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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Michael Bell on January 19, 2005, at 21:01:50
It's a social phobia killer. Only been two weeks on it, and the anti-SP effects are already kicking in. I went to a club the other night, and my confidence level was high. I felt so relaxed, so non-threatened, like I was the man, and yet didn't have that "out of it" experience that Klonopin causes.
Problem is I'm having surgery in a few weeks and already have to start tapering off. Hell!
I recommend this drug to all Social Phobes who have not reached a satisfying level of functionality yet. Just watch out for the hypotension and blood sugar problems (not to mention hypertension issues).
Posted by johnsmith12345 on January 19, 2005, at 21:12:22
In reply to Nardil kicks @ss!, posted by Michael Bell on January 19, 2005, at 21:01:50
Sounds good....but do you have an emergency antihypertensive pill to take just in case?
Also why do you need to taper off for the surgery?
Posted by banga on January 19, 2005, at 21:35:31
In reply to Nardil kicks @ss!, posted by Michael Bell on January 19, 2005, at 21:01:50
Do you gain weight on this usually?
Posted by TheOutsider on January 20, 2005, at 5:21:24
In reply to Re: Nardil kicks @ss!, posted by banga on January 19, 2005, at 21:35:31
Hey Michael
Glad to hear Nardil is working for your SA!
I wish I could find a doctor in the UK who would prescribe it *sigh*
In one of your previes posts you mentioned CCK-B antagonists as a possible future treatment for Social Anxiety.
Do you know if there are any CCK-B agonists waiting to be aproved?
Posted by Michael Bell on January 20, 2005, at 7:16:15
In reply to Re: Nardil kicks @ss!, posted by johnsmith12345 on January 19, 2005, at 21:12:22
> Sounds good....but do you have an emergency antihypertensive pill to take just in case?
>
> Also why do you need to taper off for the surgery?I don't have any antihypertensive pills, though I do have a stock of Klonopin which I think is supposed to slow down norepinephrine release. As far as the surgery, you're not supposed to be on Nardil at the same time b/c anasthesia lowers blood pressure like Nardil, and there's the risk of it dipping too low, possibly causing coma.
Posted by Michael Bell on January 20, 2005, at 7:18:06
In reply to Re: Nardil kicks @ss!, posted by banga on January 19, 2005, at 21:35:31
> Do you gain weight on this usually?
That's supposed to be the case. I haven't noticed any weight gain, then again its only been two weeks. But I think it's affecting my blood sugar levels, so I wouldn't be surprised if carb and sugar cravings kick in big time, causing some weight gain. Also, I work out pretty regularly.
Posted by cosis on January 20, 2005, at 15:16:59
In reply to Re: Nardil kicks @ss! » banga, posted by Michael Bell on January 20, 2005, at 7:18:06
> > Do you gain weight on this usually?
>
> That's supposed to be the case. I haven't noticed any weight gain, then again its only been two weeks. But I think it's affecting my blood sugar levels, so I wouldn't be surprised if carb and sugar cravings kick in big time, causing some weight gain. Also, I work out pretty regularly.Glad it is working for you, be sure to watch out for the carb cravings... :)
Posted by ace on January 20, 2005, at 19:21:18
In reply to Nardil kicks @ss!, posted by Michael Bell on January 19, 2005, at 21:01:50
> It's a social phobia killer.
Bro, it's also a depression and anxiety killer!!
Only been two weeks on it, and the anti-SP effects are already kicking in.Give it 6 weeks and you'll be ready to tell the world you love it!
I went to a club the other night, and my confidence level was high. I felt so relaxed, so non-threatened, like I was the man, and yet didn't have that "out of it" experience that Klonopin causes.
Nardil is brilliant, period.!
>
> Problem is I'm having surgery in a few weeks and already have to start tapering off. Hell!That's not too good. Is there any possible way to avoid surgery? I say this because a lot of people once they re-start Nardil do not get the same great effects...i don't want to scare you, but this is sometimes the case.
>
> I recommend this drug to all Social Phobes who have not reached a satisfying level of functionality yet. Just watch out for the hypotension and blood sugar problems (not to mention hypertension issues).Use Adalat for hypertensive crises.
Weight gain is usually minimal, nothing like Zyprexa.
But, what surgery are you having, and what medications will be used in surgery....is the surgery 100% necessary??
Ace- Nardil freak!
Posted by Michael Bell on January 20, 2005, at 21:01:22
In reply to Re: Nardil kicks @ss! » Michael Bell, posted by ace on January 20, 2005, at 19:21:18
It's throat surgery to remove some polyps. I hadn't heard that discontinuation of Nardil was a problem when restarting it as far as effectiveness is concerned. Are you saying this is a common thing? I'm hoping this won't be an issue with me b/c (1) I've only been on it for two weeks before tapering off so full effectiveness hasn't been reached yet and (2) I tried Nardil for three weeks about a year ago, and it seems just as effective now as before.
Wish me luck. Unfortunately, the surgery can't be avoided.
