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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by zonked on May 12, 2010, at 16:53:57
Today's my second day on Marplan (10mg 2x/day, to be increased to 15mg 2x/day on Saturday.)
Now, the skeptic in me is thinking this must be placebo, but I seem to feel a tiny bit better--I was actually cracking jokes and laughing today. Time will tell if it's really going to work, I'll keep my progress posted periodically here. Also on 1mg klonopin as needed, which has quieted my anxiety a bit.
In a way, I would not be surprised if it DID work quickly, as Nardil started working within a week when I first started it in '07. Also I may have gotten a jump start as I did not do a proper washout from the nardil I'd been taking (some % of MAO could have already been inhibited). Yeah, I know you're supposed to do a 2 week washout but I did not want an entire 2 weeks completely unmedicated, plus, the fact that they are such similar drugs put me at ease. I would have endured the washout if I had been on a strong serotonergic, since serotonin syndrome is a real risk with MAOIs.
Hope SLS and I both get some relief from this med--what are the odds we'd both be starting it at the same time? :-)
-z
Posted by SLS on May 12, 2010, at 17:14:17
In reply to Marplan update thread..., posted by zonked on May 12, 2010, at 16:53:57
> Hope SLS and I both get some relief from this med--what are the odds we'd both be starting it at the same time? :-)
That would be way cool.
- Scott
Posted by Phillipa on May 12, 2010, at 20:50:31
In reply to Re: Marplan update thread..., posted by SLS on May 12, 2010, at 17:14:17
Congrats and hope it continues to work well. Phillipa
Posted by zonked on May 12, 2010, at 22:43:58
In reply to Re: Marplan update thread..., posted by SLS on May 12, 2010, at 17:14:17
Scott,
What time do you take your second dose? I've been taking my doses at waketime and 12:30, respectively.
(I get up between 6-7:30 and head to sleep between 10-11:30).
MAOIs have always given me insomnia, I am not klonopin's biggest fan as a sleeping pill because of hangover type effects the next AM--i may ask for temazepam 30mg if I have trouble falling asleep like I did last night.
Also how quickly are you going up on Marplan? Best of luck to the both of us, I really am starting to get some hope. :)
-z
Posted by SLS on May 13, 2010, at 6:09:36
In reply to Re: Marplan update thread... » SLS, posted by zonked on May 12, 2010, at 22:43:58
> What time do you take your second dose? I've been taking my doses at waketime and 12:30, respectively.
For now, I am taking Marplan 10mg t.i.d (30mg/day), with my last dose taken at bedtime. It is only day three at this dosage. I have no trouble sleeping yet.
> i may ask for temazepam 30mg if I have trouble falling asleep like I did last night.
You can try temazepam, but it doesn't have a good reputation as a sleep initiator. It is better for maintenance. Still, I would not want to predict how this drug will affect you. I used it briefly and found that it was "clean" in that it did not produce any lingering effects the next morning.
- Scott
Posted by zonked on May 14, 2010, at 11:31:42
In reply to Marplan update thread..., posted by zonked on May 12, 2010, at 16:53:57
Hi,
Today I go up to 30mg/day from 20 (10mg at waketime and 20mg at noon). Depression seems modestly improved, I am feeling emotions again--a movie I watched last night made me crack up laughing and tear up too (scene appropriate of course)--but my anxiety and concentration are problematic.
The anxiety is generalized and social also--the Klonopin I've been taking helps, but is a bit too "stoning" and I wake up with the legendary Klonopin hangover... Still having problems with falling and staying asleep too. Meeting with a crisis clinic doctor to try to get this resolved today, I still haven't been assigned a regular psychiatrist yet.
Xanax is notoriously hard to get prescribed from Medicaid/Medicare doctors in this city, but I am going to persist, as it is the only anxiolytic I've ever been prescribed which doesn't give me side effects.
Also, I've noticed since starting Marplan that I've been getting the physical symptoms of anxiety worse than I can remember having--blushing and shaking rather easily, increased pulse, that sort of stuff. Triggered by social interaction...
Does anyone think a beta-blocker might help as an adjunct? Any opinions welcome!
