Psycho-Babble Medication Thread 1095422

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MAOI large doses

Posted by MightyKondrian on October 14, 2017, at 12:59:24

Anyone experience with larger than large doses with their MAOI? I'm on 120mg phenelzine but might try 135mg or even 150mg only on the odd occasion. Definitely not every day!
This morning I accidentally took my whole daily dose in the morning. Seems stronger and I'm still 'up'

MightyKondrian

 

Re: MAOI large doses MightyKondrian

Posted by SLS on October 14, 2017, at 20:07:34

In reply to MAOI large doses, posted by MightyKondrian on October 14, 2017, at 12:59:24

Nardil is a seductress. Be careful.

Regarding dosage, I would not go above 120 mg/day. Nardil is different from Parnate. Its kinetics are not linear. This is because it inhibits its own metabolism. So, doubling the dosage will yield more than a doubling of blood levels. I don't happen to know what the factor is, but it is probably exponential. When titrating, it is often suggested that one give at least 3 weeks for a particular dosage to work before considering an increase.

How long have you been taking Nardil at 120 mg/day? There are no guarantees, but some people don't respond to Nardil until they have been taking it for 12 weeks. Any kind of acute improvement in mood immediately after a dosage increase is unlikely to last. It does not surprise me that you caught a "buzz" from ingesting 120 mg of Nardil all at once. In my early experiences with Nardil, I found it mildly euphoric or stimulating immediately after every dose while taking 90 mg/day. I would guess that Nardil does more than just inhibit MAO oxidase and GABA transaminase. Perhaps there is something going on with dopamine release.


- Scott

 

Re: MAOI large doses SLS

Posted by MightyKondrian on October 15, 2017, at 17:52:21

In reply to Re: MAOI large doses MightyKondrian, posted by SLS on October 14, 2017, at 20:07:34

Thanks SLS, I hear you loud and clear.

Now, I've been feeling great all day. 'Normal' is a more appropriate word. Not high, no low moods.

I went fishing today with my father. Was a very pleasant day. I know it sounds like anyone would find it relaxing but it was more than that. Maybe talking a little more than usual but I just found it a simple nice day out. But yeah, anxiety and depression free.
My SA was not apparent and I said afternoon to most people walking by. Mind you half of them spoke to me 1st. The old usual "caught anything yet?" lol

One valid point I must add is that when 1st on phenelzine many years ago my doc was the great Professor David Nutt. I remember him casually saying that I can take them all in one go (morning I think he said) though I never tried that as I was doing OK on 60mg then slowly up to 90mg till I eventually gave up on it and switched to Marplan (isocarboxazid). And I should also note that despite the top official dose was 60mg I went right up to 150mg with it lol.

MightyKondrian
Lastly I began taking 50mcg of Clonidine Friday. Tonight I increase to 100mcg noct for 5 days then 200 (100mcg twice daily). Could well be the start of some honeymoon-period perhaps. Hope it lasts.

Jeez I'm on 7 psych meds now, plus my insulin.

MightyKondrian

 

Re: MAOI large doses

Posted by PeterMartin on October 16, 2017, at 3:55:05

In reply to Re: MAOI large doses SLS, posted by MightyKondrian on October 15, 2017, at 17:52:21

How did you do on 150mg of Marplan? I take it but always have w.in the 40-60 range. That's been good for me and I always seemed to get spacey when I tried 60 and 70.

 

Re: MAOI large doses PeterMartin

Posted by MightyKondrian on October 16, 2017, at 6:13:43

In reply to Re: MAOI large doses, posted by PeterMartin on October 16, 2017, at 3:55:05

> How did you do on 150mg of Marplan? I take it but always have w.in the 40-60 range. That's been good for me and I always seemed to get spacey when I tried 60 and 70.
>
>

Well It creept up from 60 up to 120mg over 10yrs or more. The last couple yrs I went up to 150mg.
All Hydrazine derivative MAOIs seem to have side effect that come on somewhat delayed. Then they last for anywhere from 3-9 months. but they always pass, eventually.
My doc did say I have an unusual tolerance to Marplan. I'm hoping to (if the clonidine doesn't help) try up to increase my phenelzine to 150mg.

