![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 45. This is the beginning of the thread.
Posted by Elizabeth on October 14, 1999, at 1:36:15
I decided to take the plunge and find an antidepressant that won't muck with my sleep, so yesterday I went down to 20mg of Parnate with the intention to get down to zero in the next few days. I'm not sure what I'm going to do afterwards - my pdoc absolutely does not want me quitting antidepressants altogether, and I'm very much inclined to agree with him. The things we thought of are:
-Marplan
-nortriptyline (and possibly add Marplan after starting the nortrip.)
-Remeron (starting on a high dose to (hopefully) minimize side effects)Might also add Ritalin or Dexedrine if it seems warranted.
Does anyone have any thoughts/alternative ideas? I pretty much know the side effects (though I'm fuzzy on what to expect from Marplan since I don't know many people who've taken it). My pdoc says that he prefers the MAOI or MAOI-tricyclic idea because Remeron has been very hit-or-miss in his experience.
I'm pretty nervous, but I really *have* to start getting some decent sleep. [2 words: organic chemistry]
Posted by JohnL on October 14, 1999, at 3:18:57
In reply to dropping Parnate, posted by Elizabeth on October 14, 1999, at 1:36:15
Hi Elizabeth. Just wanted to comment that I favor your pdoc's preference of MAOI+TCA. I think Remeron is fabulous for sleep, but kind of spotty as an antidepressant. Better when used an an adjunct to something else I think.
I was wondering though why your current Parnate must be stopped? Other than sleep, are you happy with it? I just get real hesitant about starting from scratch. Would working with the Parnate be a consideration? I don'tknow, I'm just wondering.
For example... Nortriptyline or Remeron, for me, produce good sleep. I've even broken a Remeron tab into tiny chunks (perhaps 3mg) and found them to be just as sedating as 7.5mg or 15mg. I would think that would be safe with an MAOI, especially with your knowledge and cautious approach. Or, the same with Nortriptyline. I've done this. The smallest dose is a 10mg capsule. I've emptied the contents of a capsule and mixed the desired amount in a small glass of water. It is completely tasteless and the smallest dose can be customized to one's liking. Here too I would think there is a real possibility of cautiously adding a sedating agent with the smallest of doses to start with.
I'm sure you're already aware of these things I mention. But I did want to comment in case there is anything that might be found helpful. Wishing you a good night's sleep soon! :) John
Posted by Annie on October 14, 1999, at 17:22:23
In reply to dropping Parnate, posted by Elizabeth on October 14, 1999, at 1:36:15
Elizabeth,
There is some information from former Marplan users in the last archive. My post was only on the BB for about 15 minutes before being archived, so it's no wonder you missed it. I am now on Neurontin monotherapybut other options mentioned were MAOI with Dexetrine and Wellbutrin with lithium.Good luck. Annie> I decided to take the plunge and find an antidepressant that won't muck with my sleep, so yesterday I went down to 20mg of Parnate with the intention to get down to zero in the next few days. I'm not sure what I'm going to do afterwards - my pdoc absolutely does not want me quitting antidepressants altogether, and I'm very much inclined to agree with him. The things we thought of are:
>
> -Marplan
> -nortriptyline (and possibly add Marplan after starting the nortrip.)
> -Remeron (starting on a high dose to (hopefully) minimize side effects)
>
> Might also add Ritalin or Dexedrine if it seems warranted.
>
> Does anyone have any thoughts/alternative ideas? I pretty much know the side effects (though I'm fuzzy on what to expect from Marplan since I don't know many people who've taken it). My pdoc says that he prefers the MAOI or MAOI-tricyclic idea because Remeron has been very hit-or-miss in his experience.
>
> I'm pretty nervous, but I really *have* to start getting some decent sleep. [2 words: organic chemistry]
Posted by kjm on October 14, 1999, at 21:54:28
In reply to Re: dropping Parnate, posted by Annie on October 14, 1999, at 17:22:23
Regarding sleep disturbances, I understand that
the antidepressant Nefazodone (Serzone) 400-600mgs
is pretty good for preserving the normal stages
of sleep. Also, Trazodone -
which I have seen added at bedtime (25-100mg)
to regular SSRIs, which can be activating.
