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Suggest Treatment For Severe Tiredness And Depression
Question: Just past a week with Parnate, 30 mgs over the past few days:
-tiredness is just as bad
-I have been feeling increasingly weak in addition to tired. Like I've taken muscle relaxer. My blood pressure has not dropped much, if at all.
-using ritalin or provigil with this for energy and cognitive functioning is starting to make me a little nervous and paranoid.
-My appetite has gone and I am smoking again.
In asking myself if it is working as an anti-anxiety/antidepressant, I have these observations:
-I am not having a lot of suicidal ruminations, or melancholic depression. These weren't bothering me very much when I started (although they have in the past).
-I feel a little more unmotivated and uncaring than before, which was the bigger problem. Not sure if this is a function of being so tired. This feels less of a problem when I wake up and gets worse after I take my Parnate.
-I spent a weekend fishing trip and felt very alienated and nervous around my friends, Paranoid at times. When I was alone on the boat I felt constantly like something bad was going to happen. I'm not sure if this is untreated anxiety, or agitation of some kind from the medicine.
This weird "unsafe/unwelcomed" feeling when I am alone outside was clearly absent over the last two months when I reduced and stopped taking effexor. It was present on Effexor and on Celexa. The social anxiety is typically better, however, on these medicines.
So I have a couple of questions:
-I am taking an antidepressant to combat apathy, anhedonia in addition to other symptoms but the sedation and weakness makes this worse. Do I need something more activating? Is this less of a problem at higher doses? I have not encountered any hypotension yet. I mentioned before these symptoms are hampering work and school and if there isn't a REASONABLE promise that they will improve soon I will need to stop.
-My friend suggested that the weakness is from a drop in neurepinephrine and the increased paranoia is from serotonergic activity especially at 5-ht2 and 5ht3 receptors. He said Nortriptyline (which he is a big proponent of) could address both of these issues and improve my sleep. Is this a valid suggestion? I know this would make it harder to evaluate the parnate, but theoretically is it possible? I know a lot of people use this combination.
-My doctor prescribed parnate to take before bed, which seemed against everything I have read. Would this make a difference?
-tiredness is just as bad
-I have been feeling increasingly weak in addition to tired. Like I've taken muscle relaxer. My blood pressure has not dropped much, if at all.
-using ritalin or provigil with this for energy and cognitive functioning is starting to make me a little nervous and paranoid.
-My appetite has gone and I am smoking again.
In asking myself if it is working as an anti-anxiety/antidepressant, I have these observations:
-I am not having a lot of suicidal ruminations, or melancholic depression. These weren't bothering me very much when I started (although they have in the past).
-I feel a little more unmotivated and uncaring than before, which was the bigger problem. Not sure if this is a function of being so tired. This feels less of a problem when I wake up and gets worse after I take my Parnate.
-I spent a weekend fishing trip and felt very alienated and nervous around my friends, Paranoid at times. When I was alone on the boat I felt constantly like something bad was going to happen. I'm not sure if this is untreated anxiety, or agitation of some kind from the medicine.
This weird "unsafe/unwelcomed" feeling when I am alone outside was clearly absent over the last two months when I reduced and stopped taking effexor. It was present on Effexor and on Celexa. The social anxiety is typically better, however, on these medicines.
So I have a couple of questions:
-I am taking an antidepressant to combat apathy, anhedonia in addition to other symptoms but the sedation and weakness makes this worse. Do I need something more activating? Is this less of a problem at higher doses? I have not encountered any hypotension yet. I mentioned before these symptoms are hampering work and school and if there isn't a REASONABLE promise that they will improve soon I will need to stop.
-My friend suggested that the weakness is from a drop in neurepinephrine and the increased paranoia is from serotonergic activity especially at 5-ht2 and 5ht3 receptors. He said Nortriptyline (which he is a big proponent of) could address both of these issues and improve my sleep. Is this a valid suggestion? I know this would make it harder to evaluate the parnate, but theoretically is it possible? I know a lot of people use this combination.
-My doctor prescribed parnate to take before bed, which seemed against everything I have read. Would this make a difference?
Brief Answer:
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
Before I answer your question I like to share one medicinal secrete about parnate. It has been observed during clinical practice that the parnate shows action when there is at least some form of postural hypo tension. Absence of any hypo tension till date indicates two things
1. The dose is not reached to adequate level.
2. The medicine did not start any action which can be measured in regard to depression.
The another thing which I like to comment is tiredness and amotivation/low motivation. Yes they are related and related to your atypical/resistant depression. In my opinion with improvement of depression these two symptoms should improve.
