I've been prescribed generic parnate. I gave treatment resistant depression. It was in back order and is now at the pharmacy. I am afraid to start it. Have been doing a deep dive on food restrictions and there is so much conflicting information out there. I feel like I owe it to myself to try it, and am also very fearful. Is anyone having success with MAOI therapy? Any tips? Experiences wirth sharing? Coping with dietary things?
Thank you! I've only been on this site for about a month and I really appreciate all of you! Your honesty, your feedback and support are valuable and very much appreciated!!! I wish we were all skipping down the path of sunshine and rainbows... and for now, sending each of you warmest wishes!!
Written by
Casivalentina
To view profiles and participate in discussions please or .
Hey there! This topic is really interesting to me, also, because I'm in the very same spot you are. Doc just brought up the MAOI route, and I'm skeptical and a little apprehensive because of it. If they're "the original antidepressants," and apparently no joke as far as effectiveness (if that's true), why were so many subsequent, new drugs needed as time went on? You aren't alone out there in this - feel free to hit me up if you do begin the therapy - I'd love to know what your thoughts are on it. Best wishes to you going forward,
hey Casivalentina and Beaujie —- so I have taken the generics of 2 MAOIs (Parnate and Nardil) for treatment resistant bipolar depression in the past.
***Obv I can only speak for myself and my experiences so please don’t take this as gospel or professional medical advice***
Being bipolar, I think that added a complication into the mix (along with the like 5 other meds I was on lol), so it triggered my mania.
I can say that it was the only class of antidepressants that I felt my mood lift- but again I wasn’t able to continue because that evolved into a manic episode.
What I would’ve done differently (if I had unipolar depression)- was definitely start at a low level and track my emotions daily- like all others it takes time to take effects.
Suggestions in terms of the whole side effects thing—
1- Food: I put a list on the fridge and a card to put in my wallet that had food stuff for if/when I was eating somewhere that food prep wasn’t in my control,
2- Interactions with Medications- since there are so many—- including prescription, otc, and even like supplements (if I remember correctly)— I just was really careful- always referring to it before trying anything new and making sure to let all medical providers I was on it.
3- Support Systems- I educated my family about my restrictions, not that they had to have the same ones but just a safety thing, another set of eyes to look out.
4- Other Medical Concerns- so I wasn’t on them long enough to do this part, but even though I don’t have any other medical concerns, I was going to get a med id bracelet.
One that said I was on MAOi and also had what I couldn’t have in terms of emergency medicine in case I was ever in a situation I couldn’t communicate it (I believe there is some medications that could be potentially used by emergency services— I want to say epinephrine but again, not entirely sure).
Anyway- I hope that helps a little
Good luck on you’re journey.
(The reason I tried 2 different MAOIs were to see if it was actually the medicine that triggered the mania or something else- it wasn’t clear at the time bc some other stuff went on at the same time and I really wanted it to work so I wanted to try again)
Thanks SO much for this insight. I don't want to hijack Casi's thread, so I'll just add a few thoughts here -
May I ask how many other classes of AD meds you took or tried, if any, before reaching the "hardcore" MAOI phase? My thought is that maybe you were being treated solely for BP prior to this?
You found journaling to be helpful. I always say I'm going to keep up with my emotions on paper, but my paranoia eventually reminds me this is just one more window into my inner-self that someone with malicious intentions can peer into in some alternate world, lol. I know it sounds nuts, but in the moment that fear is real enough to repel me from continuing. Something I hope I can overcome, because I can see how it could be extremely beneficial to finding patterns in progress.
My dox warned me, right away, about the precautions I'd have to take when it comes to certain foods. I don't really mind that so much right now because most of the foods on the list are not on my menu anyway.
I'v'e not thought about med interactions as of yet - but no doubt it would be broached with me before I would make the call to begin.
Luckily, I do have family members close to me who could act as that second set of eyes. Did you find the restrictions and precautions to become overbearing at any point, or like you couldn't or didn't want to continue forward with the treatment?
I have anaphylaxis to certain meds - this would definitely be something I think merits an additional line on it, lol.
