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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by john locke on November 1, 2015, at 13:27:18
Sup y'all. I'm thinking about starting Nardil (phenelzine) for atypical depression, but have a few questions about it first. Just in case it "poops out" on me (aka loses effectiveness after a period of time), have any of y'all found any effective methods to combat this? Secondly, what medications have you found helps with the potential side effects (insomnia, anorgasmia, constipation, headaches, etc.)? Anything else that you all think might be good for me to know will be welcomed too!
Cheers,
John
Posted by Lamdage22 on November 1, 2015, at 14:21:20
In reply to Nardil, posted by john locke on November 1, 2015, at 13:27:18
Hi John,
Nardil caused me some trouble. I went psychotic on it.
There is a risk.
Posted by SLS on November 1, 2015, at 16:21:38
In reply to Nardil, posted by john locke on November 1, 2015, at 13:27:18
> Sup y'all. I'm thinking about starting Nardil (phenelzine) for atypical depression, but have a few questions about it first. Just in case it "poops out" on me (aka loses effectiveness after a period of time), have any of y'all found any effective methods to combat this?
I am not aware of anything you can do preemptively to prevent Nardil poop-out. It is an interesting idea, though. I find that I do better when I take Nardil with desipramine or nortriptyline. Nardil does poop-out from time to time. Other drugs that you can consider that are generally safe to add to MAOIs are Wellbutrin and Buspar. Both of these drugs can enhance the antidepressant effect of Nardil as well as combat sexual side effects.
> Secondly, what medications have you found helps with the potential side effects (insomnia...). When Nardil upset my sleep, I took Ativan. Perhaps Ambien would be a better choice, as it does not impact negatively sleep architecture. Benzodiazepines inhibit delta-wave stage 4 restorative sleep. Ambien has its own side effect profile, which you may or may not experience. It can have significant amnestic effects. Perhaps you can start with melatonin. There is also Belsomra (suvorexant), the first of a new class of orexin antagonist drugs that do not interact with benzodiazepine receptors. I really don't know anything about its efficacy, side effects, or withdrawal potential.
> anorgasmia
Many people recover their ability to reach orgasm after 3 months. If you don't, Buspar or Periactin (cyproheptadine) might help.
> constipation, headaches
I have never known people who describe these things. I guess I just don't know enough people. I would keep things simple and use NSAIDs for headaches. Difficulties urinating is more likely to occur than constipation. A drug named bethanechol can help with this.
Dizziness is often a problem. If it becomes severe, you can try Florinef (fludrocortisone).
Try not to set yourself up for a nocebo effect. Parnate might be a better choice of MAOI if you are concerned with side effects.
Why have you chosen to go with a MAOI?
- Scott
Posted by SLS on November 1, 2015, at 16:52:31
In reply to Nardil, posted by john locke on November 1, 2015, at 13:27:18
I was taught that manic psychosis produced by antidepressants is a phenomenon that occurs only when there is a bipolar component to one's affective disorder. Unfortunately, it sometimes takes an antidepressant to uncover bipolarity, so you don't always know in advance what the risk of psychosis is. Interestingly, MAOIs (especially Parnate) have been used in the past to treat psychotic depression *.
* http://www.psychotropical.com/9-anti-depressants/maois
- Scott
Posted by john locke on November 1, 2015, at 19:09:01
In reply to Nardil, posted by john locke on November 1, 2015, at 13:27:18
Thanks Scott, that's really good info. I seem to have a textbook case of atypical depression, with the accompanying social phobia. From all my research, Nardil seems like the best to combat this.
A few more questions. The only other AD I've used is lexapro. Will it therefore be hard to get a Nardil prescription, as I've heard it is normally a "last line" treatment?
Secondly, I'm wondering how much I can count on Nardil to be my long-term solution to my atypical depression. I've read about poop outs on a lot of message boards. Then again, it seems like people who are having problems with their meds are the ones who are most likely to post on these boards. Would it be naive to think that Nardil could be the life-long answer to my problem?
