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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Chairman_MAO on October 12, 2011, at 17:16:48
I saw my pdoc today. He agreed to do Marplan, but I have to discontinue the Dexedrine (60mg/day) until whatever my final dose of Marplan is going to be and reintroduce it.
I am scared to death of relapsing (substance abuse) due to lack of impulse control given that I have to come off of the Dexedrine.
That sure was a nice month of feeling normal ... here's hoping I made the right choice.
I don't have much of a support network out there, so I am glad to have you guys and this forum.
This is going to be one foggy month ... and it was so nice to finally be able to focus again. And I still have tapering off of clonazepam in the future, too.
It took 1.5 years to reach 60mg/day of Dexedrine on Nardil. I asked him this time if it would take that much time again. He said no, not that much time, but it would still have to be gradual.
I'm going to have to work on letting go of resentment toward myself for discontinuing the Nardil, because I wouldn't have to go through this had I not dropped out of treatment. I'd still be on Nardil, and then have the Dexedrine back.
Wish me luck! ;-)
--cm
Posted by Phillipa on October 12, 2011, at 17:43:25
In reply to Starting Marplan ... here I go into the unknown, posted by Chairman_MAO on October 12, 2011, at 17:16:48
I wish you much luck and will be looking for updates. Post as often as you need to. Phillipa
Posted by Chairman_MAO on October 12, 2011, at 18:01:47
In reply to Re: Starting Marplan ... here I go into the unknown » Chairman_MAO, posted by Phillipa on October 12, 2011, at 17:43:25
I'll probably be posting plenty of them, because I'm not going to want to go "out there" much until everything is stabilized again. That's going to take quite a while ...
And I don't even want to think about what it's going to be like when I finally get a job and can no longer see this guy (because the place he's at only takes medicaid and charity care clients). Hopefully he'll be able to convince _someone_ who I have access to to prescribe this ultra-forbidden combination. One step at a time, though ...
Thanks for the support.
Posted by floatingbridge on October 12, 2011, at 21:51:34
In reply to Re: Starting Marplan ... here I go into the unknown » Phillipa, posted by Chairman_MAO on October 12, 2011, at 18:01:47
Wishing you the best, Mr. Mao. Will look for your updates.
Posted by Chairman_MAO on October 12, 2011, at 22:38:56
In reply to Re: Starting Marplan ... here I go into the unknown » Chairman_MAO, posted by floatingbridge on October 12, 2011, at 21:51:34
Thanks. I feel the fog returning as my last dose of Dexedrine wears off and my bedtime medication kicks in. I'm giving myself three tablets tomorrow instead of six just so I can get out of bed, and then that's it until the final dosage of Marplan is reached. Then the titration upward of Dexedrine begins all over again. I'm forcing myself to believe that he'll do it a little more rapidly this time because I don't have another year to spare before getting functional again.
OK, calm down self, you're in good hands ... ;-)
I wish more people had access to doctors willing to do stuff like this. He's a rare and aging breed ...
Posted by jono_in_adelaide on October 13, 2011, at 2:29:22
In reply to Re: Starting Marplan ... here I go into the unknown » floatingbridge, posted by Chairman_MAO on October 12, 2011, at 22:38:56
Very best of luck!
Why the change from Nardil to Marplan?
Posted by SLS on October 13, 2011, at 2:38:05
In reply to Re: Starting Marplan ... here I go into the unknown, posted by jono_in_adelaide on October 13, 2011, at 2:29:22
I experienced a short-lived improvement with Marplan. Afterwards, I felt somewhat dysphoric. I did not gain weight on it to the degree that I do on Nardil.
I know that Marplan has the reputation for being a weak version of Nardil, but there are people whom respond to it whom do not respond to Nardil. I hope that you are one of them.
Good luck!
- Scott
Posted by Chairman_MAO on October 13, 2011, at 7:07:58
In reply to Re: Starting Marplan ... here I go into the unknown, posted by jono_in_adelaide on October 13, 2011, at 2:29:22
> Very best of luck!
>
Thanks
> Why the change from Nardil to Marplan?I had discontinued Nardil due to weight gain and frustration with the doctor I had at the time. In retrospect, as I said before, I wish I had found some other way to keep taking it, because now I have to titrate this up and then titrate the Dexedrine up all over again. But oh well ...
