![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 36. Go back in thread:
Posted by DynaUnity333 on October 23, 2004, at 6:18:51
In reply to Re: STOPED and RESTARTED Nardil,great only for a time » Tepiaca, posted by King Vultan on October 21, 2004, at 22:51:09
> >
> > King I reached the dose of 75mg , and never felt relief.
> > Do you think I am of those people who find more relief at little doses.
> > Im thinking of decreasing the dose to 15mg
> > Does this make any sense to you?
> >
> > How have you felt with the parnate tod?
> > have you found relief?
> >
> >
>
> Anything is possible, I suppose, but it seems hard to believe 15 mg of Nardil would work when 30 mg isn't. However, I've gotten boosts myself sometimes when lowering the dosage of meds or dumping them altogether, but this has generally only been temporary. Typically, it would be in the case of dropping an SSRI such as Zoloft, probably having something to do with dopamine levels rising back up to normal.
>
> Parnate at 50 mg/day is working reasonably well, but I think I would be doing even better if I got more sleep. This is definitely the worst of the 12 drugs I have tried as far as insomnia. I am alternating between Halcion and OTC antihistamines, and even the Halcion is just barely adequate. I think maybe I'll try trazodone again and see if it doesn't work better than when I tried it on Nardil (it made me depressed at that time, but I think the Parnate has made some changes in receptor densities such that it may work better now).
>
> ToddI don't know how anything about Nardil, but i know that the statement about lowring medication if higher doses aren't working not making any sense, is a misconception.
I absolutely hated paxil, hated hated hated. doctors kept ramping up the dose and i got worse and worse.
As i was coming off during my slow taper, i felt much relief from depression, anxiety and even physical pain to a point, when i hit the 2mgs (liquid form) per day. I make no sense of it except that maybe sometimes the more is better attitude adopted in medicine these days can be not only completely wrong, but in some cases quite problematic
Posted by jujube on October 23, 2004, at 20:45:31
In reply to Re: STOPED and RESTARTED Nardil,great only for a time » Tepiaca, posted by King Vultan on October 22, 2004, at 23:11:45
> >
> > > >
> >
> > Do you think that increasing and decreasing the dose could be the solution ?
> > or this is not something safe?
> >
>
>
> Well, I wouldn't say that it's not safe, but I think it's less than ideal to have to resort to something like that in order to feel better. In my mind, it's a little along the lines of utilizing sleep deprivation as an antidepressant treatment. I would rather take a drug at a constant dosage and efficacy (assuming it works, of course, which I know is easier said than done).
>
>
> >
> > > Parnate at 50 mg/day is working reasonably well, but I think I would be doing even better if I got more sleep. >
> > > Todd
> >
> >
> > Todd how do you compare the Nardil and Parnate in terms of social anxiety ?
> >
> > Thank you very much !
> > Tep
> >
>
>
> I think they're both very good drugs for social anxiety. For me, Parnate seems superior, as it gives me the self confidence and boldness that I naturally seem to be lacking. Nardil did make me more sociable but did not address my own particular manifestation of social phobia as well as Parnate does. I think it really depends on the individual as to which one is a better choice.
>
> ToddCould you please tell me if Parnate is effective for generalized anxiety disorder? I had great success with Paxil when it was prescribed for me about 8 years ago, but stopped taking it about two years ago. When the depression and anxiety came back with a vengence earlier this year, I tried Paxil again, with no response. The doctor switched me to Prozac and it was 2 weeks of hell. Next came Effexor XR, which kept me apprehensive and left me apathetic and unmotivated. I am now on Celexa and, after 6 weeks, have not noticed any significant improvement. I am becoming frustrated and demoralized, and getting to the end of my rope. Anything you can tell me or any suggestions you may have would be greatly appreciated. I live in Canada, which means that some drugs, such as Cymbalta and Lexapro are not available yet.
Thanks so much.
Tamara
Posted by King Vultan on October 23, 2004, at 23:41:16
In reply to Re: STOPED and RESTARTED Nardil,great only for a time » King Vultan, posted by jujube on October 23, 2004, at 20:45:31
> > >
> > >
> >
> >
> >
> > >
>
> Could you please tell me if Parnate is effective for generalized anxiety disorder? I had great success with Paxil when it was prescribed for me about 8 years ago, but stopped taking it about two years ago. When the depression and anxiety came back with a vengence earlier this year, I tried Paxil again, with no response. The doctor switched me to Prozac and it was 2 weeks of hell. Next came Effexor XR, which kept me apprehensive and left me apathetic and unmotivated. I am now on Celexa and, after 6 weeks, have not noticed any significant improvement. I am becoming frustrated and demoralized, and getting to the end of my rope. Anything you can tell me or any suggestions you may have would be greatly appreciated. I live in Canada, which means that some drugs, such as Cymbalta and Lexapro are not available yet.
>
> Thanks so much.
