Psycho-Babble Medication Thread 1062694

Shown: posts 1 to 10 of 10. This is the beginning of the thread.

 

Anyone prefer TCA to MAOI?

Posted by tom2228 on March 17, 2014, at 19:45:01

I've been on Marplan for 3 and a half years, with shorter trails of Nardil and Parnate scattered within. I got an almost full response for some time, but my life has changed a lot and I am getting only a partial response at 50mg and quite miserable most of the time.

I just had to find a new doctor and will see her on Monday. Luckily her office guy said she is okay with MAOI + stimulant, but not comfortable adding a TCA. And I'm not even sure she will be okay with Desoxyn yet, esp. given my substance abuse history that I haven't decided what to say about yet.

It is getting so tiring and nerve-wracking trying to find good care and find someone who will be okay with the meds I take!! Up until now I've been "stuck" with an unsupportive, hands-off doctor for a while because he is liberal enough. but now I am so nervous that the new doctor won't like the generic name for Desoxyn and leave me without it and the dim prospect of finding a doctor that's both okay with it, MAOIs, the combination, and now add in a TCA -- forget it!!!

I am trying to brace myself with the prospect that I won't be able to convince the new doctor to add a TCA. And if she is okay with Desoxyn -- even if she's not -- I would be stupid to leave her for a new doc because I am desperate for relief and can't wait any longer.

Has anybody tried TCAs, MAOIs (or both together) and prefer the TCA alone?

Marplan is arguably not doing it for me but it helps with a lot of aspects and I don't know whether I can give it up. I have spent a while on this med and it gave me enough relief to develop a sense of self on it. I went off, tried Nardil , tried Parnate again, only to go back to what was missing -- Marplan.

I only feel like myself on Marplan. I don't know who I am off of it.

But I don't want to be depressed anymore -- I might have to change a lot for this to happen, but I am afraid I will lose my self of self.

Is there anyone who can reassure me that a TCA might just work better?

Thanks for reading.

 

Re: Anyone prefer TCA to MAOI?

Posted by phidippus on March 17, 2014, at 22:13:57

In reply to Anyone prefer TCA to MAOI?, posted by tom2228 on March 17, 2014, at 19:45:01

The one thing about taking a tca over an maoi is you get the flexibility of adding other medications in order to augment your treatment-and sometimes that's necessary to treat depression.

If your depression is severe as you say, the only TCAs that are going to measure up to Marplan in Imipramine and Clomipramine.

>I only feel like myself on Marplan. I don't know who I am off of it.

You probably are beset with symptoms that your inner self says "why am I feeling this way?"

>I am afraid I will lose my self of self.

You will never lose your sense of self, I gaurantee it.

>Is there anyone who can reassure me that a TCA might just work better?

A TCA might just work better

Eric

 

Re: Anyone prefer TCA to MAOI?

Posted by tom2228 on March 17, 2014, at 22:29:46

In reply to Re: Anyone prefer TCA to MAOI?, posted by phidippus on March 17, 2014, at 22:13:57

> The one thing about taking a tca over an maoi is you get the flexibility of adding other medications in order to augment your treatment-and sometimes that's necessary to treat depression.
>
Eh, the only meds you truly can't use with MAOIs are SSRIs and clomipramine, impiramine, and amitriptyline.. just about?
But in the sense of being able to encounter a doc who's comfortable with those combinations.. definitely more flexibility without the MAOI.

> If your depression is severe as you say, the only TCAs that are going to measure up to Marplan in Imipramine and Clomipramine.
>
I've done some foraging and found that Marplan is a dopamine beta-hydroxylase inhibitor, meaning it inhibits the synthesis of NE from DA hence my theory that NE is what I'm really missing. If I had to go off the Marplan, maybe the restoration of NE functioning would offset part of the severity of my depression? In which sense Marplan is both helping and hurting my depression.

> >I only feel like myself on Marplan. I don't know who I am off of it.
>
> You probably are beset with symptoms that your inner self says "why am I feeling this way?"
>
Yeah I just feel screwed, like what happened to me -- I could say it's all the sh*t I've been through with the crystal meth battle but I really thing it all comes down to the bipolar getting much worse in the past few years. And that there's something right yet very wrong with my meds combination that I can't figure out.

Perhaps Marplan is my crutch that I relied on during those dark years of drugs and vegging out and Marplan is a return to that sense of security with familiar pain. No lie though, it does help with the depression. I think I'm just personalizing the depression and projecting my feelings on these meds.

