Posted by King Vultan on August 22, 2004, at 23:11:12
After being off Nardil for almost two weeks now and having more or less returned to normalcy (for me, anyway), I have a few observations to offer:
1) The stuff really is very good for social phobia/anxiety. My social phobia was perhaps 90% eliminated, and I have never felt as sociable as I did while on it.
2) Nardil IMO is clearly superior to the SSRIs as far as avoiding emotional blunting and apathy, presumably because its MAO-A inhibition has a powerful effect on both serotonin and norepinephrine. My opinion is that the SSRIs seem to leave the norepinephrine system behind in the dust to atrophy--not a good thing.
3) I think that too much Nardil is not necessarily a good thing, either, as I was starting to feel some of the negative effects on emotionality and spirituality that I traditionally attribute to SSRIs at dosages of 90 and 105 mg/day of the Nardil. Perhaps part of the reason was that the enormous amount of serotonin evidently being made available was excessively depleting dopamine. Of course, the amount of dopamine available was also unusually large because of Nardil's MAO-B inhibition, but serotonin unfortunately always seems to win this battle. If I had to do it over again, I think I would have stayed at 75 mg/day.
4) Speaking of serotonin and dopamine, this drug is clearly very, very similar to the SSRIs in terms of sexual side effects. I experienced a profound loss of libido worse than any other drug I have taken, combined with delayed orgasms (for me, this is not necessarily a bad thing, though). In defense of Nardil, I made it up to the maximum recommended dose and slightly beyond, but was never able to get anywhere close to a full therapeutic dose of an SSRI such as Zoloft. If I had been able to, maybe I would have experienced the same thing.
5) This is only the second drug I can report that definitely induced weight gain, the other one being Zoloft, on which I gained perhaps 5 pounds over a period of years due to an increase in appetite. On Nardil, I gained no less than 9 pounds in two months, and once I realized this was basically able to do no better than hold my own despite dramatically increasing my exercise--I was running over 20 miles a week--and carefully considering every calorie consumed. I cannot say that the Nardil really had much of an effect on my appetite and am forced to conclude that the culprit was some weird metabolic mechanism beyond my comprehension. During the two weeks of tapering the drug and the two weeks of washout, most of the weight has magically just melted off, this despite my decreasing my running closer to what I was doing pre-Nardil. The reputation Nardil has for inducing weight gain seems to be well deserved, from what I can see.
6) I tapered off this drug starting at a level of 7 x 15 = 105 mg/day and dropping 1 pill every three days. I am reasonably tough and tolerate withdrawal symptoms fairly well but would not suggest anyone exceeding this rate of decline. Those who are sensitive to withdrawal effects would probably be advised to not taper off any faster than one pill a week.
In my case, when I got down to about 45 mg/day, I experienced this blasted REM Rebound Syndrome that I was not even aware existed. The net effect is a lot of vivid dreaming, tossing and turning, and insomnia. I had started alternating Benadryl one night and Halcion the next while on Nardil to combat the severe insomnia it induced; the effects of this REM rebound thing totally overpowered my sleeping meds and was substantially worse than the actual Nardil insomnia.
I also experienced the usual weird tinnitus and vertigo I typically get during Effexor withdrawals and also experienced an intense hunger in the first week after getting down to zero (from my body's metabolism perhaps speeding back up to normal and demanding more food?--heck if I know). However, in the last week, I've been battling some significant nausea problems. It seems like my sense of smell has improved, and I have also become significantly more squeamish. I recall a very similar thing happening to me when I first started Wellbutrin and am wondering if this is somehow dopamine related. Clearly, my dopamine levels have risen, judging from my increased--though still mediocre--libido. I know that dopamine is involved with smell, as Parkinson's patients have a tendency to lose their sense of smell, and I know that dopamine agonists also tend to cause nausea. Well, the point is probably just an academic one, anyway.
Todd
poster:King Vultan
thread:381095
URL: http://www.dr-bob.org/babble/20040821/msgs/381095.html