Psycho-Babble Medication Thread 15234

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Marplan success stories?

Posted by Scott L. Schofield on November 15, 1999, at 8:41:56

Has anyone had success with Marplan?
How long did it take to work?

I would be particularly interested to hear from people for whom neither Parnate nor Nardil produced and adequate response.

I suffer from treatment-resistant bipolar depression. (I would guess that treatment-resistance is not an uncommon story here). MAO-inhibitors have been only partially effective, but seem to work better than anything else.


Thanks.

Scott

 

Re: Marplan success stories?

Posted by Elizabeth on November 16, 1999, at 3:18:15

In reply to Marplan success stories?, posted by Scott L. Schofield on November 15, 1999, at 8:41:56

> Has anyone had success with Marplan?
> How long did it take to work?

I should be starting it "any day now." I will certainly let you know, and I know there are others here who have tried it.

> I would be particularly interested to hear from people for whom neither Parnate nor Nardil produced and adequate response.

I can't help you there; I responded to both. Nardil caused excessive weight gain (like, about 40%) and pooped out after 8 months or so each time I tried it; Parnate's cardiovascular effects prevented me from getting to a fully effective dose.

Can I ask what you've tried so far? Are you on a mood stabilizer at the moment?

 

Re: Marplan success stories?

Posted by Scott L. Schofield on November 16, 1999, at 8:58:32

In reply to Re: Marplan success stories?, posted by Elizabeth on November 16, 1999, at 3:18:15

>> Has anyone had success with Marplan?
How long did it take to work?

> I should be starting it "any day now." I will certainly let you know, and I know there are others here who have tried it.

>> I would be particularly interested to hear from people for whom neither Parnate nor Nardil produced and adequate response.

> I can't help you there; I responded to both. Nardil caused excessive weight gain (like, about 40%) and pooped out after 8 months or so each time I tried it; Parnate's cardiovascular effects prevented me from getting to a fully effective dose.

> Can I ask what you've tried so far? Are you on a mood stabilizer at the moment?

Unfortunately, I think the list of which drugs I haven't been on would be shorter.

I was first diagnosed as unipolar by Fred Quitkin et al. at Columbia Presbyterian / New York Psychiatric in 1982. I was enrolled in their study comparing tricyclics versus MAO-inhibitors for the treatment of atypical depression. I was a rapid-cycler at the time. It wasn't until 1992 that I was diagnosed as bipolar by the staff at the NIH. All of my manic episodes involved treatment with MAOIs. I have never experienced a spontaneous mania. I remain in a state of severe depression without respite. If it weren't for the mild improvement afforded me by Lamictal, I doubt I would be able to write this post.

It is only this past month that I requested of my doctor to give "mood-stablizers" a more central role in my treatment. Obviously, an antidepressant-centered approach has not worked. This approach seems to be the one chosen by the researchers at the NIH for treatment-resistant bipolar depression. Sometimes I get the feeling that there is a sort of mentality like "If you throw enough sh_t against the wall, some of it is bound to stick." I wish some of that sh_t would stick to me.

The only remission I experienced was while taking a combination of desipramine and Parnate. It lasted for about six months before I became hypomanic, and then manic (mixed state, I guess). After getting control of the mania with Klonepin, the doctor decided not to go back to what worked. I've been f'd ever since. At least I learned that life *can* be good.

Right now, I am taking Depakote, Lamictal, imipramine, and Marplan. I've been on Marplan for less than a week. Of course, I'm not looking for anything to happen for a few weeks yet. I think it takes about two weeks just to establish a steady-state degree of inhibition (not sure).

What dosage are you to work up to?

What were the autonomic side-effects you suffered while taking Parnate?

40% REALLY sucks.


Good Luck.

- Scott

 

Re: Marplan success stories?

Posted by Adam on November 16, 1999, at 11:21:14

In reply to Marplan success stories?, posted by Scott L. Schofield on November 15, 1999, at 8:41:56

Please let us know how things go, guys. Marplan is choice #2 for me if Parnate doesn't work out (projecting into the
future).

