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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Terry8 on March 16, 2011, at 15:03:48
I didn't see anything in the archives, but my apologies if this has been discussed before. I'm newish to Parnate and experiencing the usual nighttime insomnia and afternoon fatigue. I've heard that you should take the doses earlier in the day to prevent insomnia, but most people seem to have the problem anyway. What about flip flopping the timing entirely?
I take my doses at 8am, 12pm, and 3pm. By 2pm I'm very tired, and though I haven't been napping in the afternoon, I'm sure if I let myself I could fall asleep in a heartbeat. But by 8pm I'm wide awake again and can't get to sleep until 2am at the earliest. So I get really tired six hours after the first dose, and am wide awake another six hours later.
What if I were to take the doses in the evening, starting around dinnertime? So a first dose at 6pm, a second at 9pm, and last one at midnight (followed by going to bed). If the pattern holds, I'd be tired and ready to sleep six hours after the first dose (around midnight) and waking up again six hours later, around 6am -- a bit more like the rest of the world.
Or does it not work like that? Has anybody tried this?
Thanks!
Posted by emmanuel98 on March 16, 2011, at 19:36:21
In reply to nighttime Parnate dosing?, posted by Terry8 on March 16, 2011, at 15:03:48
I've had terrible insomnia with parnate, literally 48-72 hours without sleep. I switched my dose to 2 in the morning and 1 in the afternoon. It hasn't really made a difference, since the drug stays in your system and affects the MAOIs however often you take it. I don't experience any daytime sleepiness though. Since I started trazadone and lorazapem, I have slept like a baby every night. Even when I wasn't sleeping, I didn't get tired during the day. I felt like I was on amphetamines.
I tried low dose seroquel, but it made me gain weight, so I stopped. It did work though, as long as you can avoid the weight gain.
Posted by Terry8 on March 18, 2011, at 8:31:14
In reply to Re: nighttime Parnate dosing?, posted by emmanuel98 on March 16, 2011, at 19:36:21
> I've had terrible insomnia with parnate, literally 48-72 hours without sleep. I switched my dose to 2 in the morning and 1 in the afternoon. It hasn't really made a difference, since the drug stays in your system and affects the MAOIs however often you take it. I don't experience any daytime sleepiness though. Since I started trazadone and lorazapem, I have slept like a baby every night. Even when I wasn't sleeping, I didn't get tired during the day. I felt like I was on amphetamines.
>
> I tried low dose seroquel, but it made me gain weight, so I stopped. It did work though, as long as you can avoid the weight gain.Sorry my original message came through twice... it was my first attempt at posting -- maybe they can be merged?
Thanks for replying. I'm lucky enough to get some sleep each night so far, but a decent night sleep is getting 4 uninterrupted hours. I hadn't wanted to add a med for sleep, but my doctor offered Trazadone, so maybe if things don't improve I'll give it a try.
Posted by shalhevet on March 22, 2011, at 23:12:07
In reply to nighttime Parnate dosing?, posted by Terry8 on March 16, 2011, at 15:03:48
www.dr-bob.org/babble/20100318/msgs/940842.html
We sound alike.
Unfortunately, nothing ever put a dent into the afternoon fatigue except taking Dexedrine. I'm pretty much guaranteed to be wound up all night if I take the Parnate after about 2PM, though. I take most of my Parnate around 10PM and sleep by 1AM.
Now I'm very interested in trying Xyrem. In the meantime, it's Ambien or Xanax.
Posted by desolationrower on March 23, 2011, at 4:36:57
In reply to Re: nighttime Parnate dosing? » Terry8, posted by shalhevet on March 22, 2011, at 23:12:07
I didn't find that terribly helpful.
its probably worth monitoring your blood sugar, and pulling out all the stops:
pharmaceutical: modafilal et al
caffiene
peppermint
ginger/capsacicin-d/r
Posted by Terry8 on March 24, 2011, at 14:56:47
In reply to Re: nighttime Parnate dosing?, posted by desolationrower on March 23, 2011, at 4:36:57
> I didn't find that terribly helpful.
>
> its probably worth monitoring your blood sugar, and pulling out all the stops:
> pharmaceutical: modafilal et al
> caffiene
> peppermint
> ginger/capsacicin
>
> -d/rCaffeine I can only do in moderation, it seems--more than a cup (or perhaps two, if had slowly) makes my blood pressure go up a fair bit (though only on one occasion, and during the third large cup -- but I've been hesitant to try again). I've been on Ritalin in the past in combination with other medications (not Parnate); do you know whether Modafilil be safer, i.e. less likely to cause high blood pressure than Ritalin, given my reaction to caffeine? I'm not sure where my pdoc stands on Modafilil, whereas he has mentioned adding Ritalin if necessary.