Alternatively, one can try a sleeping pill
like Imovane (Zopiclone) that also is suposed
to preserve normal sleep architecture.good luck
kjm
Posted by anita on October 15, 1999, at 17:37:00
In reply to dropping Parnate, posted by Elizabeth on October 14, 1999, at 1:36:15
Hey Elizabeth,
Watch out for Parnate withdrawal. Mine was terrible even tho I went down slowly, tho the lithium may protect you from that. IMHO I wouldn't wait more than the required time to start another AD.
For me, Remeron helped sleep. In fact, I took it for sleep. Seems to be worth a shot for depression, tho there's that weight gain problem (same with Marplan). Personally nortriptyline did nothing for me except give me dry mouth -- did any of the other tricyclics help you?
take care,
anita> I decided to take the plunge and find an antidepressant that won't muck with my sleep, so yesterday I went down to 20mg of Parnate with the intention to get down to zero in the next few days. I'm not sure what I'm going to do afterwards - my pdoc absolutely does not want me quitting antidepressants altogether, and I'm very much inclined to agree with him. The things we thought of are:
>
> -Marplan
> -nortriptyline (and possibly add Marplan after starting the nortrip.)
> -Remeron (starting on a high dose to (hopefully) minimize side effects)
>
> Might also add Ritalin or Dexedrine if it seems warranted.
>
> Does anyone have any thoughts/alternative ideas? I pretty much know the side effects (though I'm fuzzy on what to expect from Marplan since I don't know many people who've taken it). My pdoc says that he prefers the MAOI or MAOI-tricyclic idea because Remeron has been very hit-or-miss in his experience.
>
> I'm pretty nervous, but I really *have* to start getting some decent sleep. [2 words: organic chemistry]
Posted by Adam on October 15, 1999, at 18:29:47
In reply to dropping Parnate, posted by Elizabeth on October 14, 1999, at 1:36:15
Hey, Elizabeth,
Funny you should want to sleep for O-chem. When I took it (which seems like an age ago), I used to wish at three in the morning
that there were more hours in the day (I was a double major, just to make my life more difficult than it already was.) I think if
I had had selegiline back then, I would have been in heaven.Anyway, is there nothing you can take in addition to parnate to get some sleep when you need it? I guess since you're already on
three of four meds you probably want to avoid unfettered polypharmacy.I don't know if we are in any way similar, but what I know of myself is that after trying numerous meds an MAOI is about the only
thing that has worked for me. Remeron was one thing I tried, and while I slept like a baby, it made me feel drowsy when I didn't
want to be, and as for its supposed anxiolytic effects, I more or less atrributed them to the fact I was in what often felt like
an antihistamine fog. As an antidepressant, I think it did attenuate my dysphoria to some extent, but it had nowhere near the mood
elevating effects that selegiline has had. I've heard that parnate is perhaps the most mood-elevating AD out there. Are you sure
you want to kiss that goodbye?I say this with the utmost respect for you and your knowledge about ADs and psychopharmacology, which eclipses mine completely. I
guess I just hope you do OK, and, well, I can't really give Remeron high marks as an AD when I compare it to an MAOI. As always,
though, your milage may vary.Best of luck with whatever decision you make! I'm keeping my fingers crossed.
> I decided to take the plunge and find an antidepressant that won't muck with my sleep, so yesterday I went down to 20mg of Parnate with the intention to get down to zero in the next few days. I'm not sure what I'm going to do afterwards - my pdoc absolutely does not want me quitting antidepressants altogether, and I'm very much inclined to agree with him. The things we thought of are:
>
> -Marplan
> -nortriptyline (and possibly add Marplan after starting the nortrip.)
> -Remeron (starting on a high dose to (hopefully) minimize side effects)
>
> Might also add Ritalin or Dexedrine if it seems warranted.
>
> Does anyone have any thoughts/alternative ideas? I pretty much know the side effects (though I'm fuzzy on what to expect from Marplan since I don't know many people who've taken it). My pdoc says that he prefers the MAOI or MAOI-tricyclic idea because Remeron has been very hit-or-miss in his experience.
>
> I'm pretty nervous, but I really *have* to start getting some decent sleep. [2 words: organic chemistry]
Posted by Elizabeth on October 15, 1999, at 20:12:27
In reply to Re: dropping Parnate, posted by Adam on October 15, 1999, at 18:29:47
> Funny you should want to sleep for O-chem. When I took it (which seems like an age ago), I used to wish at three in the morning
> that there were more hours in the day (I was a double major, just to make my life more difficult than it already was.) I think if
> I had had selegiline back then, I would have been in heaven.I believe the sleep loss may be mucking with my memory and attention. I had an exam yesterday and it sucked quite a lot. I could handle the work load if only I were able to do a decent job. Part of it is anxiety, but experience tells me that anxiety is also worsened by sleep deprivation.
