![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by SLS on December 16, 2006, at 6:36:52
Hi all.
I increased my dose of Nardil from 60mg to 75mg a few days ago.
I am beginning to respond. The antidepressant effect is unmistakable.
Yay!
I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
Currently:Nardil 75mg
nortriptyline 100mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
- Scott
Posted by saturn on December 16, 2006, at 7:52:33
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
Posted by Emme on December 16, 2006, at 8:02:09
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
Yay!!!!!!!!!
em
Posted by Meri-Tuuli on December 16, 2006, at 9:01:24
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Emme on December 16, 2006, at 8:02:09
Thats great news Scott. Really great. Enjoy!!
Posted by blueberry1 on December 16, 2006, at 9:07:44
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
Very cool! I wish blessings upon you that goodness will continue to increase.
Posted by Phillipa on December 16, 2006, at 9:56:56
In reply to Re: Nardil + nortriptyline is working., posted by blueberry1 on December 16, 2006, at 9:07:44
Scott that's great!!!!You've waited so long. I'm so happy for you. Love Phillipa
Posted by Crazy Horse on December 16, 2006, at 15:11:13
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
> Hi all.
>
> I increased my dose of Nardil from 60mg to 75mg a few days ago.
>
> I am beginning to respond. The antidepressant effect is unmistakable.
>
> Yay!
>
> I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
>
>
> Currently:
>
> Nardil 75mg
> nortriptyline 100mg
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> - ScottFantastic!!! Best wishes, thoughts, prayers, etc. for you Scott.
-Monte
Posted by Tomatheus on December 16, 2006, at 19:19:02
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
> I am beginning to respond. The antidepressant effect is unmistakable.
Scott,
That's great to hear! I hope that your response lasts.
I'm wondering, did you notice any significant AD effect from Nardil at 60 mg, or is this the first clear sign of a response that you've had since starting Nardil this time around?
Tomatheus
P.S. I still own you a Nardil-related post from ages ago. I started writing it when I had a small trace of energy, and then I fell back into my "normal" state of extreme psychomotor retardation and couldn't add a word to it. If you're still interested, I can finish it up.
Posted by SLS on December 16, 2006, at 20:06:40
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Tomatheus on December 16, 2006, at 19:19:02
> > I am beginning to respond. The antidepressant effect is unmistakable.
>
> Scott,
>
> That's great to hear! I hope that your response lasts.
>
> I'm wondering, did you notice any significant AD effect from Nardil at 60 mg,Yes, but it plateaued and dissipated somewhat.
> P.S. I still own you a Nardil-related post from ages ago. I started writing it when I had a small trace of energy, and then I fell back into my "normal" state of extreme psychomotor retardation and couldn't add a word to it. If you're still interested, I can finish it up.
When you have the energy, I'd be interested. However, it wouldn't be important enough for you to struggle over it right now. I'm sorry to hear that you are so severely ill. Psychomotor retardation is a reliable index of illness severity. I suffer from it greatly.
- Scott
Posted by Phillipa on December 16, 2006, at 20:55:24
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 16, 2006, at 20:06:40
Scott what happens when you start to respond? How do you feel different. Love Phillipa ps what do you do different?
Posted by UgottaHaveHope on December 16, 2006, at 23:36:31
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Phillipa on December 16, 2006, at 20:55:24
What is the logic behind it? Nardil alone, wouldnt work? What do the other drugs do? It makes my day to hear that you are feeling better. Michael
Posted by snapper on December 17, 2006, at 1:21:24
In reply to Scott how did you come up with this combo?, posted by UgottaHaveHope on December 16, 2006, at 23:36:31
Scott I wish you nothing but continued success. Thanks for the update.
Snapper
Posted by SLS on December 17, 2006, at 6:07:27
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Phillipa on December 16, 2006, at 20:55:24
> Scott what happens when you start to respond? How do you feel different.
I have more mental and physical energy. I become more socially motivated with less social anxiety. I become more motivated toward activity in general and enjoy things more. My thinking becomes more positive without effort. Food tastes better. Music sounds better. Colors seem more intense. My memory is better. My thoughts are quicker and clearer.
