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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by g_g_g_unit on May 23, 2012, at 2:12:16
I decided to stay away from the board for a little while (it may have only been just over a week, but whatever -- I found it therapeutic in some respects).
Anyway, I'm taking 45mg of Parnate now split three times a day. Valium wasn't really helping me sleep, so I switched over to Klonopin. I started on 0.5mg, which knocked me out the first night, but is no longer effective (either for onset or maintenance) and I'm only getting 4-5 hours sleep a night.
I find it great for panic/hyper-vigilance, but maybe a little dulling. It also saps the anti-ADD and motivational benefits of Parnate (though so does not sleeping, I imagine).
Anyway, no effect on mood as of yet. I was busier when stimulated, but still kinda bored by everything. Maybe 60mg will do the job.
Posted by SLS on May 23, 2012, at 6:03:27
In reply to update, posted by g_g_g_unit on May 23, 2012, at 2:12:16
> I decided to stay away from the board for a little while (it may have only been just over a week, but whatever -- I found it therapeutic in some respects).
>
> Anyway, I'm taking 45mg of Parnate now split three times a day. Valium wasn't really helping me sleep, so I switched over to Klonopin. I started on 0.5mg, which knocked me out the first night, but is no longer effective (either for onset or maintenance) and I'm only getting 4-5 hours sleep a night.
>
> I find it great for panic/hyper-vigilance, but maybe a little dulling. It also saps the anti-ADD and motivational benefits of Parnate (though so does not sleeping, I imagine).
>
> Anyway, no effect on mood as of yet. I was busier when stimulated, but still kinda bored by everything. Maybe 60mg will do the job.
For some people, Klonopin produces the depressive symptoms and flat affect that you describe. I don't think these things disappear with continued use. I hope I'm wrong.I like combining short acting and longer acting BZD receptor agonists at bedtime. I recently had some success using a combination of Sonata and Ativan. For myself, I will administer (Sonata or Halcion or Ambien) + (Ativan or Restoril). I do not experience a hangover the next day with these treatments. I would be very surprised if your doctor were to consider such aggressive combination treatment. However, this is what I found necessary in order to treat total insomnia the first time I combined Parnate with a TCA.
Some people consider Gabitril (tiagabine) to be a reasonable choice for insomnia. However, clinical studies do not support this claim. Besides, I feel that the drug is unpredictable. It can actually cause agitation rather than reduce it.
I hope you can find an answer for the insomnia.
- Scott
Posted by g_g_g_unit on May 24, 2012, at 22:36:09
In reply to Re: update » g_g_g_unit, posted by SLS on May 23, 2012, at 6:03:27
> For some people, Klonopin produces the depressive symptoms and flat affect that you describe. I don't think these things disappear with continued use. I hope I'm wrong.
>
> I like combining short acting and longer acting BZD receptor agonists at bedtime. I recently had some success using a combination of Sonata and Ativan. For myself, I will administer (Sonata or Halcion or Ambien) + (Ativan or Restoril). I do not experience a hangover the next day with these treatments. I would be very surprised if your doctor were to consider such aggressive combination treatment. However, this is what I found necessary in order to treat total insomnia the first time I combined Parnate with a TCA.
>
> Some people consider Gabitril (tiagabine) to be a reasonable choice for insomnia. However, clinical studies do not support this claim. Besides, I feel that the drug is unpredictable. It can actually cause agitation rather than reduce it.
>
> I hope you can find an answer for the insomnia.
>
>
> - ScottHi Scott,
I met with my psychiatrist today. I told him that I was having difficulty with sleep on-set, but not maintenance, and thus having to continually up my Clonazepam dose. His suggestion was precisely to combine a short-acting agent (in this case, Temazepam) with 0.5mg Clonazepam.
Two further matters were discussed. I said I was having trouble reasoning who determines when I'm 'well'. I understand I suffer from a very severe case of anxiety, but I said that I also pride myself on (what's left of) my cognitive abilities and wouldn't want to take anything that (too severely) compromised them.
He agreed, that it was up to me, a fact I brought up in light of the fact that Clonazepam was producing a lot of cognitive dulling, though I think it's easing up a bit regardless. However, it does interfere with the stimulating effect quite a bit and I'm not satisfied at all with my ability to read on the combination -- something he said I may have to cope with (which I guess is a slight contradiction of his earlier statement, but oh well).
