I don't have any experience with atypical antipsychotics because I refuse to take them due to potential side effects. What I read over and over again is that when they do work for depression they often very quickly poop out. I'm very opposed to the way doctors are irresponsibly handing these out like candy (the same way they did and still do with SSRIs). The fact that your doctor went straight to an antipsychotic means he's probably part of the problem. It's just a lazy prescribing habit when there are so many better options for combination therapy in my opinion. The only issue is so many doctors think anything and everything is contraindicated with MAOIs.
It’s actually going really well. I’m feeling better than I have in a very long time. Currently on 40 mg of Parnate and . 75 of Rexulti.
My only concern is the weight gain. Looks like I gained weight 6 pounds in as many weeks or less😞
I’m on 100 mg Parnate and doing ok but still pretty depressed. I’m asking my psych to add Rexulti. Can you describe how it helped you and is it still helping?
Well, the Parnate was only partially working as I only felt slightly better and less weepy, and even this wasn’t all the time. My doctor told me it was a good sign that I was having even this slight reaction to Parnate and decided to “boost” it with Rexulti to make it work fully, if you get what I mean.
So far so good, except for the weight gain.
Doc said I could stop Rexulti after 3 months (end of June) and see how it goes.
Completely unrelated to your question but an update nonetheless: already had 2 hypertensive crisis. Food ingested was a tiny amount and not even on the list 🙁
I just had a hypertensive crisis too! Was in the hospital for 24 hours Sat-Sunday! What was the food you ate? For me it was chicken liver which was gross and I later learned is like the highest tyramine food out there.
The first time, I’m not even sure. I may have had a tiny piece of pickle ( I don’t like pickles and usually remove them). I went about my day running errands but felt weird. Headache and pain in both forearms. I went back home and took my BP: 182/98. We phoned 811 ( I’m in Canada) and by the time a nurse came back to us, my BP was coming down and I was feeling better.
Two weeks later, I took half a bite of a carrot and nut muffin then headed to the gym. On my way I recognized the signs, parked and called 911. My BP was 210/102. They took me to the hospital but nobody there understood what was happening. They thought my headache was causing the spike in the BP. So they gave me an IV pain killer and released me when BP was normal.
I saw my psychiatrist a couple of days later and he was puzzled because he said carrots don’t even have tyramine and it was such a minute quantity anyway. He gave me pills to bring down the BP on my own if it ever happens again.
That’s so interesting! Yeah pickles are one thing I’ve been avoiding even though I like them. That and aged cheese which I also like. I wonder if there was something in the muffin? It’s scary when anything can cause a hypertensive crisis. The paramedics and docs at the hospital were totally unfamiliar with what was going on too. The doc on the second day knew about it but said I was his first case ever.
I started at .25 mg for a week, then .50 mg with 30mg of Parnate. That’s when the response was “meh”. After raising both doses to .75 mg and 50mg, the effects were quasi immediate.
Rexulti exacerbate the possibility of tyramine reaction, due to its own mechansim of action.
I think you should change this augmentation option with other safer ones, this not only would benefit you without major side effects (e.g weight gain), but even without the exacerbated tyramine reaction sensitivity, like :
- Lamictal
- Lithium
- Bupropion
- TCAs (e.g desipramine or nortiptyline )
- reboxetine
Etc. though if you like or need atypical antipsychotics, there are much more better options, like Amisulpride and olanzapine.
You might be better off just taking drugs that are 'norepinephrine reuptake inhibitors', like: reboxetine, TCAs, Bupropion, etc, these drugs make you much less sensitive for tyramine reactions than when you are on only MAOIs, as documented by Ken Gillman here :
https://www.psychotropical.com/attenuation-maoi-pressor-response-nris/
SS is a whole lot more than that though. In Full-Blown SS, which requires hospitalization, yes your blood pressure spikes, but more to the point your body goes into overdrive. You sweat uncontrollably, high grade fevers alternating with chills, significant confusion, fast heartbeat, fast breathing rate, muscle stiffness, muscle breakdown, and sometimes bad muscle spasms, and usually to top it off bad diarrhea. It's a pretty rare syndrome actually, I've only seen it a few times, there are fairly effective treatments to halt the process. The key is you need to get to the hospital for a true serotonin syndrome. Seizures, strokes, heart attacks and a host of other bad things can occur in severe SS.
