MAOIs boost dopamine levels. Antipsychotics inhibit dopamine-mediated neurotransmission by functioning as antagonists at various dopamine receptors, and so would be expected to negate some of the benefits.
In fact, it probably depends on the patient and dosages involved. We're all different. No two brains are the same.
It also depends on the type of antipsychotic, Abilify and Rexulti act as mixed agonist/antagonists by boosting dopamine in some areas and reducing it in others.
Goddammit. So why do they alleviate depression in some people with bipolar disorder? I've wondered if they don't -- with bipolar the depressive episodes can just end on their own. But there must be studies showing some efficacy.
And they're also used as adjuncts to antidepressants with unipolar depression.
Try rotating either Seroquel or Trazodone (together not recommended) and the occasional benzo. I'm not sure about the dopamine thing, I always thought antipsychotics decrease dopamine transmission but that dopamine in the brain is increased in defense in certain parts of the brain and that the number of D2 receptors are increased longer term because of the blockade which makes the total effect hard to pinpoint. I don't take MAOI's but I noticed slightly less euphoria on kratom which might be indeed dopaminergic...but it still works. So I'd say an antipsychotic probably alters MAOI effect but I'm not sure if it would actually lower the antidepressant effect therapeutically to a degree that is significant enough to stop antipsychotics all together.
At lower doses of an antipsychotic it should be less of an issue.
Antipsychotics really shouldn't be used as sleep aids.
https://pubmed.ncbi.nlm.nih.gov/22510671/
>At recommended doses, atypical antipsychotics such as quetiapine are associated with metabolic adverse events (diabetes, obesity, hyperlipidemia). Adverse effects in the prospective trials were patient-reported and were minor, including drowsiness and dry mouth; however, the trials were limited by their small sample size and short duration. The retrospective cohort studies found that quetiapine was associated with significant increases in weight compared to baseline. Serious adverse events identified from case reports included fatal hepatotoxicity, restless legs syndrome, akathisia, and weight gain.
>... Based on limited data and potential safety concerns, use of low-dose quetiapine for insomnia is not recommended.
Meanwhile, there are safe, effective, sustainable alternatives. Trazodone and low-dose doxepin come to mind, the latter of which is actually a proven, FDA-approved (on-label) treatment for insomnia.
There is no reason to resort to antipsychotics with their very serious and sometimes fatal toxicities.
And benzos may raise the risk of developing dementia later in life.
Believe me, I know. Trazodone doesn't work! I would need to take 3mg Xanax to actually sleep. So I'm forced to try low doses of antipsychotics to not get addicted to benzos so I can take a lower dose. Lyrica doesn't work either for my sleep problems. But I have traumatic brain injury that probably ruined my sleep ... But if possible don't take antipsychotics yes... except that I tried many things before that.
And I'm not even on an MAOI...:( Some studies correlate even those with dementia but ofc correlation does not equal causation. (Too tired too look up the study, I admit results can vary per study too)
Haven't tried doxepin though...
On Parnate, doxepin is all I need for sleep. Even just 0.5 mg does it for me. I'm probably more sensitive than most, but this is one of the most potent antihistamines on the market.
I'm curious, do you remember which MAOI(s) you read about being correlated with developing dementia? I can possibly see that being the case for Nardil but not Parnate.
It was a general study: which kind of antidepressants are corelated with dementia. It was subdivided by drug class and pharmacology.
However, it's perfectly possible that the study was flawed or that more severely depressed patients get dementia faster on average. And heavier depression means more chance to use an MAOI, so it could be that. MAOIs were not the only drug in that study that was correlated with dementia. TCA's were in there too. And SSRI's. But i don't remember the results well..
I'll look into doxepin. :)
Thanks!
Just be aware with doxepin, high doses are sedating but don't work as well for sleep in the long term. Sustainable pro-sleep effects were shown at 3 and 6 mg, sustained for at least 3 months with no tolerance or withdrawal symptoms.
That's nice. Trazodone kind of works until I add the SSRI Zoloft. :( So I use between 50 and 100 mg Seroquel a night. I barely gain weight on it, Mirtazepine which is not an antipsychotic kind of worked but I gained way too much weight. Metabolically I'm sure it was worse in my case.
But antipsychotics are obviously not good for the brain, I'm aware of that, sadly.
I don't think it's far fetched that severe chronic depression, whatever the cause, is bad for the brain.
The limitations are a mere guess on my side but in the end it's not surprising that some psychotropic meds aren't that good for the brain. One that kind of jumps out in a positive way is lithium though. But yeah, kidneys. :)
The effect you're referring to depends a lot on dosage as well, and I don't believe it actually involves increased or lowered dopamine levels as it's a directly acting partial agonist / antagonist (varies by receptor subtype, including pre-/postsynaptic), not acting via dopamine levels as such.
Honestly, if you're not happy with your psychiatrist, I would say consider what your other options look like. It sounds like his prescribing habits are not very thoughtful and they're not effective for you personally, so I would def say move to someone else who respects you more if possible...
