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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by ChicagoKat on October 23, 2012, at 19:37:29
It's been 3wks and Nardil is not kicking in. In fact, my mood has plummeted with each passing day. I'm back in the abyss. And I know, I know, you will all tell me to give it more time. Which I will. But I can say that this experience is SO different from the one I had the first time I was put on Nardil...it only took 1 1/2 - 2wks to start really working (ie, not the blip), and I certainly never had this major deterioration in my mood. My gut is telling me Nardil is not going to work this time. And, of course, the Ritalin I've been on to help keep my mood up while waiting for Nardil to work has pooped out. Doesn't take long for me to develop tolerance, that's for sure.
Anyways, in case my pdoc wants to try Parnate instead, I was wondering if it's necessary to have a washout between two MAOIs. Seems to me you wouldn't need it, but I seem to remember reading somewhere that it was necessary. Just getting ready for future options.
Posted by gilmourr on October 23, 2012, at 20:19:20
In reply to Nardil pooped out? Switch to Parnate?, posted by ChicagoKat on October 23, 2012, at 19:37:29
Can you write out a brief timeline of your Nardil usage? Like..
15 mg - 2 weeks
30 mg - 1 week
45 mg - 6 weeksI've noticed that it takes 30 days for me for Nardil to even out and start working. I get an initial jump 5 days after I start it and then it goes stagnant or gets a little worse, then after 30 days it just starts really working. But it has to be on the RIGHT dose and it has to be 30 days on the SAME dose. You can't fiddle with it and you need to know what worked in the past the best.
Posted by phidippus on October 23, 2012, at 22:13:08
In reply to Nardil pooped out? Switch to Parnate?, posted by ChicagoKat on October 23, 2012, at 19:37:29
>It's been 3wks and Nardil is not kicking in.
You should have experienced some improvement in your symptoms by now. Nardil may simply not be the best choice for you.
>my mood has plummeted with each passing day.
This is concerning. Are you safe?
>it only took 1 1/2 - 2wks to start really working
My concern is that you may have cyclothymia. You have described a sort of cycling in your mood, kind of swinging between depresssed and more depressed. I wonder if you've made this observation of yourself. I wonder how a little bit of mood stabilizer and antidepressant would affect you.
>Ritalin I've been on to help keep my mood up while waiting for Nardil to work has pooped out.
I doubt it has pooped out. I just think it can't keep up with your depression.
>I certainly never had this major deterioration in my mood.
How are life stressors? Do you find yourself worrying a lot?
>I was wondering if it's necessary to have a washout between two MAOIs.
Yes. I'm too tired to explain why, LOL
Eric
Posted by Phillipa on October 23, 2012, at 22:45:33
In reply to Re: Nardil pooped out? Switch to Parnate? » ChicagoKat, posted by phidippus on October 23, 2012, at 22:13:08
Is it two weeks? Washout? What are you able to do throughout the day? Drive, Shop, Visit people? Or just stay in bed? And then experience a lift and be able to do things? Phillipa
Posted by ChicagoKat on October 24, 2012, at 11:23:44
In reply to Re: Nardil pooped out? Switch to Parnate? » ChicagoKat, posted by phidippus on October 23, 2012, at 22:13:08
Hi Eric,
I'm safe. Not quite ready to give up yet. I think I might have been told before that I have cyclothymia...and do I worry a lot? Hell YES...i've always been an incredible worrier.
I have tried mood stabilizers in the past, Lamicta and Lithium, but they had no effect on my mood whatsoever.
I was afraid a washout is required. Cos I think that's what my pdoc might suggest when we meet next in 2 weeks.
Maybe if you find yourself less tired sometime you could explain the need for a washout to me. It doesn't make a lot of sense to me.
Thanks for your reply, and I hope you are feeling even a little better,
Kat
Posted by ChicagoKat on October 24, 2012, at 11:29:07
In reply to Re: Nardil pooped out? Switch to Parnate?, posted by gilmourr on October 23, 2012, at 20:19:20
Hi Gilmourr,
I started at 15mg/day, then increased to 30mg/day after 3 days, then went to 45mg/day 3 days after that, then went to 60mg/day about a week after that.
I did experience the brightening in my mood a few days after I started, but ever since my mood has gotten increasingly worse, which it never did the first time I was on Nardil...and the first time the true benefits had kicked in by this point.
