Can someone help me with detective work and my response to Parnate Please?! - Social Anxiety Forum
 
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post #1 of 8 (permalink) Old 04-16-2016, 02:23 PM Thread Starter
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Can someone help me with detective work and my response to Parnate Please?!


If someone could maybe do a little detective work and offer their analysis of what might be going on with my response to Parnate, I'd greatly appreciate it! For some historical perspective, throughout my 8 years of being on many different medications, I always seemed to not respond too well to medications that worked on norepinephrine. I think they would make me too stimulated and give me more anxiety.


So anyways here are some of the things that have gone on with Parnate... I seem to have inconsistent efficiency. Sometimes I feel more calm and in a better mood, and then other times I feel extremely agitated and am unable to get out of my head. I am stuck in my head worrying/obsessing/ruminating over pretty much the same thought. This then leads to suicidal ideation because I can't get out of my head and focus on what's happening around me. Then I can get pissed off and really angry. Other times I get too overwhelmed from what seems to be some type of overstimulation where my brain can't stop thinking about this same worry and then I start crying.

Now I should note, this type of inability to get out of my head began a few months prior to Parnate. I had gotten off Paxil and also was doing TMS when I started having this extreme self monitoring where I think about every little thing I do and I get worried about my cognition and worried about getting confused. This is the same type of worry that keeps going on and on in my head and makes it so I can't get out of my head. I don't know if it was a withdrawal from Paxil or if maybe TMS caused some overstimulation, perhaps increasing norepinephrine?

Also, I couldn't tolearte 50-60 mg of Parnate as I had bad insomnia and real bad agitation. I'm thinking that maybe the norepinephrine effect of Parnate causes some overstimulation, which leads to agitation, suicidal thinking, anger, etc? And this may have also happened when I did Transcranial Magnetic Stimulation as it supposedly can increase the firing of all the neurotransmitters like norepinephrine? Can overstimulation cause obsessive type of worrying where you can't seem to get out of your head?

Does my theory sound like it could be on the right track in why I am responding like this?
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post #2 of 8 (permalink) Old 04-17-2016, 10:43 PM
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Quote:
Originally Posted by Iwillovercomeanxiety1 View Post
Can overstimulation cause obsessive type of worrying where you can't seem to get out of your head?

Does my theory sound like it could be on the right track in why I am responding like this?
Sure makes sense. Couple questions -
How do you do on SSRIs? When's the last time you tried one?
What about TCAs?
Lithium?
Also is weight gain a deal breaker for you?
Where do you think you rate on the continuum for OCD or for GAD?

Without knowing more it initially sounds like raising serotonin and lowering norepinephrine could help.

I wonder if clomipramine is an option instead of Parnate? Or a mood stabilizer (I believe we chatted about that), something like Latuda or Saphris. Also - this is kinda out there, but the controlled release trazodone called "Oleptro". It is probably easiest to try an antipsychotic first since it's compatible with Parnate and can also serve as a bridge med. If you like it, that is.

Parnate isn't stimulating for me, but for some it can be. I know in the past when previous meds were overstimulating, it was just torture. I would have given anything for my brain to shut up and my body to stop tensing.

Sorry you're struggling. Hang in there. You can do this.

Medication-related posts are for brainstorming purposes only. Talk to your doctor.

My meds: Parnate, Lamictal, Wellbutrin, trazodone
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post #3 of 8 (permalink) Old 04-18-2016, 01:58 PM Thread Starter
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Originally Posted by Caedmon View Post
Sure makes sense. Couple questions -
How do you do on SSRIs? When's the last time you tried one?
What about TCAs?
Lithium?
Also is weight gain a deal breaker for you?
Where do you think you rate on the continuum for OCD or for GAD?

Without knowing more it initially sounds like raising serotonin and lowering norepinephrine could help.

I wonder if clomipramine is an option instead of Parnate? Or a mood stabilizer (I believe we chatted about that), something like Latuda or Saphris. Also - this is kinda out there, but the controlled release trazodone called "Oleptro". It is probably easiest to try an antipsychotic first since it's compatible with Parnate and can also serve as a bridge med. If you like it, that is.

Parnate isn't stimulating for me, but for some it can be. I know in the past when previous meds were overstimulating, it was just torture. I would have given anything for my brain to shut up and my body to stop tensing.

Sorry you're struggling. Hang in there. You can do this.
Thank you for that. I was on an SSRI just a few months ago. I was on Zoloft and I had some suicidal ideation on that as well. I have been on Zoloft a few times. When I was first on it about 7 years ago it worked really well and I got 80% better with it and CBT. However these last couple times it just doesn't really work much.

I think the only TCA I've tried is Nortriptyline. I tried it maybe half a year ago. I don't think I was on it too long and came off of it because of increased fatigue.

I haven't tried Lithium, but I did try Lamictal. I wasn't on Lamictal too long either because of increased fatigue. Perhaps I just need to give some meds a little longer? I give the primary ones good long trials though, but then don't have as much patience with the adjunct or secondary medications.

Weight gain is not really a big deal. It's funny, usually I either don't have the side effect or have a suppression in appetite from medications that are notorious for weight gain like Paxil, Remeron, Nardil, etc. I also exercise a lot so I can overcome it, but of course I'd prefer not to have a med put weight on me.

I definitely have GAD and worry A LOT. OCD I believe I do have, but its mainly just me obsessing about the same thought. I don't know that there are any compulsions to it. I just know I definitely am obsessing a lot about my cognition and feeling confused.

