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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by GeorgeM on November 21, 1999, at 15:03:43
hello. i've been on marplan 80 mg/day for three months, now. it's been terrific for my social phobia. have not had to rely on benzodizepines once i stepped up to 80 mg/day. A very, very positive benefit has been the effect upon my mood. am much more patient, at ease, relazed, etc. around my few young children, and also at work. i really feel i'm a better person when i'm on marplan, and i'm not talking about depression - i'm must more patient, understanding, and so forth. i also suffer less from "disinhibition" than when i was on either nardil or parnate - i.e., talking out of place, being too talkative, not being as aware of social or career consequences from speaking up and taking certain unpopular positions.
In terms of side effects, i was initially a little lethargic, but 15 mg/day pindolol cured that (5 mg tid). i've had no erectile or libido difficulties, only very delayed or absent orgasm. pergolide (dopamine agonist) is supposed to work wonders for this. i'll have to be sure to speak with my psychdoc about this at next visit.
don't mean to overstress the "better person" aspects of marplan, but it was not something i experienced either with nardil, parnate, or high dose selegiline.George
Posted by Scott L. Schofield on November 22, 1999, at 8:37:26
In reply to Marplan - social phobia and well-being, posted by GeorgeM on November 21, 1999, at 15:03:43
Hi GeorgeM.
> i've been on marplan 80 mg/day for three months, now.
How long did it take you to work up to 80 mg?
Thanks.
- Scott
Posted by George M on November 22, 1999, at 22:32:06
In reply to Re: Marplan - social phobia and well-being, posted by Scott L. Schofield on November 22, 1999, at 8:37:26
Scott - it took me about one month. My family and others have notice a tremendous change, for the better, in irritability, patience, understanding, sympathy, etc. I've never been diagonosed for depression, but this just makes me seem like i'm a better person.
Are you using it for social phobia? Does it also work for you? I've heard clonidine and marplan are very effective at blocking gaba receptors. Might be a better combination than pindolol and marplan.
Lastly, have you found any effective treatment for anorgasmia?
Thanks,
George
Posted by Scott L. Schofield on November 27, 1999, at 17:43:49
In reply to To: Scott Marplan titration, clonidine, orgasm, posted by George M on November 22, 1999, at 22:32:06
> Are you using it for social phobia? Does it also work for you? I've heard clonidine and marplan are very effective at blocking gaba receptors. Might be a better combination than pindolol and marplan.
>
> Lastly, have you found any effective treatment for anorgasmia?First things first. You couldn't possibly be asking any more wrong a person regarding anorgasmia with MAO-inhibitors. I committed the cardinal sin of applying my own experiences to everyone else. I was politely reprimanded for doing so. Anyway, when I saw some people posting their experiences with anorgasmia as an MAOI side-effect, I posted a question to get an idea as to how pervasive a problem it is. It really wasn't meant to be any kind of 'study', but I was truly taken back at how many people replied that they had some big-time trouble reaching orgasm.
Follow the thread starting from:
My newly prescribed "social phobia" meds - fyiI think you'll find some good answers to your questions there.
(Feel free to disregard my "make-ass" comments and subsequent replies).I've been on Marplan for a little over two weeks at a dosage of 30mg per day. Nothing yet. I haven't noticed any substantial side-effects either. Some people here have posted that they were taking 50 to 80 mg/day, so there is still room for hope.
I suffer from chronic bipolar depression that's pretty heavy-duty. Nardil and Parnate were only partially effective, even when combined with a tricyclic, amphetamine, and thyroid at the same time. Social-phobia was a real big part of things early on. I don't know - maybe I no longer have enough energy to be phobic about anything. After a little mental rearranging, I seem to be left with something less than phobia but bigger than a bread-box. The French have called this sort of thing "l'inhibition". I certainly do feel inhibited around others.
I'm keeping pindolol on my short-list of things to add to an MAOI.
A combination of buspirone and pindolol seems interesting also. As far as clonidine having GABAergic effects, you've got me curious, so I think I'll look into that.I'll post every now and again to let you know how I'm doing.
Thanks.
- Scott
Posted by Mark on November 29, 1999, at 10:04:12
In reply to Re: To: Scott Marplan titration, clonidine, orgasm, posted by Scott L. Schofield on November 27, 1999, at 17:43:49
Did Marplan work better for your social phobia George than Parnate or Nardil? Which of the three works the best, and which of them caused weight gain?
