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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by fuji on October 12, 2002, at 6:44:37
I am curious as to what people think of Nardil and when do they decide to try it? Do you try an MAOI after exhausting most of the other common approaches like SSRI's and augmentation. I figure if I bring it up to my doc I would like to know what I am talking about. He's quite open to most possibilities but he's never mentioned the MAOI at all. It's something I am thinking about because everything else just doesn't quite make it. Almost but not quite if you know what I mean!
Thanks for any help
Posted by cosis on October 12, 2002, at 8:43:35
In reply to Nardil, posted by fuji on October 12, 2002, at 6:44:37
Hi
What will you be taking Nardil for?
Nick
Posted by Eilidh on October 12, 2002, at 9:56:36
In reply to Nardil, posted by fuji on October 12, 2002, at 6:44:37
As MAOI'S are older antidepressants psychiatrists tend to work their way through the more modern ones first. It has taken 12 years for me to reach an MAOI, only been taking it for last 3 weeks.
As you will have seen from this board, MAOI'S require the user to commit to following a diet which has restrictions because of MAOI reaction with tyramine. Any of the MAOI''S can also, like all other antidepressants, have undesirable side effects.
MAOI's can sometimes bring relief to the user when all other antidepressants have failed to do so. Although you will again note from this board that this is sometimes short term, and not at all for others.
I have to say that after 3 weeks I am certainly more motivated and physically active.
You have nothing to loose by discussing the option with your doctor if you feel you are not being helped sufficiently by your current medication. If he has a negative view of MAOI's ask him why this is so. You should not loose out on an opportunity because he/she is inexperienced with thier use.
Good luck
Eilidh
Posted by Lucy Nash on October 12, 2002, at 13:06:39
In reply to Re: Nardil » fuji, posted by Eilidh on October 12, 2002, at 9:56:36
Nardil is especially good if you're an "atypical" depressive, with a lot of anxiety and/or phobia problems.
I was suffering from agoraphobia and social phobia when I started Marplan, which is similar to Nardil - it worked wonderfully. True, the food restrictions are a bummer at first, but I don't really miss cheese any more.
Posted by ZeeZee on October 12, 2002, at 18:06:58
In reply to Re: Nardil, posted by Lucy Nash on October 12, 2002, at 13:06:39
Lucy,
I've used Nardil and Parnate in the past for agoraphobia/panic and they worked tremendously. I recently re-tried Parnate but had to stop because of weird side effects (and Nardil had too many s/e in the past, although effective.) Would you mind telling me how the Marplan is working for you? Any side effects? I'm considering trying this since I seem to respond well to the MAOI's unlike the other AD's. Of course the difficulty will be in finding a doc familiar with MAOI's and willing to prescribe in particular Marplan. Any experience you can share would be appreciated.
Thanks
Posted by cosis on October 14, 2002, at 9:36:12
In reply to Re: Nardil, posted by Lucy Nash on October 12, 2002, at 13:06:39
Pizza is fattening anyway :)
Posted by djmmm on October 14, 2002, at 16:07:30
In reply to Nardil, posted by fuji on October 12, 2002, at 6:44:37
It only took a few years of switching SSRIs, Benzos, second generation AD's (effexor, wellbutrin, etc), and combos of each before I decided to try Nardil...you should be very proactive when it comes to medication and side-effects.
Never settle for a drug that only helps you a little, and leaves you with uncomfortable side-effects. For me, at least, Nardil has had very few side-effects, far fewer than the SSRIs. A good Psychiatrist should have no problem letting you try a MAOI...Be aggressive.
the diet is not a problem..it seems that most discussion about the "difficult to follow" MAOI diet and the "dangerous" MAOIs is done by those who are not taking MAOIs...pizza, beer, etc is fine in moderation; people vary, so the only way to find out is to experiment with small amounts of a specific food.
