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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by ger man on October 13, 2011, at 3:46:50
I take nardil for 2 weeks now,yesterday i increased my dose as the initial side effects went away quickly. My depressive and also psychic symptoms of anxiety already improved to some degree and i hope it will become more and more effctive as treatment continues. In regards to my physical symptoms of anxiety there is only little improvement yet. These symptoms mainly include nervous tension and heart palpitations plus a feeling of tightness in my chest. How is nardil combating those symptoms or is it doing anything against those symptoms at all as it is more an antidepressant than a tranquillizer as benzos are?
Posted by Chairman_MAO on October 13, 2011, at 7:11:07
In reply to nardil physical symptoms, posted by ger man on October 13, 2011, at 3:46:50
I'd wait 4-6 weeks after you reach a given dose to assess how it's doing. It didn't have the magical effect on anxiety that it did for me definitely until at least 4 weeks into treatment. Best of luck.
Posted by ger man on October 13, 2011, at 9:36:35
In reply to Re: nardil physical symptoms » ger man, posted by Chairman_MAO on October 13, 2011, at 7:11:07
> I'd wait 4-6 weeks after you reach a given dose to assess how it's doing. It didn't have the magical effect on anxiety that it did for me definitely until at least 4 weeks into treatment. Best of luck.
When the anti-anxiety effect kicked in,was it also effective against the physical symptoms like inner tension and restlessness?i increased the dose to 45mg a day,i think this is at least what it needs to be effective and as i told the side effects are minimal.
Posted by Chairman_MAO on October 13, 2011, at 11:43:44
In reply to Re: nardil physical symptoms, posted by ger man on October 13, 2011, at 9:36:35
I didn't even start at 45mg. My doctor started me immediately at 60mg. That was a modest improvement, so then we did 75mg for a month; during that month it really started to kick in. Raised to 90 not long after that, where I stayed for a long time until eventually going up to 120. I was at 120 until a few months before I went off of it, when I went back to 90.
NOTE: When I was at 120mg/day, I was also taking 60mg/day of dextroamphetamine. I think there was a synergistic effect at that high dose.
Everyone is different. You can draw blood and monitor platelet MAO-B. I brought that up with my pdoc last night, and he told me that with MAOIs, you dose based upon clinical response and that there isn't much utility in even bothering to draw blood for that because it doesn't tell you much. That is, the test isn't going to tell you much that simply raising the dose more won't tell you, and you can keep raising the dose with those unless you encounter untoward side effects.
I know that's more than you asked, but the gist of it is that yeah, it was somewhat effective (at 60mg), but 60mg was nothing like one or two tablets more.
Posted by ger man on October 13, 2011, at 12:45:50
In reply to Re: nardil physical symptoms » ger man, posted by Chairman_MAO on October 13, 2011, at 11:43:44
> I didn't even start at 45mg. My doctor started me immediately at 60mg. That was a modest improvement, so then we did 75mg for a month; during that month it really started to kick in. Raised to 90 not long after that, where I stayed for a long time until eventually going up to 120. I was at 120 until a few months before I went off of it, when I went back to 90.
>
> NOTE: When I was at 120mg/day, I was also taking 60mg/day of dextroamphetamine. I think there was a synergistic effect at that high dose.
>
> Everyone is different. You can draw blood and monitor platelet MAO-B. I brought that up with my pdoc last night, and he told me that with MAOIs, you dose based upon clinical response and that there isn't much utility in even bothering to draw blood for that because it doesn't tell you much. That is, the test isn't going to tell you much that simply raising the dose more won't tell you, and you can keep raising the dose with those unless you encounter untoward side effects.
>
> I know that's more than you asked, but the gist of it is that yeah, it was somewhat effective (at 60mg), but 60mg was nothing like one or two tablets more.My pdoc decided to titrate it up slowly as im very med sensitive. How long did you take the nardil?? was it effective long term in you?
Posted by Chairman_MAO on October 13, 2011, at 13:03:41
In reply to Re: nardil physical symptoms, posted by ger man on October 13, 2011, at 12:45:50
It was definitely effective for social phobia and anxiety in the long-term for me. The initial "magic" had worn off (as hypomania tends to do), but it was more effective for my anxiety/phobia issues than 4mg/day of clonazepam alone (which I am on now) is. To date, nothing has worked like the MAOIs do. I am hoping that Marplan will be similar enough minus the weight gain, but I suspect that I might have to get the dose a lot higher than 40mg/day to achieve that.