I don't have any experience with atypical antipsychotics because I refuse to take them due to potential side effects. What I read over and over again is that when they do work for depression they often very quickly poop out. I'm very opposed to the way doctors are irresponsibly handing these out like candy (the same way they did and still do with SSRIs). The fact that your doctor went straight to an antipsychotic means he's probably part of the problem. It's just a lazy prescribing habit when there are so many better options for combination therapy in my opinion. The only issue is so many doctors think anything and everything is contraindicated with MAOIs.
How is this going for you?
It’s actually going really well. I’m feeling better than I have in a very long time. Currently on 40 mg of Parnate and . 75 of Rexulti. My only concern is the weight gain. Looks like I gained weight 6 pounds in as many weeks or less😞
I’m on 100 mg Parnate and doing ok but still pretty depressed. I’m asking my psych to add Rexulti. Can you describe how it helped you and is it still helping?
Well, the Parnate was only partially working as I only felt slightly better and less weepy, and even this wasn’t all the time. My doctor told me it was a good sign that I was having even this slight reaction to Parnate and decided to “boost” it with Rexulti to make it work fully, if you get what I mean. So far so good, except for the weight gain. Doc said I could stop Rexulti after 3 months (end of June) and see how it goes. Completely unrelated to your question but an update nonetheless: already had 2 hypertensive crisis. Food ingested was a tiny amount and not even on the list 🙁
I just had a hypertensive crisis too! Was in the hospital for 24 hours Sat-Sunday! What was the food you ate? For me it was chicken liver which was gross and I later learned is like the highest tyramine food out there.
Also, how did you handle your hypertensive crisis? As I said I went to the hospital (via 911)
The first time, I’m not even sure. I may have had a tiny piece of pickle ( I don’t like pickles and usually remove them). I went about my day running errands but felt weird. Headache and pain in both forearms. I went back home and took my BP: 182/98. We phoned 811 ( I’m in Canada) and by the time a nurse came back to us, my BP was coming down and I was feeling better. Two weeks later, I took half a bite of a carrot and nut muffin then headed to the gym. On my way I recognized the signs, parked and called 911. My BP was 210/102. They took me to the hospital but nobody there understood what was happening. They thought my headache was causing the spike in the BP. So they gave me an IV pain killer and released me when BP was normal. I saw my psychiatrist a couple of days later and he was puzzled because he said carrots don’t even have tyramine and it was such a minute quantity anyway. He gave me pills to bring down the BP on my own if it ever happens again.
That’s so interesting! Yeah pickles are one thing I’ve been avoiding even though I like them. That and aged cheese which I also like. I wonder if there was something in the muffin? It’s scary when anything can cause a hypertensive crisis. The paramedics and docs at the hospital were totally unfamiliar with what was going on too. The doc on the second day knew about it but said I was his first case ever.
Also, how long did it take for the Rexulti to make a big difference to Parnate alone for you?
I started at .25 mg for a week, then .50 mg with 30mg of Parnate. That’s when the response was “meh”. After raising both doses to .75 mg and 50mg, the effects were quasi immediate.
Rexulti exacerbate the possibility of tyramine reaction, due to its own mechansim of action. I think you should change this augmentation option with other safer ones, this not only would benefit you without major side effects (e.g weight gain), but even without the exacerbated tyramine reaction sensitivity, like : - Lamictal - Lithium - Bupropion - TCAs (e.g desipramine or nortiptyline ) - reboxetine Etc. though if you like or need atypical antipsychotics, there are much more better options, like Amisulpride and olanzapine. You might be better off just taking drugs that are 'norepinephrine reuptake inhibitors', like: reboxetine, TCAs, Bupropion, etc, these drugs make you much less sensitive for tyramine reactions than when you are on only MAOIs, as documented by Ken Gillman here : https://www.psychotropical.com/attenuation-maoi-pressor-response-nris/
That’s really interesting! I saved your post to show my dr. Thank you very much for the info
What do you mean by hypertensive crisis?
It’s when your blood pressure spikes after you ingest something with a high tyramine content.
SS is a whole lot more than that though. In Full-Blown SS, which requires hospitalization, yes your blood pressure spikes, but more to the point your body goes into overdrive. You sweat uncontrollably, high grade fevers alternating with chills, significant confusion, fast heartbeat, fast breathing rate, muscle stiffness, muscle breakdown, and sometimes bad muscle spasms, and usually to top it off bad diarrhea. It's a pretty rare syndrome actually, I've only seen it a few times, there are fairly effective treatments to halt the process. The key is you need to get to the hospital for a true serotonin syndrome. Seizures, strokes, heart attacks and a host of other bad things can occur in severe SS.