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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by floater995 on July 26, 2007, at 20:24:36
I've had problems with depression for nearly ten years now. The very first antidepressant I was given, Zoloft, worked well and completely got rid of my social inhibition but pooped out after a few months. I was later prescribed other SSRI's and Wellbutrin without much effect.
About five years ago I started taking Nardil and eventually settled into 90mg/day. The Nardil kept me depression-free and allowed me to nearly complete a second bachelor's degree in biochemistry. Two and a half years ago I got accepted to pharmacy school (conditional on the completion of the degree). Shortly before that I had begun titrating off Nardil because I thought it would be better to risk some degree of depression than to be stuck with the social stigma of being medicated (the food restrictions on MAOI's make concealment more difficult).
As I titrated off Nardil over a number of months I first experienced disorientation, nausea, and weight loss. Then I became manic and finally I became paranoid and extremely delusional.
The mania and psychosis are long gone (thanks to a few months of Zyprexa) but now I am stuck in a two-year strong depression. I briefly tried Parnate without luck and am now on no medications and no longer even bother seeing a psychiatrist. I've become a recluse, hiding out in my parents' home, unable to get a job.
Nardil withdrawal was a terrifying, humiliating experience and I am hesitant to once again become physically "addicted" to it. Yet I'm currently dead in the water and keep wondering whether I should just go back to Nardil. Or should I try something else? Any thoughts? Thanks.
Posted by saturn on July 26, 2007, at 20:52:33
In reply to To Nardil or not to Nardil?, posted by floater995 on July 26, 2007, at 20:24:36
>>>The Nardil kept me depression-free and allowed me to nearly complete a second bachelor's degree in biochemistry.
I'm have no experience with MAOI's, but the above statement is quite significant. If Nardil really worked for you that well for a good period of time (?) I would suggest definitely weighing this tremendous potential benefit against the lesser inconvenieces related to stigmatization and concealment of psychiatric disorders.
Best regards and luck.
Posted by Phillipa on July 26, 2007, at 22:14:08
In reply to Re: To Nardil or not to Nardil? » floater995, posted by saturn on July 26, 2007, at 20:52:33
I agree with saturn it just makes good sense and how will people know of the diet restrictions? We all have different tastes in foods. Love Phillipa
Posted by floater995 on July 27, 2007, at 0:02:02
In reply to Re: To Nardil or not to Nardil?, posted by Phillipa on July 26, 2007, at 22:14:08
Thank you for the input. Going back on Nardil does seem like the logical thing to do.
Even though I tapered off of Nardil largely because of potential stigma, it isn't really a factor at this point. Instead I'm somewhat hesitant because of the horrific withdrawal I went through. I'm worried that should I go back on Nardil, I might at some point end up going through withdrawal again.
It's far from unreasonable to think that I might end up without insurance at some point in the future, and thus be forced into withdrawal. Or, perhaps at some point in the future Pfizer will simply stop making Nardil. I don't think there's any guarantee Nardil will be produced indefinitely. Maybe I should just stop worrying, go back on Nardil, and enjoy however many semi-normal years I might get.
Posted by Sentience on July 27, 2007, at 5:45:11
In reply to To Nardil or not to Nardil?, posted by floater995 on July 26, 2007, at 20:24:36
I'm in a very similar position as you Floater...I have spent the last 5 months or so titrating off the Nardil & had been completely drug free for 2 months. I just decided last night to recommence the Nardil.
The withdrawal was the most difficult and painful thing to do, as I had been on the drug for 17 consecutive years. I am not even depressed any more, I just feel this really strange blankness that enveloped me since I started tapering off. It's with much trepidation that I am recommencing the Nardil.
I would say that as you responded so well to Nardil, it only makes sense to start taking it again. I live in Australia and the Nardil is not sourced from Pfizer, it comes from Link Pharmaceuticals. So don't lose too much sleep over Pfizer deciding that its just not worth the effort to make it any more, even though they DID reformulate it back in 2003 to cut costs.
Good luck & let us know if you decide to recommence.
Cheers
Posted by floater995 on July 27, 2007, at 20:41:07
In reply to Re: To Nardil or not to Nardil? » floater995, posted by Sentience on July 27, 2007, at 5:45:11
Wow, your 17 years on Nardil makes my 3 years seem like nothing more than a trial. What caused you to decide to stop taking Nardil? If you've been off Nardil for only two months, it's possible that the "strange blankness" you mention might still go away. I really don't know at this point if I will start taking Nardil again or not, and I'm not sure I'll make a decision any time soon.
