![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by porkpiehat on May 22, 2018, at 11:48:31
My marplan has been on backorder for almost a month now. I've spaced out my pills and now Im completely out. Confusion is setting in. I've called all the CVS and Walgreens in my area and nothing!
I have no idea what to do and my pdoc is clueless. I can keep my dopamine and NE up with ritalin I guess, which I've already been doing in microdoses while on Marplan.
Please help with suggestions! I know Nortriptyline is the preferred bridge drug, but it's not a drug I like much.
Thank you!
Posted by linkadge on May 22, 2018, at 16:38:09
In reply to solutions for MAOI withdrawl? Marplan on backorder, posted by porkpiehat on May 22, 2018, at 11:48:31
You could try some herbal MAOIs like rhodioloa, cocoa and quercetin.
Linkadge
Posted by porkpiehat on May 24, 2018, at 12:15:44
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder, posted by linkadge on May 22, 2018, at 16:38:09
> You could try some herbal MAOIs like rhodioloa, cocoa and quercetin.
>
> LinkadgeI didn't know about these? Are any of them more or less active on the MAOI-B side? I dislike too much NE/DA it zones me out and feel detached, as well as hyperfocused.
I have a scrip for Nardil. I'm hesitant I don't want to be on it I just don't want to go through hell. I feel much lighter and empathetic since tapering off Marplan, with less "drive" and persecuted thinking.
>
Posted by linkadge on May 24, 2018, at 20:01:36
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » linkadge, posted by porkpiehat on May 24, 2018, at 12:15:44
Quercetin is more of an MAO-a inhibitor, while cocoa is more of a MAO-b inhibitor - not sure about rhodiola.
If you are feeling better off marplan, you could always wait a bit longer and see how it goes.
Not sure. Nardil can be a good med - not sure if you've taken it before.
Linkadge
Posted by porkpiehat on May 27, 2018, at 22:32:11
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder, posted by linkadge on May 24, 2018, at 20:01:36
Started Nardil today, took 30 mgs to see if I would have any immediate reactions that I need to consider for work, sleep, social time etc.
It's been a week since I took any marplan. Night terrors coming back, anger, and lack of drive starting to emerge.
Hopefully there is still enough MAO inhibition in my brain that I won't have to endure all the nasty start up side effects.
One concern is that I was taking .5 mgs of Klonopin at night with hydroxyzine for sleep and overall anxiety...but Nardil has its own gaba-activity, so not sure if I should continue.
Any insight here? None from my doctor.
Posted by linkadge on May 28, 2018, at 7:06:56
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » linkadge, posted by porkpiehat on May 27, 2018, at 22:32:11
Nardil will raise gaba in a different way than clonazepam. Nardil slows the metabolism of gaba (leading to higher levels) while clonazepam makes the brain more responsive to gaba.
There could certainly be synergy in terms of gaba effect. That being said, clonazepam and nardil are frequently used together for social phobia. The dose of clonazapam is low too, so I don't see any issues.
Wait a few days (if possible) between dose increases of Nardil. If sedation is excessive, then you could try lowering the clonazepam, but I wouldn't be too worried.
Linkadge
Posted by porkpiehat on May 28, 2018, at 12:00:40
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » porkpiehat, posted by linkadge on May 28, 2018, at 7:06:56
> Nardil will raise gaba in a different way than clonazepam. Nardil slows the metabolism of gaba (leading to higher levels) while clonazepam makes the brain more responsive to gaba.
>
> There could certainly be synergy in terms of gaba effect. That being said, clonazepam and nardil are frequently used together for social phobia. The dose of clonazapam is low too, so I don't see any issues.
>
> Wait a few days (if possible) between dose increases of Nardil. If sedation is excessive, then you could try lowering the clonazepam, but I wouldn't be too worried.
>
> Linkadge
>
> Thank you. trying to determine best time of day to take the nardil. Some people say it is activating but they may be taking large doses at once. I expect to eventually feel overly sedated most of the day, but maybe being on MAOIs for the last year will allow me to skip that.
