Posted by SLS on September 30, 2021, at 7:35:33
In reply to Re: Why do meds constantly stop working for me?, posted by rose45 on September 28, 2021, at 12:04:35
> Scott,
>
> An interesting thing has happened.
>
> 4 days ago, the unbearable anxiety which I have been having to endure, started to disappear, and I have been getting better ever since. I hadnt had any change in lifestyle, and then I noticed that 6 days ago, I had collected my new supply of generic lamotrigine. I am convinced that is the reason for my new-found peace of mind. (My depression is mainly anxious depression)
>
> I will give it some more time, to make sure that this is not a 4 day wonder. The brand name of the generic is Accord. It could very well be, from what I have read on other threads, that some generics are really bad. I am going to ask my gp if he can prescribe the GSK lamictal to see if that also makes a difference. Not sure he will agree. But at least if i have to stick to a generic, I will stick with Accord. I didnt make a note of all the generic lamotrigine packets I have receivd in the past year. That would have helped.
>
> This is totally miraculous. It would be great if it could avoid me having to withdraw from the parnate and go on to marplan.
>
> So right now, Im taking:
>
> 125mg lamotrigine
> 40 mg parnate
> 25mg olanzapineRose.
I am elated to hear this. Very. May your improvement continue indefinitely beyond 4 days. I know only too well my disappointments when an antidepressant wouldn't last beyond 3 days.
Several comments:
1. Ask your doctor to prescribe GSK Lamictal - with no substitution - telling your prescription insurer that you have tried at least 2 generics without an acceptable improvement according to your doctor.
2. That you have had a noticeable improvement at 125 mg/day of lamotrigine leads me to believe that you have room to increase the dosage if necessary. My guess is that your going above 200 mg/day will be unnecessary, but I would not give up on your entire treatment regime without moving up *gradually* to 200 mg/day to lamotrigine first.
3. In my opinion, the effective range of Parnate is 40-90 mg/day. Again, you have room to work with, and again, I would not abandon Parnate until that range is explored. 60 mg/day is probably the sweet spot statistically, but 40 mg/day could easily be *your* sweet spot.
4. Marplan can help people for whom no other drug does. Of the MAOIs that I've tried, including the EMSAM preparation for selegine, Marplan had the mildest side-effect profile, and the brief improvement I experienced felt than Parnate. It felt sort of like a hybrid improvement of Parnate and Nardil. Like Nardil, Marplan is a hydrazine derivative. Parnate is not. Nardil is well known to be significantly better for anxiety disorders than Parnate, including social anxiety disorder, generalized anxiety disorder, and panic disorder. For me, Nardil is also "pro-social". Parnate is not. However, the improvement I experienced with Marplan lasted for only a few days. Thereafter, it made me feel significantly worse. If you don't have success with Marplan, try Nardil if you haven't yet done so *with* the other drugs that you are currently taking. I would say that the effective range for Nardil is 60-90 mg/day. I have only rarely seen someone report that 45 mg/day of Nardil was optimal - maybe 1-2 people.
5. Nardil can take up to 3 months (12 weeks) to produce a robust antidepressant effect. That assumes that you are taking the dosage that is your sweet-spot - the lowest effective dosage - for at least 4-6 weeks (my estimation).
6. Nardil can produce moderate-severe side effects which includes hypotension and urination "hesitancy" (delayed micturition) to total urinary retention. These things have always plagued me in the past. This time, I played out a hunch and began at 1/2 a pill and increased more gradually than in the past. My guess was that if I don't *trigger* these side effects, they might not emerge at all or be greatly mitigated. Good hunch. At 120 mg/day, I had absolutely no hypotension (orthostatic or otherwise) and a short period of mild urinary hesitancy.
* Again, I am (cautiously) optimistic for you - especially if you get beyond your 4-day window.
Good luck.
- Scott
P.S. I am not proof-reading this. I'm sure you'll figure it out.Some see things as they are and ask why.
I dream of things that never were and ask why not.The only thing necessary for the triumph of evil is that good men do nothing.
poster:SLS
thread:1116886
URL: http://www.dr-bob.org/babble/20210723/msgs/1117121.html