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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by SFY on November 4, 2004, at 14:41:58
I have anhedonia/dysthymia/lack of motivation (though my energy is OK) with a lifelong history of SP (more anticipatory anxiety, avoidance, and brain lock than physical symptoms). Right now, my emotional range seems to be even more dampened than usual. I also have recurrent, chronic insomnia which manifests as early awakening.
I just tried Selegiline (5-10mg with DLPA) to no effect (except for the paradoxical side effect of killing my libido and causing sexual dysfunction). With my current pdoc, I've tried Wellbutrin, Effexor, Celexa, Lexapro, and Dextroamphetamine with no success.
In the past, Prozac was effective for treating my major depression (though causing insomnia and sexual dysfunction) but didn't do anything for my SP. Nardil (with Klonopin) did a decent (but not spectacular) job on my SP. I had to give it up though after it started causing chronic insomnia which persisted long after I went off the Nardil. I started Mirtazapine after that and have continued to take a small dose at bedtime for years to manage my insomnia. (I went off it now because of possible interaction with the Selegiline.)
I had a consultation a little while ago with an uber-pdoc whose first (and only) recommendation after our one-hour meeting was Parnate. He also suggested Risperdal to deal with any insomnia issues caused by the Parnate.
I've been putting off trying Parnate with my pdoc (hence the Selegiline trial). First, because of a vacation where the dietary restrictions would have been problematical. Mostly though because I'm concerned about the insomnia especially since Parnate is more activating than Nardil. When my insomnia kicks in for more than a few days, I become a complete useless zombie. I have have some concerns about the diet but I dealt with this issue successfully when I was on Nardil.
My pdoc said that since my insomnia is obviously depression-related, a successful trial of Parnate might help resolve it. But if not we can always try the recommended dose of Risperdal or some other AP. I'm a little wary of taking an AP just for sleep but even more so after reading posts here that APs have caused anhedonia in some people (which would defeat the purpose of taking the Parnate in the first place). So I'm having problems making a decision (which is a problem anyway because of my dysthymia) about trying Parnate or something else.
I just wanted to get other people's experiences, insights, recommendations on my course of action.
Thanks!
Posted by Laree on November 4, 2004, at 15:57:10
In reply to What To Do Now? (anhedonia/dysthymia), posted by SFY on November 4, 2004, at 14:41:58
I have had chronic insomnia for years; however, my main problem is sleep onset. I tried Seroquel (an atypical AP) for a while. The degree to which it worked was actually a bit frightening. Soon after I took the nightly dose I literally felt I could NOT FIGHT FALLING ASLEEP! It was insane. I have been on many meds that are supposed to help with insomnia (Ambien, Sonata, Klonopin, Hydroxyzine, Elavil, Valium, Flexeril, Zanaflex, Oxazepam) and nothing has ever worked like Seroquel did; however, it's side effects were intolerable to me. I'd have the WORST hangovers in the morning. I felt like I just could not get up--sort of a "did I get run over by a train last night?" feeling. Also, weight gain (or potential for it) was an issue for me.
I don't think I'd ever touch this med again. In fact, I called the Astra-Zeneca about it & told them I could not believe it is not a scheduled med. I felt it was extremely potent (possibly to a dangerous degree). Anyway, a very low dose of Risperdal at night might be different. The same thing had been recommended to me before but I would not take it mainly due to the poss. of weight gain.
What other sleep meds could provide a safe interaction w/Parnate if you needed one, do you know? It is my belief that Ambien reacts with relatively few other meds--prob. Sonata as well, which is supposedly good for your type of insomnia.
Best,
L.
> My pdoc said that since my insomnia is obviously depression-related, a successful trial of Parnate might help resolve it. But if not we can always try the recommended dose of Risperdal or some other AP. I'm a little wary of taking an AP just for sleep but even more so after reading posts here that APs have caused anhedonia in some people (which would defeat the purpose of taking the Parnate in the first place). So I'm having problems making a decision (which is a problem anyway because of my dysthymia) about trying Parnate or something else.
>
> I just wanted to get other people's experiences, insights, recommendations on my course of action.
>
> Thanks!
Posted by King Vultan on November 5, 2004, at 13:03:21
In reply to What To Do Now? (anhedonia/dysthymia), posted by SFY on November 4, 2004, at 14:41:58
I take Parnate myself and have also tried Nardil, along with about ten other meds. I think Parnate is a good choice for your symptoms, but there is a good possibility it will give you insomnia. If it doesn't, great, but you do need to have a gameplan in case it does. A very low dose of Risperdal was actually something I was considering myself because this drug apparently blockades serotonin 2A receptors very selectively at low dosages, which has a number of therapeutic benefits, at least in theory. Improving sleep would be one of them, but there are others. What makes me wary is the paradoxical responses I've had to some other drugs that also blockade serotonin-2A receptors, such as nortriptyline and trazodone. Still, I may discuss it with my pdoc at some point.
