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What can I mix with Parnate (MAOI)

maoi parnate schizophrenia depression

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#1 YoungSchizo

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Posted 06 October 2017 - 05:54 PM


Hey guys,

 

I've been on Parnate for 4 weeks now. On 20mg it got rid of my suicidal ideation (the biggest improvement), lifted my depression a little, decreased anxiety, increased my motivation and concentration a bit and it kinda works a bit "antipsychotic". With antipsychotic I mean that I have more control over my thoughts, can arrange thoughts more easily and (traumatic) memories from the past has somewhat stopped haunting me. 

However, the anhedonia, avolition and social withdrawal are still there and severe. I tried to raise my dosage twice to 30mg (in the hopes to get it's full antidepressant benefits and in the hopes it might help with my negative symptoms), once a couple of weeks ago and once this past weekend. Both times it lost it's antipsychotic effects and increased my positive symptoms, I also get melancholically depressed at that dose. I can't even tolerate 25mg without getting those adverse effects.

 

I was wondering, since 20mg isn't even considered a "therapeutic" dose and is fairly low, if I can maybe mix it with other antidepressant without evoking serotonin-syndrome or hypertension. I'm already on Mirtazapine, varying dosages of 15/30mg (for sleep) and so far haven't noticed any interactions with Parnate but I also don't notice any other benefits. So my question is, what are my options to mix with Parnate? 


Edited by YoungSchizo, 06 October 2017 - 05:57 PM.


#2 Stinkorninjor

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Posted 06 October 2017 - 07:22 PM

Hmm, haven't you instead simply considered raising the dosage of one of your antipsychotics instead of adding another antidepressant? Thereby, you might be able to avoid some of these problems, and still increase Tranylcypromine dosage.

 

You might perhaps also look into Modafinil - it's got some evidence of efficacy against negative symptoms, and some evidence of synergy with antidepressants.

 

The concerns with concomitant use with an MAOI are mostly theoretical, and hasn't really been proven in a clinical setting, since the two would so rarely be prescribed at the same time, and since MAOI's have also gone out of popular use before the introduction of Modafinil to the market.

 

Here, some examples of their combined use:

 

https://www.ncbi.nlm...pubmed/15341899

 

https://www.omicsonl...9.php?aid=58366

 

And here's a small note from an alleged specialist that the combination is likely to be less dangerous than classic monoamine reuptake inhibitors...

http://www.dr-bob.or...sgs/763156.html

(it's not much, but it's something)

 

No hypertensive crisis.

 

 

Of course, if you've tried modafinil and found it to worsen positive symptoms, then Modafinil is off the table...

 

 

Otherwise, as previously stated - a Third-gen antipsychotic like Brexpiprazole, or that one that's being approved in the EU soon (man, I gotta' read up on it!) - and possibly Ondansetron.



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#3 YoungSchizo

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Posted 06 October 2017 - 09:25 PM

Hmm, haven't you instead simply considered raising the dosage of one of your antipsychotics instead of adding another antidepressant? Thereby, you might be able to avoid some of these problems, and still increase Tranylcypromine dosage.

 

You might perhaps also look into Modafinil - it's got some evidence of efficacy against negative symptoms, and some evidence of synergy with antidepressants.

 

The concerns with concomitant use with an MAOI are mostly theoretical, and hasn't really been proven in a clinical setting, since the two would so rarely be prescribed at the same time, and since MAOI's have also gone out of popular use before the introduction of Modafinil to the market.

 

Here, some examples of their combined use:

 

https://www.ncbi.nlm...pubmed/15341899

 

https://www.omicsonl...9.php?aid=58366

 

And here's a small note from an alleged specialist that the combination is likely to be less dangerous than classic monoamine reuptake inhibitors...

http://www.dr-bob.or...sgs/763156.html

(it's not much, but it's something)

 

No hypertensive crisis.

 

 

Of course, if you've tried modafinil and found it to worsen positive symptoms, then Modafinil is off the table...

