Posted by 4WD on April 19, 2008, at 12:43:35
In reply to Re: 6 weeks on Nardil » 4WD, posted by SLS on April 19, 2008, at 5:18:29
Hi Scott,
Thanks for responding again. Thanks for the advice about not thinking of it as breakthrough depression. It's much better to think of it the way you do.I'm already having insomnia so not sure about the Deplin. B vitamins have a tendency to make me more anxious. I have noticed that if I take a B complex tablet, I will be more scared all day. I do go ahead and take one at bedtime a few times a week because I have heard that Nardil can deplete B vitamins or some particular B vitamin. If I take it at bedtime, I sleep through the extra scaredness. I guess one thing I could do is take a lot of folic acid. I know it doesn't begin to compare to Deplin but it couldn't hurt. Maybe just folic acid won't make me more scared.
You don't have an anxiety disorder, do you? That's really my bugaboo. I was up to 8 mg of clonazepam a day. I have brought it down to 1.5mg a day plus 15mg a day of Valium in divided doses. My pdoc has suggested adding Inderal when I take 5mg of Valium instead of having to take 10 mg of Valium at a whack. It does seem to be helping a bit but it's only been two days. I'll keep trying though because I'd like to keep the Valium down to 10mg a day if possible. But even at 15mg a day plus my 1.5 Klonopin that's still only equivalent of 3mg of Klonopin a day. I'm very proud of myself for titrating it down so rapidly (it has been about a months worth of titrating). I started titrating down during the second of third week of Nardil because in the beginning it had a definite anxiolytic effect. I don't know if that has pooped out of if I'm more scared these days because I have titrated down fairly rapidly.
The main reason I think 45mg of Nardil may be enough is that I only weigh 51kg. And I'd rather keep the dose as low as possible so as to minimize side effects. Constipation, insomnia (which is better if I take my last Nardil of the day by 3 or 3:30. Also, a little nausea ocasionally and a serious problem with hypotension. I have measured it when I was feeling very lightheaded and it has been as low as 70/50. I am drinking a pint a day of salty water to help combat that. My internist told me that my last electrolyte check showed that I had a low salt level anyway. He rechecked it when I saw him Thursday but I don't have the results back yet.
But I feel I am 70% in remission from depression; maybe 80%. So I am so happy. Nardil is really working for me. Here's to the dissipation of side effects.
Anyway, thanks again for responding. You know more about meds than anyone on this board and it's great to have your opinion because I trust your advice more than that of anyone else.
I am so glad for you that you are doing well and have your life back. I remember when you first starting posting that you were achieving remission
I was thrilled for you. I am so glad you found Deplin - finally - something that worked. You have had such a long hard stuggle, it makes me exceedingly glad that you have finally found relief. You deserve it.Thanks again,
Marsha
> Hi Marsha.
>
> > Thanks for responding.
>
> For you, I'll always try to respond.
>
> > I don't think I can tolerate a dosage increase right now.
>
> I find that the side effects of Nardil dissipate over time. I'm currently taking 90mg. But then again, my brain was a tough nut to crack.
>
> > I think I'll try to stay at 45 for another few weeks and then if I'm not in complete remission maybe I'll be able to go up to 60mg by then.
>
> The best you could ever hope for given your treatment resistance is a saw-tooth improvement instead of a linear one. You might not really need more, as some people do respond to 45mg. It is the exception rather than the rule. Nardil is purported to be useful at dosages up to approximately 1mg/1kg of body weight.
>
> > But I'm doing pretty great on 45. Just a little breakthrough depression now and then.
>
> "Great" is an awefully big word. Perhaps you should give 45mg longer than just a week. Either way, you will arrive at an optimal dosage through trial-and-error. Breakthrough depression is expected early in treatment. I do not refer to these periodic worsenings as breakthrough depression nor partial relapse. Rather, I like to call them recessions during the initial stages of response. One of my doctors at the NIMH thought that these infrequent episodes were almost like the brain resetting itself.
>
> > I keep thinking it will continue to build in my system and after a full ten week trial at 45, I will not need to increase the dosage.
>
> Good thinking. :-)
>
> > I have considered Deplin. I even asked my pdoc about it but he had never heard of it. I guess I need to look up the web page and print it out for him. But I may not need it. (I am already on 5 meds).
>
> Deplin is nothing more than a super-charged folic acid. It induces an increase in the amounts of DA, NE, and 5-HT synthesized (as described by its manufacturer). If you get a little insomnia (or more insomnia), that might mean that Deplin is doing its work.
>
> > If I continue to improve on the Nardil I may not need to augment it.
>
> Absolutely.
>
> > What do you think about what my other doctor reading to me from the PDR that once full remission on Nardil is achieved, the dosage should slowly be lowered by one pill a day over a period of time?
>
> Yes, I have heard of this phenomenon. It sometimes does indeed take a higher dosage to achieve sufficient MAO inhibition than it does to maintain it. However, I don't think that the magnitude of dosage decrease as is described by the PDR is particularly smart. It is a very old idea that evolved in the late 1970s and early 1980s.
>
> > The PDR actually says this.
>
> I know.
>
> > It says that you should be able to maintain remission on as little as 15mg a day - once you have achieved full remission. I told this to my pdoc and he said he had heard that too. But no one on this board that I know of has ever tried going this route. It's something I would consider trying. of course if the depression returned I'd up the dose again in a heartbeat.
>
> You darn well better!
>
>
> - Scott
poster:4WD
thread:823866
URL: http://www.dr-bob.org/babble/20080412/msgs/824249.html