-Z
Posted by SLS on May 14, 2010, at 12:00:12
In reply to Re: Marplan update thread... - 5/18, posted by zonked on May 14, 2010, at 11:31:42
> Hi,
>
> Today I go up to 30mg/day from 20 (10mg at waketime and 20mg at noon). Depression seems modestly improved, I am feeling emotions again--a movie I watched last night made me crack up laughing and tear up too (scene appropriate of course)--but my anxiety and concentration are problematic.
>
> The anxiety is generalized and social also--the Klonopin I've been taking helps, but is a bit too "stoning" and I wake up with the legendary Klonopin hangover... Still having problems with falling and staying asleep too. Meeting with a crisis clinic doctor to try to get this resolved today, I still haven't been assigned a regular psychiatrist yet.
>
> Xanax is notoriously hard to get prescribed from Medicaid/Medicare doctors in this city, but I am going to persist, as it is the only anxiolytic I've ever been prescribed which doesn't give me side effects.
>
> Also, I've noticed since starting Marplan that I've been getting the physical symptoms of anxiety worse than I can remember having--blushing and shaking rather easily, increased pulse, that sort of stuff. Triggered by social interaction...
>
> Does anyone think a beta-blocker might help as an adjunct? Any opinions welcome!
>
> -Z
It might be a bit early to be evaluating Marplan for therapeutic benefits and side effects. Treating side effects with beta-blockers might act to potentiate the hypotensive effects of Marplan.I know it is difficult to be patient.
- Scott
Posted by zonked on May 19, 2010, at 11:05:31
In reply to Re: Marplan update thread..., posted by SLS on May 12, 2010, at 17:14:17
Scott,
How are you doing, how many weeks into treatment are you, and where are you at dose-wise?
Tuesday I increased to 40mg/day (20 b.I.d.) and it's barely taken the edge off my depression/anxiety...
Also I am a bit worried, my blood pressure and pulse since starting Marplan are higher (159/95 and 110bpm), but consistent--almost the exact numbers a week apart.
Normal for me is like, 130-140something over 80-90something, pulse in the 90s.
The ONLY "forbidden" thing I've been doing is one cup of coffee in the morning (which is allowed according to the Marplan website's diet card.). Strangely enough, I was able to eat and drink things like coffee, salami, etc without any increase in BP on parnate and nardil, respectively.
Afraid to tell pdoc cuz this med is having *some* effect, and don't want to stop it.
Feedback welcome--perhaps there's an antihypertensive I can take daily to bring BP down a bit?
Hanging in there, it's hard.. And hope you (SLS) are doing well.
Thinking of asking for a bump up to 50 or 60 if there's no improvement by next Tuesday...
-z
-z
Posted by SLS on May 19, 2010, at 12:22:19
In reply to Re: Marplan update thread 5/19 » SLS, posted by zonked on May 19, 2010, at 11:05:31
Hi Zonked.
I am still taking 30mg of Marplan, but I have been taking it for only 10 days total. I experienced a mild blip improvement 4 days ago, but it lasted for only a fraction of the day. MAOIs do that to me sometimes when I first start taking them. It is a bad sign, I think. Never has such an early response prognosticated a robust and long-lasting improvement.
I hope you have better luck.
- Scott
Posted by zonked on May 19, 2010, at 17:26:59
In reply to Re: Marplan update thread 5/19 » zonked, posted by SLS on May 19, 2010, at 12:22:19
Scott,
Hang in there man. It'll be interesting to see where we are at in another 3 weeks or so. I, too, have had flashes where I've felt better.. Today I've felt a lot more like myself than I have been. I am learning not to expect remission to be waking up one day and feeling completely better, it may take a few weeks and perhaps more dose adjustments for the effect to be consistent...
Interestingly, I tested my BP at the store today and it was my usual--not elevated at all (although, my pulse was still about 110bpm).
-z
> Hi Zonked.
>
> I am still taking 30mg of Marplan, but I have been taking it for only 10 days total. I experienced a mild blip improvement 4 days ago, but it lasted for only a fraction of the day. MAOIs do that to me sometimes when I first start taking them. It is a bad sign, I think. Never has such an early response prognosticated a robust and long-lasting improvement.
>
> I hope you have better luck.
>
>
> - Scott
Posted by JayBTV2 on May 20, 2010, at 20:12:16
In reply to Re: Marplan update thread 5/19 » SLS, posted by zonked on May 19, 2010, at 17:26:59
I wish you both luck and please keep updating. I've been doing well on Marplan for a little over two months. Kinda like Zonked said just feeling more like myself....
