![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Snell on April 15, 2014, at 5:51:08
Hello. I've been taking Parnate (tranylcypromine) 60 mg/d for eight (8) months and the side effects (the fragmented sleep and the anxiety) are starting to eat me alive. (I haven't lost response to the antidepressant properties of the medication.) These side effects have become very bad in the last month.
For the sleep we've tried zolpidem and zaleplon. We can't use any of the antidepressant sleep meds (mirtazapine, doxepin, trazodone) for obvious reasons. At this point I fall asleep for an hour and a half. That's usually it for the night. Then, in the afternoon, I will get hit by a wave of exhaustion that knocks me out for between two and three hours. Please don't tell me not to take naps. Sleep medicine doctors are on it; it is not a "nap"--it's getting hit by an avalanche.
For the anxiety we've tried about four different SGAs as well as raising my clonazepam as well as lamotrigine. We even tried gabapentin.
One of the worst problems is that because the MAOI interacts with *everything*, we have an arm tied behind our back in fighting these side effects.
So two questions: (1) Is there something you could think of that would allow me to stay on the Parnate/tranylcypromine? But what I'm really wanting to know is (2) How long do I have to be off the Parnate before I can begin my old, beloved regimen of venlafaxine and EMSAM?
A request: I'm sleep-deprived and irritable and don't think I could handle replies that are overly pedantic or patronizing. Thanks.
Posted by Phillipa on April 15, 2014, at 9:54:11
In reply to Post-Parnate washout period length?, posted by Snell on April 15, 2014, at 5:51:08
I didn't know you could take Ensam and Effexor together? Phillipa
Posted by europerep on April 15, 2014, at 15:56:31
In reply to Post-Parnate washout period length?, posted by Snell on April 15, 2014, at 5:51:08
> We can't use any of the antidepressant sleep meds (mirtazapine, doxepin, trazodone) for obvious reasons.
Hi,
what are those obvious reasons? That they produce serotonin syndrome when given together with tranylcypromine? Because that is generally not the case.
Trazodone is, as far as I know, the most common add-on to combat MAOI insomnia in the US. Amitriptyline would theoretically be possible too, and mirtazapine probably as well. It should be done carefully and so on, but it's definitely possible.
You can find a lot of literature on MAOI combination treatments via google, pubmed, etc.
ER
Posted by jono_in_adelaide on April 15, 2014, at 18:51:54
In reply to Post-Parnate washout period length?, posted by Snell on April 15, 2014, at 5:51:08
Theres no reason you couldnt take 25-50mg of doxepin at bedtime along with Parnate
Posted by jono_in_adelaide on April 15, 2014, at 18:54:32
In reply to Re: Post-Parnate washout period length? » Snell, posted by europerep on April 15, 2014, at 15:56:31
You could also try taking a benzo or z drug plus 25mg of Phenergan - the effects are addetive.
Given that you have daytime anxiety, a long acting benzo might be a good bet, say 15-30mg of Tranxene at bedtime, plus either Phenergan or doxepin 25mg
Posted by LostBoyinNC45 on April 25, 2014, at 22:48:47
In reply to Post-Parnate washout period length?, posted by Snell on April 15, 2014, at 5:51:08
What do the sleep medicine doctors say about the napping? Thats classic EDS and sleep apnea symptoms. Not depression symptoms.
My experience has been real simple. If my sleep disordered breathing is not treated properly, nothing I do psychopharmacology wise works well. Its black and white like that for me and simple. My psychiatrist has a problem with that, my other doctors do not have a problem with it. In fact my primary care physician even suggested it to me and I told him, "man, that is exactly the way it is for me. Pull out that CPAP therapy and you could pump me up on all the psych meds from now to doomsday and Im STILL "depressed." Stick my CPAP therapy back in the equation and "boom" Im doing OK all of a sudden.
Any chance you have sleep disordered breathing underneath your depression? 60 mg of Parnate is A LOT of Parnate. The most I could tolerate was the standard dosage of 30 mg and that was plenty and perfect, anymore and it was overstimulating and I'd get the insomnia. 60 mg Parnate is A LOT of MAOI, way more than I could ever tolerate. I'd be awake most of the time if I took 60 mg Parnate.
Are your sleep medicine docs intimidated by your psychiatrist, by any chance? Sometimes sleep medicine docs dont want to get involved if they believe your depression is real severe, they dont want to encroach onto the psychiatrist's territory, especially if you went to the sleep doc with a "history" of psych problems first.
Eric
>
>
> A request: I'm sleep-deprived and irritable and don't think I could handle replies that are overly pedantic or patronizing. Thanks.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.