Posted by Sparkboy on November 17, 2001, at 18:42:05
In reply to Re: MAOI for Atypical other than Parnate » Sparkboy, posted by Lorraine on November 16, 2001, at 10:33:14
> John:
>
> This is Lorraine. I have atypical depression and have tried Parnate (too aggitating); Nardil (allergic reaction); Mocloebemide (too much anxiety even with Neurontin thrown in). My anxiety is low grade panic attacks. At this point, I am thinking about Marplan--would you please expand on what you have to say about Marplan? It is very difficult to find info on this drug. I know one woman who is one it and she says that she has the histamine (stuffy nose) side effect and sexual dysfunction. I'd really appreciate your views. I see my pdoc on Monday to decide on a new strategy.Lorraine,
Yes, Parnate is a real kick in the pants. Many find the experience too harsh. Before ruling it out, I'd like to know how long you were on it. The first time I took it, it caused every feeling I was trying to escape. The first 10 days consisted of insomnia (3 hours sleep) and anxiety attacks. On the tenth day, the AD effect kicked in. It was like flipping a switch. Imagine your nervous system fouled with a black goo, and suddenly it's washed clean with a flood of hot, soapy water. I'll never forget it. I calmed down quickly and totally. If your agitation was part of this adjustment phase, then a legitimate strategy might be to add a short-term benzo, like Ativan, until the AD effect kicks in. I was on Klonopin when I did a retrial of Parnate one time. After the AD effect kicked in, I took the next dose of Klonopin (out of habit), and it about knocked me out. I stopped the Klonopin cold turkey and stayed off it after the Parnate quit working again. If you get nothing but agitation after 3-4 weeks, then it's probably not the one.
I found Marplan almost as stimulating as Parnate. When that effect peaked, I could feel it one night, off and on, trying to break through the depression, but it couldn't quite do it. Marplan is an old drug. It was taken off the market for a few years because of low sales and questionable effectiveness. I don't agree with this last, since different people often need a different biological key to knock out their depression. I would certainly give it a try. Marplan should be in the latest Physician's Desk Reference, or a kind pharmacist can give you a package insert. Searching MEDLINE or google.com might give some info.
Nardil at 90 mg/day was a bust. Nothing but a craving for sweets.
Speaking of side-effects, I have been fortunate to be able to tolerate most anything, and realize that for others this is often not the case. But, I do feel it important to put up with as much as possible during the initial adjustment period (up to say a month). Anxiety is not always obvious, even to a doctor (I conceal it quite well), and it's important to be in touch with what you're experiencing and keep the doctor informed. Unless you're prone to getting hooked, anti-anxiety meds are a legitimate tool for managing a temporary effect.
Last year, I tried tianeptine, a European anti-depressant. It is a serotonin re-uptake enhancer (serotonin depleter). When it didn't work, I went back to my previous low dose of moclobemide. The result was a severe anxiety reaction (something I didn't get from moclobemide before). This leads me to believe moclobemide exerts its regulating effect on me by keeping serotonin levels up. My first reaction to any MAOI is anxiety.
Moclobemide doesn't give me an AD effect, but lifts the grogginess enough to prevent oversleeping. I have found hours of sleep to be the key. Too much sabotages the anxiety, but leads to grogginess and leaden fatigue. Not enough can cause episodes of high energy and/or intense anxiety. I find this mood instability to be distinct from bipolar disorder, since bipolar meds do not affect it. It can be altogether vicious. I manage my sleep fairly well with Ambien a couple of nights a week.
Neurontin has been good for steadying things down. I don't feel an acute anti-anxiety effect, but it seems to stop that snowball effect of quick escalation when something unexpected comes up. Also controls that initial blast of anxiety on waking in the morning.
I will be so glad when doctors figure out atypical depression. On Parnate, I'd go right to sleep every night and wake up calm and refreshed every morning. It was that heaven known as normal.
--John
poster:Sparkboy
thread:83164
URL: http://www.dr-bob.org/babble/20011113/msgs/84541.html