Regarding your first question I like to comment that you need to more and the following is minimum.
Daily morning exercise
Start your day with lemon juice and
Relaxation exercises such as yoga and meditation.
I will not favor the discontinuation of medication because initial one week is more particular about side effects and it takes time to act. Secondly I feel this is resistant depression and parnate have excellent role in resistant depression and we should use it to full potential. I understand that that there are side effects and hampering your work but I feel they are transient one and we should not abandon medication.
Your friend is partially right as there is deletion of noradrenaline during first two weeks of treatment which could be responsible for decreased energy but paranoia thing have less clear pathology and serotonin is just a partial contributor and not all alone responsible for it.
I do not think we can use nortryptiline with parnate as there is serious risk of side effects and it could be the last option if any.
Regarding dosing schedule there is no problem in taking it bedtime provided there is no insomnia.
I hope this answers your almost all questions on this day.
Feel free to write back to me if you have more questions.
Thanks and regards.
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
Before I answer your question I like to share one medicinal secrete about parnate. It has been observed during clinical practice that the parnate shows action when there is at least some form of postural hypo tension. Absence of any hypo tension till date indicates two things
1. The dose is not reached to adequate level.
2. The medicine did not start any action which can be measured in regard to depression.
The another thing which I like to comment is tiredness and amotivation/low motivation. Yes they are related and related to your atypical/resistant depression. In my opinion with improvement of depression these two symptoms should improve.
Regarding your first question I like to comment that you need to more and the following is minimum.
Daily morning exercise
Start your day with lemon juice and
Relaxation exercises such as yoga and meditation.
I will not favor the discontinuation of medication because initial one week is more particular about side effects and it takes time to act. Secondly I feel this is resistant depression and parnate have excellent role in resistant depression and we should use it to full potential. I understand that that there are side effects and hampering your work but I feel they are transient one and we should not abandon medication.
Your friend is partially right as there is deletion of noradrenaline during first two weeks of treatment which could be responsible for decreased energy but paranoia thing have less clear pathology and serotonin is just a partial contributor and not all alone responsible for it.
I do not think we can use nortryptiline with parnate as there is serious risk of side effects and it could be the last option if any.
Regarding dosing schedule there is no problem in taking it bedtime provided there is no insomnia.
I hope this answers your almost all questions on this day.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor:
The weakness and lethargy is definitely parnate-related. I have an active job doing sports massage therapy but now my legs and arms shake when I work and I get tired climbing stairs. Work is my exercise routine, and I meditate regularly. All good suggestions though!
Today was my first day getting postural hypotension. The dizzyness on standing was followed by vision problems which was followed by a serious migraine. How long should I wait for the weakness and sedation to fade before making a change?
sorry, I forgot to add the following question...Given the low dose and short duration of parnate:
-can I stop "cold turkey" without a taper?
-do I have to wait a full 2 weeks before returning to Celexa or Effexor?
Thanks
The weakness and lethargy is definitely parnate-related. I have an active job doing sports massage therapy but now my legs and arms shake when I work and I get tired climbing stairs. Work is my exercise routine, and I meditate regularly. All good suggestions though!
Today was my first day getting postural hypotension. The dizzyness on standing was followed by vision problems which was followed by a serious migraine. How long should I wait for the weakness and sedation to fade before making a change?
sorry, I forgot to add the following question...Given the low dose and short duration of parnate:
-can I stop "cold turkey" without a taper?
-do I have to wait a full 2 weeks before returning to Celexa or Effexor?
Thanks
Brief Answer:
Not more than one month
Detailed Answer:
Dear XXXXXXX
Thansk for follow up.
The weakness and fatigue can be expected to continue for one or two more weeks. In my experience most patients seize to complain about fatigue and tiredness within one month of parnate use.
For 30 mg parnate and 10 days of use I do not see any problem with cold turkey discontinuation. This is because the withdrawal effects are very rare with such short use of parnate.
Regarding your last question since parnate is irreversible MAO inhibitor you need to wait for two ore weeks after discontinuation to start a new medication.
I hope this answers you further.
Thanks and regards.
Not more than one month
Detailed Answer:
Dear XXXXXXX
Thansk for follow up.
The weakness and fatigue can be expected to continue for one or two more weeks. In my experience most patients seize to complain about fatigue and tiredness within one month of parnate use.
For 30 mg parnate and 10 days of use I do not see any problem with cold turkey discontinuation. This is because the withdrawal effects are very rare with such short use of parnate.
Regarding your last question since parnate is irreversible MAO inhibitor you need to wait for two ore weeks after discontinuation to start a new medication.
I hope this answers you further.
Thanks and regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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