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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by tecknohed on October 15, 2007, at 9:54:39
For social phobia/depression/OCD-like symptoms.
My first thought is Marplan. I tried it before, on its own, but found it lacked the desired anxiolytic effect I'm after. But this time I'll be armed with clonazepam. Still, theres very little info on it helping Social phobia. Or any other anxiety disorders for that matter. It DID lift my mood significantly.
Or theres Parnate which seems to be the second MAOI in line for SP (after Nardil). But from what I've read of peoples accounts Parnate sounds like a very rocky ride. Some say its stimulating, some say it knocks them out & some say it dose both!
I'm not sure if either of them are helpfull for OCD.
Coming off MAOIs is hard enough (for me) not to mention the agonising wait during washout periods.
Any experiences, comments or suggestions will be greatly appreciated.
Posted by Phillipa on October 15, 2007, at 11:41:55
In reply to Marplan or Parnate - can't decide!, posted by tecknohed on October 15, 2007, at 9:54:39
Tech don't think they help OCD only the SSRI's and anafranil a TCA. Well good luck with what you decide. Phillipa
Posted by tecknohed on October 15, 2007, at 14:38:29
In reply to Marplan or Parnate - can't decide!, posted by tecknohed on October 15, 2007, at 9:54:39
Posted by brooke484 on October 15, 2007, at 18:30:45
In reply to Anyone doing well on Marplan? (nm), posted by tecknohed on October 15, 2007, at 14:38:29
I wish I could answer yes, but I just started it 4 weeks ago and haven't felt anything yet. Of course, I'm only on 25 mgs (since Sat). The good news is that I don't really have any side effects like I did on Nardil. Maybe a little more anxiety when I increase the dose, but no stomach upset, lightheadedness, palpitations, etc. So I'll stick with it for awhile and see what happens. This is my first time taking it. I couldn't take Parnate and Nardil was great back in 1996, but not the second time around.
Good luck in your decision.
Brooke
Posted by alienatari on October 15, 2007, at 21:55:35
In reply to Marplan or Parnate - can't decide!, posted by tecknohed on October 15, 2007, at 9:54:39
Parnate did not help my OCD at all. It was weird, I was always tired on it. So much so that I had to have a small rest in the afternoons but I would be alright again 30 minutes later. I have read a lot of people have experienced this. I also couldnt sleep much on it. Went without sleeping for 5 days on it which was one of the reasons I stopped it, plus I had a reaction to cranberry juice which gave me an awful headache.
> For social phobia/depression/OCD-like symptoms.
>
> My first thought is Marplan. I tried it before, on its own, but found it lacked the desired anxiolytic effect I'm after. But this time I'll be armed with clonazepam. Still, theres very little info on it helping Social phobia. Or any other anxiety disorders for that matter. It DID lift my mood significantly.
>
> Or theres Parnate which seems to be the second MAOI in line for SP (after Nardil). But from what I've read of peoples accounts Parnate sounds like a very rocky ride. Some say its stimulating, some say it knocks them out & some say it dose both!
>
> I'm not sure if either of them are helpfull for OCD.
>
> Coming off MAOIs is hard enough (for me) not to mention the agonising wait during washout periods.
>
> Any experiences, comments or suggestions will be greatly appreciated.
Posted by tecknohed on October 16, 2007, at 6:40:44
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 15, 2007, at 18:30:45
Thanx brooke484.
You know, 25mg IS a pretty small dose. The one time I tried marplan in the past I was up to 40mg within 2 weeks. In fact it kicked in within that time & I found it a very good antidepressant. Mind you it was a bit over stimulating & gave me insomnia & didn't help the anxiety. Diphenhydramine sorted out the insomnia, which sorted itself out eventually. But because my pdoc (my previous one) was against the idea of giving me a benzo for the anxiety, I stopped it. THIS time I already have that benzo onboard.
From what I've read, the idea is to get a patient up to 40mg/day as soon as possible, starting with 10mg TWICE daily. http://www.rxlist.com/cgi/generic/isocarbo_ids.htm
Seems to me the dosing is similar to Nardil (10mg Marplan = 15mg Nardil).Still, it's sometimes wise to increase slowly. Hopefully you can get to a full dose long enough for it to 'do some magic' & without side effects. (maybe if you're on it long enough we can compare notes)
Have you considered adding a benzo (that benzo being clonazepam) or are you/your doc against the idea? Just a thought.
Funny, whilst writing this post I think I've made up my mind!
Take care mate!
Posted by tecknohed on October 16, 2007, at 7:03:00
In reply to Re: Marplan or Parnate - can't decide!, posted by alienatari on October 15, 2007, at 21:55:35
Thanx alienatari!