Posted by Jedi on July 28, 2007, at 2:21:29
In reply to Re: To Nardil or not to Nardil? » floater995, posted by Sentience on July 27, 2007, at 5:45:11
Sentience,
Your situation sounds almost exactly like mine. I went off Nardil in February for a trial of Parnate. This lasted for about three months and I've been off all MAOIs for almost two months now. I was taking Nardil for most of the past ten years. Several times I have almost started back on Nardil. I am not deeply depressed, just a level of dysthymia that I have lived with since I was a teenager. I am still taking clonazepam at 2mg daily and don't feel I can give it up at this time.I believe that after long term use of any medication that affects the brain's neurotransmitters, there will be a long period for the brain to adjust to being without that medication. That is why I am going to tough it out for another couple of months before starting back on Nardil. If I was experiencing severe depression like Floater, I would have started back on Nardil already.
For me, the Nardil saved my life and stopped the major depression. But, it also took away an edge that was there before the major depression hit. This little edge, though sometimes painful, was also a part of me. It kept me motivated and moving forward. With the depression and then with Nardil, it was just too easy to postpone important things in my life. Life is too short to always be putting things off.
Since your situation sounded so similar to mine, I thought I would share this with you. It helped me to write it down and solidify some of my thoughts on the subject. So, thank you for that.
Good luck,
Jedi
> I'm in a very similar position as you Floater...I have spent the last 5 months or so titrating off the Nardil & had been completely drug free for 2 months. I just decided last night to recommence the Nardil.
>
> The withdrawal was the most difficult and painful thing to do, as I had been on the drug for 17 consecutive years. I am not even depressed any more, I just feel this really strange blankness that enveloped me since I started tapering off. It's with much trepidation that I am recommencing the Nardil.
>
> I would say that as you responded so well to Nardil, it only makes sense to start taking it again. I live in Australia and the Nardil is not sourced from Pfizer, it comes from Link Pharmaceuticals. So don't lose too much sleep over Pfizer deciding that its just not worth the effort to make it any more, even though they DID reformulate it back in 2003 to cut costs.
>
> Good luck & let us know if you decide to recommence.
>
> Cheers
Posted by Sentience on July 28, 2007, at 4:23:00
In reply to Re: To Nardil or not to Nardil?))Sentience, posted by floater995 on July 27, 2007, at 20:41:07
Hey Floater
The main reason for deciding to discontinue the 45 mg/day Nardil, would have to be that old chestnut: Side-effects.
Although I had managed to adjust to many of Phenelzine's effects during the 1st few months of treatment and nearly all of them after several years, the drug was reformulated in 2003 and suddenly my condition began to deteriorate depression and anxiety came back and a bunch of new side-effects emerged.
I knew that the drug had changed cuz there was a short period here in Australia, where it couldn't be bought at the local pharmacy at all & I could only obtain it from my local hospital, which was importing Nardil from the UK. That situation lasted several months, and then I learned that pharmacies were carrying Nardil again, however, the packaging, labelling and even the drug looked different and now it was being distributed by Link Pharmaceuticals instead of Parke-Davis (Pfizer)
So for the last 3 or 4 years my situation had been one of feeling under-treated by the Nardil. Merely increasing the dose only seemed to increase side-effects but with no substantial gain in beneficial effects. At doses higher than my
usual 45 mg/day... anywhere between 60 and 90 mg/day, I would experience increasing delayed ejaculation, constipation, gastric pain on laying down at night to go to bed....(possibly related to slow gut motility leading to pockets of gas), increased sweating, and hypo mania at around the 90 mg/day dose.
As for the feeling of blankness going away eventually... there's always that possibility yes ..... but at the moment I feel as though I'm barely clinging to my job as a bookmaker's agent. Not that anything has been said to me regarding my performance, but I come home absolutely wrecked from the extra effort required to do what I used to do with my eyes closed.
I'm really not comfortable with the idea of going back to the inferior Nardil, however, I still think it's preferable to the way I'm now feeling.... even though its not exactly depression or anxiety.
I plan to continue taking 45 mg/day for a few weeks until it kicks in... however that long may take.... considering my 17 year relationship with the damn drug and then review my situation. If I feel wonderful and Nardil is once again the god-send miracle it used to be ..... then I'll stick with it... If the side-effects kick in with a vengeance ... then I may decide that Nardil really isn't worth the hassle any more and try to deal with BLANKVILLE Central of being 100% drug-free.
