the TCA's...since TCA's are not helpfull for social phobia (they help for panic attacks but that's it). That's my opinion...

Anyway, that's was my story...I hope you will feel more good soon ;-) I will follow the evolution of your situation...and I will post mine at the same time ;-)

Have a good day


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## dss (Oct 28, 2008)

Well good to hear your story and hope the Parnate can help you Vincent. 

I'm on 20mg currently at Day 7 and have a better mood and calm feeling while on it. I take 10mg in the morning and 10mg at lunch and I don't really notice much insomnia from it. The first 3-4 days I would be a bit restless at night waking up a bit more then usual but it wasn't anything too out of the ordinary. Last couple of nights I've slept through well so I don't see it being a problem anymore. I've read you shouldn't take it past 3pm as it can effect your sleep more so then so that would be something to follow if you are having trouble sleeping. 

I'll make some updates as I progress here in the following weeks. Unless I notice breakthroughs at 20mg I'll be moving up to 30mg near January so looking forward to that.


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## Noca (Jun 24, 2005)

Welcome to SAS Vincent!


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## Vincent_32 (Dec 17, 2008)

*Thanks Noca*  If I well understand, it's a forum with only social anxiety topics here?  I just ask this question because i'm a member of another forum about general psychiatric problems but it seem that I can't find a lot of answers on the other forum, since not a lot of people are have social phobia and anxiety as a main problem...But they are also very nice on that board...it's seem to be the same here...anyway's...

*To answer to dss*, I don't feel a calming effect on the Parnate, it's seem to be a lot more activiting than the Nardil or the newer drugs, you always want to sleep all day long, even if you drink 10 cups of coffee... Did you have only a social phobia problem or you have also some comorbidities like general anxiety, panic attacks, depression and agoraphobia?

I have to admit that the general anxiety became my main problem as well as the depression and agoraphobia, but my social anxiety is the main part of the problem. Having social phobia for more than 14 years and never find something to releive it make all of this happen. I do several therapies (CTB) in the past and like I write before, I try everything...exception of the "new" cymbalta, that's the new thing very popular in Canada...but from what I read and also what my psychiatrist say, it's nothing else than a more or less good version of effexor-xr....so not very helpfull for social phobia directly.

The main problem about the newer drugs is that they are safer but not very effectives to threat directly social phobia and anxiety, even if the Paxil and Zoloft are the only ones to be approve for this by the FDA in the States and health Canada. They just relieve some comorbidities like panic attacks with or without agoraphobia, and sometimes they cure the depression that developp with time when the social phobia is not treat well...or depression caused by the use of some drugs like the benzos...or the abuse of alcohol...but even for depression, I never find a good newer drug to treat me well...

Anyway's...I have big hopes about the Parnate...Even if I feel a little bit more anxious on it, at first, I always react fast to side-effects and I feel them always. I tend to have the worst side-effects of the list. It's always like for all the drugs I try. I think my general anxiety make me feel like this, I have a fixation on my body sensations and if I feel something not normal, I begin to feel bad and I do a panic attack...So that's easy to blame the new pill for this...but in fact that's not the pill but just something wrong in my head...

I hope the Parnate will be able to reduce my social phobia anxiety. I'm tired to ne be able to go where I want, when I want, without thinking about 1 000 000 things at the same times, about where I Will have to walk to go there, if I will see peoples I know, if I will be watch by everyone or judge. I'm also a lot tired to not having the abilities to make new friends and to be often alone... And i'm also tired to not having the necessary level of energy to find a good work...or just to finish my university studies...

For the insomnia, I do this since more than 4 years. I can fall asleep very fast at night, less than 10 minutes, but i'm awake after 2 or 3 hours and i'm not able to stay in the bed and fall asleep again. SO I have to leave my bedroom, make others things, open my laptop, take my emails...and I generally return in my bed at 8 or 9 AM...I sleep 1 more hour and I have to do a nap in the middle of the afternoon , at least 1:30 hours...to be able to do something at night with the only friend I have. I worked on that in another CTB I do last year, I had a cedule to respect and days without nap...and it was crazy as hell...I was not able to respect that cedule...I always feel tired, that's not my fault...I also do severe amnenia cause I had a gastric by-pass for the obesity problem I had from my youth to 25 years old. That's not helping for my energy, even if I recieve intravenous iron each month and even if I take oral iron pills everyday...and a lot of others vitamins that my bodies don't absord very well that comes from the food I eat...since I don't digest a lot of food, I also don't digest the vitamins or pills I take. It's why, I can't take a XR version of a medecine...It have to be a regular version not en extend release cause I will not absorb all the drugs in my blood...Well, that's another story...

