Posted by SLS on February 29, 2016, at 16:58:39
In reply to Re: Parnate » SLS, posted by Bob on February 29, 2016, at 15:10:29
> My current regimen is getting slowly more complex. I currently take the following:
> Nortriptyline 200mg (75mg 2x per day and 50mg at bedtime)For most people, this is too much. If you haven't already checked your blood level, you can do that and get a good idea if a dosage adjustment is necessary. The reason I mention this is because nortriptyline has a very real therapeutic window. More is not better. If the dosage of nortriptyline is too high, it stops working.
Have you ever tried desipramine? I am doing better on desipramine than I had been doing on nortriptyline. I find that it gives me more mental energy. I get more things done. I take 300 mg/day. I am optimistic that I will respond more robustly to desipramine than to nortriptyline. Stay tuned...
> Brintellix 10mg (5mg 2x per day)
I have no personal experience with this drug, and have not seen enough anecdotes to have an opinion. I have had experience with Viibryd, and have a doctor who has used it quite a bit. I would recommend talking to your doctor about it. Compared to Britellix, Viibryd is a more potent serotonin reuptake inhibitor. Viibryd is also a 5-HT1a partial agonist (like aripiprazole and buspirone), while Brintellix is a full agonist. I don't know for sure what the significance of this is, but my guess is that a partial agonist would act more like a stabilizer of serotonin activity.
> Aripiprazole 4mg (2mg 2x per day)
I would explore higher dosages. For me, the sweet-spot is 10 mg/day. I lose the antdepressant effect at 5 mg/day. However, my depression is of an unusual type of bipolar disorder.
> Lithium 112.5mg at bedtime
Why not 300 mg/day (150 mg x 2)?
> Lithothyronine T3 25mcg in the morning
Does it help depression? What about thyroxine T4?
> Pramipexole .375mg (.125mg 3x per day)
I'm not a big fan of full agonists of dopamine receptors. They usually don't help that much or for that long. I have seen two exceptions, though.
> I assumed that Parnate might have to be taken multiple times per day to stabilize blood levels.I don't think there are any blood levels to stabilize. Parnate is more of a hit-and-run drug. Still, I make it a habit of dosing three times a day. I would be just as comfortable dosing twice a day.
> Seems like the levels would get pretty low with a once per day dosing and a 2-hr half-life. I've found for some reason that for me it seems even for meds with a relatively long half-life it helps to dose more than once per day. This is especially true when starting a new medicine.
The first time I tried Parnate, I needed to take it 3 or 4 times a day to help reduce postural hypotension.
> I'm not getting a super-robust response from what I'm now taking and everything I take eventually fades in effectiveness. I recently added small amounts of pramipexole which is actually helping somewhat. MAOIs are the only class of drug I haven't tried to date and there is suggestions that they are more suited to atypical depression (which I seem to have) and are less prone to losing effectiveness over time. Then again I've seen people on this very forum who claim to have lost effect with MAOIs.
It is my impression that Nardil is more likely to poop-out than Parnate. It happens, though, that someone will respond well to Nardil for many years and be completely unresponsive to Parnate.
> I think I saw recently where you said if you don't achieve remission with your current regime you may try an SNRI?
I have never combined Effexor or Cymbalta with a therapeutic dosage of nortriptyline or desipramine.
> Is the Parnate + nortriptyline not helping enough?
I have switched from nortriptyline to desipramine because I felt that I was stuck with an unacceptable improvement. Things get a little complicated because I only recently discontinued prazosin, which apparently was "polluting" my response to desipramine. Perhaps the prazosin was limiting my response to nortriptyline as well. If I get stuck again, I would opt for doing a very quick switch back to nortriptyline as an experiment.
I try not to leave any stone unturned.
- Scott
Some see things as they are and ask why.
I dream of things that never were and ask why not.- George Bernard Shaw
poster:SLS
thread:1086592
URL: http://www.dr-bob.org/babble/20160131/msgs/1086613.html