Elizabeth, what were the cardiovascular problems? Did it have to do with spontaneous hypertension? I thought the big
problem with Parnate was sleep.

Thank you!

> Has anyone had success with Marplan?
> How long did it take to work?
>
> I would be particularly interested to hear from people for whom neither Parnate nor Nardil produced and adequate response.
>
> I suffer from treatment-resistant bipolar depression. (I would guess that treatment-resistance is not an uncommon story here). MAO-inhibitors have been only partially effective, but seem to work better than anything else.
>
>
> Thanks.
>
> Scott

 

Re: Marplan success stories?

Posted by Elizabeth on November 17, 1999, at 2:42:59

In reply to Re: Marplan success stories?, posted by Scott L. Schofield on November 16, 1999, at 8:58:32

> Unfortunately, I think the list of which drugs I haven't been on would be shorter.

LOL. You and I have something in common, then.

> I was first diagnosed as unipolar by Fred Quitkin et al. at Columbia Presbyterian / New York Psychiatric in 1982. I was enrolled in their study comparing tricyclics versus MAO-inhibitors for the treatment of atypical depression.

I know the study well. I take it you have atypical features?

What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.

> I was a rapid-cycler at the time. It wasn't until 1992 that I was diagnosed as bipolar by the staff at the NIH. All of my manic episodes involved treatment with MAOIs. I have never experienced a spontaneous mania.

Around here [Boston], I've been hearing that called "bipolar III." I have had antidepressant-induced mania as well, although it's not a consistent thing (it's only happened a couple times, and only once was it severe).

The impression I've gotten is that tricyclics are the worst for inducing mania, especially mixed (i.e., dysphoric) mania (which happened to me on Effexor - it was associated with serotonin syndrome, though, which is a whole different can of worms).

> I remain in a state of severe depression without respite. If it weren't for the mild improvement afforded me by Lamictal, I doubt I would be able to write this post.

I've heard some good things about Lamictal for depression (I took 500 mg for several months and never got any good out of it, alas).

> It is only this past month that I requested of my doctor to give "mood-stablizers" a more central role in my treatment. Obviously, an antidepressant-centered approach has not worked. This approach seems to be the one chosen by the researchers at the NIH for treatment-resistant bipolar depression.

Huh. I've always thought it was risky to throw antidepressants at a bipolar individual (including bipolar III).

> Sometimes I get the feeling that there is a sort of mentality like "If you throw enough sh_t against the wall, some of it is bound to stick." I wish some of that sh_t would stick to me.

I understand. I still have a sort of feeling of despair, like I can't quite reclaim my life.

> The only remission I experienced was while taking a combination of desipramine and Parnate. It lasted for about six months before I became hypomanic, and then manic (mixed state, I guess). After getting control of the mania with Klonepin, the doctor decided not to go back to what worked. I've been f'd ever since. At least I learned that life *can* be good.

Have you had this mood disorder all your life? Mine only really surfaced in adolescence.

> Right now, I am taking Depakote, Lamictal, imipramine, and Marplan. I've been on Marplan for less than a week. Of course, I'm not looking for anything to happen for a few weeks yet. I think it takes about two weeks just to establish a steady-state degree of inhibition (not sure).

MAO gets blocked pretty quickly; as with other antidepressants, the longer-term receptor changes are probably what makes them work. But anyway, I'm more curious about side effects (I know I respond to MAOIs).

> What dosage are you to work up to?

"As tolerated."

> What were the autonomic side-effects you suffered while taking Parnate?

Spontaneous hypertensive episodes [not related to food-drug interactions].

> 40% REALLY sucks.

It wasn't too bad actually...it was well distributed, and as soon as I stopped taking the Nardil I lost it pretty fast (because I was depressed but no longer having that side effect).

 

Re: Marplan success stories?