Since more than 1 1/2 years, I stop the university, I don't work, I had to wait severals months before being able to meet a psychiatrist, I had my reference paper made by my family doctor to take an apointment with a psychiatrist but it's a public health system in the Canada, so I had to wait my turn. The same apply for the therapy...if you don't have the money to afford a private psychologist, you have to wait your place on the wating list...so I din't have the money for this and I wait more than 1 year...I just begin another CTB therapy 3 weeks ago after all the time I wait...In the mean time, my psychiatrist had 1 year to find a good drug to help me to treat or control my social phobia and my anxiety problems, but my psychiatrist didn't succed to reach that goal before I begin my new therapy...I will have to put more energies and efforts in that therapy and I will also have to fight my social phobia anxiety and cope with my panic attacks problem when I Will do social "exposition"...That's one of the thing I will work on that therapy...Try to change my automatic thinks with positive thinks...

So you can imagine that always have to wait like this before receive some treatments is just a loose of time and it's also not helping because the mental health state always deteriorate...

Anyway's...I will continue to put some update of my progress on Parnate. I'm suppose to up my dosage to 30 mg in 1 or 2 weeks, I have to look at my cedule again, I have a lot of memories problems since a little while...thanks to the benzos drugs!!! :boogie

For *bluebird274*, I wish you good luck with the Parnate...like you see, you're not alone in the same boat. You can look at the Nardil topics, since it's similar to the Parnate, except for the Gaba activaties with the Nardil...They have a similar mechanism of action on a lot of neurons...I don't think the gaba effect of Nardil make it a more good drug for social anxiety or phobia. I think in fact that everyone is different, so we all react differently on drug. Some lucky people fall on the good drug at the first try, especially the newer drug with less side effects, but they are exceptional people I think since I never know someone who try only one kind of drug to help with his social phobia problem. What I can say, after 14 years searching for the good drug, i'm not a desesperate case and I have big hopes about finding the good one for me. So, continue and persiste....i'm sure you will have some relief of your symptoms soon... Think that you are one of the lucky person who find a GOOD doctor to help you, MAOI's are not common prescribe drugs and a lot of doctors fear them. You are lucky to have a good doctor like that. Yeah, maybe you will feel more side-effects on a MAOI's, and maybe you will find the diet to be a little bit hard to follow (don't care about it, just don't eat not fresh protein products and blue cheese...) but a lot of studies show a more good success rate and remission on them...Too bad, we can't find studies who compare old MOAI'S with newer drugs...but i'm sure the newer drug will have very low results compare with the MAOI's... I know some studies exists about TCA's and SSRI's comparaison, but they show similars results. I read somewhere ( I don't remember where, I think it's a book...) but I read that MAOI'S give between 60-85% of success rates, compare with 15-20% with the SSRI'S (Paxil, Zoloft) and the SRNI'S drugs (effexor, cymbalta...)...so you can see the difference. If MAOI's don't work, don'T be dissapointed like I was with the Nardil experience, i'm sure you will find something!!!

Take care of you, and post your progress here !!! Bye


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## ThirdEyeGrind (Feb 7, 2006)

Can you switch from Nardil to Parnate just like that. I know you gotta wait two weeks before you can start stuff like SSRI's or Adderall. I know that Parnate is sorta stimulating right? I've been really tired at work and my doc. wouldn't prescribe me Parnate. Shouldn't he have? I don't get it. He just lowered my Nardil dose as well as my Clonazepam. The funny thing was that the lowering the Clonazepam was my idea so I might not be as tired. Frickin doc. taking tips from me. But yea, can you just switch from Nardil to Parnate? is the question. Thankyou.


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## Noca (Jun 24, 2005)

Vincent, if you look in the "secondary disorders" forum you will find lots of other illnesses like depression, OCD, etc, but yeah the main focus of this board is SA(social anxiety).


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## dss (Oct 28, 2008)

AprilEthereal said:


> Can you switch from Nardil to Parnate just like that. I know you gotta wait two weeks before you can start stuff like SSRI's or Adderall. I know that Parnate is sorta stimulating right? I've been really tired at work and my doc. wouldn't prescribe me Parnate. Shouldn't he have? I don't get it. He just lowered my Nardil dose as well as my Clonazepam. The funny thing was that the lowering the Clonazepam was my idea so I might not be as tired. Frickin doc. taking tips from me. But yea, can you just switch from Nardil to Parnate? is the question. Thankyou.


I thought I read there is still a significant time you need to wait if you switch Nardil to Parnate or vice versa. I went manerix -> parnate though and it was only a week.


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## bluebird274 (Dec 1, 2008)

It's nice to see there are others who are new to parnate as well. I'm at about the 3 and a half week mark now, which means I've been on the 30mg dose for over a week.

So far I'm experiencing some strong side effects:
*Insomnia* - I've had a heck of a time with getting to sleep. I'll lie in bed several hours, just tossing and turning. I get this strange almost creepy crawly sensation in my legs and I have to keep moving them and this also prevents me from falling asleep. When I do sleep it's very light.

*Fatigue* - It's funny because I do find this drug to be stimulating, especially mentally but a lot of the time I feel physically weak and drained. It's like someone has turned on a faucet and all my energy pours away. I used to be able to do intense workouts of an hour and a half at the gym and now I just can't do it, I don't have the strength even though I really try. 
However, my doctor says this is a side effect that should fade away, so I'm really hoping it will.