> ps what do you do different?
Clean my apartment.
Go out with friends.The degree of improvement as of now is only mild, but it is there. I am still scared that it won't develop into something more robust or persistent. I guess my history of brief responses to antidepressants leads me to have this apprehension. Still, I am somewhat optimistic.
- Scott
Posted by SLS on December 17, 2006, at 6:22:55
In reply to Scott how did you come up with this combo?, posted by UgottaHaveHope on December 16, 2006, at 23:36:31
> What is the logic behind it? Nardil alone, wouldnt work? What do the other drugs do? It makes my day to hear that you are feeling better. Michael
Well, MAOIs alone have produced only partial responses at best. TCAs have produced either robust brief responses or persistent partial responses when combined with Lamictal. The only thing that ever got me well was a combination of Parnate + desipramine in 1987. Unfortunately, that combination was errantly discontinued and doesn't work anymore. Fortunately, despite concerns regarding the induction of serotonin syndrome, I was able to convince my doctor to go along with the Nardil + nortriptyline combination. Fortunately, I had already tried Parnate + nortriptyline with him, so it was hard for him to say no. Now, all I have to do is to convince him to raise the dosage to 90mg in a few weeks if necessary.
For now, I would say that the two main TCAs to avoid with Nardil are imipramine and clomipramine. Desipramine and nortriptyline seem safe.
I'm not sure I answered your question. I guess a TCA won't work if there isn't enough neurotransmitter around that an inhibition of reuptake would significantly increase synaptic concentrations. An MAOI would help provide an increase in the amount of neurotransmitter available by preventing its breakdown.
- Scott
Posted by UGottaHaveHope on December 17, 2006, at 18:51:52
In reply to Re: Scott how did you come up with this combo? » UgottaHaveHope, posted by SLS on December 17, 2006, at 6:22:55
Scott: What did Nardil or Parnate alone do for you? Do you recommend it?
Posted by Tomatheus on December 18, 2006, at 0:29:22
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 16, 2006, at 20:06:40
> > I'm wondering, did you notice any significant AD effect from Nardil at 60 mg,
>
> Yes, but it plateaued and dissipated somewhat.Shoot. I was afraid of that. I had a similar response to the film-coated Australian Nardil at 75 mg/day before I started preparing the tablets in enteric capsules like Michael Bell was doing for a while with the U.S. Nardil (to make a long story short, I then went into complete remission for about a month, lost my response completely and noticed an abrupt increase in side effects after receiving a Nardil bottle without any silica gel inside of it, tried the enteric-capsule approach with the U.S. Nardil, experienced a consistent-but-only partial response for about two months, had severe panic attacks shortly after receiving what was probably a "bad lot" of Nardil from my pharmacy, and finally gave up on the medication entirely).
At 60 mg/day of the film-coated Australian Nardil, my response also followed the same type of pattern (with the plateau and subsequent dissipation), but in my case, the AD effect was hardly noticeable. I had to get up to 75 mg/day before I started feeling noticeably improved.
Of course, just because I couldn't get a lasting response (anything longer than about two weeks) from film-coated Nardil at 60 or 75 mg/day doesn't mean that you won't from 75 or 90 mg/day of the medication. Even though you only experienced short-term relief at 60 mg/day, maybe the effects of the nortriptyline, Lamictal, Topamax, and Abilify that you're taking will somehow mix well with the effects of 75 mg/day of Nardil to produce a nice long-term effect. So, I think there's still some reason to be optimistic, despite the fact that the dissipation of Nardil's AD effect that you experienced at 60 mg/day doesn't seem to be a good sign.
> > P.S. I still own you a Nardil-related post from ages ago. I started writing it when I had a small trace of energy, and then I fell back into my "normal" state of extreme psychomotor retardation and couldn't add a word to it. If you're still interested, I can finish it up.
