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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by joemzak on January 18, 2006, at 21:27:14
In reply to Re: MAOI withdrawal » joemzak, posted by Jedi on January 18, 2006, at 2:16:18
>
Finding this board really eased my worries. But Jedi, when I read your post it was like looking in a mirror!
I too have gained and lost so much weight. I went on liquid diets 3 times and lost (and then gained) 60 pounds. (Now 100 overweight) This was after being on Nardil 5 years and the last liquid diet was 9 years ago. I had read Nardil causes weight gain. But, not being a doctor, I assumed it meant 10-15 pounds. Why it would do that-I didn't know or care as that much weight seemed like an easy trade off for being on something that helped me live without depression. No doctor (psychiatrist) that I ever had (and I had one for 5 years, one for 12 years, one for 1 years, and a new one I just started with a few weeks ago) ever told me that the weight gain could be enormous. In retrospect, I don't think any of them ever knew that! So, I lived all these years thinking I just had no will power. For most of those years, I worked in the fashion industry in NYC where appearance is so important, so my weight gain was doubly troubling. (Aside - I have seen the light and how shallow that was)
Also, I grew up eating very normal balanced meals. My mother was an excellent cook, enjoyed it, and so every night's dinner was fresh prepared. I often thought about my childhood and could not remember liking sweets. In fact, I remembered eating a half piece of apple pie whenever my mother baked one was my limit! So my new sweet tooth when I started Nardil was very puzzling to my family and me. That sweet tooth turned into a mean addiction to sugar where now I can eat a pint of Hagan Daz, a bag of Famous Amos chocolate Chips, and maybe, a couple hours later, something to top it all off! It was only 9 months ago that I found out that this sugar/carb addiction was COMPLETELY due to Nardil. I found this out from a doctor specializing in weight control/research at NY Presbyterian Hospital. At my first visit he said that all his patients on Nardil have the exact same problem and to get them to stop eating carbs was his most difficult task. Suddenly, a light bulb went off in my head and all the pieces fit. For the first time, I saw it wasn't MY fault or MY will power…it was that damn little orange pill (or 6 of them/day in my case) With that came anger that not one of my psychiatrists ever told me that!
I too, thought of exercising to keep the weight in check. But at 270 pounds (5' 10 " and normal weight of 170 pounds) I huff and puff after a small flight of stairs and my lower back problem -spondylolisthesis - keeps me from even walking more than 4 blocks!Regarding my slow tapering…
As you know, I have been on Nardil for almost 19 years. In the last 3 years, Nardil has been responsible for some very bizarre side effects. I mentioned them in my last post. But to demonstrate how frightening they were, I will elaborate on two of them.
About 2 years ago my sleeping became disturbed. For all of my life, all I needed to do was lie down and sleep came minutes later. And a full 8 hours was the norm. Suddenly, I couldn't fall asleep and when I did 5-6 hours was the maximum I could stay asleep. Some nights were worse; I got tired, irritable and a bit confused. My Internist gave me some Halcyon (always worked very well for me)
The first night (after taking 50mg - double the recommended dose) I slept 6 1/2 hours. I took it the next night, and IT DIDN'T WORK AT ALL. I was up all night. Went back to my doctor, and he gave me a few 100mg Seconals…a sure way to get to sleep via "passing out". LOL THEY DID NOT WORK! I wound up taking 500mg, which are 5 "reds", and NOTHING. Not even drowsiness!
Another bizarre episode happened in July 2004. I had been taking 6 mgs. of Ativan for 4 days, just 4 days. The 5th day I didn't need it so didn't take it. Within 5 hours of awakening that morning, my walking seemed funny. It got worse and within 2 hours I was unable to coordinate the movement of my legs to walk. I fell a couple of times when I got up to walk to the kitchen…I was now petrified. Then, as the walking worsened, I started finding it difficult to talk. Within an hour of that onset, my speech was so slurred it became unintelligible. Frightened and thinking I was about to die, I called an ambulance and went to the hospital. For 3 days I lied in that bed unable to sleep and with levels of anxiety higher than I ever experienced. I woke up on the 4th day and I was miraculously normal again…no problem walking, talking and no anxiety! I had x-rays, a CAT scan and "you name it" tests done and the results were all normal…they could find nothing to explain what happened to me. As I was being released, a doctor said that the Ativan caused it and that next time I should titrate down for a few days after taking them. RIDICULOUS!!! 3 Ativan per day for 3, maybe 4 days was NOT excessive and does not require titration down off them. Not for most anyone, nor me. And, I had taken Ativan before, for longer time periods, and no problems beset me then. This was just another frightening and bizarre effect that Nardil decided to play on me. But, in deference to my psychiatrist and internist, these effects were no where to be found in any medical literature. But, also finding someone that has been on Nardil for 19 years was also, nowhere to be found in any medical literature!