>
> Tamara
It's hard for me to say because I no longer have GAD, having slowly and painfully conquered this problem over the years. I have to believe Nardil would be better than Parnate because of Nardil's effects on GABA, which should make Nardil more anxiolytic. My overall anxiety levels are relatively low and have not been noticeably affected by either drug. I think I can give Nardil a recommendation if a person is willing to put up with all the blasted side effects, but I'm not so sure about Parnate. Perhaps someone with higher levels of anxiety who has tried Parnate could give you a better answer.Todd
Posted by jujube on October 24, 2004, at 7:56:45
In reply to Re: Parnate and anxiety » jujube, posted by King Vultan on October 23, 2004, at 23:41:16
Thanks. I appreciate your taking the time to resond. At this point, I am trying to research options to discus with my pdoc at my next visit. Anxiety is such a big part of my depression. It seems the anxiety comes first and then the depression follows when I can't get a hold on the anxiety and my apprehensive thoughts. So, I really need something that quashes the anxiety. Xanax works really well, but he doesn't want to give it to me. And, a big part of what I am going through, I am pretty sure, is hormonal. Everything went downhill (severe anxiety, thoughts of death, etc.) after I had my first Depo Provera shot (a synthetic hormone injection that stays in your system for 3 months). Who knows, maybe once the shot wears off, the anxiety and depression will become more manageale. Anyways, sorry for rambling. And, thanks again.
Tamara
Posted by ravenstorm on October 27, 2004, at 12:22:31
In reply to Re: Parnate and anxiety » King Vultan, posted by jujube on October 24, 2004, at 7:56:45
Does anyone know if the transdermal patch (in theory) will be able to be tolerated by people with anxiety? I can't handle wellbutrin even with remeron (or maybe because of-since remeron effects NE as well). Trying to hold out for the patch before giving up and tring to make it through the start up of an SSRI, but if it is going to be like WB I might as well give up now. Anybody know anything about how this might "theoretically" affect people (since no one here has probably done a clincial trial with it!)
Posted by jujube on October 27, 2004, at 12:49:17
In reply to Re: Emsam and anxiety, posted by ravenstorm on October 27, 2004, at 12:22:31
I'm sorry I don't have an answer for you. I do, however, have a question for you, if you don't mind. I am needing to find a new AD, and was wondering what your experience has been on Remeron? So far I have tried Paxil (worked great the first time I was put on it years ago, but 2nd time nothing), Prozac, Effexor and now Celexa. I need something for both anxiety and depression. Anything you can tell me would be greatly appreciated. Hope someone can help you with your question. Thanks so much.
Tamara
> Does anyone know if the transdermal patch (in theory) will be able to be tolerated by people with anxiety? I can't handle wellbutrin even with remeron (or maybe because of-since remeron effects NE as well). Trying to hold out for the patch before giving up and tring to make it through the start up of an SSRI, but if it is going to be like WB I might as well give up now. Anybody know anything about how this might "theoretically" affect people (since no one here has probably done a clincial trial with it!)
Posted by ravenstorm on October 27, 2004, at 14:20:13
In reply to Re: Emsam and anxiety » ravenstorm, posted by jujube on October 27, 2004, at 12:49:17
I could only take 15mg as practically lapsed into a coma when I tried to up the dosage at all. Helps with sleep but has made me have anger issues (husband noted this two weeks after starting remeron) which WB has exacerbated. Did not do enough for depression at 15mg and felt tired a lot. WB added which was great when it kicked in, but then increased anxiety so much that I have dropped to only 100mg WB and am still having a ton of anxiety. I'm not that thrilled with it as a medication.
Posted by jujube on October 27, 2004, at 15:17:00
In reply to Re: Emsam and anxiety, posted by ravenstorm on October 27, 2004, at 14:20:13
Thanks. I had been hearing that Remeron can be really sedating, and that it's antidepressant effect may not be that great. Also, apparently it can cause a lot of weight gain (yuk). Well, I will continue my search and discuss options with the pdoc next Monday.
Take care.
Tamara
> I could only take 15mg as practically lapsed into a coma when I tried to up the dosage at all. Helps with sleep but has made me have anger issues (husband noted this two weeks after starting remeron) which WB has exacerbated. Did not do enough for depression at 15mg and felt tired a lot. WB added which was great when it kicked in, but then increased anxiety so much that I have dropped to only 100mg WB and am still having a ton of anxiety. I'm not that thrilled with it as a medication.
Posted by yznhymer on October 27, 2004, at 21:32:51
In reply to Re: Emsam and anxiety, posted by ravenstorm on October 27, 2004, at 12:22:31
> Does anyone know if the transdermal patch (in theory) will be able to be tolerated by people with anxiety? I can't handle wellbutrin even with remeron (or maybe because of-since remeron effects NE as well). Trying to hold out for the patch before giving up and tring to make it through the start up of an SSRI, but if it is going to be like WB I might as well give up now. Anybody know anything about how this might "theoretically" affect people (since no one here has probably done a clincial trial with it!)
Do a search for selegiline on this site. Some people actually did participate in the patch trials and posted extensively about it. I believe a fellow named Adam had some very good experiences with it.
Mark
Posted by ravenstorm on October 28, 2004, at 15:52:55
In reply to Re: Emsam and anxiety » ravenstorm, posted by yznhymer on October 27, 2004, at 21:32:51
I did look up those posts by/about Adam. THe only thing I could glean was that he had a severe depressive disorder but no word about anxiety.
I did find one person who took oral selegeline had anxiety (similar to WB). Others had no anxiety but perhaps were not predisposed to it.