>
> When you have the energy, I'd be interested. However, it wouldn't be important enough for you to struggle over it right now. I'm sorry to hear that you are so severely ill. Psychomotor retardation is a reliable index of illness severity. I suffer from it greatly.I've actually been feeling ok for most of the past week on a combination of the Goldshield Parnate (20 mg/day) and SAM-e (200 mg/day). I don't feel quite as upbeat as I did when I was in remission on 75 mg/day of my partially homemade enteric version of the Australian Nardil, and my thinking still feels somewhat clouded a lot of the time due to what I think is probably some residual fatigue. But I've been more or less functional for several days now, and I've actually been able to keep my sleep-wake pattern from falling out of whack, which is a lot more than I can usually say. I have some reason to believe that the right dose of SAM-e (hopefully the 200 mg/day) may allow me to get a lasting response from the Goldshield Parnate instead of the 2-3 day tease that I usually get from it, but it's far too early for me to declare victory. Time will tell what my long-term response will be.
At any rate, if the partial response that I'm experiencing right now continues for at least another few days, I'll get that message of mine finished up when I get the chance.
Tomatheus
Posted by SLS on December 18, 2006, at 5:55:36
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Tomatheus on December 18, 2006, at 0:29:22
Hi Tomatheus
> So, I think there's still some reason to be optimistic, despite the fact that the dissipation of Nardil's AD effect that you experienced at 60 mg/day doesn't seem to be a good sign.
Part of me agrees with you. I think I may already be plateauing on the 75mg, but I'm going to give it another 2 weeks. After all of these years, it is hard not to look at these responses microscopically. In retrospect, macroscopically, it may be that these are just a few down days on an overall trend upwards. I'll try to remain cautiously optimistic. My treatment history tells me to be somewhat pessimistic, though.
> I've actually been feeling ok for most of the past week on a combination of the Goldshield Parnate (20 mg/day) and SAM-e (200 mg/day).
Interesting combination. It makes sense. I received a boost from S-AMe for the short time I took it with Parnate. I didn't continue with it because my system was very unstable at the time, and I was about to see a new doctor. I wanted to leave him with as simple a regime as possible to work with.
> I have some reason to believe that the right dose of SAM-e (hopefully the 200 mg/day) may allow me to get a lasting response from the Goldshield Parnate instead of the 2-3 day tease that I usually get from it,
It really is a tease, isn't it?
I think our brains have been entrained to maintain an errant homeostasis, and does a damned good job at doing so.
> but it's far too early for me to declare victory. Time will tell what my long-term response will be.
Yup. I hope you don't mind if I send a few prayers your way.
Take care.
- Scott
Posted by SLS on December 18, 2006, at 6:21:01
In reply to Re: Scott how did you come up with this combo?, posted by UGottaHaveHope on December 17, 2006, at 18:51:52
Hi.
> Scott: What did Nardil or Parnate alone do for you? Do you recommend it?
The first time I tried either drug alone, I received a strong antidepressant response that didn't last for more than a month. However, I think I have demonstrated that my case is unusually resistant to treatment. I would not use it as a model to represent the average. If you have never tried a MAOI, I think it makes sense to first try one without combining it with a TCA.
Good review:
http://users3.ev1.net/~drtony/MAOIs.htm
- Scott
Posted by JerryPharmStudent on December 18, 2006, at 6:38:40
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
> Hi all.
>
> I increased my dose of Nardil from 60mg to 75mg a few days ago.
>
> I am beginning to respond. The antidepressant effect is unmistakable.
>
> Yay!
>
> I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
>
>
> Currently:
>
> Nardil 75mg
> nortriptyline 100mg
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> - Scottgreat to hear it's working - but be very careful of SS. I was on nardil and took some cough suppressant - dextromethorphan which increases serotonin and had full-blown serotonin syndomr within 15 mins. Had to be rushed to teh ER and then stay the night in intensive care - for fear that my kidneys would fail.
SS is a horrific experience - please be careful.
Posted by SLS on December 18, 2006, at 8:18:47
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by JerryPharmStudent on December 18, 2006, at 6:38:40
> > Hi all.
> >
> > I increased my dose of Nardil from 60mg to 75mg a few days ago.
> >
> > I am beginning to respond. The antidepressant effect is unmistakable.
> >
> > Yay!
