Posted by SLS on October 17, 2002, at 8:05:59
In reply to Re: Nardil, posted by Lucy Nash on October 15, 2002, at 12:34:47
Hi Lucy.
Lucy:
> > Sometimes, discontinuing an MAOI abruptly is easier than tapering slowly. The anxiety should pass much more quickly. Nightmares are common because MAOIs can completely block REM and dreaming. When you stop the MAOI, a REM rebound occurs, leading to vivid dreaming.Scott:
> My understanding is that stopping an MAOI abruptly was potentially dangerous.That's probably a good rule-of-thumb in general. There is a potential risk of seizure, but I don't know high. However, only one such event has been reported on Medline. The other thing that can happen with some people is that discontinuing Nardil can induce a manic state that is sometimes severe.
I chose my words poorly and not detailed properly in my previous post. I was replying to someone's quandary as to how to avoid a protracted period of withdrawal symptoms as they tapered slowly off Nardil. It was not meant to be a general suggestion or one of discontinuing abruptly a high dosage.
In some situations, reducing the dosage of an MAOI beyond some threshold allows for the reappearance of depression and anxiety (along with things like increased heart rate, sweating, and other autonomic disturbances - PHYSIOLOGICAL SYMPTOMS) as part of what is called a "depressive rebound". I think this can be avoided by discontinuing Nardil completely once this point is reached, but probably not above a dosage of 45mg. This might prevent a protracted period of depressive rebound as one continues to taper slowly. This has been my experience with both Nardil and Parnate. I guess I shouldn't extrapolate to others, though.
> I did this once inadvertently and felt absolutely dreadful (headache, depression) in about 12 hours. Do you think this was due to stress and anxiety because I'd forgotten my Nardil, or could these have been physiological symptoms?
That's hard to say. You would not have lost the MAO inhibition in so little time. However, I am convinced Nardil does other things beyond MAO inhibition that occur immediately upon dosing and lasting more short-term. These are probably therapeutic. That Nardil is stimulating during the first few days when beginning treatment, when there is very little MAO inhibition argues well for this notion. My guess is that waiting 12 hours beyond a regularly-planned morning dose might very well have been responsible for your experience.
> Plus, I've always considered myself fortunate that Nardil hasn't blocked my REM sleep 100%.
Blocking REM inhibits dreaming.
Discontinuing a drug that inhibits dreaming can exaggerate and extend REM during the withdrawal period.
> I'm a lifelong poor sleeper and insomniac, so I tend to wake up during particularly complex or disturbing dreams.
In your case, blocking REM would be good, no?
Thanks for intercepting my crappy post. :-)
- Scott
poster:SLS
thread:123328
URL: http://www.dr-bob.org/babble/20021012/msgs/123989.html