Tranylcypramine is still on the cards but certainly not the time for that. I must ask him about Moclobemide or Selegiline. He said he'd be much more confident with most combinations. Then I can have lashings of different cheeses in my pizzas! :D

MightyKondrian

 

Re: MAOI large doses MightyKondrian

Posted by SLS on October 16, 2017, at 10:37:01

In reply to Re: MAOI large doses PeterMartin, posted by MightyKondrian on October 16, 2017, at 6:13:43

> > How did you do on 150mg of Marplan? I take it but always have w.in the 40-60 range. That's been good for me and I always seemed to get spacey when I tried 60 and 70.
> >
> >
>
> Well It creept up from 60 up to 120mg over 10yrs or more. The last couple yrs I went up to 150mg.
> All Hydrazine derivative MAOIs seem to have side effect that come on somewhat delayed. Then they last for anywhere from 3-9 months. but they always pass, eventually.
> My doc did say I have an unusual tolerance to Marplan. I'm hoping to (if the clonidine doesn't help) try up to increase my phenelzine to 150mg.
>
> Tranylcypramine is still on the cards but certainly not the time for that. I must ask him about Moclobemide or Selegiline. He said he'd be much more confident with most combinations. Then I can have lashings of different cheeses in my pizzas! :D
>
> MightyKondrian


Both the selegiline patch and moclobemide are treatments with low probabilities of being robustly or persistently effective. You will most likely feel very much better with moclobemide early in treatment - maybe within the first few days. This will probably last for a week to a month before you must continually increase the dosage to maintain an improvement up to a maximum of 1200 mg/day. Also, you really should consider consuming no more than 50 mg. of tyramine at any one meal. If I were you, I imagine I would try both treatments because I am desperate, and you never from where will come your healing. Because of this, I already tried both drugs. I guess I would try the selegiline patch first if moclobemide is not available in your country. However, the selegiline patch is not very effective until you get to 12 mg/24 hrs. At this dosage, selegiline becomes less selective and inhibits both MAO-A and MAO-B. In my estimation, it is the inhibition of MAO-A that exerts most of the antidepressant effect. So, it won't be a surprise if moclobemide makes you feel better at first. The ideal MAOI would be an irreversible and selective MAO-A inhibitor.

I hope one of these two drugs bring you to remission.

What drugs have you combined with Nardil so far?


- Scott

 

Re: MAOI large doses SLS

Posted by MightyKondrian on October 16, 2017, at 20:37:27

In reply to Re: MAOI large doses MightyKondrian, posted by SLS on October 16, 2017, at 10:37:01

> Both the selegiline patch and moclobemide are treatments with low probabilities of being robustly or persistently effective. You will most likely feel very much better with moclobemide early in treatment - maybe within the first few days. This will probably last for a week to a month before you must continually increase the dosage to maintain an improvement up to a maximum of 1200 mg/day. Also, you really should consider consuming no more than 50 mg. of tyramine at any one meal. If I were you, I imagine I would try both treatments because I am desperate, and you never from where will come your healing. Because of this, I already tried both drugs. I guess I would try the selegiline patch first if moclobemide is not available in your country. However, the selegiline patch is not very effective until you get to 12 mg/24 hrs. At this dosage, selegiline becomes less selective and inhibits both MAO-A and MAO-B. In my estimation, it is the inhibition of MAO-A that exerts most of the antidepressant effect. So, it won't be a surprise if moclobemide makes you feel better at first. The ideal MAOI would be an irreversible and selective MAO-A inhibitor.
>
> I hope one of these two drugs bring you to remission.
>
> What drugs have you combined with Nardil so far?
>
>
> - Scott
>

Thanks for your replies.

I dont actually plan on taking Moclobemide or selegiline in the near future. I just want to query my doc if there might be room for these meds in the future, should I need them.
I've only tried moclobemide once. I was falling asleep strait after my evening meal. Not good for someone who suffers exhaustion & lethargy on a regular basis so it soon went out the window. Yes it is available here in the UK. Interestingly, inside the patient info leaflet is a part about combining it with escitalopram! Obviously a known combo that works? I wonder how common that is.

