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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 44. Go back in thread:
Posted by SLS on December 21, 2015, at 7:21:26
In reply to Re: Nardil washout and then restart, posted by john locke on December 20, 2015, at 20:56:55
> > My GUESS is that being on Nardil for only two weeks would not set you up for what is called "drug-induced drug-refractoriness" (not responding a second time to the same drug).
>
> Say I wanted to see if I could treat my depression without medication after being on Nardil for a while. Could I just drop the dose of Nardil down to,say, 15mg a day so that it has no therapeutic effect but still stays in my system?Do you think this would guard against the "drug-induced drug-refractoriness"?That's an excellent thought. However, I wouldn't go into Nardil treatment with that plan in mind. If Nardil does work, you would be taking a chance of losing the full therapeutic effect by reducing the dosage so low for an extended period of time. What you are proposing is untested, and I don't think it is worth the gamble.
I think you should first consider the course of your illness in your decision making process. How often do you get depressed? Have you been moderately-severely depressed more than three times in your lifetime? How long has your most recent episode lasted for? If your depression is recurrent or chronic, I would consider indefinite treatment. Social anxiety is a somewhat different story. It may be possible to reduce its severity using psychotherapeutic tools. Even if there is no "reason" for your social anxiety, CBT or DBT can be helpful. It is hard to predict how successful such therapies would be, but it wouldn't hurt to try. Anxiety and depression can reinforce each other. It is possible that reducing one will improve the other.
> > What are your concerns with taking Nardil?
> Mainly poop out and sexual dysfunction
Which drugs are you considering that do not have the potential to exhibit these things?
I don't think Nardil poop-out would affect the potential for other drugs to work. In other words, I doubt there is the same sort of cross-tolerance as might be seen between SSRIs. Therefore, poop-out should not be a concern. Many people, including myself, have lost the ability to achieve orgasm when starting Nardil treatment, only to see it resolve after a few months. It might take longer to orgasm, but pleasurable sensations are not reduced. Just keep trying.
> > What drugs have you already tried?
> lexapro and zoloft. I didn't really give either an honest go because I really just wanted the NArdil scriptMy impression is that you feel that you should try other drugs first. This is logical, especially since you have not given a single antidepressant or anxiolytic a chance to work. I would consider trying Effexor first. In my estimation, it is more effective than the SSRIs for treating depression, and more effective than most for treating anxiety disorders. Effexor is also less likely to poop-out and produce sexual side effects from what I can see. It can be more difficult to discontinue than most of the SSRIs (which can also be difficult), but if it does work, you won't have to worry about this. I have discontinued Effexor 300 mg/day three times using a flexible taper. I didn't suffer. Everyone is different in so many ways when it comes to neurobiology. My taper method might not work for anyone else but me for all I know.
What do you think?
You will still have to wait two weeks from your last dose of Nardil before you can start a serotonin reuptake inhibitor, including Effexor. Nardil stays in the system longer than Parnate, so I would wait the full 14 days. You should be able to taper the dosage and discontinue Nardil within a week. Perhaps you can reduce the dosage by 15 mg every two or three days.
- Scott
Posted by Escapee on December 21, 2015, at 7:59:47
In reply to Re: Nardil washout and then restart, posted by john locke on December 20, 2015, at 2:16:42
> Social anxiety and atypical depression. I'm worried that the Nardil will be working well (or doing something at least), but, due to side effects, I'll want to wash out and try something else, whether it be medication or not. Then it might not work if I try to get back on it. For this reason I'm thinking that maybe I should try all possible things before trying Nardil.
>
> I started Nardil 2 weeks ago and am up to 60 mg.2 weeks is far too short a time. After 3 weeks i went to 60. But you will get side effects but they will pass on thier own with time. When it kicks in (at least for me) theres no mistaking it! I had wild side effect yet i wasnt gonna drop nardil for anything!
I remember walking Warwick Castle but my hypotention got so bad it could barely see anything, just a bright haze and could barely see where i was going! The most major side effect was being unable to urinate. Had to wear a catheter for a month. All i could think of is "i aint giving this good feeling for nothing"!
Side effects usually come on slowly, often AFTER the med takes effect. Tho there can be a mild calming effect in the 1st couple weeks.
