![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 61 to 85 of 97. Go back in thread:
Posted by SLS on April 23, 2018, at 20:33:45
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on April 23, 2018, at 19:05:20
> Still doing great and this feels different. Confidence and some excitement to do what I like to do.
>
> If Metformin keeps holding my weight and my mood continues I'll be quite happy. I see my doc in 2days.
>
> Will update.
<smile>
- Scott
Posted by PeterMartin on May 7, 2018, at 15:56:04
In reply to Re: Hoping Nardil kicks in at 60 (wk3) » PeterMartin, posted by SLS on April 23, 2018, at 20:33:45
Still been very up and down on Nardil. My Metformin is now at 2000mg (past week) and maybe that's having more of an affect on my mood than I realize.
Anyway today marked 2 months on 75mg. I woke up not wanting to get out of bed / depressed. it's been 4 or 5 days since Ive really felt pretty good. I called my doc and he oked me to try 90mg.
Hopefully the side effects (wt particularly) won't be extremely tough w/ this increase. I'm a fairly heavy person so I'm also very hopeful that I needed this higher dose to get to a proper level of MAO inhibition.
I'll update at some point...
Posted by SLS on May 7, 2018, at 21:10:02
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 7, 2018, at 15:56:04
> Still been very up and down on Nardil. My Metformin is now at 2000mg (past week) and maybe that's having more of an affect on my mood than I realize.
>
> Anyway today marked 2 months on 75mg. I woke up not wanting to get out of bed / depressed. it's been 4 or 5 days since Ive really felt pretty good. I called my doc and he oked me to try 90mg.
>
> Hopefully the side effects (wt particularly) won't be extremely tough w/ this increase. I'm a fairly heavy person so I'm also very hopeful that I needed this higher dose to get to a proper level of MAO inhibition.
>
> I'll update at some point...Good luck at 90 mg. I would be optimistic. I'm sure you know the general formula for arriving at a target dosage of Nardil = 1 mg per kg (body weight).
75 mg: 165 lbs
90 mg: 200 lbs
If you continue to experience a partial and episodic improvement, perhaps adding another drug would help.
Intuitively, one would think that adding a mood stabilizer would make sense. Have you ever tried lithium? I find that 300 mg/day helps with depression, but not mania, when combined with Parnate. I experienced a mild improvement using Trileptal, Lamictal and Topamax. Abilify would be a good choice therapeutically, but it causes weight gain. Saphris represents an alternative to Abilify.
- Scott
Posted by PeterMartin on May 10, 2018, at 22:44:10
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 7, 2018, at 21:10:02
I used to take Lithium w/ Marplan for a number of years until I realized it was elevating my BP a great deal (160/95 average to 200+/100+ when I started noticing). That was only taking 600mg and even a decreased 300.
I read a ton of backthreads on all of these things - didn't you have a serotonin syndrome issue w/ Lithium & an MAOI? I thought you might have. I do think it helped but in general I can only tolerate low dose Li. When I get in to therapeutic range it makes me very flat and unmotivated...depressed. I do like it in theory though (grows grey matter). I've heard microdosing might even be helpful....one in a while if I'm depressed I'll take a 1/4 cap I have left over and placebo or not I seem to calm a bit.
Trileptal was a med I've never tried that I considered. It seems more likely to flatten you out that give you a spark which is really what I need. I was on Abilify for a few months in the late 00s and it caused pretty bad akathesia after a bit. RLS at night...that kinda stuff and I can't tolerate that side effect. I've seen a few studies that would make me feel confident about Metformin holding off Abilify wt gain.
Saphris is interesting. I'm curious to see how you do on that. I hadn't originally realized it was a sublingual medicine. My doctor isn't super familiar with Nardil so I'm not sure he'd be comfortable w/ adding too much on top of it.
It's still very early at 90 for me. I definitely feel the hypotension today and dizzyness at time after sitting for a while then standing. I have a good deal of brain fog but I'd say outwardly I'm cheerful and doing what I'd usually do. Hopefully this is an indication that the true therapeutic effect is aroudn the corner.
My wt crept up about 5lbs but I was going out for pancakes everymorning and only on 1500 metformin. I've just kicked that up the max 2000 and have eliminated my daily diner run. Metformin can take months to full work so I'd be ecstatic to get relief and a slight decrease in my wt. We'll see......I know that's a lot to expect w/ Nardil (wt).
