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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Charles Darwood on January 12, 2010, at 23:43:04
This is the only drug that works for me, but anomalously causes severe sedation--worse than mirtazapine or trazodone. I admit that I've never tried nardil, but that one's supposed to be the non-stimulating MAOI.
Suggestions?
Posted by inanimate peanut on January 13, 2010, at 15:46:54
In reply to Experiencing Sedation with Parnate, posted by Charles Darwood on January 12, 2010, at 23:43:04
Just out of curiousity-- have you tried adding Tyrosine? Did it help?
Posted by Charles Darwood on January 14, 2010, at 0:04:02
In reply to Re: Experiencing Sedation with Parnate, posted by inanimate peanut on January 13, 2010, at 15:46:54
Yes, I've tried both tyrosine and phenylalanine supplements (500mg) to prevent sedation on Parnate; neither seems to have an appreciable pharmacological effect (either positive or negative).
I also take lithium, (600mg) so that *might* account for some of the sedation, although I never experienced any sedation when I was on lithium monotherapy (1200mg) or even when I was taking lithium, carbamazepine, (400mg) and alprazolam (6mg). Parnate has been wonderful for bipolar depression and allowed me to taper off the benzodiazepines (except for episodic panic attacks); my only complaint is the sedation it causes, though the upside to this is that it has helped my insomnia--which seems to be a fortuitously paradoxical reaction.
One possible explanation for this response--and this is just my hypothesis--is that the sedation is caused by the short-half life of parnate and that it's the "comedown" from the drug that accounts for its soporific effect. I suspect norepinephrine is the culprit here. If I'm right, then I might benefit from a higher dosage of Parnate. I'm taking 30mg a day now. When I see my psychiatrist in February, I hope he'll be receptive to my desire to titrate to 60mg so I can test this hypothesis. I'm a very energetic, high-metabolism person, so this phenomenon is quite puzzling to me.
How is Parnate working for you?
Posted by inanimate peanut on January 14, 2010, at 13:57:57
In reply to Re: Experiencing Sedation with Parnate, posted by Charles Darwood on January 14, 2010, at 0:04:02
Parnate took me from crying 24/7 (literally except when I was sleeping), suicidal, having panic attacks, and in the hospital to where I am just semi-functional but surviving (lack of any motivation, lack of pleasure, sleeping 13 hours a day). I actually give it tons of credit because that was a huge change. Now I just need to find it a friend that will take me the rest of the way to normal, which is what I spend my time here doing.
Posted by delna on January 15, 2010, at 3:12:16
In reply to Experiencing Sedation with Parnate, posted by Charles Darwood on January 12, 2010, at 23:43:04
> This is the only drug that works for me, but anomalously causes severe sedation--worse than mirtazapine or trazodone. I admit that I've never tried nardil, but that one's supposed to be the non-stimulating MAOI.
>
> Suggestions?Sedation with Parnate is quite common despite the fact that it is supposed to be stimulating.
Adding Provigil or Ritalin (or other stimulant) can really help.D
Posted by Willful on January 15, 2010, at 22:48:26
In reply to Re: Experiencing Sedation with Parnate » Charles Darwood, posted by delna on January 15, 2010, at 3:12:16
I found parnate incredibly sedating. To the point where I could barely stay awake at lower doses. Even higher doses didn't solve the problem completely.
I'm not sure what causes it, but I had extremely disrupted sleep, which might have contributed.
How's your sleep? are you dreaming normally? do you think that you're getting into the deeper levels of sleep?
You're at a low dose, but I had the same problem at 40 mg and 60 mg as you have. It wouldn't hurt to try a higher dose though to see if it gets better.
Willful
Posted by Charles Darwood on January 18, 2010, at 3:10:03
In reply to Re: Experiencing Sedation with Parnate, posted by Willful on January 15, 2010, at 22:48:26
My sleep is OK; I occasionally take an antihistamine like diphenhydramine whose anticholinergic properties offset the diarrhea problems with which lithium users are undoubtedly familiar. I have no idea if my sleep "architecture" is good, but I have dreams, etc.
I'm going to try Parnate 60mg/day to see if this dosage is less sedating. For now, I've taken to drinking coffee (which, for a bipolar, is something I've always avoided). If nothing else works, I may eventually try low-dose modafinil. We'll see.
Posted by OneMind on January 31, 2015, at 17:19:18
In reply to Re: Experiencing Sedation with Parnate, posted by Charles Darwood on January 18, 2010, at 3:10:03
I also experience tremendous sedation on parnate (tranylcypromine), it eventually wears off a few hours after the dose, I'm just so surprised as it is widely reported that parnate is amphetamine-like and somewhat addictive. I also noticed that skipping a day makes the sedation the next day much worse.
Adding provigil helps somewhat, adding a stimulant helps tremendously (daytrana patch is nice choice), though I think this needs to be done with caution. I'm on parnate 30-40mg day.
As far as its efficacy in depression, WHAT A MIRACLE DRUG. Totally works for me, so grateful this drug exists. Blows SSRIs out of the water.
Another thing to consider, I know this has been discussed elsewhere. On the question if Parnate can cause a false positive on a urine drug screen for amphetamines, the answer is unequivocally YES. I don't know why. I'm not suggesting it is converted to amphetamine in the body. I'd suspect that the molecule is "similar enough" to bind to the antibodies used in standard screening tests. It probably varies from company to company, person to person and timing of dose in relation to the test.
Random piece of psychopharmacological advice: try N-acetylcysteine 1,000 twice daily. Lots of emerging evidence for this compound in a variety of psych disorders. I find its a really nice booster. Unfortunately, it will never get the full research attention it deserves as its over the counter and can't be patented by a drug company. Research suggests its operating on the NDMA/glutamate system, a neurotransmitter than thus far has eluded drug development in depression, with the recent exception of Ketamine.
Posted by Robert_Burton_1621 on February 4, 2015, at 3:31:41
In reply to Re: Experiencing Sedation with Parnate, posted by OneMind on January 31, 2015, at 17:19:18
OneMind, that is a very informative post.
On your last bit of advice, you may be interested in this brief case report from J Clinical Psychopharm (2003)33(5), at 719 - 20.
This is the end of the thread.
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