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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Elimino Pete on March 21, 2009, at 0:00:53
In reply to Shy Guy Intro + Site Help, posted by Elimino Pete on March 17, 2009, at 19:29:45
Hi everyone and thanks in advance for listening.
First, I decided I was not in a good board for a response, so I hope this accomplished the effect of moving my post to where I'll likely be visiting most.
I am curious about other experiences with MAOIs. I'm on Emsam Patch 6 mg right now and getting perhaps subtle relief. I am trying to decide about whether to increase the Emsam dose or go back to Nardil, or consider Marplan. I was on Nardil for years, but went off it well before this formula problem I keep reading about. THAT concerns me. After years of no results on SSRIs and almost every other "newer" antidepressant out there, I decided to go back to the tried and true, but sad to hear it's not the same any longer.
For some related info, I have moderate to severe SP, GAD, ADD and depression that I consider a secondary effect to the other conditions. I'm middle-aged and also use Klonapin 5 mg bid, Inderal LA 120 mg (essential tremor & anxiety issues), and Adderall 5 mg bid. BTW, while my doc knows Adderall and MAOIs are technically contraindicated, he believes that in these smaller doses, the benefits may outweigh the risk. Hope he's right about that! I seem to tolerate the combination okay, best I can tell.
Below is the original post in "Newbies."
> Greetings,
>
> I am new here of course, and quite shy about this sort of thing. I hope to push myself to share and care with you. Dr. Bob's boards were highly recommended and after browsing a bit, I see why.
>
> I have a password manager that makes it easier to log on when I go to the site instead of waiting until I post. I am not the most computer literate, but thought I'd at least find the log-on link or page! Okay, I give up. Will one of you kindly take pity on the awkward freshman here and draw me a picture?
>
> Thanks...and Cheers!
Posted by Phillipa on March 21, 2009, at 0:13:59
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by Elimino Pete on March 21, 2009, at 0:00:53
Welcome to babble meds. Oh I always wanted to try the EMSAM patch but pdoc said it would be too stimulating as anxiety so high. But like the idea of a patch and bypassing intestinal tract. How do you find the 6mg of Emsam no dietary restrictions. How about rashes? Love Phillipa
Posted by Elimino Pete on March 21, 2009, at 1:00:35
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by Phillipa on March 21, 2009, at 0:13:59
Hi Phillipa,
I never knew there was a stimulating factor to Emsam. That could explain the increase in my sense of anxiety, particularly physically generated anxiety (nervousness, tremor). It's been a long time, but I recall not being able to take Parnate because of that same issue. I tried it before Nardil. My psychiatrist is not too smart about MAOIs and I actually had to bring up the possibility of trying this to him. He still thinks it is spelled "Ensam" in fact! I have to take the lead with my treatment. Seems MAOIs are relics to most of the younger psychiatrists. So thank you for that insight.
My instincts tell me that if I can be assured that this "New Nardil" is worthy, it is my best route to take. It worked much better on social anxiety.
To answer your questions:
The lack of dietary restrictions is wonderful. I used to take Nardil back in the early 50s (just kidding..late 80s) when the MAOI diet was much stricter than it is today, but I always took a bit more liberal approach-- what my doctor at the time called the European MAOI mentality. I am pleased to see the States moving toward that. If I increase the dose, the diet thing kicks in, but I'm told it is still a lesser risk than in having the drug enter the GI tract. I don't know...maybe I'm just less reactive, so I'm certainly not making any recommendations for anyone to abuse the diet by any means.
I have had no significant skin reactions to the patch sites, but I do know one person who uses Emsam for migraine and she has had horrible issues. Do you hear of a lot of that?
Posted by jedi on March 21, 2009, at 4:13:59
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by Elimino Pete on March 21, 2009, at 0:00:53
Hi,
Do you really take 5mg of clonazepam(Klonopin) twice a day. A 10mg daily dose of this benzo would be huge. I have fairly severe social anxiety along with treatment resistant atypical depression. I am taking 75mg of Nardil daily. I was taking 2mg of clonazepam as an augmentor. But, I was developing some memory problems after years on clonazepam, so I am now down to .25mg per day. I should be completely off of clonazepam within a couple of weeks. I take 25mg of Seroquel nightly for Nardil induced insomnia.I have been on 45+ different combinations of medications. Nardil, in my humble opinion, is still the best for social anxiety and atypical depression. I was on Nardil years before and years after the formula change. They both worked well for these conditions.
One thing that is different for me, and I don't know if it has anything to do with the new formula; is I now have no hypomania when I first start Nardil after being off of it for a long time. I first used Nardil in 97 or 98 and when the med started working, I had hypomania - bordering on euphoria.
Anyway, I hope that EMSAM will work for you. It will probably have a lot lees side effects than Nardil.
Good Luck,
Jedi> Hi everyone and thanks in advance for listening.
>
> First, I decided I was not in a good board for a response, so I hope this accomplished the effect of moving my post to where I'll likely be visiting most.