I called the Marplan support yesterday (they know me ha). They couldn't say when it would be available again but I'm pretty sure I could get that patience assistance once it is. Talking to them and having them tell me the assistance program would be possible in my case makes me feel a little better about the bumpy start w/ Nardil. If I keep rolling and never reach stability at somepoint I should be able to get back on Marplan which worked amazing for me for 7yrs....
Thanks for given me a reason to ramble....
Hoping I wake up tomorrow "clicked in".....
Posted by SLS on May 11, 2018, at 7:10:29
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 10, 2018, at 22:44:10
> I used to take Lithium w/ Marplan for a number of years until I realized it was elevating my BP a great deal (160/95 average to 200+/100+ when I started noticing). That was only taking 600mg and even a decreased 300.
That sucks.
> I read a ton of backthreads on all of these things - didn't you have a serotonin syndrome issue w/ Lithium & an MAOI?
No. My episode of SS occurred when I introduced Effexor to Parnate. I took about 10-25 mg. The episode lasted for several hours. I was babbling gibberish, was incoherent in thought, and experienced muscle rigidity.
> I thought you might have. I do think it helped but in general I can only tolerate low dose Li.
Can you handle 150 mg taken at night?
> When I get in to therapeutic range it makes me very flat and unmotivated...depressed.
Exactly. Me, too.
> I do like it in theory though (grows grey matter). I've heard microdosing might even be helpful....one in a while if I'm depressed I'll take a 1/4 cap I have left over and placebo or not I seem to calm a bit.
I think 150 mg/day could possibly help with depression, elongate telomeres, and reduce the risk of contracting Alzheimer's Dementia.
> Trileptal was a med I've never tried that I considered. It seems more likely to flatten you out that give you a spark which is really what I need.
Actually, I didn't find it flattening at all. It was neutral with respect to sedation and flat affect. It helped clear up thinking and gave me some improvement in thought speed and clarity. Tegretol is the drug that can produce sedation.
> I was on Abilify for a few months in the late 00s and it caused pretty bad akathesia after a bit.
How many days or weeks did it take for the akathisia to appear? Can you describe what you experienced.
> I've seen a few studies that would make me feel confident about Metformin holding off Abilify wt gain.
Thanks for telling me this. If I continue to experience weight gain, I will definitely ask my primary care provider for it.
> Saphris is interesting. I'm curious to see how you do on that. I hadn't originally realized it was a sublingual medicine. My doctor isn't super familiar with Nardil so I'm not sure he'd be comfortable w/ adding too much on top of it.
That's understandable. Saprhis is an antipsychotic that is incidated for schizophrenia and mania. It also has antidepressant effects and generally does not produce much weight gain. I just wish that it were delivered orally. I'm sure this will be but a minor inconvenience should Saphris give me my life back.
> It's still very early at 90 for me. I definitely feel the hypotension today and dizzyness at time after sitting for a while then standing.
This might remain a problem, but the frequency and intensity of the dizziness might lessen over time. It did for me. In my experience, the dizziness is an indicator that you are at a therapeutic dosage. The brain fog will disappear completely if Nardil is the right drug for you.
> I'd say outwardly I'm cheerful and doing what I'd usually do. Hopefully this is an indication that the true therapeutic effect is aroudn the corner.
Those are monumental improvements, even if they are mild by degree. I am optimistic for you.
> My wt crept up about 5lbs but I was going out for pancakes everymorning and only on 1500 metformin. I've just kicked that up the max 2000 and have eliminated my daily diner run. Metformin can take months to full work so I'd be ecstatic to get relief and a slight decrease in my wt. We'll see......I know that's a lot to expect w/ Nardil (wt)
Let me know how the metformin works for you.
I was talking with my doctor yesterday about Nardil and Marplan. He characterized Marplan as being predominantly a drug for depression while Mardi is better for anxiety. I wish Marplan was less expensive. What they charge for this old drug is unconscionable. Even if it is fully covered by insurance, this mammoth price ultimately costs the entire middle class more money in increased premiums, Medicare and Medicaid coverage, and higher taxes.