Posted by ace on January 22, 2005, at 21:52:35
In reply to Re: Restarting Nardil = never effective again? ?ace, posted by Michael Bell on January 20, 2005, at 21:01:22
> It's throat surgery to remove some polyps. I hadn't heard that discontinuation of Nardil was a problem when restarting it as far as effectiveness is concerned.
It has been for many, unfortunately.
Are you saying this is a common thing?Reasonably so...but for some it is no problem...I don't want to scare you.
I'm hoping this won't be an issue with me b/c (1) I've only been on it for two weeks before tapering off so full effectiveness hasn't been reached yet
Good point...I would actually advice to get off it ASAP.
and (2) I tried Nardil for three weeks about a year ago, and it seems just as effective now as before.
You sound as if you are going to be OK....This fact -- you tried it before, greatly mitigates the possibility of a average response.
>
> Wish me luck.Totally man!!! Your a Nardil user, which means you are my brother!!!!!
Unfortunately, the surgery can't be avoided.
Ace -- Nardil Champion....2005
Posted by tsirch on January 23, 2005, at 2:00:19
In reply to Re: Restarting Nardil = never effective again? » Michael Bell, posted by ace on January 22, 2005, at 21:52:35
No worries! AS a former Nardil user of ten years, when you resume usage, it will kick *ss, for at least ten years. When you restart it, it may take a while, a little coffee in my case, but it will work.
Posted by jasmineneroli on January 23, 2005, at 2:05:35
In reply to Re: Restarting Nardil = never effective again? » ace, posted by Michael Bell on January 20, 2005, at 21:01:22
Hi Michael:
Good luck with the surgery!
I have just been doing an archive search on Tianeptine and read some of your posts on a combo that included Klonopin, Tianeptine & occasional Adderall.
Two questions:
1)Presumably, since you are now taking Nardil, that combo wasn't as effective as hoped. Can you tell me what happened?
I have GAD and already take Klonopin, was interested in adding Tianeptine.2)My daughter, however, has pretty severe Social Anxiety and Anhedonia (which is probably part of the SA, rather than depression). Also, possible GAD & ADD. You seem to have very similar symptomology to her.
She lives in another city and her doc insists on Celexa only, won't give her Klonopin. She is so debilitated, she finds working a torture. She also isolates herself at home - socially withdrawn. I've sent her some of my Klon. and she's found amazing relief, it makes her able to go to work!
Would you now recommend Nardil only, for her situation? Or did the previous combo, give relief too?Feeling a bit helpless and wanting to provide suggestions for my daughter's doc. Thanks for your time.
Jas
Posted by Michael Bell on January 23, 2005, at 9:04:01
In reply to Re: Restarting Nardil = never effective again?, posted by jasmineneroli on January 23, 2005, at 2:05:35
>
I try not to get political about meds, but first things first, FIND A NEW DOCTOR FOR YOUR DAUGHTER!! Assuming that you have that option, of course. Look, if Social Phobia is your daughter's primary problem, SSRIs are NOT the right med for her, especially as monotherapy. I've said it before and I'll say it a million times, SEROTONIN DEFICIENCY IS NOT THE MAIN CAUSE, OR EVEN A MAJOR CAUSE, OF SOCIAL PHOBIA. If anything, the serotonin receptors are hypersensitive. The only reason SSRIs considered the "first line of treatment" by some docs is because SSRIs are a multibillion dollar industry. These drugs were developed to fight depression, and the manufacturers push to extend the label to cover other disorders in order to make more money. For anxiety, the only reasons SSRIs may work is because they cause INCREASED anxiety in the first couple weeks, then the receptors become desensitized. In other words, the brain becomes numb past the point of any feeling at all, let alone anxiety. (Disclaimer: Klono + SSRI can, however, be a very effective combo for some. If you do come across an SSRI that really helps your daughter, then obviously go with it). However, a truly informed doctor, especially one who specializes in anxiety, will prescribe Klonopin as the first line of treatment without a second thought.GABA. GABA. GABA. GABA. GABA. And again, GABA. Your daughter needs a drug that effects GABA. GABA disfunction is the primary cause of social phobia. Period. The most effect drugs (legal and illegal) for SP all have profound and primary effects on the GABA system. Klonopin, Xanax, Ativan, Xyrem, Alcohol, Nardil. You said your daughter found amazing relief from the Klono you sent her. Proof positive. Yes, other transmitters are probably involved to some degree (CCK for example, dopamine transmission in the amygdala as well), but GABA is the main culprit!
Sorry for that little rant. And thanks for the good luck wishes regarding the surgery. Now to answer your questions. Regarding the Klonopin + Adderall + Tianeptine combo, here's why I stopped it:
1) Klonopin: It is extremely effective for social anxiety. Nothing compares (except maybe Nardil). Especially useful for the physical symptoms, but it does help for the phobic thought processes as well. I'M STILL ON SMALL DOSES OF KLONO (.5 mg/day). I would definitely recommend this as the first line of treatment for social phobia. For people who have Social Phobia (or possibly GAD) as their only diagnosis, I say stay away from SSRIs and try to get a benzo, especially Klonopin
2) Tianeptine: has some anxiolytic activity, but the effects are fleeting and inconsistent. Some days seemed to work, others it did not. Too expensive in light of the questionable effectiveness.