I slept less than normal on Nardil, but it was regular at least, and it was enough to get by on (I seemed to need less sleep, though I wasn't manic). But this is just ridiculous!
> Anyway, is there nothing you can take in addition to parnate to get some sleep when you need it? I guess since you're already on
> three of four meds you probably want to avoid unfettered polypharmacy.Are you kidding? "Polypharmacy" is my middle name. :-) Modafinil was just making things worse, so I stopped taking that; the only things I take on a daily basis now are Parnate (tapering off), lithium, and a Ca/Mg/K supplement. Yeah, I've tried an awful lot of sleep aids. Ambien works somewhat but it doesn't last long enough.
> I don't know if we are in any way similar, but what I know of myself is that after trying numerous meds an MAOI is about the only
> thing that has worked for me.After talking to my doc, I think I'm going to do as JohnL suggests and go with the TCA/MAOI combo. I've never had an adequate trial of a tricyclic. I'm hoping to use sneaky tricks to avert the side effects this time. (Desipramine gave me jitters, BTW.) If Marplan turns out to be a problem, I may drop it and substitute low-dose Parnate.
>Remeron was one thing I tried, and while I slept like a baby, it made me feel drowsy when I didn't
> want to be, and as for its supposed anxiolytic effects, I more or less atrributed them to the fact I was in what often felt like
> an antihistamine fog.Not too surprising! My thought is that it would be worth a try, but given that it's rather unpredictable, the tricyclic-MAOI combo might be preferable.
>As an antidepressant, I think it did attenuate my dysphoria to some extent, but it had nowhere near the mood
> elevating effects that selegiline has had. I've heard that parnate is perhaps the most mood-elevating AD out there. Are you sure
> you want to kiss that goodbye?It's not like I can't ever go back on it! But yes -- if I can't function adequately, it's not worth it to me.
Thanks...take it easy.
Posted by Elizabeth on October 15, 1999, at 20:28:07
In reply to Re: dropping Parnate, posted by anita on October 15, 1999, at 17:37:00
> Watch out for Parnate withdrawal. Mine was terrible even tho I went down slowly, tho the lithium may protect you from that. IMHO I wouldn't wait more than the required time to start another AD.
Hi Anita. I'm all too familiar with MAOI withdrawal symptoms. (Everyone, for a description, look under "amphetamine withdrawal" in DSM-IV.) I have this elaborate and diabolical plan for avoiding/minimizing them. (Remember the scene in _Trainspotting_ in which Mark first tries to quit? It's nothing at all like that.)
> For me, Remeron helped sleep. In fact, I took it for sleep. Seems to be worth a shot for depression, tho there's that weight gain problem (same with Marplan). Personally nortriptyline did nothing for me except give me dry mouth -- did any of the other tricyclics help you?
(Have you ever taken Marplan?)
I don't have atypical depression (instead I get "melancholic features") but have never taken a tricyclic long enough to find out if they would work. The side effects always got to me.
Posted by Elizabeth on October 15, 1999, at 20:31:07
In reply to Re: dropping Parnate because of insomnia, posted by kjm on October 14, 1999, at 21:54:28
Hi kjm. Serzone and trazodone are good suggestions (probably what I would suggest in fact ), but neither of them is sedating for me. (I have had good trials of most nontricyclic antidepressants.) Zopiclone isn't available where I live, but I do sometimes take zolpidem (somewhat related). It doesn't last long enough to be much help.
Posted by Elizabeth on October 16, 1999, at 19:23:59
In reply to dropping Parnate, posted by Elizabeth on October 14, 1999, at 1:36:15
I'm now down to 10mg of Parnate. I haven't noticed any withdrawal symptoms. My plan is to increase the lithium to 900mg and if necessary use buprenorphine to get through the washout period. If I do decide to add Marplan (I'm not sure about this part yet), I will use pindolol to accelerate its onset.
Wish me luck.
