10 replies to this topic

[penisbreath]

Just wanting some advice -- suffer from atypical depression, ADD, severe OCD ..

Never really had an AD response until I was placed on Parnate last year. SSRIs ameliorated some of the physical side-effects like leaden paralysis but did nothing for cognition/anhedonia. I'd been in a near-vegetative state for about 3 years and Parnate brought me back to life, but I needed 60mg in order to achieve a stable remission.

The problem was a) I seem to be highly sensitive to medication (particularly stimulants) and even 10mg at a time could be overpowering, so I was dosing 6 times a day, which was highly impractical. What's more, any overlap in dosing would just leave me feeling foggy and non-functional.

b) The medication had no effect on my OCD/anxiety.

Anyway, I ended up coming off it because I was fearful of the diet restrictions and wanted to trial Memantine, which failed to pan out. So now I've spent the past 5 months in a depressed, highly anxious, borderline-suicidal state. I did manage to haul my a** off to see one final psychiatrist who received rave reviews online, and who wants to revisit Parnate. He's a psychopharmacologist and so is looking at 60mg as a minimum dose, with the idea of tapering upwards once stabilized.

My last psychiatrist suspected I might have some issue with a slow metabolism, but this guy doesn't agree -- though he hasn't given any basis for that decision. He also doesn't want me splitting the dose up through the day, and believes it should all be taken before 3pm in order to avoid insomnia.

So, I'm a little concerned about clumping everything together given that I already felt overstimulated taken 6x10mg about 1.5 hours apart ... hence, my first question: Does anyone know if Parnate becomes *more* anxiolytic at higher doses? This is something I've heard before. I've just started again on 30mg a day, which is okay, because I can space it appropriately.

Second question: I'm taking 0.5mg of clonazepam twice a day. I was put on it about five days ago. I trialed Xanax on its own for about two weeks and had a full-blown paradoxical reaction (i.e. increased anxiety, activation, etc.). Either clonazepam isn't doing anything for me, or it's making me worse, because I can generally swear I feel more alert after taking it. I used it last time I was on Parnate and would sometimes have difficulties sleeping after dosing .. so I donno .. given the half-life and all, how long is necessary to determine if Clonazepam is/n't working? I e-mailed this new psychiatrist and he didn't think it was the clonazepam.

Finally, is anyone aware of any supplements that can help possibly mellow the Parnate and curb the overstimulation so I can reap the anti-attentional benefits? I have no idea why, but anything classically inhibiting (Taurine, magnesium, Memantine) just activates me these days. NAC seemed like a perfect candidate but it causes respiratory issues. What about Uridine?

Thank you for reading!

[socialpiranha]

i've only had experience with phenelzine and moclobemide not parnate, clonazepam is one of the best meds out there for anxiety but like xanax can have a paradoxical effect though less likely than xanax. In certain cases in can cause irritability agitation and even automatism. I had the paradoxical effect with xanax as well, felt a lot like forskolin and other cAMP elevators very panicky. i find clonazepam can make me very irritable when its wearing off.

in terms of something to take the edge off the stimulation, sarcosine might be helpful although i don't know if its totally maoi friendly or not. some ppl find hydroxyzine helpful although i don't. etifoxine has "background" effects and can be used in conjunction with benzo's, it also increases nerve growth factor in the brain and repairs damaged peripheral nerves(cured my akathisia!).

[penisbreath]

Thanks for your response. I've been on clonazepam a few times now and I'm convinced it's jacking me up -- I'll take it before bed and feel sedated for 20 minutes or so, then suddenly become wired. My psychiatrist kind of implied I was being a hypochondriac when I emailed him about it, though.

[penisbreath]

sarcosine might be helpful although i don't know if its totally maoi friendly or not.

Sarcosine actually sounds really enticing. I found an impressive study on its use in OCD. What makes you think it wouldn't be MAOI friendly? Isn't it basically just an NMDA agonist?

[Tom_]

Consider other additional diagnoses personality disorders & neurodevelopmental are the most likely.

Get yourself off clonzepam. Benzos long term is the worst idea known to man.

moclobemide should be your first MAOI trial, followed by phenelzin.

Have you tried any tricyclics? Again they should be tried ususally before MAOI's. Clomipramine is very effective in depression and OCD.

What about psychotherapy and behavioual activation? I'm actually beginning to get sick and tired of having to recommend it as much as a I recommend medication :L Its going to play just as an important part in long term treatment response.

In STAR*D a Mirtazapine, Venlafaxine combined proved slightly more effective than monotherapy MAOI. With a lot less side effects.