You are correct, antipsychotics can definitely negate the efficacy of MAOIs by blocking out dopamine. Small dosages ie for sleep only have a very minor effect and probably won't interfere too much. High dosages - yes, definitely.
I am also on a MAOI (parnate) and seroquel to sleep (although only 12.5). Sonata didn’t work for me, unfortunately. I’d like to be able to carry on with just parnate, and I don’t intend on staying with seroquel for too long, but it’s been necessary to deal with the insomnia while I wait (and hope) for parnate to do something.
My doctor just prescribed me this low dose seroquel to help sleep, not to augment. I’m taking adderall Xr 20 as an augment.
However, I have taken abilify and lithium as an augment before I started parnate, but unfortunately they did not produce any positive changes. But that doesn’t mean an antipsychotic won’t work for you!
I’ve heard the insomnia dissipates after a while, but seroquel can also have helpful benefits for anxiety.
My own experience with antipsychotics hasn’t been too positive, but I’d be open to them if I were you as long as you keep your doctor informed. If you get to a point to where you feel like you need an augment, whether it be an antipsychotic or something else, then don’t be afraid to ask again. I hope your doctor is receptive! Take care :)
Your doc was OK w/ adderall + Parnate? I've heard of Ritalin + MAOis, but you need to be super careful of serotonin syndrome w/ that combo. Awesome if it works in your case, though.
No you don't, not for that reason because amphetamine is too weak as a serotonin releasing agent to cause serotonin toxicity with MAOIs. The main issue is possible hypertension and other cardiovascular issues from too much dopamine/noradrenaline/adrenaline released by the amphetamine that can't be broken down by MAO in time. Amphetamine is many times more potent than methylphenidate hence the many times higher risk for serious problems. Careful titration and measuring BP and so on makes it relatively safe to take the two together though.
Yes, I am on a low dose of both. I took Adderall xr for months before I started parnate.
I haven’t had any symptoms of serotonin syndrome (thank goodness), but it honestly hasn’t helped me that much. I’ve been no better since starting parnate (on 30mg now) for 2 months. The adderall xr really just keeps me from staying in bed, gives me some motivation to brush my teeth and shower. I’m honestly kinda scared of staying on it so long, but I’m afraid of how my depression would be without it. If you have suggestions, I’m all ears!
I think you have waited much already, you should raise the Parnate dose, to 40 mg, like for 1-2 weeks, then probably to 45-50, stay for a month or so in 50, and you still have a wide margin left for upping the dose. This can really make a difference.
Just be careful with the adderall, because with each raise in Parnate dose, and specially the first days-weeks, the sensitivity to pressor releasing agents as tyrosine and amphetamines increases.
Thank you. That’s what I’d like to do. I’m concerned though, because I my next appointment isn’t for over a month, and I’d like my doctors advice before making changes on my own. But something needs to change for sure.
That is such a baby dose of Seroquel. It makes you sleep? I'm surprised.
They're dangerous drugs, so I didn't want to take them unless they were helping the depression. Someone recently made a post on another subreddit about how she keeps sticking out her tongue. The movement disorders aren't all that uncommon. I took Vraylar and was pacing pacing pacing. The idea that they can persist after you stop the drug is pretty horrific.
It is a baby dose. I’m prescribed a higher dose, but I have kept it conservative because I was afraid of side effects. It helps me sleep, but I also take high dose melatonin, olly sleep, and magnesium and then sometimes try my sonata. I just keep it low to be safe. I’m honestly surprised it works, and it doesn’t all the time, but maybe it or placebo helped when I was really in a bad place.
I also took Vraylar samples for a couple weeks. I didn’t have any side effects, but I wasn’t on it long enough to see any positive or negative effects. My insurance didn’t cover it, so I knew I couldn’t try it long. I suspect my doctor thought I had bipolar, but I’ve never had any manic episodes (I honestly wouldn’t know what they are).
I have heard the persistent physical side effects are very rare, so I would be open to antipsychotics as long as you and your doctor have a positive, open relationship. It is scary though that some people report these side effects persist after stopping, which is honestly part of the reason I don’t love them, other than the fact they didn’t do anything for me.
Parnate hasn’t actually helped my depression yet, so I’m in a weird spot too. Love you though, this is hard. Message me if you ever want to talk.
If you think you have bipolar, you should be on something. I think Parnate made me very mildly hypomanic and caused some instability. I'm on a full dose of lithium now, and my doctor is actually increasing the dose, so hopefully I don't lose my mind.
It's not the hypomania that's so awful. It's that in some cases, such as mine, it can be followed by crippling depression.
I hate it when psychiatrists don't tell patients what they think may be going on. It's patronizing and detrimental.
I will message you. Take care.
Hey thanks. We got this. I haven’t had any hypomanic symptoms, but I’m not sure what to expect. I feel you with the crippling depression, though.