Okay, after these two mentioned and other problems Nardil was giving me, I knew I had to get off them. My last few experiences getting off Nardil was in 1998 and 1999 and 2001. For the first two times, it was prior to hip surgery. I got off them with the help of oxycodone (Percocets). I suffer so much whenever I try to stop taking them. The psychic pain is so unbearable; I remember saying to a friend that it was like someone taking my soul from me. The only thing that stops this psychic pain (and extreme anxiety, confusion, and so on) is to take narcotics. My psychiatrist of 12 years understood this and was not hesitant to prescribe it for me for the two weeks prior to surgery. The attempt in 2001 was undertaken because this was the time the bizarre episodes began happening. Now, even the oxycodone didn't take all the pain away. The problem was that as I awoke in the morning, I was in a semi-vegetative state…could not even get out of the bed to get to the oxycodone in time.
So, I went to my psychiatrist and said get me off! He said I should take one less pill per day every 2 weeks. Something in my head was telling me to do it slower, so I asked him if I could go down 1/2 pill every two weeks. He said that I could cut it with a pill cutter and thought slower was better. I began the next day-Tuesday. By Thursday, I wasn't feeling right. On Friday, I was feeling "out of my skin" I stayed on course for 6 days and had to give up. Although it was not even close to being as bad as when I had to stop cold turkey prior to surgery, it was bad enough that I knew I could not go on like that. My doctor scratched his head not knowing what to do. I went back on 6 per day.
To skip to where I am now, going down just 1/4 every 2 weeks…
I left the psychiatrist I was seeing and started with a new one. In our first meeting she said she felt that what I felt was not my depression coming back, but some sort of withdrawal.
A few weeks later, I scoured the Internet looking for answers. That was the day I found this board (Thank God) and also the day I found this article from the Journal of Psychiatry on the Web:
"http://www.psychiatrist.com/pcc/abstracts/pcc030404.htm"
Although written for a scientific journal, it is very readable. It was the first time I heard of the extreme difficulty getting off anti-depressants, especially Nardil. Also, in it he states that the effects could be likened to withdrawal from SPEED! He also states that if these effects begin within several days from
The lowering of the dosage, that it was certainly NOT depression returning but was in fact, a withdrawal…which he calls "discontinuation symptoms".
Also, he states anti-depressants should be tapered off by not more that 10% per week. Taking 90 mg of Nardil, that would be roughly 9 mg./week…or realistically 1/2 pill. That didn't work for me. So, I thought that being on Nardil for 19 years, 3 times the length than anyone in the article, so I came up with lowering my dosage by 1/4 pill AND every 2 weeks. What I thought was since I was on it 3 times longer, I should stretch out my tapering by 3 times longer than he suggests (yes hard to cut, but very doable with a good pill cutter) I presented this to my psychiatrist and she thought it was a great idea! (Should I have been a doctor? LOL)
I began this past weekend, and yesterday - Tuesday - was my D-day. It was that amount of time that I started feeling terrible when I tried decreasing my dosage by 1/2 pill. BUT, low and behold, I WAS FINE YESTERDAY! AND I FEEL FINE TODAY! I am beginning to think I found the answer!!!!I guess I should end this, lest I want to write a book. Let me just say, I too tried the Omega 3's, but without going off Nardil. My doctor said it would boost the Nardil. Well, nothing really happened except that when I burped, it tasted like an entire school of fish in my mouth! LOL
Lastly, maybe you too experience a type of "withdrawal" like I do. Just a suggestion, but before you give up and go back on the "orange devil", maybe you should read the article and talk to your doctor about extremely slow tapering like I am doing. So far, it's working for me. AND WE BOTH WERE DIAGNOSED WITH ATYPICAL DEPRESSION WITH ANXIETY DISORDER!!!!!I can't thank you enough for your posting. I also hope that just maybe something I've said helps you. And, if you ever move to New York, let me know. I sure can use a gym buddy!
