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Old 03-30-2006, 05:33 PM   #1 (permalink)
 
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Default Me, Parnate, and MAOIs

I've had some people ask about my experiences with this drug, when I go on it. Right *now* what I have to say is concerning my pre-medication research and findings. I haven't taken it yet, but here is some information on Parnate (tranylcypromine) and on MAOIs in general.

I would encourage people to independently check anything I say about MAOIs. (Or any drug, really.)



First, two relevant abstracts:

J Clin Psychopharmacol. 1988 Aug;8(4):279-83.

Tranylcypromine in social phobia.

Versiani M, Mundim FD, Nardi AE, Liebowitz MR.

Department of Psychiatry, Federal University of Rio de Janeiro, Brazil.

Thirty-two patients meeting DSM-III criteria for social phobia entered a 1-year drug treatment with tranylcypromine in dosages between 40 and 60 mg/day. After exclusion of the early dropouts, improvement was rated as marked and moderate in 62% and 17% of the sample (N = 29), respectively. Alcohol abuse was associated with a poor outcome. Side effects were frequent and in some cases delayed the attainment of efficacious dosages until the third month of treatment. No serious adverse reactions occurred. The findings, relative to efficacy, are in accordance with a previous trial with phenelzine but need confirmation in double blind controlled studies.

___________

J Psychiatr Res. 1988;22 Suppl 1:87-98.

Monoamine oxidase inhibitors in anxiety disorders.


Tyrer P, Shawcross C.

Mapperley Hospital, Nottingham, U.K.

Monoamine oxidase inhibitors (MAOI's) have been shown to be significantly superior to placebo in the treatment of some anxiety disorders, particularly agoraphobia and mixed anxiety--depressive states. There is no convincing evidence that MAOI's are effective treatment in pure anxiety states, whether or not panic is present as a major symptom, although they are effective in so-called endogenous anxiety. Many past published studies of MAOI's have yielded poor results because the drugs have been prescribed for insufficient time (less than four weeks) or at too low dosage. There are no important therapeutic differences between the MAOI's apart from the faster speed of response with the nonhydrazine compound, tranylcypromine. Treatment often has to be long-term, and some degree of pharmacological dependence may develop. A few clinical studies have compared the efficacy of MAOI's and tricyclic antidepressants in anxious disorders. There is growing evidence that MAOI's are somewhat more effective than tricyclic antidepressants in the treatment of anxiety disorders and when phobic anxiety is an important component of a depressive disorder.
_______________


Quote:
Originally Posted by apprentice1
about Thorazine as an anti-dote for hyper-tension. I am sorry, I posted a stupid post, what can I say? I will edit it to at least take out my "doctor myself" remedy. It is just that I was "treated" with thorazine when I was 22. What size tablet did he give you if I can ask? What you said made sense.
I can understand the Thorazine concern - it's definitely a hardcore medication. I don't have a Rx in my hand for Parnate or for Thorazine yet, I have to wash out from the Wellbutrin first and then meet again with my psychiatrist April 11th.
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Old 03-30-2006, 07:20 PM   #2 (permalink)
 
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Why Parnate?

I have severe treatment-resistant depression (part of bipolar disorder). I also have a lot of social avoidance behaviors despite *symptomatic* relief from Valium (diazepam) or Topamax (topiramate). I have some cognitive and attentional problems as a result of my depression. (It may be undiagnosed inattentive ADD, but I don't know.) I have compulsive eating problems and chronically low energy. Parnate is a good choice for those symptoms. I am ready for a very effective medication for depression. MAOIs are that.

Nardil is the more common MAOI, although it is not a common medication by any means. I recall reading that somewhere around 10,000-15,000 people worldwide take Nardil (phenelzine). Compare that to over a million people on Prozac. Even fewer people take Parnate - scripts worldwide are about half that of Nardil. Marplan is the least used of all, and the manufacturer was at one point going to stop making it (I believe they still do now, however).

MAOIs have different profiles. While they all work on serotonin, norepinephrine, and dopamine, they have differing degrees on this. Nardil heavily effects serotonin, and does something with GABA although I'm not sure how important that is. Nardil is a good choice for people with really dark moods, and can having a very 'soothing' effect. My intuition is that Nardil is the best choice for severe social anxiety disorder. (One (1991) study found that it was more effective than Xanax or placebo.) Parnate works stronger on norepinephrine and dopamine. It is a good choice for people who have problems with oversleeping and overeating, or concentration problems. 10mg of Parnate is considered to be equal to 1mg dextroamphetamine. Marplan is considered to be sort of an "in-between" of the two, so for many people it's a good compromise drug.

