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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by SLS on October 27, 2011, at 4:53:24
I hope Marplan is still working for you.
What dosage are you at? How high will you go?
When do you begin adding amphetamine?
- Scott
Posted by Chairman_MAO on October 31, 2011, at 21:24:57
In reply to How's It Going? » Chairman_MAO, posted by SLS on October 27, 2011, at 4:53:24
> I hope Marplan is still working for you.
>It is working a little for anxiety; I felt overmedicated and cut my clonazepam back to 3mg/day and I'm OK. I cannot cut 2mg pills into any smaller amounts than I already did so that's where it will stay for now.
I have adjusted to the GI upset, and don't feel any carbohydrate cravings.
> What dosage are you at? How high will you go?
>
I am at 40. I am going to ask him to cut to the chase and titrate up to 80 next month; I don't want to be doing this for months. In the past I took 120mg/day of Parnate and 120mg/day of Nardil. I only cut the Nardil back to 90 because the carb cravings on 120mg/day were just outrageous, but 120mg/day seemed somewhat more effective, although it's hard to say for sure.I don't feel like waiting for months just to get to a therapeutic dose.
> When do you begin adding amphetamine?
>
After the dose of Marplan is set. Next appointment is 11/12. I'm going to tell him that I understand that given that it's a new drug he started me off at 40, but that I'm taking this for anxiety also, and not just depression, and given that I'd always required high doses of MAOIs in the past, I'd appreciate if I could just get the upward titration over with. I need the high doses to help with the anxiety/social phobia.>
> - ScottThanks for asking.
Posted by SLS on November 2, 2011, at 6:20:12
In reply to Re: How's It Going? » SLS, posted by Chairman_MAO on October 31, 2011, at 21:24:57
I thought you might be interested in this. I encountered it quite a few years ago.
- Scott
--------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/7931218J Neural Transm Suppl. 1994;41:127-34.
Comparisons of the actions of high and low doses of the MAO inhibitor tranylcypromine on 5-HT2 binding sites in rat cortex.
Goodnough DB, Baker GB.
SourceDepartment of Psychiatry, University of Alberta, Edmonton, Canada.
AbstractTranylcypromine (TCP) is a commercially available antidepressant drug, and recent literature reports suggest that high doses of this drug may be particularly effective in treating refractory depression. Down-regulation of 5-HT2 receptors in rat cortex is an effect produced after chronic administration of several antidepressants, and we have conducted a chronic study comparing low- and high-dose TCP in this regard. Male Sprague-Dawley rats were administered TCP (0.5 or 2.5 mg/kg/day) or vehicle (distilled water) via Alzet minipumps implanted subcutaneously in the dorsal thoracic area. Groups of rats were killed 4, 10 or 28 days after pump implantation and whole cortex was dissected out and utilized for preparation of a membrane fraction. Binding studies were performed with this fraction using 3H-ketanserin as the radioligand. Down-regulation (decrease in Bmax) of the 5-HT2 binding site was observed in high-dose animals after 10 and 28 days but not after 4 days. Low-dose TCP had no effect on 5-HT2 densities at any time interval. The affinity of 3H-ketanserin for the 5-HT2 site was not affected by either dose at any time interval. These results suggest that down-regulation of the 5-HT2 site may contribute to the efficacy of high-dose TCP in the treatment of refractory depression.
PMID:
7931218
[PubMed - indexed for MEDLINE]
Posted by Chairman_MAO on November 3, 2011, at 19:44:16
In reply to Re: How's It Going? » Chairman_MAO, posted by SLS on November 2, 2011, at 6:20:12
> I thought you might be interested in this. I encountered it quite a few years ago.
>Thanks, already know about this one. ;-)
Posted by Chairman_MAO on November 14, 2011, at 19:36:16
In reply to Re: How's It Going? » Chairman_MAO, posted by SLS on November 2, 2011, at 6:20:12
Up to 60mg/day Marplan today, which my pdoc says is the max. We'll see how it goes. Tapering off of clonazepam by decreasing 0.5mg every 14 days. I told him that I was worried about the 50% decreases from 1mg to 0.5mg to 0, and he said that if it's really hard he'll address it at that time.
I told him I thought that 80 was the max, but then I checked and it does seem to say that generally you shouldn't exceed 60. Given that he prescribed me 120mg/day of phenelzine at one time, I'm not too worried about him refusing more if I really need it. I hope I don't.
The benzo taper has to be complete before he'll start me on the Dexedrine again for obvious reasons. What I'm hoping for from this 60mg/day is something like I got from, let's say, 90mg/day of Nardil.
Here's hoping ...
Posted by SLS on November 14, 2011, at 20:22:57
In reply to Re: How's It Going? » SLS, posted by Chairman_MAO on November 14, 2011, at 19:36:16
> Up to 60mg/day Marplan today, which my pdoc says is the max. We'll see how it goes. Tapering off of clonazepam by decreasing 0.5mg every 14 days. I told him that I was worried about the 50% decreases from 1mg to 0.5mg to 0, and he said that if it's really hard he'll address it at that time.
>
> I told him I thought that 80 was the max, but then I checked and it does seem to say that generally you shouldn't exceed 60. Given that he prescribed me 120mg/day of phenelzine at one time, I'm not too worried about him refusing more if I really need it. I hope I don't.
>
> The benzo taper has to be complete before he'll start me on the Dexedrine again for obvious reasons. What I'm hoping for from this 60mg/day is something like I got from, let's say, 90mg/day of Nardil.
>
> Here's hoping ...All systems go!
- Scott
Posted by Chairman_MAO on November 15, 2011, at 6:46:14
In reply to Re: How's It Going? » Chairman_MAO, posted by SLS on November 14, 2011, at 20:22:57
> All systems go!
>
>
> - Scott
>Yup! *crosses fingers* I already feel better from upping the dose by 20mg, but I've been at this long enough to know that's transitory. I'm lucking out in the side effects department because I don't notice any carb cravings.
I am trying not to be intimidated by the benzo taper. I have a somewhat irrational fear that doing this will make me more likely to relapse (substance abuse). I drank alcohol a few days ago, which is not something I have ever had a problem with, but I cannot afford to use _anything_ that is not prescribed _ever_. I've got a _really_ good guy in my corner--the best anyone could ever hope for on medicaid--and I don't want to blow it. And by that I mean that should I drink alcohol, there is always the possibility that my inhibitions could be loosened and I take something else, and then it could get really bad.
I think I gotta work on some mindfulness stuff and join a support group. The 12-step stuff seems lacking in "adult supervision", if you know what I mean. There is small SMART recovery group (run by psych grad students and volunteers) that I once went to that I should try again.
I mean, how many doctors who take charity care will do an MAOI + psychostimulant combo? I am really lucky and I can't mess this up. Plus, aside from losing him, there is this whole thing called "life" that I want to re-establish.
Thanks for your support.
This is the end of the thread.
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