Your experience with Parnate is similar to a whole load more experiences I've read. Kind of puts me off the drug really. Not only that, even people who have had success with the drug usually say it poops out in the end.
Thanx for your input. I'm gonna give Marplan another bash.
Posted by brooke484 on October 16, 2007, at 9:43:31
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by tecknohed on October 16, 2007, at 6:40:44
I wish I could just jump to 40 mgs but I've always had to take it slow. I mean, 25 mgs is giving me quite a bit of anxiety already. I'll go up to 30 this weekend and then stay there until I see my doctor. And yes, I do take ativan, but it's not working like it used to (maybe I need the brand, not generic). And I have klonopin too, just in case. I used to take a benzo maybe 1-2 times a week, but with Marplan I find I need it every day! Hope this starts working soon. I need some relief!
brooke
Posted by tecknohed on October 16, 2007, at 13:44:29
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 16, 2007, at 9:43:31
> I wish I could just jump to 40 mgs but I've always had to take it slow. I mean, 25 mgs is giving me quite a bit of anxiety already. I'll go up to 30 this weekend and then stay there until I see my doctor. And yes, I do take ativan, but it's not working like it used to (maybe I need the brand, not generic). And I have klonopin too, just in case. I used to take a benzo maybe 1-2 times a week, but with Marplan I find I need it every day! Hope this starts working soon. I need some relief!
>
> brookePerhapse daily use of a benzo isn't such a bad idea. It depends which way you look at it I suppose. On the one hand daily benzo use will inevitably lead to dependency of some sort, though not necessarily 'addiction'. Yet the way I see it is, if it helps & you can stabilize yourself on a particular dose then a benzo can be used indefinitely. For example, if my combo of clonazepam + Marplan works then I will stay on it for as long as it continues to work, hopefully for the rest of my life. There is no shame in it.
Fact is many many people use benzos daily without needing to increase the dose. Ceratainly some benzos are better tolerated long term than others. Clonazepam (Klonopin) seems one of the least likely to need frequent increases in dosage, once you get to the right dose. My pdoc is certainly happy for me to stay on it indefinitely, as long as it is helping.
Also, if you have social anxiety (do you?) then Klonopin may be a better option for you than Ativan, especially for daily use.
Of course what you do is entirely yours & your docs decision. The above are just my own thoughts on the matter.
I really do hope things work out well for you. And if you ever want to talk more privately then feel free to babblemail me.
Good luck!
Posted by brooke484 on October 16, 2007, at 20:37:09
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by tecknohed on October 16, 2007, at 13:44:29
For some reason Ativan has never became a problem. Even if I take it every day, I could still stop it without going through withdrawal. Now Klonopin was a different story. I will not go back to taking that every day. I took it for 4 years and it took me a whole year to get off.
I have a question (if you can remember). Did Marplan make you feel worse in the beginning? And did you have any side effects?
brooke
Posted by brooke484 on October 16, 2007, at 20:40:12
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 16, 2007, at 20:37:09
Never mind that question about side effects. You already answered it. Sorry.
brooke
Posted by alienatari on October 17, 2007, at 0:24:51
In reply to Re: Marplan or Parnate - can't decide! » alienatari, posted by tecknohed on October 16, 2007, at 7:03:00
Np I hope marplan works well for you.
Take care :)
> Thanx alienatari!
>
> Your experience with Parnate is similar to a whole load more experiences I've read. Kind of puts me off the drug really. Not only that, even people who have had success with the drug usually say it poops out in the end.
>
> Thanx for your input. I'm gonna give Marplan another bash.
Posted by CoutureMan on October 28, 2007, at 6:01:04
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 16, 2007, at 20:40:12
Hi brooke, Just curious how you are doing on the Marplan. Does it cause much more anxiety than Nardil and is it causing insomnia?
Thanks,
CM
Posted by brooke484 on October 28, 2007, at 10:17:16
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by CoutureMan on October 28, 2007, at 6:01:04
Well, I've been on it for 6 weeks now and I can't say it's doing anything really. I've only been taking 30 mgs for a week, so I guess I need to give that more time (I always have to increase it slowly). The anxiety that I did have in the beginning is gone, but the insomnia is still there and has gotten worse since I went up to 30 mgs. I think I average about 4-5 hours a night if I'm lucky. I think I'm going to try taking the second dose around 5 and see if that helps. Right now I'm taking it at bedtime. With Nardil, the higher I went the worse the side effects became. By the time I got to 60 mgs I was having palpitations and major anxiety. Marplan is nothing like that. My only real complaint is the insomnia.
