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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by orchidrare on April 21, 2008, at 10:30:12
Hello There
I am hoping someone might lend a little help with some side effects I am experiencing on Parnate. Your aid would be much appreciated.
I have had dysthymia (double depression) since about 9. I am now in my 30's. I have tried the various ADs (SSRI's, TCA's, Effexor, Wellbutrin, etc.) medications with minimal success. I have now been put on Parnate, starting with 10mg per day increasing by 10mgs per week up to 40 mg per day. I have been on 40mgs per day for nine days.
Within one hour on the first day I started taking (10mg) I developed weakness that saw me needing help to walk and tremendous fatigue. It seemed my head was also struggling with this weakness, if that makes sense. I have continued to increase the dose nonetheless. The weakness has improved enough to move unaided (though not enough to leave the house) but my voice is still weak and the 24-hour fatigue is still marked.
It has also seemed to bring on a deep depression with absolutely no drive and motivation, none of which seems linked to the weakness which I had originally thought. It is as if I am a human-shaped balloon and all the air has been taken out leaving me heavy and unable to lift limb or whole body or mind. I have always struggled with lack of energy and wondering what is the point. But I have never experienced not caring about anything, which I have developed in the last few weeks. I just don't care.
I am persevering as the medication deserves it's chance to work and I want it to work. The doctor agrees with this. Will the weakness and fatigue subside? And the apathy? Has anyone else experienced an increase in depression on Parnate?
Thanks for reading this.
Posted by Quintal on April 21, 2008, at 12:00:50
In reply to Parnate Users-increase in Depression?, posted by orchidrare on April 21, 2008, at 10:30:12
That sounds a lot like what happened to me when I first started Parnate. In the beginning it made my depression much worse to the point where I felt suicidal, so I kept raising the dose until I felt the stimulant effect, and from then on it was much better. In the end I was taking 80-120mg a day, but my psychiatrist didn't approve of this and took me off it. For the short time I took Parnate it was one of the most effective ADs I've ever tried. I can only advise you stick it out a little longer or try raising the dose further (if you can tolerate it and your pdoc agrees).
The weakness might be related to hypotension - it's common at the beginning of treatment with MAOIs. Have you checked your blood pressure?
Q
Posted by Bob on April 21, 2008, at 14:15:27
In reply to Re: Parnate Users-increase in Depression?, posted by Quintal on April 21, 2008, at 12:00:50
> That sounds a lot like what happened to me when I first started Parnate. In the beginning it made my depression much worse to the point where I felt suicidal, so I kept raising the dose until I felt the stimulant effect, and from then on it was much better. In the end I was taking 80-120mg a day, but my psychiatrist didn't approve of this and took me off it. For the short time I took Parnate it was one of the most effective ADs I've ever tried. I can only advise you stick it out a little longer or try raising the dose further (if you can tolerate it and your pdoc agrees).
>
> The weakness might be related to hypotension - it's common at the beginning of treatment with MAOIs. Have you checked your blood pressure?
>
> Q
If it was one of the most effective ADs you ever tried, why were you taken off of it? Why didn't your doc just lower your dose?
Posted by orchidrare on April 21, 2008, at 15:08:42
In reply to Re: Parnate Users-increase in Depression? » Quintal, posted by Bob on April 21, 2008, at 14:15:27
> > That sounds a lot like what happened to me when I first started Parnate. In the beginning it made my depression much worse to the point where I felt suicidal, so I kept raising the dose until I felt the stimulant effect, and from then on it was much better. In the end I was taking 80-120mg a day, but my psychiatrist didn't approve of this and took me off it. For the short time I took Parnate it was one of the most effective ADs I've ever tried. I can only advise you stick it out a little longer or try raising the dose further (if you can tolerate it and your pdoc agrees).
> >
> > The weakness might be related to hypotension - it's common at the beginning of treatment with MAOIs. Have you checked your blood pressure?
> >
> > Q
>
>
> If it was one of the most effective ADs you ever tried, why were you taken off of it? Why didn't your doc just lower your dose?
>Thank you for your post and reassurances. Last check my blood pressure was 95/78. I am sorry you had to come off Parnate. Depression is an evil beast. I hope your current regime is working.
Posted by Quintal on April 21, 2008, at 15:16:56
In reply to Re: Parnate Users-increase in Depression? » Quintal, posted by Bob on April 21, 2008, at 14:15:27
Because the prescribing guidelines set an upper limit of 30mg here in the UK, in fact I think the PDR in America says the same thing, but most pdocs there seem to prescribe *much* higher doses. I didn't want to continue at 30mg because it made me feel worse in that dose range. I don't know why, but the prescribing advice is too conservative and an awful lot of people that come here are taking more than the recommended maximum dose. The prescribing guidelines recommend lowering the dose to one tablet daily as a maintenance dose, but I've never heard of anyone doing this.
My pdoc actually discharged me at the next appointment, so I was left with no treatment for two years. That's just the way he is, it has no reflection on the efficacy of Parnate.