May I ask what caused your cessation of the two MAOIs? Were you moving on to another option, or was it caused by all the restrictions, etc.? I wonder because I'm trying to gauge whether or not I think I could keep up with it all. Being that you gave two of them a chance, I'm thinking the bipolar mania was something they both led to?
If I'm gonna get back into the journaling my emotions, I guess I better get started because he's got me on the two-week "flush" period between any other ADs and beginning these. So, right now I'm not taking anything for MDD, which in itself is scary. So far, so good.
Thank you so much for taking this time. I know it has already helped me to gain your insights.
Hey— I just wanna let you know that I did see this and I will respond as soon as I can in greater detail- it’s kind of a lot and I’ll do the best I can.
In terms of other AD I’ve been on… SSRI, SNRI, Atypical, and Tricyclics. In total, I had tried about anywhere between 3-6 different meds in each category (except tricyclics- just one)
I’d also tried antipsychotics as an avenue to help elevate the depressive symptoms of bipolar m- not mania. I tried about maybe 4-6.
I’m always on at least one mood stabilizer to address potential manic symptoms. I was on lithium for a few years.
I’ve also had ECT and done 2 Ketamine cycles.
I’ve been diagnosed with bipolar for the past 20 years so this is all over that time span.
To clarify about my form of bipolar disorder, I have what’s called “mixed features”, meaning during an episode I can experience symptoms of both mania and depression. During my lifetime, severe depression has been the primary concern— I’ve only had 2 pure manic episodes, both proceeded by taking an MAOi.
I discontinued the MAOis because of the intensity and severity of the mania- the first time we didn’t know if that was the cause and it was very traumatic. The second time I tried was bc, like I previously mentioned, I wasn’t sure if it was the MAOI that caused it— when I tried another and I started to experience symptoms of mania I discontinued immediately.
MAOis work differently than other antidepressants, they target different neurotransmitters which is what I attribute to them being the only class of anti depressants that triggered my mania. I was also on other medications at the time which I’m sure contributed to the adverse reaction.
I am still working through the PTSD that resulted from the first manic episode I experienced.
Currently, in addition to psychotropics, I had VNS surgery in May 2024. It’s been turned on just over 7 months. I’ve been starting to see a definite stabilization in my mood- I wouldn’t say I have depressive symptoms anymore, I get sad- less intense and is always a reaction to something, not just free floating feeling like crap without a reason why.
I hope this was helpful- I’m not sure if I answered everything, tbh talking about my experience (as opposed to just general pointers) still causes a lot of anxiety for me.
I’m more than happy to discuss journaling in greater detail- I honestly used it more as a tracking tool of my emotions in general, like a scale of 1-10, recorded side effects, any triggers. It was Les like journaling and more like keeping track of data to see if I saw any progress (in terms of the medications effect on my moods)
I just got into actual journaling, like expressing my feelings not just data collection— I did not find it helpful before because I was so unstable, cognitively and emotionally- it just seemed to make things worse, like more ruminating over the things causing my depression.
Now that I’m more emotionally stable and am able to identify and challenge my cognitive distortions i find it helpful, if able to reflect on what’s going on in a more realistic and balanced way
First off, THANK YOU for going through all that. I have no doubt you took a risk to yourself in doing so, and I will make sure not to ask any more questions about your actual experiences.
I feel badly for hijacking this thread, but, being someone about to embark on the MAOi journey, I saw your thoughts here and had to ask more.
You covered everything I asked about
We're exploring also wether or not there could be a bipolar factor at play with me - so I wonder, but won't go into it with preconceived notions, of course, whether I would have the same kind of reaction you did. It's been a 20+ year journey for me, as well. Maybe that's part of why I feel so desperate.I'm going to research VNS and what this is all about - I had never heard of this before.
What you describe as "mixed features" reminds me of what I was diagnosed with at one point toward the beginning of my journey - "rapid-cycling" bipolar disorder. They explained that this means that during an episode I will experience multiple undulations of high and low within a short period of time, rather than just one or the other. I don't know if they were talking about the same thing, but it definitely sounds like it. It was devastating when I moved to NC and was then told during a hospital stay by different psychiatrists that "rapid-cycling" bipolar doesn't actually exist, and that it had to be one or the other. I don't know if it's like this with you, but with me I have always been far more emotionally and otherwise stable when I've known what was wrong with me - I guess I've kinda attached it to my sense of self and personal identity. Don't know what's going on again? Time to start searching again and feeling lost. Have you ever heard of the "rapid-cycling" version?
