![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by SLS on February 17, 2020, at 10:05:48
I have to choose between Marplan and Parnate next week. Any and all comments are welcome.
:-)
For me, Parnate increases mental energy - which is nice. However it lacks the ability to treat anhedonia and amotivation. It also doesn't improve clarity of thought, cognitive blunting, and memory impairments. I feel flat and don't want to do anything. Parnate is a dead end for me, and I don't want to live out my years that way.
I guess this is my main question:
Is there anyone who has taken both Marplan and Parnate who had a better response to Marplan?
Thanks.
- Scott
Posted by undopaminergic on February 17, 2020, at 10:18:05
In reply to Marplan compared to Parnate. Which one?, posted by SLS on February 17, 2020, at 10:05:48
> I have to choose between Marplan and Parnate next week. Any and all comments are welcome.
>As you describe, Parnate leaves a lot to be desired, so try Marplan if you haven't!
If Marplan turns out less useful than Parnate, you can always try the latter again. It seems that the worst you could do is waste a little time.
In other words, Marplan sounds like a 'plan to me.
-undopaminergic
Posted by Jadde on February 17, 2020, at 11:57:02
In reply to Marplan compared to Parnate. Which one?, posted by SLS on February 17, 2020, at 10:05:48
> I have to choose between Marplan and Parnate next week. Any and all comments are welcome.
>
> :-)
>
> For me, Parnate increases mental energy - which is nice. However it lacks the ability to treat anhedonia and amotivation. It also doesn't improve clarity of thought, cognitive blunting, and memory impairments. I feel flat and don't want to do anything. Parnate is a dead end for me, and I don't want to live out my years that way.
>
> I guess this is my main question:
>
> Is there anyone who has taken both Marplan and Parnate who had a better response to Marplan?
>
> Thanks.
>
>
> - ScottGood luck!
Jade
Posted by Jadde on February 17, 2020, at 12:25:08
In reply to Re: Marplan compared to Parnate. Which one? » SLS, posted by Jadde on February 17, 2020, at 11:57:02
Btw- in March I will have been on Nardil at 75mg for 12 weeks. If that doesnt pan out, Ill be switching to Marplan.
Jade
Posted by Lamdage22 on February 17, 2020, at 13:39:38
In reply to Re: Marplan compared to Parnate. Which one? » Jadde, posted by Jadde on February 17, 2020, at 12:25:08
Hmmm, Isn't Marplan Parnate minus the activating metabolite? How can MAO Inhibition lead to a different outcome, just because it is achieved by a different substance?
I don't know what I would do. It depends on what has been tried. You probably need a main "lifter" so that supplements even make sense. I get that.
Posted by sigismund on February 17, 2020, at 23:14:27
In reply to Re: Marplan compared to Parnate. Which one?, posted by Lamdage22 on February 17, 2020, at 13:39:38
Try Marplan, Scott.
Posted by sigismund on February 17, 2020, at 23:16:09
In reply to Re: Marplan compared to Parnate. Which one?, posted by sigismund on February 17, 2020, at 23:14:27
The scoop on Marplan is that it is better tolerated than Nardil, and a large metaanalysis reported that it has outperformed placebo more robustly than Parnate or Nardil (Thase et. al., Neuropsychopharmacology 1995;12:185-219).
Posted by beckett2 on February 18, 2020, at 2:48:02
In reply to Marplan compared to Parnate. Which one?, posted by SLS on February 17, 2020, at 10:05:48
My assumption is you'll choose Marplan. I'm rooting for you :)
Posted by Lamdage22 on February 18, 2020, at 4:10:14
In reply to Re: Marplan compared to Parnate. Which one?, posted by sigismund on February 17, 2020, at 23:16:09
I agree with the others and hope it will pay off for you.
Posted by undopaminergic on February 18, 2020, at 10:56:14
In reply to Re: Marplan compared to Parnate. Which one?, posted by Lamdage22 on February 17, 2020, at 13:39:38
> Hmmm, Isn't Marplan Parnate minus the activating metabolite?
My current understanding, is that there is no such metabolite, but rather, the tranylcypromine (Parnate) itself has an intrinsic amphetamine-like action. That would seem to be the main reason why higher doses, beyond what is enough for complete MAO inhibition, is due to that intrinsic stimulant effect.
Selegiline, on the other hand, has amphetamine metabolites.
> How can MAO Inhibition lead to a different outcome, just because it is achieved by a different substance?
>The answer, as I see it, is that the only difference lies in what *other* effects a MAOI has. For isocarboxazid (Marplan) there are no known "other" effects beyond the MAOI inhibition, whereas phenelzine (Nardil), tranylcypromine, and selegiline, all have additional effects.