>
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Posted by porkpiehat on May 31, 2018, at 9:04:02
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » linkadge, posted by porkpiehat on May 28, 2018, at 12:00:40
OMG I feel so cognitively impaired but relatively happy.
Having conversations are very difficult I feel like I am try to speak in a foreign language and ultimately saying the wrong thing.I'm hoping it's just the synergy between nighttime klonopin and the Nardil gaba effect. Tried to go without last night and woke up with panic attacks. switched to ativan instead.
will add some ritalin today to see if it helps. Cognitive function has been the best thing to improve on the other MAOI's and is pretty important.
Posted by SLS on May 31, 2018, at 14:00:12
In reply to day five at 45mgs Nardil....verbal skills failing » porkpiehat, posted by porkpiehat on May 31, 2018, at 9:04:02
> OMG I feel so cognitively impaired but relatively happy.
> Having conversations are very difficult I feel like I am try to speak in a foreign language and ultimately saying the wrong thing.
>
> I'm hoping it's just the synergy between nighttime klonopin and the Nardil gaba effect. Tried to go without last night and woke up with panic attacks. switched to ativan instead.
>
> will add some ritalin today to see if it helps. Cognitive function has been the best thing to improve on the other MAOI's and is pretty important.I experienced "brain-fog" at the beginning of Nardil treatment. It cleared up after a week or two.
I wish I could be more helpful.
- Scott
Posted by Porkpiehat on May 31, 2018, at 15:19:10
In reply to Re: day five at 45mgs Nardil....verbal skills failing » porkpiehat, posted by SLS on May 31, 2018, at 14:00:12
Wondering if it clears at higher dosages but I dont really intend to go higher unless needed. This might just be a stop gap until Marplan is reintroduced.
I hope its not benzo related it was hard to sleep without.
I took 5 mg Ritalin today it helped with the fog but increased manic racy feeling. Lamictal and .25 klonopin brought me back into my skin and I dont feel foggy. Quite a tightrope to walk everyday?
How long were you on Nardil Scott?
Posted by SLS on June 1, 2018, at 7:15:54
In reply to Re: day five at 45mgs Nardil....verbal skills failing » SLS, posted by Porkpiehat on May 31, 2018, at 15:19:10
> Wondering if it clears at higher dosages but I dont really intend to go higher unless needed.
For me, brain fog showed up at a very low dosage - 5-10 mg/day. It seems that this can happen at the start of treatment and perhaps upon dosage increases. I am not under the impression that going higher than 90 mg/day will clear things up.
This might just be a stop gap until Marplan is reintroduced.
> I hope its not benzo related it was hard to sleep without.
It was hard to sleep without what? In what ways do you have trouble sleeping?
> How long were you on Nardil Scott?I have been on and off Nardil several times. I get more benefit early in treatment than I do later on. I can't remember what is the longest length of time that I took Nardil for steadily. It was more than a few months. I see many people report that they don't respond to Nardil until 12 weeks have passed. Hopefully, you have more patience than I do. I have made plans to discontinue Parnate and try Trintellix. I would then move to Effexor if necessary. I am willing to go back to Nardil 90 mg/day should I not respond to these treatments.
Do you get dizzy upon standing? Do you have problems initiating urination?
- Scott
Posted by Lamdage22 on June 2, 2018, at 13:06:49
In reply to Re: day five at 45mgs Nardil....verbal skills failing » Porkpiehat, posted by SLS on June 1, 2018, at 7:15:54
Hey Scott,
Effexor is mildly effective for me. Its the second best i have tried. First is Trazodone. People say its not very strong AD but it has been the best so far.
I really am waiting for stuff like Rapastinel. Id take the risk of trying with that one. Until then i want to keep my head still.
The Nardil fog goes away or at least you get used to the fog so that you dont notice it anymore.
Posted by SLS on June 2, 2018, at 20:50:07
In reply to Re: day five at 45mgs Nardil....verbal skills failing, posted by Lamdage22 on June 2, 2018, at 13:06:49
> Hey Scott,
>
> Effexor is mildly effective for me. Its the second best i have tried. First is Trazodone. People say its not very strong AD but it has been the best so far.What dosage of trazodone works best for you?