 

 

Otherwise, as previously stated - a Third-gen antipsychotic like Brexpiprazole, or that one that's being approved in the EU soon (man, I gotta' read up on it!) - and possibly Ondansetron.

 

Zyprexa I won't raise because on higher dosages some of my positive symptoms get worse. Latuda I can't raise because then it'll interact with Mirtazapine.

I have tried Modafinil before and it didn't cause aggravation of positive symptoms. However, it made feel drugged (speedy.. like I had 10 cups of coffee without experiencing the side-effects) and I don't like drugs that makes me feel drugged. But I think it must have been a decade or so that I've tried Modafinil, I'll have a look into it again.

 

My dad was unable to bring me Ondansetron from abroad and I'm pretty much broke for the upcoming 2 months so I won't be able to trial that anytime soon. I want to swap Latuda (and maybe Zyprexa also) for Cariprazine but Cariprazine is still not marketed in the EU although it has been approved in May this year. I have no idea when it will be marketed, someone told it'll be all the way in the second quarter of 2018!  :|?



#4 Stinkorninjor

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Posted 06 October 2017 - 09:33 PM

At what dosage did you try Modafinil? 200 mg? Simply consider using a lower dosage - some people get effects at as low as 50 mg, and you're also taking antipsychotics with it this time, so it's bound to feel different - I'd argue the antihistaminergic properties of Tranylcypromine (parnate) is bound to alter the experience quite a bit.

 

For what it's worth, I find that the ONLY thing which helps me with the dreadful antihistamine hangover I get from Mirtazapine is Modafinil - not even classical stimulants can fully get me back from that, but Modafinil can.



#5 YoungSchizo

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Posted 06 October 2017 - 09:46 PM

At what dosage did you try Modafinil? 200 mg? Simply consider using a lower dosage - some people get effects at as low as 50 mg, and you're also taking antipsychotics with it this time, so it's bound to feel different - I'd argue the antihistaminergic properties of Tranylcypromine (parnate) is bound to alter the experience quite a bit.

 

For what it's worth, I find that the ONLY thing which helps me with the dreadful antihistamine hangover I get from Mirtazapine is Modafinil - not even classical stimulants can fully get me back from that, but Modafinil can.

 

Yes. 200mg I think (if that's the lowest dosage they come in). But, it just came to mind, I already suffer from sleep maintenance insomnia and I'm guessing Moda will only make it worse.

 

For a long time, Mirta and Zyprexa was the ultimate combo for me. I slept well and wake-up refreshed. Now however, ever since adding Latuda (which is a great drug for positive symptoms and therefore I'm taking it) I also wake-up with a "hangover", it takes me at least 2 hours to fully wake-up.

 

Can't I mix Parnate with one of the more activating antidepressants?



#6 CWF1986

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Posted 07 October 2017 - 07:18 AM

 

At what dosage did you try Modafinil? 200 mg? Simply consider using a lower dosage - some people get effects at as low as 50 mg, and you're also taking antipsychotics with it this time, so it's bound to feel different - I'd argue the antihistaminergic properties of Tranylcypromine (parnate) is bound to alter the experience quite a bit.

 

For what it's worth, I find that the ONLY thing which helps me with the dreadful antihistamine hangover I get from Mirtazapine is Modafinil - not even classical stimulants can fully get me back from that, but Modafinil can.

 

Yes. 200mg I think (if that's the lowest dosage they come in). But, it just came to mind, I already suffer from sleep maintenance insomnia and I'm guessing Moda will only make it worse.

 

For a long time, Mirta and Zyprexa was the ultimate combo for me. I slept well and wake-up refreshed. Now however, ever since adding Latuda (which is a great drug for positive symptoms and therefore I'm taking it) I also wake-up with a "hangover", it takes me at least 2 hours to fully wake-up.

 

Can't I mix Parnate with one of the more activating antidepressants?