> >
> > I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
> >
> >
> > Currently:
> >
> > Nardil 75mg
> > nortriptyline 100mg
> > Lamictal 150mg
> > Topamax 100mg
> > Abilify 10mg
> >
> >
> > - Scott
>
> great to hear it's working - but be very careful of SS. I was on nardil and took some cough suppressant - dextromethorphan which increases serotonin and had full-blown serotonin syndomr within 15 mins. Had to be rushed to teh ER and then stay the night in intensive care - for fear that my kidneys would fail.
>
> SS is a horrific experience - please be careful.
Thanks for your concern, Jerry. I'll be especially wary of the signs and symptoms of SS. So far, so good.
- Scott
Posted by Oppycat on December 18, 2006, at 11:15:15
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
> Hi all.
>
> I increased my dose of Nardil from 60mg to 75mg a few days ago.
>
> I am beginning to respond. The antidepressant effect is unmistakable.
>
> Yay!
Great news, Scott! I've followed your plight for many years.Michael
>
> I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
>
>
> Currently:
>
> Nardil 75mg
> nortriptyline 100mg
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> - Scott
Posted by UgottaHaveHope on December 18, 2006, at 12:44:57
In reply to Re: Nardil + nortriptyline is working. » JerryPharmStudent, posted by SLS on December 18, 2006, at 8:18:47
How likely are they to happen? Do they have meds to take in case you accidentially mix up a MAOI with something you shouldnt? Michael
Posted by Tomatheus on December 25, 2006, at 0:04:35
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 18, 2006, at 5:55:36
Scott,
See below for my responses to different sections of your post...
> > I've actually been feeling ok for most of the past week on a combination of the Goldshield Parnate (20 mg/day) and SAM-e (200 mg/day).
>
> Interesting combination. It makes sense. I received a boost from S-AMe for the short time I took it with Parnate. I didn't continue with it because my system was very unstable at the time, and I was about to see a new doctor. I wanted to leave him with as simple a regime as possible to work with.You might considering giving it another try if the addition of Nardil to your med cocktail doesn't ultimately work out for you (and I'm sorry to hear that it hasn't been as of late).
Despite the fact that I couldn't get more than an initial 3-day response out of the Goldshield Parnate as monotherapy, it does seem to be significantly more potent than the GlaxoSmithKline Parnate. When I took the GSK Parnate, I felt that charged-up stimulant effect (which was probably the result of the drug's amphetamine metabolite) for a few hours on my first two days of the drug, but it always seemed to have a powerful hypnotic effect on me in the mid to late afternoon no matter what I tried to do to combat it. I didn't give it anything close to a full trial (I stopped after about two weeks at 20 mg/day) because the sleep attacks were causing me to sleep through afternoon and evening classes that I was taking at a university at the time. Now, sleeping through morning classes was sometimes a problem for me during my college days, but sleeping through afternoon and evening classes was just too far out of the ordinary for me. But in the time that I spent on the GSK Parnate, I did not notice much of an antidepressant effect at all. Just that charged-up kind of energy for a few hours on the first two days and sleep attacks in the middle of the day every day.
Considering that I didn't give the GSK Parnate much of a trial, the fact that I didn't notice a significant antidepressant effect from it might sound like something that's just to be expected. And in and of itself, it is. After all, when I took Nardil, I didn't even start to feel its AD effect until I had been at 75 mg/day for more than a week. That was after more than a month of titrating upward and then waiting for a response at 60 mg/day. The thing is that when I took the Goldshield Parnate, I noticed a partial boost in both mood and energy on day one, an even stronger boost on day two (something that I would consider to be a partial response, but not full remission), pretty much the same thing on day three as on day two, a slightly weaker version of that same AD effect on day four, and then pretty much nothing on day five or at any point thereafter. That's the "tease" that I was referring to, and I seem to get that on a lot of meds. It sounds like you've probably also experienced it quite a bit yourself, unfortunately. Even though that "tease" effect that I had on the Goldshield Parnate may not sound like anything to get hyped up about, it was far different than the response that I had to the GSK Parnate. I did not notice *any* midday fatigue whatsoever on the Goldshield version, which was quite a surprise to me.
