Posted by gilmourr on June 7, 2013, at 9:35:38
In reply to Nardil agitation, depression, suicidal thoughts, posted by Daniell on April 30, 2013, at 15:27:46
> I've been on Nardil 45mg for 2 weeks, 60mg for 2 weeks. Then 3 days ago I woke up with chills, diarrhea, high blood pressure, fast pulse, but worst of all extreme agitation e.g. head scratching, face scratching, teeth chattering, and a deep feeling of restlessness in my body. Worse than that I've been extremely depressed, to a point where I have only been once or twice in my life before, but combined with the agitation/inner restlessness I have felt suicidal urges. I have had suicidal thoughts before as part of depression but never planning exactly how I would do it and writing a detailed note. As I wrote it I cried and seemed to have some sort of panic attack or something as I couldn't seem to breathe and was gasping for breath. I started to imagine exactly how I would do it and how difficult it would be, even in an apparently 'peaceful' way. I looked death in the face and I was frightened beyond belief. I want to kill myself so badly on Nardil but I am so scared of death, and also what if I don't suceed I might end up immobile for the rest of my life, mentally tortured but unable to do anything about it.
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> But I don't have the mood to get the necessary things to kill myself peacefully, so I then in despair as I couldn't take the pain I looked in the kitchen for butchers knives and again, imagined myself doing it, the gruesome way and once again not guaranteed. I rang my hospital and they didn't take me seriously, they said my thoughts were 'of my own volition' and not their problem, then they hung up. I tried two more times but again they told me to just wait until my outpatient appointment, they would not admit me. If they felt this and had this pain themselves, they would know it's an emergency. I always thought serious suicidal thoughts were an emergency anyway, especially when the disturbing 'urge' is there from the extreme agitation on Nardil. I'm in the UK so we only have the NHS which is a public service, this is what it is like.
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> I used to take venlafaxine before and in the first 2 weeks or so it was very uncomfortable but diazepam solved it. With Nardil, nothing seems to work. I use diazepam and quetiapine to sleep and sometimes in the day, both of them at best take the edge of things but the thoughts and severe depression remain. I had depression before this obviously so I need a strong antidepressant, hence Nardil, but is it right for me? I've heard that it can take a week or two for receptors to downregulate so I should wait it out in theory, what do you guys think?
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> I would need to be sedated and monitored quite closely if I keep taking Nardil. For the past 2 days I've had to stop. From what I've read I must have had a mild case of serotonin syndrome, which surely means that MAO is inhibited to quite a high degree? I'm only around 55 Kg and I was thinking quite possibly I am sensitive to this medicine such that a lower dose might be better?
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> Also, people say that once 80-90% MAO inhibition is achieved, therapeutic response will be seen. Obviously that must not be the case for me. I would have thought that once MAO inhibition is maximal and monoamines are at high levels, things actually should get worse for a while after that until receptors downregulate and the brain adapts as a whole?
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> What should I do? Will Nardil work for me if I wait for the agitation/severe depression to go away then stick it out at a lower dose? Any suggestions would be greatly appreciated...
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Could be adrenergic storm. Nardil is potent on norepinephrine. Serotonin syndrome always is considered first but people never bring up the chance of AS.High blood pressure, fast heart beating, chills, extreme agitation seem like signs of an overactive CNS.
It might be of benefit to try Clonidine with Nardil and see if the reduction in NE helps. Or maybe try a benzo to see if it helps as well since benzos are usually known to calm a person down.
Plus serotonin syndrome is quite difficult to get, or at least some doctors I've spoke with in ER's or other locations have said.
I also get symptoms like this when I go too high on Nardil, but I believe it's the NE effect rather than serotonin just because you say "CHILLS" and normally I get those ALWAYS with NE based meds like cymbalta or parnate.
poster:gilmourr
thread:1042961
URL: http://www.dr-bob.org/babble/20130527/msgs/1044833.html