You also mention the dietary restriction as being the main reason for wanting to discontinue the Nardil. As for the dietary restrictions of Nardil.. I personally have never really had any problem with drinking beer or red wine ..consuming cheese of any kind ... pizza.. bananas .... avocados ... in fact just about most of the foods listed as MUST AVOID. This has been my experience on 45 mg/day over 17 years. I weigh 80 Kg.. and am now 48 and in very good health otherwise.
I realise that there are people who post on these boards who HAVE had a bad reaction from eating the wrong food.. so I wonder if that comes down to luck.... dosage or individual variation of tolerance & metabolism of tyramine. I have read anecdotal evidence and also some clinical papers where the Nardil diet is over-stated and may even be used by the drug company as an excuse to dump the drug and force us to use the newer more expensive SSRIs... which are pretty much useless for those of us who have arrived at Nardil as the last resort.
Hope there was some useful information in there for you and Jedi too. The Internet is the best thing to happen for us loonies who formerly had to rely on the crap the drug companies pushed onto us. With their under-reported and trivialised descriptions of side-effects. They WILL eventually become more accountable to us, the consumers of their expensive crappy products!!
Posted by Sentience on July 28, 2007, at 6:54:19
In reply to Re: To Nardil or not to Nardil? » Sentience, posted by Jedi on July 28, 2007, at 2:21:29
Hi Jedi
Thanx for sharing that with me. I have a bunch of questions for you if you don't mind. What was your experience with the Parnate like? I guess it is inferior to Nardil otherwise you would have stayed with it.
I'm also wondering why you discontinued the Nardil in the 1st place? and why you have 'nearly' started back on it several times before but didn't?
Do you find that you need the benzo Clonazepam adjunct, because the "new" post-2003 Nardil is no longer as effective at influencing the GABA levels? Did you need the clonazepam when you were taking the old pre-2003 Nardil?
I'm not sure what is the source of this blankness that I feel, although I can describe how it affects me: I feel as though the lights are on but there's no one home. For example: I was walking my dog the other day & a little old lady stopped to talk to me... I couldn't put two words together to say anything. I struggled to blurt out a couple of yes/no answers. My point is that this was hardly an anxiety inducing event, and yet my mind was just vacant. It was very distressing to feel that way
A friend dropped in to visit me a while back and I had a similar paucity of words or even topics of conversation. It was almost as though my ego had evaporated into thin air. I had nothing to say and couldn't think of any new topics to discuss with her.
I may add that this has not occurred to me either before or during Nardil treatment, only since I started tapering off up until the present time. I'm finding it a lot easier to express myself though writing as I have time to gather my thoughts & edit them as I go.
Does any of that sound similar to what you experience?Cheers
Sentience
Posted by floater995 on July 28, 2007, at 12:22:28
In reply to Re: To Nardil or not to Nardil?))Sentience » floater995, posted by Sentience on July 28, 2007, at 4:23:00
New Nardil didn't seem to be less effective for me but may have resulted in somewhat worse side effects (digestive malaise, increased sweating).
I mentioned dietary restrictions as making concealment more difficult. However I did get away with eating quite a lot of the foods on the avoid list. I chose what foods I would break the rules on based on what I read online. But I didn't break all the rules, and unfortunately if I start taking Nardil again I will have forgotten exactly what I got away with.
"The Internet is the best thing to happen for us loonies who formerly had to rely on the crap the drug companies pushed onto us. With their under-reported and trivialised descriptions of side-effects." Yeah, having read about Nardil before starting it, I knew that the worst side effects would pass after a couple months. Also, as I mentioned, a little internet surfing allowed me to find out that the restricted foods list was excessive.
I hope your restarting Nardil takes care of the blankness, and does so with minimal side effects. I really don't know if I will go back on Nardil. At this point my inactivity is a problem and I sort of need a catalyst to get going again.
(I don't know why the carrots in the post title always become closed closed paretheses marks. Oh well.)
Posted by Jedi on July 28, 2007, at 15:07:02
In reply to Re: To Nardil or not to Nardil? » Jedi, posted by Sentience on July 28, 2007, at 6:54:19
Hi,
In response to your questions:>What was your experience with the Parnate like? I guess it is inferior to Nardil otherwise you would have stayed with it.
This was my 2nd trial on Parnate. I had tried it many years ago and had no luck knocking back a serious major depression. This time I titrated off Nardil quickly and titrated up to 80mg of Parnate over about a months time. The idea was to get my MAO inhibition back up quickly before the major depression had a chance to return. Parnate was working fairly well for me. I quit because of a rare autohypertensive reaction. I would get a splitting headache and my BP would be way up. This was not a tyramine reaction or a reaction to any other medication taken with Parnate. I tried dosage reduction, which didn't help; so I had to quit Parnate.