I've had some seemingly minor but for me really important successes on this medication. A few days after going up in my dose to 30mg I was able to finally get my hair cut! I've been needing one for months but I could never bring myself to do it because of my anxiety. It was out of the question. But I did it and I know this change is due to the positive effects of the parnate. I was also able to do a few other things like this that I'd been putting off for months and months due to fear. I've even inquired about starting some volunteer work in January. I'm finding I can think more positively about the future and I've noticed more of a belief/confidence that I can start doing volunteer work without negative emotions paralyzing me. The desire has to be there, I think, but the medication offers that extra all-important push.

*Vincent,* congratulations on getting your benzo dosage down so low. I was addicted to them as well and it was only after getting off them that I could see how damaging those drugs were for me. They really devastated my memory as well. I have literally years of my life that I cannot remember. I've had a lot of problems in the year and a bit that I've been off benzos but I came off them cold turkey which was crazy. However I'm so much better than I was even just a couple a months ago, so the brain definitely heals itself.

Good luck to everyone and I look forward to reading more about your experiences!


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## Vincent_32 (Dec 17, 2008)

*Hi bluebird274 *;-) Thanks for your answer&#8230;Finally someone with social phobia who likes to write long text!!! I like that! Lol

Like I already write, I'm only on 20mg/day and I experience side-effects as well&#8230;

*Insomnia* - We seem to have a different type of insomnia. I can fall asleep very fast but I'm awake early, mean that I sleep 2-3 hours maximum and I can't fall asleep again, so I have to get up, I can't stay in my bed lying and thinking about 1 000 000 things at the same times. I open my laptop, do some laundries, open facebook, answer to my emails, and things like that. I normally do a LONG nap in the afternoon, since I'm not working and I don't go to school for now. I know it's a bad habit but like I write before, I do a CTB last year and we work hard on a schedule that I had to respect and I was not able to do a day without a nap. If I don't do a nap in the afternoon, I will have a strong headache at night and I will not be able to do something with a friend, I will have to stay home and watch TV&#8230;And I will not sleep more the night after!!! For the muscles spasm or the sensations you feel in your legs, that's normal, I experience the same effect right now, I need to move, it's another reason why I can't stay in my bed and lying without sleeping&#8230;Even during the day, I can see some muscles in my arms, my butt or my legs doing some contractions that I can't control. It remembers me a lot the muscles spasm I had when I withdraw too fast the benzos drugs.

*Fatigue* - I find the Parnate to be stimulating, more than the Nardil in fact, but after 3 hours the effect fades away. Mentally it remember me a lot amphetamines drugs, especially the Ritalin (Focusin)&#8230; at the same time, I feel also physically weak and drained. I was already like that before but I feel worst since I start the Parnate. I think the DA and NE effects are the one who is more present at the beginning of the treatment, some people will react more well to the DA and NE effects of the MAOI's by experiencing more stimulation without fatigue and the lack of strength, and other's people like me and you will find it more energy drained&#8230; Your doctor is probably right, the effect will fade away with time&#8230; Did you always feel like this on a antidepressant drug? Is it your first experience on a MAOI drug? Did you take others AD drugs before like the newer things like Effexor-XR, Cymbalta, Paxil, and others AD like this???

Congratulation, that's nice to read that you feel some improve over your social phobia problem. You give me a lot of hope!!! I never improve on any drugs I try before. Yeah, the benzo drugs work at first, especially the Rivotril (Clonazepam), but I was just feeling on drugs on it&#8230;I was not myself&#8230;and after a couple of months it stop working and leave me with an addiction problem&#8230; I hope I will have the same improve experience when I will be at 30mg&#8230;I can't increase my dose to 30mg until the 31 December. My new psychiatrists give me a prescription with the exact amount of pills I have to take until I meet him again the 14 January. He knows that I have a big tendency to go to fast on increasing dosage. I think it's normal, we all want to see some improvements fast no??? I do social phobia since 14years and I never feel an improve of it&#8230;and I'm tired of that situation. I can't have a normal life, a good job, or just finish my school (university). I'm 32years old and I haven't accomplished something good in my life. I have to do interview to have a job and I can't&#8230;I always do panic attacks and I can't answer to the questions the people ask to me. Amway's&#8230;I'm not able to do something alone in fact. I always need to be accompanied&#8230;just going to the convenience store to buy a cigarette pack makes me feel really anxious. I have to look inside the store and see if it's full of people, if it's the case, I go to another store&#8230;I can drive 2 hours to find a store without clients inside&#8230;that's crazy&#8230;

*bluebird274*, how you succeed to getting off your benzo drugs??? Like I write before, I'm at 20mg of Valium /day, divide in 5mg dose 4 times a day. I don't feel less anxious when I take it&#8230; but if I don't take it, I feel like I will do a seizure&#8230;Did you had those strange sensations inside your head, like your brain are moving or just strange sensations inside your head when you stop them completely??? How did you succeed to stop them completely? Did you tape your dose slowly or stop cold turkey? Did the cognitive problems fade away with time or I will stay on the slow motion mood for the rest of my life? Before I start them back in 2005, I was really fast on everything. I never had to study a lot at school, I had a big interest in everything new, I never had a cognitive problem before&#8230;now I feel like I'm retarded, I can't even speak&#8230;it's like I have something inside my mouth that make the words impossible to said&#8230; I can't articulate well and I sometimes I don't remember what I was saying 1 minute before&#8230; Those drugs are life destroyer I think. Doctor doesn't realize they are just very bad&#8230;it's like putting a band aid on the problem without curing it at all. I try several times to stop my valium pills, but each time, even if I do a slow taper method, I fail. I always fear the SEIZURE&#8230;because the strange sensations inside my head make me really anxious. I just need to be reassured I think&#8230;