Also, review everything u eat or other meds u take to avoid interactions. Never play with the dose. And watch ur caffein intake. When it kicked in for me i was caffein free. Didnt need it 😊
Posted by John locke on December 21, 2015, at 8:57:40
In reply to Re: Nardil washout and then restart, posted by Escapee on December 21, 2015, at 7:59:47
> > Social anxiety and atypical depression. I'm worried that the Nardil will be working well (or doing something at least), but, due to side effects, I'll want to wash out and try something else, whether it be medication or not. Then it might not work if I try to get back on it. For this reason I'm thinking that maybe I should try all possible things before trying Nardil.
> >
> > I started Nardil 2 weeks ago and am up to 60 mg.
>
> 2 weeks is far too short a time. After 3 weeks i went to 60. But you will get side effects but they will pass on thier own with time. When it kicks in (at least for me) theres no mistaking it! I had wild side effect yet i wasnt gonna drop nardil for anything!
> I remember walking Warwick Castle but my hypotention got so bad it could barely see anything, just a bright haze and could barely see where i was going! The most major side effect was being unable to urinate. Had to wear a catheter for a month. All i could think of is "i aint giving this good feeling for nothing"!
> Side effects usually come on slowly, often AFTER the med takes effect. Tho there can be a mild calming effect in the 1st couple weeks.
> Also, review everything u eat or other meds u take to avoid interactions. Never play with the dose. And watch ur caffein intake. When it kicked in for me i was caffein free. Didnt need it 😊
>
>
Glad to hear it's working so well for you!This may have been said--what are you taking it for, and for how long?
Posted by SLS on December 21, 2015, at 10:05:07
In reply to Re: Nardil washout and then restart, posted by Escapee on December 21, 2015, at 7:59:47
> Had to wear a catheter for a month.
Did they try bethanechol (Urecholine) first?
> All i could think of is "i aint giving this good feeling for nothing"!
Yup.
- Scott
Posted by John locke on December 21, 2015, at 10:40:58
In reply to Re: Nardil washout and then restart » john locke, posted by SLS on December 21, 2015, at 7:21:26
I see all my symptoms in my dad, so I'm kind of convinced it's biological. He either doesn't know it or won't admit it, but he definitely has social anxiety disorder.
I think I'll definitely see Nardil through as this point. Im wondering, is it incomceivable for a drug like Nardil to work for a lifetime? I understand that poop out is a shot in the dark in that it can happen to anyone, but at the same time, can it work for 40 plus years potentially? I mean, you read a lot about Nardil poop out, but you also have to consider that if the drug loses its effectiveness for someone, that person would be much more likely to come looking for answers on message boards like this one. Makes me wonder what the actual rate of poop out is for Nardil.
I've also read of people successfully countering poop out from Nardil by simply washing out and restarting. Guess everyone's just different.
Posted by Lamdage22 on December 21, 2015, at 12:46:33
In reply to Re: Nardil washout and then restart, posted by John locke on December 21, 2015, at 10:40:58
Potentially yes.
I think the social anxiety aspect of Nardil doesnt tend to poop out. For me only the AD effect pooped out (and gave way to psychosis). The SA aspect didnt poop out.
Scott?
Posted by Lamdage22 on December 21, 2015, at 12:51:30
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 21, 2015, at 12:46:33
Why isnt Phenylethylidenehydrazine (GABA-T inhibitor) marketed as an anxiolytic?
Is it not orally active?
Posted by Lamdage22 on December 21, 2015, at 12:58:34
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 21, 2015, at 12:51:30
I think this may be VERY good for me.
Posted by SLS on December 21, 2015, at 16:21:00
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 21, 2015, at 12:46:33
> Potentially yes.
>
> I think the social anxiety aspect of Nardil doesnt tend to poop out. For me only the AD effect pooped out (and gave way to psychosis). The SA aspect didnt poop out.
>
> Scott?That's interesting. I hadn't heard that, but reports of real-world experiences are important to take seriously. I'll keep what you reported in mind.
- Scott
Posted by SLS on December 21, 2015, at 16:27:52
In reply to Re: Nardil washout and then restart, posted by John locke on December 21, 2015, at 10:40:58
> I've also read of people successfully countering poop out from Nardil by simply washing out and restarting. Guess everyone's just different.
Yes, my previous posts have described this.
In the "old days", when doctors didn't have many tools to work with, they were perhaps more creative at using the few drugs that were available. Some doctors would treat Nardil poop-out by having their patients discontinue the drug and waiting three months before restarting it. One of my doctors actually treated someone by cycling back and forth between Parnate and Nardil.
Good luck.