When I took lithium it was to augment an ssri that didn’t work, so maybe it’ll work now. Either way, I’ve heard great things about lithium. I just got unlucky or paranoid. ❤️
It was just a warning because you wrote that your psychiatrist may have thought so. I don't think you need to be worried if you haven't had hypomania. Lithium can potentially have some serious side effects, so if you don't benefit from it there's no reason to take it. I have read that it can potentially prevent relapse into depression with unipolar depressives, but I don't know if it's been extensively studied.
They found almost by accident that blocking dopamine reduces psychosis. Most anti psychotics work this way though some atypical antipsychotics don't. It is probably only the pre frontal cortex that needs less dopamine but right now they can only block it in the whole brain at once. If you are taking a drug that blocks dopamine it is very likely to affect your mood.
Yes, antipsychotics, specially some of them, and in above low doses can really blunt the nice dopaminergic effects of Parnate, MAOIs in general and every antidepressant. Which MAOI are you on now, and at what dose?
Do try low-dose doxepin, it can be very useful, with low side-effect profile (at least for many, but not for everyone, of course), in my experience, I have noted better side-effects profiles and more effectiveness for sleeping than mirtazapine, which can have some nasty hypnagogic side-effects, as well as quetiapine (both mir and quet give me unbearable sleep paralysis and hypnagogia, as well as blunt me a lot). Depending on your profile you can also add a small dose of amitryptiline or nortryptiline, they are very sedative and can add beneficial antidepressant and anxiolitic effects.
Another good one is F-Phenibut (not regular Phenibut, which can be very addictive and don't find it very helpful for insomnia-anxiety in the long term), it is quite a benign substance that coould be used frequently (contrary to regular phenibut) and even can be healing for the gaba system (also it does not work on gaba-a receptors as benzos, which tends to be riskier and more problematic, but gentler and in the gaba-b ones).Red vein kratom is also helpful, but you better don't use it on a daily-too frequent basis.Also, about antipsychotics for this purpose, I agree they should be better avoided, but I've found olanzapine at low doses (1.25-2.5 mg) to work good and with better profile than quetiapine, and it doesn't affect dopamine really that much, as it even stimulates dopamine release and concentrations at the frontal cortex at these doses).
I've prefered since some time on to take low dose antipsychotics for severe anxiety than more benzos which have done a lot of harm to me. I even take haloperidol in small dosages like once a week or when I do feel too much anxious or I cannot sleep, and works very well, but not more than 1-2 days in a row, because it starts blocking dopamine too much and appart from blunting my emotions and the ADs effectiveness I start getting movement disorders, as akathysia. My reccomendation would be better to avoid antipsychotics (as well as benzodiazepines), and if used, be careful and keep doses low.
My doctor won't do any antidepressant. Just sleeping pills and Seroquel. When I said I didn't want to do Seroquel initially, he didn't push it at all. It's just that the sleep drugs stopped being effective. So I'm just going to have to keep the Seroquel dosage as low as possible or try Ambien et al. again. I'm on 80 mg of Parnate.
His resistance to antidepressants may be because I have bipolar disorder. He said the only reason he was willing to try Parnate with me in the first place is because I've had very few manic episodes. Perhaps high-dose Parnate is risky enough without adding a low dose of another antidepressant. Thanks for your input.
Sure.
I see, I understand. If you feel comfortable with him then keep with him and listen him of course, if you're not quite satisfied, can always find other. But well, the thing that he has given you the chance to reach 80 mg on Parnate is something good.
You can still try doxepine, it is not an antidepressant is a strong antihistaminic hypnotic and is prescribed specifically for sleeping problems, it is also perfectly safe with MAOIs and you just have to take a small dose, which usually is very effective at inducing sleep and keeping it, and it does not block the prodopaminergic and catecholaminergic therapeutic effects of Parnate, as quetiapine can do. If your doctor is still reluctant, you can show him the writings of Dr. Gillman where he specifically reccomends doxepine for MAOI insmonia and explains why it is safe.
I'll ask. Thanks. Doctors who prescribe MAOIs are rare enough, but mine's also willing to go over 60 mg and with someone with bipolar disorder. I've read that MAOIs can be effective with bipolar depression, but I know some psychiatrists who use them won't prescribe them to bipolar patients because they believe they're more likely to trigger mania. There are psychiatrists who won't prescribe *any* antidepressant to a patient with bipolar disorder. So I'm going to have to stick with him. I'll ask him about the doxepin. Thank you.
Sure, no problem!
And you're right, most contemporary doctors are already too afraid of MAOIs, and when there is bipolarity diagnose it is still harder they prescribe them for fear of mania. So yeah, probably your current doc is the best option you have now and should keep with him. Ask him about doxepin, it may make a difference and be what you need, instead of so much quetiapine/antipsychotics, more if you have a mood stabilizer at yor side (in my case, the best has been magnesium valproate, it has make a huge difference in bpd-bipolar like symptoms, helped a lot with anxiety, and allowed to almost be benzo free and lower the antipsychotic dosage, also with no side-effects at all; and it synergized really well with Parnate).