Thanks for sharing your experience with me and thanks also to give me some hope on the Parnate improve and the benzo&#8230;you seem to be a very nice person&#8230;and I will follow your story also ;-)

Good luck with the volunteer work, I'm sure you will be able to do it. I plan also to find a job as soon as I will feel better. I think staying at home without doing anything don't help, but I feel also a lot paralyzed about finding a job&#8230;I always wonder if I will be able to work 8 hours in a row without having problems with the fatigue and things like that. I work hard before, I had a very difficult and physical job...I do it for 10 years... I had to stop at the end because I was not able to cope with the stress...

For now, I don't feel a lot productive. I was suppose to take some courses at the university this winter but just thinking about all the books I will have to read and the exams I will have to do, it make me feel very anxious and also emptied of all the small amount of energy I have right now&#8230; I think I need to wait a little bit more and see if the Parnate will make a good effect on me or not&#8230;The CTB i just begin 3 weeks ago will be also very helpful, it's not the first I do, but this one is just about social phobia problem. I will have to work on my exposure in public situation and finding a job is a part of the list of activities that make me feel anxious&#8230;so I will see&#8230;

So another time, thanks again!!! Have a good day!!! 

*dss *- I switch from Nardil to Parnate without a wash out period. I think the Parnate is more strong, so you just need to be careful and don't start it at an high dose, since the enzymes is probably already destroy in your system because of the Nardil&#8230;the parnate kick off more fast if you don't do a washout period&#8230; For the Manerix I don't know. My doctor or my new psychiatrist doesn't find it efficient at all for social phobia. Some studies show good results for social phobia (similar to the ones get with SSRI'S or SRNI'S), and other studies show no result at all compare with placebo group. The FDA doesn't approve it because of those studies. In Canada, all the doctors prefer to give Manerix than old MAOI's because they are safer, but the 600mg daily dose is not enough to get a complete destruction of the enzymes in the system. The fact that it have a really short half-life effect and a reversible effect also, more type A reversible than type B, make it a less efficient drugs than the old MAOI's. My family doctor always told me it was more a placebo at 600mg/day, he said that to see some improve, like the ones get on regular SSRI's or SRNI's, the dose have to be more than 900mg day&#8230;and at this stage, the diet need to be follow, like on the old MAOI's, so he don't see any interest to prescribe it over the old MAOI'S, since at 900mg and more, they have similar side-effects and a less success rate&#8230;

*Noca* - Thanks for the information&#8230;You see, I don't take the time to look at all the website&#8230;I will do it more in the next few days ;-) When I will have more energy


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## bluebird274 (Dec 1, 2008)

Thought I'd give everyone on here an update of my parnate experience. It's been about 8 weeks now, and it's been a roller coaster ride. I think I'll have to come off it because of the side effects. It was helping a lot with the terrible depression that comes with my anxiety - I suddenly had an interest in things, and began writing again, and feeling creative, and my family noticed a real positive change. I had more confidence in social interactions. However, the hypotension (low blood pressure) has become worse as my dosage increased to 30mg, which isn't all that high. 

This hypotension is impossible to live with. I'm so weak, my limbs have no strength, and as soon as I leave my apartment, all I'm thinking about is how soon can I get back so I can rest. This is tough to live with because at my worst I always turned to physical exercise as a way to help. I was in good shape, attending the gym nearly every day. It's really important to me. 
Now i haven't been to the gym in weeks, and last time I tried I lasted barely 5 minutes walking on the treadmill. The weakness is indescribable. It's just a total body drain, as though I'm physically shutting down.

The weird thing is this drug acts like an amphetamine on my brain, so mentally I became more and more stimulated, but physically weaker. So instead of being house bound due to anxiety, it was just the physical exhaustion.

Also, the stimulating effects of parnate have become too intense. Anxiety is my main problem, not depression, and my counselor told me the other day that by talking to me and looking at me her impression (if she didn't know I was taking parnate) was that I was on uppers. She said my eyes were really wide, and I seemed very hyper - artificially so. And this was after three days of reducing my dose from 30mg to 10mg and I was feeling a lot less hyper.

I actually had a weird bi-polar cycle (I'm not bi-polar normally) when I went several days so "high" that I was awake 36 hours, then I'd sleep for about 4 and this went on for several days. I thought it was great at the time because I was getting so much done. I was writing like a fiend and being so productive after months of lethargy. Also, I had no appetite and I liked it that I was losing weight (I'd put on some weight from previous meds). But then I crashed, and was feeling terrible several days after that.

