Expert: Ivan Goldberg, M.D. - 4/25/2010

Question
Parnate is best thing I've  found, in 35 years, but it only  works for about 5 weeks  and  then  it quits.  My system is  hard  to   manage.  Most meds  make  me sleepy Is there a  way  to  make  parnate  work  for  me?                                                                                                                                                                                                                                                                                                                                  I

Answer
Hi Pat . . .
You did not mention the dose of Parnate that you have taken. One of the most common reasons for Parnate to "poop-out is that it is being prescribed in an inadequate dose. I have used doses up to 200 mg/day. See the abstract below.

Best regards . . .

Ivan
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Pharmacopsychiatry. 1989 Jan;22(1):21-5.
High dose tranylcypromine therapy for refractory depression.
Amsterdam JD, Berwish NJ.

Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia.
Abstract
A substantial number of depressed patients will experience a chronic, treatment-resistant affective disorder. Aggressive treatment of these patients with various drug combinations, unconventional antidepressants, or electroconvulsive therapy has met with only partial success. There remains a pressing need to identify more effective methods of utilizing "first-line" antidepressant agents to achieve a more rapid therapeutic action. To this end, we initiated a study using high doses of the MAO inhibitor tranylcypromine, at a range of 90 mg to 170 mg daily, in seven refractory depressed patients who had failed to respond to at least three prior treatments regimens. Four out of seven subjects (57%), who had failed to respond to a mean of 8 +/- 5 prior treatment, had a complete response, and one patient had a partial response to high dose tranylcypromine. The mean SD maximum tranylcypromine dose for the responders was 112 +/- 16 mg daily (range 90 mg to 130 mg). Response did not appear to be a function of severity of illness, duration of present episode, or the number of prior treatment failures. Overall, the side effect profile was favorable, and no "cheese reactions" were encountered. These observations are of clinical significance and suggest the need for further controlled studies using high doses of tranylcypromine.

PMID: 2710808 [PubMed - indexed for MEDLINE]