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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by rose45 on January 20, 2022, at 6:17:05
Since Parnate stopped working for me, I am suffering dreadful anxiety. There are very few people on here on Marplan, but have any of you found Marplan to be helpful for anxiety? Both Parnate and Nardil worked well, but no longer work. I am in UK and pretty desperate as the state service is dire. I have heard that Marplan is weaker than the other 2 maois, but since I reacted so well to the other 2, Im hoping that marplan can work also.
All feedback appreciated.
Posted by SLS on January 20, 2022, at 14:37:46
In reply to marplan for anxiety, posted by rose45 on January 20, 2022, at 6:17:05
> Since Parnate stopped working for me, I am suffering dreadful anxiety. There are very few people on here on Marplan, but have any of you found Marplan to be helpful for anxiety? Both Parnate and Nardil worked well, but no longer work. I am in UK and pretty desperate as the state service is dire. I have heard that Marplan is weaker than the other 2 maois, but since I reacted so well to the other 2, Im hoping that marplan can work also.
>
> All feedback appreciated.Marplan (isocarboxezid) is chemically related to Nardil - a hydrazine.
Marplan was often described as being a "weak" Nardil. However, Marplan works for a specific type of case of depression and anxiety. The defining characteristic of Marplan responders is that they respond to Marplan. That was Scott attempting to make a joke. It was lame, but the point I was making is that you don't know how well Marplan will work for you until you try it. Some people who don't respond to Nardil go on to respond to Marplan. Marplan is much milder with respect to side effects compared to Nardil. This is particularly true of brain fog, delayed micturition (beginning to urinate), and low blood pressure which often causes dizziness and fainting. In some ways, Marplan feels like an admixture of Nardil and Parnate to me. I'm hoping for you that it will be more "pro-social" and more "anti-anhedonic". There is no generic version of isocarboxizid, so it is very expensive.
Another thought:
EMSAM (transdermal selegiline) has been reported to produce improvements in social-anxiety disorder at lower dosages and early in treatment. I don't know if EMSAM can effectively treat generalized anxiety disorder (GAD) or panic disorder. Nardil can be great for these indications.
- Scott
Posted by Lamdage22 on January 21, 2022, at 4:34:15
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 20, 2022, at 14:37:46
Good insight :)
> The defining characteristic of Marplan responders is that they respond to Marplan.
Posted by rose45 on January 21, 2022, at 9:32:33
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 20, 2022, at 14:37:46
Thank you Scott.
I am the person who lives in UK, and reacted well to lamotrigine being added as augmentation to parnate. You were very helpful with your posts and I do appreciate them and your taking the time to write.
The lamotrigine has since stopped working and I am now in a terrible state again and barely functioning with unbearable anxiety and cannot think straight. Still taking the lamotrigine and parnate though neither is working, and lamotrigine has destroyed my memory.
The nhs free mental care is really bad, and offered ECT which I dont want. They asked what I would agree to and I suggested Marplan since I reacted well to both parnate and nardil. Only maois have ever worked for me and Im hoping that marplan can work too, even though it is supposedly weaker than the other two.
Of course, as you say, I have to try it to find out, but am really scared as it is my last hope being offered by the NHS and I cannot afford to go private, and Im not functioning. My state before going on meds was really non functional, and that is where I am again.
Posted by Christ_empowered on January 21, 2022, at 13:00:50
In reply to Re: marplan for anxiety, posted by rose45 on January 21, 2022, at 9:32:33
i am so terribly sorry about your situation. have you been prescribed sedatives...benzodiazepines, gabapentin, Lyrica?
I don't think lyrica is very popular here in the US for psych indications. gabapentin was, to some extent still is.
I did read that Lyrica was popular in other countries...canada, I think...maybe parts of the EU?
I seem to recall reading that there is a distinct discontinuation syndrome associated with both gabapentin (I would assume higher doses and chronic usage) and also with Lyrica. Here in the US, Lyrica is a Schedule V controlled substance, so it is officially regarded as less (potentially) problematic than ativan, valium, etc.
other than that...a large study in the US found that the combination of Effexor and Remeron had results in "treatment-resistant depression" roughly comparable to an MAOI (I think they used Parnate?). not ideal, but...
all I could really come up with. and...
I know this is probably going to sound extra-obnoxious, but: what do you mean by anxiety? is low mood involved? facial flushing, trembling? ruminations?
I just ask because if you can break down what your anxiety involves, it -might- be easier for a treatment provider to put something together that provides some relief.