I am feeling pretty stupid at the moment. A lot of my decision making about meds lately has somewhat centered around not wanting to be on anything I couldn't easily get off, or anything I couldn't take concurrently with the MAOI patch when/if it comes out. (A while back it looked like it was going to be before the end of the year) I was so interested in the patch because I have such a bad stomach and I have heard that MAOI's kick butt in terms of depression etc. I haven't reallized until recently that the different MAOI's are so different. I just thought they all worked on the three big neurotransmitters so they were probably just somewhat different in the same way that different SSRIs are different depending on the person. OK, DUH, not true. Seems like selegeline will be more activating than parnate. But, I have found plenty of examples of people with anxiety who take parnate and it helps their anxiety. (The person who got too activated by oral selegeline found that parnate helped both her anxiety and depression).
In my own defense, I was too screwed up for much of last year to think all that clearly. I did try nortriptyline, celexa, prozac, remeron, WB and all the natural supplement crap. The remeron/WB combo gave me a good month and a half of somewhat normal (still some crappy side effects) but I thought I could limp along on it until the patch came out. But the last month or so on the combo has been excruciating, hellish anxiety. And so as of yesterday, I will be unable to continue with the WB. And the irony of all this? I get withdrawal syndrome (NOT as bad as paxil, but serious deterioration in mood and nausea/insomnia) when I tried to stop the remeron (I thought this drug didn't have a discontinuation syndrome--but again, I'm super sensitive). At least when I was trapped on paxil, it worked and didn't make me angry and tired like remeron. And the greater Irony of course is that I may not tolerate the patch anyway if it is going to affect me like WB.
Anyway, I'm trying to decide what to do next. NE seems to not agree with me. Not even the small amount that remeron affects,(oh, and my pdoc didn't even know that remeron affects NE!) so I think cymbalta is pretty much out. I can try lexapro again and see if I can make it through the start ups since I have a small toe hold on sanity compared to before.(Made me seriously ill for four days--puking foggy headed, worsening of mood) when I tried it the first time before moving on to remeron. Should have tried it longer, but again, was afraid of not being able to get back off of it. Which was stupid thinking, as I probably won't be able to tolerate the patch anyway!
Oh, back to the topic at hand. Sorry for digression. I asked my doctor (who I have virtually no faith in anymore because he doesn't think WB really causes anxiety and he mentioned that he doesn't think effexor is hard to get off of!) if he prescribed MAOI's and he said he gives nardil. I asked if nardil didn't tend to make people fat and asexual and he said it wasn't that much of a problem. He then said he wanted me to try to keep taking the remeron and lowered WB awhile longer, but I called yesterday and left a message that I just couldn't do it anymore. Severe anxiety destabilizes my mood faster than anything. I am crying all the time, and leaving the house is difficult. (Which is sooooooooo dangerous this time of year for me. This summer I exercised outside three to six times per day. It is critical for me to keep exercising with my seasonal affective disorder, but I need to go join a gym this time of year and I am too anxious from the WB to even go to one!!!!!!!!)
I would think nardil plus remeron would be a sure way to guarantee obesity!!!!!!!!! (But as the previous poster indicated, he didn't gain weight at all) I don't know how he would react if I tried to demand a trial of parnate first. I didn't really get too far with questions on the phone because when I'm having anxiety, it is difficult for me to talk on the phone and process what the other person is saying. Also a bit freaked out about the withdrawal syndrome of MAOIs. Don't get me wrong, if I find something that works again, I won't go off of it. The fear is trying something, discovering it doesn't work and then having to go through withdrawal. Its not just the physical discomfort (though that is pretty severe--its the anxiety and suicidal ideation--which is what was going on last week-- that scare the hell out of me).
Finally, if anyone is even reading this. I would like to apologize if I have been out of hand in some of my posts. I'm pissed off that I thought I was done with this and I'm not. I'm pissed off that I get so sickand or suicidal when I try to come on and off these meds. That and i'm on two meds that seems to cause me to be angry (husband noted it after only two weeks on the remeron--should have just stopped taking it then and I wouldn't have to worry about withdrawal!!!) Regardless of all that, you all have enough problems of your own without having to listen to my whining.
Sorry. Sorry. Sorry.
P.S. am trying to research through old posts but it is hard to tell if people taking parnate have anxiety disorders or just atypical depression. Also, found some pubmed reports on parnate addiction (their word, not mine)--is that possible?
p.p.s if I go on an MAOI I can't have children. But at this point I have pretty much told my husband he would be better off divorcing me as I may never be well enough again to have children, and if I do get well I may be on something that causes birth defects (like MAOIs)
Posted by yznhymer on October 28, 2004, at 16:40:48
In reply to MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 28, 2004, at 15:52:55
> I did look up those posts by/about Adam. THe only thing I could glean was that he had a severe depressive disorder but no word about anxiety.
>
> I did find one person who took oral selegeline had anxiety (similar to WB). Others had no anxiety but perhaps were not predisposed to it.
