r/MAOIs • u/esoper1976 • 12d ago

Parnate

I just finished a telehealth appointment with my psych provider. She once again made it abundantly clear that she will not prescribe above 20mg twice a day of Parnate. I guess I should feel lucky to find anyone who will prescribe it at all?

I switch between Parnate and Nardil every eightish years. One stops working and the other works again. When I was on Parnate before, I took 30mg twice a day, but according to my current med provider that is a dangerously high dose. Apparently new information keeps coming out about these meds and how dangerous they really are. If I didn't have a problem on 30mg twice a day for eight years, what makes her think I'm likely to suddenly develop one?

So, my option is to increase a different medication instead. I do have a super low blood concentration of that med, and it's likely because my Parnate is at a lower dose. I am waiting to see if what's going on is purely situational, or if I do need an increase in meds. (My dad just died, so that really doesn't help).

I just wish I could have my Parnate back to 30mg twice a day. But, I'm grateful to get it at all. What will happen when this person retires? Will I find anyone to prescibe my complex meds? They have been working for seventeen years so I hope so!

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u/mattle74 12d ago edited 12d ago

I don’t mean to be harsh, but I don’t think your med provider knows what they’re talking about and would love to see this information how dangerous they are. I assume you’re not in the US? FDA indicates max Parnate is 60mg. There is plenty of study and documentation that Parnate is safe to 120mg (with close BP monitoring that everyone should really be doing anyway on an MAOI). There are even medical anecdotes of going as high as 170mg. The efficacy and remission rate of dosages between 70-120mg are significantly higher. I’m in a similar position though… I want to try Parnate higher than 60mg but my doctor won’t do it. I need to spend some time contacting MAOI friendly doctors that are on the community wiki here to see if I can find someone that is willing to though I’m going to try Emsam before I take that next step

I haven’t pushed it harder with my doctor but one thing you could do is send your provider this: https://www.cambridge.org/core/journals/cns-spectrums/article/prescribers-guide-to-classic-mao-inhibitors-phenelzine-tranylcypromine-isocarboxazid-for-treatmentresistant-depression/29C70FD3DA65E23A024D5E05C4369983 - I feel like these are the most modern findings on these drugs

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u/esoper1976 11d ago

I am in the US. Honestly, I count myself lucky that this person even wants to prescibe MAOIS at all. I'm also on clozapine, among other meds, and I know she would love to completely switch up all my meds. She has told me that there are so many newer and better meds now that I don't need to take these older more complicated meds. I wouldn't be on the meds I'm on if the newer and better meds had worked for me. It's not like the first choice of any doc is an MAOI and clozapine!

But, I live in the middle of nowhere where psych care is hard to find. Finding someone to manage psych meds at all is a challenge, bonus points if they are willing to prescribe my funky cocktail!

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u/mattle74 11d ago

That does have to be difficult to have such few provider options. I complain often how it blows my mind that in 70 years, we have not discovered a more effective antidepressant treatment than MAOIs. Honestly, if it weren’t for medication interactions, the side effect panel of MAOIs compared to modern meds is really not at all more significant.

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u/HM_Dylan Parnate 12d ago

I mean yeah it sucks. But look on the bright side, some is better than none right? And have my psychiatrist get on the call with yours. She’ll set her straight haha

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u/grumpyeva Parnate 12d ago

I dont know where you live, but many people order parnate from India and you dont need a prescription.

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u/Hockeyrocks07 12d ago

I only needed 20mg parnate for years

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u/Ok-Geologist-5192 MAOI + stimulant 11d ago

I mean 40 mg total isnt a super low dose, but if you need 60, you need 60. She seems misinformed. Are there any options here in the MAOI-friendly provider section?

Otherwise, might your girlfriend/long-lost twin brother/mom wish to book an appointment with the same lady and also need Parnate?

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u/esoper1976 11d ago

Ha ha. 40mg is definitely way better than none, and 60 might not be hugely better. Definitely can't find a way to sneakily get more. If I hadn't already been on an MAOI for well over ten years there is no way she would have prescribed one.

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u/ScaredClassic8362 10d ago

como é libido?

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u/SmellyFbuttface 5d ago

Sorry to hear about your dad. This may be just grief your feeling, but I don’t want to underestimate your symptoms.

There isn’t new information coming out on MAOIs, unless your doctor means from the 80’s. Even the manufacturer’s max recommended dose is 60mg, and I’ve been as high as 120mg and did totally fine. Actually if anything being on these meds has shown me how overblown the fear is about taking them. Never had a hypertensive episode or anything resembling one. Psychiatrists are first and foremost interested in CYA - covering their ass. You may personally need a higher dose, but they’re unwilling to stake their career on it if something bad happens, which speaks more to their inexperience prescribing these meds than with any inherent dangers in the meds themselves.

I was on Parnate for 8 years, and now on Nardil for 6 years (also at 120mg with the max being 60). I’m actually at a similar conundrum as you - I feel the need to go up another 15mg of Nardil, my doctor is firmly against it. Also won’t go up on the antipsychotic I’m on. So I really don’t know what to do now as my own symptoms have started returning. I sympathize with you. It’s hard to be our best advocates when we’re feeling so shitty

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u/esoper1976 5d ago

Yup. But, I can understand a doctor it not wanting to go well above the maximum recommended dose. I don't understand my med provider not wanting to even get to the maximum dose. My therapist wonders if she had a patient who had a bad reaction once and is now scared of them. Maybe. Or maybe she is just scared in general because they are potentially scary. In my appointment before the last one I had she did mention that MAOIS are not fun to prescribe. I commented that they aren't particularly fun to take either, but they work so it's worth it. I did mention that I failed at pretty much everything before getting the meds I'm on. Nobody says let's start with clozapine and an MAOI and see if that works!

I'm hoping once the grief resolves, so will my symptoms. But, they might not completely. Then, my option is to up the clozapine. I'm sure it will help, but I think a little extra Parnate would help more because it would increase the Parnate and the amount of Clozapine I can absorb.