> ... You probably need a main "lifter" so that supplements even make sense. I get that.
>I'm not sure what you are saying. Why do supplements make sense?
-undopaminergic
Posted by undopaminergic on February 18, 2020, at 11:14:26
In reply to Re: Marplan compared to Parnate. Which one?, posted by Lamdage22 on February 18, 2020, at 4:10:14
> I agree with the others and hope it will pay off for you.
Me too. I hope you'll keep us posted on further developments.
-undopaminergic
Posted by SLS on February 18, 2020, at 14:25:50
In reply to Re: Marplan compared to Parnate. Which one? » SLS, posted by Jadde on February 17, 2020, at 11:57:02
Hi, Jade.
> > I have to choose between Marplan and Parnate next week. Any and all comments are welcome.
> >
> > :-)
> >
> > For me, Parnate increases mental energy - which is nice. However it lacks the ability to treat anhedonia and amotivation. It also doesn't improve clarity of thought, cognitive blunting, and memory impairments. I feel flat and don't want to do anything. Parnate is a dead end for me, and I don't want to live out my years that way.
> >
> > I guess this is my main question:
> >
> > Is there anyone who has taken both Marplan and Parnate who had a better response to Marplan?
> >
> > Thanks.
> >
> >
> > - Scott
>
> https://www.google.com/search?q=marplan+verses+parnate&rlz=1CDGOYI_enUS735US735&oq=marplan+verses+parnate&aqs=chrome..69i57.9260j0j7&hl=en-US&sourceid=chrome-mobile&ie=UTF-8
>
> Good luck!
>
> Jade
This was a great find, Jade! Thanks.Since the 1960s, Marplan has always been described as being a "weak" Nardil. That's why I was never drawn to it. My case is rated as "very severe" on depression rating scales (37) and is all but intractable. I turn 60 tomorrow, and thoughts of committing suicide now intrude my mind often. It seems inevitable.
Here is the passage that I found most compelling:
"Marplan (isocarboxazid). Marplan, like Parnate, comes in 10 mg pills, and is dosed pretty much identically. Marplan was withdrawn from the U.S. market in 1994 for unclear reasons, apparently due primarily to the economics of marketing it. But it was reapproved by the FDA under new ownership (Roche Pharmaceuticals) and with a new, more generous maximum approved dose of 60 mg/day (vs. the former 30 mg/day). The scoop on Marplan is that it is better tolerated than Nardil, and a large metaanalysis reported that it has outperformed placebo more robustly than Parnate or Nardil (Thase et. al., Neuropsychopharmacology 1995;12:185-219)."
Years ago, Thase was one of the foremost researchers for mood illness.
Thanks again. I think I'll send the article to my doctor.
- Scott
Posted by Tom2228 on February 18, 2020, at 18:15:46
In reply to Re: Marplan compared to Parnate. Which one? » Jadde, posted by SLS on February 18, 2020, at 14:25:50
Ive taken all 3 at varying times in the past decade, always returning to Marplan...until the crushing shortage. Rechallenge of Nardil worked for a little bit until the honeymoon wore off then it just drove me crazy for about a year until I went back to Parnate. My life has invaluably changed for the better and have experienced several months (Im severely rapid cycling) of stability, remission from depression (a *real* feat), anxieties, you name it and no need to look back despite Marplan newly available.
IME Marplan is a very effective drug. It is often underdosed, however. I would suggest not giving up until you have spent adequate time on at least 80-90mg, which is the dose that worked best for me for years.
N.B. Last time I was on 90mg Marplan I required 50-75mg desipramine, 80mg methamphetamine, and 1.25mg pramipexole. Now with 100-120mg Parnate Ive dropped the TCA in favor of 15mg dextroamphetamine + the methamphetamine, and seem to be okay without the dopamine agonist.
Of course its highly individual, but bottom line, I believe Marplan is highly underrated (and underdosed for those who need it. My doctor had someone on 175mg Marplan + 45mg Dexedrine). Just dont give up on it; it mixes very well with adjuncts too since it itself has few if any side effects (barring some weight gain).
Desoxyn is another adjunctive option that I believe you have not trialed. It is a very gentle med, relatively free of side effects, and most importantly has been found at lower/ therapeutic doses to be *neurotrophic*. The toxicity we all know about is associated with recreational doses. Where does the fine line exist? Who knows, but MAOIs are neuroprotective so.. IMO its worthy of serious consideration for those who are so recalcitrant. Id probably be dead without it. 10yrs and sharp as a tack.