>
> I am feeling pretty stupid at the moment. A lot of my decision making about meds lately has somewhat centered around not wanting to be on anything I couldn't easily get off, or anything I couldn't take concurrently with the MAOI patch when/if it comes out. (A while back it looked like it was going to be before the end of the year) I was so interested in the patch because I have such a bad stomach and I have heard that MAOI's kick butt in terms of depression etc. I haven't reallized until recently that the different MAOI's are so different. I just thought they all worked on the three big neurotransmitters so they were probably just somewhat different in the same way that different SSRIs are different depending on the person. OK, DUH, not true. Seems like selegeline will be more activating than parnate. But, I have found plenty of examples of people with anxiety who take parnate and it helps their anxiety. (The person who got too activated by oral selegeline found that parnate helped both her anxiety and depression).
>
> In my own defense, I was too screwed up for much of last year to think all that clearly. I did try nortriptyline, celexa, prozac, remeron, WB and all the natural supplement crap. The remeron/WB combo gave me a good month and a half of somewhat normal (still some crappy side effects) but I thought I could limp along on it until the patch came out. But the last month or so on the combo has been excruciating, hellish anxiety. And so as of yesterday, I will be unable to continue with the WB. And the irony of all this? I get withdrawal syndrome (NOT as bad as paxil, but serious deterioration in mood and nausea/insomnia) when I tried to stop the remeron (I thought this drug didn't have a discontinuation syndrome--but again, I'm super sensitive). At least when I was trapped on paxil, it worked and didn't make me angry and tired like remeron. And the greater Irony of course is that I may not tolerate the patch anyway if it is going to affect me like WB.
>
> Anyway, I'm trying to decide what to do next. NE seems to not agree with me. Not even the small amount that remeron affects,(oh, and my pdoc didn't even know that remeron affects NE!) so I think cymbalta is pretty much out. I can try lexapro again and see if I can make it through the start ups since I have a small toe hold on sanity compared to before.(Made me seriously ill for four days--puking foggy headed, worsening of mood) when I tried it the first time before moving on to remeron. Should have tried it longer, but again, was afraid of not being able to get back off of it. Which was stupid thinking, as I probably won't be able to tolerate the patch anyway!
>
> Oh, back to the topic at hand. Sorry for digression. I asked my doctor (who I have virtually no faith in anymore because he doesn't think WB really causes anxiety and he mentioned that he doesn't think effexor is hard to get off of!) if he prescribed MAOI's and he said he gives nardil. I asked if nardil didn't tend to make people fat and asexual and he said it wasn't that much of a problem. He then said he wanted me to try to keep taking the remeron and lowered WB awhile longer, but I called yesterday and left a message that I just couldn't do it anymore. Severe anxiety destabilizes my mood faster than anything. I am crying all the time, and leaving the house is difficult. (Which is sooooooooo dangerous this time of year for me. This summer I exercised outside three to six times per day. It is critical for me to keep exercising with my seasonal affective disorder, but I need to go join a gym this time of year and I am too anxious from the WB to even go to one!!!!!!!!)
>
> I would think nardil plus remeron would be a sure way to guarantee obesity!!!!!!!!! (But as the previous poster indicated, he didn't gain weight at all) I don't know how he would react if I tried to demand a trial of parnate first. I didn't really get too far with questions on the phone because when I'm having anxiety, it is difficult for me to talk on the phone and process what the other person is saying. Also a bit freaked out about the withdrawal syndrome of MAOIs. Don't get me wrong, if I find something that works again, I won't go off of it. The fear is trying something, discovering it doesn't work and then having to go through withdrawal. Its not just the physical discomfort (though that is pretty severe--its the anxiety and suicidal ideation--which is what was going on last week-- that scare the hell out of me).
>
> Finally, if anyone is even reading this. I would like to apologize if I have been out of hand in some of my posts. I'm pissed off that I thought I was done with this and I'm not. I'm pissed off that I get so sickand or suicidal when I try to come on and off these meds. That and i'm on two meds that seems to cause me to be angry (husband noted it after only two weeks on the remeron--should have just stopped taking it then and I wouldn't have to worry about withdrawal!!!) Regardless of all that, you all have enough problems of your own without having to listen to my whining.
>
> Sorry. Sorry. Sorry.
>
> P.S. am trying to research through old posts but it is hard to tell if people taking parnate have anxiety disorders or just atypical depression. Also, found some pubmed reports on parnate addiction (their word, not mine)--is that possible?
>
> p.p.s if I go on an MAOI I can't have children. But at this point I have pretty much told my husband he would be better off divorcing me as I may never be well enough again to have children, and if I do get well I may be on something that causes birth defects (like MAOIs)I'm sorry you are having such a bad time of it. Drug trials that don't work out are really the pits. I just had to ditch Cymbalta after 2 weeks, and I don't know what Imna do next. I too am hoping the EMSAM patch may be the ticket. Fortunately, I haven't had the kind of depression that causes suicidal ideation in almost a decade, so as bad as I often feel, its nothing compared to the snakepit of dispair that depression can induce.
I've been concentrating on making the quality of my life as good as it can be given the fact that I'm chronically tired, unmotivated, disinterested, and irritiable. It has helped, but then I have more leeway then when I was younger and had to hold down a job, raise kids, etc. Cheri Huber (sic) has written some wonderful and easy to read books based on zen principles that have helped me immensely to live with depression until I find the path to remission:
"The Depression Book: Depression As an Opportunity for Spiritual Growth"
"There is Nothing Wrong With You"
I know very little about meds but I do share your sensitivity to side effects. Others here will probably have better medical advice for you than I can muster. I'll share a couple of layman's thoughts though...
