[mrm3601]

Hi.

I've suffered from major depression my entire adult life and I've been psychiatrically hospitalized 3 times for it. I'm currently on the following:

1. Parnate 60 mg
2. Abilify 5 mg (to boost the effectiveness of the Parnate)
3. Lamictal 100 mg
4. Lunesta (for sleep)

My psychiatrist has told me that he's going to consider raising the dose of Parnate I'm on to 80mg, maybe even higher in the future. But I've read that, supposedly, the highest maximum dose is 60mg.

Is anyone on more than 60 mg of Parnate?

Thanks

[deliquesce]

parnate has been a life saver for me. that said, i am lucky in that i only have to be on 15mg.

found this info for you:

Safety of high-intensity treatment with the irreversible monoamine oxidase inhibitor tranylcypromine in patients with treatment-resistant depression.

Adli M, Pilhatsch M, Bauer M, Köberle U, Ricken R, Janssen G, Ulrich S, Bschor T.
Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany. mazda.adli@charite.de
INTRODUCTION: Because the irreversible monoamine oxidase inhibitor tranylcypromine (TCP) was introduced nearly 50 years ago, only few studies exist on today's clinical prescribing practice together with 2nd and 3rd generation psychotropic drugs. METHODS: We performed a practice-based observational study of patients with depression treated with TCP in two psychiatric departments in Berlin to assess side effects, effectiveness, comedication and acceptance of the low-tyramine diet. RESULTS: We identified thirty-two patients treated with TCP at a mean dose of 51.9 mg/day after an average of 3.3 pre-treatments in the current episode. Dosing of TCP and the use of multiple psychotropic comedications indicate a high-intensity treatment. The most frequent side effects resulted from arterial hypotonia (28%). Dietary restrictions were mainly rated as moderate. 59% of patients remitted (HAMD- (21)<9 or CGI-I=1) and 22% responded (HAMD- (21) reduction >50% or CGI-I=2). DISCUSSION: A high-intensity treatment of inpatients with TCP is clinically feasible, i.e., the use of high doses and multiple comedications with a good benefit-risk-ratio. Prospective data aiming at comparisons with modern antidepressants and clarifying further safety issues are warranted.

so from what i'm reading, if the average dose was ~59mg, then other ppl have also gone up higher.

but looking at the combo you are on - parnate, abilify and lamictal are all activating drugs. if sleep is a problem for you, it would make better sense (to me) to reduce the dosage of the other drugs a bit to help get the sleep back on track. i have always functioned better when ive been able to maintain my own sleep cycles without the use of medication for that. i dont know - maybe it's just me - but sleep whilst on sleeping pills feels very different to natural sleep.

i would encourage you to talk to your doc about your concerns, however. i've been on higher than recommended clinical maximum doses before without ill effects, but eventually we've decided that if i need to go that high then maybe a different drug would be more beneficial instead. that's how i came across parnate.

[mrm3601]

Thanks so much for your response, deliquesce. I appreciate it. In fact, my psychiatrist will be lowering the dose of Lamictal and Abilify while also considering raising the dose of the Parnate. I agree with you, of course, regarding the importance of sleep--believe me, I know it.

I had a full physical exam by my general practitioner a few months ago but my psychiatrist has told me that before if and when he does raise the dose of Parnate from 60mg to 80 mg that I should have another exam: blood pressure, liver functions, etc.

Thanks again.

[mrm3601]

Thanks for your reply, deliquesce. I appreciate it.

In fact, my psychiatrist has told me that if he does increase the dose of Parnate I'm on from 60mg to 80 mg that he'll also lower the dose of Lamictal (which he's already lowered) and Abilify.

I agree with you, of course, in regard to the importance of sleep. Believe me--I know the importance of it. But thus far the combination of the Parnate, Abilify, and Lamictal has not adversely effected my sleep. Of course, I am on Lunesta, a sleeping medication and I think it is largely due to the Lunesta that I sleep as well as I do (however, I do acknowledge the fact that, for me, it will not be a good idea for me to be on this sleep medication for a lengthy period of time).

Even though I received a full physical exam from my general practitioner a few months ago my psychiatrist has told me that before he'll raise the Parnata from 60mg to a higher dose he will want me to get another exam (blood pressure, liver functions, etc.).

Again, thank you for your valuable message.

[mrm3601]

Thank you for your reply, Fly.

In fact, my psychiatrist has lowered the dose of both the Lamictal and the Abilify I'm on. And, as I say, he's also prescribed Lunesta to help me to sleep. I acknowledge that Lunesta, at least for me, is not to be used long term.

My psychiatrist has told me to get a full exam and I've had lab tests of my blood (Metabolic and Hepatic Panels) before he'll consider raising the dose of Parnate I'm on.

Thanks again.

Originally Posted by deliquesce

parnate has been a life saver for me. that said, i am lucky in that i only have to be on 15mg.

found this info for you:

so from what i'm reading, if the average dose was ~59mg, then other ppl have also gone up higher.

but looking at the combo you are on - parnate, abilify and lamictal are all activating drugs. if sleep is a problem for you, it would make better sense (to me) to reduce the dosage of the other drugs a bit to help get the sleep back on track. i have always functioned better when ive been able to maintain my own sleep cycles without the use of medication for that. i dont know - maybe it's just me - but sleep whilst on sleeping pills feels very different to natural sleep.

i would encourage you to talk to your doc about your concerns, however. i've been on higher than recommended clinical maximum doses before without ill effects, but eventually we've decided that if i need to go that high then maybe a different drug would be more beneficial instead. that's how i came across parnate.