Posted by Scott L. Schofield on November 17, 1999, at 10:25:41

In reply to Re: Marplan success stories?, posted by Elizabeth on November 17, 1999, at 2:42:59

> > Unfortunately, I think the list of which drugs I haven't been on would be shorter.

> LOL. You and I have something in common, then.

Yeah. This sucks. (What does LOL mean?)

> > I was first diagnosed as unipolar by Fred Quitkin et al. at Columbia Presbyterian / New York Psychiatric in 1982. I was enrolled in their study comparing tricyclics versus MAO-inhibitors for the treatment of atypical depression.

> I know the study well. I take it you have atypical features?

Yes. Although when my depression did not remit satisfactorily, Dr. Quitkin used an interesting term: atypical reactive-type with endogenomorphic characteristics.

> What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.

Remain an admirer from afar.

> > I was a rapid-cycler at the time. It wasn't until 1992 that I was diagnosed as bipolar by the staff at the NIH. All of my manic episodes involved treatment with MAOIs. I have never experienced a spontaneous mania.

> Around here [Boston], I've been hearing that called "bipolar III." I have had antidepressant-induced mania as well, although it's not a consistent thing (it's only happened a couple times, and only once was it severe).

Each successive mania can be worse than the one previous. The damned thing seems to sink its claws deeper and deeper (kindling). Not only that, but the following depression(s) can be more resistant to treatment. I wish the doctors who treated me ten years ago knew this. Not that it's their fault, but they really f'd me big-time.

A few years ago, a contributor from alt.support.depression posted a list of bipolar subtypes that he said was being considered for DSM-V. I believe there were five (possibly six) subtypes. One of them described the drug-induced-only mania. I think this was discussed as a possible type III as early as 1990. His list "bumped" it to a type IV. I should mention that a mania can also be precipitated upon discontinuation of an antidepressant. This has happened to me twice.

> The impression I've gotten is that tricyclics are the worst for inducing mania, especially mixed (i.e., dysphoric) mania (which happened to me on Effexor - it was associated with serotonin syndrome, though, which is a whole different can of worms).

Dangerous stuff. I never liked worms.

> > I remain in a state of severe depression without respite. If it weren't for the mild improvement afforded me by Lamictal, I doubt I would be able to write this post.

> I've heard some good things about Lamictal for depression (I took 500 mg for several months and never got any good out of it, alas).

> > It is only this past month that I requested of my doctor to give "mood-stablizers" a more central role in my treatment. Obviously, an antidepressant-centered approach has not worked. This approach seems to be the one chosen by the researchers at the NIH for treatment-resistant bipolar depression.

> Huh. I've always thought it was risky to throw antidepressants at a bipolar individual (including bipolar III).

Risk vs benefit. Bipolar depression is a mother. I'm lucky that MAOIs budge me at all. I'm not terribly optimistic.

> > Sometimes I get the feeling that there is a sort of mentality like "If you throw enough sh_t against the wall, some of it is bound to stick." I wish some of that sh_t would stick to me.

> I understand. I still have a sort of feeling of despair, like I can't quite reclaim my life.

I've been out of work and out of mainstream for nine years. I hate being on the public rolls. I'm not a lazy person.

> > The only remission I experienced was while taking a combination of desipramine and Parnate. It lasted for about six months before I became hypomanic, and then manic (mixed state, I guess). After getting control of the mania with Klonepin, the doctor decided not to go back to what worked. I've been f'd ever since. At least I learned that life *can* be good.

> Have you had this mood disorder all your life? Mine only really surfaced in adolescence.

Ditto.

> > Right now, I am taking Depakote, Lamictal, imipramine, and Marplan. I've been on Marplan for less than a week. Of course, I'm not looking for anything to happen for a few weeks yet. I think it takes about two weeks just to establish a steady-state degree of inhibition (not sure).