John
Posted by Lamdage22 on November 2, 2015, at 0:06:39
In reply to Re: Nardil » john locke, posted by SLS on November 1, 2015, at 16:52:31
Psychosis is listed as a side effect regardless if you are bipolar or not.
Posted by Lamdage22 on November 2, 2015, at 0:55:08
In reply to Re: Nardil, posted by Lamdage22 on November 2, 2015, at 0:06:39
My point being:
It can make you psychotic in the absence of mania!
Posted by Lamdage22 on November 2, 2015, at 1:47:00
In reply to Re: Nardil, posted by Lamdage22 on November 2, 2015, at 0:55:08
I am not saying dont try. I am saying be careful is all.
Posted by SLS on November 2, 2015, at 5:59:30
In reply to Re: Nardil, posted by Lamdage22 on November 2, 2015, at 0:06:39
> Psychosis is listed as a side effect regardless if you are bipolar or not.
Where is it listed?
I had trouble finding literature suggesting that psychosis can occur specifically in the absence of bipolarity. Can you point me in the right direction for supportive evidence? This is an important question that I would like to gain more insight into. Nardil can produce transient euphoria, but I have never seen it produce psychosis in bipolar 2 or psychotic depression. I don't completely trust package labelling. It is not meant to be a treatise on the phenomenology of the illness it treats nor the side effects it may or may not produce. I would prefer to see scientific literature to be found in peer-reviewed journals, but I am open to other things to be able to scrutinize.
I'll start by looking at the package label.
- Scott
Posted by Lamdage22 on November 2, 2015, at 6:08:02
In reply to Re: Nardil, posted by john locke on November 1, 2015, at 19:09:01
> Secondly, I'm wondering how much I can count on Nardil to be my long-term solution to my atypical depression. I've read about poop outs on a lot of message boards. Then again, it seems like people who are having problems with their meds are the ones who are most likely to post on these boards. Would it be naive to think that Nardil could be the life-long answer to my problem?It would be optimistic to think that Nardil is the only thing you need to do to get rid of depression for the rest of your life. It would be more realistic to say, hey maybe Nardil will support me in what i am doing a great deal.
Its most likely not your one way ticket to Nirvana no questions asked.
I think you get what i mean. Thats my two cents anyway.
Posted by Lamdage22 on November 2, 2015, at 6:17:07
In reply to Re: Nardil » Lamdage22, posted by SLS on November 2, 2015, at 5:59:30
You are right its not listed. As Cannabidiol is much more of an AP than a mood stabilizer, i guess i will find out if i am bipolar or not So far the evidence doesnt convince me!!
If i was bipolar and manic on Rapastinel or a combo of Rapastinel and Nortriptyline, i am not sure if id take a mood stabilizer.I would try to reduce the mania by reducing or discontinuing the offending AD. The side effect profile of anti-manics doesnt convince me. I can say for a fact i would NEVER be manic without a BIG TIME AD!
Sorry for hijacking the thread.
> Psychosis is listed as a side effect regardless if you are bipolar or not.
>
> Where is it listed?
>
> I had trouble finding literature suggesting that psychosis can occur specifically in the absence of bipolarity. Can you point me in the right direction for supportive evidence? This is an important question that I would like to gain more insight into. Nardil can produce transient euphoria, but I have never seen it produce psychosis in bipolar 2 or psychotic depression. I don't completely trust package labelling. It is not meant to be a treatise on the phenomenology of the illness it treats nor the side effects it may or may not produce. I would prefer to see scientific literature to be found in peer-reviewed journals, but I am open to other things to be able to scrutinize.
>
> I'll start by looking at the package label.
>
>
> - Scott
Posted by SLS on November 2, 2015, at 6:18:09
In reply to Re: Nardil, posted by Lamdage22 on November 2, 2015, at 1:47:00
If you were using the package label as a source of information, this is what it contains:
"The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality."
"Screening Patients for Bipolar Disorder:
A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that Nardil (phenelzine) is not approved for use in treating bipolar depression."
