![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by gpznos on February 19, 2013, at 5:06:20
Hi
I am planning on starting Marplan very soon. My question is which of the following drugs need to be discontinued and also if I need any washout period:Nortriptyline 135 mg
Lexapro 10 mg
Mirtazapin 15 mg
Lithium 600 mg
Valdoxan 25 mg
Posted by SLS on February 19, 2013, at 5:40:03
In reply to Do I need a washout?, posted by gpznos on February 19, 2013, at 5:06:20
> Hi
> I am planning on starting Marplan very soon. My question is which of the following drugs need to be discontinued and also if I need any washout period:
>
> Nortriptyline 135 mg
> Lexapro 10 mg
> Mirtazapin 15 mg
> Lithium 600 mg
> Valdoxan 25 mg
>Lexapro is the drug that will produce a dangerous reaction when combined with Marplan (serotonin syndrome). Even though you are taking a low dosage of Lexapro, I would still recommend a 10 - 14 day waiting period between your last dose of Lexapro and your first dose of Marplan. If you wanted to, you could actually keep the nortriptyline, lithium, and Valdoxan. I am not so sure about mirtazapine, and would not recommend that you continue taking it. By the way, although 15 mg/day of mirtazapine is great for sleep, it won't often help with depression. Most doctors don't appreciate the effectiveness of mirtazapine because they don't use dosages that are high enough to produce an antidepressant response. 45 - 90 mg/day is what I consider to be therapeutic.
Good luck.
- Scott
Posted by gpznos on February 19, 2013, at 8:14:22
In reply to Re: Do I need a washout? » gpznos, posted by SLS on February 19, 2013, at 5:40:03
> > Hi
> > I am planning on starting Marplan very soon. My question is which of the following drugs need to be discontinued and also if I need any washout period:
> >
> > Nortriptyline 135 mg
> > Lexapro 10 mg
> > Mirtazapin 15 mg
> > Lithium 600 mg
> > Valdoxan 25 mg
> >
>
> Lexapro is the drug that will produce a dangerous reaction when combined with Marplan (serotonin syndrome). Even though you are taking a low dosage of Lexapro, I would still recommend a 10 - 14 day waiting period between your last dose of Lexapro and your first dose of Marplan. If you wanted to, you could actually keep the nortriptyline, lithium, and Valdoxan. I am not so sure about mirtazapine, and would not recommend that you continue taking it. By the way, although 15 mg/day of mirtazapine is great for sleep, it won't often help with depression. Most doctors don't appreciate the effectiveness of mirtazapine because they don't use dosages that are high enough to produce an antidepressant response. 45 - 90 mg/day is what I consider to be therapeutic.
>
> Good luck.
>
>
> - ScottThanks Scott
10-14 days seems like a long time as I have understood the half-time of Lexapro is 30 hours - or have these two "times" nothing to do with eachother? Forgive my ignorance, I just want to get started ASAP.Do you think I could continue Lithium and Nort in the previous doses or should they just be taken as add-ons?
gpznos
Posted by Phillipa on February 19, 2013, at 9:46:15
In reply to Re: Do I need a washout? » SLS, posted by gpznos on February 19, 2013, at 8:14:22
Good luck it must be hard to go without meds for two weeks. Did the lexapro help you at all? Since the dose was low can I ask why you didn't take a higher dose before deciding on Marplan? Thanks Phillipa
Posted by gpznos on February 19, 2013, at 10:35:37
In reply to Re: Do I need a washout? » gpznos, posted by Phillipa on February 19, 2013, at 9:46:15
Well from my experiences with Lexapro I know that if I go above 10 mg I dont like the feeling it gives me. The Marplan decision has to be approved by my pdoc first - he might have another opinion.
But since Nort have pooped out or been to little on its own, Lithium was added almost 3 months ago and I am still not doing well consistently, I will try and convince him to let me go to Marplan.
Since about the time I started the Lexapro I now also have tinnitus.BTW: Which "emergency" drugs can be used these 2 weeks?
