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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by 90%there on December 8, 2014, at 12:29:23
Hi all. Come to the point that my MAOI (isocarboxazid) has lost its umph. Get to see my dear Pdoc Friday. Not seen him for 5+ yrs. Since then Iv'e had verious changes to my doses. I suffered from this so went straight back to my original doses. Feeling more afloat but still struggling with no energy. I take a TCA (amitriptyline) with it. Ive read so may suggest that Nortryptyline is a good addon to phenelzine.
That or try a higher dose MAOI then try switching. If all else fails probably get back on phenelzine. Start again. Will be tricky which ones to stop and when if I do switch but i trust my doc.
Anything to say? Please, go ahead ;)
Posted by PeterMartin on December 8, 2014, at 16:32:12
In reply to What to do!?, posted by 90%there on December 8, 2014, at 12:29:23
> Hi all. Come to the point that my MAOI (isocarboxazid) has lost its umph. Get to see my dear Pdoc Friday. Not seen him for 5+ yrs. Since then Iv'e had verious changes to my doses. I suffered from this so went straight back to my original doses. Feeling more afloat but still struggling with no energy. I take a TCA (amitriptyline) with it. Ive read so may suggest that Nortryptyline is a good addon to phenelzine.
> That or try a higher dose MAOI then try switching. If all else fails probably get back on phenelzine. Start again. Will be tricky which ones to stop and when if I do switch but i trust my doc.
> Anything to say? Please, go ahead ;)
>Nothing to suggest but glad you are taking isocarboxazid as I am as well. I'm also hitting a bit of a rut after 4yrs of using it w Lamictal. I see my doc in Jan. Hadn't considered adding a TCA so I'm interested to see what other say.
Btw I had good success with 20mg for a while then went to 30. I've tried higher dosages but always end up kinda spacey.
Hope some others chime in.
Posted by 90%there on December 8, 2014, at 18:01:14
In reply to Re: What to do!?, posted by PeterMartin on December 8, 2014, at 16:32:12
> Nothing to suggest but glad you are taking isocarboxazid as I am as well. I'm also hitting a bit of a rut after 4yrs of using it w Lamictal. I see my doc in Jan. Hadn't considered adding a TCA so I'm interested to see what other say.
>
> Btw I had good success with 20mg for a while then went to 30. I've tried higher dosages but always end up kinda spacey.
>Yea I tried Lamictal with is but was eventually put on quetiapine (Seroquel) 50mg. Small dose strong effect! I take 90mg/day of isocarboxazid with my doc's backing all the way. I have huge problems with hypersomnia. Hoping switching to Nortriptyline might give back some energy. I also take bupropion 300mg and clonazepam 5mg. Sorry you have problems with higher doses of isocarboxazid. Have you already tried phenelzine?
> Hope some others chime in.
>
>
Posted by Lou Pilder on December 8, 2014, at 19:30:30
In reply to Re: What to do!? » PeterMartin, posted by 90%there on December 8, 2014, at 18:01:14
> > Nothing to suggest but glad you are taking isocarboxazid as I am as well. I'm also hitting a bit of a rut after 4yrs of using it w Lamictal. I see my doc in Jan. Hadn't considered adding a TCA so I'm interested to see what other say.
> >
> > Btw I had good success with 20mg for a while then went to 30. I've tried higher dosages but always end up kinda spacey.
> >
>
> Yea I tried Lamictal with is but was eventually put on quetiapine (Seroquel) 50mg. Small dose strong effect! I take 90mg/day of isocarboxazid with my doc's backing all the way. I have huge problems with hypersomnia. Hoping switching to Nortriptyline might give back some energy. I also take bupropion 300mg and clonazepam 5mg. Sorry you have problems with higher doses of isocarboxazid. Have you already tried phenelzine?
> > Hope some others chime in.
> >
> > 90%,'
You wrote that you are taking 4 drugs in combination. I am unsure as to how this could happen. If you could post answers to the following, then I could have the opportunity to respond accordingly.