Interestingly, I tried taking a partially homemade version of the GSK Parnate at one point (preparing it in the enteric PlasminPlus capsules as I did at times with both the Australian Nardil and the "new" U.S. Nardil), and I responded to it in pretty much the same way that I responded to the Goldshield version. The Goldshield Parnate has an enteric coating. The GSK version does not. SmithKline Beecham changed Parnate's formulation in the early 1990s, but even the "old" U.S. Parnate did not have an enteric coating. So, I don't have any reason at this point to think that the "old" Parnate was necessarily any different from the "new" version, but I can say that based on my experience, the Goldshield version had a much more potent and consistent AD effect than the current GSK version. It wasn't consistent in terms of its effects over the long haul (not in my case, at least), but when I did feel its AD effect, it was more or less consistent over the course of a day, much unlike the GSK Parnate.
Obviously, your response to the Goldshield Parnate might not be the same as mine was, but my guess is that you'd probably notice a difference between that version and the GSK version.
But anyway, before I spend the rest of the night going into excessive detail on my response to the Goldshield Parnate as monotherapy, I should probably update you on my response to the Goldshield Parnate-SAM-e combo that I've been on.
In my last post, I wrote that I had been noticing a partial AD response (a boost in both mood and energy, but I don't think that I wrote that in my post) for about a week. But I also mentioned that I was noticing some of what I described as residual fatigue. Generally speaking, the fatigue seemed to be the strongest right after taking my dose of SAM-e in the morning. Unfortunately, the fatigue seemed to slowly build over the course of time until it just became too much. I started feeling extremely unfocused, and my symptom of leaden paralysis was particularly bad. I still didn't feel quite as drained as energy as I feel when I'm not taking any meds, but my ability to function and to concentrate on things like writing Psycho-Babble posts became severely impaired.
As I mentioned, the fatigue that I was experiencing seemed to grow slowly worse with time until I finally started to feel overwhelmed by it. In addition to that, the fatigue seemed to be the worst shortly after taking my SAM-e dose (not immediately after taking it, but 1-2 hours after taking it, which is to be expected when taking something with an enteric coating). Before the fatigue started to get out of control, I was able to control it to an extent with caffeine, which as you probably know, is an adenosine antagonist. Among other things SAM-e breaks down into adenosine, and it's been suggested that the effects of SAM-e often tend to build up over time. So, I suspected that the increasing fatigue that I was experiencing was probably due to the SAM-e. Or in other words, the balance that I was trying to achieve between the Goldshield Parnate and SAM-e seemed to be not quite so balanced, with the effects of the SAM-e outweighing the effects of the Goldshield Parnate. So, the first thing that I tried doing was reducing my SAM-e dose to 100 mg/day (I cut my 200 mg tablet in half and then broke up the contents of each half until I could get 100 mg worth to fit into an enteric capsule). That didn't do much good. I ended up feeling slightly more irritable than I had been feeling at 200 mg/day of SAM-e (and still 20 mg/day of the Parnate) and not any more energized. So, finally, I did what I probably should have done instead of lowering my SAM-e dose and raised my dose of SAM-e back to 200 mg/day and then went up to 30 mg/day on the Parnate. Considering that my symptom of leaden paralysis was particularly bad at 20 mg/day of Parnate and 200 mg/day of SAM-e and that MAOIs tend to be effective at treating depressive states associated with leaden paralysis, it made sense that I would probably benefit from a little more MAO inhibition.
So far, my approach seems to be working. This is now my third day taking 30 mg/day of the Goldshield Parnate and 200 mg/day of SAM-e and my second consecutive day feeling the AD effects (a boost in both mood and energy). I still notice a little bit of fatigue right after taking my dose of SAM-e in the morning, but it seems to be more mild than it was when I was taking it with 20 mg/day of Parnate. And if anything, the fatigue seems to be becoming less intense with time instead of becoming more intense, which is probably a good sign. So, now it's just a matter of waiting to see if the response that I'm getting now will last. I have some reason to believe that it might. Even though a partial response lasting about a week at 20 mg/day of the Goldshield Parnate and 200 mg/day might not sound like much to most people, an AD response lasting more than 3-4 days is almost unheard of for me. More significantly, I was able to get a more prolongued response out of 20 mg/day of Parnate with SAM-e than I could get with the same dose of Parnate as monotherapy. I also have some theoretical reasons as to why I think combining the Goldshield Parnate with SAM-e might work, but that would take quite a while to explain. But given my response so far, I do think that there is some reason to be optimistic that I might be able to get a sustained AD response out of this combo at the dose that I'm currently at. But as I've said, I'm still nowhere close to the point of being ready to declare victory.
