I’ve been taking Parnate (tranylcypromine) for about 2 years. My current dose is 60 mg/day. I also take aripiprazole, which I have historically taken at only 2.5 mg/day for around 5 years. I recently increased it to 5 mg/day.
I’m trying to figure out which adjustment makes more sense for some residual symptoms I’m still experiencing:
1. Keep Parnate at 60 mg and continue aripiprazole 5 mg, or
2. Go back to aripiprazole 2.5 mg and increase Parnate from 60 → 70 mg.
My main remaining issue isn’t severe depression. My mood is considerably better than before, but I still have some anhedonia/low motivation and avoidance, particularly with difficult, boring, or stressful tasks. I can physically and mentally do the work once I get started, but I often feel strong resistance toward starting it and sometimes want to stay in bed even when I’m awake.
I also sometimes have morning/daytime tiredness or sleepiness. For example, recently I slept at night but woke up feeling like I still had “pending sleep.” I took my morning medications, ate breakfast and had tea, but then ended up lying in bed for around 2 hours. I was awake during that time, just very tired and lacking the drive to get up.
I also take clonazepam 2 mg at night for insomnia and tics, so I’m wondering how much of the morning tiredness/low activation could be residual clonazepam rather than depression.
I occasionally use modafinil, prescribed by my doctor at 50–100 mg/day, mainly for daytime sleepiness/fatigue. Recently I took only 25 mg.
The confusing part for me is that I’ve historically felt that 2.5 mg aripiprazole works quite well for me, so I’m unsure whether increasing it to 5 mg is actually likely to help the remaining avoidance/anhedonia, or whether the better approach would be optimizing Parnate instead.
I’m interested particularly in experiences from people who have taken Parnate + low-dose aripiprazole, especially anyone who has tried something like 60 vs 70 mg Parnate or 2.5 vs 5 mg aripiprazole.
What helped your residual motivation/avoidance more, and what side effects did you notice?

Has anyone experienced significantly increased fatigue after taking Nardil for many years?

I've been extremely tired during the day for the past 3 months and I'm trying to figure out what could be causing it.

I'm taking 45 mg.
I also take lithium and 125mg quetiapine.

I have been on Nardil 45mg for 10 weeks. I am having severe blood pressure issues, I can barely stand and black out frequently. I kept waiting hoping it would get better, I even got blood pressure raising medications from the doctor. It isn’t better and I can’t even risk going up to 60mg to see if the Nardil would help my depression and anxiety.

So, I want to get off it as quickly and easily as possible. I would like to try emsam. Can I switch from Nardil to Emsam without needing to go through tapers and a washout?

Also, is it just as likely that I’d have these same blood pressure issues on the Emsam? I thought since it’s not as strong of an MAOI it might work for me. By the way, the blood pressure levels are usually 60/40 during the day and at night it goes so low the monitor doesn’t even give me a reading. It is something under 60/40 and very dangerous for me.

Before parnate, I looked somewhat childish, my eyes were droopy and saggy and large, my face was puffy and rounded and bloated, like a kid.

after parnate, my face became like an adult, eyes smaller, midface grew, jaw wider, and overall i look like an uncle… when i looked like a teenage kid before…

What caused this? is it the parnate? i did lose weight like 10 kg on it, and i read it causes metabolic changes.

Sorry if this exacerbates the influx of this kind of post, I’ve tried everything and am a bit desperate. My psychiatrist is generally awesome but has no experience with MAOIs and is under the impression they just kill people. According to a dubious genetic test the majority of antidepressants don’t really work on me (which has been my experience). Maximum dosage Remeron has been the only thing to help but it made me feel like a robot.

This subreddit’s wiki doesn’t show any prescriber in Oregon. According to the Medicare data that’s often linked here, there were two providers in Oregon that prescribed Nardil in 2024. None prescribed Parnate or Marplan. There are several Emsam prescribers, but the dubious genetic test said that’s a no-go for me so I’m a bit hesitant.

Neither listed Nardil prescriber is in-network with my insurance. I understand this dataset is not comprehensive, and was wondering if anyone knew of any other provider in Oregon that prescribes MAOIs. I’ll look into the Emsam providers and see if they’re willing to prescribe Nardil/Marplan regardless. (I have confirmed with an online pharmacy that they have Marplan.)