Keep in mind that I am dysthymic, have ADD/ADHD (diagnosed inattentive ADD in childhood but who really knows, and the labels don't really matter), and have social phobia/agoraphobia as well as generalized anxiety. One could also say that I've suffered episodes of atypical depression, but I have never been formally diagnosed as such.
This is why I use the MAOI + psychostimulant combination: literally nothing else gets me close to feeling well and functional.
Posted by jedi on October 14, 2011, at 1:02:58
In reply to Re: nardil physical symptoms, posted by ger man on October 13, 2011, at 12:45:50
Hi ger man,
I have been on Nardil for over a decade. The MAOIs can and do work for an extended period for many people. I am diagnosed treatment resistant, double(dysthymia also), atypical depression, with social anxiety. Nardil + clonazepam is the only combination that has worked for all of my symptoms. This is out of 45+ different combinations of antidepressants and augmenters.Nardil is the "BOMB" for atypical depression and social anxiety. As the Chairman alluded to, don't mistake the initial hypomania as the antidepressant effect of the medication. Many people will have this, I did. But don't chase the dragon! It is very intoxicating after being depressed for so long.
In my very non-expert opinion, Nardil should be 2nd tier and not last resort for atypical depression with social anxiety. It will often work when 10s of other medications have failed.
I am in the end phases of a 4 month taper off Nardil. I took 90mg for years. I have taken 60mg for the past few years. I'm a large man, about 240 lbs. 60mg is the dose that I have to be at to get the level of MAO inhibition I need for serious depression.
I am currently on 15mg Nardil and .25mg of clonazepam. I've tried stopping Nardil at least 5 times in the past. This has always lead to a return of depressive symptoms within a few months. This is the slowest taper I have ever done, and so far I am happy with the results.
On a side bar. I still have a prescription for 90mg of Nardil. I fill it every month. I will never quit an MAOI without an emergency stash of several months. In the past, I have had P-Docs retire or leave town, leaving me with no source of the medication. I saw one P-Doc for 9 months when I was off Nardil. He would have let me die before putting me back on the only medication that had ever worked for me. There is a huge amount of misinformation about the MAOIs in the medical community. You have to take your own study to another level to use these drugs. I've known at least 10 people on this board that have more knowledge of the MAOIs than any MD I have ever seen. I am not joking.
This medication can and does work long term for many people. It absolutely blows away any other meds for severe atypical depression with social anxiety. Your mileage may vary, but Nardil + clonazepam worked synergistically for me. I would not be here to write this without phenelzine!
Good Luck and be Well,
JediPS Sorry everyone. I haven't been on the board very much during this long taper. It just seems better for me to concentrate on things other than the disease during this time. I probably won't be on much for a while. But feel free to babble-mail me anytime, if you want to pick my limited brain!
> > I know that's more than you asked, but the gist of it is that yeah, it was somewhat effective (at 60mg), but 60mg was nothing like one or two tablets more.
>
> My pdoc decided to titrate it up slowly as im very med sensitive. How long did you take the nardil?? was it effective long term in you?
Posted by ger man on October 14, 2011, at 2:57:51
In reply to Re: nardil physical symptoms » ger man, posted by jedi on October 14, 2011, at 1:02:58
> I am in the end phases of a 4 month taper off Nardil. I took 90mg for years. I have taken 60mg for the past few years. I'm a large man, about 240 lbs. 60mg is the dose that I have to be at to get the level of MAO inhibition I need for serious depression.
>
> I am currently on 15mg Nardil and .25mg of clonazepam. I've tried stopping Nardil at least 5 times in the past. This has always lead to a return of depressive symptoms within a few months. This is the slowest taper I have ever done, and so far I am happy with the results.> This medication can and does work long term for many people. It absolutely blows away any other meds for severe atypical depression with social anxiety. Your mileage may vary, but Nardil + clonazepam worked synergistically for me. I would not be here to write this without
Why do you stop it if it works so well? I never would risk a relapse after being in good condition for years. For me i think there wont be a life without meds anymore. Maybe in my older days in the far future,but for the next decades i think i have to find a combo or a med that works.
Posted by ger man on October 14, 2011, at 3:08:57
In reply to Re: nardil physical symptoms, posted by ger man on October 14, 2011, at 2:57:51
I just wanted to add that i didnt experience the instant lifting effect on nardil that many of you mentioned here, it was more an initial brain fog with other slight physical dlside effects. After two weeks on 30 mgs i started to feel marginal relief from depressive an anxiety symptoms. My main symptoms are bad physical and psychic general anxiety mixed with panic attacks and social anxiety. My depression comes with the other symptoms but i suppose it wouldnt be that intense without the other symptoms. My pdoc said once that i suffer from kind of neurotic depression and that my personality is kind of neurotic.
