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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by vanvog on March 24, 2013, at 1:54:12
I wish someone told me about this before I started taking Parnate, even in psych literature there is no mention of this.
I have atypical depression i.e. oversleeping, I was hoping that Parnate would help me reduce my sleep but right now it looks like my sleeping problems are getting worse not better.
I have extreme fatigue periods on Parnate so I have to take naps, the thing is if I take a nap it's totally unpredictable how long it will take until I wake up, it can be anywhere from 1 hour to 12 hours, this is ridiculous. I can get a good nights sleep than take a nap during the day which can last 10-12 hours, how is this even possible? I spend up to 18 hours a day sleeping and then sometimes just 6 hours of sleep and I'm good for 24 hours or more without sleep. It's impossible for me to keep a regular sleep schedule on Parnate.
Has anyone else experienced disruptions in your circadian rhythm?
Posted by Tomatheus on March 24, 2013, at 16:02:52
In reply to PARNATE Disruption Of Circadian Rhythm, posted by vanvog on March 24, 2013, at 1:54:12
Vanvog,
I wouldn't say that I experienced the kinds of disruptions to my circadian rhythm that you have been experiencing when I took the American Parnate (which was made by GlaxoSmithKline at the time), but I did experience drowsiness in the afternoon that led me to discontinue the medication. The problem that I faced with that version of Parnate was that I too couldn't avoid taking afternoon naps, and I basically ended up sleeping through afternoon and evening classes that I was taking at the time. I probably would have ended up failing the classes if I had continued to take Parnate because there was nothing I could do to avoid sleeping during the afternoon while I was on that medication (or at least the American version of it).
Interestingly enough, I experienced no afternoon drowsiness when I took a generic version of Parnate that's made by a company called Goldshield for the U.K. When I took the Goldshield version of tranylcypromine by itself, I experienced a significant reduction in my fatigue and related symptoms that lasted for about three days before the response faded. The same thing happened when I tried increasing the dose of the medication. So, while I didn't get any long-term benefits from taking the Goldshield tranylcypromine by itself, afternoon drowsiness was not a problem for me on that particular version of the medication.
Tomatheus
Posted by cassandracomplex on March 24, 2013, at 16:17:20
In reply to PARNATE Disruption Of Circadian Rhythm, posted by vanvog on March 24, 2013, at 1:54:12
Yes, every time I've taken it. It's like the rules of sleep are thrown out the window: sometimes I sleep for 12 to 14 hours and sometimes I wake up 2 hours later and cannot fall asleep again for hours (if I fall asleep again at all). I take Ambien for sleep initiation and Klonopin for night terrors; I have taken Valium in the past for this purpose as well. I used to operate on an entirely artificial sleep schedule: Dexedrine one or two hours before I needed to wake up, my first dose of Parnate two to four hours after that, my second dose of Parnate an hour or two after that, sometimes another dose of Dexedrine in between, and Ambien, Seroquel, and Valium to fall asleep at night. I was on 120 mg of Parnate at this time and have taken from 70 to 120 mg therapeutically. Currently, I am on 70 mg.
The biggest problem for me is that stimulants - well, over-stimulate me. At least Dexedrine and Adderall. I'm not sure about any of the Ritalin analogues or Provigil; by the time I resorted to stimulants, my sleep was so disrupted that my job was in danger and I needed something that worked immediately and effectively. Back then, it was only hypersomnia, but now it's both.
There actually have been some studies on this.
1) Afternoon fatigue and somnolence associated with tranylcypromine treatment.
Joffe RT.
J Clin Psychiatry. 1990 May;51(5):192-3.ABSTRACT
The author examined a series of 23 depressed and 15 obsessive compulsive disorder outpatients who were treated with 40-80 mg/day of tranylcypromine to determine the frequency and clinical features of fatigue and somnolence. Four (all depressed) of the 38 patients experienced hypersomnolence and fatigue in the late afternoon. The somnolence was severe enough to impair their ability to work and drive. Afternoon fatigue and somnolence appear to be important and not uncommon side effects of tranylcypromine treatment.2) Severe daytime somnolence in patients treated with an MAOI.
Teicher MH, Cohen BM, Baldessarini RJ, Cole JO.
Am J Psychiatry. 1988 Dec;145(12):1552-6.ABSTRACT
Eight patients with hypersomnolent, anergic major depression benefited markedly from treatment with relatively high doses of phenelzine or tranylcypromine but experienced intense afternoon somnolence and disrupted sleep. Reducing the dose of monoamine oxidase inhibitor (MAOI) or substituting isocarboxazid sometimes provided relief, but altering the schedule of drugs or meals did not. Bedtime sedation alleviated the disrupted sleep but had little effect on daytime somnolence. The mechanism underlying this side effect is unknown; sleep deprivation, narcolepsy, or hypotension does not account for it. Patients given an MAOI should be assessed for this disturbance and cautioned to avoid risk of injury when it occurs.3) Influence of some monoamine oxidase inhibitors on the sleep-wakefulness cycle of the cat.
Oniani TN, Akhvlediani GR.
Neurosci Behav Physiol. 1988 Jul-Aug;18(4):301-6.ABSTRACT
The influence of some monoamine oxidase inhibitors (phenelzine, transamin [tranylcypromine], nialamide) on the structure of the sleep-wakefulness cycle of the cat was studied. It was shown that these monoamine oxidase inhibitors elicit and increase in slow-wave sleep in the sleep-wakefulness cycle due to complete suppression of paradoxical sleep and significant decrease in wakefulness. After the cessation of the action of the monoamine oxidase inhibitors, a selective rebound of wakefulness is observed against the background of complete or partial absence of paradoxical sleep. The gives grounds for the hypothesis that during partial deprivation of wakefulness under the influence of monoamine oxidase inhibitors an intensification occurs on the accumulation of specific need for this physiological state, the satisfaction of which is accomplished as the result of its rebound in the post-deprivational cycle, i.e., after the termination of the EEG of the synchronizing effect of the monoamine oxidase inhibitors.4) Monoamine oxidase inhibitors in resistant major depression. A double-blind comparison of brofaromine and tranylcypromine in patients resistant to tricyclic antidepressants.