True or false:
A. The same prescriber prescribed all of the drugs that I am taking now and to take them all in combination in combination.
B. That prescriber told me that I could die from the effects of taking those drugs together.
C. The prescriber told me that I could have a stroke from taking these drugs together
D. The prescriber told me that the drugs could be addictive
E. The prescriber told me that seizures could happen from the drugs
F. The prescriber told me that there has to be a period of time to stop a drug listed here before taking another of these drugs.
G. The prescriber told me, "Trust me".
Lou
>
>
Posted by PeterMartin on December 9, 2014, at 5:52:54
In reply to Re: What to do!? » PeterMartin, posted by 90%there on December 8, 2014, at 18:01:14
I was on phenelzine for a short time ten years ago. It was effective but almost too much so (borderline mania). JD consider trying it again but one of my main concerns at this point is weight gain - particular belly fat. I can't seem to stop the 10 to 20lbs yearly gain and it's put me in the obese category for the first time in my life. Nardil is notorious for packing on the lbs so for that reason I'd prefer to not give it another trial.
I'm not terrible at the moment just having much more breakthrough depression and cycling. Hoping that my doctor and I may be able to find an adjunct that may make sense to address either the weight gain issue (which in turn I think would help mood) or the breakthrough depression. So it goes....
BTW some posts are best to just ignore.
Posted by Lou Pilder on December 9, 2014, at 7:20:01
In reply to Re: What to do!?, posted by PeterMartin on December 9, 2014, at 5:52:54
> I was on phenelzine for a short time ten years ago. It was effective but almost too much so (borderline mania). JD consider trying it again but one of my main concerns at this point is weight gain - particular belly fat. I can't seem to stop the 10 to 20lbs yearly gain and it's put me in the obese category for the first time in my life. Nardil is notorious for packing on the lbs so for that reason I'd prefer to not give it another trial.
>
> I'm not terrible at the moment just having much more breakthrough depression and cycling. Hoping that my doctor and I may be able to find an adjunct that may make sense to address either the weight gain issue (which in turn I think would help mood) or the breakthrough depression. So it goes....
>
> BTW some posts are best to just ignore.PM,
You wrote that some posts are best to just ignore. I am unsure as to what you want readers to think when they read that. If you could post answers to the following, then I could have the opportunity to respond accordingly.
True or false:
A. The post that you are referring to as to ignore is my post here in this thread.
Fill in:
B. If so, the reason for the post to be best ignored by you is:___________________________________
________________________________________
_________________________________________
________________________________________
C. The post to be ignored, if not my post, is;(post here the URL)
Lou
Posted by 90%there on December 9, 2014, at 16:15:45
In reply to Re: What to do!?, posted by PeterMartin on December 8, 2014, at 16:32:12
Of course its done professionally. I get treated at a psychopharmocology dept. and my doc's a Neuropsychopharmacologist. I would'nt trust a standard psychiatrist watch over my helth. I've met some terible ones I tell ya. I could do alot better.
I know what you're getting at and I'm not impressed with you bad mouthing medicine. Is that why you're here?
Just for you, my doc:
http://www.bristol.ac.uk/neuroscience/people/person/10559/
And one for luck, my prev Doc:
http://www.imperial.ac.uk/people/d.nuttThey are not magicians but try thier darn hardest. More helpfull comments please?
Posted by 90%there on December 9, 2014, at 16:17:50
In reply to Lou's request-almoze » 90%there, posted by Lou Pilder on December 8, 2014, at 19:30:30
sorry, its 5 meds in combo :)
Posted by Lou Pilder on December 9, 2014, at 16:30:32
In reply to Re: What to do!? » PeterMartin, posted by 90%there on December 9, 2014, at 16:15:45
> Of course its done professionally. I get treated at a psychopharmocology dept. and my doc's a Neuropsychopharmacologist. I would'nt trust a standard psychiatrist watch over my helth. I've met some terible ones I tell ya. I could do alot better.