They also have different side effect profiles. All of them can cause insomnia and lowered blood pressure. These tend to go away over time. Nardil tends to cause sexual side effects, although those can go away in some cases over time. Nardil also tends to cause the most weight gain, which is a good or a bad thing depending on your body type. Marplan can do these things too although I am not sure if they tend to be less common or not.

Parnate may or may not cause sexual side effects - I have heard of it actually increasing sex drive in fact. Same with weight gain or loss - many people lose weight on it. Some of that could simply be from dietary restrictions, however. Parnate causes the most insomnia and activation and is a very very unsubtle drug for most people. However, if you are very "low-energy" and low motivation and antisocial (like me), this makes it a good choice. Parnate is structurally related to amphetamine, so some people develop an addiction to it, although I suspect this is pretty uncommon. (Euphoria is something that most all the MAOIs can induce, especially in the beginning stages or at high doses. I actually think that the euphoria is better termed 'euthymia' - it's not clear to me that the euphoria is from an inherent property of the medications or if it has more to do with the fact that a depressed or anxious person finally feels dramatic relief.)

More later, when I get time.
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Old 03-30-2006, 09:12 PM   #3 (permalink)
 
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I've read websites that say parnate is better for SA. It is more tolerated with less side effects. I think MAOI's raise blood pressure. I think parnate does it more because it works on dopamine and NE more. It is also supposed to have amphetamine metabolites, which makes blood pressure go up. It also makes a reaction more likely since the blood pressure is already raised it doesn't take as much to push the pressure to high(which I believe what a hypersensitive crisis is). It is also more likely to cause dopergenic reactions which pretty much has the same symptoms as a trymane reaction. So things like caffine or foods that have high levels of dopamine are more likely to cause reactions.

Nardil works mostly SE and GABA so things like caffine can enhance it's effects.

So, parnate is going to give more activating effects, make you more confident and maybe talkative. Similar to the effects of amphetamines. It will probably have less side effects, but be less forgiving on the food/med restrictions.

Nardil will be more soothing giving an anti-anxiety effect. It seems to be more forgiving on the food/med restrictions. It will have more side effects, though.

I don't really know how much MAO Inhibition effects GABA. Nardil has a metabolite that works on GABA through another means than MAO Inhibition. I don't know if parnate works on GABA or not.

Some of that might be wrong, thats just what I remember from a long time ago.
I was going to see about parnate, but I was in a "i don't want to do anything" mood, so I skipped my doc appt. monday.
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Old 03-30-2006, 09:35 PM   #4 (permalink)
 
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Default Re: Me, Parnate, and MAOIs

Quote:
Originally Posted by Caedmon
There is no convincing evidence that MAOI's are effective treatment in pure anxiety states...
That part would concern me, since I think I'd be pretty close to a "pure anxiety state".
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Old 03-30-2006, 09:45 PM   #5 (permalink)
 
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Quote:
Originally Posted by workman
It also makes a reaction more likely since the blood pressure is already raised it doesn't take as much to push the pressure to high(which I believe what a hypersensitive crisis is). It is also more likely to cause dopergenic reactions which pretty much has the same symptoms as a trymane reaction. So things like caffine or foods that have high levels of dopamine are more likely to cause reactions.
Parnate is associated (rarely) with 'spontaneous hypertensive reactions'. The theory being that it reacts to its own amphetamine metabolite. I don't know if this happens with Nardil and Marplan or not, but I know it does for Parnate.

I'm not sure if BP is typically raised or not, with MAOIs. I have read that hypotension (lowered BP) is a common side effect. Anyone know?

Quote:
It will probably have less side effects, but be less forgiving on the food/med restrictions.
That's my prediction as well.
Quote:
I was going to see about parnate, but I was in a "i don't want to do anything" mood, so I skipped my doc appt. monday.
Hope you feel better soon.
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Old 03-31-2006, 12:19 AM   #6 (permalink)
 
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Quote:
Originally Posted by Caedmon
Euphoria is something that most all the MAOIs can induce, especially in the beginning stages or at high doses. I actually think that the euphoria is better termed 'euthymia' - it's not clear to me that the euphoria is from an inherent property of the medications or if it has more to do with the fact that a depressed or anxious person finally feels dramatic relief.
There's definitely the aspect of dramatic relief causing a kind of psychological (as opposed to physical, chemically induced) euphoria.

