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Hope to go on Parnate soon!

3K views 32 replies 8 participants last post by  UltraShy 
#1 ·
Hey all.

I do not consider social anxiety to be the crux of my problem, it is more chronic anergic bipolar II depression. BUT I like this forum due to the MAOI expertise here.

I personally ended up interested in MAOIs just by looking through everything on PubMed on treatment resistant, Bipolar depression. I just tallied it up and I have been on 11 different meds for depression / bipolar, OK lithium and lamictal only count partially as antidepressents but in some people they offer good prophylaxis. I am only counting Wellbutrin once even though I have been on it 6(!) times at doses up to 750mg / day.

I was very impressed on how MAOIs performed in the literature. Their superiority was obvious. And I find all sorts of patients that offer very positive MAOI experiences. In contrast, the ignorance of doctors, and their reliance on pharma company salesmen to spoon feed them information, is appalling.

Now I say I *hope* to go on Parnate, my Dr. hasn't approved it yet. But I think the odds are good, he is very open to listening to what I have to say. After I found out about low dose, sublingual ketamine I researched it and discussed my findings with him. Pretty soon I head to the compounding pharmacy and picked up my syringe and bottle. I feel pretty lucky that I actually get to do this sort of thing, even if Ketamine hasn't proved a silver bullet for me.

My current med cocktail is lithium, lamictal, wellbutrin and ketamine. Low side effects and it helps with some of my symptoms, I have been free of suicidal ideation. But I want a complete remission damnit and chronic symptoms are very stubborn. I would say my most problematic symptoms are anhedonia, anergia, and a lack of motivation and drive.

I had a temporary but grand remission on lamictal. I think it was probably psychogenic (placebo) but nonetheless, living for even a week without depression symptoms is like a revelation. It has motivated me to pursue treatment aggressively. When you have chronic depression (dysthymia) it is hard to know what you are missing because the symptoms can be so pervasive.

I have a few questions if anyone cares to hazard a guess:
1. Is there any difference between brand name and generic Parnate? I am strongly inclined to believe that people are just being paranoid when they say that they experience a difference. A lot of people complain about the "new" Nardil but they are a self selected sample and I am curious how many of the people that complain were aware of the change before they experienced treatment failure.

2. I am a little excited about the combination of ketamine + Parnate... not for any recreational purposes but just because it seems like such a good roundup of effective mechanisms of action. The whole hog of NMDA antagonism and biogenic amine amplification. Neurogenesis and a rapid increase in dendrite growth. Two very potent neuroprotective agents working together (hopefully).

It seems pretty safe but I find myself unable to figure out what the combo will do, or what I should expect. I know that NMDA antagonists seem to "reset" tolerances to various drugs, and/or potentiate them. This isn't just recreational drug users who have noted this but clinicians as well. I myself have noted greater potency from tobacco of all things shortly after I use ketamine.

Potentiating a simple drug is easy to understand. But Parnate does SO much. I have seen numerous papers that argue that the full therapeutic action of Parnate is not accounted for by its MAOI action, there are trace amines, there is the supposition that it has an amphetamine-like effect. Although I have seen a lot of people repeat this amphetamine hypothesis it isn't supported in the literature, by the way.

SO - here is the million dollar question: what would you expect from mixing the two drugs? Lower doses of Parnate needed? A more activating effect profile? Lower side effects? I know no one can answer this question authoritatively, BUT this is the best place on the internet to ask this question.

3. Final question for the people here who are already on MAOIs - would you add in Ketamine if you could? Why or why not?
 
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#2 ·
Hi, I never noticed any amphetamine like buzz from Parnate but was never on a decent dosage for a regular time. I take nardil at the moment and I`ve heard some interesting stuff regarding ketamine. Would you be able to explain the effects you get from it ?

If its anything like the stuff we took recreationally in my younger days then I`ll give it a pass :-|).
 
#8 ·
Hi, I never noticed any amphetamine like buzz from Parnate but was never on a decent dosage for a regular time.
That's because there is no amphetamine-like buzz even at a stunning 200 mg per day (yes, I really did take 20 pills a day for a while).

I know Parnate is a substituted amphetamine in chemical structure, though just because the molecule looks at lot like amphetamine doesn't mean it acts anything like amphetamine. Just ask all the Parnate patients who would love nothing better than an afternoon nap if it's stimulating like amphetamine.
 