> I know what you're getting at and I'm not impressed with you bad mouthing medicine. Is that why you're here?
> Just for you, my doc:
> http://www.bristol.ac.uk/neuroscience/people/person/10559/
> And one for luck, my prev Doc:
> http://www.imperial.ac.uk/people/d.nutt
>
> They are not magicians but try thier darn hardest. More helpfull comments please?90%,
You wrote,[...I wouldn't trust a standard psychiatrist watch over my he(a)lth...I know what you're getting at...you bad mouthing medicine...helpful comments please?...].
I have the following requests so that I could have a better understanding of what you are wanting to mean and respond accordingly.
A. Why would you not trust a standard psychiatrist?
B. If you know what I am getting at, could you post that here now?
C. What constitutes in your thinking bad mouthing medicine?
D. What constitutes a helpful comment?
Lou
Posted by 90%there on December 9, 2014, at 16:48:05
In reply to Re: What to do!?, posted by PeterMartin on December 9, 2014, at 5:52:54
> I was on phenelzine for a short time ten years ago. It was effective but almost too much so (borderline mania). JD consider trying it again but one of my main concerns at this point is weight gain - particular belly fat. I can't seem to stop the 10 to 20lbs yearly gain and it's put me in the obese category for the first time in my life. Nardil is notorious for packing on the lbs so for that reason I'd prefer to not give it another trial.
> > I'm not terrible at the moment just having much more breakthrough depression and cycling. Hoping that my doctor and I may be able to find an adjunct that may make sense to address either the weight gain issue (which in turn I think would help mood) or the breakthrough depression. So it goes....
>
> BTW some posts are best to just ignore.Hi, I know many dread weight gain on phenelzine, but for me it was somnolence. Attacks of it- Good job I got off the train for work at the last stop . Many times I'd get woken up by the driver. Trains were the worst, but anything that came without motion- book, TV & films (yes and snoring in the cinema lol.)
Bupropion helped that for a time too. Also lofepramine was ok. Modafinil was hopeless. Tolerance built instantly. More recently I've been looking into nootropics. Centrophenoxine has been helping me wake up earlier (some times) at 750mg twice daly. Just added citicoline to see if it augments before I try one of the recetams.
Oh, for weight gain on Phenelzine eat more PROTEIN. Lower your carbs to 1/4 your calorie intake. And eat protein BEFORE anything else. I found this good for losing appetite. But have SOME carbs- without them you may develope Ketoacidosis. Protein shakes are perfect.
Posted by 90%there on December 9, 2014, at 16:51:30
In reply to Lou's request-bahadmowth » 90%there, posted by Lou Pilder on December 9, 2014, at 16:30:32
> You wrote,[...I wouldn't trust a standard psychiatrist watch over my he(a)lth...I know what you're getting at...you bad mouthing medicine...helpful comments please?...].
> I have the following requests so that I could have a better understanding of what you are wanting to mean and respond accordingly.
> A. Why would you not trust a standard psychiatrist?
> B. If you know what I am getting at, could you post that here now?
> C. What constitutes in your thinking bad mouthing medicine?
> D. What constitutes a helpful comment?
> Lou
>LOL
Posted by 90%there on December 9, 2014, at 16:55:49
In reply to Lou's request-bahadmowth » 90%there, posted by Lou Pilder on December 9, 2014, at 16:30:32
Posted by phidippus on December 10, 2014, at 14:03:57
In reply to What to do!?, posted by 90%there on December 8, 2014, at 12:29:23
Can you take a stimulant with the MAOI?
Eric
Posted by 90%there on December 10, 2014, at 14:50:32
In reply to Re: What to do!? » 90%there, posted by phidippus on December 10, 2014, at 14:03:57
> Can you take a stimulant with the MAOI?