Posted by Lynne on October 16, 1999, at 21:52:28
In reply to Re: dropping Parnate, posted by Adam on October 15, 1999, at 18:29:47
I also had to stop using Parnate because of my blood pressure being too low. I then tried Marplan and it made me too tired. It seemed to be a smoother drug than Parnate. I am now using Selegiline.
Adam, Could you tell me how long it took for you to notice the AD effect and also what doseage of Selegiline you are on.
Thanks, Lynne
Posted by JohnL on October 17, 1999, at 2:53:19
In reply to Re: dropping Parnate (update), posted by Elizabeth on October 16, 1999, at 19:23:59
> I'm now down to 10mg of Parnate. I haven't noticed any withdrawal symptoms. My plan is to increase the lithium to 900mg and if necessary use buprenorphine to get through the washout period. If I do decide to add Marplan (I'm not sure about this part yet), I will use pindolol to accelerate its onset.
>
> Wish me luck.Sounds like you've made up your mind. Go for it! BEST WISHES! :)
Posted by Elizabeth on October 17, 1999, at 17:12:42
In reply to Re: dropping Parnate, posted by Annie on October 14, 1999, at 17:22:23
> There is some information from former Marplan users in the last archive.
Annie, I can't seem to find this. Could you tell me what subject/thread title it's listed under? Thanks!
Posted by anita on October 17, 1999, at 17:16:49
In reply to Re: Elizabeth, posted by JohnL on October 17, 1999, at 2:53:19
Well good luck Elizabeth! Just some comments while I'm in a writing mood: I didn't experience any Parnate withdrawal until 2 days after I was off it completely. I'd get a supply of benzos for it too ;-). One thing I noticed about TCAs is that while the dry mouth was horrible at first it did get better, and when I combined an SSRI with a low-dose tricyclic I actually had no side effect, for what that's worth.
How long are you waiting after you stop Parnate to start Marplan or whatever? I did fine with only 10 days. BTW, did you find lithium to help with irritability? BTW, I haven't tried Marplan yet, scared of weight gain.
take care,
anita> > I'm now down to 10mg of Parnate. I haven't noticed any withdrawal symptoms. My plan is to increase the lithium to 900mg and if necessary use buprenorphine to get through the washout period. If I do decide to add Marplan (I'm not sure about this part yet), I will use pindolol to accelerate its onset.
> >
> > Wish me luck.
>
Posted by Annie on October 17, 1999, at 20:54:05
In reply to Marplan -- Annie, posted by Elizabeth on October 17, 1999, at 17:12:42
> > There is some information from former Marplan users in the last archive.
>
> Annie, I can't seem to find this. Could you tell me what subject/thread title it's listed under? Thanks!Elizabeth,
I'm sorry. I must have had a temporal lapse. The posts are found in the September 14 archive. The first thread is dated 9/26 - "Looking for the Marplan users". The other is dated 9/27 - Anyone switching from Nardil to Marplan". Sorry for the confusion. If you have any other questions about Marplan after reading the posts, I'd be glad to answer them.
Annie
Posted by Elizabeth on October 17, 1999, at 21:16:34
In reply to Re: Elizabeth, posted by anita on October 17, 1999, at 17:16:49
> Well good luck Elizabeth! Just some comments while I'm in a writing mood: I didn't experience any Parnate withdrawal until 2 days after I was off it completely. I'd get a supply of benzos for it too ;-).
I have a big bottle of 2mg Xanax, but actually I was going to use buprenorphine (they're not compatible). I think I'll be okay.
>One thing I noticed about TCAs is that while the dry mouth was horrible at first it did get better, and when I combined an SSRI with a low-dose tricyclic I actually had no side effect, for what that's worth.
MAOIs and amphetamines give me dry mouth also (presumably a sympathomimetic thing). I did the Prozac/desipramine thing briefly but got pretty jittery and had to drop the dmi.
Constipation is the thing I'm worrying about, not dry mouth. I get away with using Buprenex occasionally by adding
> How long are you waiting after you stop Parnate to start Marplan or whatever? I did fine with only 10 days. BTW, did you find lithium to help with irritability? BTW, I haven't tried Marplan yet, scared of weight gain.
10 days is what the manufacturer recommends; my research suggests 7 is fine.
I don't think the mechanisms of weight gain have been well elucidated; also, isocarboxazid is the least-studied of the three remaining "classic" MAOIs. Therefore, there doesn't seem to be much information about weight gain with Marplan. I think the best bet is to ask around (see if you can find some docs who have experience using it).
