![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by gardenergirl on March 3, 2004, at 13:48:53
I have been on Nardil for atypical depression since Sept. I started at 45mg, which worked well for me except during a particularly extra stresful time. I upped it to 60 mg in late January.
My main symptoms prior to tx: extreme difficulty getting out of bed. Alarm would go off, I would not get up. Would notice I was already late, would not get up. I think this is the "leaden paralysis" of atypical depression. I also would always be late, related to the above, but also difficulty keeping track of time. Last, I had terrible procrastination when it comes to writing tasks. As a student, all of these were a real problem.
At 45mg, I experienced early awakening, usually around 5 or 5:30, sometimes as early as 4 am. I could never get back to sleep and usually felt pretty refreshed. This was good as it allowed me to get started on stuff and get to places on time. At 60mg this went away. I fully expected to go through a bit of insomnia when I upped it, but instead, my vegetative symptoms are returning. I am late again, I can't get out of bed, I am procrastinating out the wazoo.
Here's my question: what is causing this? Here are my hypotheses.
1) Related to Nardil in some way. Better sleep cycle was actually insomnia and was a passing SE?
2)Nardil is pooping out.
3)I missed two doses (15mg each)one day within the last few days. I have never done this before. Can it have such an effect?
4)Therapy is stirring stuff up to the point that I am getting more depressed as I deal with the emotional stuff. This could be acting against the anti-vegetative effects of Nardil?
5)I am working more on my dissertation, and set myself a deadline to have a complete draft. This is causing enough internal pressure to trigger another depressive episode despite the Nardil.
6)Weight gain from Nardil is making me depressed.
7)I just do better on 45mg.
What do the rest of you think? Any other ideas? What should I do? Anyone else experinece something like this?
gg
Posted by ace on March 3, 2004, at 20:44:53
In reply to Nardil question: Ace, Mattdds, others please help!, posted by gardenergirl on March 3, 2004, at 13:48:53
> I have been on Nardil for atypical depression since Sept. I started at 45mg, which worked well for me except during a particularly extra stresful time. I upped it to 60 mg in late January.
>
> My main symptoms prior to tx: extreme difficulty getting out of bed. Alarm would go off, I would not get up. Would notice I was already late, would not get up. I think this is the "leaden paralysis" of atypical depression. I also would always be late, related to the above, but also difficulty keeping track of time. Last, I had terrible procrastination when it comes to writing tasks. As a student, all of these were a real problem.
>
> At 45mg, I experienced early awakening, usually around 5 or 5:30, sometimes as early as 4 am. I could never get back to sleep and usually felt pretty refreshed. This was good as it allowed me to get started on stuff and get to places on time. At 60mg this went away. I fully expected to go through a bit of insomnia when I upped it, but instead, my vegetative symptoms are returning. I am late again, I can't get out of bed, I am procrastinating out the wazoo.
>
> Here's my question: what is causing this? Here are my hypotheses.
>
> 1) Related to Nardil in some way. Better sleep cycle was actually insomnia and was a passing SE?
I believe the 'early awakening' was indeed a passing side effect.>
> 2)Nardil is pooping out.No, I don't think so...I think you need a higher dose of 75-90mg.
>
> 3)I missed two doses (15mg each)one day within the last few days. I have never done this before. Can it have such an effect?Very unlikely.
>
> 4)Therapy is stirring stuff up to the point that I am getting more depressed as I deal with the emotional stuff. This could be acting against the anti-vegetative effects of Nardil?Maybe. But when Nardil makes you feel good (at your optimum dose) I find it unlikely any exterior issues can shake its AD effect.
>
> 5)I am working more on my dissertation, and set myself a deadline to have a complete draft. This is causing enough internal pressure to trigger another depressive episode despite the Nardil.Read above. When Nardil is acting 100%, I doubt any external factors can work against it.
>
> 6)Weight gain from Nardil is making me depressed.Read above.
>
> 7)I just do better on 45mg.I think you are passing through more side effects, and I believe ultimately you will need a higher dose....
>
> What do the rest of you think? Any other ideas? What should I do? Anyone else experinece something like this?I experienced the sleep phenomenon and also the vegetative sx in early therapy with Nardil. Time got rid of them...90mg created an unshakeble, breathtaking AD response.