I want something like Nardil that doesn't result in my gaining 50% of my weight while on it.
Posted by Chairman_MAO on October 13, 2011, at 7:09:11
In reply to Re: Starting Marplan ... here I go into the unknown, posted by SLS on October 13, 2011, at 2:38:05
Yeah, I hope I'm not one of them either. In the end, it is [hopefully] going to be augmented with dextroamphetamine, so that should help. How high did you push the dose before giving up?
Posted by SLS on October 13, 2011, at 7:54:17
In reply to Re: Starting Marplan ... here I go into the unknown » SLS, posted by Chairman_MAO on October 13, 2011, at 7:09:11
> Yeah, I hope I'm not one of them either. In the end, it is [hopefully] going to be augmented with dextroamphetamine, so that should help. How high did you push the dose before giving up?
I don't remember the dosage of Marplan that I arrived at. Sorry.
With Nardil, I arrived at a dosage of 90mg. That seems to be the optimum dosage for me. 120mg doesn't help any more than 90mg.
- Scott
Posted by kakalak on October 13, 2011, at 9:34:31
In reply to Re: Starting Marplan ... here I go into the unknown » jono_in_adelaide, posted by Chairman_MAO on October 13, 2011, at 7:07:58
Were you ever on Parnate? I'm pretty new here so I don't know your history. What were you taking prior to and why did you switch to Nardil? How long were you on it?
Posted by Chairman_MAO on October 13, 2011, at 11:55:58
In reply to Re: Starting Marplan ... here I go into the unknown » Chairman_MAO, posted by SLS on October 13, 2011, at 7:54:17
With me, too, 90mg/day seemed to be the optimal dose. I might have been more _comfortable_ and/or felt better at 120mg/day for whatever reason while I was on 60mg/day of d-amphetamine. After I lost the Dexedrine, I eventually cut back to 90mg/day because I realized that the 120mg/day was doing nothing except making me even more hungry and retain even more water.
The thing with Marplan is that there are far fewer studies about it; moreover, I'm taking it primarily for social phobia which could require a higher dose. I'm sure my doctor would go up to at least 80 and perhaps higher if necessary, but I don't want to spend forever titrating that up because we cannot resume the psychostimulant (which will take more months to titrate back up to 60mg/day) until the dose of Marplan is set.
I wish that he could just hospitalize me and do this very aggressively. Unfortunately, these days, unless you are a wreck and/or suicidal, there is no admission to the hospital, so this whole process will probably take at least another half a year, if not longer.
I'm still grateful, though, because I really hit the lottery with regard to a doctor who someone on medicaid (or even charity care, it is a state-funded University Hospital behavioral health clinic) and willing to do this sort of treatment at all. I've often wondered what percentage of physicians have ever combined a psychostimulant with an MAOI in the course of their practice in the recent past. What, one or a handful of them in most states at best?
Posted by jono_in_adelaide on October 13, 2011, at 18:17:56
In reply to Re: Starting Marplan ... here I go into the unknown » jono_in_adelaide, posted by Chairman_MAO on October 13, 2011, at 7:07:58
Ah, gotcha..... the weight gain thing is what has stopped me trying Remeron
Have you ever tried Parnate?
Posted by Chairman_MAO on October 13, 2011, at 22:48:15
In reply to Re: Starting Marplan ... here I go into the unknown, posted by jono_in_adelaide on October 13, 2011, at 18:17:56
> Ah, gotcha..... the weight gain thing is what has stopped me trying Remeron
>
The being in a fog all day and it not working _and_ causing more anxiety at higher doses was what made me give up on Remeron. ;-)> Have you ever tried Parnate?
Yes, up to ~200mg/day. It feels fantastic--if you take a dose every 2 hours or so. The short half-life of tranylcypromine (it has active metabolites that accumulate, and the best effect is a synergy of the MAO inhibition plus tranylcypromine itself plus its metabolites) made it like a roller coaster. If I could get it compounded into an extended release formulation, I'd be using it at the highest dose possible.
And so I'm going with Marplan (Nardil caused too much weight gain). Hope to get the dose up quickly so that I can begin to add back the dextroamphetamine, which has to be done gradually.
This is the end of the thread.
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