> MAO gets blocked pretty quickly; as with other antidepressants, the longer-term receptor changes are probably what makes them work. But anyway, I'm more curious about side effects (I know I respond to MAOIs).

> > What dosage are you to work up to?

> "As tolerated."

And you tolerate this?

> > What were the autonomic side-effects you suffered while taking Parnate?

> Spontaneous hypertensive episodes [not related to food-drug interactions].

Did this occur at the beginning or later on? I've read that it is not uncommon to see this at the beginning, but it disappears quickly (if you're still around to find out).

> > 40% REALLY sucks.

> It wasn't too bad actually...it was well distributed...

Cool.


Get better.

Scott

 

Re: Marplan success stories?

Posted by Elizabeth on November 18, 1999, at 0:47:02

In reply to Re: Marplan success stories?, posted by Scott L. Schofield on November 17, 1999, at 10:25:41

> > LOL. You and I have something in common, then.
>
> Yeah. This sucks. (What does LOL mean?)

"Laughing out loud." (i.e., "you have just said something that amuses me greatly.")

> > I know the study well. I take it you have atypical features?
>
> Yes. Although when my depression did not remit satisfactorily, Dr. Quitkin used an interesting term: atypical reactive-type with endogenomorphic characteristics.

That seems contradictory. I wonder what he meant by it?

> > What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.
>
> Remain an admirer from afar.

Yes...?

> Each successive mania can be worse than the one previous. The damned thing seems to sink its claws deeper and deeper (kindling).

This is my experience with recurrent depression also: the episodes get worse and closer together.

> Not only that, but the following depression(s) can be more resistant to treatment.

That happened to me, sorta: I stopped Prozac after taking it for 2 or 3 years, then when I tried it again it no longer worked (and I went through a long succession of meds).

> I wish the doctors who treated me ten years ago knew this. Not that it's their fault, but they really f'd me big-time.

I know...it's so frustrating.

> A few years ago, a contributor from alt.support.depression posted a list of bipolar subtypes that he said was being considered for DSM-V. I believe there were five (possibly six) subtypes. One of them described the drug-induced-only mania.

I remember seeing that list somewhere also. I wonder who we should ask to get the inside dirt on DSM-V .

> I think this was discussed as a possible type III as early as 1990. His list "bumped" it to a type IV. I should mention that a mania can also be precipitated upon discontinuation of an antidepressant. This has happened to me twice.

Yes, I've read and heard reports of that. I had a sort of mixture of hypomania and anxiety when I d/c'd Nardil the first time.

> Dangerous stuff. I never liked worms.

"Nobody loves me, everybody hates me, ..."

> > Huh. I've always thought it was risky to throw antidepressants at a bipolar individual (including bipolar III).
>
> Risk vs benefit. Bipolar depression is a mother. I'm lucky that MAOIs budge me at all. I'm not terribly optimistic.

Well, "depressed" and "optimistic" usually aren't on speaking terms with each other.

> I've been out of work and out of mainstream for nine years. I hate being on the public rolls. I'm not a lazy person.

I've been having serious troubles since '94 or '95 (and I'm only 23). It does seem to have been getting better in the last year, but it's still up and down.

> > Have you had this mood disorder all your life? Mine only really surfaced in adolescence.
>
> Ditto.

This seems like the norm.

> > "As tolerated."
>
> And you tolerate this?

What am I supposed to do? It's not like there's a way of predicting what dose a particular individual will need.

But anyway, more specifically, I'm supposed to go up to 30 mg (as tolerated) until I next see my pdoc (Tuesday). This is assuming the pharmacy even gets the stuff by then (as of 6pm today it hadn't come in).

> > Spontaneous hypertensive episodes [not related to food-drug interactions].
>
> Did this occur at the beginning or later on? I've read that it is not uncommon to see this at the beginning, but it disappears quickly (if you're still around to find out).

It was high enough that I wasn't about to risk waiting; and actually I did try slowly increasing the dose but found that whenever I took 20mg at a time or more, my BP would shoot up about 30 minutes after taking it.