> I called the Marplan support yesterday (they know me ha). They couldn't say when it would be available again but I'm pretty sure I could get that patience assistance once it is. Talking to them and having them tell me the assistance program would be possible in my case makes me feel a little better about the bumpy start w/ Nardil. If I keep rolling and never reach stability at somepoint I should be able to get back on Marplan which worked amazing for me for 7yrs....
I think you just convinced me to try Marplan before going back to Nardil.
> Thanks for given me a reason to ramble....
Thanks for giving me the opportunity to ramble back!
> Hoping I wake up tomorrow "clicked in".....
I hope so too. I greatly appreciate your posts.
- Scott
Posted by PeterMartin on May 16, 2018, at 0:42:22
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 11, 2018, at 7:10:29
Sorry to not answer the questions but I just wanted to post that I'm having a really rough time. Man this has been a real rollercoaster and I'm in the pit of it right now.
I started 90mg on the 6th so this is day 9 and a day where I felt like I was fighting myself. I stayed in bed most of the day. Had no interest in using the computer or doing other things I usually do. At the same time I felt this hunch like I'm on the cusp of relief. As if the chemicals are all there but I'm just not getting that flick over to feeling better....instead I'm in this terrible hole.
I had a lot of Orthostatic hypotension so I take that as a good sign. But it's just so odd that after periods of success at 60mg and 75mg that I'd be completely starting over almost at 90......waiting for it to kick in again. I just keep believing it will and if the trend of complaining about it to relief continues it may be very soon. At the same time it's very much night and day...and when I'm in the night (like now) I can't remember what it's like in the day.
I had some bad thoughts of maybe taking a small amount of marplan to try to kick me over the edge but I resisted that. I just need to wait it out and I guess I'll do it in bed - at least I'm content there and not dreading it. If anything I'm grumpy/irritable about my lack of motivation/adhedonia.
I'm still taking 2000 metformin and my wt is 221ish (it was 216ish at start on Jan 25). I can't complain about that.....I'm recently up on that from 1500 so it could be another factor in my depression. I'm not sure. I'm just frustrated. I won't be full frustrated for another few weeks at 90mg but it baffles me that at this dose I feel probably the worst I've felt (just today really)......
Hopefully I'm just really treatment _resistant_ and my "ego" or whatever will lose the battle to feel better even if it's artificially induced....
Posted by PeterMartin on May 16, 2018, at 9:20:47
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 16, 2018, at 0:42:22
Sure enough so far a better morning today. A bit of sunshine in my mind.
Hopefully the beginning.
Posted by PeterMartin on May 17, 2018, at 1:48:37
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 16, 2018, at 9:20:47
> Sure enough so far a better morning today. A bit of sunshine in my mind.
>
> Hopefully the beginning.Yea a much better day. Definitely feeling the Nardil effect. It needs to stay around this time though being at 90mg. Hopefully it'll be a smooth ride from here on out.
It's so odd to me how I can almost tell that I'm fighting it before the relief comes.
Posted by SLS on May 17, 2018, at 7:32:03
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 17, 2018, at 1:48:37
I'm following your posts, Peter.
I don't know what to suggest. My guess is that 90 mg/day is high enough for you. Some people report that they don't get the full effect of Nardil until they have been on it for 3 months. I know that you have been on it for many weeks. Perhaps you need to be on 90 mg/day for 3 months. I don't know.
I have great difficulties being patient when something begins to work and the improvements are episodic. I want to adjust dosages and add other drugs immediately when, perhaps, leaving things alone for awhile ultimately produces the best response. Patience is a scarce commodity for me sometimes.
These are some alternatives that I thought of off the top of my head. They are in no particular order. I have tried 3-8 in combination with Parnate.
1. Continue at 90 mg/day
2. Raise the dosage to 105 mg/day
3. Add Lamictal
4. Add lithium
5. Add Abilify
6. Add Saphris
7. Add nortriptyline
8. Add Wellbutrin
9. Add Ritalin or FocalinWhat are your thoughts on these?
Right now, I am having success for having added Saphris to Parnate. For me, the antidepressant effect of Saphris is qualitatively better than that I was having with Abilify.
Given your current partial responsiveness to Nardil, I think you have a good chance of finding a treatment that works.
Can you comment on Marplan? Interestingly, my doctor considers Marplan to be better suited for depression with Nardil being better for anxiety. If I need to return to a MAOI, I think I'll try Marplan before heading back to Nardil.