>
> I am curious about other experiences with MAOIs. I'm on Emsam Patch 6 mg right now and getting perhaps subtle relief. I am trying to decide about whether to increase the Emsam dose or go back to Nardil, or consider Marplan. I was on Nardil for years, but went off it well before this formula problem I keep reading about. THAT concerns me. After years of no results on SSRIs and almost every other "newer" antidepressant out there, I decided to go back to the tried and true, but sad to hear it's not the same any longer.
>
> For some related info, I have moderate to severe SP, GAD, ADD and depression that I consider a secondary effect to the other conditions. I'm middle-aged and also use Klonapin 5 mg bid, Inderal LA 120 mg (essential tremor & anxiety issues), and Adderall 5 mg bid. BTW, while my doc knows Adderall and MAOIs are technically contraindicated, he believes that in these smaller doses, the benefits may outweigh the risk. Hope he's right about that! I seem to tolerate the combination okay, best I can tell.
>
> Below is the original post in "Newbies."
>
> > Greetings,
> >
> > I am new here of course, and quite shy about this sort of thing. I hope to push myself to share and care with you. Dr. Bob's boards were highly recommended and after browsing a bit, I see why.
> >
> > I have a password manager that makes it easier to log on when I go to the site instead of waiting until I post. I am not the most computer literate, but thought I'd at least find the log-on link or page! Okay, I give up. Will one of you kindly take pity on the awkward freshman here and draw me a picture?
> >
> > Thanks...and Cheers!
Posted by bleauberry on March 21, 2009, at 11:30:56
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by Elimino Pete on March 21, 2009, at 0:00:53
I come here probably more than I wish I did and was going to stop myself from making any posts today. But when I saw yours I just had to say, "Hi, welcome!" There are some good people here with a few experts that frequently pop in.
MAOIs are always a popular topic here.
Have you ever seen the writings of Dr Gillman of PsychoTropical Research? Great stuff. His favorite meds based on experience in what works and what doesn't are the MAOIs, Parnate in particular, and a few select TCAs either by themselves or combined with Zoloft.
Go to his website and read. Many good topics including MAOIs. You may likely get some ideas you had not thought of. For example, a particular TCA alone or combined with an SSRI, or of course, Parnate.
I wonder why Parnate hasn't been tried with you yet? At websites where people rate their meds, the combination of Parnate + Klonopin seems particularly effective for people with your kinds of symptoms and history. Some people said Parnate by itself did wonders for all their symptoms including anxiety, phobias, panic, pain, fatigue, cognition, and depression.
Dr Gillman has treated over a 1000 patients with Parnate, but only about 50 with Nardil. That is based on his experience of what works, as well as the difference in side effects. Check it out. You'll get some good ideas I am sure.
Posted by Elimino Pete on March 21, 2009, at 12:42:13
In reply to Re: Shy Guy Intro + Site Help, posted by jedi on March 21, 2009, at 4:13:59
CORRECTION:
jedi, I am sorry and need to correct myself. I am only on 0.5 mg of clonazapam twice a day. Big difference for one little missed symbol. I'd up that benzo dose if I could tolerate the sedation and brain fog higher doses cause me. I've got to go do some chores now, but will reply more completely later on. Thanks for responding!
Posted by Elimino Pete on March 21, 2009, at 12:55:24
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by bleauberry on March 21, 2009, at 11:30:56
Thank you so much bleauberry! I will indeed check out this site. I had always heard Nardil to be considered the "gold standard" MAOI for social phobia. I actually tried Parnate first. The doctor liked the idea of it due to my issues with lethargy. The effects of it caused me to be quite jittery to an unbearable degree. Whether that would be the same today, I don't know. Perhaps I could learn to live with it for awhile and it would subside. At any rate, at the time, my doctor chose to switch me immediately to Nardil, which eliminated those side effects (still had others, but another story). I have more to write to you, but must run right now. Thanks for the reply. I do really appreciate it.
Posted by Elimino Pete on March 22, 2009, at 0:08:38
In reply to Re: Shy Guy Intro + Site Help, posted by jedi on March 21, 2009, at 4:13:59
Again, sorry for the misinformation. I'm an old man and can't see those dots (or lack thereof) well <grin>.
I could never take much Nardil because of intolerable urogenital function side effects. I think I was eventually brought down to a maintenance dose of only 30 mg a day, but I honestly don't remember and am not sure I can even find out...maybe it was 60 mg. It helped me, whatever it was. Though never a complete answer, it was more complete and comprehensive than anything I have ever tried.
I went off Nardil for several months after my doctor got the wild notion that I was OCD instead of SP. He was wrong. He put me on Prozac, which was an almost new drug then. I kept increasing the dose to reach a maximum that was a bit beyond the normally recommended range. I received no benefit at any time. As a side note, I curiously had none of the dreadful sexual side effects that the SSRIs give me nowadays. Taking Prozac was seemingly as if I was not taking anything. I was so disappointed and depressed about having my high hopes dashed.