I've taken phenelzine twice. Once for 3-4yrs and again starting shortly efore last xmas. In fact its only the last couple of months that I've even felt phenelzine doing anything positive- when I hit 120mg.

1st time round was the true Nardil 'blessing'. Lasted a good 3 yrs. Back then i was only adding 1 med at a time. Never stacked. In roughly this order: modafinil, L-Tryptophan (Optimax) and clonazepam (kept that to this day). I was too hard a case for that Pdoc so was handed over to the team leader and tried lamotrigine then aripiprazole. After that I requested a switch to Iso (Marplan ggrrr hate brand names lol). Then I was passed back to the previous doc's care.
Since switching back to phenelzine I've combined everything in my signature stack, plus quetiapine which was left over after isocarboxazid. Not so good with phenelzine. And theres alot of meds, like lithium that I tried on the Iso so have a chance to now try them again on phenelzine.

Thankfully I've just about reached my plateau thank heavens. Could be the clonidine. Time will tell. I cant expect more than this. The rest I need to do myself.

MightyKondrian

 

Re: MAOI large doses MightyKondrian

Posted by SLS on October 17, 2017, at 8:24:56

In reply to Re: MAOI large doses SLS, posted by MightyKondrian on October 16, 2017, at 20:37:27

I like your fiercely positive attitude.

> Thankfully I've just about reached my plateau thank heavens. Could be the clonidine. Time will tell.

In what ways do you feel different since introducing the clonidine?

> I cant expect more than this.

I hope that your psychobiological illness is now being treated such that you achieve remission.

> The rest I need to do myself.

Yes. Definitely.

For me, things occur in the following order:

Depression -> Biological treatment -> Remission -> Psychotherapy -> Healing of the Psyche -> Fun

There is very little healing of my psyche that can occur without first removing the depression. One psychologist who I was working with told me that I should continue to be treated medically so that I am well enough to profit from psychotherapy. He said that with my kind of depression, I couldn't think my way out of a paper bag.

Good luck in your endeavors.


- Scott

 

Re: MAOI large doses

Posted by MightyKondrian on October 18, 2017, at 5:42:41

In reply to Re: MAOI large doses MightyKondrian, posted by SLS on October 17, 2017, at 8:24:56

Thanks Scott.

I think the Clonidine is working a bit like a beta blocker tho via the brain. Like a mild cushioning effect.
I'm sticking to taking my phenelzine all in one go as the effect is far more apparent and seems to carry on throughout the day. Bearing in mind that I take clonazepam twice daily. So I get 2 peaks of GABA a day plus that of phenelzine's.
Something also tell me I might not need the aripiprazole. I might try every other day, once I've settled. It certainly causes me drowsiness if taken in the day.

Next is to find a councillor. I want to try CBT 1st. but I'll still be here. If it wasn't for this site I might not have found out about phenelzine as early as I did (at 24yrs) and things could have gotten ugly beyond believe. It was here I've learned most from both with posts and links.

MightyKondrian

 

Re: MAOI large doses MightyKondrian

Posted by porkpiehat on October 19, 2017, at 13:59:54

In reply to Re: MAOI large doses, posted by MightyKondrian on October 18, 2017, at 5:42:41

You both have tried Marplan? Why did you discontinue? I am huge into fishing also...but it's more compulsive than relaxing which is why I have to stop parnate.

I started switch from tranylcypromine (parnate?) tuesday and I'm controlling my own dosage. My nurse practitioner seems to know very little outside of putting everyone on lamictal and abilify.

Unlike you both I usually respond better at subtherapeutic doses. It's a hydrazine like phenylzine but the dosing is identical to parnate.

Having cognitive issues now taking 20mg Marplan but they clear up a little if I take 5 or 10 mgs parnate but I don't know if it will be safe for long.

SLS/Scott any thoughts on the pharmdynamics of this parnate/marplan mix?


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