(Wow, that was long. Hopefully you won't find it to be too long.)
> Yup. I hope you don't mind if I send a few prayers your way.
I don't mind at all. Thank you.
I hope that your holiday celebrations are as happy as they can be. Please take care.
Tomatheus
Posted by SLS on December 25, 2006, at 7:03:07
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Tomatheus on December 25, 2006, at 0:04:35
Hi Tomatheus.
Thanks for taking the time and spending the energy to compose such a comprehensive post. If I do return to Parnate, I will try to find the Goldstone product. I find your explanation regarding adenosine to be particularly interesting with respect to the development of fatigue.
Do you have any insights regarding Marplan?
Thanks.
- Scott
Posted by Tomatheus on December 25, 2006, at 17:59:36
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 25, 2006, at 7:03:07
Scott,
See below for my responses...
> Thanks for taking the time and spending the energy to compose such a comprehensive post.
You're welcome. I'm thankful to actually have the energy and the opportunity to use it to try to help others.
> If I do return to Parnate, I will try to find the Goldstone product.
I doubt that you'll be able to find a version of Parnate manufactured by a company called *Goldstone* anywhere on the planet, but you're welcome to look if you'd like. Who knows, maybe such a company exists. :)
Unfortunately for us, *Goldshield* products (including the U.K.-based company's version of Parnate) are not commercially available anywhere in the Western Hemisphere. However, word has it that it may be possible to order the Goldshield Parnate from the U.K., Australia, and other countries where it marketed as a prescription medication. If I do get a sustained response out of my Parnate-SAM-e combo, I might have to resort to such a measure after my current supply (which just somehow materialized out of thin air -- ok, j/k ;)) runs out.
Another option that you might want to consider if you're interested is getting your prescription filled at a compounding pharmacy that might be able to prepare a special enteric version of either the GlaxoSmithKline Parnate or the new generic tranylcypromine that's manufactured by Kali Laboratories (a subsidiary of Par Pharmaceutical company). As I mentioned in my previous post, I tried taking a specially prepared enteric version of the GSK Parnate and did not notice any differences between its effects and those of the Goldshield Parnate. So, an enteric version of one of the tranylcyrpomine products that's currently available in the U.S. might be an alternative worth looking into if you decide that you'd like to try an enteric form of Parnate.
> Do you have any insights regarding Marplan?
Problably nothing extremely insightful, but I did try taking Marplan using the same enteric approach that I used at times with both the Australian and the U.S. versions of Nardil. My response basically followed the same "antidepressant tease" pattern that characterized my response to the Goldshield Parnate as monotherapy. I tried taking 10 mg/day, 20 mg/day, and 30 mg/day of Marplan and felt a few days of the "tease" followed by a complete loss of my AD response each time. I could have tried higher doses, but I suspected that I would just get more of the same no matter what dose I tried, so I figured that it would probably just be a better idea to move on to other meds instead of wasting my time getting "teased" by Marplan.
Other than some slight weight gain and a bit of mild insomnia, I did not notice any side effects when I was taking Marplan.
It's hard to say whether or not my response to a non-enteric version of Marplan would have been any different from my response to the specially prepared enteric version that I tried. It's possible that I might have found a non-enteric version to be less effective and/or less tolerable than the enteric version that I took, but there's also a chance that I wouldn't have noticed a differnce between the two versions. I don't know for sure whether or not isocarboxazid (Marplan's active ingredient) undergoes significant chemical degradation in the stomach before it ultimately reaches the small intestine and gets absorbed into the bloodstream, but I decided to play it safe and just go with the enteric version to avoid any potential problems that might have occurred if I had tried taking the drug without an enteric coating.
I hope this helps some.
Tomatheus
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