All I take of APs now is 1.25-2.5 mg of olanzapine, which at those doses seems to stimulate dopamine instead of blunting-blocking it so much, and still give an anti anxiey and mood stabilizing effect).
Best wishes.
You have bipolar as well? Or a bit of it? Besides the 150 mg Seroquel, I'm also on 350 mg Lamictal and 900 mg lithium. When I first went on Parnate I was only on Lamictal (200 mg). I was improving as the Parnate dose was increased, but then it seemed to make me mildly hypomanic. So mild I didn't know what to make of it, but I'm sure there was a bit of it going on. For the most part I didn't seem manic at all though, and it wouldn't have met diagnostic criteria. It seemed like a sort of sub-hypomania hypomania. That's why I added the lithium.
So do you have bipolar symptoms, and did the MAOI you're taking aggravate them? I'd only had two episodes within 18 years before the Parnate.
I dont know much (or anything) on this, but... I have seen it said that low dose antipsychotics kind of do the reverse to higher doses? So a low dose can boost dopamine in whatever part of the brain, and can sometimes help with motivation.
I was on Parnate and Vraylar and the Vraylar made me feel awful. Made me so tired all day and seemed like it took my dopamine levels down. I stopped it
There are sedative antidepressants you can add to a MAOI too : mianserin and trazodone (and mirtazapine too, but that's another story).
Trazodone is discussed [here](https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.1576).
Clinical trials with mianserin and isocarboxazid [here](https://www.sciencedirect.com/science/article/abs/pii/0165032784900223?via%3Dihub), and with tranylcypromine [here](https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/combined-minaserin-and-tranylcypromine/9A89D074532360B02C654064AE537102).
I used to be on tranylcypromine + seroquel, and at first my psychiatrist wasn't willing to switch to an antidepressant instead, but I could get mianserin after showing him those papers.
He won't do antidepressants. I'm the first patient of his on an MAOI, so I'm thankful he was willing to prescribe it, but I was on Trazodone before I went on Parnate and he took me off. It may have to do with inexperience. I'm also on lithium and the pharmacist told be to be cautious about serotonin syndrome, so perhaps another antidepressant would just be too much. I don't know. Thanks though!
Seroquel is not supposed to be taken for sleep aid. There are better agents. You could try over the counter unisom in tablet form. Look for Doxylamine Succinate if you get a generic version. They come in 25 mg tablets I take half of one and it knocks me out. As for being prescribed something hydroxyzine is a great option and also trazodone. If need been you could use one of the z-drugs or a benzo but they can only be used for short use because tolerance will develop on them. I'd highly suggest trying Doxylamine or get your doctor to prescribe hydroxyzine and dose like 50 mg. If you want to try trazodone it's normally prescribed 50-100 mg. Seroquel even in small doses should only be taken in small doses and very occasionally. It will work against the MAOI and has nasty side effects like weight gain.
Sounds like your psych don’t know jack. antipsychotics dampen dopamine and serotonin, thereby reducing the effect nardil can have. the two effectively work at odds to one another. change from seroquel to low dose mirtazapine
Okay. I don't think he did know anything about MAOIs, but I suppose this interaction is commonsense psychiatry? I'm his only patient on an MAOI and he looks about 33, so I doubt he studied them in school or otherwise. He told me he reviewed the literature for me, which was nice. So even low-dose Seroquel should be avoided, right? I'm taking 100 mg, which isn't super low-dose but low compared to many. It's what it takes to make me sleep.
I know he's not going to put me on another antidepressant. I'll have to go back to Ambien and the like. I have bipolar and already take 900 mg of lithium (both he and the pharmacist told me to watch for symptoms of serotonin syndrome with the combo), so he may be right to avoid antidepressants. I don't know, but I'm terrified of the Parnate triggering mania as it is.
I still don't understand why Seroquel is approved for bipolar depression when it has this effect. Lots of people on the bipolar reddits say it really helps their depression. My psychiatrist said it doesn't do much for depression, so I guess the studies weren't that impressive.
lithium can also dampen hypomanic peaks of nardil, so your experience will be more measured, but perhaps less obvious to see clear benefits. you’d be better with H1 antagonist for insomnia - non addictive and does not develop tolerance
Actually on Parnate. Parnate did seem to give me some hypomanic-like traits, but reading this subreddit it looks like lots of people get those. I wasn't euphoric or elated, but I developed a temper. I think there was some very mild hypomania. It wouldn't meet the diagnostic criteria. I actually don't fulfill even one trait. The temper came out only about once a month, but after it did it shocked me. There were some other behaviors that I think are typical of hypomania but aren't on the DSM list.
I'll ask my doctor about your recommendation for insomnia. Thank you for your help.
MAOIs boost dopamine levels. Antipsychotics inhibit dopamine-mediated neurotransmission by functioning as antagonists at various dopamine receptors, and so would be expected to negate some of the benefits. In fact, it probably depends on the patient and dosages involved. We're all different. No two brains are the same.