Pleas read again: http://www.dr-bob.org/babble/20150929/msgs/1083832.html
FYI: Nardil is also known to precipitate mania upon its discontinuation, especially if it is discontiued abuptly.
- Scott
Posted by Lamdage22 on November 2, 2015, at 14:54:56
In reply to Re: Nardil » john locke, posted by SLS on November 1, 2015, at 16:52:31
We can agree on "a bipolar component".
The real question is what is the best treatment for me taking potential and actual side effects into account.
Posted by SLS on November 2, 2015, at 15:38:22
In reply to Re: Nardil, posted by Lamdage22 on November 2, 2015, at 14:54:56
> We can agree on "a bipolar component".
>
> The real question is what is the best treatment for me taking potential and actual side effects into account.The short answer is that I don't know. The long answer is that I don't know.
:-(
At baseline (untreated), how would you describe your schizoid symptoms? To what degree do you become psychotic, and what do you experience? For example, do you have auditory hallucinations (hearing voices) or visual hallucinations (seeing people or things that are not there)? Some people have themes to their schizoid psychoses. For instance, believing that there are always intruders in the house would be a theme. Others are visited by spirits that help them predict the future. Some are scared that the world is filled with powerful witches.
It has been my observation of a few people with schizoaffective disorder that mania precedes psychosis, which is then followed by depression. I don't know that this is necessarily universal or described in the literature, but it makes sense to me. Here, if you can prevent triggering the mania, you will also help prevent schizoid psychosis, and, hopefully a severe depression. I have seen the appearance of anxiety lead to mania. One woman was actually able to prevent her schizoaffective cycling by taking Xanax when the anxiety first appeared. This is only one person, of course.
I think the place to start with you is to determine the severity of your depression and make decisions at to whether an antidepressant should be used in addition to antipsychotics. A friend of mine is doing extrememly well on a combination Wellbutrin, Navane, and Saphris. Adding the Saphris actually had an energizing antidepressant effect. She is now in college and working. She is a true success story.
- Scott
Posted by Lamdage22 on November 2, 2015, at 16:30:22
In reply to Re: Nardil » Lamdage22, posted by SLS on November 2, 2015, at 15:38:22
> > We can agree on "a bipolar component".
> >
> > The real question is what is the best treatment for me taking potential and actual side effects into account.
>
> The short answer is that I don't know. The long answer is that I don't know.That makes sense :)
>
> :-(
>
> At baseline (untreated), how would you describe your schizoid symptoms?Scott, i honestly dont know if i have psychotic symptoms at all at baseline. When i withdraw APs too quickly, i am mostly paranoid. Persecutory delusions. Something along the lines of that.
To what degree do you become psychotic, and what do you experience?
On Nardil? Voices. Not many voices but very paranoid. "I am guilty" delusions. "God is going to punish me" delusions. But almost at the same time "i am god delusions". On Nardil, id speak of a mixed affect psychotic episode.
Some people have themes to their schizoid psychoses. For instance, believing that there are always intruders in the house would be a theme. Others are visited by spirits that help them predict the future. Some are scared that the world is filled with powerful witches.
My theme was that i was raped as a kid and that i am either god or some kind of demon. Like i said kind of "mixed episode".
> It has been my observation of a few people with schizoaffective disorder that mania precedes psychosis, which is then followed by depression. I don't know that this is necessarily universal or described in the literature, but it makes sense to me. Here, if you can prevent triggering the mania, you will also help prevent schizoid psychosis, and, hopefully a severe depression. I have seen the appearance of anxiety lead to mania. One woman was actually able to prevent her schizoaffective cycling by taking Xanax when the anxiety first appeared. This is only one person, of course.
>
> I think the place to start with you is to determine the severity of your depression and make decisions at to whether an antidepressant should be used in addition to antipsychotics. A friend of mine is doing extrememly well on a combination Wellbutrin, Navane, and Saphris. Adding the Saphris actually had an energizing antidepressant effect. She is now in college and working. She is a true success story.
