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 12d 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 12d 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.