Posted by ed_uk on December 31, 2004, at 14:48:30
In reply to Re: About high-dose Parnate treatment, posted by don_bristol on December 31, 2004, at 14:05:01
Hi!!
Pharmacopsychiatry. 1989 Jan;22(1):21-5.High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.
Posted by Chairman_MAO on November 4, 2004, at 4:10:07In reply to Re: Downregulating dopamine autoreceptors, posted by King Vultan on October 17, 2004, at 0:15:35
For what any anecdote is worth:
I used to take trazodone to sleep on Parnate. I absolutely hated it, primarily because of its adrenergic antagonism. I found it negated a good part of the motivational and anti-ADD effects of the Parnate that are essential for me.
At any rate, once I got over 150mg/day, the insomnia paradoxically disappeared, and I sleep like a baby. Jay Amsterdam's study of tranylcypromine in treatment-resistant depression is right on the money. At 200mg/day, I find Parnate profoundly calming, not activating. The insomnia is gone--although I can choose to stay up, as I did tonight, but that's a sleep hygene issue of mine that should not be band-aided with drugs--as is any agitation. The improvement in depression compared to, let's say, when I was taking 80mg/day is minimal, but the improvement in social phobia and self-esteem is INCREDIBLE and worlds beyond 80mg/day. Also, the hypersexuality of the lower (10-30mg/day) doses and the occasional anaorgasmia of 80mg/day seem averaged together to create a healthy, moderate sex drive with AMAZING orgasms and erotic sensorium.
I am convinced that the reason everyone thinks Nardil is better than Parnate for social phobia is that the doses of Parnate used are woefully inadequate. Honestly, I could not conceive of anyone needing any adjunctive medication for social phobia at 200mg/day, but if they did, I'm sure a pinch of clonazepam, beta-phenyl-GABA/baclofen, Neurontin, or your MAOI-friendly treatment of choice would fill in any gaps. I personally find that picamilon works wonders with it, although if there were a safe GABA-T inhibitor on the market, I'd definitely try that to push things more toward the Nardil end of things.
Maybe I should try a high quality valerian extract; anyone know of anything else besides Depakote, gama-vinyl-gaba, and the hydrazine MAOIs that inhibits GABA-T?
poster:ed_uk
thread:435178
URL: http://www.dr-bob.org/babble/20041228/msgs/436063.html