- Scott
Posted by SLS on December 21, 2015, at 16:34:13
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 21, 2015, at 12:51:30
> Why isnt Phenylethylidenehydrazine (GABA-T inhibitor) marketed as an anxiolytic?
>
> Is it not orally active?Never heard of it. Do you think it would function like Nardil with respect to GABA? Very interesting.
You sure are a motivated learner.
- Scott
Posted by john locke on December 21, 2015, at 16:43:36
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 21, 2015, at 12:46:33
> Potentially yes.
>
> I think the social anxiety aspect of Nardil doesnt tend to poop out. For me only the AD effect pooped out (and gave way to psychosis). The SA aspect didnt poop out.
>
> Scott?Nardil made you irreversibly psychotic, even when you stopped taking the drug?
Posted by john locke on December 22, 2015, at 0:15:57
In reply to Re: Nardil washout and then restart » john locke, posted by SLS on December 21, 2015, at 7:21:26
Even if there is no "reason" for your social anxiety, CBT or DBT can be helpful. It is hard to predict how successful such therapies would be, but it wouldn't hurt to try.
--Meh, I don't really believe in cognitive therapy. I think anxiety is an emotion and solely that. This emotion will very well affect your thoughts, but it doesn't work the other way around. I do read about CBT having success with treating social anxiety, though, so I guess i can only know by trying. I recall one study saying there was barely any difference in the results for patients treated with CBT versus those with simply BT.
--What is DBT?
Anxiety and depression can reinforce each other. It is possible that reducing one will improve the other.
--My first ever therapist was of the belief that depression is always a symptom of chronic anxiety. I completely agree with this. She seemed very confident that this is becoming the accepted truth in psychiatry nowadays.
Posted by Lamdage22 on December 22, 2015, at 1:56:08
In reply to Re: Nardil washout and then restart » Lamdage22, posted by SLS on December 21, 2015, at 16:34:13
> > Why isnt Phenylethylidenehydrazine (GABA-T inhibitor) marketed as an anxiolytic?
> >
> > Is it not orally active?
>
> Never heard of it. Do you think it would function like Nardil with respect to GABA? Very interesting.
>
> You sure are a motivated learner.
>
>
> - ScottYes, Scott. Its a Nardil metabolite and it is responsible for Nardils efficacy for social anxiety.
Posted by Lamdage22 on December 22, 2015, at 1:57:53
In reply to Re: Nardil washout and then restart, posted by john locke on December 21, 2015, at 16:43:36
> > Potentially yes.
> >
> > I think the social anxiety aspect of Nardil doesnt tend to poop out. For me only the AD effect pooped out (and gave way to psychosis). The SA aspect didnt poop out.
> >
> > Scott?
>
> Nardil made you irreversibly psychotic, even when you stopped taking the drug?
>
>
I took it for a long time even when it made me psychotic unfortunately. I was stubborn.
Posted by SLS on December 22, 2015, at 7:08:12
In reply to Re: Nardil washout and then restart, posted by john locke on December 22, 2015, at 0:15:57
> > Anxiety and depression can reinforce each other. It is possible that reducing one will improve the other.
> --My first ever therapist was of the belief that depression is always a symptom of chronic anxiety. I completely agree with this. She seemed very confident that this is becoming the accepted truth in psychiatry nowadays.This is not quite true. First of all, "always" is a big word. Secondly, it is true that many - perhaps most - but not all depressions are due to chronic psychosocial stress (especially early in life), of which anxiety is just one type. Not all psychosocial stress manifests as chronic anxiety. Learned negative thinking without anxiety is one example.
Not all anxiety disorders manifest as chronic anxiety. Not all chronic anxiety represent an anxiety disorder.
Depression is depression. When anxiety is a component or symptom of depression, it tends to resolve when the depression resolves. This is not true when an anxiety disorder is comorbid with depression.
Depression in young people often begins as anxiety and insomnia; the anxiety to later disappear and leave depression only - even without treatment.
Things are not so simple. In this case, I don't think the word "always" is at all helpful.
Sorry for the strong language, John, but I really object to your doctor's characterization. It is, in my opinion, counterproductive. Getting rid of anxiety will not automatically get rid of depression. In the absence of an anxiety disorder, it is more often the other way around.