Posted by JADDE on February 18, 2020, at 21:59:03
In reply to Re: Marplan compared to Parnate. Which one? » Jadde, posted by SLS on February 18, 2020, at 14:25:50
Hi Scott,I spent some time searching for you but too tired to post it in an organized fashion. I will mention, with my limited knowledge considered, I would go for Marplan plus small amount of stim (dioxin maybe?). My reasoning is this, I saw a specialist in MAOIs years ago. He is the one that put me on Parnate + Dexedrine. He explained that no one should be that depressed. I was immediately cured and happy. You may remember that didnt end well, but considering your current state of mind you need some immediate relief.
One more thing, When I first started Parnate, I felt I wasnt quite there. So I had a couple of Ritalin in my drawer and I secretly took just ONE 5mg tablet. I had TEN days of remission from adding just that one.
(Not recommending Parnate here trust me)Okay one more thing, found a bunch of posts about Marplan on Reddit, if you havent seen them.
Feel better, I will post you some stuff for your birthday :)
Jade
Posted by Lamdage22 on February 19, 2020, at 3:59:33
In reply to Re: Marplan compared to Parnate. Which one? » SLS, posted by JADDE on February 18, 2020, at 21:59:03
Hang in there, Scott. If you are 60, it means that you may enjoy the benefits of a drug that is not yet released. We don't know what comes after this life, especially if you end it with your own hands.
Posted by Lamdage22 on February 19, 2020, at 4:01:57
In reply to Re: Marplan compared to Parnate. Which one?, posted by Lamdage22 on February 19, 2020, at 3:59:33
Happy Birthday!
Posted by Jadde on February 19, 2020, at 9:51:32
In reply to Re: Marplan compared to Parnate. Which one? » SLS, posted by JADDE on February 18, 2020, at 21:59:03
>
> Hi Scott,
>
> I spent some time searching for you but too tired to post it in an organized fashion. I will mention, with my limited knowledge considered, I would go for Marplan plus small amount of stim (dioxin maybe?). My reasoning is this, I saw a specialist in MAOIs years ago. He is the one that put me on Parnate + Dexedrine. He explained that no one should be that depressed. I was immediately cured and happy. You may remember that didnt end well, but considering your current state of mind you need some immediate relief.
>
> One more thing, When I first started Parnate, I felt I wasnt quite there. So I had a couple of Ritalin in my drawer and I secretly took just ONE 5mg tablet. I had TEN days of remission from adding just that one.
> (Not recommending Parnate here trust me)
>
> https://www.reddit.com/r/pharmacymemes/comments/34p4o6/isocarboxazid_marplan/?utm_source=share&utm_medium=ios_app&utm_name=iossmf
>
> Okay one more thing, found a bunch of posts about Marplan on Reddit, if you havent seen them.
>
> Feel better, I will post you some stuff for your birthday :)
>
> JadeDesoxyn not dioxin* I better learn how to spell if Im gonna hang around here :)
Posted by SLS on February 20, 2020, at 0:42:11
In reply to Re: Marplan compared to Parnate. Which one? » JADDE, posted by Jadde on February 19, 2020, at 9:51:32
Hi, Jade
> Desoxyn not dioxin* I better learn how to spell if Im gonna hang around here :)
Especially if you don't want to poison yourself with a nasty carcinogen.:-)
Your help is greatly appreciated - even with the dioxin suggestion.
- Scott
Posted by SLS on February 20, 2020, at 1:03:10
In reply to Re: Marplan compared to Parnate. Which one?, posted by Tom2228 on February 18, 2020, at 18:15:46
Hi, Tom.
> Ive taken all 3 at varying times in the past decade, always returning to Marplan...until the crushing shortage. Rechallenge of Nardil worked for a little bit until the honeymoon wore off then it just drove me crazy for about a year until I went back to Parnate. My life has invaluably changed for the better and have experienced several months (Im severely rapid cycling) of stability, remission from depression (a *real* feat), anxieties, you name it and no need to look back despite Marplan newly available.
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?
> IME Marplan is a very effective drug. It is often underdosed, however. I would suggest not giving up until you have spent adequate time on at least 80-90mg, which is the dose that worked best for me for years.
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.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011961s039lbl.pdf
> N.B. Last time I was on 90mg Marplan I required 50-75mg desipramine, 80mg methamphetamine, and 1.25mg pramipexole. Now with 100-120mg Parnate Ive dropped the TCA in favor of 15mg dextroamphetamine + the methamphetamine, and seem to be okay without the dopamine agonist.