For insomnia, it's hard to go wrong at least trying Ambien if it's affordable on your insurance (it really isn't on my mine). There are a number of other possibilities, but I think they generally have more drawbacks and side effects than does Ambien, which many doctors will let you use every night. Risperdal at a very low dosage might not be such a bad alternative, though, as it is so selective for the 5-HT2A receptors that there may be very little blockade of the dopamine D2 receptor. I feel that blockading that particular dopamine receptor is not a great thing to be doing for someone with anhedonia.
I don't know if the super-doc you talked to had any thoughts on your paradoxical reaction to selegiline, but reactions opposite to what generally happens suggests to me that you may have hypersensitive autoreceptors in one of your major neurotransmitter systems. That is, you may have too many inhibitory receptors, which react to the release of the neurotransmitter by inappropriately slowing or shutting down the firing rate of the neuron. Selegiline is extremely dopaminergic, and your paradoxical reaction suggests a possible problem in your dopamine system, as does your anhedonia and lack of motivation.
Parnate is also dopaminergic, but less so than selegiline. If you are able to work up to a high enough dosage, which might be anywhere between 40-80 mg/day for solid therapeutic effects, I think you might find it be a very effective drug, and one that I would hope and think would induce less sexual effects than the selegiline. If you try it, I would give it time to work also. In my case, it induced periods of outright depression after some of my dosage increases, but these subsided after several days to a week. The insomnia I've suffered on it remains by far my biggest problem, but I will eventually find a med or a combo of meds that are affordable and work.
Todd
Posted by sfy on November 8, 2004, at 17:49:41
In reply to Re: What To Do Now? (anhedonia/dysthymia) » SFY, posted by King Vultan on November 5, 2004, at 13:03:21
> For insomnia, it's hard to go wrong at least trying Ambien if it's affordable on your insurance (it really isn't on my mine). There are a number of other possibilities, but I think they generally have more drawbacks and side effects than does Ambien, which many doctors will let you use every night. Risperdal at a very low dosage might not be such a bad alternative, though, as it is so selective for the 5-HT2A receptors that there may be very little blockade of the dopamine D2 receptor. I feel that blockading that particular dopamine receptor is not a great thing to be doing for someone with anhedonia.
I tried Ambien a few years ago for my endogenous (i.e., non-drug related) insomnia and it had absolutely no effect. When I took Prozac years ago, a nightly dose of trazodone helped me sleep. But the one thing that has consistently worked for my endogenous, early-awakening insomnia is a small (7.5 mg) dose of mirtazapine. Even a sleep doc recommended it after they could find no organic cause for my insomnia (it's most likely related to my constant low-level depression). Unfortunately, as far as I know, mirtazapine is contraindicated when taking MAOI's (and I don't think I want to experiment). On selegiline, I took diphenhydramine (Benadryl) but that's proved only partly effective.
>
> I don't know if the super-doc you talked to had any thoughts on your paradoxical reaction to selegiline, but reactions opposite to what generally happens suggests to me that you may have hypersensitive autoreceptors in one of your major neurotransmitter systems. That is, you may have too many inhibitory receptors, which react to the release of the neurotransmitter by inappropriately slowing or shutting down the firing rate of the neuron. Selegiline is extremely dopaminergic, and your paradoxical reaction suggests a possible problem in your dopamine system, as does your anhedonia and lack of motivation.I saw the super-doc months ago before trying selegiline (been putting off the Parnate decision for awhile) so I don't know what he would think about my reaction to it (and I'm not paying $$$ again to find out). I'll ask my regular pdoc if he has any thoughts about but I'm not sure how well-versed he is on the subject. (Though he was more than happy to let me try selegiline just on my say-so.)
>
> Parnate is also dopaminergic, but less so than selegiline. If you are able to work up to a high enough dosage, which might be anywhere between 40-80 mg/day for solid therapeutic effects, I think you might find it be a very effective drug, and one that I would hope and think would induce less sexual effects than the selegiline. If you try it, I would give it time to work also. In my case, it induced periods of outright depression after some of my dosage increases, but these subsided after several days to a week. The insomnia I've suffered on it remains by far my biggest problem, but I will eventually find a med or a combo of meds that are affordable and work.
>
> ToddI'm still struggling with the Parnate decision (esp. now that my mood seems to have brightened somewhat since I stopped the selegiline but that could just be cyclical). I was trying to see if there was one last non-MAOI option to try before taking the Parnate plunge. Or at least hoping the Emsam patch might be an option by now (though consideration my reaction to selegiline I'm not sure how worthwhile that would be).
This is the end of the thread.
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