1. If you can find an antidepressant that works on your dpression and that you can tolerate, you probably can augment with something to ease the anxiety. I envy people who get relief from their depression and anxiety from one pill, but have learned that ain't gonna be me.
2. Moclobemide (Manerix)is a selective reversible maoi available from Canada with a prescription. I didn't find it robustly effective for me, but the side effects were very tolerble (almost non-existant), and I'm usually very sensitive to side effects. Also, getting off it was a breeze. Perhaps your doc will be willing to consider it. One of my pdocs was OK with it, the most recent is not comfortable prescribing it since its not approved for sale here. I just don't think its as robust a med as Nardil or Parnate, but you may not need that level of robustness.
Best Wishes...
Mark
Posted by ravenstorm on October 28, 2004, at 16:54:11
In reply to Re: MAOIs and anxiety, confusing! my life an apology » ravenstorm, posted by yznhymer on October 28, 2004, at 16:40:48
Thank you so much for your kind words.
I will look into the books, although, I have to say I used to meditate, do energy healing the whole bit and I have lost faith in what used to sustain me as it does not even take the edge off of this. I know it is weak to lose faith because you feel bad, but part of the reason I got off a medication that worked for me was pressure from those in the energy healing communtiy (including my husband) who believed that I should be able to heal my depression without medication (plus,we wanted to have a baby and my husband refused to if I was on meds). Now, over a year later, I still don't have a medication I can take and I still don't have my life back. I literally don't even know who I am any more.
Actually, the augmentation of anxiety has been a bust for me as well. Remeron helped with anxiety somewhat but did nothing for depression, hence the WB. When the anxiety started the doctor started throwing medications on that: xanax, lorazapam (I have a paradoxical reaction to benzos--lucky me), neurontin (could not keep my eyes open on it even at a low dose etc etc. I have finally, after a month of torture had to concede defeat and stopped the WB today. Really hard to give up the only thing that made me happy for four weeks out of fifty two.
What happened with your cymbalta trial?
Again, thank you for your compassion.
Posted by ravenstorm on October 28, 2004, at 17:13:16
In reply to Re: MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 28, 2004, at 16:54:11
I will look into the moclo. It does not seem to be well regarded on this site, but I guess it doesn't hurt to look into it. Sounds like your trial of it was at least pretty painless, which is more than I can say for all the other meds I've tried.
How long were you on it? How much did you take?The last person I saw post about it said it activated their anxiety. Did that happen to you? Do you have anxiety or just depression? How many meds have you tried.
I'm glad the zen approach is helping you.
Posted by King Vultan on October 28, 2004, at 22:05:32
In reply to MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 28, 2004, at 15:52:55
If you don't tolerate drugs well with overt NE effects, Nardil seems to be much worse than Parnate; although, it is not as bad as a tricyclic. I seem to have a tendency to get constipation from any drug with even weak tendencies to do so, and I had constant constipation on Nardil. Parnate does not do this, at least not for me at 50 mg/day. The only constipation I am suffering is from the anticholinergic OTC antihistamines that I use every other night for sleep. It is easy enough to tell from the timing that that is where it's coming from.
Parnate has the fewest side effects of any of the 12 drugs I've tried, and the only one I can actually say for certain that I've noticed is insomnia, which is very, very bad. I'm seeing my pdoc next week about substituting a prescription drug like hydroxyzine for the Benadryl I currently use every other night. The Halcion/triazolam I use the other nights seems to be powerful enough, but just barely.
Nardil still might be worth a try, though. It is considered to really be very good on anxiety, and I think it also has very good antidepressant efficacy. The side effects might not affect you as much as they do some other people. However, with Nardil, I would still recommend not using a much higher dose than wherever solid therapeutic effects are obtained. Further improvements are often not large enough to justify the increase in side effects.
Todd
Posted by ravenstorm on October 28, 2004, at 23:24:57
In reply to Re: MAOIs and anxiety, confusing! my life an apology » ravenstorm, posted by King Vultan on October 28, 2004, at 22:05:32
Thanks Todd--
I would prefer to try parnate just because of the better side effect profile, but who knows if my pdoc will go for that. My blood pressure is definitely at the lower side of normal, so I have visions of myself doing permanent face plants into the carpet on Nardil.
At the moment, I'm just trying to come down from the WB!
As far as NE, definitely no good with the WB and get edginess even from the remeron. As for nortriptyline, I was only on it a few days because my heart literally felt like it was beating out of my chest for hours after I took even a small dose. So, I don't really know how that one would have effected me at higher doses.
Kind of freaked at how harsh the discontinuation is. If I got this screwed up coming off paxil wayyyyy slowly what the heck would happen to me if parnate or nardil didn't work? By the way, how much of a washout do you have to leave between MAOIs?
As far as constipation. I seem to get the opposite (EXCEPT on paxil). But that is from the SSRIs, and maybe that would have passed if I could have gotten through the start ups of celexa and lexapro.
Thanks again for your information. It has helped a lot reading your past posts as you have tried both nardil and parnate. You seem to have responded pretty well to both. (Oh, I can't remember--did you have sexual side effects on nardil?) I've heard some people only respond to one and not the other. Wierd. Sometimes I think this stuff is all chemical voodoo!
