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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Steven B on June 28, 2004, at 8:30:03
I have been on Nardil twice in the past 20 years for depression. I am 52 years old. The first experience the drug performed very well and the second time the results were ok. I mistakingly ate a piece of cheese which landed me in the hospital and that ended my MAOI experience about 2 1/2 years ago. I've been on almost every antidepressant and combo my pdoc has thought of but none with any great success. Finally we both decided it was time to go back to an MAOI since that was the only thing that really had worked in the past and he prescribed Parnate. After a couple of weeks I started noticing that I was getting very lightheaded after walking up a flight of steps, I almost fainted a couple of times and I did take a couple of falls. I noticed I had headaches a good deal of the time as well. My Dr. said lets go back to Nardil since it was the obvious winner in the past and after a 10 day miserable washout I am now back on Nardil. Its been a 10 days since I started and I am taking 45mg...2 pills in the AM and 1 in the afternoon. I have only started the third pill 4 days ago. What WORRIES THE HELL out of me after reading the other forums is all the people discussing how they changed the formula back in 2003, you need to take much more than in the past and it probably might not work. I think for me this is my last shot! My Doc says I can always go for ect but I don't feel like I'm really ready for that yet. It also scares the heck out of me. I function throughout the day... just feeling lousy most of the time and not much motivation for my job or much else. When I start feeling really lousy and get anxious about how bad I do feel, I take Klonopin...usually 1Mg. Sometimes it helps other times it doesn't. I'm trying to wean myself down to taking .05mg dosages a few times a day as I read Klonopin could cause depression too! During the washout period I was taking 1Mg of Klonopin 3 to 5 times a day.
Here's my question in a nutshell...Is anyone out there doing OK or well for depression on the new Nardil?? I still don't notice any remarkable differences in the way I feel other than I wake up half the night and have trouble going back to sleep. Lots of insomnia. Back to a Klonopin and hope to fall asleep! Should I continue to give it a shot for a couple of weeks? I have really not read too many positive things and maybe I'm psyching myself out for no reason. Maybe some others out there that are taking Nardil can tell me about their experiences for depression. I'm sure my Dr. has no clue they changed the formula and I'm not sure I want him to think that I'm telling him how to treat his patients. I also am sure he's out of other suggestions. I'm just really feeling doomed and am starting to feel there's no hope to feeling better. My wife is hassling me that she's tired of dealing with a depressed soul everyday which I can understand also. She can't understand why I take a med that I can't eat half the foods out there, can't sleep, and on top of everything else don't feel better!
Any experiences, suggestions or advice would be greatly appreciated.
Posted by King Vultan on June 28, 2004, at 12:21:12
In reply to Is Anyone Doing Ok on Nardil for Depression, posted by Steven B on June 28, 2004, at 8:30:03
I've been on Nardil since March 1 and have no experience with the old formulation. I am on 90 mg/day and have experienced a significant antidepressant and anti-anxiety effect and would say this is the best of the ten or so meds I've tried. Unmedicated, I have a difficult time functioning because of depression and a debilitating social phobia. I would rate the Nardil at this dosage as good for antidepressant efficacy and superior on social phobia.
There is one school of thought on Nardil that to assure that a sufficient trial has been conducted, one needs to take 1 mg/day per kilogram of body weight (I believe this originates from the days of the old formulation). I am approximately 150 pounds, so for me, 150 pounds divided by 2.2 pounds per kilogram gives a result of 68 mg/day. This was my experience at different dosages:
45 mg/day no adverse or therapeutic effects
60 mg/day adverse effects only (mainly insomnia)
75 mg/day some therapeutic effects with continuing insomnia, blood pressure and heart rate drop
90 mg/day more therapeutic effects with a bit more adverse effects, such as feeling cold, some twitching, some constipation
The two biggest problems for me have been insomnia and blood pressure/heart rate. For sleep, I am currently alternating between 0.125 mg Halcion one night and 50 mg Benadryl the next, as well as utilizing a sleep/relaxation CD both nights. This is giving me about six hours of sleep, which is about an hour or so less than normal but seems sufficient, agreeing with the thought I have seen repeated elsewhere that the MAOIs do seem to reduce the need for sleep.The BP/heartrate thing is a continuing problem for me. Unmedicated, it is 140/90 with a pulse of 75. On the Nardil, it is running 105/65 with a heart rate of about 55. I believe the low heart rate is the big problem, and I am experiencing continuing problems feeling faintness/weakness while or after climbing stairs, and also after sitting for extended periods of time and then getting up and walking. I've learned to feel when this is coming on, and will then either sit down if a chair is available or crouch down on the ground with my head leaning forward. It sounds like an intolerable nuisance, but like you, I don't have a lot of options left, and beyond what I've already said, I do find the Nardil to be a very beneficial and constructive drug. I really feel like a better person on it.