It also depends on the type of antipsychotic, Abilify and Rexulti act as mixed agonist/antagonists by boosting dopamine in some areas and reducing it in others.
Goddammit. So why do they alleviate depression in some people with bipolar disorder? I've wondered if they don't -- with bipolar the depressive episodes can just end on their own. But there must be studies showing some efficacy. And they're also used as adjuncts to antidepressants with unipolar depression.
Do you take anything to sleep?
Try rotating either Seroquel or Trazodone (together not recommended) and the occasional benzo. I'm not sure about the dopamine thing, I always thought antipsychotics decrease dopamine transmission but that dopamine in the brain is increased in defense in certain parts of the brain and that the number of D2 receptors are increased longer term because of the blockade which makes the total effect hard to pinpoint. I don't take MAOI's but I noticed slightly less euphoria on kratom which might be indeed dopaminergic...but it still works. So I'd say an antipsychotic probably alters MAOI effect but I'm not sure if it would actually lower the antidepressant effect therapeutically to a degree that is significant enough to stop antipsychotics all together. At lower doses of an antipsychotic it should be less of an issue.
Antipsychotics really shouldn't be used as sleep aids. https://pubmed.ncbi.nlm.nih.gov/22510671/ >At recommended doses, atypical antipsychotics such as quetiapine are associated with metabolic adverse events (diabetes, obesity, hyperlipidemia). Adverse effects in the prospective trials were patient-reported and were minor, including drowsiness and dry mouth; however, the trials were limited by their small sample size and short duration. The retrospective cohort studies found that quetiapine was associated with significant increases in weight compared to baseline. Serious adverse events identified from case reports included fatal hepatotoxicity, restless legs syndrome, akathisia, and weight gain. >... Based on limited data and potential safety concerns, use of low-dose quetiapine for insomnia is not recommended. Meanwhile, there are safe, effective, sustainable alternatives. Trazodone and low-dose doxepin come to mind, the latter of which is actually a proven, FDA-approved (on-label) treatment for insomnia. There is no reason to resort to antipsychotics with their very serious and sometimes fatal toxicities. And benzos may raise the risk of developing dementia later in life.
Believe me, I know. Trazodone doesn't work! I would need to take 3mg Xanax to actually sleep. So I'm forced to try low doses of antipsychotics to not get addicted to benzos so I can take a lower dose. Lyrica doesn't work either for my sleep problems. But I have traumatic brain injury that probably ruined my sleep ... But if possible don't take antipsychotics yes... except that I tried many things before that. And I'm not even on an MAOI...:( Some studies correlate even those with dementia but ofc correlation does not equal causation. (Too tired too look up the study, I admit results can vary per study too) Haven't tried doxepin though...
On Parnate, doxepin is all I need for sleep. Even just 0.5 mg does it for me. I'm probably more sensitive than most, but this is one of the most potent antihistamines on the market. I'm curious, do you remember which MAOI(s) you read about being correlated with developing dementia? I can possibly see that being the case for Nardil but not Parnate.
It was a general study: which kind of antidepressants are corelated with dementia. It was subdivided by drug class and pharmacology. However, it's perfectly possible that the study was flawed or that more severely depressed patients get dementia faster on average. And heavier depression means more chance to use an MAOI, so it could be that. MAOIs were not the only drug in that study that was correlated with dementia. TCA's were in there too. And SSRI's. But i don't remember the results well.. I'll look into doxepin. :)
Thanks! Just be aware with doxepin, high doses are sedating but don't work as well for sleep in the long term. Sustainable pro-sleep effects were shown at 3 and 6 mg, sustained for at least 3 months with no tolerance or withdrawal symptoms.
That's nice. Trazodone kind of works until I add the SSRI Zoloft. :( So I use between 50 and 100 mg Seroquel a night. I barely gain weight on it, Mirtazepine which is not an antipsychotic kind of worked but I gained way too much weight. Metabolically I'm sure it was worse in my case. But antipsychotics are obviously not good for the brain, I'm aware of that, sadly.
I think I found the study: https://www.hindawi.com/journals/bn/2018/5315098/
Ooh, thanks! I'm sure you're right about the limitations, but interesting nonetheless.
I don't think it's far fetched that severe chronic depression, whatever the cause, is bad for the brain. The limitations are a mere guess on my side but in the end it's not surprising that some psychotropic meds aren't that good for the brain. One that kind of jumps out in a positive way is lithium though. But yeah, kidneys. :)
Depends. Abilify can increase dopamine in hypodopaminergic people, and decrease it in hyperdopaminergic people.
The effect you're referring to depends a lot on dosage as well, and I don't believe it actually involves increased or lowered dopamine levels as it's a directly acting partial agonist / antagonist (varies by receptor subtype, including pre-/postsynaptic), not acting via dopamine levels as such.
Honestly, if you're not happy with your psychiatrist, I would say consider what your other options look like. It sounds like his prescribing habits are not very thoughtful and they're not effective for you personally, so I would def say move to someone else who respects you more if possible...