Anyway, good luck on your continuing Nardil trial. As was mentioned, dizziness and urinary retention can be problematic. If you choose to addresss these things pharmacologically, the dizziness can be dealt with by using either Florinef (fludrocortisone) or Ritalin (methylphenidate). Hopefully, any urinary retention can be remedied by taking Urecholine (bethanechol). I came close to going to the hospital a number of times for a catheter. Bethanechol helped with this enough that I was able to urinate. I was taking a TCA along with the Nardil at the time, which most likely made things worse. I never had a problem with Nardil monotherapy. Even with the combination, urinary retention subsided after a few weeks.
- Scott
Posted by Lamdage22 on December 22, 2015, at 7:42:28
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 22, 2015, at 1:57:53
I dont know how many people have the fate of developing psychosis on Nardil
Posted by SLS on December 22, 2015, at 8:57:23
In reply to Re: Nardil washout and then restart, posted by Lamdage22 on December 22, 2015, at 7:42:28
> I dont know how many people have the fate of developing psychosis on Nardil
I have had psychotic episodes in association with MAOIs: two with Nardil and two with Parnate. I have bipolar depression with rare medication-induced mania. Mine is a form of bipolar I. I haven't had an episode in 13 years. It is possible that Abilify is preventing any further manic reactions from occurring.
- Scott
Posted by John locke on December 22, 2015, at 9:36:52
In reply to Re: Nardil washout and then restart » john locke, posted by SLS on December 22, 2015, at 7:08:12
> > > Anxiety and depression can reinforce each other. It is possible that reducing one will improve the other.
>
> > --My first ever therapist was of the belief that depression is always a symptom of chronic anxiety. I completely agree with this. She seemed very confident that this is becoming the accepted truth in psychiatry nowadays.
>
> This is not quite true. First of all, "always" is a big word. Secondly, it is true that many - perhaps most - but not all depressions are due to chronic psychosocial stress (especially early in life), of which anxiety is just one type. Not all psychosocial stress manifests as chronic anxiety. Learned negative thinking without anxiety is one example.
>
> Not all anxiety disorders manifest as chronic anxiety. Not all chronic anxiety represent an anxiety disorder.
>
> Depression is depression. When anxiety is a component or symptom of depression, it tends to resolve when the depression resolves. This is not true when an anxiety disorder is comorbid with depression.
>
> Depression in young people often begins as anxiety and insomnia; the anxiety to later disappear and leave depression only - even without treatment.
>
> Things are not so simple. In this case, I don't think the word "always" is at all helpful.
>
> Sorry for the strong language, John, but I really object to your doctor's characterization. It is, in my opinion, counterproductive. Getting rid of anxiety will not automatically get rid of depression. In the absence of an anxiety disorder, it is more often the other way around.
>
> Anyway, good luck on your continuing Nardil trial. As was mentioned, dizziness and urinary retention can be problematic. If you choose to addresss these things pharmacologically, the dizziness can be dealt with by using either Florinef (fludrocortisone) or Ritalin (methylphenidate). Hopefully, any urinary retention can be remedied by taking Urecholine (bethanechol). I came close to going to the hospital a number of times for a catheter. Bethanechol helped with this enough that I was able to urinate. I was taking a TCA along with the Nardil at the time, which most likely made things worse. I never had a problem with Nardil monotherapy. Even with the combination, urinary retention subsided after a few weeks.
>
>
> - ScottBut why/how would someone become depressed without anxiety?
Posted by SLS on December 22, 2015, at 10:11:15
In reply to Re: Nardil washout and then restart, posted by John locke on December 22, 2015, at 9:36:52
> But why/how would someone become depressed without anxiety?
Are you asking about the biology behind this?
- Scott
Posted by SLS on December 22, 2015, at 10:16:40
In reply to Re: Nardil washout and then restart, posted by John locke on December 22, 2015, at 9:36:52
I forgot to ask you: Are you a political scientist?
:-)
- Scott
Posted by john locke on December 22, 2015, at 16:56:13
In reply to Re: Nardil washout and then restart » John locke, posted by SLS on December 22, 2015, at 10:11:15
yes
Posted by john locke on December 22, 2015, at 17:12:18
In reply to Re: Nardil washout and then restart » John locke, posted by SLS on December 22, 2015, at 10:11:15
Should I be worried that side effects haven't kicked in yet at day 16? Maybe tiredness is kicking in; I'm not sure. I've read that sides can be a sign that the med is working.
Posted by PeterMartin on December 22, 2015, at 18:53:50
In reply to Re: Nardil washout and then restart, posted by john locke on December 22, 2015, at 17:12:18
> Should I be worried that side effects haven't kicked in yet at day 16? Maybe tiredness is kicking in; I'm not sure. I've read that sides can be a sign that the med is working.