Posted by fuji on October 14, 2002, at 16:30:53
In reply to Re: Nardil, posted by djmmm on October 14, 2002, at 16:07:30
Thanks for your reply and everyone's reply. The diet wouldn't be much of a problem as I don't drink or eat pizza at all. I have been taking 150mg effoxor plus 40 mg. of prozac. I dropped the prozac 2 days ago and doubled the effexor and I shall see how that is for about two weeks. Depending on if there is a difference or not, I will again come back to the MAOI question. I am proactive and have tried many combos which seem to do nothing more than make me sleepy. Most drugs make me sleepy. Wellbutrin and a cup of coffee are the best sleeping aids I can take. They put me right out!!
What have been the benefits of Nardil for you if you don't mind me asking?
Thanks again.
> It only took a few years of switching SSRIs, Benzos, second generation AD's (effexor, wellbutrin, etc), and combos of each before I decided to try Nardil...you should be very proactive when it comes to medication and side-effects.
> Never settle for a drug that only helps you a little, and leaves you with uncomfortable side-effects. For me, at least, Nardil has had very few side-effects, far fewer than the SSRIs. A good Psychiatrist should have no problem letting you try a MAOI...Be aggressive.
>
> the diet is not a problem..it seems that most discussion about the "difficult to follow" MAOI diet and the "dangerous" MAOIs is done by those who are not taking MAOIs...pizza, beer, etc is fine in moderation; people vary, so the only way to find out is to experiment with small amounts of a specific food.
Posted by Lucy Nash on October 14, 2002, at 22:28:42
In reply to Re: Nardil, posted by ZeeZee on October 12, 2002, at 18:06:58
Sorry for the confusion; I'm not on Marplan now, although I have taken it in the past.
The first MAOI I was prescribed was Marplan - this was in 1989. I took it for two years with few side effects except insomnia, for which I was occasionally given temazepam (I think it's called Restoril).
Then I moved to the Philippines where Marplan wasn't available (Roche discontinued it) so I had to switch to Nardil. Nardil worked, and is working, almost as well as Marplan but I am having a lot of trouble with weight gain. I was temporarily switched to Parnate a couple of years after starting Nardil, but I suffered from a lot of nausea so I went back to Nardil.
Nowadays I am considering switching back to Marplan as it's become available again. I'm sick and tired of being 30 pounds overweight, but the thought of a total washout frightens me. I've tried to taper off Nardil a couple of times but I always have anxiety attacks and nightmares. Hopefully our new insurance plans at work will help me locate a MAOI specialist - they are very difficult to find.
Posted by SLS on October 15, 2002, at 7:19:26
In reply to Re: Nardil, posted by Lucy Nash on October 14, 2002, at 22:28:42
Hi.
Sometimes, discontinuing an MAOI abruptly is easier than tapering slowly. The anxiety should pass much more quickly. Nightmares are common because MAOIs can completely block REM and dreaming. When you stop the MAOI, a REM rebound occurs, leading to vivid dreaming.
- Scott
Posted by djmmm on October 15, 2002, at 12:20:17
In reply to Re: Nardil, posted by fuji on October 14, 2002, at 16:30:53
Interesting comment about the more (typically)stimulating meds making you sleepy...Pharmacology is very complex, My guess is that, even though you are taking something like wellbutrin, the serotonin system is still manipulated, albeit indirectly..probably similar to Ritalin's effects on the serotonin system. Some people seem to be more susceptible to the effects (genetics)
As far as *most* meds making you sleepy, thats not uncommon with the SSRIs, however most of the time this particular side effect diminishes with in the first 2 or 3 weeks.
FWIW, Prozac was really the only med that made me feel stimulated. Nardil, had interesting effects when I first began to take it, the stimulation Nardil gave me was (honestly) more of a comfortable relaxed high (for lack of a better term), as opposed to the anxious, stimulation from Prozac. The "high" from Nardil would come about 40 min after taking 60mg, and last (noticeably) for an hour of so...this wasnt a high followd by a crash, like an amphetamine high, it was more like a profound lift in mood, a profound lift in anxiety.