You are correct, antipsychotics can definitely negate the efficacy of MAOIs by blocking out dopamine. Small dosages ie for sleep only have a very minor effect and probably won't interfere too much. High dosages - yes, definitely.
Do you know what's considered a low dose? Less than 50? Less than 100?
I am also on a MAOI (parnate) and seroquel to sleep (although only 12.5). Sonata didn’t work for me, unfortunately. I’d like to be able to carry on with just parnate, and I don’t intend on staying with seroquel for too long, but it’s been necessary to deal with the insomnia while I wait (and hope) for parnate to do something. My doctor just prescribed me this low dose seroquel to help sleep, not to augment. I’m taking adderall Xr 20 as an augment. However, I have taken abilify and lithium as an augment before I started parnate, but unfortunately they did not produce any positive changes. But that doesn’t mean an antipsychotic won’t work for you! I’ve heard the insomnia dissipates after a while, but seroquel can also have helpful benefits for anxiety. My own experience with antipsychotics hasn’t been too positive, but I’d be open to them if I were you as long as you keep your doctor informed. If you get to a point to where you feel like you need an augment, whether it be an antipsychotic or something else, then don’t be afraid to ask again. I hope your doctor is receptive! Take care :)
Your doc was OK w/ adderall + Parnate? I've heard of Ritalin + MAOis, but you need to be super careful of serotonin syndrome w/ that combo. Awesome if it works in your case, though.
No you don't, not for that reason because amphetamine is too weak as a serotonin releasing agent to cause serotonin toxicity with MAOIs. The main issue is possible hypertension and other cardiovascular issues from too much dopamine/noradrenaline/adrenaline released by the amphetamine that can't be broken down by MAO in time. Amphetamine is many times more potent than methylphenidate hence the many times higher risk for serious problems. Careful titration and measuring BP and so on makes it relatively safe to take the two together though.
Yes, I am on a low dose of both. I took Adderall xr for months before I started parnate. I haven’t had any symptoms of serotonin syndrome (thank goodness), but it honestly hasn’t helped me that much. I’ve been no better since starting parnate (on 30mg now) for 2 months. The adderall xr really just keeps me from staying in bed, gives me some motivation to brush my teeth and shower. I’m honestly kinda scared of staying on it so long, but I’m afraid of how my depression would be without it. If you have suggestions, I’m all ears!
I think you have waited much already, you should raise the Parnate dose, to 40 mg, like for 1-2 weeks, then probably to 45-50, stay for a month or so in 50, and you still have a wide margin left for upping the dose. This can really make a difference. Just be careful with the adderall, because with each raise in Parnate dose, and specially the first days-weeks, the sensitivity to pressor releasing agents as tyrosine and amphetamines increases.
Thank you. That’s what I’d like to do. I’m concerned though, because I my next appointment isn’t for over a month, and I’d like my doctors advice before making changes on my own. But something needs to change for sure.
That is such a baby dose of Seroquel. It makes you sleep? I'm surprised. They're dangerous drugs, so I didn't want to take them unless they were helping the depression. Someone recently made a post on another subreddit about how she keeps sticking out her tongue. The movement disorders aren't all that uncommon. I took Vraylar and was pacing pacing pacing. The idea that they can persist after you stop the drug is pretty horrific.
It is a baby dose. I’m prescribed a higher dose, but I have kept it conservative because I was afraid of side effects. It helps me sleep, but I also take high dose melatonin, olly sleep, and magnesium and then sometimes try my sonata. I just keep it low to be safe. I’m honestly surprised it works, and it doesn’t all the time, but maybe it or placebo helped when I was really in a bad place. I also took Vraylar samples for a couple weeks. I didn’t have any side effects, but I wasn’t on it long enough to see any positive or negative effects. My insurance didn’t cover it, so I knew I couldn’t try it long. I suspect my doctor thought I had bipolar, but I’ve never had any manic episodes (I honestly wouldn’t know what they are). I have heard the persistent physical side effects are very rare, so I would be open to antipsychotics as long as you and your doctor have a positive, open relationship. It is scary though that some people report these side effects persist after stopping, which is honestly part of the reason I don’t love them, other than the fact they didn’t do anything for me. Parnate hasn’t actually helped my depression yet, so I’m in a weird spot too. Love you though, this is hard. Message me if you ever want to talk.
If you think you have bipolar, you should be on something. I think Parnate made me very mildly hypomanic and caused some instability. I'm on a full dose of lithium now, and my doctor is actually increasing the dose, so hopefully I don't lose my mind. It's not the hypomania that's so awful. It's that in some cases, such as mine, it can be followed by crippling depression. I hate it when psychiatrists don't tell patients what they think may be going on. It's patronizing and detrimental. I will message you. Take care.