#3 ·
Instead of Ketamine, you might want to look at adding Nortriptyline to Parnate.
It reduces the need for the diet, and counteracts the downstream mechanisms of Parnate reducing NE transmission.

I would say Ketamine has its uses for emergency depression treatment, like ECT. It isn't able to be used on a regular basis, and there are long term concerns with it causing bladder damage, though this was only studied in high dose addicts.

Personally i would wait for the release of the drugs based on Ketamine's mechanism, GLYX-13 & NRX1074.
 
#4 ·
I just lost a huge post that was even more in depth...

Here were the most important points. A therapeutic dose of Ketamine is 50-100 mg / week. A recreational dose is 2-3 grams a day and often much higher. Problems like urinary retention do show up at the much higher doses. Temporary cognitive impairment shows up at the higher doses. This is a different side effect profile than therapeutic doses. I would love to know the reputation many commonly prescribed meds get at 1000x their normal dose.

Addicts use ultra high doses because they are trying to maintain a dissociative experience, tolerance builds very very rapidly to this effect.

The main problem at therapeutic doses is blood pressure going up or down... no permanent damage, but enough to discontinue taking the drug.

I use sublingual Ketamine which is much safer than IV Ketamine. Same efficacy but it doesn't kick in as quickly as IV. May require more treatments to achieve response.

I want to stress that one thing you do not notice in the literature is how natural Ketamine feels. It does not cause affective flattening or any of the emotional side effects of serotonergic drugs. This is a big plus. One of the things I find attractive about MAOIs is they also seem to produce a more natural response compared to the drugs that only specifically affect serotonin. But you still read about some emotional blunting, sexual side effects etc. whereas Ketamine completely 100% doesn't do this (at therapeutic doses).

As far as the pipeline drugs - if they were doing well in trials we would have heard about it now. The pharma companies spend billions to promote their drugs and they would be generating hype. The first pharma Ketamine clone will be a blockbuster that makes gajillions of dollars like Prozac.

I believe Ketamine's mechanism of action is closely linked to the dissociative effect. It is the most reliable marker to indicate that a therapeutic dose has been reached - not just in my reckoning but according to clinicians that specialize in Ketamine. The major "innovation" of the pharmaceutical drugs in the pipeline is to remove this dissociative effect, supposedly without impairing the therapeutic action. Without getting into the chemistry, I believe the therapeutic action is a downstream effect of the dissociation. I wouldn't hold out any hope for these drugs. They will also be super expensive once released and patented.

ER treatment of acutely suicidal patients is a niche for Ketamine. It also doesn't have the cognitive/emotional side effects of serotonergic drugs. It is also a completely unique mechanism of action which might be good at augmenting other drugs or working when a patient is resistant to other drugs. You experience 3-4 hours of dissociation every week, compared to constant serotonergic side effects.

If you put aside the specific neurotransmitters, all of our current drugs appear to take 1~2 weeks to work, and the onset of therapeutic action is closely correlated with neurogenesis. Ketamine takes ~30 minutes to work, which is the same amount of time it takes to produce an explosion of dendritic connections in the brain. This is a completely different mechanism for the treatment of depression and thus should be used much more often.

If you want to learn more read "Ketamine for Depression" by Hyde. Very quick read just about 100 pages.

Ultimately I think I respond to Ketamine, but it is a 20-30% response, not a remission.

I think Ketamine actually has just about the best side effect profile out there when used at low doses sublingually, intranasally, or orally (oral causes more dissociation). There is just a paucity of funding so there are no big high quality studies. Also there is no pharma company funding research to determine the right dose / delivery mechanism. The clinicians that have experience with both IV and other methods find that the other methods have greater safety and the same efficacy, just a slower response speed.

Jaiho - thank you, I am aware of the more conventional ways of augmenting MAOIs. I am going to wait and see what my side effect profile is like before I even think about that. I may come to the forums with questions when I see a need for something like sleep meds. I made this post because I am curious if any of the research / theory nuts have an opinion. While there has been one published case study of two women taking MAOIs and Parnate finding no safety problems, I am more curious about how these meds might combine theoretically. My doctor certainly doesn't know! He admits that I know more than him on Ketamine.