Posted by SLS on February 19, 2013, at 11:56:33
In reply to Re: Do I need a washout?, posted by gpznos on February 19, 2013, at 10:35:37
> Well from my experiences with Lexapro I know that if I go above 10 mg I dont like the feeling it gives me. The Marplan decision has to be approved by my pdoc first - he might have another opinion.
> But since Nort have pooped out or been to little on its own, Lithium was added almost 3 months ago and I am still not doing well consistently, I will try and convince him to let me go to Marplan.
> Since about the time I started the Lexapro I now also have tinnitus.
>
> BTW: Which "emergency" drugs can be used these 2 weeks?Zyprexa and Ativan are two drugs that come to mind. Zyprexa is good for anxiety, depression, and suicidal ideation. Ativan can take help when anxiety is the prominent symptom. Coming off of Lexapro can produce anxiety as a withdrawal effect.
- Scott
Posted by SLS on February 19, 2013, at 12:05:06
In reply to Re: Do I need a washout? » SLS, posted by gpznos on February 19, 2013, at 8:14:22
> > > Hi
> > > I am planning on starting Marplan very soon. My question is which of the following drugs need to be discontinued and also if I need any washout period:
> > >
> > > Nortriptyline 135 mg
> > > Lexapro 10 mg
> > > Mirtazapin 15 mg
> > > Lithium 600 mg
> > > Valdoxan 25 mg
> > >
> >
> > Lexapro is the drug that will produce a dangerous reaction when combined with Marplan (serotonin syndrome). Even though you are taking a low dosage of Lexapro, I would still recommend a 10 - 14 day waiting period between your last dose of Lexapro and your first dose of Marplan. If you wanted to, you could actually keep the nortriptyline, lithium, and Valdoxan. I am not so sure about mirtazapine, and would not recommend that you continue taking it. By the way, although 15 mg/day of mirtazapine is great for sleep, it won't often help with depression. Most doctors don't appreciate the effectiveness of mirtazapine because they don't use dosages that are high enough to produce an antidepressant response. 45 - 90 mg/day is what I consider to be therapeutic.
> >
> > Good luck.
> >
> >
> > - Scott
>
> Thanks Scott
> 10-14 days seems like a long time as I have understood the half-time of Lexapro is 30 hours - or have these two "times" nothing to do with eachother? Forgive my ignorance, I just want to get started ASAP.
>
> Do you think I could continue Lithium and Nort in the previous doses or should they just be taken as add-ons?
>
> gpznosSome people like to use the rule of thumb of waiting 5 half-lives to insure that the majority of drug has left the body. Add a couple of days for good luck.
My case is a rather stubborn one. I am accustomed to being on lithium and nortriptline in combination with Parnate or Nardil. Do you think your doctor would let you do that?
- Scott
Posted by gpznos on February 20, 2013, at 9:58:55
In reply to Re: Do I need a washout? » gpznos, posted by SLS on February 19, 2013, at 12:05:06
The answer is yes.
Was at the pdoc today and we agreed to start Marplan in 8 days time from now. I shall discontinue Lexapro (10 mg) and Mirtazapin (15 mg) at once, but I will continue with Nort (135 mg), Lithium (600 mg) and Valdoxan (37,5 mg). I have sleeping pills as emergency drug.
I shall then start up with a small dose Marplan, sort of an augmentor and then maybe go higher if necessary. Does this sound reasonable?Does anybody know if Mirtazapin is dangerous to combinme with Marplan/MAOi? My doctors was not 100% sure if it was...
BTW: Marplan is apparently the ONLY MAOi option here in Denmark. The others can theorethically be imported but probably no easy and short time solution
Posted by SLS on February 20, 2013, at 13:55:49
In reply to Re: Do I need a washout? » SLS, posted by gpznos on February 20, 2013, at 9:58:55
Good plan.
- Scott
Posted by jono_in_adelaide on February 20, 2013, at 17:06:09
In reply to Re: Do I need a washout? » SLS, posted by gpznos on February 20, 2013, at 9:58:55
If need be, you can order Nardil here from the UK, they will honor a prescription written by a Danish doctor - I have used them before, they are legitimate and relaible
http://www.masters-uk.com/medicines/search.php?mode=search&page=1
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
[email protected]
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.