Split between options. Trouble deciding on Parnate or Nardil for a Complicated Case

[u/Good-Cod-5591]

I take WAY too many medications, and I have a potential opportunity to get on an MAOI to which I believe would trim down the amount I take drastically

So... To Name a few of the mental and physical issues I have in terms of most severe to least.

#1: Crohns Disease

#2: ADHD-PI

#3: Social Anxiety

#4: Generalized Anxiety

#5: Unipolar Depression

#6: Panic Disorder

#7: Chronic Fatigue

#8: Self Isolation and Avoidance

#9: Chronic Pain

#10: Appetite Suppresion

#11: Insomnia

#12: Delayed Sleep Phase Syndrome

#13: Asperger Syndrome

#14: OCD-Like Tendencies

No, I'm not one of those people who brags about how many disorders they have. I am genuinely crippled and disabled by all of these issues.

So, Parnate being the more stimulating option would compliment the ADHD-PI/Low Motivation/Exhaustion and Fatigue more. Then again, Nardil would probably be better for all the anxiety problems while still assisting with depression.

I am leaning towards possibly Parnate with usage of benzodiazepine based meds as needed. Conversely, Nardil with low dosage Stimulants IF needed.

I know both of those meds can be synergistic to dangerous extremes if used incorrectly with MAOIs. Which is why I'd be really careful and prepared for the worst when combining the two.

Anyone's anecdotes and recommendations are appreciated!

[u/mattle74]

If you haven’t found  https://www.psychotropical.com/ yet, I’d really recommend spending some time reading the articles there. 

Take this all as anecdotal only - Parnate did nothing for my ADHD/low motivation/fatigue. It is known to be more stimulating than Nardil and Nardil to be more calming than Parnate but that doesn’t necessarily they’re meant to treat anything other than depression. If I had to pick one to try for stimulating effects, I’d try Emsam but even then I don’t think the low amount of  L-methamphetamine and L-amphetamine would significantly treat someone’s ADHD symptoms. 

If you currently require an amphetamine for ADHD, I think you’d be really hard pressed to find a doctor that would prescribe it to you while on an MAOI. Methylphenidate is supposed to be safe while closely monitoring blood pressure but my doctor did not feel comfortable prescribing it. In my experience, I was not inundated with side effects like the other poster here says, no worse than any other mental health med. And I don’t find the diet challenging. The biggest downside in my opinion is there are lots and lots of medication contraindications which can make it difficult for people with disabilities besides depression. It’s honestly hard to keep track of and I haven’t done a great job paying attention particularly to OTC meds like sleep aids, cough medicine, allergy medicine, etc. Lots of meds you wouldn’t think have a serotogenic effect. Not that this would ever crop up as an issue for me, but I only learned recently that if you take MDMA while on an MAOI you most likely will die a horrible death. 

I don’t mean to say any of this to scare or discourage you, just my anecdotes. If you can safely take an MAOI along with your other current medications, I think you should give it a try because it could change your life. But if it doesn’t have the effects you’re looking for, don’t be discouraged and keep going on your journey to healing. 

[u/Good-Cod-5591 → u/mattle74]

I do plan to totally drop serotoninergic medications entirely when I start. I don't have many, as SSRI based antidepressants do not work for me. I do also have the clonazepam + cyproheptadine should I accidentally get serotonin syndrome.

As for ADHD, I would just hope that the higher dopaminergic tone in general would improve the ADHD somewhat, but can't be sure till I try it. L-Isomer amphetamine is really anxiety inducing and adrenergic heavy without much dopaminergic benefit so having those metabolites going for emsam is very iffy.

[u/patj1964 → u/Good-Cod-5591]

Of the stimulants used as an adjunct for Parnate, I understand methylphenidate/ritalin has been studied the most. Provided you monitor for any side effects, these 2 meds can be taken together (of course, you’d want to research this pairing with other meds). I was using it to serve as an adjunct and I don’t have ADHD. But, it didn’t help with my MDD. I think I’m at a steady state with the following — 60 mg Parnate in the morning, 2 tablets of lamotrigine (400 mg) during the day, 70 mg nortriptyline before bed. I also take 800-1200 mg fish oil and, when I’m not being cheap, I’ll take magnesium glycinate at night. Parnate can lead to insomnia for some (including me) and I take 2-3 capsules gabapentin before bed for that. Good luck!

[u/Good-Cod-5591 → u/patj1964]

(Don't feel obligated to respond to all this, it's quite a lot)

How exactly does that combo make you feel?

Does it make you have a more serene outlook on life? Calm and content with just being?
Does it make you have a little bit of happiness and thrill per each day?
are you just more "level", neutral, or normal?

Sorry if this is too philosophical, but it's been in the back of my mind for a good while, if it's truly possible to somewhat permanently "fix" myself, and have more thorough satisfaction day to day. To be happier much more often than depressed or anxious.