Also I mentioned it in the other thread but it's really effected my appetite. I just don't have any interest in food. Honestly it's been great I've dropped from 190 to 180 since I've been on it but every now and again I kinda wish I could enjoy something to eat.
Have you guys noticed any effect on your appetite?
Posted by SLS on May 21, 2010, at 5:15:50
In reply to Re: Marplan update thread 5/19, posted by JayBTV2 on May 20, 2010, at 20:12:16
> Have you guys noticed any effect on your appetite?
I have noticed that there isn't as much craving for carbohydrates as with Nardil. I have not had a reduction in appetite, but that it hasn't increased so far is great. I am taking 30mg and will stay at that dosage until next week. Unfortunately, I have not improved.
- Scott
Posted by zonked on May 22, 2010, at 14:11:57
In reply to Re: Marplan update thread 5/19, posted by JayBTV2 on May 20, 2010, at 20:12:16
I haven't noticed much change in appetite one way or the other.
Jay, can you describe in a bit more detail how far into Marplan treatment you noticed a significant change in mood and what dosage you were at, at the time?
Also, how were you doing when you started treatment? Moderately depressed, severely depressed? Any significant anxiety features? And are you on any other psych meds?
Thx
-z
Posted by ed_uk2010 on May 22, 2010, at 14:43:57
In reply to Re: Marplan update thread 5/19, posted by SLS on May 21, 2010, at 5:15:50
Scott,
This probably isn't an appropriate time to ask this but...
Have you ever wondered whether a complete break from psych meds for a few months might allow your brain to adjust in some way which could make it possible for you to respond to them again in future? I've just got this idea that for some people, a break from meds might allow them to become sensitive to them again. I think this could be useful if prolonged treatment had lead to a form of tolerance.
I know it might be difficult to reduce your meds but from what you've said, the improvement you currently experience from them is quite small.
What do you think? This probably doesn't sound appealing but it's just a thought. You seem to have become very resistant to medication after many years of treatment.
Posted by SLS on May 22, 2010, at 14:57:56
In reply to Re: Marplan update thread 5/19 » SLS, posted by ed_uk2010 on May 22, 2010, at 14:43:57
> Scott,
>
> This probably isn't an appropriate time to ask this but...
>
> Have you ever wondered whether a complete break from psych meds for a few months might allow your brain to adjust in some way which could make it possible for you to respond to them again in future? I've just got this idea that for some people, a break from meds might allow them to become sensitive to them again. I think this could be useful if prolonged treatment had lead to a form of tolerance.
>
> I know it might be difficult to reduce your meds but from what you've said, the improvement you currently experience from them is quite small.
>
> What do you think? This probably doesn't sound appealing but it's just a thought. You seem to have become very resistant to medication after many years of treatment.
What you say makes sense. Of course, it would be a gamble to discontinue all medication based upon an intuitive guess. I am getting about a 15-20% improvement. That is just enough to allow me to live independently. I am afraid to strip that improvement away.I will remain open to your suggestion.
Thanks, Ed.
- Scott
Posted by ed_uk2010 on May 22, 2010, at 17:42:25
In reply to Re: Marplan update thread 5/19 » SLS, posted by ed_uk2010 on May 22, 2010, at 14:43:57
For some reason I can't read Scott's reply. The screen just goes blank. Not sure why.
Posted by ed_uk2010 on May 22, 2010, at 17:47:02
In reply to Re: Marplan update thread 5/19 » ed_uk2010, posted by SLS on May 22, 2010, at 14:57:56
Hi Scott,
I can read your message now. Perhaps I was having a problem with my computer.
>What you say makes sense. Of course, it would be a gamble to discontinue all medication based upon an intuitive guess.
I know, and I agree. It was just a thought really because you have tried so many ADs recently with only small benefits. If there was a way of making the meds work again it would be fantastic.
>I am getting about a 15-20% improvement. That is just enough to allow me to live independently.
Do you think that there's a chance that certain of your symptoms are aggravated by meds? I tend to find that ADs help some of my symptoms (eg. anxiety) and worsen others (eg. fatigue).