When I went back on Nardil, it never seemed to work the same for me. I did indeed experience the hypomania and euphoria you describe when I first took it. In fact, it seemed to linger for months on end. I was no doubt naive in believing that was part of the desired clinical effect. When I went back onto Nardil after discontinuing Prozac, it never worked as well. The mania was gone from the outset, and more importantly, the anti-anxiety effect was not nearly as potent. Still, it was better than anything I had tried or have tried since then. I truly liked that euphoric effect, but in retrospect, I realize it didn't do much for the few relationships I was able to nourish, especially the one with my girlfriend at the time.
Your report of continued success with Nardil after the excipient formula changes is so encouraging to hear. Somehow I just don't see Emsam being a long term solution for me, but I'm not ready to give up until I try a dose increase. I'm trying to wait for a less chaotic time in my life to try it. Do those times ever come though?
I am so pleased that you are having success with pharmacological treatment, especially given all the trials you've endured. Wow, I thought I'd tried a lot of stuff. Continue to be well my friend!
Posted by jedi on March 22, 2009, at 1:08:01
In reply to Re: Shy Guy Intro + Site Help » jedi, posted by Elimino Pete on March 22, 2009, at 0:08:38
Hi,
Thanks for your kind words. Sometimes it is hard to be supportive of others when we are feeling so terrible ourselves. I just wrote a long response and lost it in "Cyber HE**". I'll write again later.
Good Luck in your quest for wellness,
Jedi> Again, sorry for the misinformation. I'm an old man and can't see those dots (or lack thereof) well <grin>.
>
> I could never take much Nardil because of intolerable urogenital function side effects. I think I was eventually brought down to a maintenance dose of only 30 mg a day, but I honestly don't remember and am not sure I can even find out...maybe it was 60 mg. It helped me, whatever it was. Though never a complete answer, it was more complete and comprehensive than anything I have ever tried.
>
> I went off Nardil for several months after my doctor got the wild notion that I was OCD instead of SP. He was wrong. He put me on Prozac, which was an almost new drug then. I kept increasing the dose to reach a maximum that was a bit beyond the normally recommended range. I received no benefit at any time. As a side note, I curiously had none of the dreadful sexual side effects that the SSRIs give me nowadays. Taking Prozac was seemingly as if I was not taking anything. I was so disappointed and depressed about having my high hopes dashed.
>
> When I went back on Nardil, it never seemed to work the same for me. I did indeed experience the hypomania and euphoria you describe when I first took it. In fact, it seemed to linger for months on end. I was no doubt naive in believing that was part of the desired clinical effect. When I went back onto Nardil after discontinuing Prozac, it never worked as well. The mania was gone from the outset, and more importantly, the anti-anxiety effect was not nearly as potent. Still, it was better than anything I had tried or have tried since then. I truly liked that euphoric effect, but in retrospect, I realize it didn't do much for the few relationships I was able to nourish, especially the one with my girlfriend at the time.
>
> Your report of continued success with Nardil after the excipient formula changes is so encouraging to hear. Somehow I just don't see Emsam being a long term solution for me, but I'm not ready to give up until I try a dose increase. I'm trying to wait for a less chaotic time in my life to try it. Do those times ever come though?
>
> I am so pleased that you are having success with pharmacological treatment, especially given all the trials you've endured. Wow, I thought I'd tried a lot of stuff. Continue to be well my friend!
Posted by Elimino Pete on March 22, 2009, at 12:50:30
In reply to Re: Shy Guy Intro + Site Help » Elimino Pete, posted by jedi on March 22, 2009, at 1:08:01
Hey Jedi--
I'm sorry the cybergods were so unkind to you. I know that frustration well.
Just came across this post of yours:
http://www.dr-bob.org/babble/20060610/msgs/656820.html
Although older, I found your comments intriguing. You are obviously well studied in psychopharm, and in combination with your subjective experiences, you know a lot. Our conditions seem to be similar (except you must not have ADD in the mix). Our metabolic dispositions with regard to medication also seem much alike. I'm going away for about a week in a couple days, but if you ever feel like rewriting your reply, I'd be eager to hear what you have to say.
Meantime, I wish you a good dose of added contentment. My instincts tell me you are quite deserving.
Holy ****, I just almost lost this one!
Posted by jedi on March 27, 2009, at 4:00:46
In reply to Re: Shy Guy Intro + Site Help » jedi, posted by Elimino Pete on March 22, 2009, at 12:50:30
Hey Pete,
Feel free to Babblemail me anytime. Sounds like our situations are similar.
Jedi
> Hey Jedi--
>
> I'm sorry the cybergods were so unkind to you. I know that frustration well.
>
> Just came across this post of yours:
>
> http://www.dr-bob.org/babble/20060610/msgs/656820.html
>
> Although older, I found your comments intriguing. You are obviously well studied in psychopharm, and in combination with your subjective experiences, you know a lot. Our conditions seem to be similar (except you must not have ADD in the mix). Our metabolic dispositions with regard to medication also seem much alike. I'm going away for about a week in a couple days, but if you ever feel like rewriting your reply, I'd be eager to hear what you have to say.
>
> Meantime, I wish you a good dose of added contentment. My instincts tell me you are quite deserving.
>
> Holy ****, I just almost lost this one!
This is the end of the thread.
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