I hadn't known about a possible blood sugar connection. Can Parnate cause a drop in blood sugar in the afternoon, leading to the urge to nap? (An urge which recently I've been failing to resist, unfortunately. It's so overpowering.) I'm visiting my parents this weekend, and my father has a blood sugar monitor; I'll see if I can nab some readings while I'm there.
Thanks for your reply!
Posted by Terry8 on March 24, 2011, at 15:01:35
In reply to Re: nighttime Parnate dosing? » Terry8, posted by shalhevet on March 22, 2011, at 23:12:07
> www.dr-bob.org/babble/20100318/msgs/940842.html
>
> We sound alike.
>
> Unfortunately, nothing ever put a dent into the afternoon fatigue except taking Dexedrine. I'm pretty much guaranteed to be wound up all night if I take the Parnate after about 2PM, though. I take most of my Parnate around 10PM and sleep by 1AM.
>
Thanks for replying. Seems so: I'm also on Lamictal, as you mentioned in your linked post. Oddly enough, in the past week or so my nighttime sleeping has evened out on its own, and I'm getting to sleep by about midnight or one, and sleeping mostly through the night. Now it's just the mid-afternoon sleepiness that's wearing at me. I was hoping to avoid a stimulant, but maybe it's something to consider.> Now I'm very interested in trying Xyrem. In the meantime, it's Ambien or Xanax.
Posted by desolationrower on March 25, 2011, at 5:17:28
In reply to Re: nighttime Parnate dosing?, posted by Terry8 on March 24, 2011, at 14:56:47
> > I didn't find that terribly helpful.
> >
> > its probably worth monitoring your blood sugar, and pulling out all the stops:
> > pharmaceutical: modafilal et al
> > caffiene
> > peppermint
> > ginger/capsacicin
> >
> > -d/r
>
> Caffeine I can only do in moderation, it seems--more than a cup (or perhaps two, if had slowly) makes my blood pressure go up a fair bit (though only on one occasion, and during the third large cup -- but I've been hesitant to try again). I've been on Ritalin in the past in combination with other medications (not Parnate); do you know whether Modafilil be safer, i.e. less likely to cause high blood pressure than Ritalin, given my reaction to caffeine? I'm not sure where my pdoc stands on Modafilil, whereas he has mentioned adding Ritalin if necessary.
>
> I hadn't known about a possible blood sugar connection. Can Parnate cause a drop in blood sugar in the afternoon, leading to the urge to nap? (An urge which recently I've been failing to resist, unfortunately. It's so overpowering.) I'm visiting my parents this weekend, and my father has a blood sugar monitor; I'll see if I can nab some readings while I'm there.
>
> Thanks for your reply!
>the only way modafinil will increase blood pressure is placebo. but if your doc will rx ritalin, she's a keeper. modafinil is more targeted at sleepiness though, and has less negative effect on sleep quality (important since maois can cause insomnia too)
I'm not _sure_ about what parnate does to blood sugar, but i kind of think it might be reducing capacity to handle swings. I noticed carb cravings when i took it, and i'm usually in good health. sympathetic nervous system, cortisol, etc is all related to energy metabolism, as well as their role in mood. Important to keep in mind how evolution hijacks a system that works well for something and uses it to do something else. I kind of think a low cab diet might be good for these fatigue type problems with maois. I think glucose monitors can be had for pretty cheap so i would try it out.
-d/r
Posted by Terry8 on March 25, 2011, at 21:39:19
In reply to Re: nighttime Parnate dosing?, posted by desolationrower on March 25, 2011, at 5:17:28
> I'm not _sure_ about what parnate does to blood sugar, but i kind of think it might be reducing capacity to handle swings. I noticed carb cravings when i took it, and i'm usually in good health. sympathetic nervous system, cortisol, etc is all related to energy metabolism, as well as their role in mood. Important to keep in mind how evolution hijacks a system that works well for something and uses it to do something else. I kind of think a low cab diet might be good for these fatigue type problems with maois. I think glucose monitors can be had for pretty cheap so i would try it out.
>
> -d/rI also have the carb cravings, particularly when I first get up, and then again in the afternoon. (I've put on about five pounds since starting Parnate, which I'm trying to work off right now, but it's also on top of 20lbs from the previous medication trial involving Remeron... so I'm trying to shed a lot.) It sounds like low-carb is the way to go, both for trying to break the cycle of cravings and also for the fatigue problems. At least in the past week or so the nighttime insomnia has mostly resolved on its own; for now it's just the daytime fatigue that's the problem.
