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To Mark, Re: Marplan and weight gain?

Posted by GeorgeM on November 30, 1999, at 22:02:04

In reply to Marplan and weight gain?, posted by Mark on November 29, 1999, at 10:04:12

> Did Marplan work better for your social phobia George than Parnate or Nardil? Which of the three works the best, and which of them caused weight gain?

hi, mark. so far, i'd say nardil, as monotherapy, was the definitive winner in terms of treatment. however, at an effective dose (60 mg/day), i experienced 100% erectile dysfunction and anorgasmia. nardil weight gain started at about the third week. understand from some follow-on research that the weight gain is thought to be attributable both to an increase in carbohydrate craving as well as a decrease in metabolic rate.

in contrast, parnate was stimulating (i had insomnia the first several days - likely started a too high a dose). no weight gain on parnate - i actually lost about 7 lbs that i really couldn't afford to lose. parnate was only partially effective in treating my social phobia, even dosing up to 90 mg/day (well in excess of recommended 60 mg/day max). in fact, as monotherapy, parnate seem to be no better than placebo. only when augmented by low dose klonopin (2 mg/day) did i realized a combined benefit of both. klonopin 2 mg/day monotherapy is sub-therapeutic, at least for me. so, parnate has a definite benefit, it's just not to the degree of nardil. i'd say it's about 20-30% of what nardil gave me. parnate also caused an extremely dry mouth. i always had a water bottle or diet coke in my hand at work. also, i've been on and off parnate several times: i like the therapeutic benefit of nardil, but go off it when i can no longer stand the weight gain and sexual dysfunction; then, i start parnate, and eventually have gone off that after i lose the weight and can take the dry mouth and lack of efficacy. the last time i started parnate, my wife almost immediately recognized a slowing of my speech. not a slurring, which could indicate "serotonin syndrome." she likened it to an old '45' record being played on '33' album speed. that made me think of some things when i was originally on parnate, and i recall co-workers mentioning the slow pace of my voice mails. when not on parnate, i'm consider a fast talker. but, the last time must have been much more noticeable. sometimes psychotropic drugs may act differently on subsequent usage, or have prolonged continuous use.

as far as marplan, still a little early to tell. my feeling is it's about halfway between parnate and nardil, at least so far. i'll give the 80 mg/day dose another month or two before i make final judgment. no dry mouth or sexual problems, now, although i did have some delayed orgasm between weeks 2 and 4. seems to have disappeared. interesting . . . . also, no weight gain. in fact, i think i've lost about 2 lbs. if the efficacy at 80 mg/day gets close to the nardil, i'll consider this a social phobia "wonder drug." in the meantime, i also augment this with klonopin. i probably should also consider pindolol augmentation. well . . . at least there's something to talk to my doc about in a few months. however, most interesting and surprising of all is the effect upon my overall mood. it's almost as if nothing can get me irritated or annoyed - a very enviable trait from my perspective. on an even more subtle note, i haven't noticed the disinhibition of nardil and parnate. that is, there isn't the desire to speak up in all circumstances, such as when it's not socially or career-wise the smart thing to do.

hope this helps. george




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