I also experienced a strange heart arrythmia that was a little scary. I think it may be the stimulant quality of this med. The whole time I've been on parnate, I've always been aware of my heart thumping, and then it just started beating off rhythm and it scared me enough, along with the other side effects I've been experiencing, to start lowering my dosage right away, and see the doc about maybe discontinuing parnate. 

I had high hopes for this medication, but it may do more harm than good in my case. It's so hard on the body. Not having enough physical strength to do the simplest tasks is just not something I can live with. 

My counselor said she's seen a lot of her clients do really well on Manerix, which is a reversible MAOI, so it's related to parnate and nardil, but it doesn't have all the food and medication restrictions and it's known to have the least side effects of almost all anti-depressants, including all the newer ones. 

I'm curious to know how others are doing on parnate, how you're coping with side effects, etc.


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## dss (Oct 28, 2008)

Well Bluebird I'll give you a bit of an update on how my recent Parnate experience has been.

I initially started at 20mg and after 3 weeks moved up to 30mg as planned. I was having some benefits at those doses so I decided to change my dose to 40mg and then 50mg which is where I currently am. I felt going back to my doctor at 30mg with some improvements would have just led to trying a higher dose and didn't feel like playing the waiting game in between my visits. Of course I had no major side effects to worry about and was monitoring my blood pressure and pulse so I felt it was ok to do so.

Now starting at 20mg I initially felt a better mood , some slight motivation and an almost calming effect at times. I got sick for 2 weeks after starting and the initial positive feelings seemed to be hidden behind the grogginess and overall poor feeling of being sick. I had some social situations that were tough for me to deal with in those first 3 weeks and felt no relief during them but thought it was too early to make a judgement.

After feeling better I moved up to 30mg as planned and had some of those initial feelings come back but not quite as strongly. I still felt it wasn't doing much for my SA apart from giving me a bit of motivation. After 1 week 30mg I went up to 40mg and again just had some slight increase in the same feelings. 5 days later I went to 50mg where I currently am at.

50mg seems to be the best dose so far but I still feel it's not helping with SA. I do feel like any depression I had is gone and the stimulating effect seems to focus and motivate me slightly. I think the higher I go the more stimulating it feels but I don't feel wired like you described. Could be I'm just more tolerant to medication.

I have a doctor's appointment soon and I plan to switch over to Nardil which is what I initially wanted to be on. I think that anyone who suffers from depression , especially those that are hit hard by it and lacking motivation and energy would probably love Parnate. I'm not sure it's really the best option for SA as Nardil seems to get a whole lot more use and praise for SA. Most Parnate praise seems to be from the depression side of things which is what I experienced.

Side effect wise I experienced only a couple things. Insomnia has come and gone and come again as I've changed the dose. Initially I had some restless nights but they went away after about a week. Once I got up to 40mg and 50mg I've had trouble sleeping. I would get an initial couple hours then wake up and be tossing and turning all night getting hardly any sleep. I think it's due to me changing doses fairly quick though since I've been on 50mg for a few days now it has started to ease up.

The other thing I have noticed is the odd heart rates. I could feel my heart thumping like you although it didn't really feel like it was elevated , almost like I was just more aware or it was stronger. There were times it would become elevated slightly but I was constantly monitoring it with my blood pressure and was never too high to get worried about. If I planned to stay on Parnate longer I would have looked into another medication to help with that.

Now on to Manerix..

I took Manerix for about 2 months and found it did *nothing*. No side effects , no change I could notice at all apart from taking away withdrawal side effects of my previous med. There isn't a whole lot of experiences out there but the ones I've seen just claim it's helpful for depression. Maybe it's just me but I found it to be completely useless. I guess if you want a MAOI it's kind of a safe version of one but apparently it only works on MAO-A and then slightly on MAO-B at the higher doses. I guess I should also mention I was on 600mg which is the highest listed dose although I was told I could go higher I saw no reason to.

Since you have already been prescribed Parnate why not try Nardil instead? Unless you don't like the food interactions (which are overblown) then I would try Nardil instead of Manerix.

Whatever you do I hope you find something that works , also nice to see another person from BC here


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## Vincent_32 (Dec 17, 2008)

*Parnate Update and many more...*

It's seem that i'm not the only one who get physicals side-effects that was untolerable on the Parnate!!!

Since I think i'm the one who start the thread, I will give you my story about the Parnate try...

I take it more than one month...begin at 10mg, increase at 20mg for a couple of days and reach the 40mg/day very fast...Stay at this dose for 2 weeks...Terrible side-effects, physical fatigue, I was not able to just take a walk or do anything else. I never feel the stimulation side effect of this drug...I was just always tired as hell and just wanted to stay in my bed (with insomnia at night of course)...