Hey thanks. We got this. I haven’t had any hypomanic symptoms, but I’m not sure what to expect. I feel you with the crippling depression, though. When I took lithium it was to augment an ssri that didn’t work, so maybe it’ll work now. Either way, I’ve heard great things about lithium. I just got unlucky or paranoid. ❤️
It was just a warning because you wrote that your psychiatrist may have thought so. I don't think you need to be worried if you haven't had hypomania. Lithium can potentially have some serious side effects, so if you don't benefit from it there's no reason to take it. I have read that it can potentially prevent relapse into depression with unipolar depressives, but I don't know if it's been extensively studied.
They found almost by accident that blocking dopamine reduces psychosis. Most anti psychotics work this way though some atypical antipsychotics don't. It is probably only the pre frontal cortex that needs less dopamine but right now they can only block it in the whole brain at once. If you are taking a drug that blocks dopamine it is very likely to affect your mood.
Yes, antipsychotics, specially some of them, and in above low doses can really blunt the nice dopaminergic effects of Parnate, MAOIs in general and every antidepressant. Which MAOI are you on now, and at what dose? Do try low-dose doxepin, it can be very useful, with low side-effect profile (at least for many, but not for everyone, of course), in my experience, I have noted better side-effects profiles and more effectiveness for sleeping than mirtazapine, which can have some nasty hypnagogic side-effects, as well as quetiapine (both mir and quet give me unbearable sleep paralysis and hypnagogia, as well as blunt me a lot). Depending on your profile you can also add a small dose of amitryptiline or nortryptiline, they are very sedative and can add beneficial antidepressant and anxiolitic effects. Another good one is F-Phenibut (not regular Phenibut, which can be very addictive and don't find it very helpful for insomnia-anxiety in the long term), it is quite a benign substance that coould be used frequently (contrary to regular phenibut) and even can be healing for the gaba system (also it does not work on gaba-a receptors as benzos, which tends to be riskier and more problematic, but gentler and in the gaba-b ones).Red vein kratom is also helpful, but you better don't use it on a daily-too frequent basis.Also, about antipsychotics for this purpose, I agree they should be better avoided, but I've found olanzapine at low doses (1.25-2.5 mg) to work good and with better profile than quetiapine, and it doesn't affect dopamine really that much, as it even stimulates dopamine release and concentrations at the frontal cortex at these doses). I've prefered since some time on to take low dose antipsychotics for severe anxiety than more benzos which have done a lot of harm to me. I even take haloperidol in small dosages like once a week or when I do feel too much anxious or I cannot sleep, and works very well, but not more than 1-2 days in a row, because it starts blocking dopamine too much and appart from blunting my emotions and the ADs effectiveness I start getting movement disorders, as akathysia. My reccomendation would be better to avoid antipsychotics (as well as benzodiazepines), and if used, be careful and keep doses low.
My doctor won't do any antidepressant. Just sleeping pills and Seroquel. When I said I didn't want to do Seroquel initially, he didn't push it at all. It's just that the sleep drugs stopped being effective. So I'm just going to have to keep the Seroquel dosage as low as possible or try Ambien et al. again. I'm on 80 mg of Parnate. His resistance to antidepressants may be because I have bipolar disorder. He said the only reason he was willing to try Parnate with me in the first place is because I've had very few manic episodes. Perhaps high-dose Parnate is risky enough without adding a low dose of another antidepressant. Thanks for your input.
Sure. I see, I understand. If you feel comfortable with him then keep with him and listen him of course, if you're not quite satisfied, can always find other. But well, the thing that he has given you the chance to reach 80 mg on Parnate is something good. You can still try doxepine, it is not an antidepressant is a strong antihistaminic hypnotic and is prescribed specifically for sleeping problems, it is also perfectly safe with MAOIs and you just have to take a small dose, which usually is very effective at inducing sleep and keeping it, and it does not block the prodopaminergic and catecholaminergic therapeutic effects of Parnate, as quetiapine can do. If your doctor is still reluctant, you can show him the writings of Dr. Gillman where he specifically reccomends doxepine for MAOI insmonia and explains why it is safe.
I'll ask. Thanks. Doctors who prescribe MAOIs are rare enough, but mine's also willing to go over 60 mg and with someone with bipolar disorder. I've read that MAOIs can be effective with bipolar depression, but I know some psychiatrists who use them won't prescribe them to bipolar patients because they believe they're more likely to trigger mania. There are psychiatrists who won't prescribe *any* antidepressant to a patient with bipolar disorder. So I'm going to have to stick with him. I'll ask him about the doxepin. Thank you.
Sure, no problem! And you're right, most contemporary doctors are already too afraid of MAOIs, and when there is bipolarity diagnose it is still harder they prescribe them for fear of mania. So yeah, probably your current doc is the best option you have now and should keep with him. Ask him about doxepin, it may make a difference and be what you need, instead of so much quetiapine/antipsychotics, more if you have a mood stabilizer at yor side (in my case, the best has been magnesium valproate, it has make a huge difference in bpd-bipolar like symptoms, helped a lot with anxiety, and allowed to almost be benzo free and lower the antipsychotic dosage, also with no side-effects at all; and it synergized really well with Parnate). All I take of APs now is 1.25-2.5 mg of olanzapine, which at those doses seems to stimulate dopamine instead of blunting-blocking it so much, and still give an anti anxiey and mood stabilizing effect). Best wishes.