Good luck.
- Scott
Posted by PeterMartin on May 17, 2018, at 22:30:01
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 17, 2018, at 7:32:03
> I'm following your posts, Peter.
>Thanks!
> I don't know what to suggest. My guess is that 90 mg/day is high enough for you.
>It's much like I expected in that I really feel Nardil working now. I had a few days of almost fighting w/ myself about it (and ranting here) but now I think I'm finally on the other side. I'm praying it doesn't take another down turn but so far I'm back to feeling like my confident "Marplan" self.
> These are some alternatives that I thought of off the top of my head. They are in no particular order. I have tried 3-8 in combination with Parnate.
>
> 1. Continue at 90 mg/dayThat's my plan.
> 2. Raise the dosage to 105 mg/day
I wouldn't consider at this point...
> 3. Add Lamictal
I'm on 100 (down from 150 at a month or so before starting Nardil). I'd rather keep it lower than hgiher although I know you though 150/200 would be good to consider. At the moment all is well but if I need more AD effect I may try to raise that a bit. I only have 100mg pills so it's difficult to split them in to 25mg which would make it easier to go up just a little. I find Lamictal mg changes make a big difference for me.
> 4. Add lithium
Gave me hypertension (bad) w/ Marplan after a year or so. Could retry it but I'm also concerned about weight (hence Metformin) so it's an unlikely thing for me to try.
> 5. Add Abilify
Gave me akathesia pretty bad the one time I gave it a real trial. I don't recall any particular positives.
> 6. Add Saphris
I'd be interested in Saphris. I never read up on it since it came along after I found 7yrs of remision on Marplan.
> 7. Add nortriptyline
Would be up to my doc. He's about my age (40 thus "young" for a pdoc) so he's not super experienced w/ MAOis. I'm not sure he'd be adventurous to add a tricyclic. Something to consider if 90mg fails.
> 8. Add Wellbutrin
I've tried Wellbutrin twice on its own and both times I had a horrible response. Felt terrible / GI issues / etc. Have no idea why. It's been a long time though so I'd consider.
> 9. Add Ritalin or Focalin
I wish I could but there's a risk I'd overuse/abuse those sort of meds. Marplan used to give me something I'd tell my GF was "reverse ADD" where I'd have a hard time stopping what I was doing. Like I'd be working on a project and I just couldn't break from it. Lots of noepinephrine? I dunno but I loved it ha.....maybe a bit hypomanic even at points but I always stayed w/in bounds. It was much less effective in the last number of years so in some ways it's good to try a switch now. I just pray Nardil will continue to work as it has the past 24hrs or so.....
> Right now, I am having success for having added Saphris to Parnate. For me, the antidepressant effect of Saphris is qualitatively better than that I was having with Abilify.
>I'm definitely interested to see how Saphris works for you.
>
> Can you comment on Marplan? Interestingly, my doctor considers Marplan to be better suited for depression with Nardil being better for anxiety. If I need to return to a MAOI, I think I'll try Marplan before heading back to Nardil.
>Marplan felt a lot cleaner. I didn't have the ups and downs I've had starting Nardil. But at the same time I think ultimately I'll find it's "weaker" than Nardil as most say. I get a bit of a buzz (not necessarily good but) after taking Nardil on most occasions. I never ever got that sorta instant effect from Marplan. Marplan just made me confident and be a better me in some way. I wouldn't say it motivated me to go out and do things but I did the things I enjoyed. So I'm not sure I'd recommend it for others but for me (or those who it does fit for) I think it's awesome since the side effects are way less of a pain in the a.....
Posted by PeterMartin on May 24, 2018, at 8:41:44
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 17, 2018, at 7:32:03
Had a run of good days then I had another day of selfloathing where I just wanted to go back to bed. And I did...slept a lot. Minor reprieve in the evening but woke up this morning mad at the world.
18 days on 90mg.
Posting this as the trend usually is that I get really mad and depressed about Nardil the day before I fell "a million times better". Praying this is the day before. So over this rollercoaster.
Nardil 90 (~4months, 60, 70, now 90 for 18 days)
Metformin 2000 (titrated up when I started Nardil)
Lamictal 100
Seroquel 25 (night sleep)Sometimes cayenne pepper, blueberry extract.