 

 

I've seen case reports of combining it with desipramine.  I don't know if bupropion or reboxetine would be safe or not.  Low doses of methylphenidate or amphetamine.  I've even seen reports where the combination of parnate, nortriptyline, and dextroamphetamine are used in combination.  Granted the stimulant doses are very low since parnate metabolizes into a stimulant and is not just a MAOI A inhibitor but also a MAOI B inhibitor.  There's strong empirical evidence that nortriptyline taken with parnate will very significantly reduce the pressor response or more commonly called the cheese effect.  



#7 Deaden

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Posted 07 October 2017 - 10:56 AM

http://psychotropica...pping-combining

 

You should probably increase dose and combine Parnate with Nortriptyline for your anhedonia. 


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#8 YoungSchizo

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Posted 08 October 2017 - 06:17 PM

 

 

At what dosage did you try Modafinil? 200 mg? Simply consider using a lower dosage - some people get effects at as low as 50 mg, and you're also taking antipsychotics with it this time, so it's bound to feel different - I'd argue the antihistaminergic properties of Tranylcypromine (parnate) is bound to alter the experience quite a bit.

 

For what it's worth, I find that the ONLY thing which helps me with the dreadful antihistamine hangover I get from Mirtazapine is Modafinil - not even classical stimulants can fully get me back from that, but Modafinil can.

 

Yes. 200mg I think (if that's the lowest dosage they come in). But, it just came to mind, I already suffer from sleep maintenance insomnia and I'm guessing Moda will only make it worse.

 

For a long time, Mirta and Zyprexa was the ultimate combo for me. I slept well and wake-up refreshed. Now however, ever since adding Latuda (which is a great drug for positive symptoms and therefore I'm taking it) I also wake-up with a "hangover", it takes me at least 2 hours to fully wake-up.

 

Can't I mix Parnate with one of the more activating antidepressants?

 

 

I've seen case reports of combining it with desipramine.  I don't know if bupropion or reboxetine would be safe or not.  Low doses of methylphenidate or amphetamine.  I've even seen reports where the combination of parnate, nortriptyline, and dextroamphetamine are used in combination.  Granted the stimulant doses are very low since parnate metabolizes into a stimulant and is not just a MAOI A inhibitor but also a MAOI B inhibitor.  There's strong empirical evidence that nortriptyline taken with parnate will very significantly reduce the pressor response or more commonly called the cheese effect.  

 

 

I'll have a look into Desipramine, never heard of it before. I won't go down the road with amphetamines though, also tried Ritalin in the past, made me hallucinate even though I was on antipsychotics. Modafinil seems like a safe option to consider.

 

 

http://psychotropica...pping-combining

 

You should probably increase dose and combine Parnate with Nortriptyline for your anhedonia. 

 

Thanks for reminding me of the MAOI's guide, had totally forgotten it. Gonna dig into that when I have the time.

Aside from adding Nortriptyline, do you have other suggestions in my particular situation to raise the dosage of Parnate? I have no high hopes that adding Nort will be a solution to the psychotic reaction I'm having if I raise my dose any higher than 20mg.



#9 YoungSchizo

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Posted 08 October 2017 - 06:22 PM

Also I haven't taken my (high dosed sports)multivitamins eversince starting Parnate because they're contraindicated.. I actually need them, with the cold weather coming I need it to keep away the flu and of course it's important for recovery from work-outs and as add-on to food and general health.

 

And btw who is this MAOI "God" Dr. Ken Gillman? Some people on forums say they've discussed MAOI's with him. Can I also contact him for free or will he charge me?



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#10 ThreeKings12341

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Posted 08 October 2017 - 07:39 PM

Also I haven't taken my (high dosed sports)multivitamins eversince starting Parnate because they're contraindicated.. I actually need them, with the cold weather coming I need it to keep away the flu and of course it's important for recovery from work-outs and as add-on to food and general health.

 

And btw who is this MAOI "God" Dr. Ken Gillman? Some people on forums say they've discussed MAOI's with him. Can I also contact him for free or will he charge me?

 

yep u can skype him , even deaden did it for free (i think)

 

i emailed him and he responded 2 days l8er :)


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