I'll try eating frequent small (low-carb, vegetarian, MAOI-compliant, oy vey) meals over the next few days and monitor what I can. And I have a pdoc appointment next week, so I'll see how things shake out then. Thanks for the info.
Posted by Terry8 on May 10, 2011, at 9:41:42
In reply to Re: nighttime Parnate dosing? » Terry8, posted by shalhevet on March 22, 2011, at 23:12:07
> Unfortunately, nothing ever put a dent into the afternoon fatigue except taking Dexedrine.What time did you take Dexedrine to combat the afternoon fatigue? I'll be trying the immediate release version, but I don't know how early to take it since some afternoons I zonk out around 1 or 2, but others I'm fine until 5.
Posted by shalhevet on May 10, 2011, at 12:50:03
In reply to Re: nighttime Parnate dosing? » shalhevet, posted by Terry8 on May 10, 2011, at 9:41:42
> What time did you take Dexedrine to combat the afternoon fatigue? I'll be trying the immediate release version, but I don't know how early to take it since some afternoons I zonk out around 1 or 2, but others I'm fine until 5.
>
>
I take it between 2PM and 4PM, depending on how I am feeling. Sometimes I take it twice - 1PM and 6PM if I am working through the evening and especially tired. For me it takes about 30 minutes to kick in, maybe a little less. It only lasts for 4 hours (for me, anyway) and I'd rather take it twice than take it late.Oh, and I typically crash sometime between 3PM and 6PM.
Posted by WAS on May 18, 2011, at 18:01:30
In reply to Re: nighttime Parnate dosing?, posted by shalhevet on May 10, 2011, at 12:50:03
It took me months to get over the "Sudden Somnolence Syndrome" on Parnate, but for the most part it has passed. I get a recurrence once every 2 -4 weeks for a day or two, and then it goes away again. I am completely unable to relate the recurrence to physical, dietary, mental, or any other kind of cause. I also have bouts of insomnia, but they are not correlated with the afternoon somnolence. I have tried changing everything that I could think of to change, both to sleep better at night and to be able to stay awake in the afternoon, but when I'm in the middle of a recurrence my best bet is to do what my body tells me to do - be awake when it says it is time to be awake and go to sleep when it says it is time to sleep, whatever the clock may say. Eventually it seems to work itself out.
Posted by shalhevet on May 18, 2011, at 21:04:50
In reply to Re: nighttime Parnate dosing? » shalhevet, posted by Terry8 on May 10, 2011, at 9:41:42
Hey, I just wanted to mention something that I forgot about until now. If I take my Parnate and Dexedrine too close together (less than 2ish hours), I end up with mydriasis (pupils get huge and then I get double vision) and I can't pee. Waiting 2-3 hours between doses seems to work just fine (although I do get mydriasis in the afternoon for a few hours sometimes), otherwise I'll be stuck with not being able to pee for half the day.
Hope things have been working out for you. I've recently started Xyrem. Not sure how it'll turn out for me yet.
Posted by Terry8 on May 19, 2011, at 7:49:27
In reply to Re: nighttime Parnate dosing? » Terry8, posted by shalhevet on May 18, 2011, at 21:04:50
> Hey, I just wanted to mention something that I forgot about until now. If I take my Parnate and Dexedrine too close together (less than 2ish hours), I end up with mydriasis (pupils get huge and then I get double vision) and I can't pee. Waiting 2-3 hours between doses seems to work just fine (although I do get mydriasis in the afternoon for a few hours sometimes), otherwise I'll be stuck with not being able to pee for half the day.
Thanks for both your posts! Hearing others' experiences really helps as I try to sort out what's going to work for me. I've been trying Dexedrine for about a week now, but it's a little baby dose and I'm not sure it's been helping at all with the fatigue. I might be taking it too late for me: 1:30 pm, but I also don't want it too close to my last Parnate dose, which I've been taking at 11 am.
I don't think I've had what you're describing, but I do notice that sometimes in the afternoon I feel pressure behind one eye, which would scare me more if it were attached to a headache, but it's not (just pounding heart). I'll take a peek in the mirror if it happens again. Maybe my pupils are blown and I don't even know it.
I recently went up to 40 mg Parnate and have been dosing 20 mg at 7:30 am and another 20 at 11 am (then the Dexedrine at 1:30). Today I'm going to try splitting the second dose into 10 mg at 11 am and 10 mg in the mid-afternoon, and take the Dexedrine earlier (maybe around noontime). Hopefully the smaller second Parnate dose won't interact with the Dexedrine as much even though I'm not waiting that 2-3 hours. We'll see.
All so complicated. Thanks again, and good luck with Xyrem!