Posted by SLS on May 24, 2018, at 9:49:06
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 24, 2018, at 8:41:44
> Had a run of good days then I had another day of selfloathing where I just wanted to go back to bed. And I did...slept a lot. Minor reprieve in the evening but woke up this morning mad at the world.
>
> 18 days on 90mg.
>
> Posting this as the trend usually is that I get really mad and depressed about Nardil the day before I fell "a million times better". Praying this is the day before. So over this rollercoaster.
>
> Nardil 90 (~4months, 60, 70, now 90 for 18 days)
> Metformin 2000 (titrated up when I started Nardil)
> Lamictal 100
> Seroquel 25 (night sleep)
>
> Sometimes cayenne pepper, blueberry extract.
The path to remission in TRD is not usually linear and smooth. It follows an inclined sawtooth pattern. There are ups and downs. However, each peak is hopefully higher than the one that preceded it. The downs become less deep.Look at the red line:
http://cdn.iopscience.com/images/0741-3335/53/1/013001/Full/ppcf341546fig02.jpg
One step at a time. If you truly get stuck, then you can look at augmenting strategies.
Good luck.
- Scott
Posted by PeterMartin on May 24, 2018, at 12:21:20
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 24, 2018, at 9:49:06
Thanks for the support Scott - what I needed to hear.
Posted by SLS on May 25, 2018, at 12:47:16
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on May 24, 2018, at 9:49:06
> The path to remission in TRD is not usually linear and smooth. It follows an inclined sawtooth pattern. There are ups and downs. However, each peak is hopefully higher than the one that preceded it. The downs become less deep.
>
> Look at the red line:Oops.
I meant to look at the black line!
http://cdn.iopscience.com/images/0741-3335/53/1/013001/Full/ppcf341546fig02.jpg
Sorry.
> One step at a time. If you truly get stuck, then you can look at augmenting strategies.
>
> Good luck.
Posted by Lamdage22 on May 26, 2018, at 8:13:18
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by SLS on May 25, 2018, at 12:47:16
And the Metformin helps weight issues?
Posted by PeterMartin on May 26, 2018, at 13:40:31
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by Lamdage22 on May 26, 2018, at 8:13:18
> And the Metformin helps weight issues?
I think it's slowed the gain but I have still gone from 216.9 (Jan 25) to 221 (May 25). And I'm on the max dose for about 3weeks now. So unfortunately it's not perfect nor allowing for wt loss which I'd hoped. They say it can take months to work and I still question the effectiveness of some generics. I've been taking TEVA ER for the past few weeks. If I go up in it more I may go back to Sun ER or perhaps one of the immediate brands.
Without it though I think I'd have had much worse carb craving, constipation, and gain..so I'm happy for it I just hope it's not part of the mood prob and maybe starts to help bit more. What I've gained could be water weight too as urinary retention is extremely bad at the moment. I just picked up some stinging nettle to try to help that.
Mood today isn't great but I'm better than a few hrs ago. Maybe I'll increase my lamictal again to 150. Just a little worried that will add to urinary retention, maybe blunt Nardil, and perhaps cause memory issues again. (dropped words when typing / etc)
Posted by Lamdage22 on May 29, 2018, at 2:28:13
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on May 26, 2018, at 13:40:31
the urinary retention should pass!
Posted by PeterMartin on June 3, 2018, at 9:23:06
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by Lamdage22 on May 29, 2018, at 2:28:13
Urinary retention is really bad right now. Just about a month on 90. 4+ months total. Very up and down / not happy.
Got a B12 shot yesterday and that seems to have ruined a lot of progress. Big time anxiety/depr ssion yesterday evening/night. Had to go to bed early. GF was a bit miffed about it.
Feel horrible this morning again. I've had issues w vitamins before but heard B12 is essential if taking metformin. Didn't expect this bad of a reaction.
Weight is creeping up now too. 223ish from 216 at the start.
Frustrated.
Lots of days are "good" but I read so many success stories on this stuff I don't get it. Hasn't happened here.
Posted by Lamdage22 on June 3, 2018, at 12:57:24
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on June 3, 2018, at 9:23:06
I didnt know that about Metformin. But i do take B12 anyway
Posted by SLS on June 3, 2018, at 13:08:04
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on June 3, 2018, at 9:23:06
Have you researched bethanechol (Urecholine) for urinary retention?