Posted by jedi on October 14, 2011, at 10:27:48
In reply to Re: nardil physical symptoms, posted by ger man on October 14, 2011, at 3:08:57
For me, the hypomania didn't start until after the Nardil started to kick in. This usually takes several weeks after an effective dosage is reached. This stuff takes time, but is worth it. Your neurotic depression is an ideal match for this medication. It will probably work for you. I haven't read your other posts, but clonazepam can work well with Nardil. Both affect GABA and really help the anxiety. I was on at least 5mg daily while waiting for the Nardil to kick in. It got me through the really tough days. Long term benzo use will severely affect memory. I took 2mg for years and CRS(can't remember sh*t).If not for the side effects of medications I would never try to stop. I've said several times on this board that I am a lifer on Nardil, and I may be. But I have to put myself to the test. When I think about my life before major depression and all the medications, there is no comparison. The main Nardil side effects for me are the CARB cravings and associated weight gain. Delayed ejaculation, which becomes more of a problem as we age. Insomnia, which almost always have to be treated. And a lack of motivation, which which I attribute mostly to a learned response from years of fighting depression.
The initial side effects, that go away after time, are the hypomania, daytime tiredness and postural hypotension. At least they did for me.
Remember, Nardil is the "BOMB" for your type of depression with anxiety!
Good Luck,
Jedi
Posted by ger man on October 14, 2011, at 10:58:49
In reply to Re: nardil physical symptoms » ger man, posted by jedi on October 14, 2011, at 10:27:48
>
> For me, the hypomania didn't start until after the Nardil started to kick in. This usually takes several weeks after an effective dosage is reached. This stuff takes time, but is worth it. Your neurotic depression is an ideal match for this medication. It will probably work for you. I haven't read your other posts, but clonazepam can work well with Nardil. Both affect GABA and really help the anxiety. I was on at least 5mg daily while waiting for the Nardil to kick in. It got me through the really tough days. Long term benzo use will severely affect memory. I took 2mg for years and CRS(can't remember sh*t).
>
> If not for the side effects of medications I would never try to stop. I've said several times on this board that I am a lifer on Nardil, and I may be. But I have to put myself to the test. When I think about my life before major depression and all the medications, there is no comparison. The main Nardil side effects for me are the CARB cravings and associated weight gain. Delayed ejaculation, which becomes more of a problem as we age. Insomnia, which almost always have to be treated. And a lack of motivation, which which I attribute mostly to a learned response from years of fighting depression.
>
> The initial side effects, that go away after time, are the hypomania, daytime tiredness and postural hypotension. At least they did for me.
>
> Remember, Nardil is the "BOMB" for your type of depression with anxiety!
>
> Good Luck,
> Jedi
>5 mg of clonazepam is pretty much in my sensation. Without any additional medication it takes 1-1.5 mgs of lorazepam for me to feel reflief. I dont know how side effects will develop, but to date they seem to be harmless. Before i took the Nardil i took the combination of 20 mg Lexapro with 150 mgs of Trazodone for sleep. I had bad sexual side effects from the SSRI and overwhelming carb craving from the Trazodone. By the way the Lexapro was almost ineffective as all the other SSRIs and SNRIs have been! Until now i dont have one of the side effects i had on the old combo and my sleep is still/again in balance. Without any medication i had to take a shot of Lorazepam or at least Trazodone to promote sleep. I know side effects (mainly long term) tend to manifest with proceeding tretment, so i will have to wait how it evolves.
Posted by Chairman_MAO on October 14, 2011, at 21:57:05
In reply to Re: nardil physical symptoms » ger man, posted by jedi on October 14, 2011, at 1:02:58
FWIW, I quite 90mg/day phenelzine "cold turkey" after being on MAOIs for 5 years. When I wasn't eating, I slept for a few days (maybe even a week, it was quite a blur) straight. The rebound REM (dreaming) was unlike anything I'd ever experienced. Then, it started to improve. Within two weeks, I was OK, and I think I was back to baseline in about a month, perhaps up to a week less. Hard to say, because my memory of that time was so hazy.
All in all, given how effective the medication is, the withdrawal syndrome was a walk in the park compared to SSRI withdrawal.
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