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Suggest Alternate Over The Counter Medication For Trileptal
Question: Hi doctor.
You have been helping me with Trileptal. Irritability (strangely) and sedation were both increasing independent of the other drugs and so Mr doctor and I discontinued. The anger stopped soon after.
I just filled a prescription for Parnate, which was our plan if the Trileptal didn't work. My depression and anxiety are considered atypical and complicated by complex trauma and possible borderline. It was thought an MAOI would be helpful in addressing some of the more neurotic and reactive aspects of my condition without the emotional side effects of flatness/coldness or anger from SSRIs etc.
Now that I have the pills I am nervous to start. What can I reasonably expect on start up if I start at 20mgs, during the first week or so? I have several family trips coming up; a graduate school interview; and an advanced genetics class I am currently in!
I have read a lot about insomnia combined with afternoon sedation, as well as low BP and tiredness in general. What is reasonable at this dose in the first week or so?
Thank you I enjoy your advice
You have been helping me with Trileptal. Irritability (strangely) and sedation were both increasing independent of the other drugs and so Mr doctor and I discontinued. The anger stopped soon after.
I just filled a prescription for Parnate, which was our plan if the Trileptal didn't work. My depression and anxiety are considered atypical and complicated by complex trauma and possible borderline. It was thought an MAOI would be helpful in addressing some of the more neurotic and reactive aspects of my condition without the emotional side effects of flatness/coldness or anger from SSRIs etc.
Now that I have the pills I am nervous to start. What can I reasonably expect on start up if I start at 20mgs, during the first week or so? I have several family trips coming up; a graduate school interview; and an advanced genetics class I am currently in!
I have read a lot about insomnia combined with afternoon sedation, as well as low BP and tiredness in general. What is reasonable at this dose in the first week or so?
Thank you I enjoy your advice
Brief Answer:
We need to remain optimistic
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
I am glad to know that following discontinuation of trileptal the anger has been reduced. This gives clear indication that irritability and anger observed during last weeks was result of trileptal, nuvigil and withdrawal effect of effexor.
I understand that alike any other antidepressants parnate is associated with side effects but they do not occur as a rule and there is good possibility that you will experience little or no side effects.
Insomnia is more common when the medication is taken during night but since it has stimulant like properties it is better to start with morning dose.
Afternoon sedation is very rare contrary to claims. Although I have limited experience with parnate but most of my patients were able to tolerate it when the diet was maintained as required.
Low BP is uncommon with 20 mg per day dose and even if it occurs it can be managed with simple measures like taking time while changing posture and use of stockings.
I do not have percentage for 20 mg of parnate but like to assure you that side effects are very much limited.
In my opinion there is ground for your fears but it seems they are out of proportion. Despite the report of side effects they have potential use in atypical depression and we need to target depression while worrying little about the side effects.
I hope this assists you.
Thanks and regards.
We need to remain optimistic
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
I am glad to know that following discontinuation of trileptal the anger has been reduced. This gives clear indication that irritability and anger observed during last weeks was result of trileptal, nuvigil and withdrawal effect of effexor.
I understand that alike any other antidepressants parnate is associated with side effects but they do not occur as a rule and there is good possibility that you will experience little or no side effects.
Insomnia is more common when the medication is taken during night but since it has stimulant like properties it is better to start with morning dose.
Afternoon sedation is very rare contrary to claims. Although I have limited experience with parnate but most of my patients were able to tolerate it when the diet was maintained as required.
Low BP is uncommon with 20 mg per day dose and even if it occurs it can be managed with simple measures like taking time while changing posture and use of stockings.
I do not have percentage for 20 mg of parnate but like to assure you that side effects are very much limited.
In my opinion there is ground for your fears but it seems they are out of proportion. Despite the report of side effects they have potential use in atypical depression and we need to target depression while worrying little about the side effects.
I hope this assists you.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you. Can you tell me how serious the *potential* reaction between trileptal and parnate is? I'm reading there is a washout period to reduce chance of serotonin syndrome, but I've also read they can be used together cautiously?
My last dose was less than a week ago. I'm not super worried, but part of me would almost like the chance to reintroduce the trileptal somehow if the sedation and anger were addressed. I notice after stopping how much more emotionally open I was able to be on it; a lot of my defenses and knee-jerk aversions disappeared. Also I would sleep through the night without any trauma nightmares
My last dose was less than a week ago. I'm not super worried, but part of me would almost like the chance to reintroduce the trileptal somehow if the sedation and anger were addressed. I notice after stopping how much more emotionally open I was able to be on it; a lot of my defenses and knee-jerk aversions disappeared. Also I would sleep through the night without any trauma nightmares
Brief Answer:
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
Serotonin syndrome is a serious reaction of a nature which could cause danger to life. However personally I have seen only mild cases till date no such dangerous reaction witnessed by me despite making prescription for thousand of patients.
Since there is passage of almost one week you can start parnate at lower dose such as 10-20 mg per day. In case if you experience any adverse reaction report to either me or preferably your treating doctor. On getting any information we will be ready to act in manner to stop further progression of any interaction between medications.
Although you mentioned that you are better in many aspects after stoppage of withdrawal but it is not clear why you want to take trileptal. I hope you remember that trileptal was cause of (at least contributor) in causation of anger and agitation last week and I will request to stop any planned trial with trileptal.
I hope this clarifies.
Thanks and regards.
Follow up
Detailed Answer:
Dear XXXXXXX
Thanks for follow up.
Serotonin syndrome is a serious reaction of a nature which could cause danger to life. However personally I have seen only mild cases till date no such dangerous reaction witnessed by me despite making prescription for thousand of patients.
Since there is passage of almost one week you can start parnate at lower dose such as 10-20 mg per day. In case if you experience any adverse reaction report to either me or preferably your treating doctor. On getting any information we will be ready to act in manner to stop further progression of any interaction between medications.
Although you mentioned that you are better in many aspects after stoppage of withdrawal but it is not clear why you want to take trileptal. I hope you remember that trileptal was cause of (at least contributor) in causation of anger and agitation last week and I will request to stop any planned trial with trileptal.
I hope this clarifies.
Thanks and regards.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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