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Re: Hoping Nardil kicks in at 60 (wk3) - up to 90

Posted by Tfeld on July 8, 2018, at 8:21:10

In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on July 1, 2018, at 1:46:17

> Just an update I am on Zonegran now. Been on 100mg for the past 6days. I'll go up to 200 after 2 weeks. I think it's helping my moods over all and no bad side effects to report. My weight did drop the first couple of days but now seems to be ticking back. 100 in anlow dose though. Studies suggest 400 for signicant weight loss. I'll see how it goes.
> I've dialed back the met to 1500 which seems to have helped a bit w my moods over all as well.
> Doing pretty well but can't wait to titrated up in the zonegran. My daily scale check really affects my mood for the day.
> Jumped from 224 to 229 day before starting Zonegran. Then back to 224ish. 230 is the heaviest I've ever been and I've set that as my "get off Nardil line"..... fighting hard but very optimistic about zonegran so far. The fact it may help stability is amazing. I'll update though....still very early.

Hey Peter,

Been following the board (used to participate years back) and your recent posts since the atrocious Marplan shortage. I too was a Marplan user for 8 years, most of which at 40mg, and began to have a substantial response after adjusting adjunctive meds and bumping Marplan up to 90mg with a fantastic NYC doctor whom I found on Dr. Bob's very own psychopharm tips when I was once-again desperate in 2016 to find a doc willing to manage the MAOI/ TCA (desipramine)/ stimulant (Desoxyn) combo and who had the balls to push the envelope until I got better... and I did.

...then the Marplan shortage hit. At first briefly, when I hopped back on Parnate for the 4th time and hated its guts once again. Validus Pharma did all they could searching for bottles and sent me all they had as they promised to restart production, but as you know, that never came to fruition.

I have comorbid subst abuse issues, and around the same time I was running out of my last Marplan bottle was ripped off a train and was illegally (met no mental health hygiene law criteria or dx for mania -- Columbia Presbyterian and local hospitals usually shut the door on me) but nonetheless involuntarily hospitalized in a crapshoot in Queens, but it did break the cycle of addiction and I have enjoyed 16 days of relative freedom from that nasty grip since.

I made a stat appointment this past Tuesday and we ditched our former plan to initiate venlafaxine (one of the few I never went for out of 65 attempted meds, multiple trials including TMS (failed and/ or mania) and street ketamine (WORKS)) and titrate to a very high dosage (~650mg) in favor of giving Nardil a second try.

This is week 1 and I seem to be responding so far at a low dosage (30mg) + my other meds. I am experiencing considerably more tolerability issues (mainly sleepiness and brain fog) compared to the miraculously clean Marplan, but am also experiencing pronounced therapeutic benefits to my anxiety and avoidance that I still suffered from on isocarboxazid.

I only go by my doctor's scale which means I clock in only once a week, which I believe prevents harping on often anomalous day-to-day changes that are an inaccurate reflection of long-term changes. A suggestion -- what about checking once a week as well? I find it spares my self-esteem and allows me to focus more on dietary efforts without the barrage of daily numerical input to my self-critical thought processes -- after all, the prefrontal cortex can only hold so much info at once (be it executing motivational efforts or ruminative schemata) before it begins to work less efficiently towards achievement of goals. I am actually finding that, along with the hospital routine still lingering, the phenelzine seems to be helping my appetite and sticking to not eating between meals.

Speaking of the PFC, next week the doc and I plan to focus on patching up what's left of my noggin after nearly a year of neurotoxic subst use and the hospital stripping me of most meds including ADHD Tx -- from 80mg Desoxyn + 75mg desipramine (reevaluating its utility and staying off for now) to discharged on 5mg methylphenidate. Ugh.

Currently taking:

phenelzine 30mg (formerly ISO 90mg; no desipramine)
Desoxyn 20mg (formerly 80mg)
pramipexole IR 1.25mg
clonazepam 4mg
aripiprazole 7.5mg
lithium carb 300mg
lamotrigine 25mg

and no more Deplin 7.5mg -- can no longer afford since 26 now and dropped from parents' PPO. I also take Synthroid 50mcg from past lithium complications and Truvada for PrEP.

But enough of me -- your persistence and patience has been an inspiration to me and has encouraged me not to give up on MAOIs, which I truly need. Marplan users are indeed few and far between but I am sure there are numerous nonmembers who have been following along for guidance in the aftermath of a company's once compassionate return of this uniquely useful and tolerable drug to the market to an utterly stubborn cling to their soon-expiring patent in lieu of releasing the damn proprietary crap so a different competent company can restore us to sanity -- Validus deserves a huge slap on the wrist by the FDA, but unfortunately, especially as MAOI users, that's just not how this country works.

Anyway, keep at it and NEVER give up. My pdoc promised me early on he would never stop trying for me, and I promised him the same. I'd suggest looking into an augmentation strategy before ditching Nardil and taking it slow -- many online are keen on jumping to 90mg as quickly as possible. Given my low-dosage response so far, and speaking as a recovering addict, tolerance is WAY overrated and can destroy what simply requires patience and creativity.

Lastly, my pdoc looked into things before ditching Marplan and found an American source who can import ISO from the UK. At my dosage it would require ~$1800/mo (although many insurances will cover importation, I simply doubt my Medicaid would). If you've got the income or insurance allowance and would like more info on that, send me a message and I'll try to find the info for you.

Good luck with Zonegran and congratulations on its contribution to your stability.





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