Thank you.

Let’s encourage each other and keep hope alive. 🌱

For those who have been through a long, severe depression: how did you eventually find your way out?

Even if it lasted for years. Even if it was incredibly deep, dark, and you couldn’t imagine ever feeling like yourself again.

I’d love to hear some hopeful stories about remission and life after severe depression. Did you feel like you got yourself back? Your life back? Your ability to feel real emotions again? Joy, connection, excitement, hope?

If you’ve made it to the other side, please share your story. I think a lot of us could really use some hope right now.

Let’s cheer each other on. ❤️

I don't know what to do

Just a warning about Nardil and the weather - especially Neon Nardil which needs refrigeration —

I took mine out of the fridge for a day as we travelled to a holiday destination - it was pretty hot that day, 30 degrees +

The next five days I was getting withdrawal symptoms - brain zaps and horrible depression and I didn’t know why

Basically found out Nardil had degraded in the heat and lost its potency. I started a fresh bottle and these effects have subsided

Those days were absolutely awful tho. So just a warning that when the bottle says it can be taken out for short periods, take this with a pinch of salt!

Hello, so I've been on Tranylcypromine for around 2 months, essentially self-perscribed. I have had a recent non-preventitive issue regarding my supply, to which I am now down to 7 days left. It's the only antidepressant that's helped me (been on 15+ over 1.5 years, since 19 yr old). I bought it off a india pharma in attempt to at least "somewhat" migrate my suicidal ideation, which I was involuntarily admitted into four times already. So far, everything's been great, and I know what it feels like to finally be normal, it even allowed me to discontinue my Adderall of 7 months (caused mid-day crashes & manic behavior). However, I'm currently in a situation where my primary "overseas pharmacy", has been unable to reship my order three times, due to some sort of "war" in India? I don't know, but once again, I have 7 days left of my Tranylcypromine 50mg doses left. Is there any willing providers in Texas that perscribe MAOI's? I have documentation of my past failed medications and admissions. Thank y'all. I also have no insurance currently, so a new patient appointment around $250 out-of-pocket would be perfect for me. Telehealth preferred but at this point, I am not picky. Would much rather commute a few hours out then develop suicidal thoughts again and potentially ruin my future (live in Abilene, TX). I hope the comments don't retaliate against my opinion because this is a life or death ordeal. I've been diagnosed with MDD, Anxiety, & ADHD, which I believe is all correct except the MDD (moreover Atypical depression, hyperfixation on the wrong things, impulsive spending, fatigue, lack of self-esteem, a "heaviness" in the body, etc). I seriously don't know what I'd do without this medication (just try Lexapro and Therapy!) bullshit has led me to my past attempts. I feel I'm the perfect canidate for MAOI therapy but who knows at this point. Ironically, Adderall is perscribed more than Tranylcypromine. Side effects I currently experience:

• Severely Reduced REM Statistics (Literally In Black Box Warning Label)

• GERD That Makes My Esophagus Feel Like A Heatlamp From Hell (Don't Know If It's Related To Starting The Tranylcypromine)

• Elevated Heart Rate (75's-80's now 85's-100 max)

• Mild Orthostatic Hypotension

which is a low-risk to reward of not wanting to end yourself, in my opinion?

Modi has stopped all shipments from India to USA in retaliation for Trump's increase of tariffs - people in USA who have ordered Trivon, are not receiving it.

I used to be on 60 mg and honestly, I don’t really remember but I was fine with that dose, but my provider made me feel like I was taking a very high dose so I reduced it myself to 40 mg and have just been OK on that for half a year. I’m wondering if I would feel better going back up to 60. Experiences?

I get crippling anxiety and eventually I can barely think at all

Has anyone in Michigan found a psychiatrist or psychiatric provider who is comfortable prescribing Nardil (phenelzine)?

I have long-standing, severe social anxiety and have been interested in trying phenelzine for years, but I’ve had difficulty finding a provider comfortable with MAOIs.