> I really am waiting for stuff like Rapastinel. Id take the risk of trying with that one. Until then i want to keep my head still.
It would be great if this drug were to be administered intranasally as is ketamine. I'm curious why these drugs can't be administered sublingually. It seems to me that the delivery could be better controlled that way.
- Scott
Posted by Lamdage22 on June 3, 2018, at 6:41:26
In reply to Re: day five at 45mgs Nardil....verbal skills failing » Lamdage22, posted by SLS on June 2, 2018, at 20:50:07
> > Hey Scott,
> >
> > Effexor is mildly effective for me. Its the second best i have tried. First is Trazodone. People say its not very strong AD but it has been the best so far.
>
> What dosage of trazodone works best for you?
>
> > I really am waiting for stuff like Rapastinel. Id take the risk of trying with that one. Until then i want to keep my head still.
>
> It would be great if this drug were to be administered intranasally as is ketamine. I'm curious why these drugs can't be administered sublingually. It seems to me that the delivery could be better controlled that way.
>
>
> - ScottHi Scott, i wouldnt mind going for infusions once a week. That 1h is a great investment if it helps.
I have not tried more than 75mg. If i take more i need to take my Venlafaxin past 20:00. If i take the Venlafaxine earlier i get heart racing. Sometime i wonder if i should ditch venlafaxine and take more trazodone instead.
Posted by SLS on June 3, 2018, at 9:14:10
In reply to Re: day five at 45mgs Nardil....verbal skills failing, posted by Lamdage22 on June 3, 2018, at 6:41:26
Hi.
> > > I really am waiting for stuff like Rapastinel. Id take the risk of trying with that one. Until then i want to keep my head still.
> > It would be great if this drug were to be administered intranasally as is ketamine. I'm curious why these drugs can't be administered sublingually. It seems to me that the delivery could be better controlled that way.
What I said here was confusing. What I meant to say is that sublingual delivery might be better than intranasal administration. I.V. represents the most well-controlled route.
> Hi Scott, i wouldnt mind going for infusions once a week. That 1h is a great investment if it helps.
Agreed.> I have not tried more than 75mg. If i take more i need to take my Venlafaxin past 20:00. If i take the Venlafaxine earlier i get heart racing. Sometime i wonder if i should ditch venlafaxine and take more trazodone instead.
At what time of day do you feel best?
- Scott
Posted by Lamdage22 on June 3, 2018, at 10:19:40
In reply to Re: day five at 45mgs Nardil....verbal skills failing, posted by SLS on June 3, 2018, at 9:14:10
Depression wise or anxiety wise? I am leaning towards the morning mostly because of anxiety.
Posted by Lamdage22 on June 3, 2018, at 12:33:38
In reply to Re: day five at 45mgs Nardil....verbal skills failing, posted by Lamdage22 on June 3, 2018, at 10:19:40
I take Trazodone in the morning
Posted by porkpiehat on June 7, 2018, at 10:07:51
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » linkadge, posted by porkpiehat on May 27, 2018, at 22:32:11
So nearly at two weeks on Nardil 30mgs...Confusion and communicating continues to be a problem. Been feeling more sedated and depressed after Nardil dose.
I stopped taking my nighttime benzo/sleep meds hoping it would reduce cognitive problems. My compulsive behavior and drinking cravings all but stopped, but after a few days mood, sleep, and agitation getting worse.
Coffee in the afternoon made a big difference with the concentration and depression. It's never done much since I've been on MAOIs.
Doctor suggested Naltrexone for the drinking and compulsive behavior...said I could continue taking benzos for anxiety/sleep without the resulting drinking urges. I have a scrip for antabuse/disulfram, which I've heard can increase dopamine and offset the "stupids" I get on Nardil with having to take ritalin.
I am worried that Naltrexone will take away enjoyment and desires. Even if they are compulsive, all I care about is fishing boating and drinking right now. If they go away I'm afraid there will be nothing left.
Also if the compulsiveness is a hypomanic reaction will the Naltrexone help? Anyone with experience?