In my experience, however, the MAOIs can indeed produce a degree of physical euphoria - particularly when just starting out. In order to produce a mild euphoria, you have up the dose quite a bit. At higher doses, the MAOIs are increasing your body's "feel good" chemistry. (A drug like cocaine acts primarily on dopamine and norepinephrine - causing it's euphoric effects.) Since these drugs have such a global effect on body chemistry, however, uncomfortable side effects can increase as well. If you really cranked MAOI dosage in an attempt to replicate something even remotely close to a cocaine or amphetamine high - the side effects would probably overwhelm you long before you got "high".

Even still... there are reports like this:

Quote:
ABSTRACT: Abuse of monoamine oxidase inhibitors is not common but there are a few cases of addiction in the literature. Most of these patients had an additional diagnosis, either history of past drug abuse or personality disorder and MAOI withdrawal symptoms have been reported. We encountered three patients who received MAOI under psychiatric care. They were all self medicated by increasing the doses on their own, experienced euphoria and visited various physicians to obtain MAOI prescriptions and manifestedtoxic states. One of our patients had a normal, another a schizoid and the third, an addictive personality. Two were addicted in the past to amphetamine. Therefore, it is important not to prescribe MAOI's to patients who have a history of amphetamine andother addictions.
When I first came across this, I was like, you've gotta be kidding.
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Old 03-31-2006, 08:51 AM   #7 (permalink)
 
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I have definitely read case reports of euphoria and even addiction to MAOIs. It seems to be a possibility. It makes sense. You're increasing levels of all three 'major' neurotransmitters, not just in the synaptic cleft but extracellular too. I think cocaine does something similar, although certainly to a larger extent.

How do you think that works spaceboy? I understand that, to a certain level you can inhibit MAO but I would guess that higher doses (e.g. 120mg Nardil/phenelzine) aren't inhibiting MAO anymore than lower doses (e.g. 60mg), since your body only makes so much MAO. I think? So, maybe it's an interaction between the MAO inhibition and a metabolite? Interesting to think about.

FDA indication for Parnate is 30-60mg, but I have read about people on as much as 200mg, in combination with stimulants (clinically). Not as abuse - this is for severe low-energy depression and a very skilled doctor. (It may also have to do with people being fast metabolizers.) Hmm, drugs are complicated like that.

I am bipolar. I wondered about MAOI use and mania. It would appear that there is not necessarily a higher incidence of mood destabilization on MAOIs - if anything, perhaps lower, compared to other antidepressants. Emphasis added:

Tranylcypromine versus imipramine in anergic bipolar depression
Himmelhoch JM, Thase ME, Mallinger AG, Houck P
Department of Psychiatry,
University of Pittsburgh School of Medicine, PA.
Am J Psychiatry 1991 Jul; 148(7):910-6

OBJECTIVE: This investigation compared the efficacy of the monoamine oxidase inhibitor (MAOI) tranylcypromine with that of the tricyclic imipramine in the treatment of anergic bipolar depressive illness. METHOD: A controlled, double-blind comparison was used to study 56 outpatients who met operationalized criteria for anergic bipolar depression. Patients with bipolar I and II depression were equally distributed between comparison groups. Outcome was measured by the patient-rated Beck Depression Inventory and the clinician-rated Hamilton Rating Scale for Depression, Raskin Mania and Depression Scales, Clinical Global Impression Scale, and the Pittsburgh Reversed Vegetative Symptom Scale. Twenty-eight patients were treated with tranylcypromine and 28 with imipramine. Seventy-three percent of bipolar depressive patients screened for the study met criteria for anergic depression, consistent with previous findings from studies in bipolar illness that stretch back over 100 years. RESULTS: Tranylcypromine produced statistically significant superior outcome in terms of lower attrition, greater symptomatic improvement, and higher global response without increased risk of treatment-emergent hypomania or mania. CONCLUSIONS: The authors propose that the apparently superior efficacy of tranylcypromine in bipolar depression is specifically linked to anergia and reversed neurovegetative symptoms. Bipolar I and bipolar II patients had comparable outcomes, but bipolar I patients had a significantly greater risk of treatment-emergent mood swings. Although the relatively poor showing of imipramine warrants close scrutiny, these findings provide further documentation of the utility of MAOIs in patients presenting with anergia, motor retardation, hyperphagia, and/or hypersomnia.