Try 90mg...(after 4 weeks on 60mg)
>
> gg
Posted by gardenergirl on March 3, 2004, at 21:02:13
In reply to Re: Nardil question: Ace, Mattdds, others please help! » gardenergirl, posted by ace on March 3, 2004, at 20:44:53
Ace,
Good info. Thanks. Another question. I currently take my 60mg in 4 spread out doses of 15mg each (1 tab qid). What about taking two tabs twice a day? Would that give me a kick in the a.m. to get me going?
gg
Posted by ace on March 3, 2004, at 21:26:39
In reply to Re: Nardil question: Ace, Mattdds, others please help!, posted by gardenergirl on March 3, 2004, at 21:02:13
> Ace,
> Good info. Thanks. Another question. I currently take my 60mg in 4 spread out doses of 15mg each (1 tab qid). What about taking two tabs twice a day? Would that give me a kick in the a.m. to get me going?
> gg
Hard to say without doubt. I used to take 15mg qid..I believe I didn't suffer a lot of sedation.Now I take 30mg bid- and after the second dose I usually fall aleep for an hour or so....i love this but!
It's possible it might give you a kick, but I doubt it...how long have you been on 60mg?
Posted by gardenergirl on March 3, 2004, at 22:09:01
In reply to Re: Nardil question: Ace, Mattdds, others please help! » gardenergirl, posted by ace on March 3, 2004, at 21:26:39
I've been at 60mg for about six weeks.
Posted by ace on March 3, 2004, at 23:18:51
In reply to Re: Nardil question: Ace, Mattdds, others please help!, posted by gardenergirl on March 3, 2004, at 22:09:01
> I've been at 60mg for about six weeks.
I believe it is ABSOLUTELY time to raise the dose up to 90mg.
Posted by gardenergirl on March 4, 2004, at 6:24:44
In reply to Re: Nardil question: Ace, Mattdds, others please help! » gardenergirl, posted by ace on March 3, 2004, at 23:18:51
Okay, I'll consider that. But is urinary retention dose dependent? Will it get unmanageable? Right now I can cope with it without any meds or devices. I really don't want it to get worse.
That and hyperreflexia are the main SE's that have stuck around.
gg
Posted by Questionmark on March 7, 2004, at 6:54:11
In reply to Re: Nardil question: Ace, Mattdds, others please help! » gardenergirl, posted by gardenergirl on March 4, 2004, at 6:24:44
> Okay, I'll consider that. But is urinary retention dose dependent? Will it get unmanageable? Right now I can cope with it without any meds or devices. I really don't want it to get worse.
>
> That and hyperreflexia are the main SE's that have stuck around.
>
> ggUrinary retention is dose dependent, i'm sorry to say. It's possible that the increased dose of Nardil increases the sedation and slow-moving-type effects/conditions to the point that you're not as "stimulated" or anxious about important things as you would or should be. i think i noticed this myself with Nardil. i am a hORRible procrastinator and judger of time and the like; Nardil helps with my obsessive-compulsive aspects a good deal, which helps with those problems. However, it also makes me slower and drowsier and non-anxious to the point that i don't have that "at-the-last-minute" panic that i would otherwise have, which is worse for those problems. And i think it was worse when i was on 60mg than 45mg. But, if i'm totally off and/or your depression and stress are affecting you more severely, then maybe Ace is right and you need an additional dose increase (to 75 or 90mg). If you were doing better on 45mg, though, then i would suggest going back to that for awhile and see how you do. Hope it goes well.
Posted by gardenergirl on March 7, 2004, at 12:19:07
In reply to Re: Nardil Qs » gardenergirl, posted by Questionmark on March 7, 2004, at 6:54:11
Thanks for the input. Actually, I read an article from another post in a different thread that suggests 1mg of Nardil per kg of body weight. That would put me at 75 mg. But your explanation of why I might be feeling worse at 60mg than at 45mg also makes sense. And it would explain the excessive sleeping. Ugh.
Although I do feel better since I talked about this with some people. I'm beginning to suspect it's the dissertation anxiety that is the biggest part of all this. Just need to do it, darn it!
Thanks again,
gg
Posted by sobeit on March 13, 2004, at 0:27:21
In reply to Re: Nardil Qs, posted by gardenergirl on March 7, 2004, at 12:19:07
> Thanks for the input. Actually, I read an article from another post in a different thread that suggests 1mg of Nardil per kg of body weight. That would put me at 75 mg. But your explanation of why I might be feeling worse at 60mg than at 45mg also makes sense. And it would explain the excessive sleeping. Ugh.