Posted by Tfeld on July 8, 2018, at 8:36:49
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder, posted by porkpiehat on June 7, 2018, at 10:07:51
Hey porkpiehat,
I too am a recovering Marplan user (lol) since the shortage and am on week 1 of 30mg Nardil. I posted a longer message under PeterMartin's thread if you'd like to check out my progress.
Did you wind up trying the naltrexone? I did a short (~3-day) trial of 25-50mgs back a few months ago as an attempt to attenuate meth cravings, but unfortunately I found it bored the sh*t out of me and numbed me out even further, attenuating incentive salience for all activities across the board and helping little with the meth issue. I should mention I am one of those stubbornly unstoppable compulsives when I use and not much can stop me, although I have finally achieved abstinence (16 days today) and am getting more involved than ever in my support network with my recent response to the low-dosage 30mg Nardil.
I cycle rapidly and can't remember the ins and outs since nearly most of the past year was an addictive blur, but while the meth seemed to even me out there was definitely signifiant hypomania in the mix. The naltrexone seemed not to even out the hypomania but simply crush me into flatness and depression, although I wasn't on it very long.
My pdoc has had some success with naltrexone for multiple substances including my DOC (meth), but my experience may vary considerably from your situation with alcohol, for which there is much more empirical evidence...so YMMV.
Would love to hear an update and how Nardil's going for you. I hope things are improving for you and NEVER give up!!
Posted by porkpiehat on July 8, 2018, at 12:35:44
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » porkpiehat, posted by Tfeld on July 8, 2018, at 8:36:49
> Hey porkpiehat,
>
> I too am a recovering Marplan user (lol) since the shortage and am on week 1 of 30mg Nardil. I posted a longer message under PeterMartin's thread if you'd like to check out my progress.
>
> Did you wind up trying the naltrexone? I did a short (~3-day) trial of 25-50mgs back a few months ago as an attempt to attenuate meth cravings, but unfortunately I found it bored the sh*t out of me and numbed me out even further, attenuating incentive salience for all activities across the board and helping little with the meth issue. I should mention I am one of those stubbornly unstoppable compulsives when I use and not much can stop me, although I have finally achieved abstinence (16 days today) and am getting more involved than ever in my support network with my recent response to the low-dosage 30mg Nardil.
>
> I cycle rapidly and can't remember the ins and outs since nearly most of the past year was an addictive blur, but while the meth seemed to even me out there was definitely signifiant hypomania in the mix. The naltrexone seemed not to even out the hypomania but simply crush me into flatness and depression, although I wasn't on it very long.
>
> My pdoc has had some success with naltrexone for multiple substances including my DOC (meth), but my experience may vary considerably from your situation with alcohol, for which there is much more empirical evidence...so YMMV.
>
> Would love to hear an update and how Nardil's going for you. I hope things are improving for you and NEVER give up!!I think using meth on an MOAI is a recipe for disaster! I had a problem with it years ago and only when I was taking SSRIs...My drinking and drug use increased due to compulsivity and probably the "addiction" to feeling something again and having a sex drive. That said the urge for stimulants would completely disappear when I stopped taking the SSRIs....Not sure if it was hypomania or PTSD stuff.
That said the smallest amount of stimulants will make me out of control and has even made me black out before. Are you saying you are bipolar? Have you tried all the various mood stabilizers etc? They kill the hypomanic symptoms in me but the side effects are worse than the disease. Is the stimulant use worse while taking serotonergic AD's?
I never started the Naltrexone. I have been looking into Low Dose Naltrexone as a dual solution for compulsiveness, anxiety, PTSD etc. It's a way lower dose than the dose the doctor probably gave you. I'm also considering it as a replacement for the MAOIs.
The tiredness and demotivation I've had since moving up to 45mgs Nardil has all but removed drinking and compulsiveness. I've stayed at home/in bed binging on the Sopranos. Having half a cocktail seems to kill the lethargy oddly.The one thing that's been consistent with me across the 16 mos I've been taking MAOIs is hyperfocus/compulsiveness; and extreme detachment from my friends and family. It's like I don't love them anymore, and humanity as a whole seems hopeless and stupid. I've lost interest in doing healthy things like eating right, exercising, and excelling in my career/wanting to go back to school; being involved politically; dating.