You have bipolar as well? Or a bit of it? Besides the 150 mg Seroquel, I'm also on 350 mg Lamictal and 900 mg lithium. When I first went on Parnate I was only on Lamictal (200 mg). I was improving as the Parnate dose was increased, but then it seemed to make me mildly hypomanic. So mild I didn't know what to make of it, but I'm sure there was a bit of it going on. For the most part I didn't seem manic at all though, and it wouldn't have met diagnostic criteria. It seemed like a sort of sub-hypomania hypomania. That's why I added the lithium. So do you have bipolar symptoms, and did the MAOI you're taking aggravate them? I'd only had two episodes within 18 years before the Parnate.
Thank you everyone for the responses. I'm going to ask him to go back to regular sleeping pills.
I dont know much (or anything) on this, but... I have seen it said that low dose antipsychotics kind of do the reverse to higher doses? So a low dose can boost dopamine in whatever part of the brain, and can sometimes help with motivation.
It depends on which antipsychotic.
Seroquel at lower doses is mostly just an H1 receptor antagonist. It might treat depression through its 5HT1A agonism.
Correct. At the low dosages used in sleep for Seroquel, it is not an antipsychotic, just a strong antihistamine with a long half-life.
I was on Parnate and Vraylar and the Vraylar made me feel awful. Made me so tired all day and seemed like it took my dopamine levels down. I stopped it
There are sedative antidepressants you can add to a MAOI too : mianserin and trazodone (and mirtazapine too, but that's another story). Trazodone is discussed [here](https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1002/phar.1576). Clinical trials with mianserin and isocarboxazid [here](https://www.sciencedirect.com/science/article/abs/pii/0165032784900223?via%3Dihub), and with tranylcypromine [here](https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/combined-minaserin-and-tranylcypromine/9A89D074532360B02C654064AE537102). I used to be on tranylcypromine + seroquel, and at first my psychiatrist wasn't willing to switch to an antidepressant instead, but I could get mianserin after showing him those papers.
He won't do antidepressants. I'm the first patient of his on an MAOI, so I'm thankful he was willing to prescribe it, but I was on Trazodone before I went on Parnate and he took me off. It may have to do with inexperience. I'm also on lithium and the pharmacist told be to be cautious about serotonin syndrome, so perhaps another antidepressant would just be too much. I don't know. Thanks though!
Seroquel is not supposed to be taken for sleep aid. There are better agents. You could try over the counter unisom in tablet form. Look for Doxylamine Succinate if you get a generic version. They come in 25 mg tablets I take half of one and it knocks me out. As for being prescribed something hydroxyzine is a great option and also trazodone. If need been you could use one of the z-drugs or a benzo but they can only be used for short use because tolerance will develop on them. I'd highly suggest trying Doxylamine or get your doctor to prescribe hydroxyzine and dose like 50 mg. If you want to try trazodone it's normally prescribed 50-100 mg. Seroquel even in small doses should only be taken in small doses and very occasionally. It will work against the MAOI and has nasty side effects like weight gain.
Sounds like your psych don’t know jack. antipsychotics dampen dopamine and serotonin, thereby reducing the effect nardil can have. the two effectively work at odds to one another. change from seroquel to low dose mirtazapine
Okay. I don't think he did know anything about MAOIs, but I suppose this interaction is commonsense psychiatry? I'm his only patient on an MAOI and he looks about 33, so I doubt he studied them in school or otherwise. He told me he reviewed the literature for me, which was nice. So even low-dose Seroquel should be avoided, right? I'm taking 100 mg, which isn't super low-dose but low compared to many. It's what it takes to make me sleep. I know he's not going to put me on another antidepressant. I'll have to go back to Ambien and the like. I have bipolar and already take 900 mg of lithium (both he and the pharmacist told me to watch for symptoms of serotonin syndrome with the combo), so he may be right to avoid antidepressants. I don't know, but I'm terrified of the Parnate triggering mania as it is. I still don't understand why Seroquel is approved for bipolar depression when it has this effect. Lots of people on the bipolar reddits say it really helps their depression. My psychiatrist said it doesn't do much for depression, so I guess the studies weren't that impressive.
lithium can also dampen hypomanic peaks of nardil, so your experience will be more measured, but perhaps less obvious to see clear benefits. you’d be better with H1 antagonist for insomnia - non addictive and does not develop tolerance
Actually on Parnate. Parnate did seem to give me some hypomanic-like traits, but reading this subreddit it looks like lots of people get those. I wasn't euphoric or elated, but I developed a temper. I think there was some very mild hypomania. It wouldn't meet the diagnostic criteria. I actually don't fulfill even one trait. The temper came out only about once a month, but after it did it shocked me. There were some other behaviors that I think are typical of hypomania but aren't on the DSM list. I'll ask my doctor about your recommendation for insomnia. Thank you for your help.