Anyone who is concerned about some of the unfair side effects attributed to Ketamine - I invite you to take 1000x of the therapeutic dose of whatever it is taking now.
 
#5 ·
While there has been one published case study of two women taking MAOIs and Parnate finding no safety problems, I am more curious about how these meds might combine theoretically. My doctor certainly doesn't know! He admits that I know more than him on Ketamine.
I just came a cross this article while looking around, seems to be a third case on a male,

It mentions all 3 case reports and a "proposed" mechanism.
http://www.ecnp-congress.eu/presentationpdfs/49/P.1.g.062.pdf

You have probably already seen it tough... Maybe the references can give some more insight.
 
#6 ·
Thank you watertouch. I did see an abstract for this study but it is nice to have the full text. My doctor is uncertain of the safety of the combo and wants some data so this will be handy.

My doctor did put me on Parnate, and he wants to go SLOWLY. Right now is day 8, my third day of 20 mg/day. Surprisingly it is already working. Something I care about greatly is that it is SO SMOOTH and natural. This isn't something discussed in the literature, but it is important for me that my emotions are natural and I do not feel a constant chemical buzz pushing me in one direction or the other. I kind of expect this benefit to fizzle out, but it is very promising. I was on adderall for a while, while it was helpful I could feel the constant chemical release. An improvement over constantly feeling bad I guess, but my issues are more chronic. I am hopeful this will work out.

Actually reading your posts is one of the primary reasons I am interested in augmenting with an NMDA antagonist, in order to prevent "poop out." You have alluded to this in your posts. Can you tell me more? I understand you have been on Parnate a few times, and it stops working, and then you go back on it. I really want to avoid this. I have trialled so many combos and ineffective drugs... I want one drug regimen that works and stick with it.

Did you want to stay on Parnate or did you feel like you didn't need it after you recovered from a depressive episode? If you have been on it several times, don't you want some kind of prophylactic treatment?

Anecdotally it seems the poop out rate of MAOIs, and Parnate in particular, is pretty low compared to the SSRI garbage doctors normally hand out.
 
#7 ·
Actually reading your posts is one of the primary reasons I am interested in augmenting with an NMDA antagonist, in order to prevent "poop out." You have alluded to this in your posts. Can you tell me more? I understand you have been on Parnate a few times, and it stops working, and then you go back on it.
Njae the depressions comes and goes, the Dysthymia and Anhedonia kinda is always there, and anxiety such.

You have so to say 2 effects MAO-inhibition and then the pill itself has some effects, for Parnate it effects some serotonin receptors and have Amphetamine like propertys with the dopamine.

The MAOI effect doesn't really poop-out (learned that the hard way ;)) But the "stimulating" effect kinda do.

For be its been several reasons to haven taken brakes n such, Tried Parnate first time 2011, Its been all from diet & drug interactions (taking a break to be able to eat at Swedish "festivus" days, Midsummer, Christmas) to taking a break when Sabbath came to town (one never know how that night would end, but not with me in the E.R with Hypertensive Crisis.):grin2:

Other breaks or such have been anything from trying other meds, or doing some physical test/hormonal bloodwork.

I choose to take these breaks because i feel "stable" or that things have stagnated/pooped out. And then after a while /weeks, month i reflect back and feel that i did better on Parnate.

And then i start again, And the inital "stim" effect is there, so im guessing its like some "drug-free holiday". Like when people use Stimulants..

NMDA-antagonist like Memantine is used to avoid stim tolerance.
Not sure how Ketamine would do...

And the drugfree holidays could also have some effects on varius receptors and sleep (MAOIs kill REM-sleep)

Right now im "in between" meds, my damn Pdoc wrote me a script for Parnate, i did a break to do some test at an Endocrinologist, and after that i started Parnate again.
And after 2 weeks i needed a refill, The Fuuker has withdrawn the prescribtion... Thanks for telling me or what.:mum

Has to resort to Vyvanse now, wich i don't like that much. Better then nothing altough.
Gonna tear my Dr a new one when i see him in 3weeks. haven't seen him since June...

WHO WITHDRAWS A PATIENTS ANTIDEPRESSANT, WITHOUT TELLING THE PATIENT!!!
 
#14 ·
3. Final question for the people here who are already on MAOIs - would you add in Ketamine if you could? Why or why not?
Hell, yes, I would add ketamine if I could.