Antidepressant-associated mania: a controlled comparison with spontaneous mania.
Stoll AL, Mayer PV, Kolbrener M, Goldstein E, Suplit B, Lucier J, Cohen BM, Tohen M.
Bipolar and Psychotic Disorders Program, Mailman Research Center, McLean Hospital, Belmont, Mass.
Am J Psychiatry. 1994 Nov;151(11):1642-5.

OBJECTIVE: Antidepressants have been associated with the induction of mania and rapid cycling. This study examined whether antidepressant-associated manic states differ in any way from spontaneous mania. METHOD: Forty-nine consecutive inpatients with antidepressant-associated manic states were compared with 49 matched inpatients with spontaneous mania in a blind, retrospective chart review. RESULTS: Across virtually every clinical measure examined, the patients with antidepressant-associated manic states experienced milder and more time-limited manic episodes than the patients with spontaneous mania. The patients with antidepressant-associated manic states were subject to frequent checking by nurses and hall restriction for a significantly shorter period of time than the patients with spontaneous mania. The patients with antidepressant-associated manic states also had significantly less severe levels of delusions, hallucinations, psychomotor agitation, and bizarre behavior, according to a standard rating instrument, than the patients with spontaneous mania. For further study the patients with antidepressant-associated mania were divided into subgroups taking four individual classes of antidepressant drugs: tricyclics (N = 19), fluoxetine (N = 13), monoamine oxidase inhibitors (MAOIs) (N = 8 ), and bupropion (N = 6); three patients taking combinations of drugs were not included in these analyses. The patients with MAOI- and bupropion-associated mania had a slightly lower overall rating of severity of psychopathology at admission than the subgroups with fluoxetine- and tricyclic-associated mania. CONCLUSIONS: Antidepressant-associated mania appears to be a milder and more time-limited syndrome than spontaneous mania and may represent a distinct clinical entity. MAOIs and bupropion may be associated with milder manic states than either tricyclic drugs or fluoxetine.
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Old 03-31-2006, 06:34 PM   #8 (permalink)
 
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Re: mania and MAOIs - here's a post from these forums related to this:

Quote:
Originally Posted by lostsoul
Can't sleep just thought I'd share my experience with medication. I've tried many over the years finally thought I found one that worked with Nardil.

It worked very well I felt great, wonderful! My fears begin to vanish, social anxiety became a thing of the past. I thought I was brilliant I was just impressed to hear myself talk and I would never stop moving. Eventually I started to feel like had a mission from god...
Nardil precipitated a manic state in this person. Read the rest at:
http://www.socialanxietysupport.com/vie ... hp?t=33148
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Old 03-31-2006, 09:04 PM   #9 (permalink)
 
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Quote:
Originally Posted by Caedmon
I have definitely read case reports of euphoria and even addiction to MAOIs. It seems to be a possibility. It makes sense. You're increasing levels of all three 'major' neurotransmitters, not just in the synaptic cleft but extracellular too. I think cocaine does something similar, although certainly to a larger extent.


How do you think that works spaceboy? I understand that, to a certain level you can inhibit MAO but I would guess that higher doses (e.g. 120mg Nardil/phenelzine) aren't inhibiting MAO anymore than lower doses (e.g. 60mg), since your body only makes so much MAO. I think? So, maybe it's an interaction between the MAO inhibition and a metabolite? Interesting to think about.
I don't know to what degree you can inhibit MAO, and what effect something close to 100% inhibition would produce.

"Too much of a good thing" ... recently I had read on the internet somewhere, that if MAO is inhibited over 80% by an MAOI, dopamine levels actually begin to drop dramatically. I'm too lazy to go looking for it right now.

I do know that the effects of cocaine are vastly - let me say that again - vastly more intense as far as euphoria goes.

This is from a book I have called "Drugs and the Brain" - sort of a layman's guide to various drug actions.

Quote:
Apparently the major action of amphetamines is to release dopamine and norepinephrine from the storage vesicles. The amphetamine molecules diffuse into the nerve ending where the neurotransmitter is contained and, because of their close chemical similarity to dopamine and norepinephrine, displace those neurotransmitters from their storage sites. The neurotransmitters are thus pushed out into the synaptic cleft, where they stimulate appropriate receptors.