Anyway, he wanted to raise the dose to 60mg -- from my understanding, speaking to Dr. Jenkins from Harvard, who specializes in OCD, this is generally the dose he finds effective for anxiety/panic/OCD. However, the suggestion came at the very end of our appointment and I said can we delay a week, because I was going to bring up the idea of introducing Memantine to hypothetically preserve the stimulation from 60mg of Parnate next time I see him.
However, I'm beginning to think it might be worthwhile seeing what 60mg of Parnate alone does for me (and hopefully weaning off the Clonazepam), before introducing another agent. I'm sure that will be my doctor's reasoning for saying no(?), but in some way it makes sense. Right now I'm feeling quite depressed and emotional on 45mg of Parnate, but it seems like some people experience a turnaround at 60mg.
I think I'd be disappointed if Parnate didn't help my ADD in the long-term (since no one will prescribe a stim with it), but maybe there's more to be gained initially by seeing if it works as an AD and anxiolytic?
Posted by SLS on May 25, 2012, at 6:18:00
In reply to Re: update for SLS » SLS, posted by g_g_g_unit on May 24, 2012, at 22:36:09
> His suggestion was precisely to combine a short-acting agent (in this case, Temazepam) with 0.5mg Clonazepam.
I have always been under the impression that temazepam is relatively ineffective for sleep initiation, but good for sleep maintenance. So, if you are disappointed in its efficacy, that would argue for trying Sonata, Ambien, or Ativan. I would still give temazepam a try first. You never know how you will react to it. It might be the perfect drug for you. It should produce very little if any hangover effect the next day. It has no active metabolites.
Parnate and memantine (Namenda): I have seen it written in many places on the Internet that memantine prevents tolerance to psychostimulants. However, I have never seen it for myself, and I don't recall seeing and scientific articles that reports memantine as being effective in this capacity. Memantine itself has been reported to help with ADHD and might potentiate stimulants (as opposed to preventing tolerance). Either way, it is not unreasonable to try memantine.
http://www.ncbi.nlm.nih.gov/pubmed/22436083
If necessary, amphetamine or methylphenidate can be added to Parnate to treat the ADHD.
http://www.ncbi.nlm.nih.gov/pubmed/15554766
FYI: Memantine has been demonstrated in many studies to prevent tolerance to the antinociceptive (pain-reduction) effects of opioids. This is pretty much an accepted property of this drug.
- Scott
Posted by g_g_g_unit on May 25, 2012, at 7:49:06
In reply to Re: update for SLS » g_g_g_unit, posted by SLS on May 25, 2012, at 6:18:00
> I have always been under the impression that temazepam is relatively ineffective for sleep initiation, but good for sleep maintenance. So, if you are disappointed in its efficacy, that would argue for trying Sonata, Ambien, or Ativan. I would still give temazepam a try first. You never know how you will react to it. It might be the perfect drug for you. It should produce very little if any hangover effect the next day. It has no active metabolites.I suggested Ambien, but he said he doesn't like mixing sleep-aids of differing classes (i.e. Z-drugs with benzodiazepines).
>
> Parnate and memantine (Namenda): I have seen it written in many places on the Internet that memantine prevents tolerance to psychostimulants. However, I have never seen it for myself, and I don't recall seeing and scientific articles that reports memantine as being effective in this capacity. Memantine itself has been reported to help with ADHD and might potentiate stimulants (as opposed to preventing tolerance). Either way, it is not unreasonable to try memantine.From what I understand, it definitely attenuates tolerance, rather than simply potentiating stimulants, since certain early, transient effects (increased sociability, mood boost, etc.) seem to persist with treatment. I can't provide any proof though; only subjective accounts.
Since people confuse the stimulating effect with an anti-depressant effect in Parnate, I thought that preventing tolerance to the stimulant effect might cause some confusion in me about whether it was genuinely working. That said, I've also e-mailed a) a neuropsychiatric centre, and b) two OCD specialists, and none use Memantine off-label for OCD (my personal psychiatrist won't prescribe it, but will refer to someone who does). This country is kind of ridiculous in my opinion.
Do you find Parnate itself helpful for anhedonia? Lately, my moods have been feeling quite dark and grey, but I know one poster here (Serge) said that would happen to him until he hit 60mg.
>
> If necessary, amphetamine or methylphenidate can be added to Parnate to treat the ADHD.
>
> http://www.ncbi.nlm.nih.gov/pubmed/15554766I'm not aware of any psychiatrist in my state who would prescribe Parnate with a stimulant. I've given up on that idea.