> take care,
> anitayou too,
-elizabeth
Posted by Adam on October 18, 1999, at 9:38:44
In reply to Re: dropping Parnate& question for Adam, posted by Lynne on October 16, 1999, at 21:52:28
Hi, Lynne,
Unfortunately, it is difficult to answer both of your questions because of the manner in which I have gone about taking selegiline.
I am currently enrolled in a study being done at McLean hospital in Belmont, MA (and there are other such studies being done in other
parts of the country) where selegiline HCl is being delivered transdermally (via a "patch") rather than orally. This mode of delivery
has a few important implications:
-Because it avoids first-pass metabolism, a much lower dose of selegiline per patch is needed to achieve a therapeutic blood level
than would be needed in oral administration.
-The metabolite profile in transdermal delivery differs from that of oral delivery. Less L-amphetamine and L-methamphetamine seem to
be produced.
-Anecdotally, the response to selegeline delivered transdermally can be extremely rapid compared to other ADs taken orally. My doctors
have seen a full response in less than two weeks. Why this is I have no idea, and it hasn't been explained to me.
-Of course, no dietary restrictions.Now, the study began with an eight week long double-blind phase where the patient might get a) nothing, b) 10mg/patch or c) 20mg/patch
of selegiline. During this period, I didn't experience much relief from depression, though I did notice some benefit after about six
weeks, and also I slept far less than I did before on Remeron. But I really have no idea if I was on anything at that point or not.
Once the blinded phase was over I began the open-label phase where I knew I was getting 20mg/patch. The response I experienced was
dramatic. In about two to three days I knew something was up. I spent about a week after that being "hyper-Adam" which wasn't all bad
except my friends seemed a bit confused and I slept about four hours a night, max. I've since settled down a bit, but the improvement
in mood is still there. I sure hope it lasts.Anyway, it is possible I was not on anything to begin with, and just had a super-robust response as soon as I got on the drug. My
guess, however (and this is the merest guess) is that I was on a low dose patch, was very slowly responding, and went into high
gear as soon as I got on the elevated dose. This just seems most plausible to me. I can't rule out the placebo effect even at
this stage, but my response was so beyond what I expected, I find this unlikely.What all of this means for oral administration of selegiline I'm not certain. What I do know is that...
-It takes longer to respond to oral selegiline, on average. Expect the usual 4-6 week time frame for an AD trial.
-You might have to get up to 50mg, 60mg, or even more selegiline orally to experience a good antidepressant response. Since
selegiline only comes in 5mg tablets max., you'll be popping a lot of pills.
-Some of the more annoying side effects of selegiline may be more pronounced when it is administered orally, due to the
differences in metabolism.All of this has left me in a bit of a quandry: What do I do once the study is over? I might wind up trying tranylcypromine
orally instead of selegiline until the patch becomes available commercially. Or I might just take selegiline orally. I guess
I'll cross that bridge when I get to it.> I also had to stop using Parnate because of my blood pressure being too low. I then tried Marplan and it made me too tired. It seemed to be a smoother drug than Parnate. I am now using Selegiline.
>
> Adam, Could you tell me how long it took for you to notice the AD effect and also what doseage of Selegiline you are on.
>
> Thanks, Lynne
Posted by anita on October 18, 1999, at 18:48:13
In reply to Anita, posted by Elizabeth on October 17, 1999, at 21:16:34
> Constipation is the thing I'm worrying about, not dry mouth. I get away with using Buprenex occasionally by adding
I have it chronically, and docusete sodium (2 pills/day) has always helped me as long as I take it every day. I've tried everything on the market, literally.
> I don't think the mechanisms of weight gain have been well elucidated; also, isocarboxazid is the least-studied of the three remaining "classic" MAOIs. Therefore, there doesn't seem to be much information about weight gain with Marplan. I think the best bet is to ask around (see if you can find some docs who have experience using it).
According to studies done when it was available in the US years ago, the incidence of significant weight gain with Marplan is 20% while Nardil is 74%. I have a list of the percentages of Marplan side effects from this period (which used more people than the trial currently listed by the manufacturer) if you want it.