Q
Posted by undopaminergic on April 23, 2008, at 2:16:42
In reply to Re: Parnate Users-increase in Depression? » Bob, posted by Quintal on April 21, 2008, at 15:16:56
> Because the prescribing guidelines set an upper limit of 30mg here in the UK, in fact I think the PDR in America says the same thing, but most pdocs there seem to prescribe *much* higher doses. I didn't want to continue at 30mg because it made me feel worse in that dose range. I don't know why, but the prescribing advice is too conservative and an awful lot of people that come here are taking more than the recommended maximum dose. The prescribing guidelines recommend lowering the dose to one tablet daily as a maintenance dose, but I've never heard of anyone doing this.
>From the (FDA-approved) prescribing info:
"The usual effective dosage is 30 mg per day, usually given in divided doses. If there are no signs of improvement after a reasonable period (up to 2 weeks), then the dosage may be increased in 10 mg per day increments at intervals of 1 to 3 weeks; the dosage range may be extended to a maximum of 60 mg per day from the usual 30 mg per day."I suspect that anyone needing no more than 30 mg is quite fortunate and exceptional. However, one Parnate expert says most patients respond to 30-50 mg.
Posted by Questionmark on April 27, 2008, at 2:38:21
In reply to Re: Parnate Users-increase in Depression? » Bob, posted by Quintal on April 21, 2008, at 15:16:56
Your pdoc sounds like a jerk-- and an idiot. Apparently they're not any better in the UK than here in the US. Oh yeah, and that whole lowering to one pill a day maintenance dose thing? Pure bull. I just wrote a whole post about that concept in a different thread.
Maybe you should try to find another doc who would be willing to prescribe you Parnate, if you're not fine right now?
> Because the prescribing guidelines set an upper limit of 30mg here in the UK, in fact I think the PDR in America says the same thing, but most pdocs there seem to prescribe *much* higher doses. I didn't want to continue at 30mg because it made me feel worse in that dose range. I don't know why, but the prescribing advice is too conservative and an awful lot of people that come here are taking more than the recommended maximum dose. The prescribing guidelines recommend lowering the dose to one tablet daily as a maintenance dose, but I've never heard of anyone doing this.
>
> My pdoc actually discharged me at the next appointment, so I was left with no treatment for two years. That's just the way he is, it has no reflection on the efficacy of Parnate.
>
> Q
Posted by Questionmark on April 27, 2008, at 2:42:33
In reply to Parnate Users-increase in Depression?, posted by orchidrare on April 21, 2008, at 10:30:12
That's strange. I experienced moments (periods?) of extreme depression when i was on Parnate, but they were totally of the excessively emotional, oversensitive, feeling-too-much nature. Incidentally Nardil has been by far the best antidepressant for me-- best drug period for all my issues in general.
> Hello There
>
> I am hoping someone might lend a little help with some side effects I am experiencing on Parnate. Your aid would be much appreciated.
>
> I have had dysthymia (double depression) since about 9. I am now in my 30's. I have tried the various ADs (SSRI's, TCA's, Effexor, Wellbutrin, etc.) medications with minimal success. I have now been put on Parnate, starting with 10mg per day increasing by 10mgs per week up to 40 mg per day. I have been on 40mgs per day for nine days.
>
> Within one hour on the first day I started taking (10mg) I developed weakness that saw me needing help to walk and tremendous fatigue. It seemed my head was also struggling with this weakness, if that makes sense. I have continued to increase the dose nonetheless. The weakness has improved enough to move unaided (though not enough to leave the house) but my voice is still weak and the 24-hour fatigue is still marked.
>
> It has also seemed to bring on a deep depression with absolutely no drive and motivation, none of which seems linked to the weakness which I had originally thought. It is as if I am a human-shaped balloon and all the air has been taken out leaving me heavy and unable to lift limb or whole body or mind. I have always struggled with lack of energy and wondering what is the point. But I have never experienced not caring about anything, which I have developed in the last few weeks. I just don't care.
>
> I am persevering as the medication deserves it's chance to work and I want it to work. The doctor agrees with this. Will the weakness and fatigue subside? And the apathy? Has anyone else experienced an increase in depression on Parnate?
>
> Thanks for reading this.
>
>
Posted by elanor roosevelt on April 27, 2008, at 14:52:31
In reply to Parnate Users-increase in Depression?, posted by orchidrare on April 21, 2008, at 10:30:12
I had an odd time with Parnate
It happened slowly over several months and it took a long time for me to figure out because i slowly started hating myself and eventually experienced such extreme self-loathing that I didn't understand that I needed help
surely i did not deserve it
it is scary to look back at it
i was lucky that i had occasional windows of lucidity and managed to make some calls because once i said some things out loud i realized how fragile i wasis 40mg your target?
it sounds like you are going through a real nightmare
don't some pdocs supplement parnate with stimulants?
you've got to get moving and get out of your house
This is the end of the thread.
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