>
> Although I do feel better since I talked about this with some people. I'm beginning to suspect it's the dissertation anxiety that is the biggest part of all this. Just need to do it, darn it!
>
> Thanks again,
> gg
Although it appears you've ended this thread, I thought I would add my experience should you come back to read any new postings. With more than 15 years dedicated to Nardil therapy, I've experienced most of the potential side-effects associated with this med - except a tyramine reaction! I began at 45mg (weight 155 lbs) and initialy experienced insomnia, hyper-reflexia, bradycardia, orthostatic hypotension, urinary retention, slowed bowel transit, weight gain, dry mucosal tissues, geographic tongue, anorgasmia, tinnitus at bedtime, worsening dermatitis, cramps of the lower extremities, and an incredible chocolate craving. These gradually began to lessen in intensity, with many becoming "acceptable" in exchange for the benefit derived (increased social interaction, improved mood, reduced anxiousness). The one side-effect that did not lessen over time for me was the insomnia. It was just as easy for me to stay awake the entire night as it was to try to fall asleep. I became accustomed to getting 4-5 hours sleep per night, but constantly struggled with difficult awakening in the morning. The first 5-6 years, I would reduce my dosage to 15mg during the summer to get a break from the insomnia and, although my mood would be stable, the social anxiety always returned. During the first 3 years, my dosage varied from 45mg to 105mg - learning that anything over 75mg was intolerable for me. I've learned that many of the side effects are dose-dependent and that optimal dosage needs to be titrated per individual. Early on I would experience a mild serotonin-reaction if I took more than 30mg at one time, but now I find the most effective method for taking the med is a single 60mg dose at bedtime. I've constantly struggled with the sleep issue, so initiated an investigation through the university hospital neurology department to include PSG/MSLT ("sleep studies"),sleep apnea workup, CPAP trial, stimulant trials, and sedative/hypnotic trials - all failing to produce an answer or benefit. Of interest to me was the complete lack of REM sleep and reduced stage 4 sleep of 75%, recorded during the PSG. It's still the best explanation for the insomnia, easy awakening during the first half of the night, and the resultant difficulty awakening in the morning. You may be experiencing a similar sleep pattern as you increase the dosage, since the loss of REM sleep appears to be dose dependent. You should continue titrating the dosage to determine your optimal level of function.
Posted by Questionmark on March 13, 2004, at 3:11:49
In reply to Re: Nardil Qs, posted by sobeit on March 13, 2004, at 0:27:21
> > Thanks for the input. Actually, I read an article from another post in a different thread that suggests 1mg of Nardil per kg of body weight. That would put me at 75 mg. But your explanation of why I might be feeling worse at 60mg than at 45mg also makes sense. And it would explain the excessive sleeping. Ugh.
> >
> > Although I do feel better since I talked about this with some people. I'm beginning to suspect it's the dissertation anxiety that is the biggest part of all this. Just need to do it, darn it!
> >
> > Thanks again,
> > gg
>
>
> Although it appears you've ended this thread, I thought I would add my experience should you come back to read any new postings. With more than 15 years dedicated to Nardil therapy, I've experienced most of the potential side-effects associated with this med - except a tyramine reaction! I began at 45mg (weight 155 lbs) and initialy experienced insomnia, hyper-reflexia, bradycardia, orthostatic hypotension, urinary retention, slowed bowel transit, weight gain, dry mucosal tissues, geographic tongue, anorgasmia, tinnitus at bedtime, worsening dermatitis, cramps of the lower extremities, and an incredible chocolate craving. These gradually began to lessen in intensity, with many becoming "acceptable" in exchange for the benefit derived (increased social interaction, improved mood, reduced anxiousness). The one side-effect that did not lessen over time for me was the insomnia. It was just as easy for me to stay awake the entire night as it was to try to fall asleep. I became accustomed to getting 4-5 hours sleep per night, but constantly struggled with difficult awakening in the morning. The first 5-6 years, I would reduce my dosage to 15mg during the summer to get a break from the insomnia and, although my mood would be stable, the social anxiety always returned. During the first 3 years, my dosage varied from 45mg to 105mg - learning that anything over 75mg was intolerable for me. I've learned that many of the side effects are dose-dependent and that optimal dosage needs to be titrated per individual. Early on I would experience a mild serotonin-reaction if I took more than 30mg at one time, but now I find the most effective method for taking the med is a single 60mg dose at bedtime. I've constantly struggled with the sleep issue, so initiated an investigation through the university hospital neurology department to include PSG/MSLT ("sleep studies"),sleep apnea workup, CPAP trial, stimulant trials, and sedative/hypnotic trials - all failing to produce an answer or benefit. Of interest to me was the complete lack of REM sleep and reduced stage 4 sleep of 75%, recorded during the PSG. It's still the best explanation for the insomnia, easy awakening during the first half of the night, and the resultant difficulty awakening in the morning. You may be experiencing a similar sleep pattern as you increase the dosage, since the loss of REM sleep appears to be dose dependent. You should continue titrating the dosage to determine your optimal level of function.