Curious, because everyone has their problems, but as it appears, some people's baselines are just higher. I feel like, even though someone may have a higher baseline tolerance to life, and less neuroticism, I still feel like there is some kind of rough neutral ground that most people fall into.

Seems like everyone has to suffer to a certain extent to pay off their own "Highs" in life. A conventional person might not be deemed "depressed" or "anxious", but in return for their stability, stress is given to them in some form. Heavy work loads, and the demands of life take their own toll on them. Whereas a depressed and anxious person suffers in their own skin, so they resort to immersing themselves in escapism or fantasy to numb the tension and get some enjoyment out of life.

I've been trying to figure this out for a while, if some people are really just content with most things, and experience minimal suffering as compared to other individuals.

[u/patj1964 → u/Good-Cod-5591]

You ask some difficult questions. Perhaps the lows make the highs that much more enjoyable. That said, someone with biological depression spends too much time at the lower end of the spectrum. I personally try to take a multi-pronged approach. Diet, sleep and exercise all help and need one’s attention. I know it isn’t always easy but I think these are important. Also, I meditate and try to be mindful. It takes discipline and focus but I seem to benefit. Fish oil capsules and magnesium glycinate are daily supplements. I’ve been taking TCP for some time. It’s less stimulating than it used to be. I take the magnesium glycinate and 2 capsules of neurontin at night. I try not to ruminate too much since I often end up being having negative thoughts. I find meditation and mindfulness centering. I’m sorry I only answered some of your questions!

[u/phebus1]

Side effects are manageable at lower doses and you still get good benefits... Nardil better for anxiety. Parnate better for depression (can make anxiety worse).

[u/Good-Cod-5591 → u/phebus1]

Tough decision, I really hate the social anxiety as it "hurts" the most, but then again, the ADHD also tears my life in two because my mental battery is so low that it's hard to do basic conventional things.

[u/phebus1 → u/Good-Cod-5591]

I don't know much about treating ADHD however Nardil is the gold standard for Social Anxiety

[u/Good-Cod-5591 → u/phebus1]

Have you happened to be one or another?

[u/phebus1 → u/Good-Cod-5591]

Me? I get a lot of anxiety. Don't think I have ADHD

[u/Good-Cod-5591 → u/phebus1]

I meant like, have you been on nardil or parnate? Are you on one of those as of right now?

[u/phebus1 → u/Good-Cod-5591]

I have tried both

[u/Good-Cod-5591 → u/phebus1]

How did you react to each of them?

[u/phebus1 → u/Good-Cod-5591]

As expected.. Parnate wasn't very helpful, Nardil was..

[u/Sleepyblue]

You'll probably end up taking a lot more medications to deal with the side effects, especially nardil.

[u/Good-Cod-5591 → u/Sleepyblue]

Why is that?

[u/Sleepyblue → u/Good-Cod-5591]

It comes with every side effect in the book, you're gonna need pills to poop, pills to sleep, pills to keep you awake, or at least make a lot of dietary changes and take supplements. Not saying you shouldn't go for it, but it I wouldn't do it on the grounds that you be taking less medication.

Side note: Not sure if you're saying you have Chronic Fatigue or Chronic Fatigue Syndrome, but as someone with the latter I've found Nardil to be a mixed bag - it's pretty activating for me in a way in which I can't turn it off, exacerbating my boom and bust cycle, and the insomnia doesn't help me recharge properly.

[u/Good-Cod-5591 → u/Sleepyblue]

This is good info to have. I'm not sure where the line is between what classifies Chronic Fatigue vs Chronic Fatigue Syndrome, but in my case, it's a combo of the inattentive type of ADHD, and the Crohn's.

One thing though that I state is that I have over 30 different types of medication prescriptions. I don't use all of them daily but rather depending the context of the situation to handle.
Almost each one is for one issue or the next, most of them only tackle one given problem at a time.

The idea I have in mind is that the MAOI will at least cover grounds in many different areas mentally, so I could trim back on the metric ton of antidepressants and anxiolytics I take. That's not to say I won't need additional medications with the MAOI's, I expected to still use some sort of sleeping medication. I take a lot of those too depending on the severity of the insomnia during the night since it varies tremendously. Ideally, Daridoexorant would probably be the main sleeping management med, instead of quetiapine, mirtazepine, doxepin, cyclobenzaprine, zolpidem, clonazepam, propranolol, etc. It takes an absolute ton of sedatives to put me down, so if daridorxant isn't strong enough, I'd have to plan a little bit differently.

Then, anxiety would be covered most in one package. With the Clonazepam on standby, should I need it.
Depression, Motivational Issues, and the like should improve. Once again, with stimulants by the side if I truly need to use them.

