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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by gilmourr on September 21, 2012, at 18:24:01
Here's a timeline of the events.
Was on Nardil 60 mg for 3-3.5 weeks, developed bad mood swings.
Stopped 60 mg on September 9th, went back to 45 mg. My mood swings have still been occuring until today.
Severe anxiety began on the 13th and lasted until the 18th
Started Biaxin (antibiotic) on the 15th until the 19th (5 days in total). This inhibited CYP 3A4 which most likely caused Nardil to become more concentrated in my body from the 15th - 19th (my body probably treated it like 60 mg)
My severe anxiety stopped on the 19th, no klonopin needed currently.
** Now my theory is that the 60 mg takes about 4 days to get out of my system. But then I started Biaxin which probably turned the new 45 mg level into 60 mg because Biaxin inhibits CYP3A4.
** One question is, if biaxin inhibits 3A4 and it concentrates to 60 mg, would the MAO regeneration period restart when I took the biaxin? And would MAO regeneration only start on the 19th because that's when I stopped it?
OPTION 1: I stay on 45 mg, nothing is inhibiting the Nardil now (I just take seroquel at night) and I hope that my mood picks up as the MAO regenerates.OPTION 2: I use 30 mg for a few days to pick up the speed of MAO regeneration and then go back on 45 mg in like 5 days.
** Basically I'm throwing a big jam on the 28th and I don't want to have a severe mood swing, so I'm trying to get the mood swings down to a level I can handle by the 28th. If not, I'll just drink my depression away for that night I guess. :/What would you do, option 1 or 2? And do you think I can just take klonopin if I feel depressed? Sometimes it gives me a high
EDIT: I took 30 mg in the day, I felt pretty level, then I took 15 mg more and now I'm having a mood swing. Though yesterday I took 45 mg altogether in the morning and didn't have a swing until 2 AM so I'm not sure if it matters what time I take the last 15..
Posted by phillipa on September 21, 2012, at 19:22:18
In reply to MAOI + Inhibition + Antibiotic + HELP :(, posted by gilmourr on September 21, 2012, at 18:24:01
I don't feel it would be wise to get drunk. Can one drink on Maois? Phillipa
Posted by enndub on September 21, 2012, at 21:42:59
In reply to Re: MAOI + Inhibition + Antibiotic + HELP :( » gilmourr, posted by phillipa on September 21, 2012, at 19:22:18
> I don't feel it would be wise to get drunk. Can one drink on Maois? Phillipa
Red wine and tap beer can cause a hypertensive crisis due to tyramine content, but otherwise it is physically safe.
That being said, I noticed that alcohol consumption significantly worsened my mood and anxiety for a week or so and increased my side effects of tremor and orthostatic hypotension, so I had to cut alcohol completely out of my life, even in social situations. A small price to pay for relief from depression and anxiety.
Posted by phillipa on September 21, 2012, at 23:32:06
In reply to Re: MAOI + Inhibition + Antibiotic + HELP :(, posted by enndub on September 21, 2012, at 21:42:59
No getting drunk then. Phillipa
Posted by gilmourr on September 22, 2012, at 6:41:20
In reply to Re: MAOI + Inhibition + Antibiotic + HELP :(, posted by enndub on September 21, 2012, at 21:42:59
Yeah, that doesn't happen to me when I'm on Nardil 45 mg. I can eat/drink whatever I want and there is no new depression or anxiety or side effects.
It's just cause I went up to 60 mg that I began to get mood swings.
Posted by SLS on September 22, 2012, at 8:40:26
In reply to MAOI + Inhibition + Antibiotic + HELP :(, posted by gilmourr on September 21, 2012, at 18:24:01
> This inhibited CYP 3A4 which most likely caused Nardil to become more concentrated in my body...
Where did you find the information regarding Nardil (phenelzine) and CYP3A4? I was under the impression that Nardil inhibited CYP3A4, but that it was not metabolized by it.
* Important: Nardil is metabolized primarily by monoamine oxidase. It actually inhibits its own metabolism. The higher the dosage of Nardil you take, the more rapidly it accumulates. In other words, going from 30 mg to 60 mg does not increase the amount of Nardil in the body by a factor of 2 only. The factor increases exponentially. Levels continue to increase for several weeks, even though one takes the same dosage. Some doctors believe that the dosage necessary to establish therapeutic MAO inhibition by Nardil is higher than the dosage necessary to maintain it. So, one might need to take 60 mg in order to initiate an antidepressant response, but only 45 mg to maintain it. Personally, I don't subscribe to this idea. Perhaps it happens in a minority of people. There always seems to be exceptions when it comes to psychopharmacology.
It has been my observation that most people with MDD need a minimum dosage of 60 mg/day of Nardil in order to respond optimally to it.
- Scott
Posted by gilmourr on September 22, 2012, at 16:13:33
In reply to Re: MAOI + Inhibition + Antibiotic + HELP :( » gilmourr, posted by SLS on September 22, 2012, at 8:40:26
I only need 45 mg for it to work. But I've been on 45 mg for 14 days (though I was on Biaxin for 5 days) after coming from 60 mg.
My anxiety is still an issue and my mood still isn't great. I actually have sometimes huge mood swings. It took 30 days last time for 45 mg to work great on my mood and anxiety, but why would it take THAT long this time? Wouldn't it speed up since I was on 60 mg already, just going down a bit..
If I was on Nardil 60 mg for 1 week or 3 weeks, would it make a difference in how long my MAO would regenerate to the 45 mg level? Or would it take 1-3 weeks in both cases?
I just have some stuff I gotta do on the 28th of september (which will be the 20th day on 45 mg). Will I most likely be good enough by then?
This is the end of the thread.
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