Side effects are definitely a good indicator.
I take Marplan (the most similar MAOI to Nardil) and had to restart it twice this year. Once due to an insurance issue (off Jan through March then restart) and then most recently I stopped taking Marplan from Oct 30th through Nov 17th (over 2wks).
In Sept/October I noticed my blood pressure was elevated (140ish/95ish). I take 4meds total and tried taking less of each for a day or two at a time but was unable to get it to come down. Prior to noticing it elevated in Sept it had been 117/76 in March (at my last Marplan restart) then in July/Aug 100ish/60ish (which I now believe is thanks to Marplan).
When I noticed the elevated bp get to 160/110 late Oct I went to Urgent Care. Of course they assumed it was the Marplan causing a problem as MAOis are most known for potential to cause hypertensive crisis. What I found out later is that originally MAOis were originally prescribed as anti-hypertensives and in general should lower bp (See: http://www.psychotropical.com/maois-and-blood-pressure-anti-hypertensive-effect).
But yea to get to the point after I stopped my bp didn't get worse but it didn't improve either (stayed 140-150 over 95-100 mostly). Meanwhile my mood tanked. I started sleeping from 11pm until 10am when I used to get up before my gf around 6ish to get breakfast and then find something to get into. I was hurting mentally pretty badly.
My doctor let me restart Marplan on Nov 17th. I've journaled everyday since Oct regarding changes to try to narrow down what med was doing what. So due to that I can tell you some date events on this most recent Marplan restart:
Nov 17: Restart (at 30mg which is slighly under recommended dose but what I was on previously from 2011-2014 and then spring/summer 2015)
Nov 24: First earlier wake day. Instead of waking up at 9am this is where I started having a few days getting up ~7am. Which for me is nice. I don't oversleep. So something was happening.
Nov 28: Noted as "First real early wake day". Started getting up at 6:30 read to go out to grab breakfast/etc.
Nov 29: First time I noticed my Blood pressure on my home cuff down a bunch. I got 120/85 but as it turned out it kinda went back up for a while to 135/95.....either way the was some bp affect starting to take place.
Dec 9th: Saw my doctor and he advised to go to 40mg Marplan (recommended dose after a wk per pdr) for a wk then go to 50mg. The max recommended dose of Marplan is 60mg. So now I'd be in the middle of the recommended range rather than 10mg below which I had been in times before.
Dec 15: BP still around 135/95
Dec 16: 130/89 - Marplan to 50mg
Dec 20: 126/90
Dec 21: 117/79
Dec 22 (Today): 98/68
So yea for me it take about a month to notice the side effects. In my case the hypotension side effect is super beneficial as I'd probably need bp meds if it weren't for Marplan. I think when Urgent care took me off it cold turkey I had a bit of rebound hypertension.I also checked my earlier 2015 restart and I startted on 5/13. I measured my bp on 5/17 and was concerned w/ a 150/90 reading. I didn't have a cuff at the time so I just waited it out only checking weekly and the main drop happened around 6/10 (90/70).
Sadly my ability to orgasm has also pretty much gone away the last couple of days but I've had that come and then go away after a period of time. I also noticed when I stopped Marplan in early '15 and also in Nov I started have the opposite of anorgasmia (premature actually)....which was kinda nice. But yea that was another side effect that just started coming around the last few days (about a month) after restarting Marplan on Nov 17th......the increase to a good dose was probably needed and I now believe that is probably why I had elevated bp in Sept/Oct - I actually needed a dose increase on Marplan not a reduction/cesesation.
But yea I would say in my experience stopping and restarting has worked fine. My mood is great and I'm ecstatic that my bp has come around. I'd give it at least a month to 6wks. Watch for the low bp on standing. Watch for libido. Those sorta things.....
Sorry if this reads terrible as I'm writing it stream of thought, I didn't intend to write this much, and I'm not going to proof-read :) That said maybe it'll be insightful and good luck!!
Posted by baseball55 on December 22, 2015, at 19:35:00
In reply to Re: Nardil washout and then restart, posted by John locke on December 22, 2015, at 9:36:52
> But why/how would someone become depressed without anxiety?
I've never really suffered from anxiety. But I've suffered greatly from depression. The two times I had anxiety, I wasn't depressed but was under tremendous stress. The idea that depression is just a subset of anxiety makes no sense to me. It sounds like your doctor has limited experience with depression.
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