I hope this helps. :-)
Posted by SLS on January 21, 2022, at 13:19:06
In reply to Re: marplan for anxiety, posted by rose45 on January 21, 2022, at 9:32:33
Hi, Rose.
I'm sorry that you feel stuck right now.
Just a few questions:
1. What is your current dosage of lamotrigine?
3. What was the maximum dosage you went up to and for how long?
2. Do you take the original Lamictal or generic lamotrigine?
3. Are you using the same pharmacy?
4. Has there been a change in the name of the generic manufacturer you were dispensed?
5. Was your memory impaired when lamotrigine was working well?
6. Is your memory worse now than it was before you relapsed?
> Thank you Scott.
>
> I am the person who lives in UK, and reacted well to lamotrigine being added as augmentation to parnate. You were very helpful with your posts and I do appreciate them and your taking the time to write.
>
> The lamotrigine has since stopped working and I am now in a terrible state again and barely functioning with unbearable anxiety and cannot think straight. Still taking the lamotrigine and parnate though neither is working, and lamotrigine has destroyed my memory.
>
> The nhs free mental care is really bad, and offered ECT which I dont want. They asked what I would agree to and I suggested Marplan since I reacted well to both parnate and nardil. Only maois have ever worked for me and Im hoping that marplan can work too, even though it is supposedly weaker than the other two.
>
> Of course, as you say, I have to try it to find out, but am really scared as it is my last hope being offered by the NHS and I cannot afford to go private, and Im not functioning. My state before going on meds was really non functional, and that is where I am again.
>
>
Posted by rose45 on January 21, 2022, at 14:26:37
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 21, 2022, at 13:19:06
> Hi, Rose.
>
> I'm sorry that you feel stuck right now.
>
> Just a few questions:
>
> 1. What is your current dosage of lamotrigine?
>
> 3. What was the maximum dosage you went up to and for how long?
>
> 2. Do you take the original Lamictal or generic lamotrigine?
>
> 3. Are you using the same pharmacy?
>
> 4. Has there been a change in the name of the generic manufacturer you were dispensed?
>
> 5. Was your memory impaired when lamotrigine was working well?
>
> 6. Is your memory worse now than it was before you relapsed?
>
>
>
>
>
>
> > Thank you Scott.
> >
> > I am the person who lives in UK, and reacted well to lamotrigine being added as augmentation to parnate. You were very helpful with your posts and I do appreciate them and your taking the time to write.
> >
> > The lamotrigine has since stopped working and I am now in a terrible state again and barely functioning with unbearable anxiety and cannot think straight. Still taking the lamotrigine and parnate though neither is working, and lamotrigine has destroyed my memory.
> >
> > The nhs free mental care is really bad, and offered ECT which I dont want. They asked what I would agree to and I suggested Marplan since I reacted well to both parnate and nardil. Only maois have ever worked for me and Im hoping that marplan can work too, even though it is supposedly weaker than the other two.
> >
> > Of course, as you say, I have to try it to find out, but am really scared as it is my last hope being offered by the NHS and I cannot afford to go private, and Im not functioning. My state before going on meds was really non functional, and that is where I am again.I dont just feel stuck, I feel suicidal and cannot think clearly. The mental pain is unbearable and it has been going on for too long.
1. I reduced the lamotrigine to 125 mg
2. I went up to 200 mg but there was no difference between 100 and 200 and there were too many side effects.... too much loss of hair, loss of memory and ability to express myself etc..
3.original lamictal, but when it worked for 6 weeks at 125 mg, it was with a generic. When I switched to lamictal, it soon stopped working. When I switched back to the same generic, it wouldnt work either.Yes same pharmacy
It only worked with one particular generic, but no longer does with that generic or with lamictal either.
Yes my memory has been impaired all along.
Maybe my memory is worse now because of the overwhelming anxiety.I dont seem to react in any logical way to anything. I cant see a way out. sorry if this is muddled. Thank you for caring
>
>
Posted by rose45 on January 21, 2022, at 14:32:04
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 21, 2022, at 13:19:06
> Hi, Rose.
>
> I'm sorry that you feel stuck right now.
>
> Just a few questions:
>
> 1. What is your current dosage of lamotrigine?
>
> 3. What was the maximum dosage you went up to and for how long?
>
> 2. Do you take the original Lamictal or generic lamotrigine?
>
> 3. Are you using the same pharmacy?
>
> 4. Has there been a change in the name of the generic manufacturer you were dispensed?