I have been taking Nardil for 2 years (I think) and am free of clinical depression, social anxiety...what I find so wonderful about this medication is that, it has allowed me (from day one) to hold on to a wide range of emotions..I get sad and angry and anxious, but when appropriate; I have no proplems with apathy, I have never changed my diet, I have never had a hypertensive reaction.
Posted by Lucy Nash on October 15, 2002, at 12:34:47
In reply to Re: Nardil, posted by SLS on October 15, 2002, at 7:19:26
> Hi.
>
> Sometimes, discontinuing an MAOI abruptly is easier than tapering slowly. The anxiety should pass much more quickly. Nightmares are common because MAOIs can completely block REM and dreaming. When you stop the MAOI, a REM rebound occurs, leading to vivid dreaming.
>
>
> - ScottMy understanding is that stopping an MAOI abruptly was potentially dangerous. I did this once inadvertently and felt absolutely dreadful (headache, depression) in about 12 hours. Do you think this was due to stress and anxiety because I'd forgotten my Nardil, or could these have been physiological symptoms?
Plus, I've always considered myself fortunate that Nardil hasn't blocked my REM sleep 100%. I'm a lifelong poor sleeper and insomniac, so I tend to wake up during particularly complex or disturbing dreams.
Posted by SLS on October 17, 2002, at 8:05:59
In reply to Re: Nardil, posted by Lucy Nash on October 15, 2002, at 12:34:47
Hi Lucy.
Lucy:
> > Sometimes, discontinuing an MAOI abruptly is easier than tapering slowly. The anxiety should pass much more quickly. Nightmares are common because MAOIs can completely block REM and dreaming. When you stop the MAOI, a REM rebound occurs, leading to vivid dreaming.Scott:
> My understanding is that stopping an MAOI abruptly was potentially dangerous.That's probably a good rule-of-thumb in general. There is a potential risk of seizure, but I don't know high. However, only one such event has been reported on Medline. The other thing that can happen with some people is that discontinuing Nardil can induce a manic state that is sometimes severe.
I chose my words poorly and not detailed properly in my previous post. I was replying to someone's quandary as to how to avoid a protracted period of withdrawal symptoms as they tapered slowly off Nardil. It was not meant to be a general suggestion or one of discontinuing abruptly a high dosage.
In some situations, reducing the dosage of an MAOI beyond some threshold allows for the reappearance of depression and anxiety (along with things like increased heart rate, sweating, and other autonomic disturbances - PHYSIOLOGICAL SYMPTOMS) as part of what is called a "depressive rebound". I think this can be avoided by discontinuing Nardil completely once this point is reached, but probably not above a dosage of 45mg. This might prevent a protracted period of depressive rebound as one continues to taper slowly. This has been my experience with both Nardil and Parnate. I guess I shouldn't extrapolate to others, though.
> I did this once inadvertently and felt absolutely dreadful (headache, depression) in about 12 hours. Do you think this was due to stress and anxiety because I'd forgotten my Nardil, or could these have been physiological symptoms?
That's hard to say. You would not have lost the MAO inhibition in so little time. However, I am convinced Nardil does other things beyond MAO inhibition that occur immediately upon dosing and lasting more short-term. These are probably therapeutic. That Nardil is stimulating during the first few days when beginning treatment, when there is very little MAO inhibition argues well for this notion. My guess is that waiting 12 hours beyond a regularly-planned morning dose might very well have been responsible for your experience.
> Plus, I've always considered myself fortunate that Nardil hasn't blocked my REM sleep 100%.
Blocking REM inhibits dreaming.
Discontinuing a drug that inhibits dreaming can exaggerate and extend REM during the withdrawal period.
> I'm a lifelong poor sleeper and insomniac, so I tend to wake up during particularly complex or disturbing dreams.
In your case, blocking REM would be good, no?
Thanks for intercepting my crappy post. :-)
- Scott
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