Do you think you'll try the patch when it comes out? or are you pretty happy on the parnate?
Posted by King Vultan on October 29, 2004, at 7:50:16
In reply to Re: MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 28, 2004, at 23:24:57
>
> Kind of freaked at how harsh the discontinuation is. If I got this screwed up coming off paxil wayyyyy slowly what the heck would happen to me if parnate or nardil didn't work? By the way, how much of a washout do you have to leave between MAOIs?
>The standard washout period switching between the traditional MAOIs is two weeks, which I think is wise. Nardil, in particular, has a very long half life of MAO-A inhibition, despite the fact that the drug itself only has a half life of a few hours. Why Nardil and Parnate differ in their half lives of MAO-A inhibition is something I don't quite understand.
> As far as constipation. I seem to get the opposite (EXCEPT on paxil). But that is from the SSRIs, and maybe that would have passed if I could have gotten through the start ups of celexa and lexapro.
>
> Thanks again for your information. It has helped a lot reading your past posts as you have tried both nardil and parnate. You seem to have responded pretty well to both. (Oh, I can't remember--did you have sexual side effects on nardil?) I've heard some people only respond to one and not the other. Wierd. Sometimes I think this stuff is all chemical voodoo!
>
> Do you think you'll try the patch when it comes out? or are you pretty happy on the parnate?
I seem pretty weak in the dopamine/libido department to begin with, and Nardil lowered my libido even more; although, my understanding is that this is a little unusual and not as common as it is with SSRIs. Nardil also definitely delayed orgasm, which no other drug that I've ever tried was able to do. I must profess to not having much interest in the patch; I would probably be more inclined to try selegiline orally first, but I don't think it will be necessary, given that Parnate seems to be pretty well suited to me.Todd
Posted by Ritch on October 29, 2004, at 10:19:54
In reply to MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 28, 2004, at 15:52:55
I get the worst anger from Remeron and/or Wellbutrin and have been on those in the past several times with other various meds. The anx. with WB has been pretty consistent as well-to the point of agoraphobia. I would consider myself an NE sensitive individual as well. But like yourself, find that stimulating meds are the only ones that work during lethargic seasonal depressions. I think what *might* be helpful for you would be to forget the Remeron and Wellbutrin (to get rid of the anger and anxiety) and go for a serotonergic at a lowdose and then add a dopaminergic kick for the alertness. What about using Celexa liquid at just 2mg/day to avoid the startup hell and to settle down the anxiety and then add a *fragment* of something like Provigil to get you woke up, and then titrate and balance the two together carefully? I tend to feel avoidant with a predominately noradrenergic med, but emboldened on a predom. dopaminergic med. I know this is all complicated and I have to struggle with very similar issues. I can pretty much wipeout my depression but at the cost of being horribly anxious. I can wipeout anxiety and then feel lethargic and depressed. What a hassle. I hope you can get something worked out-maybe the MAOI route would be best. I've thought about moclobemide as well. Best wishes.
Posted by ravenstorm on October 29, 2004, at 17:36:19
In reply to Re: MAOIs and anxiety, confusing! my life an apology » ravenstorm, posted by King Vultan on October 29, 2004, at 7:50:16
Todd, so happy you have found something that works for you!!!!!!!!!
Ritch: so appreciate the suggestions and they totally make sense to me. Unfortunately there are a few snafus:
1)When I tried 5mg of celexa I had a really extreme reaction to it: I shook like a leaf (could have gotten through that) and I could not stop moving (I think the technical term for it starts with an A., but I don't remember what it is!) It was much worse than what I have described it as. It was very freaky and also very disappointing to me, as I was really happy my previous Pdoc had suggested celexa, because that was the SSRI I would have chosen for myself (longer half life than some others, some said fewer side effects etc etc).
Now, I could possibly try Lexapro again, it made me feel like crap even at 2mg (severe nausea, severe dizzyness, fog head, feeling as if head was disconnected from body, crying more.), however, if I took off of work I could probably make it through (and since I'm currently on remeron that would block the nausea). My only concern is my last pdoc didn't even want me to try it because she said it caused more GI problems than even other SSRIs, and with my stomach problems I probably wouldn't be able to take it. I would be willing to try it again, though, I think.2) I want to be off remeron as of yesterday, but when I tried cutting my dose in half, within seven days my mood nose dived, I had insomnia and I got nauseaus and dizzy. Don't think I can go through withdrawal to something until I am feeling a bit better. (Didn't expect ANY of this as I've always been told you can just stop taking remeron)
Something that still just does NOT make sense to me is that when I first started on AD's I was put on full doses of medication, had some unpleasant start ups and then was fine. For example, the first AD I was tried on was Zoloft. I was given 50mgs, had severe headaches, nausea and cotton head but also stopped crying and had no more panic attacks. When those symptoms didn't clear within two weeks, I was switched to 20mg paxil and all those symptoms disappearead. I was pretty much feeling great with a total of three to four weeks. Now, even miniscule doses of things totally screw me up!! The other thing is that I was totally fine on a low maintenance dose of 2mg-5mg of paxil for years and yet after the final withdrawal I ended up with worse anxiety and depression than I had ever been before starting paxil (seriously, thousands of times worse!!!!Had never been suicidal in my life!)
