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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 Elizabeth on December 2, 1999, at 20:51:27
People who take or have taken Marplan: what dose are you taking/did you take, and is/was it effective at that dose?
(I'm taking 40 mg/day, can't tell yet if it's working.)
Posted by JohnB on December 2, 1999, at 23:07:08
In reply to Marplan survey, posted by Elizabeth on December 2, 1999, at 20:51:27
Hi, Elizabeth. I've been on Marplan for about a month, but have only recently moved up from 40 mg/day to 80 mg/day, as I, too, was not experiencing any therapeutic effect at 40 mg. It's still too early to tell if 80 mg/day is going to work. I'll let you know in a few weeks. I guess there's always the potential of augmenting with pindolol or something else.
On a side note, I'm tired of trying new meds. I really haven't found anything other than Nardil and Klonopin to be effective, yet Nardil's side effects were terrible . . . . . and yet, it worked so well. Argh!!! Also, my psychodoc and I have been experimenting with too many meds recently - gabapentin, buspirone, celexa, remeron, bupropion/parnate combination, Klonopin/Pindolol/Buspar combination, ad nauseum. I feel like a laboratory guinea pig.
By the way, I haven't tried Serzone (generic name Nefazodone), though some people have indicated that it is effective. The recent research on Medline, particular a study by Van Ameringen, et. al, seem to suggest that it's effective. The Van Ameringen study seems to have had the highest sample size of any research I've been able to find. The authors refer to a 69.6% rate for "moderate or marked improvement," but I'm not sure what this means. In most studies, the authors seem to reference only % marked improvement. I don't want "moderate improvement." Been there, done that, as the saying goes. I've copied and pasted the article's medline abstract, below.
In the meantime, I promise to post if I stay on Marplan long enough at 80 mg/day to see if it's effective. As you can see, I'm losing my patience in trying to find something therapeutic, yet without intolerable side effects. In fact, I'm thinking of having a serious discussion with my psychdoc about seeing what antidotes might be available for Nardil induced weight gain and sexual dysfunction. Perhaps amantadine or bromocriptine . . . . . . . . . Better get back in my laboratory cage.
See you. JohnB :)
-----------------
Nefazodone in social phobia.Van Ameringen M, Mancini C, Oakman JM
Anxiety Disorders Programme, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada. vanamer@fhs.mcmaster.caBACKGROUND: A variety of drug treatments have been shown to be effective in the treatment of social phobia. This study attempted to assess the efficacy of nefazodone, a new novel serotonergic drug, in the treatment of social phobia. METHOD: Nefazodone was administered to 23 patients who had a primary DSM-IV diagnosis of social phobia, generalized type (diagnosed by the Structured Clinical Interview for DSM-IV), in a 12-week open clinical trial. Treatment began at 100 mg of nefazodone daily and was increased according to clinical response and side effects. Patients completed self-report measures at baseline and at weeks 4, 8, and 12. These measures included the Fear of Negative Evaluation scale, the Social Avoidance and Distress scale, the Social Anxiety Thoughts Questionnaire, the Fear Questionnaire, the State-Trait Anxiety Inventory, the Beck Depression Inventory, the Social Adjustment Scale Self-Report, and the Sheehan Disability Scale. Clinicians completed the Liebowitz Panic and Social Phobic Disorders rating form and the Brief Social Phobia Scale. RESULTS: Twenty-one of the 23 patients completed the 12-week trial. Sixteen (69.6%) were considered responders (moderate or marked improvement), and 7 (30.4%) were considered to be nonresponders (minimal improvement or no change in symptoms). Measures of social anxiety, social phobic avoidance, depression, and social functioning showed a statistically significant change at endpoint. CONCLUSION: These findings support a role for nefazodone in the treatment of social phobia, generalized type. Controlled studies will be required to further investigate this preliminary finding as well as to compare nefazodone with other pharmacologic treatments of social phobia.
Publication Types:
Clinical trial
PMID: 10084635, UI: 99182126
Posted by Judy on December 3, 1999, at 9:44:30
In reply to Marplan survey, posted by Elizabeth on December 2, 1999, at 20:51:27
> People who take or have taken Marplan: what dose are you taking/did you take, and is/was it effective at that dose?
Hi Elizabeth
I took Marplan this past summer. At 40 mg/day, I felt almost no effects at all - good or bad - and I requested that my dosage be increased to 60 mg/day. After several days at 60, some benefits became apparent: increased energy, lessening of depression. Had I been able to stay at 60 mg/day, it might have been a good drug for me, BUT...