I had several hypertensives crisis without eating forbiden food on the avoid list, they call them spontaneous hypertensives crisis...with high blood pressure of 220/90...so I had to take more than 6 times a Apo-Nifed "Antidote" pills to low my blood pressure...anyway my blood pressure was always over the acceptable limit of 140/80-90...I had heart arrythmia problem at the same time, I never had this before...At night I had hypotension orthostatic problems...I wake up often in the middle of the night and I was not able to walk or stay on my feet, I had photophobia, it was impossible to open the light, one night, it was so crazy and I was feeling so bad that I almost had a faint. I had to cry to someone else in the house to come in my room and give me a lot of salt with water, to rise my blood pressure... At the same time, I had also orthostatic hypotension at the same time than the hypertension...it was really crazy...

That's too bad...it was doing some good effects on my social phobia...I was able to reduce my valium intake by half at the end...10mg-15mg instead of 20mg and more usually...

I had an appointment 2 weeks ago with my family doctor and he told me to reduce my dose to 30mg or 20mg...until I reach an acceptable stage of good effects and acceptable side-effects profile...Since it's not the one who prescribe to me the Parnate, and that my PDoc appointment was delayed until next week, I just take the decision to stop it 6 days ago...why??? Because I was becoming crazy with the side-effects...It was the same at 20-30 or 40mg... Sedation at day time, a BIG physical fatigue, I gain some weight, even if I was not eating a lot, at the end I Was wondering if it was really the Parnate who make me less anxious in social events or it was because I had too much side-effects and all my concentration and my thoughts were directed to the side-effects and not the people around me...???

So i'm free of the Parnate since 6 days...I had to return to my normal intake of Valium of 20mg/day...Im more and more anxious...more than ever in fact...I have to deal with a lot of daytime sedation, i'm worse than I was before I try the Parnate...

To answer to *bluebird274*, I also think a lot about the Manerix...but my family doctor always refuse to prescribe it to me because it's not effective at all. Severals studies show some really promising results at weeks 1 until weeks 8...but at weeks 12, all the people on 600mg /day, 900mg/day or 1200mg/day have the same level of depression or anxiety than the people on the placebo group... No wonder why it never pass the test for the FDA in the States!!! The fact that the Manerix play only a key role on the Type-A of MAO (More Se and NE field...) and less in the type-B (more stimulation, probably DA and epepherine...), and the fact that it's a reversible one, make it less suitable for a long-term treatment, since your body will get used of it fast and you will need to increase the dose, until you reach the limit of 1200mg authorized in the Canada...600mg is the usual dose...but well that's too low...at 1200mg/day, the diet became important to follow...not at 600mg...

I have my next appointment with my Psychiatrist next week. If my psychiatrist proposes the Manerix I will say no...I don'T have another month to loose on a AD's drug who will not work...or who will sork only 8 weeks...(Too bad, I lost the weblinks about studies of the MAnerix..but the studies who show no improve at weeks 12 really exist, whatever the dosage the people who participate in the study take daily...).

I seriously think about going on a TCA's...since I only try 2 of them (Imipramine and Elavil), my main problem is social phobia and the lack of motivation and energy...and since I know the TCA's are not really effective in the Social phobia field (a lot of studies exist about this fact also...), maybe I will ask for *desipramine* (act only on the NE...) or *nortriptyline*( act more on NE than SE...)...since I always get bad reaction on all the SSRI drugs...everything who toutch the serotonin affect me a lot on my motivation and my energy ...as well as making me fat...

I will maybe also propose something more new like *Adderall-XR *or something less expensive but more stimulating like *Dexedrine*, since some people with social phobia and lack of energy and motivation answer more well to stimulant drugs than others ones...

Maybe I will ask again for the Nardil...I know I don't improve on 75mg/day for 3 months...When I up the dosage to 90mg, I experienced a lot of orthostatic hypotension and at the time it was freaking me out a lot, so I stop after 2 weeks at 90 mg...but this time, with all the high blood pressure I experienced on the Parnate and the worst orthostatic hypertension crisis I had in my life on the Parnate, maybe I will be able to tolerate the orthostatic hypotension for a more long time than 2 weeks...and maybe it will fade away...like when I was on the Parnate??? Who know...Too bad in the Canada we don't have the others MAOI's, especially the Emsam patch and the Marplan...

That's strange because all the people with who I talk on the Internet in another medical board and who are on the Parnate talk about the "stimulant" effect of the Parnate on them...All what I get on it is the more pronounced daytime sedation and the NO physical energy ...it was like I was running a marathon everyday...without moving my *** from my computer chair or my bed...

Well...I wish good luck to you *bluebird274*, give me some news about your situation ...and also about what you will experience next...

For *Dss*, that's true...Generally, Nardil is the gold standard for social phobia and anxiety...Parnate is more for people with depressive illiness...but sometimes, someone can experience the 2 things together...I mean that my untreat social phobia make me feel depressive after a while...so the lack of motivation, the lack of concentration and the lack of energy is a part of my daily life...I can't continue to tolerate them in my life...I will never be able to achieve something good if I stay like this... The Nardil tend to make people more relax...But I can told you that for my experience, that I don't see a lot of improve on my social phobia as well for my depression symptoms on the Nardil in 2007...I give it a 3 months try at 75mg...I think it was enought no??? I wonder if I really need to do a second try on it or not???