Cocaine may behave in exactly the same way, but, to date, scientists have been unable to define its precise molecular action.
This is a very different action from the MAOIs (which inhibit the "janitorial" enzyme that oxidizes excess neurotransmitters [monoamines] after they've been released from their storage sites.) In the case of stimulants like amphetamine and cocaine, their effects are specific to dopamine and norepinephrine - affecting no other neurotransmitters. (the molecules of these stimulants closely resemble DA and NE molecules.) However, by inhibiting MAO, there are going to be increased levels of dopamine and norepinephrine available in the synapses - but it doesn't include only these. It also has an effect on seratonin along with every other neurotransmitter.
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Old 04-01-2006, 10:01 AM   #10 (permalink)
 
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I thought cocaine affected SE. I'll admit I don't know very much about the way most recreational drugs work.

More abstracts that I found interesting while doing my daily compulsive medication research:

Bipolar depression: issues in diagnosis and treatment. [Tranylcypromine (Parnate) for refractory bipolar depression]

Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.

Metabolism of monoamine oxidase inhibitors. [Tranylcypromine may not metabolize into amphetamine - it's controversial.]

Insight into the mechanisms of action of the MAO inhibitors phenelzine and tranylcypromine: a review. [This is a full-text article, not just an abstract. Fascinating info on MAOIs. I have always been taught in research classes that going off of abstracts is bad form, because the body of the article can be full of ill logic. I mean, it's the best we laymen can do, but I always am pleased if I can read the entire article. Anyway, what the article does is point out how MAOIs work very differently than just on SE, NE, and DA. Phenelzine (Nardil) may do a LOT of stuff with GABA, in unique ways - and that GABA action could, indeed, be responsible for some of its antidepressant/ antianxiety efficacy. MAOIs actually cause neurological changes (good ones), contributing to their efficacy, e.g. decreasing 5HT2 receptors. Their action on dopamine has a complex, almost bell-shaped response - robust at mid doses, and like you said spaceboy, lowers again at higher doses.]

Monoamine oxidase inhibitors and weight gain. [Phenelzine (Nardil) causes weight gain, but not as much as TCAs - I didn't know that. Also, isocarboxazid (Marplan) causes less weight gain than phenelzine, and tranylcypromine (Parnate) causes no weight gain based on literature.]

Adverse reactions to monoamine oxidase inhibitors. Part I. A comparative study. [Phenelzine (Nardil) may cause more side effects, BUT it may not necessarily end up being less tolerable than Tranylcypromine (Parnate) or having more dropouts.]

VASCULAR CRISES ASSOCIATED WITH MONOAMINE-OXIDASE INHIBITORS. [I am told that this Bethune 1964 study found that "a retrospective analysis of the incidence of acute hypertensive crisis in 692 patients treated with MAOIs found that the incidence was 8.4% prior to instituting dietary restrictions but 3.3% after dietary restrictions were imposed." I read this somewhere, posted by someone who seemed very knowledgeable. (I was just copying and pasting information into a Word document whilst compiling information on MAOIs.) I can't independently verify that because I can't read it in the non-existent abstract nor do I have the article in front of me. Anyway I thought it was interesting that less than 10% of patients had a hypertensive crisis back in the day, even though they weren't dissuaded from eating certain foods.]

Sorry guys, when I do research I end up using the generic names of the drug because that's what you have to enter in the search parameters. Just remember, Nardil = phenelzine, Parnate = tranylcypromine.
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Old 04-03-2006, 10:07 AM   #11 (permalink)
 
