Posted by zonked on June 16, 2011, at 20:05:19
In reply to ... And all things Nardil ... Re: Morning dread... » zonked, posted by Questionmark on June 16, 2011, at 18:46:25
> I have almost always taken Nardil 3x/day.
> The past several years i have varied my dose a lot (i know, it sounds foolish, but i have my reasons), 45mg being the max and often trying my damnedest to maintain on less. Currently i am only taking 30mg and have recently begun taking it 4x a day, as an experiment.Even the PDR/prescribing information (which is *so* outdated) recommends a titration up to "at least 60" as quickly as the patient can tolerate. Harvard medical school recommends a dose of 1mg per kg of body weight per day (I am NOT going to ask how much you weigh, but it's something to consider.) Why a max of 45 of Nardil until now? How long have you been on it? And even the PDR says it may take 90mg to get sufficient MAO inhibition in some individuals. I think you owe it to yourself to ask your MD to go higher!
>
> But i have to disagree with a number of the other posters in saying that Nardil is probably not a factor in this morning phenomenon. I feel pretty strongly that the nature of Nardil is largely involved in this.My morning dread pre-dated taking Nardil - it's a feature of my depression. When I began to have a robust response (a day/two after increasing to 60), the dread was reduced by about 50%. What's weird is that I have required 90mg to respond last time, but 60 seems to have done the trick this time around. Who knows WTF is going on. Oh, I do weigh about 40-50lbs less than last time... hrm...
> Despite the half-life supposedly being 11 hours, and despite MAO enzymes supposedly taking several days for the body to manufacture again, for whatever reason, experientially, Nardil has very temporally limited effects. After about 6 or so hours from my last dose, I start to notice a difference in how i feel-- worse mood, more drowsy, more susceptible to anxiety. I also notice that if i only get 4 or 5 hours of sleep, I do not wake with those same feelings of dread, etc as I normally do. Presumably because it has been less time since my last dose of Nardil.
> Nardil is just so damn unpredictable. SSRIs seem to give the same effects from one hour or day to the next. On Nardil it seems as if random periods of low mood, and drowsiness in particular, are unavoidable. The problem is, part of what makes it so good is also what makes it so hard to figure out and define -- it's such a complicated drug. It affects so many different neurotransmitter systems as well as a few trace amines. Trying to make sense of it all is not easy.
>I agree 100%. Seriously, it's not an easy med to dose or take. I too wish there were an XR version...The MAO inhibition alone doesn't explain the AD effect of Nardil (or for that matter Parnate either) because, on either drug, my symptoms start returning within a day or so of discontinuing the drug. (Either accidental or intentional.)
> 1) Splitting the doses definitely seems preferable (at least 3x/day).
>
> 2) The higher the dose -- or at least the higher the nighttime dose -- the less severe the negative morning effects.
> 3) The more evenly you can divide your doses, the better.This is *very* helpful information, and I thank you for it. Do let me know how you do on 60... hopefully better than you have been doing.
Best,
-z
poster:zonked
thread:987723
URL: http://www.dr-bob.org/babble/20110610/msgs/988407.html