Posted by Phillipa on May 22, 2010, at 20:13:42
In reply to Re: Marplan update thread 5/19 » SLS, posted by ed_uk2010 on May 22, 2010, at 17:47:02
Ed no anxiety relief for me from ad's. But low dose of benzos allows sleep and a bit of recovery. Then it's push push push. Love PJxxx
Posted by SLS on May 26, 2010, at 13:15:09
In reply to Re: Marplan update thread 5/19 » SLS, posted by ed_uk2010 on May 22, 2010, at 17:47:02
> Do you think that there's a chance that certain of your symptoms are aggravated by meds?
Lamictal might be adding to the memory and cognitive impairments that my depression produces. Other than that, I can't think of anything.
For the past three days, I have noticed an improvement. Although subtle, it is unmistakable. This may not be terribly meaningful, though. With a new drug, I often experience this sort of response that lasts 1-3 days and then disappears. It usually occurs 10-13 days after beginning treatment. That is where I am right now. I am trying not to get my hopes up at this point, but it is difficult. I tend to be an optimist.
- Scott
Posted by bulldog2 on May 26, 2010, at 15:49:11
In reply to Re: Marplan update thread 5/19 » ed_uk2010, posted by SLS on May 26, 2010, at 13:15:09
> > Do you think that there's a chance that certain of your symptoms are aggravated by meds?
>
> Lamictal might be adding to the memory and cognitive impairments that my depression produces. Other than that, I can't think of anything.
>
> For the past three days, I have noticed an improvement. Although subtle, it is unmistakable. This may not be terribly meaningful, though. With a new drug, I often experience this sort of response that lasts 1-3 days and then disappears. It usually occurs 10-13 days after beginning treatment. That is where I am right now. I am trying not to get my hopes up at this point, but it is difficult. I tend to be an optimist.
>
>
> - ScottPossibly you could convince your p-doc to let you go to 90 mg? I once read a article where an opinion was rendered that part of the problem with marplan is the 60 mg limit is to low and leads to the impression that the drug is weak.
Posted by SLS on May 26, 2010, at 17:16:34
In reply to Re: Marplan update thread 5/19 » ed_uk2010, posted by SLS on May 26, 2010, at 13:15:09
> For the past three days, I have noticed an improvement. Although subtle, it is unmistakable. This may not be terribly meaningful, though. With a new drug, I often experience this sort of response that lasts 1-3 days and then disappears. It usually occurs 10-13 days after beginning treatment. That is where I am right now. I am trying not to get my hopes up at this point, but it is difficult. I tend to be an optimist.
I paid my doctor a visit today. He consented to allow me to increase my dosage of Marplan gradually to 60mg.
I'm still fighting optimism. I get tired of riding the rollercoaster, but I always get excited when I begin to respond favorably to anything. It's hard not to feel good when you feel good.
- Scott
Posted by Phillipa on May 26, 2010, at 21:14:07
In reply to Re: Marplan update thread 5/19, posted by SLS on May 26, 2010, at 17:16:34
Scott are you saying if you feel good you don't allow yourself to? Could that be part of the problem. Thinking as I write. Phillipa
Posted by SLS on May 27, 2010, at 6:24:43
In reply to Re: Marplan update thread 5/19 » SLS, posted by Phillipa on May 26, 2010, at 21:14:07
> Scott are you saying if you feel good you don't allow yourself to?
No. I am saying that when I start to feel good, I tend to assume that it is the beginning of a new life which I begin to plan for. It is an emotional let-down to then relapse and have to give up so many wonderful things. I am just trying to prevent a big disappointment by tempering my reaction to what might be a fleeting response to treatment. When a treatment works, there is nothing I could do to prevent myself from undergoing the positive changes in conscious experience, even if I tried "not to allow it".
- Scott
Posted by ed_uk2010 on May 27, 2010, at 14:02:38
In reply to Re: Marplan update thread 5/19 » ed_uk2010, posted by SLS on May 26, 2010, at 13:15:09
>Lamictal might be adding to the memory and cognitive impairments that my depression produces.
Perhaps you could try a lower dose?
>For the past three days, I have noticed an improvement.
I hope it continues for you Scott. I think it's a good sign that you're feeling optimistic.
Posted by Phillipa on May 27, 2010, at 19:56:45
In reply to Re: Marplan update thread 5/19 » SLS, posted by ed_uk2010 on May 27, 2010, at 14:02:38
Me also and thanks for clarifying Scott. Phillipa
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