>
> 5. Was your memory impaired when lamotrigine was working well?
>
> 6. Is your memory worse now than it was before you relapsed?
>
>
>
>
>
>
> > Thank you Scott.
> >
> > I am the person who lives in UK, and reacted well to lamotrigine being added as augmentation to parnate. You were very helpful with your posts and I do appreciate them and your taking the time to write.
> >
> > The lamotrigine has since stopped working and I am now in a terrible state again and barely functioning with unbearable anxiety and cannot think straight. Still taking the lamotrigine and parnate though neither is working, and lamotrigine has destroyed my memory.
> >
> > The nhs free mental care is really bad, and offered ECT which I dont want. They asked what I would agree to and I suggested Marplan since I reacted well to both parnate and nardil. Only maois have ever worked for me and Im hoping that marplan can work too, even though it is supposedly weaker than the other two.
> >
> > Of course, as you say, I have to try it to find out, but am really scared as it is my last hope being offered by the NHS and I cannot afford to go private, and Im not functioning. My state before going on meds was really non functional, and that is where I am again.I dont just feel stuck, I feel suicidal and cannot think clearly. The mental pain is unbearable and it has been going on for too long.
1. I reduced the lamotrigine to 125 mg
2. I went up to 200 mg but there was no difference between 100 and 200 and there were too many side effects.... too much loss of hair, loss of memory and ability to express myself etc..
3.original lamictal, but when it worked for 6 weeks at 125 mg, it was with a generic. When I switched to lamictal, it soon stopped working. When I switched back to the same generic, it wouldnt work either.Yes same pharmacy
It only worked with one particular generic, but no longer does with that generic or with lamictal either.
Yes my memory has been impaired all along.
Maybe my memory is worse now because of the overwhelming anxiety.I dont seem to react in any logical way to anything. I cant see a way out. sorry if this is muddled. Thank you for caring
>
>
Posted by rose45 on January 21, 2022, at 15:08:30
In reply to Re: marplan for anxiety, posted by Christ_empowered on January 21, 2022, at 13:00:50
> i am so terribly sorry about your situation. have you been prescribed sedatives...benzodiazepines, gabapentin, Lyrica?
>
> I don't think lyrica is very popular here in the US for psych indications. gabapentin was, to some extent still is.
>
> I did read that Lyrica was popular in other countries...canada, I think...maybe parts of the EU?
>
> I seem to recall reading that there is a distinct discontinuation syndrome associated with both gabapentin (I would assume higher doses and chronic usage) and also with Lyrica. Here in the US, Lyrica is a Schedule V controlled substance, so it is officially regarded as less (potentially) problematic than ativan, valium, etc.
>
> other than that...a large study in the US found that the combination of Effexor and Remeron had results in "treatment-resistant depression" roughly comparable to an MAOI (I think they used Parnate?). not ideal, but...
>
> all I could really come up with. and...
>
> I know this is probably going to sound extra-obnoxious, but: what do you mean by anxiety? is low mood involved? facial flushing, trembling? ruminations?
>
> I just ask because if you can break down what your anxiety involves, it -might- be easier for a treatment provider to put something together that provides some relief.
>
> I hope this helps. :-)Thanks Christ Empowered,
I havent been given anything . The NHS is overstretched and are in the dark ages - they dont prescribe benzos although I do have a small amount of lorezapam which I got from my gp but I dont want to take it too often and get addicted or run out.
The anxiety feels chemical, like caused by parnate no longer working, and all the suppressed anxiety is no longer suppressed by the drug. I dont know how else to describe it, but it is mental torture
Parnate worked so well for me, if only I could get it to work again... I should be open to trying Effexor and Remeron but I really cant start experimenting again...and they have so many side effects...... Im hoping against hope that Marplan will work....that is probably not an objective way of thinking,. Thank you for responding and for your feedback. I think it is impossible to help me bearing in mind the limitations of the system here in uk. I do appreciate your post. Thank you. I have a friend who was given Lyrica , but she said it didnt help her - and since Im on an maoi, the nhs would not give it to me anyway.
Posted by Lamdage22 on January 24, 2022, at 3:14:57
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 20, 2022, at 14:37:46
We should recmommend you for the nobel-prize.
>The defining characteristic of Marplan responders is that they respond to Marplan.
Posted by SLS on January 25, 2022, at 12:52:00
In reply to Re: marplan for anxiety, posted by rose45 on January 21, 2022, at 14:26:37
I just saw your post, Rose. I don't have time to give it my full attention, but I'll try to get back to you.