> I'm also wondering why you discontinued the Nardil in the 1st place? and why you have 'nearly' started back on it several times before but didn't?
I was actually pretty stable when I stopped Nardil for the trial on Parnate. It comes back to the side effects of Nardil. The worse for me was the severe carbohydrate cravings which caused some massive weight gain over the years. Other side effects that were problems was edema in my lower extremities and delayed ejaculation.
I have nearly started back on Nardil several times, not because of major depression, but because of a chronic low level depression(dysthymia). Also, lurking in the back of my mind is the knowledge that the times I have been off Nardil, for other medication trials, the major depression has eventually returned. For me, the major depression is life threatening, and I don't want to risk going there again.
> Do you find that you need the benzo Clonazepam adjunct, because the "new" post-2003 Nardil is no longer as effective at influencing the GABA levels? Did you need the clonazepam when you were taking the old pre-2003 Nardil?I have always used clonazepam as an augmentor with Nardil, before and after the formulation change. For me they work synergistically for relief of my social anxiety, which has been a problem since my teenage years. That was a long time ago, I just turned fifty. I am currently taking 2mg of clonazepam daily. This does not work as well for my social anxiety as 1mg combined with Nardil.
> I'm not sure what is the source of this blankness that I feel, although I can describe how it affects me: I feel as though the lights are on but there's no one home. For example: I was walking my dog the other day & a little old lady stopped to talk to me... I couldn't put two words together to say anything. I struggled to blurt out a couple of yes/no answers. My point is that this was hardly an anxiety inducing event, and yet my mind was just vacant. It was very distressing to feel that way ...
Does any of that sound similar to what you experience?Yes, your experiences with Nardil and your withdrawal from it really seem to mirror my own. With my social anxiety, I can usually fake some kind of a response, but internally I'm a wreck. I believe the 2mg of clonazepam keeps me from doing a total meltdown. My hope, after two months off MAOIs, is that the major depression won't return and maybe I'll start feeling more normal after a few more months off the meds.
Be well,
Jedi
Posted by Sentience on July 28, 2007, at 20:18:13
In reply to Re: To Nardil or not to Nardil? » Sentience, posted by Jedi on July 28, 2007, at 15:07:02
Hey Jedi,
A few things. Firstly, You mention a rather rapid turn-around of discontinuing the Nardil & then commencing the Parnate, within 1 month. I can understand the reasoning for wanting to intervene before the depression took root. I guess many people could do that & experience no untoward reactions. However, in your case, I'm wondering if the hypertensive crises were due to an insufficient washout of the Phenelzine. MAOIs are known to interact and a minimum 14 washout is recommended. Just a thought, as you say, other than that you responded well to the Parnate.
Oddly enough for me, I'm experiencing increased appetite and a slight increase in weight gain, since tapering off Nardil began in February. I'm not on any other medications. Yet when I originally commenced Nardil back in 1991, I experienced considerable weight gain, which was actually a good thing for me back then, as I was able to exercise and converted most of it to muscle mass. I'm wondering if its not so much the Phenelzine per se, or whether it's due to some induced change in metabolism as a result of MAO inhibition .
Have you ever tried Omega 3 supplementation for the chronic low level dysthymia you mention? My understanding of how the Omega 3 tricglycerides work is that they basically exert their main effect by reducing the viscosity of cell membranes... In this instance the neuron membrane.
This occurs at two locations pertinent to speeding up our mental functioning:
1. Along the axon where the electrical ionic exchange of sodium & potassium ions during the nerve impulse occur.
2: At the nerve endings where neurotransmitters are stored in vesicles, to be released into the synapse, and also the receptors on the post-synaptic membrane.
If the nerve impulse can move along membranes more efficiently in a more fluid environment, then it may help alleviate that low level depression that you experience. I've been on 900 mg/day of marine triglycerides (EPA & DHA)for 9 months now, and I attribute my absence of depressive symptoms to that.
It's always good to learn that there are others out there who share similar stories & diagnoses. Good luck with your plan to tough things out before recommencing the Nardil again.
Posted by Jedi on July 28, 2007, at 22:01:14
In reply to Re: To Nardil or not to Nardil? » Jedi, posted by Sentience on July 28, 2007, at 20:18:13
> A few things. Firstly, You mention a rather rapid turn-around of discontinuing the Nardil & then commencing the Parnate, within 1 month. I can understand the reasoning for wanting to intervene before the depression took root. I guess many people could do that & experience no untoward reactions. However, in your case, I'm wondering if the hypertensive crises were due to an insufficient washout of the Phenelzine. MAOIs are known to interact and a minimum 14 washout is recommended. Just a thought, as you say, other than that you responded well to the Parnate.
