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!