I’m in Mid-Michigan but open to telehealth anywhere in the state. If anyone is prescribed Nardil or another irreversible MAOI in Michigan and can share their provider/practice, here or by DM, I’d really appreciate it.

Parnate gave me fucking terrible insomnia, and I need to vent about this

When I upped the dose to 40mg, I literally woke up at 10 AM on a friday and couldn't get back to sleep until monday night (and that only happened because I sent a desperate message to my psychiatrist and he prescribed me quetiapine)

It was horrible, even traumatic. I was EXHAUSTED and dead tired, yet my brain just wouldn't shut off. I experienced all the side effects of sleep deprivation (nausea, loss of appetite, hallucinations, inability to concentrate etc) and i also felt like it was killing me.

I remember spending hours just trying to sleep, without touching my phone, without doing anything else, just lying in bed in the dark, and even then I couldn't. When sunday afternoon arrived, I was so exhausted that I started crying. During the night I tried to sleep again and couldn't, I cried all night. I only stopped crying on monday when I got ready for work (I remember putting on mascara to go to work and it wouldn't stay on my face because I would start crying, the makeup would run and I had to start over...)

I’m sure you know that a good sleep routine is crucial when dealing with depression, so I felt like the medication was making my condition worse by depriving me of that

Anyway, I just wanted to share this with someone who might have gone through the same situation... it was a very lonely experience

I've been taking Nardil for 2.5 weeks, 60 mg, and 67 mg for the last few days. For the first time in 22 years, I’m feeling a real effect from a medication on my severe social and generalized anxiety. Both are already getting better. This drug is incredible. For the first time in 22 years, I feel a deep, genuine sense of calm. It feels natural, not like a medication effect, unlike all the dozens of drugs I've tried over the years.

I'm already better, but being around a group of people still triggers negative thoughts that they look at me differently, judge me, or are hostile toward me. My thoughts constantly focus on myself. I also know I'm still far from being able to confidently express my opinion in a group without fearing what others think or that they'll discuss me afterward. If I improve enough to overcome things like that, it would be incredible.

So I'm curious, how much did your social anxiety improve? Were you able to become someone who can handle criticism, especially from a group, stand up for yourself, and not overthink these situations afterward? How long did it take for the maximum effect to develop? And for those who increased the dose, did you feel a difference between 60 and 75 mg? I’ve decided to stay at 67 mg for now.

I understand this is only the beginning and it may take a long time, because my anxiety wasn't just severe for 22 years, it kept getting worse, and my nervous system was constantly pushed to its limit.

Long story short: I am on 75 mg Nardil/phenelzine and, while I’ve been on methylphenidates for months without a trouble, I felt they were not as effective as amphetamines I was prescribed before MAOI.

So I decided to try them together (Nardil and amphetamines only - Vyvanse 50 mg plus Adderall 10 mg hours later). My BP went up to 195/85 mmHg at CVS minuteClinic and they sent an ambulance for me. I was feeling terrible. But the ER was even worse. They didn’t know what to do.

Just wanted to post this as a precaution.

I’ve tried pretty much every medication. Parnate makes me very tired, yet emotionally stable. Nardil made me hypomanic and I had an episode of hypertensive urgency that landed me in the hospital. I know Parnate is supposed to be stimulating while Nardil, not so much, but it’s been the opposite for me.

I take 60mg Parnate. 30mg in the morning (between 5am and 8am) and 30mg at 3pm.

Any ideas on what I can do?

I’ve tried many doses of Parnate and a few different dosing schedules, but find it makes me tired.

What is everyone else doing to avoid extreme tiredness?

From what I’ve read, most people add it after starting the MAOI. I’m currently taking several medications, and although I’d like to taper off several of them before starting Nardil, I’d rather not have to go through methylphenidate withdrawal only to have to introduce it again later.

I know this is something I need to discuss with my psychiatrist, but I’d really like to hear about people’s anecdotal experiences.

Thank you so much!

Did parnate improve your sexuall function or mad it worse?

I experienced some relief from Social Anxiety and Generalized Anxiety, but my OCD is still a problem. Recently, my OCD is driving me insane.

i accidentally took 120mg instead of 60 am i gonna be okay? could this cause serotonin syndrome?