Psycho-Babble Medication Thread 1039965

Shown: posts 1 to 8 of 8. This is the beginning of the thread.

 

RETRY - please help

Posted by gpznos on March 10, 2013, at 7:02:50

Hi all

After my hospital stay (ECT) ended almost 2 months ago I have been home waiting to get well enough to start working.
(As previously the last 5 years) there have been periods of 6-7 days of feeling normal/good and then the usually 4-6 days of being depressed, some crying etc. and some days in between of mixed state.

One week ago I started Marplan 10 mg but I am also taking Lithium 600 mg, Nort 135 mg and Valdoxan 37,5 mg.
Now, I know 10 mg Marplan is not much but my pdoc want to start up slowly but is it realistic that 10 mg will do anything? I have read that one should move up slowly with the MAOi but if the "minimum" effective dose is, say, 30 mg then why wait? On the description it says: Normal start dose is 30 mg, can be set up to 50 mg but strangely enough there is also mentioned a so-called maintenance dose normally at 10-20 mg, seems low???
I guess the pdoc wants to make sure i comply to Marplan - I just want to feel better ASAP.

For the time being I am having the morning worsening thing, feeling real down and with no energy, then some of the days I get better as the day progresses and normally I feel good/normal in the evening.
Is Marplan known for helping with this?
Are there other meds that can help with this?

As always all inputs are most welcome!

 

Re: RETRY - please help

Posted by Meatwood_Flack on March 10, 2013, at 7:53:28

In reply to RETRY - please help, posted by gpznos on March 10, 2013, at 7:02:50

Your doctor may be slow playing the dosage to minimize the severity of side effects (of which MAO's are the worst offenders.) Also, unfortunately, what may be a therapeutic dose for one may be too high, or too low, for another. Patience in the face of distress is tough, no doubt. I've been patient for over a year with no relief. Have you shared your concerns with your doctor? Good luck and I hope you feel better soon.

 

Re: RETRY - please help » Meatwood_Flack

Posted by SLS on March 10, 2013, at 8:07:10

In reply to Re: RETRY - please help, posted by Meatwood_Flack on March 10, 2013, at 7:53:28

> Your doctor may be slow playing the dosage to minimize the severity of side effects (of which MAO's are the worst offenders.)

In what ways are MAOIs the worst offenders with respect to side effects?


- Scott

 

Re: RETRY - please help » gpznos

Posted by SLS on March 10, 2013, at 8:40:49

In reply to RETRY - please help, posted by gpznos on March 10, 2013, at 7:02:50

> Hi all
>
> After my hospital stay (ECT) ended almost 2 months ago I have been home waiting to get well enough to start working.
> (As previously the last 5 years) there have been periods of 6-7 days of feeling normal/good and then the usually 4-6 days of being depressed, some crying etc. and some days in between of mixed state.

I think you might need to focus more on mood stabilizers like Trileptal and Depakote, or even Topamax. Some people with rapid-cyclicity find Keppra useful, but I have not seen it used regularly. Increasing your dosage of lithium might be necessary for your mixed-states, but that is not certain. For depression, 300 - 600 mg/day can help. For bipolar mania, 900 - 1500 mg/day is usually required. Lamictal can help with depression, but might not put the breaks on the manic component of a mixed-state. Using a drug like Abilify often helps with depression, and might even prevent mania.

Marplan can be effective, but I don't think you will glean any benefit from it until your dosage is increased to 40 - 60 mg/day. MAOIs are a good choice for bipolar depression. I like Parnate. Marplan was not as effective for me as Nardil, although its side effect profile was more favorable. Your doctor might be slow to increase your dosage because you are currently taking a TCA. You should get a blood level of nortriptyline if you haven't already done so. I need 150 mg/day to keep me in the therapeutic range. However, it is possible to take too much nortritpyline because it has a therapeutic window. For some people, it works at 75 mg/day, but not at 150 mg/day.

Your diurnal pattern of feeling worse in the morning and feeling better later in the day is usually associated with melancholic depression, and is often treated with TCA. Remeron can work, too. (Remeron made me feel worse). However, bipolar depression can present with an admixture of symptoms. It is as if it were a hybrid of melancholic and atypical unipolar depressions. This describes me. Atypical symptoms predominate, but there is a great deal of anxiety and no mood reactivity. Perhaps this is why a combination of MAOI + TCA has worked so well for my bipolar depression in the past.