Unfortunately, ketamine infusions are not covered by any insurance and very few docs do ketamine treatment at all.

I'm fully willing to use black market ketamine diverted from vets. I have injected vials of ketamine, though only twice and not enough to have any opinion on it.

And I have plenty of MAOI experience over the last 3 years. Was on 120 mg of Parnate -- tried up to 200 mg. Been on 90 mg Nardil for 2 years now.

I found Parnate to be entirely devoid of side effects even when taking 20 pills a day, though that dose had to be divided to avoid raising BP.
 
#18 ·
^huh, nice of him to babble about that in COURT! Somethings should not be said. Nice to get ATF, or DEA to look into one.

Civil court, im thinking something like the TV-show Judge Judy!...

So he only got $2.5M.... Makes me wonder just what kind of mansion you have bought? :grin2:
 
#21 ·
I PMed you my address and I just checked that the home I bought is still listed on real estate sites such that you can see pics and all the details, including the price I paid.

He doesn't like that I have 1.23 acres while he has 0.1. I sarcastically asked him if he compares penis size in the locker room as well. I wasn't aware we were having a contest, though evidently he feels we are.

Imagine how pissed he would have been had I bought an 18 acre site my Realtor showed me for the construction of a new home.
 
#20 ·
Depends on how you define the term 'lawyer'. He is indeed a 1994 graduate of UW-Madison Law School. Though he has NEVER practiced law. He also is not a member of the bar.

You can add law to the exceptionally long laundry list of careers he has failed at. Of course, none of his failures in career or relationships (according to his twisted mind) have anything to do with him being a neurotic PITA.

He retired from his "career" of grading business law exams (which paid $3,000 per year -- three thousand, lest you think I forgot some zeros) upon turning 55. That was 9 years ago.

He has since been collecting SS disability for OCD. I would note that the SS Administration gave me two fully extended middle fingers along with a "f*** you!" instead of lifetime income as he gets, though they do concede that I am indeed disabled (a view shared by every MD or therapist who has ever met me).
 
#22 ·
@UltraShy yeah your inbox is full.. But yeah it looks Sweet, 1.2 Acres yard. Maybe you could by that horse you always wanted! :grin2:

18acres :O... Your own Forrest included?

After checking out what squarefeet equal to in the metric system hmm....hehe... Im not agreeing with your brother, and the court thing thats just low.

Make sure to invite your brother to the housewarming party!
 
#26 ·
@UltraShy yeah your inbox is full.. But yeah it looks Sweet, 1.2 Acres yard. Maybe you could by that horse you always wanted! :grin2:

18acres :O... Your own Forrest included?
I don't recall the 18 acres have much, if any, trees. It was entirely surrounded by farm land. It was on the far northern border of Washington County in the town of Wayne (a place I never knew even existed). Very rural out there. I would presume the 18 acres was once farmed.

That's back when my Realtor was looking for land that I could use as my own shooting range. He estimated that I would need a 250 foot driveway and the idea of plowing that really turned me off. Though it was a whole lot of land for $100,000. We actually drove out there and looked at that property.

He also found 29 acres that was a former golf course, but correctly assumed I didn't want to pay $169,000 for land alone.

Make sure to invite your brother to the housewarming party!
He is not my brother any longer. He will forever be referred to as Satan or the Beast. The idiot probably still thinks he's my beneficiary, even though I disinherited way back in 2009 when he was a raging drunk, downing a liter of whiskey daily.

If he didn't like me being mom's beneficiary, just imagine how pissed he would be if he found out he wasn't even #2 in line. Had I predeceased my mom, the money would have gone to the NRA.

I have to write up a will or trust to ensure he never gets this home. A trust has the advantage of never going through probate, thus the disposition of assets are entirely private. This will keep the snoop out of the Washington County Courthouse to take a peek at my estate plan such that he can hound & harass my beneficiaries.

I want the home & everything in it to go to my best friend Patty. She would actually appreciate this home. The online pics fail to show that it's my own personal forest, with countless trees. When there are leaves on the trees, you can't even see my house from the street. Patty will also get everything in the house, though Satan won't even know about all my possessions, such as the 62 pounds of silver I just bought today.
 
#25 ·
I do not consider social anxiety to be the crux of my problem, it is more chronic anergic bipolar II depression. BUT I like this forum due to the MAOI expertise here.
You probably already know this but be careful with antidepressants in case they destabilize.