Those medications sound like interesting options. I'm really not too sure if I should stick with Parnate and try to augment it or go back to Nardil or drop the MAOIs and try to augment something like Lexapro and just stay away from Norepinephrine type of meds..

Do you know if those gene test for medications are valuable at all? Can they give me a clue on what type of medications I should target? My psychiatrist said the gene testing is not the standard of care..
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post #4 of 8 (permalink) Old 04-20-2016, 06:14 PM
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Originally Posted by Iwillovercomeanxiety1 View Post
I definitely have GAD and worry A LOT. OCD I believe I do have, but its mainly just me obsessing about the same thought. I don't know that there are any compulsions to it. I just know I definitely am obsessing a lot about my cognition and feeling confused.

Do you know if those gene test for medications are valuable at all? Can they give me a clue on what type of medications I should target? My psychiatrist said the gene testing is not the standard of care..
I would raise the dose, found it worked good for me 100mg+... I sometimes had to use betablockers tough to lower the BP, (For me i get a raise of BP from Parnate)...
About your other question about tests, Dr. Stahl writes this: (from neiglobal.com)


Quote:
Are the new pharmacogenomic assays of any clinical utility? If so, when would one be of greatest benefit in making a treatment decision?
Great question, complicated answer. NEI members can get a free test from Genomind to test drive this idea in one patient. Insurance is actually reimbursing some tests especially the cytochrome P450 enzymes. Testing is also available from other companies like AssureRx. A number of assays are now commercially available and emphasize P450 enzymes, and a number of neurotransmitter related genes, and are probably most advanced for treatment resistant depression application, and more for treatment than for diagnosis in general in psychiatry. The most common genes available for testing are:
CYP 2D6, 1A2, 2C9, 2C19, 3A4/5
SERT (the serotonin transporter), variation associated with poor efficacy and poor tolerability;
5HT2A receptor gene;
5HT2C receptor gene
CACNA1C, calcium channel gene
DRD2 dopamine receptor gene
ANK3 signal transduction cascade
COMT catechol O methyl transferase enzyme’s gene
MTHFR Methylene tetrahydrofolate reductase
Not enough space here to explain these, but in brief, these are probably best established to help guide selection of treatment, not to guide diagnosis; and the best data are in treatment resistant depression where some of these gene variants predict poor efficacy or poor tolerability.
However, no gene tells you everything about a patient to dictate any specific treatment. This is about the balance of the evidence where the genomics help you make a decision and help make you more confident (and the patient more confident) about your decision.
Stephen M. Stahl, MD, PhD
Adjunct Professor, Department of Psychiatry,
University of California, San Diego School of Medicine
Honorary Visiting Senior Fellow, University of Cambridge, UK

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post #5 of 8 (permalink) Old 04-21-2016, 10:40 AM Thread Starter
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I would raise the dose, found it worked good for me 100mg+... I sometimes had to use betablockers tough to lower the BP, (For me i get a raise of BP from Parnate)...
About your other question about tests, Dr. Stahl writes this: (from neiglobal.com)

How come you think raising the dose would help with the GAD and OCD? What mechanisms in a higher dose do you think help with GAD and OCD?





I feel like a larger dose probably would work better for me, it's just I get bad insomnia at 50-60mg, which makes it counterproductive and ineffective. If I could treat the insomnia, then I could actually give the Parnate more of a chance to work at a higher dose.
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post #6 of 8 (permalink) Old 04-21-2016, 04:04 PM
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How come you think raising the dose would help with the GAD and OCD? What mechanisms in a higher dose do you think help with GAD and OCD?
Not really sure about the "mechanism of the pill" since MAO should be inhibited at lower doses.. But i found that i "ruminate" less and doesn't worry as much about things...

About sleep, ive always had problem sleeping or falling asleep... At about 23:00 and after i actually feel more energetic then during the day...

As for Parnate, for me it causes some type of "Narcolepsy"... I get dead tired at 19:30... And thats just to early to go to bed... After that "sleep attack" subsides... I then get energetic at 23:00 or so....

Benzo helps me fall asleep, but then i sleep for 3-4hours...
I kinda go with that. and every 3-4 days i use Theralen/alimemzine wich works somewhat like an Antipsychotic and get to sleep some 8hours... But it gives me "hangover" the day after.
Ive had this problem even at low doses such as 20-30mg of Parnate...

But yeah Caedmon like Trazodone. I don't have that in Sweden, but yeah guess you have to play around and find a sleepmedicine that works for you...

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post #7 of 8 (permalink) Old 04-22-2016, 12:39 PM
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A correction that Theralen/alimemzine i take, well i sleept for 12hours today on it, sleept through 3alarms, on highest volume...
Well i usually reffers to it as a "sledgehammer", it is brutal.

Parnate is a weird medicin!

Hello Darkness my old friend... I've come to talk with you again.

V1bzz:- Nardil is here to help us understand what it is to be old people

What's Dr. Stahl say?
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post #8 of 8 (permalink) Old 04-26-2016, 08:58 PM
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On the days that I tapered off Parnate, I felt much, much better. Before you go up to >50mg doses, try 10mg or even 5mg and see how you feel. I felt 90% remitted from depression and was definitely more social the day after my final 5mg dose. I'm going to try moclobemide now and see how it goes.

Keep in mind that my pharmacogenetic assay indicated that I'm a poor metabolizer, so lower doses may be better for me.
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