I'll admit I was titrated up MUCH faster the first time, up by a tablet a day until after 4days I was at 60mg/day. Hadn't thought about that til now; maybe that's why it's taking longer?
Posted by gilmourr on October 24, 2012, at 14:05:01
In reply to Re: Nardil pooped out? Switch to Parnate? » gilmourr, posted by ChicagoKat on October 24, 2012, at 11:29:07
> Hi Gilmourr,
>
> I started at 15mg/day, then increased to 30mg/day after 3 days, then went to 45mg/day 3 days after that, then went to 60mg/day about a week after that.
>
> I did experience the brightening in my mood a few days after I started, but ever since my mood has gotten increasingly worse, which it never did the first time I was on Nardil...and the first time the true benefits had kicked in by this point.
> I'll admit I was titrated up MUCH faster the first time, up by a tablet a day until after 4days I was at 60mg/day. Hadn't thought about that til now; maybe that's why it's taking longer?I don't see why you're titrating to 60 mg so fast. 45 mg is a good dose to test out. You should've got up to 45 and stayed there for 4-6 weeks. If you felt a bit better then go up to 60 and do 4-6 weeks.
MAOI's are the most important drugs not to jump shark early.
You've been on..
15 mg - 3 days
30 mg - 3 days
45 mg - 1 week
60 mg - unknown.This is not enough to jump off Nardil. Pick 45 mg or 60 mg and stay there for 4-6 weeks.
Posted by phidippus on October 25, 2012, at 16:49:06
In reply to Re: Nardil pooped out? Switch to Parnate? » phidippus, posted by ChicagoKat on October 24, 2012, at 11:23:44
>I think I might have been told before that I have cyclothymia
Then the medication strategy would be different-basically a mood stabilizer along with an antidepressant.
>I have tried mood stabilizers in the past, Lamicta and Lithium, but they had no effect on my mood whatsoever.
If you didn't notice them having an effect on you, they may have been working perfectly.
Anyway, adding Lithium to an antidepressant recognized as an excellent augmentation strategy.
>I was afraid a washout is required.
Actually, a washout is not always recommended between two MAOIs.
>you could explain the need for a washout to me
Washout gaurantees that a medication change, especially between two antidepressants does not cause seratonin syndrome, a hypertensive crisis or enzymatic deactivation.
I wish you were feeling better! How long have you been on the Nardil now?
>do I worry a lot? Hell YES
Ruminating is one of the hardest things to treat.
Eric
Posted by schleprock on October 25, 2012, at 18:26:37
In reply to Re: Nardil pooped out? Switch to Parnate? » ChicagoKat, posted by phidippus on October 25, 2012, at 16:49:06
Why is adding Lithium to an antidepressant considered an excellent augmentation strategy?
Posted by ChicagoKat on October 25, 2012, at 19:19:44
In reply to Re: Nardil pooped out? Switch to Parnate? » ChicagoKat, posted by phidippus on October 25, 2012, at 16:49:06
If ruminating is one of the hardest things to treat no wonder I'm having such a hard time with it.
I've now been on Nardil 3 1/2 weeks, and I am feeling as low as I did before I started it.
Oh, I looked up cyclothymia, and the definition definitely does not describe me. I don't get hypomania (sure wish I did though!)
I think I am probably looking at a life of fighting with Ritalin (tolerance builds up in me really quickly) for a few relatively depression-free moments every now and then. Sigh.
Posted by phidippus on October 25, 2012, at 20:55:04
In reply to Re: Nardil pooped out? Switch to Parnate? » phidippus, posted by ChicagoKat on October 25, 2012, at 19:19:44
>If ruminating is one of the hardest things to treat no wonder I'm having such a hard time with it.
Does any of your ruminating have an obsessive quality to it? Thinking of the same things over and over?
I definitely do my fair share of ruminating. I find its best dealt with psychologically-I use a lot of my CBT, DBT and ACT to deal with it.
>I've now been on Nardil 3 1/2 weeks, and I am feeling as low as I did before I started it.
How are life stressors?
I think you need to stop the Nardil and move onto Parnate.
>I think I am probably looking at a life of fighting with RitalinI think I am probably looking at a life of fighting with Ritalin
Never give up.
