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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Joe44 on May 9, 2007, at 23:30:01
Hi everyone,
I accidently posted this in the substance use forum also (meant to post it here).
Hi,
I recently started taking parnate for depression and concerntration issues (my type of depression was characterized by huge amounts of sleep and some axiety).
I have started taking parnate, first two days 20mg first thing in the morning (around 8a,) and 20mg at 12:30pm, now I'm up to 30mg for the second dose (day 4). My problem is; I only get positive effects after the second dose. I am wondering if I should be upping the morning dose, as I have read in other threads on this forum that doses of 60mg+ can actually have less side effects than lower doses.
I notice that my heartrate doesn't race as much after the second dose properly kicks in and I can concerntrae, think clearly, but more importantly, it works as an anti-depressant. I also notice tinglying feelings around my head when the second dose kicks in, has anyone else encoutered this?
My tabs are 10mg, I'm not sure if they come in larger amounts, but 50 tans won't last too long at 60mg+ doses, even with a couple of repeats that I have. This isn;t too much of an issue, as I ahve a healthcare card (an Australian thing)- they only cost my $4.90 AUD per 50tabs. So if going to higher doses might help, I am willing to do it.
Oh, I should also point out, that before the second dose, I feel quite tired, which really hold me back at work. After the second dose, I feel more relaxed, still tired, but not as much and the HR is still up.
Another weird effect is that my penis has shrunk! I mean I can still get an erection, but when its not erect, its noticably smaller than usual - hmmm.
If I did decide to go off parnate and try sertraline, how long would I have to wait, having only been on an MAOI for 4 days?
Any advice would be greatly appreciated.
Cheers,
Joe
Posted by Quintal on May 10, 2007, at 17:52:18
In reply to Parnate Help/Question, posted by Joe44 on May 9, 2007, at 23:30:01
Hi Joe,
You're the only person I've heard of having a positive response to such a low dose of Parnate! I think higher doses would very likely be more beneficial to you. I noticed racing heartbeat and euphoria after taking my morning dose (40mg I think), and after each subsequent dose. There is a phenomena that people here have coined 'Parnate Slump', which is a sense of drowsiness and heavy fatigue that hits quite suddenly, usually in the afternoon as the stimulant effect of morning dose is wearing off. Most people taking doses higher than 20mg have found that spreading their dose evenly throughout the day can help with this and delay the fatigue until a more appropriate time (i.e. bedtime). Unfortunately this tends to cause insomnia for which most Parnatians remedy with a benzo or Ambien/Lunesta etc. Lyrica has also been used for this purpose.
The penis shrinkage might be due to having more noradrenaline knocking about your synapses. It's a powerful vasoconstrictor meaning that less blood flows into your penis when you get an erection, hence the perceived shrinkage. This is common with noradrenergic drugs - can't say I noticed it much myself on Parnate but it was very pronounced with reboxetine.
Q
Posted by Joe44 on May 10, 2007, at 19:42:03
In reply to Re: Parnate Help/Question » Joe44, posted by Quintal on May 10, 2007, at 17:52:18
Hi Q,
Thanks for the response. Last night I took 20mg before bed (with 20mg oon temazeapan) and felt great this morning, took a second dose of 20mg and might take another 20mg later this afternon (60mg in total).
The penis thing seems to be ona nd off, as I woke up this morning and it was normal size...even when it was smaller (getting less blood flow) I could still get a normal size erection, jus that it was small when facid.
However the relief parnate is starting to give seem sto be worth these minor side effects, might try some coffee to help with the afternoon tiredness, failing that perhaps orer some provigil (wish it wasn't some expensive).
How long do you recommend one stay at a particular dose before going for the next level? And do the pills come in large amounts (say 20mg), as my doc is reasonably flexible if I show him some research and explain that I understand the risks (mostly the food limitions with MAOIs).
Again, thanks for the replies, it's always nice to hear from other people going through similar things.
Posted by Quintal on May 10, 2007, at 20:36:41
In reply to Re: Parnate Help/Question, posted by Joe44 on May 10, 2007, at 19:42:03
Hi Joe,
Going from 30mg to 60mg in one day sounds a little too fast, although I did something like that myself and had no problems. 20mg/week increments are probably the safest way. Parnate only comes in 10mg tablets, and it's the same for all generic brands as far as I know.
I'm surprised you're taking Parnate before bed, did your pdoc advise you to do that because most advise taking the last dose before 3:00PM? Daytime tiredness tends to be less of a problem when you take all your dose during waking hours, so maybe try that before ordering Provigil?
Yeah, the penis shrinkage is most noticeable when it's flaccid - it can even turn bluish purple as if it's very cold! If it's only mild there might be no effect on your erections, but when it's more severe erections tend to become weak and floppy, and some people become (temporarily) impotent that way. Maybe a good idea to wait for a while after each dose increase to see the full effect to limit this side effect?
My pdoc refused to prescribe more than 30mg (and I was already taking 80-120mg/day by that point and running out bofore the end of the month). He considered the doses abuse of Parnate and discharged me soon afterward, so I'd try not to increase it too much on your own just in case your pdoc has a similar reaction (hopefully not). It turned out my pdoc thought he was being very flexible by prescribing Parnate at all and I'd pushed the boundary too far.
Q
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