---------------------
I don't believe my hypertensive problems with tranylcypromine were related at all to washout of phenelzine. When the problem happened, I had been completely off phenelzine for almost three months. The spontaneous hypertensive reaction is just a rare side effect that happens sometimes in very few people.
References:
http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=8399806&ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumhttp://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=2486182&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
-------------------------
> ... I'm wondering if its not so much the Phenelzine per se, or whether it's due to some induced change in metabolism as a result of MAO inhibition.
--------------------------
I know that Phenelzine causes intense sweet carbohydrate cravings in many users, especially me. It may also have an affect on metabolism. Tranylcypromine, on the other hand, does not seem to cause weight gain in most people. Weight loss is more common. Since both medications inhibit monoamine oxidase, I don't think that MAO inhibition caused my weight gain.
--------------------------
> Have you ever tried Omega 3 supplementation for the chronic low level dysthymia you mention? My understanding of how the Omega 3 tricglycerides work is that they basically exert their main effect by reducing the viscosity of cell membranes... In this instance the neuron membrane. ...
--------------------------
Yes, I have been taking fairly high doses of Omega-3 fatty acids for at least 18 months. It has not seemed to help my mood problems but I think that the scientific evidence to their health benefits is becoming substantial. I currently take 1800mg of EPA and 1200mg of DHA on a daily basis.Thanks again for sharing your situation.
Jedi
Posted by Sentience on July 30, 2007, at 10:30:39
In reply to Re: To Nardil or not to Nardil? » Sentience, posted by Jedi on July 28, 2007, at 22:01:14
Hi Jedi
Thanx for sharing that information. In regard to the EPA & DHA, how did you arrive at that dosage regimen that you mentioned. Do you have any links to information of effective dosages of the Omega-3 fatty acids for the treatment of depression?
There appears to be an optimum level for the treatment of depressive symptoms. Do you have any links to studies that suggest an optimum dose? This excerpt is from an early study done at Harvard in 1999 by Dr Andrew Stoll.
"...Less may also be more. Large doses may result in oxidative stress as omega-3 is being metabolized.. This may explain why some studies using EPA (see above) failed at higher doses. Accordingly, Dr Cott recommends omega-3 be taken with vitamins C and E. Dr Stoll also recommends taking vitamins C and E with omega-3 (1.5 to 3.5 grams of omega-3 a day, taken with food)."
see: http://www.mcmanweb.com/article-15.htm
Your dose of 1.2 g & 1.8 g gives you the 3 grams of Omega-3 per day which is in the upper range of what's suggested here.
Cheers
Sentience
Posted by Jedi on July 30, 2007, at 14:16:42
In reply to Re: To Nardil or not to Nardil? » Jedi, posted by Sentience on July 30, 2007, at 10:30:39
Hi,
Most of the studies I've read show the relationship between the consumption of omega-3 fatty acids and depression are inconclusive. I used to take larger doses of 2400mg EPA and 1800mg DHA. My current dosage is derived from looking at the studies on benefits on inflammation and cardiac health. At one point in 2006 I was off Nardil and getting by quite well on high dosage omega-3. But there are so many variables in depression, my success could have been a placebo effect. I eventually went back to Nardil because of the return of major depressive symptoms.Dosages used in the studies seem to be all over the chart.
Be Well,
Jedihttp://ajp.psychiatryonline.org/cgi/content/full/163/6/969
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16812965
> Hi Jedi
>
> Thanx for sharing that information. In regard to the EPA & DHA, how did you arrive at that dosage regimen that you mentioned. Do you have any links to information of effective dosages of the Omega-3 fatty acids for the treatment of depression?
>
> There appears to be an optimum level for the treatment of depressive symptoms. Do you have any links to studies that suggest an optimum dose? This excerpt is from an early study done at Harvard in 1999 by Dr Andrew Stoll.
>
> "...Less may also be more. Large doses may result in oxidative stress as omega-3 is being metabolized.. This may explain why some studies using EPA (see above) failed at higher doses. Accordingly, Dr Cott recommends omega-3 be taken with vitamins C and E. Dr Stoll also recommends taking vitamins C and E with omega-3 (1.5 to 3.5 grams of omega-3 a day, taken with food)."
>
> see: http://www.mcmanweb.com/article-15.htm
>
> Your dose of 1.2 g & 1.8 g gives you the 3 grams of Omega-3 per day which is in the upper range of what's suggested here.
>
>
>
> Cheers
> Sentience
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