Maybe a mood stabilizer is something to explore again, if we're onto anything with bipolar. I'm so sorry to hear of the trauma you experienced, and are still working through, as a result of the MAOis. I can't imagine. At least now, and thanks to you, I'm going to have it in the back of my mind, going in. I wonder if VNS can be used in conjunction with an MAOI? My doc is going to have a lot of questions from me tomorrow, lol.
At risk of sounding frantic - I probably do - it's because I'm desperate for some relief. It doesn't even need to be a lot. Anything is welcome at this point. But this struck a nerve because right now my docs can't even agree on a set of diagnoses, and like I said, it's been over 20 years living with it all. I feel like crying even typing that.
I can't tell you how much your knowledge and experience means to me. THANK YOU. So much.
Thank you so much for sharing experience. Wow. It sounds like you went through a great deal. My doctor actually expressed that mania can be a potential side effect, which he thought might be beneficial in my case since I'm so depressed. Definitely doesn't sound like that's the case with you. And it makes me wonder if you're truly bipolar if the two manic episodes you describe were precipitated by the MAOI? Just a thought. Anyway, thank you again for sharing what was helpful for managing the restrictions. I appreciate you!!
Since I experience mania and depression simultaneously, however the MAOI works heightened the mania and decreased the depression—
Tbh- I always wanted to experience a “pure” manic episode… then I did- and it was a f*cking nightmare. It can be fun while it’s happening, but then it ends and you realize you’ve done some really embarrassing sh*t.
I’ve had episodes that were more manic than depressive in symptoms over the years, much more mild then the two I experienced but again, not the fun thing that it seems— impulse control is basically non existent and you don’t see consequences to anything.
Like everything, it’s on a spectrum so some people experience mild manageable symptoms— I’ve had that type of episode as well, i won’t lie, it’s a nice reprieve from depressive symptoms, but it’s short term and when the depression comes back its pretty devastating.
Not trying to scare you, I just want to give a more balanced perspective on mania, and obviously I can only give you my experiences, other people may feel differently.
Ok that may have come off a little preachy or potentially condescending—- totally not my intention.
I’ve had different diagnoses by different doctors over the years— always coming back to bipolar- but they changed them so much bc I wasn’t showing “textbook”bipolar symptoms so I’m alittle, ok a lot, sensitive when that subject comes up.
I also spent a lot of time trying to convince professionals that it was bipolar and was usually dismissed or they treated me like a kid- even knowing that I’m a licensed mental health provider.
Oh my gosh! Not at all! Please don't apologize. You did not come off preachy or condescending at all!! No worries. I'm a psych nurse practitioner, that's why I was speculating (not currently practicing) and I've seen drug induced mania in my patients and experienced it myself when on prednisone years ago.
Oh my gosh! That sounds really scary. I can only imagine. No wonder you're struggling with some PTSD as a result. I'm sorry you had to go through that. Bless your heart. Sigh
Thanks- but I guess if that never happened I wouldn’t have been so desperate I’d go the VNS route which has been awesome so far so having to do some trauma works a small price to pay
-I can’t tell you if you’d have the same experience if you also have bipolar disorder w an MAOI- what I can tell you is that after, when I was doing research on other people who had an experience like mine, there was only one study that mentioned it bc it’s so rare-
-I thought I a rapid cycler for a while, it’s not a diagnosis like bipolar one- it’s real, it’s just a symptom not a diagnosis— it maybe a specifier, like “mixed features” but I’m pretty sure it’s not and would prob fit under unspecified bipolar disorder
-mixed and rapid cycling are hard to distinguish from each other, it’s hard to tell if someone’s going back and forth between mania and depression or experiencing alittle of both simultaneously
-I totally understand feeling more stable when you know your diagnosis- but something I learned over the years is treat the symptoms, not the diagnosis. A diagnosis is very broad and no one fits it completely. While it may make us feel more comfortable “knowing”, if we were treated based solely on a diagnosis, we could be getting treated for symptoms we don’t have and not being treated for ones we do that don’t fit that particular diagnosis. I know after 20+ years, my mental illness became more of an identity than an illness- which did me a disservice when the symptoms started to go away because I’d been neglecting all the other aspects of my identity and now honestly feel kind of lost.