I also begin a new CBT a couple of weeks ago...that's not easy to get exposed to social situation and work on anxiety level and tolarabelities without being stable on a drugs at the same time...

Well Iwill give you some updates soon...and told you what "drug" will be my next experimentation...

Bye!

Vincent ;-)


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## Medline (Sep 23, 2008)

I think Moclobemide should be used in the high dose range (900-1200mg/day) so that it has a little more action on dopamine, still no MAOI diet has to be followed. I would also recommend adding low dose Amisulpride (50mg Solian/day) to further increase dopaminergic neurotransmission. Nevertheless I think Parnate/Nardil will still be more powerful than this combo.


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## linuxman5 (Oct 22, 2008)

Bluebird274: Your experiences with Parnate mirror mine. The fatigue/weakness was just unbearable! Like you, I could no longer work out, hell, walking up a flight of stairs wore me out and I was in great shape. 

My guess is the weakness was from hypotension, but I don't know for sure. Some people have had success on Marplan, which appears to have far fewer side effects than Parnate or Nardil.


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## bluebird274 (Dec 1, 2008)

I told my doctor about the negative side effects of the parnate. She hasn't seen me in ages, but when she first saw me she was so impressed with how much weight I'd lost (barely ate on parnate), that it seemed from that point on her mind was made up that's I should stay on it.

I felt like an idiot because it was like I was trying to convince her that I'm not just looking for reasons to stop taking the drug. After telling her about the side effects - no strength in my limbs at all, and heart beating out of whack, she just tells me that every drug has its downside, and you have to weigh the pros and the cons. 

Then she tells me that I focus on only the negative aspects of the medication. It was frustrating because she doesn't realize how much I'll actually put with on a medication if it's helping me. 

Now I think she just sees me as someone who is not willing to tolerate any negative side effects whatsoever. It's not at all true, I just don't want to waste more of my life on medication with side effects almost as incapacitating as what I'm using them to treat.


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## dss (Oct 28, 2008)

That's unfortunate. The higher doses of Parnate brought on more side effects for me , some of which I would have probably started to worry about if I planned on staying on it (Postural hypotension , slightly increased heart rate).

Sounds like the weakness and heart issues aren't really a great choice to live with , especially if it's not even helping in a major way. I would personally make another appointment and try and stress the issue of weakness and heart rate and see if there are any potential other meds that could help with it. If you would rather not deal with added meds or feel like it's not helping enough anyways then just tell her you want to stop and try something new or whatever your plan may be.


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## CopadoMexicano (Aug 21, 2004)

good luck


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## Medline (Sep 23, 2008)

In clinical trials high doses of Parnate were well tolerated. At higher doses Parnate starts to act not just as a MAOI but as a NARI too, therefore reducing the likelihood of a tyramine-induced hypertensive crisis.


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## Bluemeow (Apr 18, 2009)

*Medline Please tell me where you go your info*



Medline said:


> In clinical trials high doses of Parnate were well tolerated. At higher doses Parnate starts to act not just as a MAOI but as a NARI too, therefore reducing the likelihood of a tyramine-induced hypertensive crisis.


I know I'm reviving an old thread here, but I would like to know what study you are citing which indicated that Parnate at high doses starts to act like a NARI too?

If you happen to remember that link you found way back in January, I'll be very impressed!

I'm interested in this because I just started Parnate, and well, it hasn't been smooth sailing so far. I need something to spur me on and remind me I need to give Parnate a fair chance. I can put up with a few rough weeks if I believe there's a good possibility of improvement down the road.

Thanks


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## IllusionalFate (Sep 10, 2008)

This thread sounds EXACTLY of what Nardil is like for me (75mg). I can't even see anything since the orthostatic hypotension is so bad, and it persists long after standing up so I only can see bright colors or a dark gray until I can get blood to my head (by leaning forward or lying down for instance). I'm also having comorbid ADD which I've never experienced at ALL before trying Nardil. I think this may be due in part to the cognitive blunting induced by the drug.


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## Medline (Sep 23, 2008)

Bluemeow said:


> I know I'm reviving an old thread here, but I would like to know what study you are citing which indicated that Parnate at high doses starts to act like a NARI too?
> 
> If you happen to remember that link you found way back in January, I'll be very impressed!
> 
> Thanks


This is data from the German manufacturer of tranylcypromine. The website is www.jatrosom.de , the info is from the section for medical professionals only (http://www.jatrosom.de/jat20mg_log.html), but one can login with Username: jatrosom & Passwort: jatrosom or just jump directly to http://www.jatrosom.de/faq.html