Another option would be medium dose moclobemide (or any maoi but this is the safest combo) and Clomipramine (could be any antidepressant but is paticually effective in OCD).

I would recommend a meds treatment plan as follows:

Mirtazapine (45mg max dose) + Venlafaxine (300mg max dose) should trial for 6 weeks before discarding if there is no treatment efficacy, wait another 2-4 if there is partial treatment response.
if no TCA's tried consider as monotherapy
moclobemide monotherapy (dose 300mg maximum)
moclobemide + Clomipramine
reconsider Tranylcypromine (could try lower dosage incombo with another drug)

[Strangelove]

Your situetion sounds "complex" as mine also... I do not have an answer for helping with your issues, just a few remarks that you may want to investigate further. Parnate has a similar action like amphetamines at around 1/10 strength, I am not sure if you can get over this effect that you can feel for more than a couple hours? In general yes can be anxyolytic (depending on the kind of anxiety) as (I do not remember the mechanism of action) would bring down dopamine in prefrontals, helping if this is an issue, at the same time increasing dopamine in other areas. I think reading that inositol can be almost a miracle for ocd. Most importantly do not think medication and therapy as your only possible solutions, suplementation of vitamins/precursors e.t.c can have great impact on brain health under the guidance of a therapist, Mr Walsh being a good example, Nutrient Power: Heal Your Biochemistry and Heal Your Brain. Also "brain machines" could put an extra piece on the "puzzle" of getting well.

[darksanity]

You'd probably be better off with Nardil (phenelzine) than Parnate. Have you tried Nardil?

Edited by darksanity, 18 May 2013 - 07:12 AM.

[penisbreath]

You'd probably be better off with Nardil (phenelzine) than Parnate. Have you tried Nardil?

I was placed on Nardil fairly early into treatment, about 5 years ago. I wasn't really prepared for the side-effects so bailed after the chronic insomnia became too much. My psychopharmacologist thinks Nardil is an inferior choice because it won't help ADHD.

There seem to be reports of Parnate becoming more anxiolytic at higher doses. I think it downregulates 5-HT2a receptors at 80mg. Right now, 40mg is just anger/despair-inducing, so I'm hoping for a rapid titration. If I don't get results at higher doses, I'll bail.

Get yourself off clonzepam. Benzos long term is the worst idea known to man.

It's a temporary measure to deal with Parnate start-up effects.

moclobemide should be your first MAOI trial, followed by phenelzin.

Moclobemide was a moderate anxiolytic, poor anti-depressant; I'd revisit Phenezile if all else fails, but then I'd have to abandon any hope of treating my attentional symptoms.

Have you tried any tricyclics? Again they should be tried ususally before MAOI's. Clomipramine is very effective in depression and OCD.

Clomipramine agitated me and caused dysphoria. I've used amitriptyline for sleep. Low-dose nortriptyline was good for ADD, but not anxiety.

What about psychotherapy and behavioual activation? I'm actually beginning to get sick and tired of having to recommend it as much as a I recommend medication :L Its going to play just as an important part in long term treatment response.

I was in psychodynamic therapy for 2 years. I plan to revisit CBT once my symptoms are under more effective control. I tried recently and there was very little that could be achieved in this state.

[socialpiranha]

sarcosine might be helpful although i don't know if its totally maoi friendly or not.

Sarcosine actually sounds really enticing. I found an impressive study on its use in OCD. What makes you think it wouldn't be MAOI friendly? Isn't it basically just an NMDA agonist?

nmda receptors are closely linked with serotonin function so i dunno if it could cause serotonin syndrome or not. probably not actually because nmda antagonists definitely cause serotonin syndrome and sarc is an indirect agonist. I just thought i should mention it just in case cause interactions can be fatal.

[socialpiranha]

moclobemide made me see everything with a tint of red it was extremely strange. The blissful ignorance of being an animal with savage tendencies was shattered too, i felt like a wild beast ha very weird. Phenelzine took away anxiety but not independently from making me tired, i couldnt keep my eyes open. parnate is pretty much the only only thing on the market for any mental health issue i haven't tried. I'm saving it as a last resort because of its side effect profile, if i feel like quitting the game i'll try parnate first. until then i'll be focusing on research drugs targeting glucose transport/insulin resistance, cortisol, dynorphin and the stress response and neurotrophic factors.

[lourdaud]

Try adding an NRI to your MAOI I'd say.
I'm on moclobemide and reboxetine and this may be the best combo I've tried so far. Helps with both atypical depression, anxiety and ADHD.