- Scott
Posted by PeterMartin on June 5, 2018, at 12:59:13
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on June 3, 2018, at 13:08:04
> Have you researched bethanechol (Urecholine) for urinary retention?
>
>
> - ScottI've heard of it and almost called my doctor yesterday to ask but my ability to pee has come back a bit. I've been taking dandelion and nettle which might be helping.
Right now though I'm really beside myself as I was doing pretty ok on Saturday until I foolishly decided to get a b12 shot. After nearly 2 days straight. I'm slowly getting better but I don't feel the Nardil doing much aside from the little kick I get after taking a 2pill dose.
I really need to feel like there is relief in site. I have no idea why B12 threw everything off the way it did. I've had them before and never had this bad of a reaction. Metformin decreases b12 so you're supposed to supplement it if it gets low so I figured it was a good move....
I'm very adhedonic and unmotivated. All I'm really feeling from the Nardil at the moment is pretty strong hypotension on standing. Really hope it surprises me. Tomorrow is exacxtly one month on 90mg (over 4 months total).
Posted by rose45 on June 8, 2018, at 11:34:26
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90 » PeterMartin, posted by SLS on June 3, 2018, at 13:08:04
For what it is worth, when I was in the Maudsley hospital in London, they would not let me take any B vitamins with the Nardil.... they seemed to think there was some contra indication. does anyone else know about this?
Posted by PeterMartin on June 13, 2018, at 20:50:45
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by rose45 on June 8, 2018, at 11:34:26
I think the B12 shot definitely did throw me off for about a week. I also find the recommended b6 supplement (even miniscule 5mg doseages) to have negative effects on my mood. Typical for me though.
I think Nardil finally kicked in after about 6weeks on 90 (after months on 60/75). Yesterday was a very positive day for me. Today a bit less so but I'm still bouncing between the max dose of Metformin and slightly less. I think it dips my mood but if from what I read and experience on lower dosages the sides go away when your body adjusts. Whther or not it can keep Nardil weight neutral is a different question. Been steady last couple weeks but up from 216 to 223 since I started Nardil in late Jan. That's w daily 20min exercise bike. We'll see.
Posted by PeterMartin on July 1, 2018, at 1:46:17
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on June 13, 2018, at 20:50:45
Just an update I am on Zonegran now. Been on 100mg for the past 6days. I'll go up to 200 after 2 weeks. I think it's helping my moods over all and no bad side effects to report. My weight did drop the first couple of days but now seems to be ticking back. 100 in anlow dose though. Studies suggest 400 for signicant weight loss. I'll see how it goes.
I've dialed back the met to 1500 which seems to have helped a bit w my moods over all as well.
Doing pretty well but can't wait to titrated up in the zonegran. My daily scale check really affects my mood for the day.
Jumped from 224 to 229 day before starting Zonegran. Then back to 221..now 224ish. 230 is the heaviest I've ever been and I've set that as my "get off Nardil line"..... fighting hard but very optimistic about zonegran so far. The fact it may help stability is amazing. I'll update though....still very early.
Posted by Tfeld on July 8, 2018, at 8:21:10
In reply to Re: Hoping Nardil kicks in at 60 (wk3) - up to 90, posted by PeterMartin on July 1, 2018, at 1:46:17
> Just an update I am on Zonegran now. Been on 100mg for the past 6days. I'll go up to 200 after 2 weeks. I think it's helping my moods over all and no bad side effects to report. My weight did drop the first couple of days but now seems to be ticking back. 100 in anlow dose though. Studies suggest 400 for signicant weight loss. I'll see how it goes.
>
> I've dialed back the met to 1500 which seems to have helped a bit w my moods over all as well.
>
> Doing pretty well but can't wait to titrated up in the zonegran. My daily scale check really affects my mood for the day.
>
> Jumped from 224 to 229 day before starting Zonegran. Then back to 221..now 224ish. 230 is the heaviest I've ever been and I've set that as my "get off Nardil line"..... fighting hard but very optimistic about zonegran so far. The fact it may help stability is amazing. I'll update though....still very early.Hey Peter,
Been following the board (used to participate years back) and your recent posts since the atrocious Marplan shortage. I too was a Marplan user for 8 years, most of which at 40mg, and began to have a substantial response after adjusting adjunctive meds and bumping Marplan up to 90mg with a fantastic NYC doctor whom I found on Dr. Bob's very own psychopharm tips when I was once-again desperate in 2016 to find a doc willing to manage the MAOI/ TCA (desipramine)/ stimulant (Desoxyn) combo and who had the balls to push the envelope until I got better... and I did.
