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Re: Marplan success stories?

Posted by Scott L. Schofield on November 17, 1999, at 10:25:41

In reply to Re: Marplan success stories?, posted by Elizabeth on November 17, 1999, at 2:42:59

> > Unfortunately, I think the list of which drugs I haven't been on would be shorter.

> LOL. You and I have something in common, then.

Yeah. This sucks. (What does LOL mean?)

> > I was first diagnosed as unipolar by Fred Quitkin et al. at Columbia Presbyterian / New York Psychiatric in 1982. I was enrolled in their study comparing tricyclics versus MAO-inhibitors for the treatment of atypical depression.

> I know the study well. I take it you have atypical features?

Yes. Although when my depression did not remit satisfactorily, Dr. Quitkin used an interesting term: atypical reactive-type with endogenomorphic characteristics.

> What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.

Remain an admirer from afar.

> > I was a rapid-cycler at the time. It wasn't until 1992 that I was diagnosed as bipolar by the staff at the NIH. All of my manic episodes involved treatment with MAOIs. I have never experienced a spontaneous mania.

> Around here [Boston], I've been hearing that called "bipolar III." I have had antidepressant-induced mania as well, although it's not a consistent thing (it's only happened a couple times, and only once was it severe).

Each successive mania can be worse than the one previous. The damned thing seems to sink its claws deeper and deeper (kindling). Not only that, but the following depression(s) can be more resistant to treatment. I wish the doctors who treated me ten years ago knew this. Not that it's their fault, but they really f'd me big-time.

A few years ago, a contributor from posted a list of bipolar subtypes that he said was being considered for DSM-V. I believe there were five (possibly six) subtypes. One of them described the drug-induced-only mania. I think this was discussed as a possible type III as early as 1990. His list "bumped" it to a type IV. I should mention that a mania can also be precipitated upon discontinuation of an antidepressant. This has happened to me twice.

> The impression I've gotten is that tricyclics are the worst for inducing mania, especially mixed (i.e., dysphoric) mania (which happened to me on Effexor - it was associated with serotonin syndrome, though, which is a whole different can of worms).

Dangerous stuff. I never liked worms.

> > I remain in a state of severe depression without respite. If it weren't for the mild improvement afforded me by Lamictal, I doubt I would be able to write this post.

> I've heard some good things about Lamictal for depression (I took 500 mg for several months and never got any good out of it, alas).

> > It is only this past month that I requested of my doctor to give "mood-stablizers" a more central role in my treatment. Obviously, an antidepressant-centered approach has not worked. This approach seems to be the one chosen by the researchers at the NIH for treatment-resistant bipolar depression.

> Huh. I've always thought it was risky to throw antidepressants at a bipolar individual (including bipolar III).

Risk vs benefit. Bipolar depression is a mother. I'm lucky that MAOIs budge me at all. I'm not terribly optimistic.

> > Sometimes I get the feeling that there is a sort of mentality like "If you throw enough sh_t against the wall, some of it is bound to stick." I wish some of that sh_t would stick to me.

> I understand. I still have a sort of feeling of despair, like I can't quite reclaim my life.

I've been out of work and out of mainstream for nine years. I hate being on the public rolls. I'm not a lazy person.

> > The only remission I experienced was while taking a combination of desipramine and Parnate. It lasted for about six months before I became hypomanic, and then manic (mixed state, I guess). After getting control of the mania with Klonepin, the doctor decided not to go back to what worked. I've been f'd ever since. At least I learned that life *can* be good.

> Have you had this mood disorder all your life? Mine only really surfaced in adolescence.


> > Right now, I am taking Depakote, Lamictal, imipramine, and Marplan. I've been on Marplan for less than a week. Of course, I'm not looking for anything to happen for a few weeks yet. I think it takes about two weeks just to establish a steady-state degree of inhibition (not sure).

> MAO gets blocked pretty quickly; as with other antidepressants, the longer-term receptor changes are probably what makes them work. But anyway, I'm more curious about side effects (I know I respond to MAOIs).

> > What dosage are you to work up to?

> "As tolerated."

And you tolerate this?

> > What were the autonomic side-effects you suffered while taking Parnate?

> Spontaneous hypertensive episodes [not related to food-drug interactions].

Did this occur at the beginning or later on? I've read that it is not uncommon to see this at the beginning, but it disappears quickly (if you're still around to find out).

> > 40% REALLY sucks.

> It wasn't too bad was well distributed...


Get better.





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