And, my doctor wants me to take lamictal also, but so far I haven't. I prefer to try one medication at a time so I know which drug is doing what to me.
Are you thinking about trying it?
brooke
Posted by tecknohed on October 28, 2007, at 16:02:14
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 28, 2007, at 10:17:16
> Well, I've been on it for 6 weeks now and I can't say it's doing anything really. I've only been taking 30 mgs for a week, so I guess I need to give that more time (I always have to increase it slowly). The anxiety that I did have in the beginning is gone, but the insomnia is still there and has gotten worse since I went up to 30 mgs. I think I average about 4-5 hours a night if I'm lucky. I think I'm going to try taking the second dose around 5 and see if that helps. Right now I'm taking it at bedtime. With Nardil, the higher I went the worse the side effects became. By the time I got to 60 mgs I was having palpitations and major anxiety. Marplan is nothing like that. My only real complaint is the insomnia.
>
> And, my doctor wants me to take lamictal also, but so far I haven't. I prefer to try one medication at a time so I know which drug is doing what to me.
>
> Are you thinking about trying it?
>
> brookeHi brooke!
Sorry you're still not getting much success with marplan.
You know, you dont have to spread your dose out - you can take it all in one go. And why not take it all in the morning, then maybe the insomnia wont be so bad.
The label on MY bottle of Marplan says: "Take 4 tablets (40mg) in the MORNING." Of course I am to work up to 40mg, not go strait onto 40mg!
This has been my 7th day on Marplan now, and my 3rd day at 30mg. I plan to hit 40mg day after tomorrow.
So far the only side effects I've had have been mild headaches (which paracetamol helps) & also short-lived mild drowsiness shortly after taking a dose (though I do take mine at the same time as my klonopin). I suspect the Klonopin is helping to prevent any anxiety or insomnia.
So far I HAVE felt an improvement but its very 'on/off'.
I'm glad the anxiety has gone for you, that must be a BIG relief! But I'm supprised your doc wants you on lamictal when you haven't even tried a higher dose of Marplan yet. Dose he want you you on it for mood swings or something? (are you getting mood swings?)
Dont forget that until you're on a high enough dose to inhibit ENOUGH MAO (for the individual), then an MAOI simply wont work!
GIVE IT TIME.
teck
Posted by CoutureMan on October 29, 2007, at 1:38:04
In reply to Re: Anyone doing well on Marplan?, posted by brooke484 on October 28, 2007, at 10:17:16
Brooke, I may possibly try it in the future. I was at a NAMI meeting in San Francisco and talked to Dr. Terrence Ketter from the Stanford mood clinic. He says he uses Marplan alot and finds it has fewer side effects than Nardil. Hope it kicks in for you soon.
CM
> Well, I've been on it for 6 weeks now and I can't say it's doing anything really. I've only been taking 30 mgs for a week, so I guess I need to give that more time (I always have to increase it slowly). The anxiety that I did have in the beginning is gone, but the insomnia is still there and has gotten worse since I went up to 30 mgs. I think I average about 4-5 hours a night if I'm lucky. I think I'm going to try taking the second dose around 5 and see if that helps. Right now I'm taking it at bedtime. With Nardil, the higher I went the worse the side effects became. By the time I got to 60 mgs I was having palpitations and major anxiety. Marplan is nothing like that. My only real complaint is the insomnia.
>
> And, my doctor wants me to take lamictal also, but so far I haven't. I prefer to try one medication at a time so I know which drug is doing what to me.
>
> Are you thinking about trying it?
>
> brooke
Posted by brooke484 on October 29, 2007, at 10:54:52
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by CoutureMan on October 29, 2007, at 1:38:04
He's right about that. I hope it kicks in soon too.
Posted by brooke484 on October 29, 2007, at 11:01:10
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by tecknohed on October 28, 2007, at 16:02:14
I didn't know you could take all of it at one time. I took the second dose at about 6 last night and I didn't have any trouble sleeping.
About the lamictal...I think my doctor is using it to augment marplan, not for mood swings.
I'm glad someone else is on this drug. I think it's just you and me!
brooke
Posted by Darius2535 on December 6, 2007, at 10:59:56
In reply to Re: Anyone doing well on Marplan? » brooke484, posted by tecknohed on October 28, 2007, at 16:02:14
Hi Teck,
I have been following your messages recently, and I wanted to ask you how the Marplan is working for you now?
How do you feel? What dose are you on, what times you take it, and what side effects are you experiencing now?
Any Mania or major weight gain or increased appetite?