However it works fairly well for the atypical symptoms of my depression, such as feelings of persecution, hysterical tendencies, sensitivity to abandonment, constant suicidal ruminations, plus the crippling social anxiety. The biggie is the ability to concentrate and ADD/distraction type symptoms. I'm very project-oriented now. Work was torture for me before with a racing, distracted brain.
My parents are getting old and ill, and I've killed off most of my social networks. I see myself dying alone and drunk on a fishing boat...full of guilt that I wasn't emotionally present for my parents in their final years. It's a hard decision to weigh as I currently feel OK being able to function cognitively, work, etc. I don't feel the hysterical despair over my situation like before.
Anyway back to Nardil. If you are like me the jump to 45mgs might flatten you out just long enough to get some space from the meth. Soon you'll be at a high enough dose where doing meth will surely kill you, and that should be some kind of deterrent.
I'm hoping the flatness/lethargy ends and there is that emotional openness awaiting me that I started taking these drugs for. If not, I'm done!
Also of note, I can sleep way easier on Nardil than I could on parnate or marplan, at least for now.
Best of luck. hit me up anytime I've been through a lot of what you're going through. I don't know how to babblemail or I would suggest it.
Posted by Tfeld on July 8, 2018, at 14:00:52
In reply to Re: solutions for MAOI withdrawl? Marplan on backorder » Tfeld, posted by porkpiehat on July 8, 2018, at 12:35:44
Hey there, thanks for your response. MAOIs are such complicated drugs; they interest the hell out of me, but nonetheless they are strange, mercurial, and far more unpredictable as so whether you'll respond, when and what dose, and what the result is going to look like., I get it about the detachment. Marplan (+ clonazepam and other adjuncts) really started to rock my socks off as the doc and I finally pushed me past my 40mg dose of many years (lithium reduction was essential; the synergy had me glued to the couch, inert, and feeling toxic if we tried to escalate before).... I started developing a sense of self and conversing with others with more ease and less self-criticism or reproach, but strangely as we topped out at 90mg despite my depression improving and the social anxiety going out the window, I found my abundant (especially while using) social interactions profoundly superficial and lacking in interest, follow-through, or depth. Perhaps it was the hypomania and or the 75mg desipramine I was on as well, which both, or the desipramine flavor of my hypomania, kept me content hitting shallow checkmarks on accomplishments without being able to dig deeper. "Yay I'm being social! Good enough, now back to my other goals" kinda thing... in past I would just be more comfortable in social withdrawal; this time I became comfortable being social insofar as I didn't really care about the relationships themselves anymore. Very self-centered, seemed to enhance that innate quality I have as an addict.
Now with just 30mg phenelzine I'm noticing much less of an avoidant quality and a sincere, perhaps strong desire to actually connect with others with far more interest in them than me. Lack of interest in things and others has been my biggest residual symptom for years and its decrease could represent less MAOI activity, no desipramine (it's a hyperactivity med after all), as well as, being back in recovery again, a genuine desire to stop being so self-centered. I'm looking for long-term relationships, the kind I find in 12-step programs that start right off where they left off and are based on unconditional love and lack of judgment. I found on Marplan + desipramine, despite being more comfortable, I had all these nonsensical walls up about whom I'd talk to and how deeply I'd open myself to experiencing the relationship with -- always a select few. Now I'm realizing how stupid it is; we're all just people... every one of us.. so why am I leaving so many people out of my life and keeping my circle small?
In that sense, despite some sluggishness/ "Nardil naps," I'm finding myself with more usable energy than I had before. Less caught up in my head, less anxious, and more free to explore my life. And I can relate with the phenomenon of half a cocktail being energizing -- I'm completely abstinent including from alcohol, but I find with Nardil and benzos (on 4mg Klonopin) that sometimes all it takes is a little *more* GABAergic activity to sedate *the anxiety*, allowing my energy to disinhibit and become restored. Weird how that happens. Too much benzo, tired; not enough benzo, tired!