I really came to believe that the drug had somehow depleted my brain and it was only after months of suicidal, non functional anguish that I reallized that I really didn't have a choice anymore. . .I had to go back on a med. I fully expected to take my prescribed Celexa, be sick for two weeks and then be better in a month. That was a year ago.
I don't know why I react to everything so adversley now. Maybe I need to get my brain reset with rTMS!
Oh, well. Before I even try another medication I need to get this WB out of my system and pray that I return to the relatively anxiety free state I had on 15mg of remeron.
Thanks again, will keep you posted if I do try the Lexapro again. What is currently working for you?
Posted by ravenstorm on October 29, 2004, at 20:55:25
In reply to Re: MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 29, 2004, at 17:36:19
Sorry to bother you. How much moclobemide did you take and for how long?
Posted by Ritch on October 30, 2004, at 9:56:39
In reply to Re: MAOIs and anxiety, confusing! my life an apology, posted by ravenstorm on October 29, 2004, at 17:36:19
Wow! You have really been through the ringer with SSRI's. What's very odd is that your reaction over time is similar to mine. It is like some sort of "reverse" intolerance of SSRI's that is similar to the reverse intolerance to amphetamines that you hear about (smaller and smaller quantities causing worsening adverse effects). When I first tried an SSRI it was Prozac and started off with 20mg a day for nearly two weeks with just a little nausea as a side effect (along with lithium). But quickly became too agitated and reduced to about 5mg a day for a while, and then... needed to get that down to about 2.5mg/day and stayed on that for years. Later I was getting allergic reactions that could have been attributed to the Prozac and was switched to Zoloft.. then Celexa. I started the Celexa at 10mg then went to 20mg and developed shortness of breath. I got that with Prozac at a constant dose, when my depression remitted in the Spring. Eventually settled on about 2.5mg/day of Celexa for a couple of years. Then went to Effexor for a couple... blahblahblah. Anyhow, the bottom line was that: 1) The new serotonergic drugs worked remarkably well for anxiety, 2) My tolerance of the side effects got very short-fused over time, 3) They aggravated my bipolar cycling, BUT 4) If I stop them I slowly start getting more anxious and panicky and I feel worse off and end up back on them again. This all feels VERY physical-maybe it's my enteric nervous system and my central nervous system engaged in a royal battle of sorts? The SRI's chill out my head, but work over my body. Jeez. The SRi's really are anxiolytics for me.. I don't really consider them antidepressants. They reduce the stress-induced precursors to depression in some way, but don't seem to really 'solve' the depression. Only the noradrenergics like Stratterra or Wellbutrin seem to work. I'm currently on Depakote/clonazepam/tiny bit of Cymbalta (been on for over a month now). We thought the Cymbalta (tiny 1-2mg) would be the ideal thing, but it is more agitating than Effexor or Strattera! Whoa, sorry for the rant. Over all the years it looks like Depakote-or-lithium + benzo(clonazepam) + Wellbutrin + Effexor-or-Zoloft + fishoil + L-tyrosine has probably been the best overall combo that I've been on for wintertime/summertime recurrent depressions. I'm running to the porcelain bus if I take lithium, Zoloft, and to a lesser extent the Effexor, and I'm jittery, avoidant, and grouchy on the Wellbutrin, but hey I'm NOT depressed! The serotonergics lighten up the anxiety, the noradrenergics lighten the 'dark thoughts' and wake me up. I would really like a TWO MED solution here. (thinking out loud) Could I just take Depakote and low-dose moclobemide and be done with it? I understand your frustration all too well. I don't think it is just being too obsessed with meds-I'm just fed up with being depressed 50% or more out of ever year that I live-- it might not be BAD depression all that time, but it IS depression nevertheless. Well, I hope you have some luck with this problem-- I'll be back in a few days and catch up. TTYL
Posted by yznhymer on October 30, 2004, at 16:38:45
In reply to Re: MAOIs-yznhymer, how much moclo did you take?, posted by ravenstorm on October 29, 2004, at 20:55:25
> Sorry to bother you. How much moclobemide did you take and for how long?
No bother at all. :)I went up to 600mg a day, which I believe is the recommended maximum. I have to say though, that I am not good at remembering to take my second pill, so there were a fair number of days when I only took half the prescribed dosage, and this may account for the not so robust response to it. Even using one of those weekly pill organizers only helped a bit. Anyway, I did feel better when I took the 600 consistently. I was on it at least a couple of years, but I'd have to go back and check records to know exactly how long.
Mark
Posted by ravenstorm on November 2, 2004, at 21:47:38
In reply to Re: MAOIs and anxiety, confusing! my life an apology » ravenstorm, posted by Ritch on October 30, 2004, at 9:56:39
Thanks for your post Ritch. I am just starting to feel like I'm not going to get better. Like, I just totally screwed up when I didn't immediately switch onto another SSRI the minute I started having the severe withdrawal symptoms. My brain now needs meds more than it did before I started on them, but, my system seems entirely unable to tolerate them (ie getting way sick or wacked out). I am pretty severely depressed with out of control anxiety.