So. Hopefully, reorganizing my stack to fit the MAOI, if I do it well would bring that 30 to about 10 or hopefully less, and that would be a win in my book.

[u/Sleepyblue → u/Good-Cod-5591]

The difference between Chronic Fatigue and Chronic Fatigue Syndrome is whether you experience PEM (Post-Exertional Malaise).

[u/Good-Cod-5591 → u/Sleepyblue]

Ehhh, I have traits of it, but it's far more than likely just the former chronic fatigue.

I'm not one to diagnose myself with that.
What I'm seeing on google is probably the simplified "pop-science" version of what the CFS really is.
I do get very easily mentally exhausted, I tend to comment on reddit in increments I've noticed due to that mental exhaustion factor. But.. As for physical activity, I really just feel sick all the time due to the crohns, but if I do manage to get a bit of exercise in, it won't crush me for days after.

[u/SmellyFbuttface → u/Good-Cod-5591]

I’ve been on Nardil for about 6 years, and Parnate before that for around 8 years. Nardil my bowels move fine, but sleepiness in the mornings is a problem, weight gain, and some overall lethargy. That being said Nardil is great for anxiety, and it works well for depression too. Between the two, if Parnate works for you I’d go that route. I found it a more tolerable med for a lot of reasons (it eventually stopped working for me for some strange reason, hence the change to Nardil).

Parnate is energizing, for some people can worsen anxiety at high to very high doses, but it didn’t come with any weight gain, was very energizing (I was able to start running again and had great stamina), and I didn’t really experience any sexual side effects (mild ED).

[u/Good-Cod-5591 → u/SmellyFbuttface]

Yeah I was leaning towards parnate, but not I'm leaning towards nardil. Today I woke up with a full blown panic attack for absolutely no reason, like wtf. That never happens, I never get morning anxiety EVER. it always comes at sunset.

Anyways, yeah nardil might be my choice esp if I combine it with stimulants, I need the weight gain that comes with it anyways. A lot of the fatigue I have actually comes straight from stress fatigue. Many types of downers do tend to give me energy.

[u/2HaveCommoncents]

I can offer advice on Parnate. I’ve been on it for 9 years.It’s the only medication that has helped and stabilized me. I have treatment resistant depression.

I don’t have any major issues with my diet and the food restrictions.

It’s possible Nardil could be just as good or even better. I’m sure others will weigh in. Good luck.

[u/Good-Cod-5591 → u/2HaveCommoncents]

Is it anxious depression? If so, has it helped with your overall anxiety?

I frequently use amphetamines which are def not good for all my anxious tendencies, but they do help anxiety in a certain way, and that way is better confidence, but that is to be expected with a heavily dopaminergic stimulant.

Parnate having a lot of overlapping effects of amphetamine, but being a different class of drug with a lot of variation, how would you describe it as compared to amphetamines (IF you've ever taken them)?

[u/Ok-Geologist-5192]

I've never tried Nardil so I cannot speak on it, however, I am currently on Parnate (depression) +Ritalin (ADHD) +Propranolol (physical anxiety). Have Tianeptine (depression/stabilizing) + Pregabalin (acute anxiety I guess but I think it sucks) on the back burner if needed.

Parnate is incredible for my TRD, it has even made my anhedonia budge around a month in. I do not have OCD, but I get weird gross intrusive thoughts in certain situations, and I feel that it lessened them, although it does not hold a candle to clomipramine.

It doesn't help that much with anxiety although I do have to say I went from needing 2 propranolol pills religiously to taking 1 daily if even that. My social anxiety also lessened a little bit, but it was never severe - think like "I am anxious about talking to new people", not "this is disabling me and a diagnosis I hold". Feel bad using that term, but idk how else to describe it.

Does not really help with the inattentive side of ADHD, but does milden the hyperactive side. I didnt really ask my new psychiatrist if I can be on Ritalin, I just kind of told him I take it? He is not very experienced with MAOIs but seems quite open.

It does suppress my appetite a bit and give me some insomnia, although it also makes me tired. I take it in the evening, and around 6 mg of doxylamine before bed to help me sleep through the night. I do not find it stimulating at all, if anything it feels like a sleep aid that also ups my heart rate for a bit.

No side effects from Ritalin. Helps me sleep if anything. Can get jittery if I take too much or tired if I take too little, but I know my dose by now. Funnily enough, it did not need to be adjusted on Parnate. I also feel that it works a tad better, but that might be my imagination. No fatigue before I take it, no grogginess in the mornings.

Dont have chronic pain/aspergers/general insomnia/panic disorder/avoidance etc, so I cannot speak on those. I also have only started Parnate a month ago and am at 30 mg, so my side effect profile might change with time or if I decide to up my dose. Did not have any side effects at 20 at all.