And the withdrawal from parents/ family. This is a tricky one that I identify with a lot with past MAOI use. At least with Marplan, I'd become so hyperaware of the emotional issues in my life, much of which stem from early life and my parents' behavior, and much of which continues thru the present. It can become very difficult in this sense to want anything to do with them because it becomes so clear what's wrong that they just don't see and can't or won't change... that would absolutely fuel my drive to be independent, leave the house, and would usually wind me up on meth with the rest of the family now blaming me for everything and unwilling to work through the pain. Vicious, vicious cycle, so many domestic violence reports... it got extremely ugly this year.
I concur, MAOIs and meth use = not good. Part of what these psych meds for depression and anxiety do for us is make us less sensitive to the pain and more able to dismiss it, which can be good, but ya throw addictive drugs into the picture and it becomes that much easier to sweep the addiction-generated problems and pain right under the rug. Soon enough I begin to hate the world, see no purpose in humanity either, and there's so much sh*t under the rug I lose control of myself, fall down in apathy, lie there for months letting things get necrotic, until the rug is completely pulled out from under me by some jarring experience. To summarize, the apathy becomes severe and I am living for nothing but meth, have such a high tolerance from the MAOI potentiation that I'm barely feeling anything at all, and hypersomnia takes over my ability to function without hundreds of mgs keeping me half-awake. NOT fun and so glad that cycle has been broken...
The concern isn't so much the contraindications. At the risk of sounding stupidly and deathly cocky, I'd phrase it such that I seem to have pushed my brain to the limits so frequently and intensely that it's become accustomed to the traditional contraindications, with amphetamines at least. I know Nardil and Parnate can be completely diff. animals w/ respect to this issue, but I was using very high amounts of meth both when on Marplan 40mg + 175mg desipramine in past as well as the past year with Marplan 90mg and DMI 75mg, even at some point with some Wellbutrin in the mix. But MDMA, cocaine, others (not my thing anyway) I will not touch (I don't want to touch anything these days anyway); I know the risk is extremely high there. I'm not proud of being able to be on several grams of meth with a BP of 103/ 74 nearly every time read, but it's just been my experience.
The concern is more about the hypomanic detachment you alluded to. So we are taking things slow with the phenelzine and leaving out desipramine unless completely necessary... I don't want to become so high off my psych drugs that I turn my back on my life again. Next week we plan to double Desoxyn to 40mg as I was on 80mg before the hospital and seem to require a high dose and respond quite well to it without mania. My mind is just completely lost at this point and when I choose to function, I do so very well on Desoxyn. Functionality on crystal meth though, absolutely not.
Functionality has been difficult for me as a tough-to-treat bipolar. In the past I was on 0.625-10mg Zyprexa, 5-10mg Abilify, 900mg lithium + 100mg lamotrigine with the MAOI/ TCA/ sim and flourishing at work while nearly dead inside. I'm in the same boat -- how can you call is stabilization if the mood stabilizers are causing depressive symptoms? Now I take minimal, 7.5-10mg Abilify with 25mg Lamictal and 300mg lithium. Those 3, and sometimes a tad bid of Zyprexa, are all my system can handle these days. It's sad bc the BP meds would "force" me to function, and now it requires high amounts of discipline that compete with high dosages of antidepressants that I need for my sanity, and that beast called addiction. Less meds, more freedom and choices, but damn is it hard to make the right ones and stay on track. Nonetheless, I am happier in the past year than ever, and phenelzine seems to be creating a boredom not of depression but of a strong desire to fill the gaps in my day with activity rather than sleep. So provided this stays the same, once Desoxyn is tuned up again and I acclimate to whatever dose of Nardil, I'm jumping straight back into work. My life absolutely depends on it.
Phew that was a lot, but such is life, and I haven't posted since 2014 when I got on desipramine and life took off for me. I highly appreciate you reading and your conversation, and haven't a clue how to babblemail either lol... not sure if we can share emails on here but I'll try... [email protected] ... and to Dr. Bob, sorry if that wasn't okay, just trying to connect.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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