Sigh. I can't face trying anything yet. If I decide to add some moclo to the remeron I'll keep you posted on my progress. (But I'm not holding my breath on that one).
I wonder if low dose lamictal would do anything for unipolar depression?
Posted by matt66 on November 3, 2004, at 10:16:27
In reply to STOPED and RESTARTED Nardil,great only for a time, posted by Tepiaca on October 20, 2004, at 20:56:53
tepiaca,
I've had a very similar experience with nardil. Five years ago, when I first started ad's, the nardil was the eighth or ninth med I tried after breezing through the ssri's, and it worked gloriously initially. It was the best two weeks of my life. Absolutely increadible. It was like I just woke up from a decade-long slumber and finally came alive. My ability to interact with people was astonishing. I had a sense of humor finally and lost my debilitating inhibitions.It faded out after two or three weeks and during the next four years I tried everything, including shock therapy to no avail. In February '04 I tried marplan for the fourth or fifth time and it worked just like the nardil for a week or two. After that, I was stable, but not great. After increasing the dose, I would feel better for a while. It actually kept me ok (great considering some of the awful places my mind had been in the last few years) for almost six months.
Sometime in August I reached some kind of threshold. I was on 130mg a day, which is probably twice the recommended dosage. When I got that high, (without any real side effects to speak of-I'm increadibly tolerant to most meds) cost became a factor, and it wasn't doing much anyway, so I added the nardil. Within 24 hours I was at 100%. The marplan/nardil combo was great for about 5 days.
After that, each time I would sink, I would increase the nardil, and feel relief for a day maybe. When I would fade, we'd push the dose. When I dropped the marplan, the nardil alone still worked, and made me realize that the marplan wasn't really helping, but that the nardil was the one resonsible for my feeling great again.
I got up to 180mg a day of nardil without major side effects besides insomnia and constipation. At that point, we decided it wasn't practical to stay on that high a dose, since it wasn't helping much even as I raised the dose 15mg a day.
In summary, taking 30 or 45mg a day worked wonderfully when I first introduced the nardil into my system. After a perfect week or two, taking five times that amount brought only slight relief. It's such a tease for me. I'm on cymbalta now which is doing nothing.While Nardil and Marplan are the only meds I have responded to, it's not really accurate to say that they worked, since my response was so short-lived. I'm curious to know what would happen, however, if I stayed on the nardil at an average dose (say 90mg) for a longer period of time. Perhaps the initial effect wears off and the med then needs time in your system to build itself up, and that a true, sustained response may only be achieved after staying on it for a few months.
I'm also curious about augmentation strategies with the nardil, or to hear from other people who have had similar experiences with nardil who have gone on to find other meds that have worked and kept working. As a side note, I've tried parnate, moclobomide, and eldpryl without success. The Parnate I was on for three months (employing the strategy that a med needs time to start working), but it didn't do anything for me. I'll keep you updated with what I've been trying, and would be interested to find out what you have been trying as well. Since we both had such similar experiences with the nardil, that may be a tip that we'll respond similarly to other medications. Good luck....
Posted by Ritch on November 3, 2004, at 10:22:03
In reply to Re: MAOIs and anxiety, confusing! Ritch, posted by ravenstorm on November 2, 2004, at 21:47:38
> Thanks for your post Ritch. I am just starting to feel like I'm not going to get better. Like, I just totally screwed up when I didn't immediately switch onto another SSRI the minute I started having the severe withdrawal symptoms. My brain now needs meds more than it did before I started on them, but, my system seems entirely unable to tolerate them (ie getting way sick or wacked out). I am pretty severely depressed with out of control anxiety.
>
> Sigh. I can't face trying anything yet. If I decide to add some moclo to the remeron I'll keep you posted on my progress. (But I'm not holding my breath on that one).
>
> I wonder if low dose lamictal would do anything for unipolar depression?
I think Lamictal would be a good choice based on comments that I have read here. I haven't taken it yet myself-so no personal experiences to relate. One thing I can say is that lithium (by itself) has pulled me out of a summertime depression in the past. If you haven't already tried it-you might want to consider that instead-it's got a more established track record as an augmentor for unipolar depression. I'm med sensitive too and found that 600mg/day for two weeks cracked the depression, then I reduced to 300mg/day after that (tolerance issues of course). Unfortunately, I found it more effective for the summertime 'mixed' depressions I tend to get (with a lot of anxiety), and not as good for the lethargic winter SAD episodes. You might find Li more tolerable than trying to go with an SSRI again. I'm thinking about getting a light box and check it out.... I am starting to see a pattern with sleep disturbance that looks a LOT like delayed phase sleep syndrome or something like that. I forced myself to stay up an additional three hours and my sleep and alertness levels were "fixed" for two days. Hmmm. Anyhow, I would consider the Li first.. there is a pretty slow titration scheme with Lamictal and if you are really anxious.. the rash thing might get you obsessing with itchy symptoms and stuff like that. It would me anyhow. Good luck!
Posted by ravenstorm on November 4, 2004, at 20:39:03
In reply to Re: MAOIs and anxiety, confusing! Ritch » ravenstorm, posted by Ritch on November 3, 2004, at 10:22:03
Thanks Ritch. I won't take Lithium unless its a last resort because I can't be pregnant on it. Good to know about as an option though.
This is the end of the thread.
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