Thanks,
Darius
Posted by Darius2535 on December 6, 2007, at 11:40:43
In reply to Re: Anyone doing well on Marplan? » tecknohed, posted by Darius2535 on December 6, 2007, at 10:59:56
Hi everyone,
I wanted to know who is currently on Marplan and what success and effects have they achieved on it?
I have treatment-resistant depression and social/anxiety phobia. Have tried all SSRI, etc. But the only only drug that finally worked was Nardil last year.
Within weeks as soon as reaching 60mg Nardil totally lifted my depression and all anxieties, felt free, invincable, open, honest, could talk to anyone, very emotional. I couldnt believe it. That something Finally worked. I felt cured.
However it also caused a state of Mania, daytime sedation, talkativeness, repeating my words, aggressiveness, plus of course a slew of other side effects all for which my doc and I were using various antidotes to calm. In the end, I was fired from my job and was involved in 2 car accidents. I fell back into lethargic ambivalent depression, and then upped the dose to 75mg, which only caused MAJOR appetite increase and weight gain, and no more of the good effects. So I gradually discontinued it, and worked to lose the weight. That was last February (2007).
Since then my doc has tried few other meds and combos, but we still come back to the fact that MAOIs are the only one i REALLY responded to. (By the way, tried that Emsam patch before the Nardil and it didnt work at all).
Most recently, after much thought, my doc and I decided to try PARNATE, hoping it might have some effects similar to Nardil with fewer side effects and Manic state, etc.. Well I started Parnate and slowly went all the way up to 60mg on it, waited weeks and weeks. NOTHING. Yea it was stimulating, just making me run around and look to eat and eat anything decadent and fattening. I gained 15 pounds in 1 month, and NO theraputic effects. So I slowly tapered off Parnate, and now Im just washing out until maybe starting Nardil again with a new game plan, or trying MARPLAN.
My doc wants me to start Marplan, before attempting another trial of Nardil, which was the only medication that worked on me really.
So I just wanted to get some information from people who are currently taking MARPLAN, and whether it is helping them, etc..
Thanks for reading.
Darius
Posted by brooke484 on December 6, 2007, at 20:50:59
In reply to MARPLAN??, posted by Darius2535 on December 6, 2007, at 11:40:43
Well, you probably already read some of my posts. I started 40 mgs today but I have nothing positive to report because it's too soon. Either that or it's just not going to work. I've been on it 11 weeks and my only side effects are tinnitus and the lightheadedness. But that went away when I started taking Marplan 4 times a day. Now I'm just waiting for it to kick in. I plan to add Lamictal after I'm on 40 for a few weeks.
WIsh I could say this is the best drug I've taken and I'm cured, but it hasn't happened yet. It's definitely better than Nardil though. The side effects I had with that were horrible.
Good luck,
Brooke
Posted by Darius2535 on December 7, 2007, at 9:49:08
In reply to Re: MARPLAN??, posted by brooke484 on December 6, 2007, at 20:50:59
> Well, you probably already read some of my posts. I started 40 mgs today but I have nothing positive to report because it's too soon. Either that or it's just not going to work. I've been on it 11 weeks and my only side effects are tinnitus and the lightheadedness. But that went away when I started taking Marplan 4 times a day. Now I'm just waiting for it to kick in. I plan to add Lamictal after I'm on 40 for a few weeks.
>
> WIsh I could say this is the best drug I've taken and I'm cured, but it hasn't happened yet. It's definitely better than Nardil though. The side effects I had with that were horrible.
>
> Good luck,
>
> BrookeBrooke, at what times of the day do you take the Marplan? Does it cause daytime sedation or nighttime insomnia? Are you gaining weight on Marplan, is it increasing your Appetite? Any sexual problems, urinary hesitation?
You are doing the right thing by going very slow and being patient. Letting your body adjust to the med. I would keep at 40mg for the next 2 weeks, then evaluate if you feel any positive effects yet or not, then try going to 50 mg very slowly. My doc said for some people Marplan won't respond until 60 mgs a day, but to build it up VERY slowly and wait and see. So I wouldnt give up on it, and all your 11-12 weeks will go to waste. It must start doing something for you, if you slowly up the dose; you might be just as treatment-resistant as many of us.
The problem with many folks going on Anti-depressants is that they want to start on fast, go up fast, and see some RESULTS to help their depression/anxiety. And then if they dont see it working, they try to quit and wane off fast, which can cause unknown hellish withdrawal symptoms.
I hope to read your responses to my questions.
Thanks,
Darius
Posted by tecknohed on December 7, 2007, at 15:29:54
In reply to Re: Anyone doing well on Marplan? » tecknohed, posted by Darius2535 on December 6, 2007, at 10:59:56
> Hi Teck,
>
> I have been following your messages recently, and I wanted to ask you how the Marplan is working for you now?
