Posted by tom2228 on April 4, 2014, at 11:32:01
In reply to Re: Sorry Scott » tom2228, posted by SLS on April 3, 2014, at 5:56:06
> > Sorry Scott, I hope I wasn't offensive, too personal, or projecting too much.
>
> Don't be silly. I haven't been posting that often recently. Not replying to your kind and carefully written post was an oversight on my part. Your knowledge and insights are impressive, and very much welcomed.Thank you :) I actually want to be a psychiatrist if I can get past my own mental illness enough to get to that point. And okay, I'm glad I didn't make you question your sanity as I have been with this "wash out" bulls**t.
>
> > I am feeling really off lately since going off Marplan.
>
> That's understandable. I hope things don't drop off too much more for you.
>
> > It's been only 2 days on 25mg nortriptyline but I need my MAOI!! The doc will have me up to 75mg by the time I see her Monday but my social issues have become terrible and I feel I am drifting away from how I know, see, and relate to myself. The world I know seems to be shriveling up and dying.
>
> I understand completely. Unfortunately, this is something that I have experienced too many times myself. You describe it very well.
>
> > I am starting back on 10mg of Marplan tmrw morning and have enough to continue with that for 8 months, 4 at 20mg.
>
> Shouldn't you be using a minimum of 40 mg/day of Marplan, even with a TCA?
>
> Most of the literature extant regarding the combination of TCA with MAOI was written before the advent of Prozac and the SSRIs. Here is one from 1995 that you might be able to use a leverage:
>
> ---------------------------------------------
>
> http://www.ncbi.nlm.nih.gov/pubmed/7560546
>
> J Affect Disord. 1995 Jun 8;34(3):187-92.
> A 3-year follow-up of a group of treatment-resistant depressed patients with a MAOI/tricyclic combination.
> Berlanga C1, Ortega-Soto HA.
> Author information
> Abstract
>
> Treatment-resistant depression is a clinical complication that not infrequently affects a certain number of patients. Within the treatment strategies proposed for this condition, the association of a MAO inhibitor (MAOI) with a tricyclic antidepressant has gained reputation both for its unusual efficacy, as for its potential toxicity. However, when cautions are taken, it may be safely administered. Most reports on this combination have been carried in nonresistant patients and, when resistant patients are included, only the acute phase of the treatment is reported. In this study, a group of well-defined resistant patients received an open trial with the association of isocarboxazide and amitryptiline (n = 25). Those who responded were followed during the next 3 years (n = 12) and every 6 months an attempt was made to discontinue the MAOI and continue only with amitryptiline. At the end of the study, 4 patients maintained response with single medication, 6 still required both drugs and 2 relapsed. No clinical differences were apparent between the outcome groups, except that those who maintained their response only with the 2 combined drugs had more previous depressive episodes than the others. The isocarboxazide/amitryptiline combination may be a good treatment option for at least some forms of resistant depression. The safety of this treatment modality is confirmed, even when given for long periods of time. The study also suggest that there are no clinical characteristics in resistant depression that may predict the treatment outcome but, perhaps in some patients, a combined treatment is required to obtain a broader biochemical effect that could convert them from nonresponders to responders.
>
> PMID:
> 7560546
> [PubMed - indexed for MEDLINE]
>
> -------------------------------------------------------
>
>
> - ScottI *should* be on more Marplan, in my opinion, but my new doctor is conserative (old one went on surprise leave) is not okay with the TCA+ MAOI combo.. or the MAOI + stimulant which I've been on nearly 4 years. Even if the plan was to say on just Marplan and/or increase it, she was going to balance out her worries by decreasing Desoxyn to make it "safer" somehow. *ss-backwards if you ask me. Her goal was to get me off one of them so there was no formal contraindication.
So I chose to wash out from Marplan so she wouldn't mess with my ADHD meds, and was willing to give notriptyline monotherapy a shot until the benefits of the MAOI started disappearing. Now I have added back 10mg Marplan and today 20mg in desperation.
I have enough Marplan to continue like this for about 4 months then I'm screwed, unless I can fill Marplan at separate pharmacies without them calling the doc about the contraindication.
In the mean time waiting for old doc to come back, and trying to find someone better. But as far as finding a doc okay with MAOI + TCA + stim? I don't even know where to start.
This is a tough game I am trying to play. For me it's not about returning to a life a I had but more so relieving the depression so I can find what happiness is an create something that will sustain it. That's a tough biochemical task.
And thank you for the study, I brought in a lot of literature to the first appointment but she wasn't phased.
poster:tom2228
thread:1063351
URL: http://www.dr-bob.org/babble/20140328/msgs/1063655.html