>
> Of course its highly individual, but bottom line, I believe Marplan is highly underrated (and underdosed for those who need it. My doctor had someone on 175mg Marplan + 45mg Dexedrine). Just dont give up on it; it mixes very well with adjuncts too since it itself has few if any side effects (barring some weight gain).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?
> Desoxyn is another adjunctive option that I believe you have not trialed. It is a very gentle med, relatively free of side effects, and most importantly has been found at lower/ therapeutic doses to be *neurotrophic*. The toxicity we all know about is associated with recreational doses. Where does the fine line exist? Who knows, but MAOIs are neuroprotective so.. IMO its worthy of serious consideration for those who are so recalcitrant. Id probably be dead without it. 10yrs and sharp as a tack.
Woohoo!
So, what are you taking now, Tom?
Currently, I take:
nortriptyline 100 mg/day
Lamictal 300 mg/day
Lithium 300 mg/day300 mg/day is an ideal dosage of lithium for me. Going higher flattens me out and makes me feel apathetic and more depressed. It helped a bit with depression when I first added it to Parnate. I decided to stay with it, even it no longer contributes to reducing depression as a preventative for Alzheimer's Dementia.
My doctor will likely switch from nortriptyline to trimipramine if I don't respond to the addition of Marplan. I still profit from taking Lamictal. I tried to reduce the dosage a few weeks ago and felt an abrupt increase in depression.
Stay well...
- Scott
Posted by PeterMartin on February 20, 2020, at 2:32:59
In reply to Re: Marplan compared to Parnate. Which one? » Tom2228, posted by SLS on February 20, 2020, at 1:03:10
> 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.
>Actually one thing I noticed when Validus reintroduced Marplan this time is that the included patient guide (the one on their site) lists a maximum dose of 80mg. It's only in this section but it is there on the official pdf on marplan.com: (https://marplan.com/full-prescribing-information/)
--
Clinical Efficacy Data
The effectiveness of Marplan was demonstrated in two 6-week placebo-controlled studies
conducted in adult outpatients with depressive symptoms that corresponded to the DSM-IV
category of major depressive disorder. The patients often also had signs and symptoms of
anxiety (anxious mood, panic, and/or phobic symptoms). Patients were initiated with a dose
of 10 mg bid, with increases every 2 to 4 days, as tolerated, until a therapeutic effect was
achieved, up to a maximum dose of 80 mg/day. Doses were administered on a divided
schedule ranging from 2 to 4 times a day. The mean dose overall for both studies was
approximately 40 mg/day, with very few patients receiving doses greater than 60 mg/day. In
both studies at the end of 6 weeks, patients receiving Marplan had significantly greater
reduction in signs and symptoms of depression evaluated by the Hamilton Depression Scale,
for both the Total Score and the Depressed Mood Score, than patients who received placebo.
--
Btw Ive avoided chiming in on this discussion since I've been dealing w RLS issues that I'm pretty sure are related to Nardil cessation. My mood overall has been good (about 5wks on Maplan) but for almost a week I could barely sleep. I know that's not Marplan related, but it has prevented me from feeling "good". The RLS has been less the last two days a and today I finally feel like the restlessness may have abated.Being on Ritalin w/ Nardil may have complicated the switch (lots of dopamine which seems to be related to rls). I also don't think the Ritalin is helping me - probably making me worse - I'm definitely less productive and don't -feel- much of an effect anymore. I emailed my doc today that I'd like to take a break from Ritalin (asked to go back to armodafinil to hopefully prevent w/d).
Anyway I only posted cause I thought the 80mg note would be helpful (not to talk about this other stuff). But since I did post and it's known that I'm on Marplan just wanted to mention I can't give a fair assessment yet. I do think it's helping and maybe a good amount but I need to get beyond this restless leg stuff (and off the hourly up/down of ir Ritalin) before I'd be comfortable recommending it (based on this trial / worked amazing for me years back).
Sorry if this has run on sentences or typos - typing on my phone about to crash.
As of today:
Marplan 40mg (Started Jan 9 w/ import ver for a week / one month on new US batch)
Lamotrigine 250mg (Unichem batch verified by Valisure)
Metformin IR 1500mg (Mylan batch verified by Valisure)
Ritalin IR 60mg (Not going to refill / asked to switch to Armodafinil-Nuvigil again 250mg)
Seroquel ~20mg Lupin for sleep
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.
>
> https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011961s039lbl.pdfThe 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.
http://www.dr-bob.org/babble/20050510/msgs/497031.html
> 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!
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.