>
> How do you feel? What dose are you on, what times you take it, and what side effects are you experiencing now?
>
> Any Mania or major weight gain or increased appetite?
>
> Thanks,
>
> DariusHi Darius.
I'm fortunitely doing very well on Marplan at present. Been on it for nearly 7 weeks now & its settled nicely. I've been on 40mg since day 7. I also take Klonopin 3mg/day which knocks out alot of the social anxiety, probably most of it, but it wouldnt be the same without the Marplan. Klonopin + Marplan is somewhat similar to my Nardil experience which was similar to yours. However I find Marplan MUCH smoother. Without a benzo you might find it a bit over activating - possible anxiety & insomnia. The insomnia is short lived, not sure about the anxiety as the 1st time I tried Marplan my pdoc at the time would'nt give me a benzo so I quit early. This time around I already had Klonopin on board.
I've experienced virtually no dizziness or urine retention/hesitation, unlike Nardil. But anorgasmia has recently started up & I can't cum to save my life! But I trust this will go on its own with time whether I medicate it or not. Also NO daytime sedation at all, appart from a brief period in the first few weeks. No appetite changes for me nor weight gain (that I've noticed). I take 20mg breakfast, 10mg lunch & 10mg dinner.
Personally I'm glad I went to 40mg so quickly. Thats what most of the literature says to do, if its tolerated. Of course some need to work up more slowly but for me my body seems to be quite robust to MAOIs side effects, probably because I was on Nardil for 4 1/2 years. SSRIs on the other hand I just cannot handle - I feel totally doped up on them.
I also take 2 supplements - idebenone & vinpocetine. The idebenone seems to slightly enhance the Marplan & maybe smooth things out too. Vinpocetine has totally got rid of my Klonopin induce head fog, possibly from the Marplan too.
The one problem it hasn't helped that much is my hypersomnia, though it is a bit better. My energy though is fine, once I do wake up. Anyway, I think my hypersomnia is a seperate issue altogether.
I do plan to go to 50mg Marplan, probably around mid Jan, just to see if it can help any more but if after 4 weeks nothing changes I'll drop back to 40mg. Another idea I have for some 'get up & go' (I NEED less sleep) is to add a mild NRI type tricyclic, probably lofepramine (similar to desipramine). I've taken it before & it solved my hypersomnia AND depression but didn't touch my social anxiety. Luckily I'm with an excellent pdoc now (a Professor, head of Bristol Psychopharmacology Dept. UK) so he knows his stuff. He let me take bupropion with Nardil so he should let me take lofepramine with Marplan, I hope. Anyway, NRIs actually have a protective effect against MAOI-induced hypertensive crisis I do believe.
So yeah, give Marplan a go, though you MAY need a benzo (or something as good as) with it for your social anxiety as I'm not sure just how effective Marplan ON IT'S OWN really is for social anxiety. But its a DAMN GOOD antidepressant when it works. :)
teck
Posted by brooke484 on December 7, 2007, at 20:33:51
In reply to Re: MARPLAN?? » brooke484, posted by Darius2535 on December 7, 2007, at 9:49:08
Darius,
I take it around 8am, 11, 2, and 5. Splitting the dose helped so much that now I can run up my stairs without feeling faint. I do get tired in the afternoon, but I don't know if that's the medication or me being a stay at home mom to a 3 1/2 year old. Thank goodness for naps. And no, even with a nap and about 8 hours of sleep do I have insomnia. Marplan has not affected my appetite in any way. Maybe lessened it a bit if anything. And no to the last two questions.
The one thing I have to say is that even though I haven't felt any change on this drug, the side effects are nothing compared to what I went through on Nardil. I was miserable on 45 mgs. I don't think I even made it to 12 weeks. And even though this hasn't helped yet, I'm not quitting now. I remember when I took Imipramine back in the late 90's, I needed 400 mgs before it kicked in. And when it did, it really did. I've learned you have to be patient even though you're dying for it to help you.
Hope this helped a bit.
Brooke
Posted by tecknohed on December 8, 2007, at 7:46:33
In reply to Re: MARPLAN??, posted by brooke484 on December 7, 2007, at 20:33:51
>And even though this hasn't helped yet, I'm not quitting now. I remember when I took Imipramine back in the late 90's, I needed 400 mgs before it kicked in. And when it did, it really did. I've learned you have to be patient even though you're dying for it to help you.
Good on you! Praying for you that it kicks in SOON! :)
teck
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