Nolen WA, Haffmans PM, Bouvy PF, Duivenvoorden HJ.
J Affect Disord. 1993 Jul;28(3):189-97.ABSTRACT
In a double-blind study the selective monoamine oxidase-A inhibitor brofaromine was compared with the classical MAOI tranylcypromine in 39 patients with major depression resistant to treatment with tricyclic antidepressants. Concerning efficacy no significant differences were found. Ten out of 22 patients responded to brofaromine and 5 out of 17 patients to tranylcypromine. Adverse effects favoured brofaromine. Although orthostatic hypotension occurred in both groups, severe decrease in blood pressure and dizziness occurred significantly more with tranylcypromine. Both MAOIs caused a decrease in stage 4 and REM sleep and an increase in REM latency. In most patients receiving tranylcypromine REM sleep was completely abolished.5) Effects of tranylcypromine on the sleep of patients with anergic bipolar depression.
Jindal RD, Fasiczka AL, Himmelhoch JM, Mallinger AG, Thase ME.
Psychopharmacol Bull. 2003 Summer;37(3):118-26.ABSTRACT
A significant proportion of patients with bipolar disorder are hypersomnolent. It is not clear if this affects response to treatment because few studies have systematically examined treatment effects on sleep in patients with bipolar depression. Reported herein are the results of what we believe to be the first study of the effects of the monoamine oxidase inhibitor tranylcypromine (average dose=37 mg/day) on the sleep of patients with bipolar depression.Twenty-three patients with anergic bipolar depression completed sleep studies before and after pharmacotherapy. Changes in polysomnographic variables were examined using paired t tests. The patients experienced a 40% reduction in rapid eye movement (REM) sleep time, as well as significant decreases in REM percentage,REM activity, number of REM periods, and REM intensity.REM latency was prolonged by nearly 3-fold. The decrease in REM sleep was accompanied by a modest (8%) reduction in total sleep time and increased "light" sleep. There was no change in sleep continuity indices or slow wave sleep. Correlational analyses suggested that antidepressant response was only weakly associated with changes in REM sleep. These findings indicate that tranylcypromine's effects on REM sleep greatly surpass effects on sleep architecture or sleep maintenance. Moreover, effective treatment of bipolar depression did not "normalize" the hypersomnolence associated with bipolar depression.... and here's an interesting case report:
Partial sleep deprivation to prevent 48-hour mood cycles.
Churchill CM, Dilsaver SC.
Acta Psychiatr Scand. 1990 Apr;81(4):398-9.ABSTRACT
The course of a patient with the phenomenon of 48-h mood cycles, including her response to medication and to systematic partial sleep deprivation, is described. She had only a partial response to tranylcypromine alone. Partial sleep deprivation during the second half of alternate nights successfully prevented depressive mood cycles. Three to four weeks after discontinuing tranylcypromine she lost her ability to sustain this regimen. This case demonstrates an interaction between antidepressant medication and partial sleep deprivation in the prevention of depressive mood cycles.
Posted by linkadge on March 24, 2013, at 16:20:23
In reply to Re: PARNATE Disruption Of Circadian Rhythm, posted by Tomatheus on March 24, 2013, at 16:02:52
Yes. I noticed sleepiness in the afternoon and difficulty falling asleep. Sleep onset was delayed for about 4 hours. I.e. fall asleep at 1:00.
This phenomena has been noted with MAOIs
Mice lacking MAO-A exhibit the same disturbances.
Linkadge
Posted by cassandracomplex on March 24, 2013, at 16:36:45
In reply to Re: PARNATE Disruption Of Circadian Rhythm, posted by Tomatheus on March 24, 2013, at 16:02:52
I take generic Parnate from Par Pharmaceuticals. Initially, I was concerned it wouldn't be as effective as GSK but my concerns were unfounded.
What is Goldshield and is it available in the US?
Have others noticed differences between different "brands" of Parnate?
Posted by Tomatheus on March 24, 2013, at 17:12:30
In reply to Differences in Parnate 'brands'?, posted by cassandracomplex on March 24, 2013, at 16:36:45
Hi Cassandracomplex,
It seems that Goldshield Pharmaceuticals is now part of Mercury Pharma, at least according to this news release:
The version of tranylcypromine made by Goldshield is not available in U.S. pharmacies. I obtained my Goldshield tranylcypromine from an online pharmacy that I think is based out of the U.K., and as far as I know, that's the only way that anyone in the U.S. can obtain it.
I originally tried the version of tranylcypromine made by Goldshield (for the U.K.) after reading a message on this site from somebody else who had reported noticing a difference between Goldshield's tranylcypromine and the version of Parnate being made by GlaxoSmithKline at the time. I have not read any reports from individuals who've noticed a difference between the American Par generic and the American brand-name version of Parnate, nor have I tried the Par generic myself.
Tomatheus
Posted by AMB on March 25, 2013, at 9:16:04
In reply to Re: PARNATE Disruption Of Circadian Rhythm, posted by linkadge on March 24, 2013, at 16:20:23
Yes, I also experienced this, especially with Parnate. I was tired off and on during the day but up all night.
My pdoc prescribed me ritalin to help with the daytime fatigue. It's traditionally conraindicted with MAOIs but some pdocs who are up on this stuff will prescribe it. It worked well for me. He gave me trazedone for sleep as well. Hope you get some help for this.
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