I was wondering again if you felt that lithium helped irritability? I was thinking about Buspar as well, tho it seems it may increase it.
anita
Posted by Elizabeth on October 19, 1999, at 12:05:56
In reply to Re: Anita, posted by anita on October 18, 1999, at 18:48:13
> > Constipation is the thing I'm worrying about, not dry mouth. I get away with using Buprenex occasionally by adding
>
> I have it chronically, and docusete sodium (2 pills/day) has always helped me as long as I take it every day. I've tried everything on the market, literally."2 pills" where 1 pill = how much docusate Na? The stuff I have is 100mg/pill; I was taking 3 a day when I was on Buprenex all the time.
> According to studies done when it was available in the US years ago, the incidence of significant weight gain with Marplan is 20% while Nardil is 74%.
Hey, that's not too bad.
>I have a list of the percentages of Marplan side effects from this period (which used more people than the trial currently listed by the manufacturer) if you want it.
Cool beans. Where'd you find that? Stuck to a *really old* bottle of pills?
> I was wondering again if you felt that lithium helped irritability? I was thinking about Buspar as well, tho it seems it may increase it.
I didn't notice either way (irritability isn't a major issue for me), but it's used for that sort of thing sometimes. I don't think Buspar would increase irritability...where'd you hear that?
Posted by anita on October 19, 1999, at 23:58:24
In reply to Marplan & stuff - Anita, posted by Elizabeth on October 19, 1999, at 12:05:56
> > > Constipation is the thing I'm worrying about, not dry mouth. I get away with using Buprenex occasionally by adding
> >
> > I have it chronically, and docusete sodium (2 pills/day) has always helped me as long as I take it every day. I've tried everything on the market, literally.
>
> "2 pills" where 1 pill = how much docusate Na? The stuff I have is 100mg/pill; I was taking 3 a day when I was on Buprenex all the time.Yup, 200mg.
> >I have a list of the percentages of Marplan side effects from this period (which used more people than the trial currently listed by the manufacturer) if you want it.
>
> Cool beans. Where'd you find that? Stuck to a *really old* bottle of pills?Hee hee. Nope, just in a book that used an old study. I'll email them to you in a few days.
> > I was wondering again if you felt that lithium helped irritability? I was thinking about Buspar as well, tho it seems it may increase it.
>
> I didn't notice either way (irritability isn't a major issue for me), but it's used for that sort of thing sometimes. I don't think Buspar would increase irritability...where'd you hear that?Well, irritability is listed as a possible ("less common") side effect, and in one of my books I read that it can paradoxically increase anxiety and associated tenseness.
anita
Posted by Elizabeth on October 26, 1999, at 19:15:47
In reply to Re: Marplan & stuff - Anita, posted by anita on October 19, 1999, at 23:58:24
> Hee hee. Nope, just in a book that used an old study. I'll email them to you in a few days.
Cool. I'm starting it in a few days (now on 25mg of nortriptyline).
> Well, irritability is listed as a possible ("less common") side effect, and in one of my books I read that it can paradoxically increase anxiety and associated tenseness.
If it's listed under "less common" side effects, that probably means it isn't a drug effect at all, IMHO, but an incidental event.
Posted by John on October 27, 1999, at 9:49:36
In reply to Marplan & stuff - Anita, posted by Elizabeth on October 19, 1999, at 12:05:56
hi,
i've tried nardil (phenelzine), parnate (tranylcypromine) and other psychotropics to treat my social phobia. nardil has been the most efficacious, by far. like you, parnate would not initially let me sleep. i found slowly titrating the dosage upward works well - your body adjusts. also, if you're using a benzodiazepine as adjunctive therapy, then taking that at night will also help. problem for me was that parnate just was not efficacious in minimizing my social phobia.
i've now been on marplan for several weeks. no sleep problems. haven't experienced the weight gain associated with nardil, either. initial dose of 30 mg was not efficacious, so i'm now on 60 mg/day. sexual dysfunction is also not an issue - at least yet.
Posted by Just a little... on July 9, 2004, at 9:58:19
In reply to My marplan experience, posted by John on October 27, 1999, at 9:49:36
I'm currently on 30 mg's of parnate and 300 mg of lithium carbonate (which will be increased to 600 mg later this week), Overall I'd say I feel good. No problems with weight gain and my sleep is slowly but steadily improving as well.
Be that as it may my Pdoc says he doesn't notice an "adequate" anti depressant effect in me, meaning interest in things, social stuff... etc.