Posted by Terry8 on May 19, 2011, at 8:02:50
In reply to Re: nighttime Parnate dosing?, posted by WAS on May 18, 2011, at 18:01:30
> It took me months to get over the "Sudden Somnolence Syndrome" on Parnate, but for the most part it has passed.
So good to hear. Thanks for posting. My doctor has said that there's a good chance the afternoon sleepiness with pass, but it's hard to have faith in that when you're going comatose every afternoon. As for the insomnia, I tried for two months to fix my nighttime insomnia with diet, lifestyle, medication timing, you name it, and nothing helped -- I was still averaging only four hours of sleep a night. I now realize a lot of this all has to do with MAOIs having an effect on the "clock" proteins that regulate circadian rhythms. That's when I gave in and started taking Ambien at night. I'm wary of sleep medication long term, but I'm not so exhausted all the time now, and the afternoon somnolence is a bit more workable now that it's "just" sleepiness, instead of sleepiness on top of weeks of sleep deprivation.
Posted by Defective on May 19, 2011, at 12:57:17
In reply to Re: nighttime Parnate dosing?, posted by Terry8 on May 19, 2011, at 8:02:50
Hi, I just started taking parnate 14 days ago and I have a quick question. I spent the first 6 days on 30 mg, the next 3 days on 40 mg, the next two on 50, and the went up to 60 mg yesterday. I don't feel any improvement in depression. Did you feel a response any sooner than this and was your dosing at all similar. Sorry to kind of change the subject matter on your posting, but I've been dealing wiht depression for 20 years, tried 15 different medications, and don't want to waste any more time than I have to.
Best,
Defective
Posted by Defective on May 19, 2011, at 12:57:48
In reply to Re: nighttime Parnate dosing?, posted by Terry8 on May 19, 2011, at 8:02:50
Hi, I just started taking parnate 14 days ago and I have a quick question. I spent the first 6 days on 30 mg, the next 3 days on 40 mg, the next two on 50, and the went up to 60 mg yesterday. I don't feel any improvement in depression. Did you feel a response any sooner than this and was your dosing at all similar. Sorry to kind of change the subject matter on your posting, but I've been dealing wiht depression for 20 years, tried 15 different medications, and don't want to waste any more time than I have to.
Best,
Defective
Posted by deepreason on May 19, 2011, at 13:42:33
In reply to nighttime Parnate dosing?, posted by Terry8 on March 16, 2011, at 15:03:48
> I didn't see anything in the archives, but my apologies if this has been discussed before. I'm newish to Parnate and experiencing the usual nighttime insomnia and afternoon fatigue. I've heard that you should take the doses earlier in the day to prevent insomnia, but most people seem to have the problem anyway. What about flip flopping the timing entirely?
>
> I take my doses at 8am, 12pm, and 3pm. By 2pm I'm very tired, and though I haven't been napping in the afternoon, I'm sure if I let myself I could fall asleep in a heartbeat. But by 8pm I'm wide awake again and can't get to sleep until 2am at the earliest. So I get really tired six hours after the first dose, and am wide awake another six hours later.
>
> What if I were to take the doses in the evening, starting around dinnertime? So a first dose at 6pm, a second at 9pm, and last one at midnight (followed by going to bed). If the pattern holds, I'd be tired and ready to sleep six hours after the first dose (around midnight) and waking up again six hours later, around 6am -- a bit more like the rest of the world.
>
> Or does it not work like that? Has anybody tried this?
>
> Thanks!That's exactly what I did with my Nardil. My doc had me taking it at 09:00 and 12:00 and I was sleepy all afternoon then insomnia all night so I tried changing the times just as a one off. Dosed myself at 20:00 and 23:30. I had the best night's sleep I've ever had and also woke up with none of the anxiety that had been troubling me sinc starting the nardil a month earlier.
Have spoken to the doc about it since and he said yes it can affect a small amount of people that way and great you've found an answer. Apparently it used to be used sometimes at night to treat PTSD because it blocks the nightmares which was interesting because my therapist has been bugging me about why I've stopped having any dreams to discuss with him the last month.
Posted by Terry8 on May 20, 2011, at 9:36:53
In reply to Re: nighttime Parnate dosing?, posted by deepreason on May 19, 2011, at 13:42:33
Thanks for your response! Glad to hear that taking it night helped you with the insomnia -- did it affect the daytime sleepiness as well?
Posted by deepreason on May 23, 2011, at 21:47:18
In reply to Re: nighttime Parnate dosing? » deepreason, posted by Terry8 on May 20, 2011, at 9:36:53
> Thanks for your response! Glad to hear that taking it night helped you with the insomnia -- did it affect the daytime sleepiness as well?
Yes, completely removed the daytime sleepiness as well. Bit of a miracle cure to be honest :)
This is the end of the thread.
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