Posted by GeorgeM on November 30, 1999, at 22:02:04
In reply to Marplan and weight gain?, posted by Mark on November 29, 1999, at 10:04:12
> Did Marplan work better for your social phobia George than Parnate or Nardil? Which of the three works the best, and which of them caused weight gain?
hi, mark. so far, i'd say nardil, as monotherapy, was the definitive winner in terms of treatment. however, at an effective dose (60 mg/day), i experienced 100% erectile dysfunction and anorgasmia. nardil weight gain started at about the third week. understand from some follow-on research that the weight gain is thought to be attributable both to an increase in carbohydrate craving as well as a decrease in metabolic rate.
in contrast, parnate was stimulating (i had insomnia the first several days - likely started a too high a dose). no weight gain on parnate - i actually lost about 7 lbs that i really couldn't afford to lose. parnate was only partially effective in treating my social phobia, even dosing up to 90 mg/day (well in excess of recommended 60 mg/day max). in fact, as monotherapy, parnate seem to be no better than placebo. only when augmented by low dose klonopin (2 mg/day) did i realized a combined benefit of both. klonopin 2 mg/day monotherapy is sub-therapeutic, at least for me. so, parnate has a definite benefit, it's just not to the degree of nardil. i'd say it's about 20-30% of what nardil gave me. parnate also caused an extremely dry mouth. i always had a water bottle or diet coke in my hand at work. also, i've been on and off parnate several times: i like the therapeutic benefit of nardil, but go off it when i can no longer stand the weight gain and sexual dysfunction; then, i start parnate, and eventually have gone off that after i lose the weight and can take the dry mouth and lack of efficacy. the last time i started parnate, my wife almost immediately recognized a slowing of my speech. not a slurring, which could indicate "serotonin syndrome." she likened it to an old '45' record being played on '33' album speed. that made me think of some things when i was originally on parnate, and i recall co-workers mentioning the slow pace of my voice mails. when not on parnate, i'm consider a fast talker. but, the last time must have been much more noticeable. sometimes psychotropic drugs may act differently on subsequent usage, or have prolonged continuous use.
as far as marplan, still a little early to tell. my feeling is it's about halfway between parnate and nardil, at least so far. i'll give the 80 mg/day dose another month or two before i make final judgment. no dry mouth or sexual problems, now, although i did have some delayed orgasm between weeks 2 and 4. seems to have disappeared. interesting . . . . also, no weight gain. in fact, i think i've lost about 2 lbs. if the efficacy at 80 mg/day gets close to the nardil, i'll consider this a social phobia "wonder drug." in the meantime, i also augment this with klonopin. i probably should also consider pindolol augmentation. well . . . at least there's something to talk to my doc about in a few months. however, most interesting and surprising of all is the effect upon my overall mood. it's almost as if nothing can get me irritated or annoyed - a very enviable trait from my perspective. on an even more subtle note, i haven't noticed the disinhibition of nardil and parnate. that is, there isn't the desire to speak up in all circumstances, such as when it's not socially or career-wise the smart thing to do.
hope this helps. george
Posted by Mark on November 30, 1999, at 23:32:18
In reply to To Mark, Re: Marplan and weight gain?, posted by GeorgeM on November 30, 1999, at 22:02:04
Thanks a lot George. Keep me updated on how Marplan works out for you. I have this problem where I can't smile when I'm talking to people without my lips trembling. It is the worst symptom ive ever had, and i desperately want to get rid of it. Hope an MAOI will help.
Posted by GeorgeM on December 2, 1999, at 8:40:06
In reply to Re: To Mark, Re: Marplan and weight gain?, posted by Mark on November 30, 1999, at 23:32:18
> Thanks a lot George. Keep me updated on how Marplan works out for you. I have this problem where I can't smile when I'm talking to people without my lips trembling. It is the worst symptom ive ever had, and i desperately want to get rid of it. Hope an MAOI will help.
Hi, Mark. Your welcome. Your mentioning your lips trembling reminded me of some symptoms I've had. Of course, there's always the shaky voice and trembling hands when presenting. Nothing ever struck me as so embarrassing as seeing someone else's hands tremble when using an overhead projector, and the movement being projected onto a large screen. I'm sure most of the audience probably didn't notice, but I died thinking that that's how I probably look. Further, I have been terribly embarrassed waiting to urinate in a long line at a football game or other large event, especially where there aren't any partitions between urinals, and find that I just can go, because I feel there are people watching an listening. I guess this is another form of "choking" or "freezing," just like I've experienced in giving presentations.
Enough rambling. As far as my recommendation, I think you really should at least condider giving Nardil a try. It is almost universally effective, I understand. I also believe no other drug has been shown to be as effective as Nardil in any double-blind, controlled, large sample size studies. As far as the side effects, I believe they vary quite a bit from individual to individual. Though some drugs, of course, have side effects which are more common among users. You won't know until you try. In fact, some people have told me that have experienced weight loss and increased libido while taking Nardil.Also, regarding side effects - one reason so many different drugs are used is because people seem to respond differently, both in terms of efficacy of the medication and side effects. Another reason, of course, is ignorance on the part of general practitioners and some non-psychopharmacologist psychodocs. With what I now know, and based upon my experiences, I think it's unfortunate that some people rely on their general practitioners to prescribe psychotropic meds. This is a generalization, of course, and I'm sure some gp's are very knowledgable and competent in prescribing psychotropic drugs. I just haven't run across any, and I feel I'm infinitely more knowledgable about the research and efficacy of most psychotropic drugs than most gp's. It's just not their specialty or are of training.