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I am having limited success with tranylcypromine. Within two weeks of starting, I needed to up the dose to keep the energy effects going. I took the first one in the morning around 6:30am and it would wear off by noon, sometimes though coming back later on in the evening...sometimes not. I started Saturday taking one in the morning and another at around 3:30pm. that worked one day and not the next.
I had my appt. with my psychiatrist today and took along a written request to try Provigil. My problems with sleeping too much are still there, obviously. Unfortunately, it is outrageously expensive and the insurance system won't pay for it. (Something like 128 Euro for 20 pills!!) At this point we talked about upping the dose of tranylcypromine!! I explained that I had had visitors who slept in the same room with me and have told me I should get checked for sleep Apnea, because, they said, I have it...my psych told me if he can prove I have sleep Apnea he can prescribe Provigil under the insurance system so now I have to go to a Pulmonary doc (?). I have no idea how they determine things, if I will have to go to a sleep clinic...yuk...but he said if I have it they will give me a machine and a mask to wear at night that makes you breathe right. Now I have seen these things in action once in a hospital stay and I cannot imagine using such a thing, but when I said that I got a sort of "don't ask, don't tell" look from the psych doc which makes me think the main thing is to get the diagnosis so he can prescribe the Provigil...whether I use the mask is something else...in the meantime, I have taken 30mg. tranylcypromine today and slept most of the afternoon again...it is okay for today, as I am now on vacation and actually have a "date" planned for later this evening. So...the tranylcypromine at least seems to work well, really well for depression...and as for SA, well...the date... It is someone I have only net so far.He seems the complete opposite of me as far as shyness, but very understanding. After me not showing up several times and making excuses for not being able to meet he asked and I told about the SA stuff and he said he thought as much, asked if we could still talk and even offered "other alternatives" that might make meeting more easy. , and so far I haven't backed out from the meeting set for about 3 hours from now...maybe with a xanax or two, I can go through with this...wish me luck. I haven't talked to a stranger in private for I don't know how many years. Another thing! My psych doc that I like so o o much said if I take the tranylcypromine and Provigil, I will have to stop taking the xanax. I have not read any information against a combination of the three, and have read suggestions for the combo at Social Anxiety Disorder (Social Phobia). All in all, I would not give up my tranycypromine for anything else and if I can get the Provigil I would even be willing to give up the xanax...
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Old 04-03-2006, 10:34 AM   #12 (permalink)
 
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It doesn't make sense to me why he would want you to stop the Xanax. Maybe he thinks that's too many meds?

I think the rule for Parnate/tranylcypromine (well, a rough rule) is 1 mg/kg of body weight. So if you weigh 80 kg, your dose is 80mg of tranylcypromine. If you weigh 62 kg you'd aim for 60 mg. Something like that. Of course, people are different metabolizers so you may need more or less despite body weight.
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Old 04-03-2006, 10:57 AM   #13 (permalink)
 
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the dosing info for parnate says 30 mg is the usual dose and 60 is the max. 60 to 80 sounds more like nardil doses.

I'm going to make an appt. again to see about parnate or trying nardil again. The thing about parnate is that no pharmacy around here carries it.

apprentice1: how is parnate anxiety wise? does it make you more anxious? does it make more confident or talkative? I hope you go on your date. I hope it goes well.
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Old 04-03-2006, 11:10 AM   #14 (permalink)
 
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I know that's what the manufacturer says, and the PDR, but I'd say it's conservative (just like some of the food interaction lists are conservative). I think it's too low; I really do think it's 1mg/kg although I can't recall where I read that. Pretty much everyone on dr-bob is on 50-100 mg. People go as high as 200 mg (see above). Parnate seems to have a wider therapeutic window than Nardil.

Example:
Quote:
Originally Posted by Ivan Goldberg
The commonest reason people do not respond to tranylcypromine (Parnate) is an inadequate dose. When using an MAOI I follow platelet MAO levels and keep increasing the dose is sufficient to reduce those levels almost to zero. This often takes > 60 mg/day of tranylcypromine.

If a month or so on 80 mg/day or so does not lead to a significant improvement, the next thing I usually do is to add a psychostimulant such as methylphenidate or dextroamphetamine to the cocktail. Starting with small doses, the dose is gradually increased until the patient is taking about 30 mg/day of dextroamphetamine, or twice as much methylphenidate.

....

In the olden days, the early 1960s, we used to treat some patients with resistant depressions with up to 200 mg/day of tranylcypromine and if that was not effective potentiate it with dextroamphetamine, starting with 2.5 mg once a day and gradually increasing to 15 or 20 mg/day.
Any pharmacy can order the Rx and it's there within a couple of days. Refills should probably be called ahead by a couple of days if you are taking an MAOI.
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Old 04-04-2006, 12:24 AM   #15 (permalink)
 
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Versiani M, Mundim FD, Nardi AE, Liebowitz MR.

Department of Psychiatry, Federal University of Rio de Janeiro, Brazil.

Thirty-two patients meeting DSM-III criteria for social phobia entered a 1-year drug treatment with tranylcypromine in dosages between 40 and 60 mg/day. After exclusion of the early dropouts, improvement was rated as marked and moderate in 62% and 17% of the sample (N = 29), respectively. Alcohol abuse was associated with a poor outcome. Side effects were frequent and in some cases delayed the attainment of efficacious dosages until the third month of treatment. No serious adverse reactions occurred. The findings, relative to efficacy, are in accordance with a previous trial with phenelzine but need confirmation in double blind controlled studies.


