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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 Michael Bell on August 8, 2004, at 21:01:46
I've reached a crossroads in my life where I need to determine what my next long-term therapy med for SP is going to be. The Klonopin has been great for anxiety, but it's been making me more and more anhedonic and dysthymic, and I can't take it anymore. Using adjunctive meds like adderall or amisulpride or prozac have had minimal beneficial effects if any.
I once tried Nardil for about 3 weeks, and it was the best med for SP I've ever tried (in combo with Klonopin). But the side effect profile scared me too much.
Now I've come full circle, and I need your advice please. If you've ever used Nardil, especially for SP, please answer the following:
1) How real is the hypertensive crisis risk if I follow the diet?
2) What is the best med to block a hypertensive crisis from occurring?
3) Do the sexual side effects ever go away?
4) Finally, what is your overall feeling regarding Nardil as long term treatment for SP?
Thanks so much for your help. I hope everyone is making progress towards the ultimate goal.
Posted by gardenergirl on August 9, 2004, at 7:47:18
In reply to All current and former NARDIL users!! Need advice, posted by Michael Bell on August 8, 2004, at 21:01:46
> I once tried Nardil for about 3 weeks, and it was the best med for SP I've ever tried (in combo with Klonopin). But the side effect profile scared me too much.
I'm glad to hear you did well on it. I agree, the side effects can be off-putting, but for myself, I'll trade some tolerable side effects in order to not be depressed. My diagnosis is atypical depression, which is also usually responsive to MAOI's.
> 1) How real is the hypertensive crisis risk if I follow the diet?
If you follow the diet and there are never any "oops" then the risk should be fairly low, IMO and in my experience. HOWEVER, even when you are being very vigilant about the diet, sometimes it's hard to know exactly what is in foods. I had a hypertensive reaction on Thanksgiving from the dressing, which had the broth from the giblets (including chicken liver) in it. I typically don't use the giblets, so it didn't occur to me that they would be included. d'oh! I wouldn't call it a crisis, just a migraine for about 2 hours...BP was normal within about 2 hours of onset without any treatment for it. Restaurants can also be a problem. Most have been very accomdating to me. I printed out a business sized card with the restrictions on it to hand to wait staff when I order. I ask them to check with the chef/cook to make sure what I ordered is okay or for them to make recommendations for me.
Please remember, though that your results may vary. I drink red and white wine, eat mozzarella and provolone cheese, yogurt, and chocolate and caffeine within normal limits. According to older published diets and according to the package insert that comes with the Nardil, these would be no-no's. I also do not tend to leave leftovers very long. I am leery of eating them now, and usually palm them off on my hubby. ;)
Also, individuals vary in their sensitivity to tyramine, so what is okay for some is not for others. When I was washing out my prior meds, I "practiced" the diet to make sure I could handle it. I was very very cautious at first, and gradually added in items that have proven via research and others' responses to be fairly benign. So my diet is less restrictive now, but I still do not eat anything I want.
>
> 2) What is the best med to block a hypertensive crisis from occurring?I admit I have no experience with this. I do not carry anything. I have seen nifedipine (ProCardia) used by others who post. I believe that Klonopin may also be used, as one of the side effects that can be found with that is lowered BP.
> 3) Do the sexual side effects ever go away?In my experience, yes, but it took about 4 months. I just increased my dose to 75 mg from 60 mg, and the sexual SE's have returned. I am hoping that they go away again. Again, others may have different experiences.
>
> 4) Finally, what is your overall feeling regarding Nardil as long term treatment for SP?I have heard it is very effective, but I do not have SP, so I can't answer this from personal experience. Ace, a poster from Oz is very very high on Nardil for SP. I am sure he can give you a more informed opinion about this.
>Good luck to you and please let us know how you do.