>
> Ericyes, but I build tolerance too fast. I've used D/L-amphetamine, methylphenidate, MDMA and Mcat on isocarboxazid without any problems. But please don't try this! I have drug abuse issues, more past than present. And BECAUSE OF previous mind bending drug abuse it might be why build tolerance or poop out quickly.
You asked, I answered and I 100% DO NOT recommend it. Not without professional clinical guidance.90%
Posted by Lou Pilder on December 11, 2014, at 18:59:02
In reply to Re: Lou's request-bahadmowth » Lou Pilder, posted by 90%there on December 9, 2014, at 16:51:30
> > You wrote,[...I wouldn't trust a standard psychiatrist watch over my he(a)lth...I know what you're getting at...you bad mouthing medicine...helpful comments please?...].
> > I have the following requests so that I could have a better understanding of what you are wanting to mean and respond accordingly.
> > A. Why would you not trust a standard psychiatrist?
> > B. If you know what I am getting at, could you post that here now?
> > C. What constitutes in your thinking bad mouthing medicine?
> > D. What constitutes a helpful comment?
> > Lou
> >
>
> LOL
>
90,
You wrote,[...LOL...].
Since then, there has been a kind of a hush. Should I better move on?
Lou
Posted by 90%there on December 12, 2014, at 13:53:59
In reply to Lou's request-kyndovehyhush » 90%there, posted by Lou Pilder on December 11, 2014, at 18:59:02
Should I better move on?
> Lou
If I were you then yes. But I'm not you, you may say whatever you like. But to EXPECT a positive reply you need someone to agree with you and be bothered to state that. In fact for most (I imagine) members this is small talk and I really wish I'd posted in the neurotransmitter section instead.....
Posted by 90%there on December 12, 2014, at 13:58:19
In reply to Re: Lou's request-kyndovehyhush » Lou Pilder, posted by 90%there on December 12, 2014, at 13:53:59
>> In fact for most (I imagine) members this is small talk and I really wish I'd posted in the neurotransmitter section instead.....
OOPS! Last time I was here there was the basic forum then the separate Neurotransmitter section.
My mistake
Posted by tom2228 on December 19, 2014, at 1:21:17
In reply to Re: What to do!? » phidippus, posted by 90%there on December 10, 2014, at 14:50:32
> > Can you take a stimulant with the MAOI?
> >
> > Eric
>
> yes, but I build tolerance too fast. I've used D/L-amphetamine, methylphenidate, MDMA and Mcat on isocarboxazid without any problems. But please don't try this! I have drug abuse issues, more past than present. And BECAUSE OF previous mind bending drug abuse it might be why build tolerance or poop out quickly.
> You asked, I answered and I 100% DO NOT recommend it. Not without professional clinical guidance.
>
> 90%I am also on Marplan and have used extensive amount of street crystal meth (up to 2g) but MDMA no man no man no. Not that what I've done is okay but you've isn't, but MDMA + MAOI is purely asking for a death sentence, no more no less. And that I understand too. Many of us using MAOIs, and also many of us drug users have gotten to that point where we live, OK, and we die, well, OK too..
I am scared what would happen on 50mg Marplan with meth and have only gone there with a Desoxyn Rx of I think 20mg at the time. But 90mg + those drugs sheesh.. yes I am passing judgement. I do not pass judgment upon myself but in order to care about you I must pass some unto you in this situation. I hope you understand this.
I believe you (or whoever above said this) are right about the specificity of the MAOI dose and finding that before you go on. I was on 50mg before but feels weird, <40 not enough, 40 just right. It's my "goldilocks" dose although I haven't tried 45, f*ck that. Who knocks though, maybe if I went up higher -- high enough -- I could get more adequate relief. There's a forum on dr bob by physicians 1 of whom writing about using up to I think ~170mg isocarboxazid + dextromamphetamine. This implies there are secondary properties to Marplan's MAOI mode of action, which logically caps off at 100% inhibition after a certain dose -- or not?