This came from an earlier post on this thread, but I thought it was just worth mentioning again.
Parnate doesn't make me anxious at all. Where there was normally fear, there...just isn't now. It is difficult to describe...I think 10mg. one time a day is too little, but to establish a compatability record..okay. I have the go ahead to take one morning and noon and will call and ask if I can take another one, which will simply make my doctor think I am very careful and he will certainly say yes. The half-life of tranylcypromine is very low and that is what I have been noticing. It is not like Prozac where you can take 60mg. all at once in the morning, you have to space tranylcypromide in for example three times a day, because it just wears off. My observation, anyway. I read and get conflicting info as to the half-life of tranylcypromine, but figure 2.5 to 3 hours is about right. I also get conflicting info as to whether you have to spread out the days dose or can take it all at once. The instructions that came with my meds say 1 to 3 tablets a day either all at once or spread out over three doses...If the half-life is so short, an all at once dose doesn't make sense to me...
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Old 04-04-2006, 11:13 AM   #16 (permalink)
 
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Quote:
Originally Posted by Caedmon
It doesn't make sense to me why he would want you to stop the Xanax. :stu Maybe he thinks that's too many meds?

I think the rule for Parnate/tranylcypromine (well, a rough rule) is 1 mg/kg of body weight. So if you weigh 80 kg, your dose is 80mg of tranylcypromine. If you weigh 62 kg you'd aim for 60 mg. Something like that. Of course, people are different metabolizers so you may need more or less despite body weight.
Any idea where you have that information?

Today I went to the dentist so took my 10mg.Parnate and 1mg. of xanax for obvious reasons (dentist, fear, anxiety). This was about 9:00am. The appointment was for 10:15am. The appointment went great, I was friendly and not uptight at all. Doctor visits are one of the worst things for me as far as anxiety is concerned. (I cut my own hair because I couldn't stand going to a haircutter...the cape, the mirror...the panic.) Anyway, I was great but before I knew it I had missed taking my noontime dose of Parnate and it was about 2:00p.m. I took the Parnate but, again as has happened before, too late and nothing. I was in bed half an hour later having almost fallen asleep at the keyboard. Four hours later, I'm awake again. Maybe there is something to the theory about giving up the xanax. Parnate makes me feel not depressed, but is sort of speedy... I thought it really didn't help my S/A so much. Maybe I was wrong and just didn't trust it, or give it a chance. Maybe I am just on way too little a dosage of the Parnate...tomorrow is a new day...
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Treatments: xanax, Parnate, Rifun, Macrogol 4000 powder,Domperidon, Somnosan,Voltaren(Diclofenac)
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Old 04-04-2006, 03:17 PM   #17 (permalink)
 
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Quote:
Originally Posted by apprentice1
Any idea where you have that information?
I don't! And I can't re-discover the source either (stupid Google). It's one of those things that I got into my head, somehow, but I don't know where from or if it's reliable, so I could be very wrong. See the discussion pg. 1, re: dosing.

Actually, I've been thinking about what Dr. Goldberg wrote. I didn't know you could take MAO platelet levels (but I guess, sure, why not?). So that's one way to check on the level of the drug in the bloodstream and therefore, the therapeutic dose. You could always ask for that, I guess. (I try to avoid lab tests when possible because they are not always covered by my insurance.)

I think the Versiani (198 study is interesting. It's been 18 years and no follow-up study?
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Rx- Dream Team of Parnate, Adderall, & Lamictal! Just added Topamax
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Old 04-05-2006, 01:16 PM   #18 (permalink)
 
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I just posted under the Nine year Nardil thread and couldn't move the post over to here where it belongs...
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Treatments: xanax, Parnate, Rifun, Macrogol 4000 powder,Domperidon, Somnosan,Voltaren(Diclofenac)
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Old 04-05-2006, 01:19 PM   #19 (permalink)
 
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Quote:
Originally Posted by apprentice1
I just posted under the Nine year Nardil thread and couldn't move the post over to here where it belongs...
Copy & paste
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Old 04-05-2006, 01:24 PM   #20 (permalink)
 
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Thanks, Thunder. I tried that three times and gave up. One more go...your name still scares me, by the way...
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