> >I am afraid I will lose my self of self.
>
> You will never lose your sense of self, I gaurantee it.
>
Thanks. Just the feeling of my cognitive orientation and how I relate to myself. On Marplan I have the sense that I know what I want to do with my life (to become a psychiatrist) and have this gut feeling that it's right.

> >Is there anyone who can reassure me that a TCA might just work better?
>
> A TCA might just work better
>
lol. I f*ck*ng hope, if it comes down to that.
> Eric

 

Re: Anyone prefer TCA to MAOI? » tom2228

Posted by SLS on March 18, 2014, at 1:38:47

In reply to Anyone prefer TCA to MAOI?, posted by tom2228 on March 17, 2014, at 19:45:01

TCA is thought to be better suited to treat melancholic type (endogenous) depression. However, MAOI can work here as well.

What are your primary symptoms?

What are you using as evidence that you need pro-noradrenergic drugs?


- Scott

 

Re: Anyone prefer TCA to MAOI? » SLS

Posted by tom2228 on March 18, 2014, at 10:15:42

In reply to Re: Anyone prefer TCA to MAOI? » tom2228, posted by SLS on March 18, 2014, at 1:38:47


> TCA is thought to be better suited to treat melancholic type (endogenous) depression. However, MAOI can work here as well.
>
> What are your primary symptoms?
>
> What are you using as evidence that you need pro-noradrenergic drugs?
>
>
> - Scott

Thanks for your response, Scott.

I was thinking a TCA bc it's the only thing I haven't tried and the TCA + MAOI combo seems to a good option as this point -- running low on options it seems.

I seem to have both melancholic depression and atypical features if that's possible. I was atypical for most my life but have had periods, including now, where I'm down most of the time, even during the good moments. I'm sure the partial response to my meds covers some symptoms but leaves a mix of others.

Lack of interest in activities and people. Abilify has made this worse but it was present beforehand. Also lack of mental energy to carry out what I still am interested in. Like the Pristiq commercial I am constantly having to wind myself up and don't always want to.

Desoxyn gives me great quality of attention but my concentration is poor because I simply black the interest necessary to follow through. I find Desoxyn's effects are less automatic and pressure-driven like other stimulants and more mediated by my intrinsic motivation and the effort I put forth and to allow the med to work. That being said my depressed mood and lack of mental energy really gets in the way of my functioning and what this med can so for me.

At this point one might wonder why I don't just go for Strattera as an adjunct but it's more than just ADHD, these symptoms are spread across my general mood.

I have plenty of the DA pleasure/ hedonia from Marplan/ Mirapex/ Desoxyn/ possibly Abilify but lack the aspect of pleasure that I would call enjoyment. It's a mindless and empty pleasure. I lack excitement and contentment with what I'm doing. I want to enjoy things, hear the birds sings, read not because I need to amass info to be a pdoc one day but bc I enjoy it.

I have a lot of anxiety/ GAD. It is mostly cognitive anxiety about all of my issues and how I am not meeting my potential because I can't get necessary tasks done at a rate necessary to meet my academic potential and be ready for full-time school. i have trouble relaxing I bc I dont have the interest and mental energy to be able to chill, enjoy a book or TV or online game. I took Ativan for a year and a half but a benzo isn't what I'm looking for, that would make me fade into complacency. I want to light a fire under my recovery *ss.

I am generally not sad but suffer a lot and am always conscious/ anxious about how my mood affects my life -- runs my life.

My idea about the NE comes from the fact that Marplan can lower NE due to inhibition of dopamine beta-hydroxylase, and I believe I read, probably here, that chronic use of MAOIs lowers NE -- it feels that way. Depression is hard to describe.

And recently Saphris, which I know has a lot of different actions but increases NE through alpha-2 antagonism. I felt that I had what has been missing since I was younger and perhaps since I started MAOIs and maybe lithium (same time). Had more interest, excitement, contentment. It was just too sedating (not somnolence though), BID was not feasible because of this and it wore off, interacted with Desoxyn (CYP2D6), and was too antipsychotic to raise the dose after the initial improvement faded./

I feel depressed for seemingly no reason most of the time. I wonder if I am on too much meds/ too much Marplan even though I still have a lot of my original symptoms. I have made a lot of positive changes in my life.

 

Re: Anyone prefer TCA to MAOI?

