![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Tom Twilight on July 7, 2005, at 9:54:15
Hey everyone
I've been very stupid in the last few weeks, and as a result I'm feeling quite down
I was doing OK about a month ago on a combination of Effexor and Remeron/Mirtazapine
For some stupid reason I decided to discontinue this combination, partly because of the weight gain and partly because it hadn't been very helpful for Social Anxiety.After I discontinued these meds I felt alright for a week, then I began to get depressed and anxious again.
I should have restarted the Mirtaz/Effexor, but instead I made an appointment with a new Pdoc in London.
I couldn't make up my mind whether to go or not, so in the end I went but I was very tired and stressed
I came across very badly at the appointment, and the doctor wasn't very sympathetic, I hoped he'd put me on Nardil, but instead he chose Marplan.
For some reason he also put me on 10mgs, the minimun effective dose is 30mgs?!He also wanted me to go into CBT at 60 pounds ($104) a session, how am I supposed to pay for that? (like most UK people I have no issurance)
I don't know what to do, should I keep taking the Marplan and trie and work up to an effective dose?
Or should I go back to Mirtaz/Effexor?Why is it so hard to find good Pdocs in the UK?
Posted by ed_uk on July 7, 2005, at 15:25:17
In reply to Distress Signals from the UK, posted by Tom Twilight on July 7, 2005, at 9:54:15
Hi Tom,
Isocarboxazid 10mg sounds ok for a starting dose..........so long as he is willing to increase the dose substantially as required. Don't start isocarboxazid until you've been off Effexor for at least 7 days.
~Ed
Posted by Tom Twilight on July 7, 2005, at 15:30:23
In reply to Re: Distress Signals from the UK » Tom Twilight, posted by ed_uk on July 7, 2005, at 15:25:17
> Don't start isocarboxazid until you've been off Effexor for at least 7 days.
Hey Ed
I've already started the Marplan/Isocarboxazid, I've been off the Effexor for a while.
Do you have any idea about the half-life of Isocarboxazid, its so obscure I can't even find that out!
To be fair he was the most well informed UK doc I've met.
I'm just depressed because its so expensive, and I don't think that Marplan works for SA.......
Posted by ed_uk on July 8, 2005, at 13:47:34
In reply to Re: Distress Signals from the UK, posted by Tom Twilight on July 7, 2005, at 15:30:23
Hi Tom,
>I've already started the Marplan/Isocarboxazid.......
Any side effects so far? ....on your little dose!
>I'm just depressed because its so expensive........
It's a rip off. Nardil is much cheaper. Hopefully your NHS GP will prescribe your medication once you're on a stable dose etc.
Here are the net prices (not what you pay at the pharmacy....but useful for comparison)........
Nardil. Twenty 15mg tabs £3.99
Isocarboxazid. Fifty 10mg tablets £27.79
Tranylcypromine (Parnate). Twenty-eight 10mg tablets £5.08
>Do you have any idea about the half-life of Isocarboxazid.......
I don't know. The half-life of an irreversible MAOI is not relevent to it's duration of action. To be honest, it's not a particularly useful parameter to know. AFAIK, isocarboxazid it converetd to one or more active metabolites that are responsible for it's therapeutic activity.
Oh look, I just found this.......
'The plasma half life of isocarboxazid is about 2.5 hours and is unrelated to the duration of enzyme (MAO) inhibition.'
>...its so obscure I can't even find that out!
It's very obscure, much more so than Nardil!
>To be fair he was the most well informed UK doc I've met.
The fact that he'd heard of isocarboxazid is a good sign :-)
>I don't think that Marplan works for SA.......
I think there's an excellent chance that it will work. If it doesn't, you can try something else :-)
Kind regards
~Ed
Posted by Declan on July 8, 2005, at 20:56:36
In reply to Distress Signals from the UK, posted by Tom Twilight on July 7, 2005, at 9:54:15
Look I've not tried mirtazapine or Effexor, or Marplan for that matter. But I'd *much* prefer to try Marplan. Don't worry so much, it's not a bad choice at all. You might even do well on a low dose with no side effects.
Declan
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.