Parnate Withdrawal and Detox

Parnate is a brand name of the antidepressant tranylcypromine. Tranylcypromine is an MAO (monoamine oxidase) inhibitor. Parnate is prescribed to treat atypical forms of depression, particularly ones that are resistant to other antidepressant medications. MAO inhibitors can also have a potent anxiolytic (anti-anxiety) effects for many patients by boosting the expression of GABA in the brain. Tranylcypromine’s primary mechanism of action is achieved by inhibiting the breakdown of various neurotransmitters in the brain and thereby increasing their effects.

Patients should not take Parnate if they have taken other antidepressants within the last 14 days. Medications that act on serotonin can compound the effects of the drug and result in serotonin syndrome. This is a serious medical condition that can lead to toxicity and psychosis. Tell your doctor if you have a history of cardiovascular or cerebrovascular disease. Patients who are pregnant or breastfeeding should also avoid using MAO inhibitors. Tranylcypromine passes through the placenta and umbilical cord. Exposure to Parnate in the womb can result in birth defects. Tranylcypromine also becomes present in breast milk during lactation.

Although considered non-addictive by the Federal Drug Administration, discontinuing use of Parnate can still trigger specific undesirable symptoms. Withdrawal symptoms from antidepressants are referred to by the medical community as discontinuation syndrome.

Tranylcypromine has fewer withdrawal symptoms when compared to most other types of antidepressants. However, symptoms can be severe when discontinuation is not gradual. These can include headache, malaise, anxiety, motor disturbances, and insomnia.

In general, normal treatment with tranylcypromine does not result in cravings for the drug upon cessation of use, except for at high doses well above what is commonly prescribed. Parnate can be stimulating for many patients, and taking larger doses can result in an amphetamine-like effect, including undesirable withdrawal symptoms similar to those experienced by amphetamine users. Such symptoms can be easily avoided by following the prescribed dose and steadily reducing doses over time.

The onset of withdrawal symptoms from tranylcypromine is slower compared to tricyclics and selective serotonin reuptake inhibitors (SSRIs). Maintenance doses of Parnate are low, and missing a dose usually will not trigger a sudden onset of discontinuation syndrome. Your doctor will gradually reduce the dose over a period of weeks, months, or a year-plus depending on how long you’ve been taking the drug.

If you accidentally miss a dose of tranylcypromine, take another dose as soon as you realize if it’s within a few hours of your normal dose time. If more time than this has elapsed, it’s best to wait until your next scheduled treatment to avoid spiking serotonin levels. Missing a dose of Parnate is not likely to trigger a rapid onset of discontinuation syndrome.

Discontinuation symptoms can be managed by a gradually reducing the dose over a period of weeks or months. Patients may still experience increased feelings of depression while transitioning off Parnate. Nausea, dizziness, and headache may also occur.

Discontinuation of antidepressants is different from those of recreational drugs because they do not result in cravings for the drug at normal doses. In fact, tricyclics are often used as an adjunct treatment for depression to individuals who are in recovery for addiction to other substances like opioids or alcohol.

While patients detox from tranylcypromine, it’s important to avoid taking other antidepressants for the first two weeks following the final dose of the drug. Enzymes that metabolize Parante need this time to return to normal. Patients should continue to follow MAOI diet protocol until enzyme production normalizes.

Foods and alcohol that contain tyramine can result in a dangerous hypertensive (high blood pressure) crisis when combined with tranylcypromine. Tyramine is produced during fermentation and is present in high quantities in aged cheeses, tofu, yeast extracts, and red wine. These foods often contain enough tyramine to rapidly increase blood pressure in patients taking Parnate.

Tyramine is metabolized by monoamine oxidase. When mixed with a monoamine oxidase inhibitor like Parnate, it can lead to an extensive release of norepinephrine and a resultant hypertensive crisis. Spoiled food should also be approached with caution since tyramine may be present following mild fermentation.

A small percentage of patients may end up abusing Parnate for its stimulating, amphetamine-like effects. For these patients, admission to an outpatient or inpatient drug treatment facility may be necessary. However, for individuals who take Parnate as prescribed, transitioning off it can be easily managed by gradually reducing doses under doctor supervision. Younger patients may experience increased thoughts of hopelessness or suicide and should be monitored closely.

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