...then the Marplan shortage hit. At first briefly, when I hopped back on Parnate for the 4th time and hated its guts once again. Validus Pharma did all they could searching for bottles and sent me all they had as they promised to restart production, but as you know, that never came to fruition.
I have comorbid subst abuse issues, and around the same time I was running out of my last Marplan bottle was ripped off a train and was illegally (met no mental health hygiene law criteria or dx for mania -- Columbia Presbyterian and local hospitals usually shut the door on me) but nonetheless involuntarily hospitalized in a crapshoot in Queens, but it did break the cycle of addiction and I have enjoyed 16 days of relative freedom from that nasty grip since.
I made a stat appointment this past Tuesday and we ditched our former plan to initiate venlafaxine (one of the few I never went for out of 65 attempted meds, multiple trials including TMS (failed and/ or mania) and street ketamine (WORKS)) and titrate to a very high dosage (~650mg) in favor of giving Nardil a second try.
This is week 1 and I seem to be responding so far at a low dosage (30mg) + my other meds. I am experiencing considerably more tolerability issues (mainly sleepiness and brain fog) compared to the miraculously clean Marplan, but am also experiencing pronounced therapeutic benefits to my anxiety and avoidance that I still suffered from on isocarboxazid.
I only go by my doctor's scale which means I clock in only once a week, which I believe prevents harping on often anomalous day-to-day changes that are an inaccurate reflection of long-term changes. A suggestion -- what about checking once a week as well? I find it spares my self-esteem and allows me to focus more on dietary efforts without the barrage of daily numerical input to my self-critical thought processes -- after all, the prefrontal cortex can only hold so much info at once (be it executing motivational efforts or ruminative schemata) before it begins to work less efficiently towards achievement of goals. I am actually finding that, along with the hospital routine still lingering, the phenelzine seems to be helping my appetite and sticking to not eating between meals.
Speaking of the PFC, next week the doc and I plan to focus on patching up what's left of my noggin after nearly a year of neurotoxic subst use and the hospital stripping me of most meds including ADHD Tx -- from 80mg Desoxyn + 75mg desipramine (reevaluating its utility and staying off for now) to discharged on 5mg methylphenidate. Ugh.
Currently taking:
phenelzine 30mg (formerly ISO 90mg; no desipramine)
Desoxyn 20mg (formerly 80mg)
pramipexole IR 1.25mg
clonazepam 4mg
aripiprazole 7.5mg
lithium carb 300mg
lamotrigine 25mgand no more Deplin 7.5mg -- can no longer afford since 26 now and dropped from parents' PPO. I also take Synthroid 50mcg from past lithium complications and Truvada for PrEP.
But enough of me -- your persistence and patience has been an inspiration to me and has encouraged me not to give up on MAOIs, which I truly need. Marplan users are indeed few and far between but I am sure there are numerous nonmembers who have been following along for guidance in the aftermath of a company's once compassionate return of this uniquely useful and tolerable drug to the market to an utterly stubborn cling to their soon-expiring patent in lieu of releasing the damn proprietary crap so a different competent company can restore us to sanity -- Validus deserves a huge slap on the wrist by the FDA, but unfortunately, especially as MAOI users, that's just not how this country works.
Anyway, keep at it and NEVER give up. My pdoc promised me early on he would never stop trying for me, and I promised him the same. I'd suggest looking into an augmentation strategy before ditching Nardil and taking it slow -- many online are keen on jumping to 90mg as quickly as possible. Given my low-dosage response so far, and speaking as a recovering addict, tolerance is WAY overrated and can destroy what simply requires patience and creativity.
Lastly, my pdoc looked into things before ditching Marplan and found an American source who can import ISO from the UK. At my dosage it would require ~$1800/mo (although many insurances will cover importation, I simply doubt my Medicaid would). If you've got the income or insurance allowance and would like more info on that, send me a message and I'll try to find the info for you.
Good luck with Zonegran and congratulations on its contribution to your stability.
Tfeld
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