Yes, you are experiencing what is known as "psychic pain". It is terrible and you will do anything for it to end - even auto-euthanasia.
Hang in there for now...
- Scott
Posted by rose45 on January 27, 2022, at 6:49:34
In reply to Re: marplan for anxiety, posted by rose45 on January 21, 2022, at 14:26:37
Yes Scott, you are right, I dont know how much more of this I can take. Im also on 2.5mg of olanzapine and I forgot to take it last night, and today the suicidal feelings are even stronger. Can that happen just by missing 1 dose of olanzapine? I phoned the mental health department, and they are denying that such a low dose of olanzapine would have a reaction like that.
I hardly get any support from the mental health team and they are planning for withdrawal from parnate, in order to try marplan, which was my suggestion since the parnate is no longer working, and nardil also stopped working - but they are not planning supervision, and will just give me a schedule, and place me back under my gp.
This is the uk health system which is not fit for purpose.
I dont know what you can say, but I appreciate so much that you care.
Posted by SLS on January 27, 2022, at 19:23:33
In reply to Re: marplan for anxiety, posted by rose45 on January 27, 2022, at 6:49:34
> Yes Scott, you are right, I dont know how much more of this I can take. Im also on 2.5mg of olanzapine and I forgot to take it last night, and today the suicidal feelings are even stronger.
There are a couple of drugs that work to reduce suicidal ideation. Olanzapine (Zyprexa) is one of them. Why haven't you tried to go to 5.0 mg/day or 10 mg/day of olanzapine? Lithium, clozapine, and ketamine are others that come to mind.
For me, 300 mg/day of lamotrigine is the minimum effective dosage. What side effects do you experience when you increase the dosage beyond 200 mg/day? How long did you spend at the highest one dosage?
> Can that happen just by missing 1 dose of olanzapine?
It is conceivable, especially if you are barely responding to it. On the other hand, the half-life of olanzapine is 33 hours.
- Scott
Posted by SLS on January 27, 2022, at 19:30:32
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
Rose...
I forgot to mention that an old trick to remedy a relapse of depression during ongoing Nardil treatment is to stop taking it for three months and then restarting it.
- Scott
Posted by rose45 on January 28, 2022, at 12:42:53
In reply to Re: marplan for anxiety, posted by SLS on January 27, 2022, at 19:30:32
my baseline is so bad and non-functioning that I could barely survive 2 weeks without a med, let alone 3 months.
Some people on reddit say they decrease the maoi and then increase it, and that seems to work for them. When I reduced the parnate, it just stopped working altogether.
Why oh why do I not react like the majority of people.... ?maybe i could go on marplan for 3 months and then switch back to parnate ? but there is no guarantee that it would work again...
Posted by rose45 on January 28, 2022, at 13:03:51
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
>
> For me, 300 mg/day of lamotrigine is the minimum effective dosage. What side effects do you experience when you increase the dosage beyond 200 mg/day? How long did you spend at the highest one dosage?My highest dosage of lamotrigine was 200mg, but I hated it because of so much loss of hair, that I am now balding, and the loss of memory and ability to communicate are truly scary. Those side effects are still there, even though I have now decreased to 125 mg. I know you are doing well on a higher dose, but I hate this drug. Im also having trouble with my sight, and hearing and tinnitus which started more or less when I started the lamotrigine. Its hard to know if they are connected but the memory loss and general ability to communicate are very scary side effects.>
>
Posted by rose45 on January 28, 2022, at 13:32:42
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 27, 2022, at 19:23:33
For me, 300 mg/day of lamotrigine is the minimum effective dosage. What side effects do you experience when you increase the dosage beyond 200 mg/day? How long did you spend at the highest one dosage?
>My highest dose was 200 mg but the side effects of losing so much hair, as well as destroying my memory and ability to communicate were so scary, that I reduced to 125 mg. I also started to lose my hearing and eyesight and got tinnitus at more or less 125mg lamotrigine but cant know for sure whether those things are connected. I know 300 mg works for you, but I dont think you are getting all these side effects and you are getting substantial benefits. For me it has worked on and off and stopped working for no particular reason.
I was so happy on parnate - so cruel that it has stopped working. No real side effects apart from insomnia. I should never have reduced it, but how was I to know?
Posted by Lamdage22 on January 29, 2022, at 1:22:00
In reply to Re: marplan for anxiety, posted by rose45 on January 28, 2022, at 13:32:42
I know. It made me somewhat stupid.