> Was unterscheidet Jatrosom® von anderen irreversiblen MAO-Hemmern, wie Phenelzin?
> 
> Chemisch unterscheidet sich Tranylcypromin von Phenelzin und anderen irreversiblen MAO-Hemmern v.a. wegen einer fehlenden Hydrazineinheit. Das steht im Zusammenhang mit einem sehr geringen Risiko hepatischer Toxizität von Tranylcypromin, wobei aber die älteren Fälle von Lebertoxizität mit Phenelzin zumeist auf die früher übliche Komedikation mit Barbituraten zurückzuführen sind. Höher dosiertes Tranylcypromin ist in präklinischen Tests zusätzlich ein Noradrenalin-Wiederaufnahmehemmer und indirektes Sympathomimetikum (amphetaminartig). Inwieweit dies Relevanz für die klinischen Unterschiede der beiden irreversiblen MAO-Hemmer hat, ist unklar. Bei höheren Dosen, und bestenfalls nur beschränkt auf die kurzen Zeiten der Maximalplasmaspiegel, könnten die zusätzlichen noradrenergen Eigenschaften sowie eventuell auch sehr schwache amphetaminartige Wirkungen auftreten. In diesem Sinne könnte Tranylcypromin als MAO-Hemmer mit zusätzlichen „pulsierenden" monoaminergen Effekten bezeichnet werden.
> 
> *Riederer P, Lachmayer L, Laux G. Clinical application of MAO-Inhibitors. Curr Med Chem 2004; 11: 2033-43*


I will translate later, if I have to do. :afr


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## Vincent_32 (Dec 17, 2008)

*Parnate (the pros and cons)*

Well my Parnate experience turn to be the worse thing I live in my life...

And sure, above the 40 mg, it have a high effect on the NE...and strangely, it's more sedative.... and more powerfull than the Nardil, since at 20mg of Parnate I had severe hypotension orthostatic problem with hypertensive crisis that happen for no reason (not from the foods to avoid), something that only happen at 90mg of Nardil... BUT the Nardil never leave me with a blood pressure problem after I try it... and never help for the SAD anyway...

I used the Parnate only one month and it leave me with a permanent increase blood pressure... Related to the NE effect??? Maybe... the PDoc or the GP don't know....

Since my primary problem is SAD with panic disorder, the heart is an issue... I can't stop focusing on this, so I have often panic attacks trigger by this high blood pressure... so when I want to hit the gym and do cardio exercises, I ending almost each time by doing panic attacks... and when I drive the car also... who can be very dangerous because if I do a car accident, I can kill or hurt someone... I don'T care about my self than... but I care about the other peoples....

After the Parnate, I was put on the Clomipramine, an old TCA , but I was not able to take the side-effects of it... blood pressure again...

We try severals meds to reduce the blood pressure, Clonidine is one of them but never succeed to reduce it...

So I had a couple of months free of any AD's... and decide next week to start the Imipramine, who is another old TCA, but more tolerable than the Clomipramine... We all know that TCA's are not good for the SAD... but very effective for panic disorder with agoraphobia and panic attacks (trigger or not)...

For now, i'm on a low dose... 25mg x 2 by day... and it's very easy to take... I also use a Parkinson med at the same time, it's call "Mirapex"... that increasing the DA level (D3 mostly)... since SAD is often linked to a bad DA pathway...

I have no real side-effects, just strange sensations on my head (goosebumps feeling)... and no effect on my heart, who is strange cause the Tofranil (Imipramine) produce a metabolite who is call Despiramine (another old TCA affecting more the NE than anything else)... so the High blood pressure is maybe not related to the NE effect...

I suspect that the Parnate just leave me in a bad mental state, increasing my panic disorder problem and starting me focusing only on my heart.... and since the panic disorder can make a person more easy to always focus on the body sensations, I figure out that my panic attacks and high blood pressure is purely psychological... Well, I have HBP, since I monitor it often each day, but it's produce by psychologicals issues more than physicals issue.

They do on me a ECG or EKG (heart test) and everything is ok...

Anyway... what I can say is that peoples are very different... someone can deal with MAOI's... others don't... the heart effect (hypotension or hypertension) is a major problem for the MAOI's meds...

Why I choose the Imipramine, even if I know it's less effective for the SAD? Because my main problem for now is panic disorder (including panic attacks that happen suddenly or sometimes because of negatives thoughts about the heart issue)... I think the SAD can be well treat in CBT when the panic disorder is well treat with a good med, or sometimes a combo (2 meds at the same time)...

TO be honnest, I will never return on a MAOI's... Parnate or Nardil or even the Emsam patch, who are very expensive for nothing anyway...

Dealing with a lot of comorbidities (SAD, GAD, panic disorder with agoraphobia and panic attacks, body dismorphic...) make the choice of a med to be very complicated...

Anyway... that's an old thread... I didn't even remember that I start it !!! lol

Poor memory... thanks for the benzos drugs to make me acting like a dumb!!! ;-)

Well, I wish good luck to everyone who try the Parnate... it can be very effective... but also very nasty... just be sure to monitered your blood pressure often on it and make sure everything is ok... if you feel that something is wrong, or have severals hypertensives crisis without foods interractions, just stop it, that med is not for you ... Consider to try the Nardil first, who have less side-effects...


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## Bluemeow (Apr 18, 2009)

Medline, thanks for the information. I plugged the text into Google translator and I think I got the gist of it.

Vincent 32, thanks for sharing your experiences. I now how tough it is to find the combination of med's when you've got more than one issue to deal with. I have a some endocrine disorders which makes my med search a challenge too.


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