As with Nardil at theraputic dose, I lost the ability to function sexually on Marplan, had difficulty urinating and more serious edema than with Nardil - my eyes were swollen shut in the morning, my feet and ankles were outrageous by midday and the rest of my body looked generally bloated and unlike my normal body. My doctor would not recommend a diuretic for fear of dangerously lowering my BP.
The absolute worst side effect, and the one that ultimately chased me away from Marplan, was the nocturnal myoclonus that began occuring at 60 mg/day. I'm not talking about a couple of twitches while falling asleep. These were siezure-like jerks occuring every 15 seconds in every conceivable muscle - one muscle at a time! It was frightening! A friend started Marplan two weeks after I did and she began suffering myoclonus at 40 mg/day. Since our reactions to most AD's are usually 180-degree opposites, I wondered if the myoclonus was a 'universal' side effect; and I was surprised that JohnB didn't mention experiencing it at 80 mg/day.
I know you're interested in weight gain and I can report that I didn't gain immediately and fast as I did on Nardil. I put on about eight pounds during the eight or so weeks I took Marplan, but that was fluid retention - it disappeared as soon as I stopped Marplan and my urinary system began to function normally again.
My conclusions for you: I think you need to increase your dose upwards of 40 mg/day. We *know* you won't suffer sexual dysfunction! If you're not prone to edema, that probably won't be a problem so I don't think you'll find weight gain to be a problem. Myoclonus? Who knows - but maybe there is something you can take to counteract that if it becomes troublesome.
That's the best info I can provide after a relatively short-lived stay on Marplan. Good luck with it!
Judy
Posted by Elizabeth on December 4, 1999, at 9:58:07
In reply to Re: Marplan survey, posted by Judy on December 3, 1999, at 9:44:30
> My conclusions for you: I think you need to increase your dose upwards of 40 mg/day. We *know* you won't suffer sexual dysfunction!
I hate to tell you, but it looks like this is the one drug that does that to me! Time to ask my doc for some Buspar or something, I guess.
> If you're not prone to edema, that probably won't be a problem so I don't think you'll find weight gain to be a problem.
It seems okay so far. I'm losing some of the weight I gained on nortriptyline.
> Myoclonus? Who knows - but maybe there is something you can take to counteract that if it becomes troublesome.
I wonder about vitamin B6 for this. Tried it?
Posted by Judy on December 4, 1999, at 11:36:51
In reply to Re: Marplan survey, posted by Elizabeth on December 4, 1999, at 9:58:07
> I hate to tell you, but it looks like this is the one drug that does that to me!No! Say it isn't so! My faith has been shaken to its roots! If you managed to sneak past Nardil without sexual dysfunction, I figured even spinal anesthesia wouldn't stop you!!! (BTW, Viagra seems to be indicated for use with MAOI's and I've heard positive things about it. Expensive though - depends how desperate you are, I guess.)
> > Myoclonus?
>
> I wonder about vitamin B6 for this. Tried it?As a matter of fact, I was taking 100 mg/day of B6 with Magnesium in a futile attempt to alleviate constipation, so I know that amount of B6 wasn't helpful.
Posted by dc on December 11, 1999, at 7:38:13
In reply to Re: Marplan survey, posted by Elizabeth on December 4, 1999, at 9:58:07
There is a supplement made by Solgar caled B p-5-p. Pyridoxal-5-phosphate. Basically, it's a form of B-6 that is more readily absorbed. Also, for constipation try adding around 3 grams of vitamin C (preferably Ester C) to the magnesium. B-6 will not help with constipation.
Posted by Scott L. Schofield on December 12, 1999, at 14:37:38
In reply to Marplan survey, posted by Elizabeth on December 2, 1999, at 20:51:27
> People who take or have taken Marplan: what dose are you taking/did you take, and is/was it effective at that dose?
>
> (I'm taking 40 mg/day, can't tell yet if it's working.)I had been increased to 50 mg/day this past week. Within a few days I began to feel foggy and incoherent. I also found myself sleeping all day. I have not experienced any antidepressant effect, so I'm going to ask my doctor to take me off it. I'll probably go back to Nardil and hope that I can successfully augment it with something else - I don't know what.
This sucks.
I remember seeing one post in particular that described not responding until his dosage was increased from 50 mg/day to 80 mg/day.
I hope things work out for you.
- Scott
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