Posted by psychobot5000 on May 29, 2012, at 15:36:07
In reply to Re: update for SLS » SLS, posted by g_g_g_unit on May 25, 2012, at 7:49:06
>
> Since people confuse the stimulating effect with an anti-depressant effect in Parnate, I thought that preventing tolerance to the stimulant effect might cause some confusion in me about whether it was genuinely working. That said, I've also e-mailed a) a neuropsychiatric centre, and b) two OCD specialists, and none use Memantine off-label for OCD (my personal psychiatrist won't prescribe it, but will refer to someone who does). This country is kind of ridiculous in my opinion.
>
> Do you find Parnate itself helpful for anhedonia? Lately, my moods have been feeling quite dark and grey, but I know one poster here (Serge) said that would happen to him until he hit 60mg.
>
>
> >
> > If necessary, amphetamine or methylphenidate can be added to Parnate to treat the ADHD.
> >
> > http://www.ncbi.nlm.nih.gov/pubmed/15554766
>
> I'm not aware of any psychiatrist in my state who would prescribe Parnate with a stimulant. I've given up on that idea.
>I'm tempted to say: stimulant, antidepressant, whatever--they're both good for mood, and does it matter so much whether parnate's effects are one or the other?
Anyway, I stopped by to post this: over on the alternatives board, I'm trialling an extract of flowering quince, which seems to have stimulant properties and be somewhat useful for mood and affect.
http://www.dr-bob.org/babble/alter/20111229/msgs/1017886.html
If you can't get a prescription stimulant, you might wish to (cautiously!) try that as an adjunct, though I'd caution you about heart-rate and blood-pressure. If I were to use it with Parnate, I'd make sure to be just as careful about heart-rate and blood-pressure as if I were adding amphetamine.
Do you have a blood-pressure cuff? I think it's important, when adding any sort of psychostimulant or sympathomimetic to an MAOi, to keep close tabs on BP (though stimulants can also be helpful for the general hypotension that often accompanies MAOis :) ).
Hope your parnate trial and sleep work out,
psychbot5000
Posted by psychobot5000 on May 29, 2012, at 15:42:32
In reply to Re: parnate and stims » g_g_g_unit, posted by psychobot5000 on May 29, 2012, at 15:36:07
PS - G_g_g, I know you know most of that, anyway--I just felt the need to add those cautions since this is a public forum and someone else might stumble upon this thread. I'd hate to unwittingly cause someone's hypertensive crisis by failing to note the dangers of the combination.
Best,
PB
Posted by g_g_g_unit on May 30, 2012, at 1:44:43
In reply to Re: parnate and stims » g_g_g_unit, posted by psychobot5000 on May 29, 2012, at 15:36:07
>
> I'm tempted to say: stimulant, antidepressant, whatever--they're both good for mood, and does it matter so much whether parnate's effects are one or the other?Not so much. However, for me, it begs the question: why Parnate - with all the attendant risks - over a conventional stimulant then? Though I suppose the serotonergic aspect would be better suited for OCD.
I'm also somewhat reluctant because certain Memantine + stimulant users report a preservation of the euphoric effect. As wonderful as that might sound, I just don't see sustained euphoria as being therapeutically useful.
I haven't ruled out the Memantine idea, but I'm still trying to make sense of what Parnate's doing. I just raise my dose to 50mg and am experiencing a re-emergence of the fogginess, which is strange, because it was there at 40mg, but entirely absent at 45mg. The klonopin I'm taking for sleep probably isn't helping things either.
>
> Anyway, I stopped by to post this: over on the alternatives board, I'm trialling an extract of flowering quince, which seems to have stimulant properties and be somewhat useful for mood and affect.
>
> http://www.dr-bob.org/babble/alter/20111229/msgs/1017886.html
>
> If you can't get a prescription stimulant, you might wish to (cautiously!) try that as an adjunct, though I'd caution you about heart-rate and blood-pressure. If I were to use it with Parnate, I'd make sure to be just as careful about heart-rate and blood-pressure as if I were adding amphetamine.I did see your post, and relayed it to someone who can't get conventional stimulants in his country. To be honest, the idea of combining it with Parnate did cross my mind, though thank you for the suggestion.
>
> Do you have a blood-pressure cuff? I think it's important, when adding any sort of psychostimulant or sympathomimetic to an MAOi, to keep close tabs on BP (though stimulants can also be helpful for the general hypotension that often accompanies MAOis :) ).I don't, no, though I'd definitely invest in one if I planned on remaining on Parnate in the long-term.
>
> Hope your parnate trial and sleep work out,
> psychbot5000Thanks :)
This is the end of the thread.
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