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Re: solutions for MAOI withdrawl? Marplan on backorder

Posted by Tfeld on July 8, 2018, at 14:00:52

In reply to Re: solutions for MAOI withdrawl? Marplan on backorder Tfeld, posted by porkpiehat on July 8, 2018, at 12:35:44

Hey there, thanks for your response. MAOIs are such complicated drugs; they interest the hell out of me, but nonetheless they are strange, mercurial, and far more unpredictable as so whether you'll respond, when and what dose, and what the result is going to look like., I get it about the detachment. Marplan (+ clonazepam and other adjuncts) really started to rock my socks off as the doc and I finally pushed me past my 40mg dose of many years (lithium reduction was essential; the synergy had me glued to the couch, inert, and feeling toxic if we tried to escalate before).... I started developing a sense of self and conversing with others with more ease and less self-criticism or reproach, but strangely as we topped out at 90mg despite my depression improving and the social anxiety going out the window, I found my abundant (especially while using) social interactions profoundly superficial and lacking in interest, follow-through, or depth. Perhaps it was the hypomania and or the 75mg desipramine I was on as well, which both, or the desipramine flavor of my hypomania, kept me content hitting shallow checkmarks on accomplishments without being able to dig deeper. "Yay I'm being social! Good enough, now back to my other goals" kinda thing... in past I would just be more comfortable in social withdrawal; this time I became comfortable being social insofar as I didn't really care about the relationships themselves anymore. Very self-centered, seemed to enhance that innate quality I have as an addict.

Now with just 30mg phenelzine I'm noticing much less of an avoidant quality and a sincere, perhaps strong desire to actually connect with others with far more interest in them than me. Lack of interest in things and others has been my biggest residual symptom for years and its decrease could represent less MAOI activity, no desipramine (it's a hyperactivity med after all), as well as, being back in recovery again, a genuine desire to stop being so self-centered. I'm looking for long-term relationships, the kind I find in 12-step programs that start right off where they left off and are based on unconditional love and lack of judgment. I found on Marplan + desipramine, despite being more comfortable, I had all these nonsensical walls up about whom I'd talk to and how deeply I'd open myself to experiencing the relationship with -- always a select few. Now I'm realizing how stupid it is; we're all just people... every one of us.. so why am I leaving so many people out of my life and keeping my circle small?

In that sense, despite some sluggishness/ "Nardil naps," I'm finding myself with more usable energy than I had before. Less caught up in my head, less anxious, and more free to explore my life. And I can relate with the phenomenon of half a cocktail being energizing -- I'm completely abstinent including from alcohol, but I find with Nardil and benzos (on 4mg Klonopin) that sometimes all it takes is a little *more* GABAergic activity to sedate *the anxiety*, allowing my energy to disinhibit and become restored. Weird how that happens. Too much benzo, tired; not enough benzo, tired!

And the withdrawal from parents/ family. This is a tricky one that I identify with a lot with past MAOI use. At least with Marplan, I'd become so hyperaware of the emotional issues in my life, much of which stem from early life and my parents' behavior, and much of which continues thru the present. It can become very difficult in this sense to want anything to do with them because it becomes so clear what's wrong that they just don't see and can't or won't change... that would absolutely fuel my drive to be independent, leave the house, and would usually wind me up on meth with the rest of the family now blaming me for everything and unwilling to work through the pain. Vicious, vicious cycle, so many domestic violence reports... it got extremely ugly this year.

I concur, MAOIs and meth use = not good. Part of what these psych meds for depression and anxiety do for us is make us less sensitive to the pain and more able to dismiss it, which can be good, but ya throw addictive drugs into the picture and it becomes that much easier to sweep the addiction-generated problems and pain right under the rug. Soon enough I begin to hate the world, see no purpose in humanity either, and there's so much sh*t under the rug I lose control of myself, fall down in apathy, lie there for months letting things get necrotic, until the rug is completely pulled out from under me by some jarring experience. To summarize, the apathy becomes severe and I am living for nothing but meth, have such a high tolerance from the MAOI potentiation that I'm barely feeling anything at all, and hypersomnia takes over my ability to function without hundreds of mgs keeping me half-awake. NOT fun and so glad that cycle has been broken...

The concern isn't so much the contraindications. At the risk of sounding stupidly and deathly cocky, I'd phrase it such that I seem to have pushed my brain to the limits so frequently and intensely that it's become accustomed to the traditional contraindications, with amphetamines at least. I know Nardil and Parnate can be completely diff. animals w/ respect to this issue, but I was using very high amounts of meth both when on Marplan 40mg + 175mg desipramine in past as well as the past year with Marplan 90mg and DMI 75mg, even at some point with some Wellbutrin in the mix. But MDMA, cocaine, others (not my thing anyway) I will not touch (I don't want to touch anything these days anyway); I know the risk is extremely high there. I'm not proud of being able to be on several grams of meth with a BP of 103/ 74 nearly every time read, but it's just been my experience.

The concern is more about the hypomanic detachment you alluded to. So we are taking things slow with the phenelzine and leaving out desipramine unless completely necessary... I don't want to become so high off my psych drugs that I turn my back on my life again. Next week we plan to double Desoxyn to 40mg as I was on 80mg before the hospital and seem to require a high dose and respond quite well to it without mania. My mind is just completely lost at this point and when I choose to function, I do so very well on Desoxyn. Functionality on crystal meth though, absolutely not.

Functionality has been difficult for me as a tough-to-treat bipolar. In the past I was on 0.625-10mg Zyprexa, 5-10mg Abilify, 900mg lithium + 100mg lamotrigine with the MAOI/ TCA/ sim and flourishing at work while nearly dead inside. I'm in the same boat -- how can you call is stabilization if the mood stabilizers are causing depressive symptoms? Now I take minimal, 7.5-10mg Abilify with 25mg Lamictal and 300mg lithium. Those 3, and sometimes a tad bid of Zyprexa, are all my system can handle these days. It's sad bc the BP meds would "force" me to function, and now it requires high amounts of discipline that compete with high dosages of antidepressants that I need for my sanity, and that beast called addiction. Less meds, more freedom and choices, but damn is it hard to make the right ones and stay on track. Nonetheless, I am happier in the past year than ever, and phenelzine seems to be creating a boredom not of depression but of a strong desire to fill the gaps in my day with activity rather than sleep. So provided this stays the same, once Desoxyn is tuned up again and I acclimate to whatever dose of Nardil, I'm jumping straight back into work. My life absolutely depends on it.

Phew that was a lot, but such is life, and I haven't posted since 2014 when I got on desipramine and life took off for me. I highly appreciate you reading and your conversation, and haven't a clue how to babblemail either lol... not sure if we can share emails on here but I'll try... ... and to Dr. Bob, sorry if that wasn't okay, just trying to connect.




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