Posted by Lamdage22 on January 29, 2022, at 1:46:58
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:22:00
Especially reading and word finding.
Posted by undopaminergic on January 29, 2022, at 9:08:17
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:22:00
> I know. It made me somewhat stupid.
Lamotrigine?
I have no noticeable effects from it.
-undopaminergic
Posted by SLS on January 29, 2022, at 12:11:29
In reply to Re: marplan for anxiety, posted by rose45 on January 28, 2022, at 13:32:42
Rose,
Have you ever tried lithium?
I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
- Scott
Posted by Lamdage22 on January 30, 2022, at 2:15:32
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 29, 2022, at 12:11:29
Interesting. That would explain what I feel. I am on 225 Lithium Carbonate. It works like a charm. No more secure unit visits ever since, altough I started out with Lithium Orotate. To me it has a definite effect against suicidality.
> For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
Posted by rose45 on January 30, 2022, at 12:04:42
In reply to Re: marplan for anxiety, posted by Lamdage22 on January 29, 2022, at 1:46:58
so have you stopped taking it?
Posted by rose45 on January 30, 2022, at 12:29:30
In reply to Re: marplan for anxiety » rose45, posted by SLS on January 29, 2022, at 12:11:29
> Rose,
>
> Have you ever tried lithium?
>
> I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
>
>
> - ScottI have suggested low dose lithium to the psychs here, but they insist that they have to go by the blood tests, and take what is indicated, ie higher doses and that is why I have said no to it. In all honesty, Im quite relieved not to take it, as I dont want to have to deal with all the side effects, putting on weight,etc......and I dont think it is indicated for anxiety is it? And Im still taking the lamotrigine, with all its side effects.... they asked me if I want to stop the lamotrigine, and I told them I would prefer to speak to someone who could guide me. There are 2 consultant psychs for 800 patients in the unit. Its like the dark ages, and I just get to speak to a nurse.
I Know Im impossible to help, I know, because I am dealing with a dinosaur almost non existant mental service here in uk. They dont even know how to do the withdrawal from parnate and are taking weeks researching their guidelines re. how to swap from one maoi to the other....
Both parnate and nardil worked for me without any adjuncts, so Im hoping against hope that marplan will too - but I worry that people say it is so much weaker than the other two. You tried it without success, did you not?
Posted by SLS on January 31, 2022, at 21:29:26
In reply to Re: marplan for anxiety, posted by rose45 on January 30, 2022, at 12:29:30
Hi, Rose.
If you are not BIPOLAR, then tell the doctors that you want to treat your UNIPOLAR depression (MDD) with the lower dosage range of lithium currently being used to treat it. If the dosage is too high, it might actually make you feel worse. To my knowledge, no corresponding blood levels have been determined for treating MDD yet. My sweet-spot is 300 mg/day. At 450 mg/day, I begin to feel worse. I relapse at 150 mg/day.
https://www.google.com/search?sxsrf=&q=Low-dose+lithium+for+depression> > Rose,
> >
> > Have you ever tried lithium?
> >
> > I discovered recently that a low dosage of 300mg/day is critical to my treatment of bipolar depression. Once I go to 450 mg/day, I actually get worse. There are both biological and subjective clinical measures of the effects of lithium that are bimodal. For instance, low dosages of lithium increase glutamate activity while high dosages of lithium reduce it.
> >
> >
> > - Scott
>
> I have suggested low dose lithium to the psychs here, but they insist that they have to go by the blood tests, and take what is indicated, ie higher doses and that is why I have said no to it. In all honesty, Im quite relieved not to take it, as I dont want to have to deal with all the side effects, putting on weight,etc......and I dont think it is indicated for anxiety is it? And Im still taking the lamotrigine, with all its side effects.... they asked me if I want to stop the lamotrigine, and I told them I would prefer to speak to someone who could guide me. There are 2 consultant psychs for 800 patients in the unit. Its like the dark ages, and I just get to speak to a nurse.
>
> I Know Im impossible to help, I know, because I am dealing with a dinosaur almost non existant mental service here in uk. They dont even know how to do the withdrawal from parnate and are taking weeks researching their guidelines re. how to swap from one maoi to the other....
>
> Both parnate and nardil worked for me without any adjuncts, so Im hoping against hope that marplan will too - but I worry that people say it is so much weaker than the other two. You tried it without success, did you not?
>
>
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