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Re: Marplan compared to Parnate. Which one? SLS

Posted by tom2228 on February 24, 2020, at 15:46:08

In reply to Re: Marplan compared to Parnate. Which one? Tom2228, posted by SLS on February 20, 2020, at 1:03:10

> Hi, Tom.

> I'm glad it was life-changing for you. That's what I'm looking for, too.
> Do you have any plans to go back to Marplan? Is Parnate now as effective for you as Marplan was in the past?

No plans to switch back at the moment, but should Parnate fail, Id chose Marplan over Nardil in a heartbeat. Id say ISO and TCP are qualitatively different drugs. ISO tickled my affect/ brightened mood and provided mental clarity in a way incomparable to anything else, but left some stones unturned, which would revolve back into depression. TCP sufficiently treats all my stingy, recalcitrant symptoms such that full depressive remission has been possible, allowing me to function in ways I never thought possible I wouldnt trade that for the world, tho I love the feeling of Marplan. Also, the latter has a tendency to elevate me in a manic direction whereas TCP I find stabilizing.

> I hope I can convince my doctor to go that high if needed. I emailed him the 2007 Marplan company drug monograph that recommends a maximum dosage of 60 mg/day - as compared to the old recommendation of 30 mg/day.

The original (before recall) Validus package insert stated that in their clinical trials titration to 90mg was required for a few individuals to achieve maximum efficacy. Heres another link to a reposted of Dr Bobs Ppharm Tips, where Ivan Goldbergs contribution mentions having had a Pt on 170mg ISO + 15mg d-amphetamine. Also therein, Troy Caldwell mentions adding Desoxyn to high-dose MAOIs to very good effect.

> If I were to take 60 mg/day, how many weeks should I give it to work? Do you know of any literature that suggests going higher than 60 mg/day? How do you know when it makes sense to go higher?

I cant comment on how long it might take for you: In addition to YMMV, in your case youre also taking a TCA, which changes things up (probably accelerates response). In my own trials of ISO + stim + TCA, I experienced immediate mood lift (>other MAOIs) days 1-3, truer efficacy at 1wk, and full benefits at around 2wks.

In my personal opinion, I would advise against switching TCAs before properly titrating Marplan as NTI is your baseline reference, and switching TCA may confound your assessment of the more appropriate dose of ISO.

In any case, I noticed a very significant difference once reaching 80mg; 90mg being most beneficial.

If dose limitation becomes a concern or if not receiving adequate response to 60-80mg+ I would strongly consider at least trying a standard dose of Desoxyn in addition or in substitution of TCAs. Unlike other stimulants it takes approximately 1wk for the true effect to show, probably because of its significant antidepressant properties. Its also, for me, an effective anxiolytic vis-a-vis other stims that made me edgy/ tense/ irritable. I can say from 10yrs experience that a cup of coffee is more pronounced in effect vs Desoxyn, but at the same time it is IME quite effective at attacking symptoms.

> Woohoo!
> So, what are you taking now, Tom?
> Currently, I take:
> nortriptyline 100 mg/day
> Lamictal 300 mg/day
> Lithium 300 mg/day
> 300 mg/day is an ideal dosage of lithium for me. Going higher flattens me out and makes me feel apathetic and more depressed.

I get a very similar rxn to lithium: Although my level at 450mg is considered quite low at 0.2-0.3mmol/mL, if increased I too get flat, depressed, apathetic, as well as cognitively fogged. Aripiprazole and clonazepam pull the rest of the weight to keep me stable.

Parnate 100mg, as 40mg qAM + q3h(20 + 30 + 10)mg
Desoxyn 75mg, as 15mg 5x/d q3h
Dexedrine 15mg, as 5mg TID q3h
clonazepam 5-6mg, as 1mg 5x/d q3h + PRN 1mg
aripiprazole 10mg, qHS
Eskalith CR 450mg, qHS

> Stay well...
> - Scott
Thanks, Scott. Despite being relatively stable, I feel some sort of lacking / bluntedness/ apathy. I did d/c Neupro (rotigotine transdermal) 2mg about 1mo ago, and was feeling great for a few wks, then this started creeping up again past wk happens every time I try quit DA agonists. For me they are indeed potent adjuncts but, IME, produce a troublesome withdrawal syndrome, latent in appearance and recalcitrant to any other DAergics; not even a 25mg incr to Desoxyn 75mg has solved this.

Filling Neupro 2mg as we speak :-/... wish me luck as I do the same for you!

And have you come to a decision yet?

P.S. Happy belated birthday!




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