Regards,
Joe
> Joe,
> Your situation sounds very similar to mine. I've been taking Nardil off and on, mostly on, for the past 10 years. This last run has been for three years and the weight problems have gotten out of hand. I’ve gained and lost about 75 pounds a couple of times in the past three years. The carbohydrate cravings for me are intense on Nardil. I can eat three PB&J sandwiches after a full dinner, without even feeling bad about it. They say watch your chocolate consumption. Does this mean less than two pounds at a time? The only thing that has helped with the weight is two hours of strenuous exercise a day. But now, the 285 pounds has limited my ability to exercise, and is starting to cause joint problems.
>
> So, I’m tapering off also. Who told you to take a year to do it? I’ve been dropping 15mg per week, from 90mg to 15mg currently. I have had no withdrawal symptoms other than some fairly vivid dreams. I know everyone is different but a year to taper this drug seems like overkill. Besides, how can you quarter that little pill.
>
> What gave me the courage to come off Nardil are some pretty amazing affects from Omega-3 fatty acids. I am currently taking 2400mg daily of EPA and 2000mg of DHA. This has caused some insomnia but has had some good affects on mood, inflammation, immune response, etc. A couple of months ago, I posted that I was probably a lifer on Nardil. Every time I quit I would be back in major depression. If this happens, I will be back on Nardil as fast as possible. One thing worse than being 100 pounds overweight is being in a pile on the floor with no hope and no will.
>
> I’m just restarting my exercise program. This is all-important for the weight gain problem and overall health. Good luck in your effort to taper off Nardil. Maybe do some research on the Omega-3s. My diagnosis is treatment resistant atypical depression with social and generalized anxiety disorder. Oh, I’m staying on my 1mg of clonazepam, at least for now.
> Take care,
> Jedi
>
> Omega-3 fatty acids in the treatment of psychiatric disorders.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15907142&query_hl=3&itool=pubmed_docsum
>
>
> ... The article basically talks about withdrawal from anti-depressants, with a section on MAOI. Boy, was it an eye opener. He states that if the side effects occur within a few days after stopping your medication, it is NOT depression but withdrawal - which he calls discontinuation symptoms. He talks about all kinds of side effects - including one similiar to withdrawing from SPEED! The article also has recommendations for getting off meds. I now have a new doctor and started coming off Nardil today. I take 6 pills and will reduce by 1/4 pill every 2 weeks. It will take 48 weeks, but that doesn't concern me, as long as I get off these devils!
> > As far as Parnate, frankly, I need to see what my natural state of being is before I take anything else. I have been on Nardil for 18 years and maybe, just maybe, I am okay without them. 18 years ago, I started seeing a doc and was diagnosed with atypical depression. In retrospect, I believe it was and is more of a social phobic thing than depression. Anyway, the only way I will find out is to stop Nardil.
> > I have found this board so comforting that I will keep everyone posted how the long road off is progressing. Thank you all. Joe
>
>
Posted by jedi on January 20, 2006, at 12:36:26
In reply to Re: MAOI withdrawal » Jedi, posted by joemzak on January 18, 2006, at 12:38:38
Hi Joe,
Our symptoms and diagnosis are so similar, I thought I’d bounce a few more thoughts off you. Besides the atypical depression and anxiety problems, I have had dysthymia since my teen years. I am now 48 and had my first major depression starting in about ten years ago. I have had at least three major depression episodes, all while off Nardil. So actually they call this double depression.I can live with the dysthymia. In fact, I was very productive most of my life despite the disorder. I had my own computer networking company, owned and managed more than 50 residential rentals and was on the edge of total financial independence when the first major depression hit me. Talk about a fast trip down. I still have not recovered financially, and at this point I wonder if I will. It is so easy, while depressed, to just try to get through the day. This causes, after some time, a pattern of procrastination that is debilitating. If I can just put it off one more day, maybe I’ll feel better tomorrow. This is another reason for wanting to get off the meds. They have saved my life more than once, but there is more to life than just being alive.
So far, this is the best withdrawal from Nardil I have been through. In the past, I just wanted to get it washed out so I could try something else. This time, like you, I want to try going pretty much med free; and see what happens. I believe the Omega-3s are helping. I’ve been on fairly high dosage for several months. It takes that long to get a positive effect, IMHO. I take the concentrated, coated capsules that don’t give you the fish burps, yech!