> Get better.

You too.

 

Re: Marplan success stories?

Posted by Scott L. Schofield on November 18, 1999, at 12:21:05

In reply to Re: Marplan success stories?, posted by Elizabeth on November 18, 1999, at 0:47:02

> > Yes. Although when my depression did not remit satisfactorily, Dr. Quitkin used an interesting term: atypical reactive-type with endogenomorphic characteristics.

> That seems contradictory. I wonder what he meant by it?

At the time, I regarded it as a cop-out. It seemed he was hedging his bets. That way, his diagnosis would be, at worst, partially correct.

Since then, I have begun to see where he was coming from.

> > > What is Quitkin like personally, if you don't mind my asking? I've read some of his work and am a great admirer.

> > Remain an admirer from afar.

> Yes...?

I guess it's a personal thing. You might interact with him very well. Maybe he has changed over these last 16 years. At the time, though, I was not alone in my perception. However, we know how way-off that can be.

He and his team have made some major contributions. Although I haven't read closely any of his more recent work, he may be the only researcher to actually investigate the placebo response. It looked like really good stuff to me.

> > Each successive mania can be worse than the one previous. The damned thing seems to sink its claws deeper and deeper (kindling).

> This is my experience with recurrent depression also: the episodes get worse and closer together.

You have to attack it early and you have to attack it hard.

At least you have periods of remission. I've been stuck since 1982. Every second of every minute of every hour of every day of every...
[sorry for the complaining]

> > Not only that, but the following depression(s) can be more resistant to treatment.

> That happened to me, sorta: I stopped Prozac after taking it for 2 or 3 years, then when I tried it again it no longer worked (and I went through a long succession of meds).


There was some concern a few years ago that a similar thing may happen with lithium. The phenomenon has been labelled "lithium-discontinuation-induced lithium-refractoriness". There are people who have remained free of bipolar episodes for years while taking lithium, only to relapse soon after discontinuing it (especially upon abrupt discontinuation). When the lithium is restarted, there are some for whom it no longer works. I know someone who this happened to.

----------------------------------

Just for a start:

Post RM, et al.

Lithium-discontinuation-induced refractoriness: preliminary observations.
Am J Psychiatry. 1992 Dec;149(12):1727-9.
PMID: 1443252; UI: 93072508.

Terao T, et al.

Refractoriness induced by lithium discontinuation.
Am J Psychiatry. 1993 Nov;150(11):1756. No abstract available.
PMID: 8214199; UI: 94027491.

Bauer M.

Refractoriness induced by lithium discontinuation despite adequate serum lithium levels.
Am J Psychiatry. 1994 Oct;151(10):1522. No abstract available.
PMID: 7993489; UI: 94379268.

---------------------------------


> > > "As tolerated."

> > And you tolerate this?

Sorry. I meant this to be a play on words for my own amusement.

> But anyway, more specifically, I'm supposed to go up to 30 mg (as tolerated) until I next see my pdoc (Tuesday). This is assuming the pharmacy even gets the stuff by then (as of 6pm today it hadn't come in).

30 mg for me too.


See ya...

Scott

 

Re: Marplan success stories?

Posted by Elizabeth on November 18, 1999, at 13:07:20

In reply to Re: Marplan success stories?, posted by Scott L. Schofield on November 18, 1999, at 12:21:05

> At the time, I regarded it as a cop-out. It seemed he was hedging his bets. That way, his diagnosis would be, at worst, partially correct.
>
> Since then, I have begun to see where he was coming from.

Care to share with me?

> I guess it's a personal thing. You might interact with him very well. Maybe he has changed over these last 16 years. At the time, though, I was not alone in my perception. However, we know how way-off that can be.

What *was* your perception? (email me if you don't feel like posting it; my address is (embarrassment) shapere@aol.com)

I should warn you that Columbia is one of my top choice med schools (assuming I actually get through organic chemistry...I'll let you know how the test I have tonight goes!), so I may not be able to take your advice (to remain an admirer from afar)!