>
>
> - ScottMy plan is to take Cannabidiol as an antipsychotic. My fear now is that it will help psychosis but not mania. Is it possible to be manic without being psychotic?
Does CBD stabilize mood, too?
THX, Scott
Posted by former poster on November 3, 2015, at 19:04:46
In reply to Nardil, posted by john locke on November 1, 2015, at 13:27:18
Nardil is truly amazing. I was on it for about 15 years (accumulatively). I had to take clonazepam the whole time I was on it though. Seems like it just didn't work without it. Best of luck to you.
Posted by SLS on November 3, 2015, at 20:45:06
In reply to Re: Nardil » john locke, posted by former poster on November 3, 2015, at 19:04:46
> Nardil is truly amazing. I was on it for about 15 years (accumulatively). I had to take clonazepam the whole time I was on it though. Seems like it just didn't work without it. Best of luck to you.
What were you being treated for?
- Scott
Posted by john locke on November 4, 2015, at 14:49:42
In reply to Re: Nardil » john locke, posted by former poster on November 3, 2015, at 19:04:46
Why did you stop taking it? Thanks for your words of encouragement?
Posted by john locke on November 4, 2015, at 14:51:28
In reply to Re: Nardil, posted by john locke on November 4, 2015, at 14:49:42
Thanks for your words of encouragement! (didnt meant to have the question mark). I, too, was wondering what you were taking Nardil for?
John
Posted by former poster on November 6, 2015, at 21:36:01
In reply to Re: Nardil » former poster, posted by SLS on November 3, 2015, at 20:45:06
>What were you being treated for?
I was treated for social anxiety, general anxiety and depression.
Posted by SLS on November 6, 2015, at 21:58:38
In reply to Re: Nardil » SLS, posted by former poster on November 6, 2015, at 21:36:01
> >What were you being treated for?
>
> I was treated for social anxiety, general anxiety and depression.Interesting. I always thought that Nardil + Klonopin made a good combination for social anxiety. I didn't know it worked well for generalized anxiety, too.
Thanks for replying.
- Scott
Posted by Horse on November 7, 2015, at 12:29:17
In reply to Re: Nardil » john locke, posted by former poster on November 3, 2015, at 19:04:46
> Nardil is truly amazing. I was on it for about 15 years (accumulatively). I had to take clonazepam the whole time I was on it though. Seems like it just didn't work without it. Best of luck to you.
If you don't mind, (forgive me if I'm being too forward), I'm curious what caused you to discontinue.
Posted by former poster on November 7, 2015, at 17:37:55
In reply to Re: Nardil » former poster, posted by Horse on November 7, 2015, at 12:29:17
>If you don't mind, (forgive me if I'm being too forward), I'm curious what caused you to discontinue.
I don't mind at all.
I stopped taking it when I travelled abroad. Sticking to the MAOI low tyramine diet far from home would have been impossible. My Doc gave some me samples to take along to fall back on should I get anxiety returning, a new med on the market I never heard of before called Cymbalta. Doc said it's really good for social anxiety. After 3 weeks into the trip I started the Cymbalta and noticed an improvement after only a few days. Cymbalta seemed to work almost as good as Nardil giving me freedom to eat anything and travel far from home so I stayed on it for about 3 years.
Posted by john locke on November 13, 2015, at 22:25:14
In reply to Re: Nardil » john locke, posted by former poster on November 3, 2015, at 19:04:46
Did it ever poop out on you? Was any tolerance built? Did you notice any difference between the pre-2003 and current formulation?
Best,
John
Posted by former poster on November 14, 2015, at 10:39:57
In reply to Re: Nardil, posted by john locke on November 13, 2015, at 22:25:14
>Did it ever poop out on you? Was any tolerance built? Did you notice any difference between the pre-2003 and current formulation?
No poop-out that I can remember, but when the new formulation came out I did notice a decrease in effectiveness. This is when my Doc added dextroamphetamine 30mg a day to the mix. This combo was extremely effective. I later dropped the dextroamphetamine to 10mg a day keeping Nardil the same at 90mg and found it to be very suitable.
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