>
Thanks Sobeit, that was a pretty informative Nardil post (although it wasn't directed to me specifically). i'm fortunate, Nardil has never noticeablly made my insomnia any worse. If anything it may have helped it a tad.
The lack of REM sleep is caused by-- or at least caused more than anything by (i'm almost positive)-- the marked increase in synaptic serotonin levels. SSRIs decrease REM sleep dramatically as well, and Nardil completely obliterates it and is even more serotonergic than SSRIs (based entirely on personal experience, but i'd bet my left arm on that one-- that Nardil has an even greater effect on serotonin levels).
Posted by sobeit on July 3, 2007, at 0:53:28
In reply to Re: Nardil Qs (REM), posted by Questionmark on March 13, 2004, at 3:11:49
I'll be having another sleep test soon (off all meds) and will be curious how it compares to the PSG I had 3 years ago (see post below). Just wondering if this post is relevent to any others taking MAOI/phenelzine
> >
> > Although it appears you've ended this thread, I thought I would add my experience should you come back to read any new postings. With more than 15 years dedicated to Nardil therapy, I've experienced most of the potential side-effects associated with this med - except a tyramine reaction! I began at 45mg (weight 155 lbs) and initialy experienced insomnia, hyper-reflexia, bradycardia, orthostatic hypotension, urinary retention, slowed bowel transit, weight gain, dry mucosal tissues, geographic tongue, anorgasmia, tinnitus at bedtime, worsening dermatitis, cramps of the lower extremities, and an incredible chocolate craving. These gradually began to lessen in intensity, with many becoming "acceptable" in exchange for the benefit derived (increased social interaction, improved mood, reduced anxiousness). The one side-effect that did not lessen over time for me was the insomnia. It was just as easy for me to stay awake the entire night as it was to try to fall asleep. I became accustomed to getting 4-5 hours sleep per night, but constantly struggled with difficult awakening in the morning. The first 5-6 years, I would reduce my dosage to 15mg during the summer to get a break from the insomnia and, although my mood would be stable, the social anxiety always returned. During the first 3 years, my dosage varied from 45mg to 105mg - learning that anything over 75mg was intolerable for me. I've learned that many of the side effects are dose-dependent and that optimal dosage needs to be titrated per individual. Early on I would experience a mild serotonin-reaction if I took more than 30mg at one time, but now I find the most effective method for taking the med is a single 60mg dose at bedtime. I've constantly struggled with the sleep issue, so initiated an investigation through the university hospital neurology department to include PSG/MSLT ("sleep studies"),sleep apnea workup, CPAP trial, stimulant trials, and sedative/hypnotic trials - all failing to produce an answer or benefit. Of interest to me was the complete lack of REM sleep and reduced stage 4 sleep of 75%, recorded during the PSG. It's still the best explanation for the insomnia, easy awakening during the first half of the night, and the resultant difficulty awakening in the morning. You may be experiencing a similar sleep pattern as you increase the dosage, since the loss of REM sleep appears to be dose dependent. You should continue titrating the dosage to determine your optimal level of function.
> >
>
>
> Thanks Sobeit, that was a pretty informative Nardil post (although it wasn't directed to me specifically). i'm fortunate, Nardil has never noticeablly made my insomnia any worse. If anything it may have helped it a tad.
> The lack of REM sleep is caused by-- or at least caused more than anything by (i'm almost positive)-- the marked increase in synaptic serotonin levels. SSRIs decrease REM sleep dramatically as well, and Nardil completely obliterates it and is even more serotonergic than SSRIs (based entirely on personal experience, but i'd bet my left arm on that one-- that Nardil has an even greater effect on serotonin levels).
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.