I had a temporary but grand remission on lamictal. I think it was probably psychogenic (placebo) but nonetheless, living for even a week without depression symptoms is like a revelation.
Whenever I increase my lamictal dose, I get a week or so of "vrroom" and dopaminergic feeling, though like you, it doesn't last.

1. Is there any difference between brand name and generic Parnate? I am strongly inclined to believe that people are just being paranoid when they say that they experience a difference. A lot of people complain about the "new" Nardil but they are a self selected sample and I am curious how many of the people that complain were aware of the change before they experienced treatment failure.
Not that I'm aware of. I've taken both.

SO - here is the million dollar question: what would you expect from mixing the two drugs? Lower doses of Parnate needed? A more activating effect profile? Lower side effects? I know no one can answer this question authoritatively, BUT this is the best place on the internet to ask this question.
I would say it's difficult to know just how the two combine since such a combination is very rare. FWIW I find Parnate a bit sedating.

3. Final question for the people here who are already on MAOIs - would you add in Ketamine if you could? Why or why not?
If I felt I needed to trial this, sure.
 
#27 ·
@UltraShy hehe the NRA, like they don't have enough lobbying groups giving them money....

I recall having heard Patty mentioned before, so yeah that seems like a better choice!!

Probably best that you don't have your own shooting range. You would never leave home!:wink2:

62pounds of Silver...Ive heard alot of people doing this since Trump was elected..:b
 
#28 ·
@UltraShy hehe the NRA, like they don't have enough lobbying groups giving them money....
I joined the NRA for $25 in 2009. Upgraded to Life Member in January 2010 for $500.

Another SAS "gun nut" (with even more guns than me -- I have 12, waiting to get #13 which is paid for, but needs ATF approval as a Class 3), I gave him my NRA member number such that he could log in pretending to be me and buy himself a gift of Life Membership for $300.

I recall having heard Patty mentioned before, so yeah that seems like a better choice!!
Early this year I made a beneficiary change, making her 20% beneficiary with the other 80% going to the NRA. That would have given hear near $400,000, though less since I had to wire $308,000 out of that account in July to buy my home.

I want to set it up such that Patty gets the Hubertus home. Before meeting her 4 years ago I didn't even know Hubertus existed. She lives in Hubertus, just 3.5 miles from me. Hubertus is an unincorporated part of the village of Richfield. I knew of Richfield ever since they built a Cabela's there. Cabela's sells a whole lot of guns, ammo, firearm accessories and outdoors stuff. Cabela's is also our biggest taxpayer at $300,0000 -- $30k of which goes to Richfield.

Richfield's slogan is "Forward. Preserving a country way of life." It all single family homes on 1 acre+ lots.

I think my house is bigger than the Richfield Village Hall. And the Hubertus Post Office is comically small, being on par with my garage.

I concluded there is a problem with outdoor ranges: weather. I'm really almost entirely into handguns, which are perfectly suited to a 25 yard indoor range, which is heated in winter.
 
#29 ·
^ Yes that is abit less, but still a hefty sum.

80% to the NRA... Feels like i need to read up on them, guessing that Michael Moore doc, was abit bias!
 
#33 ·
I support the NRA because they are by far the most powerful pro-gun lobby in Washington.

I don't mindlessly support them on everything, and I fully recognize that they are forced to water down their public statements so as to not offend their more moderate members. For example, the NRA talks of firearms are defense against criminal thugs, though you will never hear then speak of firearms as defense against political despots who have slaughtered (unarmed) innocents by the millions.

For accounts that come with a large embedded tax liability I give them to an IRS-recognized tax-exempt 501(c)(3), specifically the NRA Civil Rights Defense Fund, which litigates pro-gun cases. (The NRA is NOT tax-exempt, due to their political lobbying activity).
 
#30 ·
caedmon, hello, you take lamictal for bipolar problem ?


Watertouch,
Just by curiosity, because I'm reaching for TCA+ ssri since few week.
So, we know that MAOI with SSRI is deadly dangerous(mostly at high dose), but about 2 ssri in the same time You said me lot of time, that was dangerous too, but dangerous as a combination of MAOI and ssri ? what Dr. Gillman say about it ?


Thanx
 
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