Eric
Posted by phidippus on October 25, 2012, at 21:05:48
In reply to Re: Nardil pooped out? Switch to Parnate? » phidippus, posted by schleprock on October 25, 2012, at 18:26:37
Specifically, there is a growing body of evidence that suggests that lithium increases the effect of antidepressants by acting at the presynaptic serotoninergic receptor to up-regulate 5-HT (serotonin) release. The effect may also be linked to a decrease in the sensitivity of presynaptic 5-HT receptors, which results in an increase in the amount of serotonin absorbed at the post-synaptic level.
More serotonin!
Eric
Posted by schleprock on October 25, 2012, at 21:33:18
In reply to Re: Nardil pooped out? Switch to Parnate? » schleprock, posted by phidippus on October 25, 2012, at 21:05:48
> Specifically, there is a growing body of evidence that suggests that lithium increases the effect of antidepressants by acting at the presynaptic serotoninergic receptor to up-regulate 5-HT (serotonin) release. The effect may also be linked to a decrease in the sensitivity of presynaptic 5-HT receptors, which results in an increase in the amount of serotonin absorbed at the post-synaptic level.
>
> More serotonin!
>
> EricWould'nt this establish Lithium as a potential risk for serotonin syndrome when used with an AD (with the AD still being taken at the typical dosage)? If not, then what is it about lithium that would make it different to other SA raising agents that carry this risk.
Posted by Phillipa on October 25, 2012, at 21:35:04
In reply to Re: Nardil pooped out? Switch to Parnate? » phidippus, posted by schleprock on October 25, 2012, at 21:33:18
That's a good question. Phillipa
Posted by phidippus on October 25, 2012, at 21:50:32
In reply to Re: Nardil pooped out? Switch to Parnate? » phidippus, posted by schleprock on October 25, 2012, at 21:33:18
>Would'nt this establish Lithium as a potential risk for serotonin syndrome when used with an AD
You are absolutely right. The ceiling for reaching SS is rather high, however, so with Lithium augmentation you have a lot of wiggle room because it doesn't upregulate serotonin like a normal AD would.
I take Lithium (1200 mg) with Viibryd (60 mg) and Vyvanse (70 mg)and only run into problems if I add another serotogenic medication.
Eric
Posted by schleprock on October 25, 2012, at 22:36:33
In reply to Re: Nardil pooped out? Switch to Parnate?, posted by phidippus on October 25, 2012, at 21:50:32
Actually, Dr. Stahl says to avoid TCAs and MAOIs when considering Lithium augmentation, maybe not such a great idea. Personally, I'd avoid Lithium at all costs. I'm with Lou when it comes to Lithium.
Posted by phidippus on October 26, 2012, at 16:59:14
In reply to Re: Nardil pooped out? Switch to Parnate?, posted by schleprock on October 25, 2012, at 22:36:33
I was on Clomipramine while on Lithium. No problem.
Eric
Posted by phidippus on October 26, 2012, at 16:59:54
In reply to Re: Nardil pooped out? Switch to Parnate?, posted by schleprock on October 25, 2012, at 22:36:33
Oh and Scott is on Parnate and Lithium.
Eric
Posted by fox87stars on October 27, 2012, at 15:01:24
In reply to Nardil pooped out? Switch to Parnate?, posted by ChicagoKat on October 23, 2012, at 19:37:29
I've been on Parnate since 2008. I had been on a host of meds before Parnate and none of them really tackled my depression. I gave Parnate a chance and it changed my life. I can't imagine life without it. Parnate is a bit stimulating, but I can imagine if you are depressed that may help. Anyway, I'm a big advocate for Parnate. I hope you are able to find a med that helps.
Posted by ChicagoKat on October 27, 2012, at 16:42:24
In reply to Re: Nardil pooped out? Switch to Parnate?, posted by fox87stars on October 27, 2012, at 15:01:24
> I've been on Parnate since 2008. I had been on a host of meds before Parnate and none of them really tackled my depression. I gave Parnate a chance and it changed my life. I can't imagine life without it. Parnate is a bit stimulating, but I can imagine if you are depressed that may help. Anyway, I'm a big advocate for Parnate. I hope you are able to find a med that helps.
Thanks for your input. I see my pdoc in a week and a half and I think he might want to try a different MAOI on me. So we'll see what he says...but I'll keep your thoughts in mind.
Take care,
Kat
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