Todd
Posted by Steven B on June 28, 2004, at 13:14:26
In reply to Re: Is Anyone Doing Ok on Nardil for Depression » Steven B, posted by King Vultan on June 28, 2004, at 12:21:12
Hi King,
It's certainly nice of you to respond and VERY POSITIVE to hear that you have some good results from the Nardil. There is some hope! I actually weigh 180lbs and I just spoke to my Dr who suggested I go to 60mg..told me to take 2 pills in the morning and 2 pills in the afternoon and call him on Friday! According to your analysis, I am not nearly on enough of this medication to notice a difference yet or maybe long enough. How long did it take you before you started feeling better? How do you take your dosages...multiple pills at one time? I read somewhere that this was not good to do but I guess you have to if you are taking 5 or 6 pills daily.Starting today as I say I will be increasing to 60Mg and it will be my 11th day. But I did 30mg for 3 days and 45mg for 7 days.
Do you take anything else like Klonopin in addition to the Nardil? I'll figure out how to deal with the sleep issue if I can start to feel better emotionally!
Once again, THANKS!
Posted by King Vultan on June 28, 2004, at 15:13:59
In reply to Re: Is Anyone Doing Ok on Nardil for Depression, posted by Steven B on June 28, 2004, at 13:14:26
If I remember correctly, I started out at 3 x 15 mg/day for a couple of weeks, then went to 60 mg/day for either two or three weeks, then to 75 for about three weeks. I've been on 90 mg/day for a couple of months. It takes less than week for me to notice a dosage change--maybe four days--so it was over a month after starting the Nardil before I gained any real therapeutic effects (as stated in my previous post, this was at 75 mg/day--YMMV). Add onto that the two week washout period before the start date plus the amount of time I spent tapering down from my old med, and it really got to be quite a long stretch operating on essentially nothing.
As for taking my pills, believe it or not, I actually take them separately throughout the day. I've read that you may get more efficient MAO inhibition by spreading the dose throughout the day, and since this is how my doctor would prefer that I take them, anyway, and I am a relatively gung ho patient, it's not a big deal for me. Currently I take one each at 6 AM, 9-10 AM, 12 noon, 2-3 PM, 5-7 PM, and 11 PM.
As I stated, the stuff is working pretty well, but I also have some indications that my dose may be just a bit subtherapeutic. My mood is pretty good, but I still have a fair amount of anhedonia. I know Parnate would likely be better for that one particular characteristic, but I feel the Nardil is too beneficial otherwise to give up on at this point. In view of that and this reformulation/effectiveness issue, I'm seeing my pdoc next week about going up to 105 mg/day. He's told me that he has gone up this high in the past, and I am relatively certain he will agree to let me go ahead with it.
Todd
Posted by gardenergirl on June 28, 2004, at 15:50:23
In reply to Is Anyone Doing Ok on Nardil for Depression, posted by Steven B on June 28, 2004, at 8:30:03
Nardil has been great for my atypical depression. I am currently on 60 mg (1 15 mg pill 4 times per day, sigh, I wish they would make an XR version....ha!) I have been on 45 mg for extended times, but I've got a tremendous amount of extra stress in my life at the moment.
It sounds like you have been through the wringer at times. I hope Nardil will be good for you again. As far as the new formulation, I was never on the old, so I can't speak from personal experience. My guess, though, is that given the long time since you were on it before, starting on the new should not really be noticeable to you. You might need a slightly higher dose than last time, but you may have needed that anyway.
As far as your wife having trouble with this, that can be understandable, but not helpful. If someone has never experienced depression themselves, it's so hard to truly "get it". You might have her browse some of the posts on here or on the Psych. board. There are also books out there that may help her to understand. Perhaps even just talking to her about what you experience may help. I tell clients of mine in therapy that depression is a debilitating illness. It's like having something like mono or MS or diabetes. There are certain things you have to do to try to stay well, and sometimes, despite your best efforts, you have a relapse.
I wish you the best.
gg
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