Posted by tom2228 on March 19, 2014, at 12:40:35

In reply to Re: Anyone prefer TCA to MAOI? » SLS, posted by tom2228 on March 18, 2014, at 10:15:42

I was just searching the board about clompiramine and found this post by a poster called CGDR2, for whom the TCA was working very well after having been on MAOIs:

"I was on Phenelzine for a while last year, and the side effects kept me stuck at 45mg, which wasn't enough for my depression. I ended up wasting a lot of time, because rather than admitting the Phenelzine wasn't enough, and trying a new drug, I simply carried on taking it until things got worse."

I can't help but relate. Trying to accept giving up Marplan if I have to..and I might have to. it's hard to say goodbye since it was the first thing to give me relief and helps me get through the day

I feel like the MAOI augments the stimulant for my ADHD, and increases my baseline cognition in a way that my thoughts are more fluid. On an SSRI my thoughts seemed too fluid, like spilled milk. Nervous about the SRI action of TCAs doing that to me.

 

Re: Anyone prefer TCA to MAOI?

Posted by tom2228 on March 20, 2014, at 10:48:49

In reply to Re: Anyone prefer TCA to MAOI?, posted by tom2228 on March 19, 2014, at 12:40:35

Tentative solution. If the new doc says no to adding the TCA, I found a source of cheap nortripyline that I would.. fail to disclose to her.

Given my response to Zyprexa I am leaning a little more towards notrip. I like/ need that type of calm/ relief but I can't stand the dulling of the intellect/ mental agility/ memory/ emotions. Has anyone found these effects to be separable with an AP or "sedating" medication? Maybe it's the 5-HT2 (c? c, b, and a?) receptors that gives that calm-yet-interested-and-motivated effect whereas the H1 gives the sedated calm that screws with alertness and other cognitive functions along with the antimuscarinic effects?

Otherwise I would go for a more stimulating TCA like protrip or desip if they were calming to a respect. Maybe Invega instead of Abilify would solve this problem and allow for a less sedating TCA.

Meanwhile, my old very liberal doc who went on surprise medical leave said he may start doing phone sessions and filling scripts soon, so there's hope/ backup!

Now I just have to pray that the new one is okay with Desoxyn once she finds out what the generic name is (she hasn't heard of Desoxyn according to her office person). I have an extra month and a half--2 months left that hopefully would last me long enough, but I'm not a fan of scheming like this. Honesty and trust is what I like; unfortunately, trust from a doc doesn't come from the get go and in my history a bit of dishonesty has helped until that trust can be established.

 

Re: Anyone prefer TCA to MAOI?

Posted by ed_uk2010 on March 20, 2014, at 12:24:48

In reply to Re: Anyone prefer TCA to MAOI?, posted by tom2228 on March 20, 2014, at 10:48:49

I would hope she knows the generic name for Desoxyn before prescribing it! If she doesn't, that would suggest she doesn't know what it is. As a controlled drug, she will need to prescribe it correctly or else the prescription won't be filled.

 

Re: Anyone prefer TCA to MAOI? » ed_uk2010

Posted by tom2228 on March 20, 2014, at 21:54:53

In reply to Re: Anyone prefer TCA to MAOI?, posted by ed_uk2010 on March 20, 2014, at 12:24:48

> I would hope she knows the generic name for Desoxyn before prescribing it! If she doesn't, that would suggest she doesn't know what it is. As a controlled drug, she will need to prescribe it correctly or else the prescription won't be filled.

Lol yeah :p

Since I had her office person ask her about it 2 weeks ago I would hope she'd take the time to look it up in the meantime.. Don't really want to watch another doctor go into shock.

Either I'll be prepared with some pubmed lit to facilitate the process, always a good strategy

 

nortriptyline starting dose

Posted by tom2228 on March 21, 2014, at 12:30:15

In reply to Re: Anyone prefer TCA to MAOI? » ed_uk2010, posted by tom2228 on March 20, 2014, at 21:54:53

Going to order the nortrip now just in case. If the doc declines no way am I waiting another week or two. I play ahead these days -- one of the perks of proper bipolar treatment, I'd say.

Starting dose -- 10 or 25mg?

Ok, I can only find the 25mg.. can the capsules be emptied and dissolved in water, half drunk to make 12.5mg? Does the water solubility of nortrip matter or just shake an go?
Would the remainder still be intact to drink the next night?


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