-VNS is a surgical implant that is attached to your left vagal nerve with leads (wires). An electrical current is transmitted from the implant to the vagal nerve and stimulates it (usually every 5 minutes for 30 seconds). The output is like a dose, and they increase it at regular intervals (every 2 weeks for the first 2 months). Then they adjust as needed. It takes at least 6 months and is used as adjunctive therapy- so you still take your meds.
*VNS is not currently covered under most insurances due to lack of research specific to its effect on mood disorders (it’s also used to control treatment non responsive seizure disorders— they found that it had a positive affect on mood which lead to seeing if it’s a viable treatment option for sever depression.
I’m participating in a 5 year clinical study to research VNS effectiveness with depression so I don’t have to pay for any of it- the device, surgery, any adjustments, etc— all I do is go in once a month for the first year and answer some questions, then they’ll have me come in less and less. It’s called the RECOVER study— it’s on the clinical study website as well and it gives more info if you’re interested.
Hi Casivalentina. Yes, I have a lot of experience with Parnate. I first took it about 50 years ago ( I am now 77) for about 4 or 5 years at 60mg/day, then stopped when it quit working (this happens with most anti-depressants and nobody seems to know why). I went back on about 3 years ago and got back up to 60mg/day, Am still on it.
I will mainly talk about ny current usage, since Parnate is viewd differently now than 50 years ago. The fears of its interactions are mostly overblown, and greatly exaggerated. The diet has been revised in the light of new findings and the fact that the old diet, where there were so many things restricted, was based on flawed studies and a few anecdotal cases. It does interact with foods containing tyramine to possibly raise your blood pressure, but now the only restrictions are on strongly aged or fermented stuff, like artisanal cheese and salami, gourmet soy sauce (the standard grocery and restauarant soy sauce is OK), certan red wines like Chianti, and fava beans and banana peels, stuff that most people don't eat anyway (again, they used to think all cheeses were forbidden, but I eat grocery store cheese and restaurant pizza with no problem; I guess the banana peel warning is for gorillas who are taking it 😂). Do a search on "New" or "Revised Parnate Diet".
The main interactions to worry about are with other medicines, mainly opiods and the stuff you find in some nasal sprays and pills, but also some other meds. Have your prescribing doctor check all the meds you are taking for interactions, and don't take any new drugs, even OTC, without checking for interactions.
Parnate was a life-save for me both times I started it; i had been on every other antidepressant on the market, and Parnate worked when nothing else did to get me out of a suicidal depresion (I also take a high dose of Ativan and 2400mg/day of gabapentin). It has the fewest side effects of any AD i have ever been on; the only one I really saw was drowsiness when first starting or when increasing the dose. It is starting to come back into favor now because the medical profession realizes it works and is not nearly as dangerous as was thought before. You still have to be watchful but the benefits far outweighh the risks I think. (I take the generic; I'm not sure if the brand-name is available anymore.) Do your research (look up Dr. Ken Gillman; he is considered the Internet expert on Parnate), talk to you your doctor, and make your decision. Hope this helped. Contact me again if you need more info.
Thank you so much for your response and sharing your experience with parnate. I chickened out and didn't pick it up again yesterday. (It's been ready since Monday). Your response is helping me feel more confident. I am planning on picking it up this morning!! I will give it a try. And also do the things that a pill can't do for me, like get out of bed when I'm not working. Turn off my tv, exercise, etc. . Those things that I know will also be helpful yet I find it difficult to follow through. Thank you again!!!
PS banana peels aren't something I'll miss... just getting! Who eats them in real life?? Cracks me up anytime I see that as a food restriction!
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Anyone else feel this way?
Anxiety Taking Over My Life
Hugs to my friends💝
For anyone struggling
Just venting on here to anyone willing to listen