In terms of the so-called "cheese" effect of MAOI's, I should share my experiences with you. I have found the concern to be overblown, at least regarding certain foods. For instance, I drink lite beer and regular beer, and also drink white wine and champagne. I also eat plenty of pizza, grilled cheese sandwiches, etc. I do stay away from dark beer, red wine, and any AGED CHEESES. I also have followed the contraindications regarding various cold medications. Further, I also communicate to my dentist and physician that I am taking an MAOI. There can be life-threatening interactions between an MAOI and certain other drugs, including certain anesthetics and pain killers. Many say it's a good idea to carry a bracelet or some identification in your wallet indicating that you're taking an MAOI, should you ever be injured in an accident, taken to the emergency room, and not be in a condition to speak before you are treated.
One last comment - as I continue to seek the 95% solution to my social phobia (I'm not sure there's a 100% solution), I consider going back to Nardil, with maybe pindolol augmentation, or asking my psychopharmacologist about other drug augmentation to combat the side effects I experienced.
He did very cautiously have me on a combination of Parnate and Burpopion. Keep in mind that this is contraindicated in the legal/consumer drug information. Nevertheless,he and other experienced psychopharmacologists have managed this and feel comfortable prescribing it. I would say if your psychdoc is not an experienced psychopharmacologist, he or she will likely be quite conservative in his/her prescribing habits.
See you, Mark. Please post your experiences.
GeorgeM
Posted by Mark on December 2, 1999, at 12:31:50
In reply to Mark, you really should give Nardil a try, posted by GeorgeM on December 2, 1999, at 8:40:06
George,
Thanks a lot for the info. I really want to start Nardil, but im afraid about the weight gain. Ive already gained about 30 lb from Zyprexa in the past. Do you think that some sort of add-on drug could counteract the weight gain effect, while still providing the anti-anxiety benefits? I'm thinking some drug that speeds up metabolism. Maybe Xenical or something. Also, do the MAOIs give a person increased self-confidence, like the SSRIs do, and generally create the same personality changes that Peter Kramer talked about in Listening to Prozac (if you aren't familiar with this, just do an Internet search. It should give you all the info about this that you need.) Thanks again, George.
Posted by Scott L. Schofield on December 12, 1999, at 13:30:47
In reply to Mark, you really should give Nardil a try, posted by GeorgeM on December 2, 1999, at 8:40:06
> In terms of the so-called "cheese" effect of MAOI's, I should share my experiences with you. I have found the concern to be overblown, at least regarding certain foods. For instance, I drink lite beer and regular beer, and also drink white wine and champagne. I also eat plenty of pizza, grilled cheese sandwiches, etc. I do stay away from dark beer, red wine, and any AGED CHEESESIt might be "overblown", but it should still be respected. There have been plenty of cases in which someone has eaten a particular forbidden food for years, only to have a severe hypertensive reaction to that same food later on.
I have eaten pizza plenty of times. I was told by one of my previous doctors that the cheap processed mozzarella was O.K., but to stay away from most others, especially aged cheeses. I always ask if any other cheeses are used. Often, parmesan cheese is used in the sauce. I consider parmesan to be dangerous, and never eat it. I wouldn't recommend that anyone eat any pizza just because I have not had a reaction to it.
What I did have a reaction to is pepperoni. I have always avoided it, but got careless one day when it was busy at work. I accidentally ate ONE AND A HALF thin slices of pepperoni on pizza before I realized what I had done. My first reaction was to say to myself "what the f_ck am I doing!" Within two or three minutes, I began to get THE headache. It is a hard and painful pounding at the back of the head where it meets the neck. The pounding seems to occur with each heartbeat. It's real scary. I found that if I remained standing, the pain would lessen. Even after it pretty much disappeared, it would start again if I sat down.
It was the real thing.
I have carried some Procardia (nifedapine?) with me in the past to help mitigate a hypertensive event. I don't know why I don't anymore except that I might be suffering from the dummy syndrome. I think I'll ask my doctor for some next time I see him. Ideally, it would be better to have some oral phentolamine (Regitine) handy. This drug used to be available in oral form, but is now only available as an injectable. I believe it is currently being investigated for treating erectile dysfunction (competing with Viagra). If it is approved, an oral form will again be available. It should be, as I have read some stuff indicating that it is superior to Viagra.
- Scott
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