Also my energy is kinda low in the afternoon which seems normal from what I've read.We have been thinking about adding an amphetamine (even though they are contraindicated) to help me get through the morning and afternoon, but my Pdoc would like me to switch to Marplan first because of it's less severe side effects(?).
He is worried about my hypertension and tachycardia (in normal situations) which supposedly are caused by Parnate... He believes Marplan will not have these side effects in me.
The tachycardia part is indeed very annoying for me, I can't do a proper target heartrate workout because my heart rate already is in it's optimal range... usually in the 110's when I start.
Has anyone experienced tachycardia with Marplan? I really like to exercise and parnate is giving me a hard time.
Thanks and take care everyone =D
Just a little... a.k.a. Falco
> hi,
>
> i've tried nardil (phenelzine), parnate (tranylcypromine) and other psychotropics to treat my social phobia. nardil has been the most efficacious, by far. like you, parnate would not initially let me sleep. i found slowly titrating the dosage upward works well - your body adjusts. also, if you're using a benzodiazepine as adjunctive therapy, then taking that at night will also help. problem for me was that parnate just was not efficacious in minimizing my social phobia.
>
> i've now been on marplan for several weeks. no sleep problems. haven't experienced the weight gain associated with nardil, either. initial dose of 30 mg was not efficacious, so i'm now on 60 mg/day. sexual dysfunction is also not an issue - at least yet.
Posted by Questionmark on July 9, 2004, at 10:38:27
In reply to Re: My marplan experience » John, posted by Just a little... on July 9, 2004, at 9:58:19
> I'm currently on 30 mg's of parnate and 300 mg of lithium carbonate (which will be increased to 600 mg later this week), Overall I'd say I feel good. No problems with weight gain and my sleep is slowly but steadily improving as well.
>
> Be that as it may my Pdoc says he doesn't notice an "adequate" anti depressant effect in me, meaning interest in things, social stuff... etc.
> Also my energy is kinda low in the afternoon which seems normal from what I've read.
>
> We have been thinking about adding an amphetamine (even though they are contraindicated) to help me get through the morning and afternoon, but my Pdoc would like me to switch to Marplan first because of it's less severe side effects(?).
>
> He is worried about my hypertension and tachycardia (in normal situations) which supposedly are caused by Parnate... He believes Marplan will not have these side effects in me.
>
> The tachycardia part is indeed very annoying for me, I can't do a proper target heartrate workout because my heart rate already is in it's optimal range... usually in the 110's when I start.
>
> Has anyone experienced tachycardia with Marplan? I really like to exercise and parnate is giving me a hard time.
>
> Thanks and take care everyone =D
> Just a little... a.k.a. Falcoi've never used Marplan but i'm pretty sure it would be much less likely to cause tachycardia than Parnate. In fact, it very well might cause bradycardia to some extent.
Posted by King Vultan on July 9, 2004, at 14:32:58
In reply to Re: My marplan experience » John, posted by Just a little... on July 9, 2004, at 9:58:19
If Marplan is at all like Nardil (they are both hydrazine derivatives, while Parnate is not), you may actually have the opposite problem where your heart rate is too slow, as suggested by Questionmark. My experience, having experienced tachycardia on tricyclics and bradycardia on Nardil, is that the bradycardia is more of a problem in practice.
The tachycardia had no real effect on my workouts, but I do not do anything that is heartrate targeted; I occasionally monitor my heartrate while I'm running out of curiousity. At age 39 earlier this year on a tricyclic (desipramine), my pulse was running about 155 bpm on the flats and as high as 168 climbing hills at a moderately strenuous pace. This may seem high, but it was simply a natural result of the pace of the workout, which was not uncomfortable. My resting heart rate on desipramine was about 90 bpm.
However, on Nardil, with a resting heartrate of about 55, I am having problems even climbing the stairs without feeling faint, and I just cannot go as fast when I'm running. I've felt my pulse sometimes at the top of the stairs (when I've laid down to avoid fainting), and it's clear that it's not going fast enough to begin with and also can't accelerate fast enough to keep up with the needed increase in cardiovascular output. Better the reflex tachycardia I experienced on the tricyclics. BTW, both types of drugs caused me hypotension. My normal BP is 140/90; on the Nardil it is about 105/65, and on desipramine it was about 110/70.
The Marplan may be better than the Nardil in this way, but I thought I would share my experience. Good luck whatever you decide to do.
Todd
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