> He and his team have made some major contributions. Although I haven't read closely any of his more recent work, he may be the only researcher to actually investigate the placebo response. It looked like really good stuff to me.

That's what I was thinking of, yes.

> You have to attack it early and you have to attack it hard.

Early I got (age 14). Hard...eh, I waffled some. Since my doc was pretty sure it was a first or second episode, he went with conventional wisdom and had me stay on the Prozac for a little more than 2 years (so that I wouldn't be off it when I went to college). I stopped towards the end of my freshman year of college. I had a relapse a couple years later, but Prozac didn't work anymore.

> At least you have periods of remission. I've been stuck since 1982. Every second of every minute of every hour of every day of every...
> [sorry for the complaining]

You have good cause.

> There was some concern a few years ago that a similar thing may happen with lithium. The phenomenon has been labelled "lithium-discontinuation-induced lithium-refractoriness".

That's rather unwieldy! (I've heard of the phenomenon, though.)

> Sorry. I meant this to be a play on words for my own amusement.

I suspected as much. :-)

> > But anyway, more specifically, I'm supposed to go up to 30 mg (as tolerated) until I next see my pdoc (Tuesday). This is assuming the pharmacy even gets the stuff by then (as of 6pm today it hadn't come in).
>
> 30 mg for me too.

I think the updated prescribing info recommends 50mg or more (if it's used as monotherapy), FWIW.

 

Re: Marplan success stories?

Posted by JohnB on November 19, 1999, at 8:36:07

In reply to Marplan success stories?, posted by Scott L. Schofield on November 15, 1999, at 8:41:56

Hi, Scott. Have taken both Nadil (60 mg/day) and Parnate (40 up to 90 mg/day) for social phobia. Recently took Marplan 60 mg/day. I stopped the Marplan because I did not notice any significant efficacy for social phobia, and it did cause anorgasmia. Bupropion adjunctive therpay may have addressed this - I just didn't give it a try.

HOWEVER, you should note that I noticed a significant mood enhancing effect on Marplan which I have never noticed on any other drug, whether SSRI, SNRI, MAOI, benzo, etc. I was much more tolerant, patient, easy going, etc. Probably the experienced the best relationships with my children for some time. I may later go back to Marplan, and see if there's some chance to offset the anorgasmia, again, with something like Bupropion or a dopamine agonist.

Best of luck.

JohnB :)

 

Re: Marplan success stories?

Posted by Scott L. Schofield on November 19, 1999, at 10:01:17

In reply to Re: Marplan success stories?, posted by JohnB on November 19, 1999, at 8:36:07

> Hi, Scott. Have taken both Nadil (60 mg/day) and Parnate (40 up to 90 mg/day) for social phobia. Recently took Marplan 60 mg/day. I stopped the Marplan because I did not notice any significant efficacy for social phobia, and it did cause anorgasmia. Bupropion adjunctive therpay may have addressed this - I just didn't give it a try.

You have to trust me on this one. It goes away. You just have to keep trying. Eventually, it will come.

> HOWEVER, you should note that I noticed a significant mood enhancing effect on Marplan which I have never noticed on any other drug, whether SSRI, SNRI, MAOI, benzo, etc.

Thanks. That sounds very encouraging.

I just spoke to my doctor yesterday, and he described a patient with a similar story.

Do you have problems with concentration, memory, and energy. If so, how did these symptoms respond to Marplan?

Did you feel smarter?

> I was much more tolerant, patient, easy going, etc. Probably the experienced the best relationships with my children for some time.

God bless.

> I may later go back to Marplan, and see if there's some chance to offset the anorgasmia, again, with something like Bupropion or a dopamine agonist.

No guarantees of course, but hopefully the anorgasmia will disappear as it has for me with MAOIs in the past.


> Best of luck.

Like-wise.


- Scott


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