- Scott

 

Re: RETRY - please help

Posted by Meatwood_Flack on March 10, 2013, at 8:42:31

In reply to Re: RETRY - please help » Meatwood_Flack, posted by SLS on March 10, 2013, at 8:07:10

The dietary restrictions, alone, seem to separate them from the other classes. Side effects certainly seem to be the rationale that many doctors use for avoiding them. I can't even get a TCA because of side effects. Both may, however, hinge less on facts than a preference by the medical-industrial complex for profitability's sake. Whatever the case, there seems to be a mentality that they should only be used if all else fails. This, of course, is based solely on my research and experience.

 

Re: RETRY - please help » Meatwood_Flack

Posted by Phillipa on March 10, 2013, at 10:16:55

In reply to Re: RETRY - please help, posted by Meatwood_Flack on March 10, 2013, at 8:42:31

Docs are now beginning to even lower the doses of SSRI's. Seems lower is better now. And benzos are coming back in vogue. Less injuries in elderly and medical problems than with atypical antipsychotics. How times change. Phillipa

 

Re: RETRY - please help » Phillipa

Posted by Meatwood_Flack on March 10, 2013, at 10:49:53

In reply to Re: RETRY - please help » Meatwood_Flack, posted by Phillipa on March 10, 2013, at 10:16:55

But are they changing for the better or simply to ward off lawsuits? If I could take a med guaranteed to kill my depression but that might make me more susceptible to falls, I would take it in a heartbeat.

 

Re: RETRY - please help » SLS

Posted by gpznos on March 10, 2013, at 12:19:05

In reply to Re: RETRY - please help » gpznos, posted by SLS on March 10, 2013, at 8:40:49

> > Hi all
> >
> > After my hospital stay (ECT) ended almost 2 months ago I have been home waiting to get well enough to start working.
> > (As previously the last 5 years) there have been periods of 6-7 days of feeling normal/good and then the usually 4-6 days of being depressed, some crying etc. and some days in between of mixed state.
>
> I think you might need to focus more on mood stabilizers like Trileptal and Depakote, or even Topamax. Some people with rapid-cyclicity find Keppra useful, but I have not seen it used regularly. Increasing your dosage of lithium might be necessary for your mixed-states, but that is not certain. For depression, 300 - 600 mg/day can help. For bipolar mania, 900 - 1500 mg/day is usually required. Lamictal can help with depression, but might not put the breaks on the manic component of a mixed-state. Using a drug like Abilify often helps with depression, and might even prevent mania.
>
> Marplan can be effective, but I don't think you will glean any benefit from it until your dosage is increased to 40 - 60 mg/day. MAOIs are a good choice for bipolar depression. I like Parnate. Marplan was not as effective for me as Nardil, although its side effect profile was more favorable. Your doctor might be slow to increase your dosage because you are currently taking a TCA. You should get a blood level of nortriptyline if you haven't already done so. I need 150 mg/day to keep me in the therapeutic range. However, it is possible to take too much nortritpyline because it has a therapeutic window. For some people, it works at 75 mg/day, but not at 150 mg/day.
>
> Your diurnal pattern of feeling worse in the morning and feeling better later in the day is usually associated with melancholic depression, and is often treated with TCA. Remeron can work, too. (Remeron made me feel worse). However, bipolar depression can present with an admixture of symptoms. It is as if it were a hybrid of melancholic and atypical unipolar depressions. This describes me. Atypical symptoms predominate, but there is a great deal of anxiety and no mood reactivity. Perhaps this is why a combination of MAOI + TCA has worked so well for my bipolar depression in the past.
>
>
> - Scott

Thank you for your answer, Scott.
I might have used the wrong word here: When I wrote "mixed state" I was not talking about manic. I am NOT manic (and BTW have no anxiety).

By "mixed state" I meant periods where my mood is between feeling normal and depressed, where I am not way down depressed but not real good either, as you wrote maybe "melancholic" could be used to describe this.

I tried Lamictal for more than a year but it did not solve this cycling problem. And I was on 750 mg Lithium 2 months ago and at that dose I never got to the "normal" feeling at all, it was to numbning. I have had several Nort dosage controls done and I am in the therapeutic window.

The thing you wrote about Remeron as a possible drug against melancholic is interesting. But is it safe to take with Marplan? According to my pdoc it is not safe but he wasnt 100% sure about this.


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