Jump to content
CrazyBoards.org

MAOI augmentation (Parnate)


Recommended Posts

Short version: is there a chance that I would have a different reaction to Abilify  when taken with an MAOI versus an SNRI and Wellbutrin?

 

Full version: I’m going to augment the Parnate I am currently taking (80mg)  

 

I tried Abilify as an augmentor while on a combination of Effexor and Wellbutrin, but had horrible akathisia at an extremely low dose. Could the removal of those two meds or addition of the MAOI mean I’d have a different response to Abilify? 

 

Same goes for stimulants. They helped but I would wipe out and crash after a few days. 

 

Thanks

Edited by meiammariah
Link to comment
Share on other sites

He only mentioned adding it in conversation (“let’s bump Parnate to 80mg for a few weeks and then we can talk about augmentation with something you may have tried before like Abilify”). 

 

I did find this report on ways to deal with akasthia, but am unsure if I would have to be on one of these indefinitely or just initially while I “adjust” - http://breggin.com/td-resources/Abilify-Akathisia-Poyurovsky2010.pdf

 

Thoughts?

 

Unfortunately the only reason he and I are having this conversation is because the Parnate isn’t doing much of anything in the way of energy and motivation. I may talk with him about giving up on it and trying either 1) Emsam or 2) Zoloft, with which I had great success about 10 years ago (it pooped out). 

 

Frustrating. So so so frustrating. 

Link to comment
Share on other sites

15 hours ago, meiammariah said:

I did find this report on ways to deal with akasthia, but am unsure if I would have to be on one of these indefinitely or just initially while I “adjust” - http://breggin.com/td-resources/Abilify-Akathisia-Poyurovsky2010.pdf

Akathisia usually goes away after you adjust to the medication. It starts after the medication is initiated and usually goes away after a little while. So you wouldn't have to be on one of these agents for long. Personally, the one medication that has helped me the most is benztropine (Cogentin), an anticholinergic. It does miracles for akathisia, but it does come with a host of side effects... like dry mouth (VERY VERY dry mouth!!!), blurry vision (can't see close up for example), constipation, urinary hesitancy or even urinary retention, and constipation. Some people tolerate it just fine, but I find that if I take it for more than a few days at a time, I start getting the blurry vision and dry mouth, and the rest of the symptoms come in later, then I will start getting anticholinergic delirium if I take it for more than a few weeks at a time.

Beta blockers and benzos do nothing for my akathisia when I get it. 5-HT2A antagonists do okay. When I was super desperate, I actually took Geodon (another antipsychotic) on top of another antipsychotic that was giving me akathisia (can't remember which one, maybe it was Vraylar?) and it calmed me down quite a bit. Geodon is a very potent 5-HT2A antagonist.

 

15 hours ago, meiammariah said:

Unfortunately the only reason he and I are having this conversation is because the Parnate isn’t doing much of anything in the way of energy and motivation. I may talk with him about giving up on it and trying either 1) Emsam or 2) Zoloft, with which I had great success about 10 years ago (it pooped out). 

Have you ever talked with him about augmenting your Parnate with a stimulant and/or a TCA?

You can start low and go slow with something like Ritalin or Adderall/Dexedrine, or a secondary amine TCA like nortriptyline, desipramine, or protriptyline. I think I read somewhere the TCA has to be started first, but some also say that it doesn't matter which medicine is started first. The stimulant can be instated after the MAOI is started, so you're good to start it whenever. It all depends on how liberal and (frankly, how old) your pdoc is. Older pdocs used to use this technique back in the 60s and 70s a lot for treatment resistant depression.

Link to comment
Share on other sites

  • 2 weeks later...

I just wanted to get back to you on this because you were kind enough to provide info when I posted my original message.

We decided to go with Abilify 5mg and address akasthia, if it arose, with Cogentin. Well, I am happy to report that there haven’t been any issues! No need for Cogentin. I will say that I was a bit restless the first few days I took it but that has subsided.

So far I’m really liking it - it’s energizing and promoting positive thinking. One issue is insomnia, but I was facing that with Parnate already—I think Abilify is simply contributing to the problem. I’ve taken Klonopin a few times to sleep. I think I’ll suggest to the doc in a few weeks that we bump Parnate down 10 or 20mg and see if that helps.  

Thanks again. 

Edited by meiammariah
Grammar
Link to comment
Share on other sites

8 hours ago, meiammariah said:

I just wanted to get back to you on this because you were kind enough to provide info when I posted my original message.

We decided to go with Abilify 5mg and address akasthia, if it arose, with Cogentin. Well, I am happy to report that there haven’t been any issues! No need for Cogentin. I will say that I was a bit restless the first few days I took it but that has subsided.

So far I’m really liking it - it’s energizing and promoting positive thinking. One issue is insomnia, but I was facing that with Parnate already—I think Abilify is simply contributing to the problem. I’ve taken Klonopin a few times to sleep. I think I’ll suggest to the doc in a few weeks that we bump Parnate down 10 or 20mg and see if that helps.  

Thanks again. 

Have you tried something like trazodone for the insomnia? You could augment with trazodone, doxepin, or zolpidem, or something like that, keep the Parnate and Abilify at the same dose, and perhaps not have to sacrifice the antidepressant response you have achieved thus far. In fact, with trazodone, at least, it may even augment your antidepressant/anxiolytic response depending on the dose.

Absolutely! Any time!

Link to comment
Share on other sites

I'm interested that you are going for 80mg Parnate, I was under the impression that doses over 60mg become toxic. Additionally, bear in mind that there is a sweet spot, medicine wise - your peak therapeutic effect will typically be somewhere in the middle of the available doses.

Link to comment
Share on other sites

  • 4 weeks later...
On 1/2/2019 at 10:08 PM, meiammariah said:

So far I’m really liking it - it’s energizing and promoting positive thinking. One issue is insomnia, but I was facing that with Parnate already—I think Abilify is simply contributing to the problem. I’ve taken Klonopin a few times to sleep. I think I’ll suggest to the doc in a few weeks that we bump Parnate down 10 or 20mg and see if that helps.  

Hi :) Im probably going to start Nardil tomorrow (it will be ready this afternoon) 

I’m very “fragile” right now with extreme anxiety, chronic treatment resistant insomnia, derealization, panic, ocd (“pure o” of intrusive thoughts, songs looping, constant worry and negative thinking) and depression. I also have times of irritability/raciness and manic feelings, but the doctors do not think this is bi polar. They think it’s a mix of my other conditions. 

I’m nervous to start Nardil die to the side effects of insomnia, mania, agitation and increased anxiety.

I hane tried many many meds without relief. Including sleeping meds, benzos, typical and atypical antipsychotics. 

Is it possible that Nardil could actually calm me down and help me sleep? 

Was hoping you could give me your 2 cents? 

I hope you’re still doing well♥️

 

Edited by Britton777
Link to comment
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

 Share

×
×
  • Create New...