Take care,
gg
Posted by King Vultan on August 9, 2004, at 8:03:57
In reply to All current and former NARDIL users!! Need advice, posted by Michael Bell on August 8, 2004, at 21:01:46
> I've reached a crossroads in my life where I need to determine what my next long-term therapy med for SP is going to be. The Klonopin has been great for anxiety, but it's been making me more and more anhedonic and dysthymic, and I can't take it anymore. Using adjunctive meds like adderall or amisulpride or prozac have had minimal beneficial effects if any.
>
> I once tried Nardil for about 3 weeks, and it was the best med for SP I've ever tried (in combo with Klonopin). But the side effect profile scared me too much.
>
> Now I've come full circle, and I need your advice please. If you've ever used Nardil, especially for SP, please answer the following:
>
> 1) How real is the hypertensive crisis risk if I follow the diet?
>I would say it is close to zero. The only thing is you might get tripped up eating some spoiled food. However, Nardil is more forgiving than Parnate as far as hypertensive crises in general.
> 2) What is the best med to block a hypertensive crisis from occurring?Nifedipene has both proponents and opponents, but my own conclusion after studying the arguments is that there are for more pros than cons than associated with it. I carry two 10 mg capsules of nifedipine at all times, but more as a psychological security blanket than anything else. If they obey the restrictions, Nardil users should really never have any need to actually use this.
>
> 3) Do the sexual side effects ever go away?I would not be real optimistic that they do, unless you are able to find relief at a lower dosage that is still therapeutic for your SP. However, I was on Nardil for only a little over five months altogether.
>
> 4) Finally, what is your overall feeling regarding Nardil as long term treatment for SP?
>It's the best one I've tried personally, with my ranking the drugs I've tried like this:
1) Nardil
2 (tie) desipramine, Vivactil
4) nortriptyline
5) Strattera
6) Wellbutrin
7) Effexor
8) Zoloft
9) Prozac
10) ProvigilI think the reason Nardil works so well is that it is very serotonergic like the SSRIs, it has an effect on GABA somewhat like the benzos do, and it also has a strong effect on norepinephrine--which I am convinced is important in my case, anyway, based on the very positive impact the TCAs had on my SP.
> Thanks so much for your help. I hope everyone is making progress towards the ultimate goal.
I sure feel like I'm making progress, and this group has been a big help.
Todd
Posted by SLS on August 9, 2004, at 10:31:11
In reply to Re: All current and former NARDIL users!! Need advice » Michael Bell, posted by King Vultan on August 9, 2004, at 8:03:57
> > 3) Do the sexual side effects ever go away?
> I would not be real optimistic that they do, unless you are able to find relief at a lower dosage that is still therapeutic for your SP. However, I was on Nardil for only a little over five months altogether.Anorgasmia is very common early in Nardil treatment. I couldn't offer you any statistics, but many people find that their ability to achieve orgasm returns after 3 months or so.
- Scott
Posted by cosis on August 9, 2004, at 11:48:52
In reply to All current and former NARDIL users!! Need advice, posted by Michael Bell on August 8, 2004, at 21:01:46
> I've reached a crossroads in my life where I need to determine what my next long-term therapy med for SP is going to be. The Klonopin has been great for anxiety, but it's been making me more and more anhedonic and dysthymic, and I can't take it anymore. Using adjunctive meds like adderall or amisulpride or prozac have had minimal beneficial effects if any.
>
> I once tried Nardil for about 3 weeks, and it was the best med for SP I've ever tried (in combo with Klonopin). But the side effect profile scared me too much.
>
> Now I've come full circle, and I need your advice please. If you've ever used Nardil, especially for SP, please answer the following:
>
> 1) How real is the hypertensive crisis risk if I follow the diet?
>
> 2) What is the best med to block a hypertensive crisis from occurring?
>
> 3) Do the sexual side effects ever go away?
>
> 4) Finally, what is your overall feeling regarding Nardil as long term treatment for SP?
>
> Thanks so much for your help. I hope everyone is making progress towards the ultimate goal.My orgasms returned after 4 months, although they are harder to achieve I can usually have one about 80% of the time.......... If I go down to 60mg I can have them all the time.......
This is the end of the thread.
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