My solution:
1) Add desipramine. Read here http://www.dr-bob.org/babble/20141120/msgs/1074361.html where I say I am taking 125mg along with my 40mg Marplan (with a stimulant and others)... it is really helping me right now be off of meth and my depression and anxiety. It feels strong and helps my energy -- nortriptyline is another great option to add and will help energy but has the side effect of being an antihistamine which is sedating -- desipramine lacks this and is 1 reason why I switched. This means it also lacks some of the weight gain of nortriptyline2) Add stimulant slowly.. tolerance you shouldn't have to worry about if you stop f*ck*ng with the recreationals! Develop a mindset that these oral pills are for MEDICATION and not recreation and this should help orient your mind in a placebo-response fashion to use the small amount appropriately. At least that is how it works for me -- I could be on hundreds of mgs of meth but notice a substantial difference whether I have taken my 10mg dose of Desoxyn which is technically the same chemical. I agree but argue it is NOT the same due to the route of admin and the pathways my mind has built over the years understanding that Desoxyn low dose is for ADHD and is not abuse. That's just me though. And yes, the Desoxyn does not work *as well* with the crystal but it still does for me. Lastly, I've been off meth for a week.
OH and 2A) Add Deplin to the combo either alone or with the stimulant; I believe it can help with stimulant tolerance by replenishing the neurotransmitter stores, which are quickly depleted by the stims especially amphetamine acutely and over time by the reuptake inhbitor stims like methylphenidate.
Alone, Deplin can prolong AD response, prevent poop-out, potentiate antidepressants (increase NT stores, promote release), and has a noticeable effect on energy. It affects dopamine3) Desoxyn -- as a meth addict hard to recommend to someone who has drug issues but I don't know your story. Pharmaceutical methamphetamine is different from crystal meth and is uniquely different from other oral stimulant medications. It just is, and has nice therapeutic synergy with Marplan.
Granted it is only given in the US and Chile. Sorry I just saw you were in the UK if I remember right.4) This is going out on a limb but Marplan + a little Parnate? Unstable and difficult to do and probably should not be done at all but I did 4 years ago because I found that a touch of Parnate was enough to get the effect but too much Parnate was overkill and has side-effects unlike Marplan. So I used enough Marplan to get proper % MAO inhibition and Parnate to top it off. I don't recommend it's too finnicky and probably too dangerous.
5) Marplan + stimulant PLUS TCA.
Marplan + stimulant was at a time enough for me. I now seem to need a tricyclic with the bunch and it could very well do what Marplan + stim and Marplan + TCA cannot do alone for you.6) Adding an atypical antipsyhotics / Abilify. It might sound like this would kill the DA boost of the MAOI but this is simply not true, especially with Abilify and especially with a stimulant on board -- I have both. Many AAPs are effective antidepressants on their own right -- and can really hit hard when combined with other antidpressants by antagnonizing serotonin receptors -- like that Effexor + Rememron strategy. Saphris felt strong on the AD properties.. supposedly Seroquel too which I see you have on board low dose. There are others that are less sedating that can help like Abilify., AVOID Geodon with MAOIs, that can produce serotonin syndrome (like the kind that you actually have to worry about :P).
7) Add Mirapex .. tired of writing.. sorry -- good night.
You are so lucky you have a doc who can explore these options with you. It has been *excruciating* to find one who can handle the MAOI + TCA + stimulant combo.
Posted by 90%there on January 4, 2015, at 15:47:54
In reply to Re: What to do!?, posted by tom2228 on December 19, 2014, at 1:21:17
Sorry for late reply. Went away for xmas.
Anyway. I simply tell it as it is. Yes, I did take MDMA whilst on isocarboxazid. Not a good idea. But I simply mentioned it to share my experience. Not to be ridiculed. I stated a fact, for no other reason than to share knowledge. Not to recommend anything at all. Sadly there's always 1 (or 2)
This is the end of the thread.
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