I wish you well in your withdrawal. I live in a small town on the West Coast, so I am kind of envious of your access to qualified mental health professionals. It seems like good pdocs like to congregate together in the large cities. Here, I have to do all of the research, then submit it to my GP. This is extremely difficult when I’m really sick. I have seen some psychiatrists that were supposed to be among the best in the country. Turns out, they weren’t. One guy’s solution:
1. Get off Nardil (It will kill you).
2. Try Prozac again (Even though none of the SSRIs have ever worked for me).
3. When that doesn’t work, come back for ECT.
No thanks; I’m going to save that one for my last resort.Take care,
Jedi
Posted by Joemzak on February 8, 2006, at 11:56:25
In reply to Re: MAOI withdrawal » Jedi, posted by joemzak on January 18, 2006, at 12:38:38
It didn't work! I was taking 5 3/4 pillls, just 1/4 pill less than my usual dose and on the 11th day my thoughts went so low. I started to think my 5 year old Pappillon would be better off in another home. I collect R. Lalique vases and starting thing why? I shouldn't have them (almost like I didn't deserve them) So I took one extra pill that evening and went bavk on my full dose next day and am fine ever since. No doctor can uhderstand how 1/4 pill could do this, that it is not possible. It was even suggested it was in my mind. I quickly got that thought out of their minds...but still, everyone is at a loos to get me off Nardil One famous doctor was most worried about my 100 pound weight gain and raised blood pressure.I am so at a loss, I want to give up. I so wish I was never given Nardil. I am truly at my wits end. I have no where else to go for help.
Posted by jedi on February 8, 2006, at 20:03:54
In reply to Re: MAOI withdrawal, posted by Joemzak on February 8, 2006, at 11:56:25
Joe,
Since we seem very similar in diagnosis and our reaction to medications, give this a try. Titrate up to a high dose of EPA and DHA. I use 2400mg of EPA and 2000mg of DHA on a daily basis. You may become hypomanic and have a bit of insomnia. I treat mine with diphenhydramine HCL (Benadryl).
After a couple of months at the high dosage of Omega-3s, go ahead and drop 15mg of Nardil. When I wasn’t taking these fatty acids, I could not even drop to 75mg. After several months on the fish oil, dropping 15mg per week was easy. My GP tried to but me on some Wellbutrin XL. Even with the low dosage of 150mg in the extended release formula; I became very agitated, somewhat mean, and aggressive. The Omega-3s were providing what my brain needed. The human brain is largely composed of DHA fatty acids anyway. I dropped the bupropion after a few days.I have a strong feeling that all of the PDOCs I’ve seen have missed a soft bipolar diagnosis. I have never responded well to SSRIs, bipolar runs in my family, and much of the research on high dosage EPA and DHA shows better results in bipolars. Use the coated, concentrated fish oil capsules. This way you avoid the “fish burps”. Even taking the concentrated fish oil, I still have to gulp down ten of those babies throughout the day to get my target dose.
I am becoming a true believer in these fatty acids. I’ve been completely off phenelzine for over three weeks with no return of major depression. This is the first time I’ve been able to be off the med and not depressed for ten years. I’m still a little hypomanic, but I can live with that. The fish oils also have proven positive effects on the cardiovascular system and inflammation. I believe that over the next few years we will see more and more positive effects documented for the Omega-3 fatty acids.
Good luck,
Jedi
> It didn't work! I was taking 5 3/4 pillls, just 1/4 pill less than my usual dose and on the 11th day my thoughts went so low. I started to think my 5 year old Pappillon would be better off in another home. I collect R. Lalique vases and starting thing why? I shouldn't have them (almost like I didn't deserve them) So I took one extra pill that evening and went bavk on my full dose next day and am fine ever since. No doctor can uhderstand how 1/4 pill could do this, that it is not possible. It was even suggested it was in my mind. I quickly got that thought out of their minds...but still, everyone is at a loos to get me off Nardil One famous doctor was most worried about my 100 pound weight gain and raised blood pressure.I am so at a loss, I want to give up. I so wish I was never given Nardil. I am truly at my wits end. I have no where else to go for help.
This is the end of the thread.
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