3) Adderall: I do NOT recommend this drug unless your child has been diagnosed with ADHD. It is certainly NOT good for social phobia as monotherapy, it causes hyperfocusing, social withdrawal. Moreover, it increases CCK release, and CCK is bad for anxiety. If it does cause euphoria, it is very short lived. Medication should NOT cause continuous euphoria, as this is not a natural state. In combination with Klonopin, it sometimes had a prosocial effect, but this was very infrequent.
So why did I start Nardil? Because although Klonopin is great for SP, it is has been known to cause depression in many people after long term use. Not the "I want to throw myself off a cliff" kind of depression, but more of a low-grade dysthymia/anhedonia. Yes it kills anxiety, but for me it also reduced the ability to feel pleasure and gave me a flattened affect. Still I recommend giving it a try, as some people may not develop this low grade depression. Nardil fixes this problem for me.
My current combo is Nardil + Klonopin.
Good luck on whatever decision you make.
Hi Michael:
> Good luck with the surgery!
> I have just been doing an archive search on Tianeptine and read some of your posts on a combo that included Klonopin, Tianeptine & occasional Adderall.
> Two questions:
> 1)Presumably, since you are now taking Nardil, that combo wasn't as effective as hoped. Can you tell me what happened?
> I have GAD and already take Klonopin, was interested in adding Tianeptine.
>
> 2)My daughter, however, has pretty severe Social Anxiety and Anhedonia (which is probably part of the SA, rather than depression). Also, possible GAD & ADD. You seem to have very similar symptomology to her.
> She lives in another city and her doc insists on Celexa only, won't give her Klonopin. She is so debilitated, she finds working a torture. She also isolates herself at home - socially withdrawn. I've sent her some of my Klon. and she's found amazing relief, it makes her able to go to work!
> Would you now recommend Nardil only, for her situation? Or did the previous combo, give relief too?
>
> Feeling a bit helpless and wanting to provide suggestions for my daughter's doc. Thanks for your time.
> Jas
Posted by ed_uk on January 23, 2005, at 9:12:26
In reply to Re: Down with serotonin! Up with GABA! » jasmineneroli, posted by Michael Bell on January 23, 2005, at 9:04:01
Nardil can usually be continued during surgery provided that the anesthetist is well educated about MAOIs and knows which drugs to avoid etc. If the anesthetist is not knowledable about MAOIs then you must stop the Nardil.
Here is some info.........
It used to be thought that MAOIs should be withdrawn well before anaesthesia, but there is now evidence that this may be unnecessary in most patients, although individual cases of both hypo- and hypertension have been seen. The MAOIs can however interact with other drugs sometimes used during surgery.
Clinical evidence and mechanism
The absence of problems during emergency general anaesthesia in 2 patients on MAOIs prompted further study in 6 others taking unnamed MAOIs chronically. All 6 were premedicated with 10–15 mg diazepam 2 h before surgery, induced with thiopental (thiopentone), given suxamethonium (succinylcholine) before intubation, and maintained with nitrous oxide/oxygen and either halothane or isoflurane. Pancuronium was used for muscle relaxation. Morphine was given postoperatively. One patient experienced hypotension that responded to repeated intravenous doses of 0.1 mg phenylephrine without hypertensive reactions. No other untoward events occurred either during or after the anaesthesia.No adverse reactions occurred in 27 other patients on MAOIs (tranylcypromine, phenelzine, isocarboxazid, pargyline) when anaesthetised. No problems were seen in eight patients on unnamed MAOIs when anaesthetised, nor in dogs on tranylcypromine given enflurane and fentanyl. Two single case reports describe the safe and uneventful use of propofol in a patient on phenelzine and another on tranylcypromine. The latter was also given alfentanil. No problems were seen in one patient on tranylcypromine when given ketamine and in another on selegiline when given fentanyl, isoflurane and midazolam. No problems were seen in another patient on phenelzine when anaesthetised firstly with sevoflurane in oxygen, followed by isoflurane, oxygen, air and an infusion of remifentanil. Unexplained hypertension has been described in a patient taking tranylcypromine when etomidate and atracurium were used. Moclobemide was stopped on the morning of surgery in a patient who was anaesthetised with propofol and later isoflurane in nitrous oxide and oxygen. Morphine and droperidol were also used. No adverse reactions occurred. Ketorolac, propofol and midazolam were used uneventfully in one patient on phenelzine.
Importance and management
There seems to be little documentary evidence that the withdrawal of MAOI before anaesthesia is normally necessary. Scrutiny of reports alleging an adverse reaction usually shows that what happened could be attributed to an interaction between other drugs used during the surgery (e.g. pethidine, sympathomimetics) rather than with the anaesthetics. The authors of the reports cited here offer the opinion that . . general and regional anaesthesia may be provided safely without discontinuation of MAOI therapy, provided proper monitoring, adequate preparation, and prompt treatment of anticipated reactions are utilised. This implies that the possible interactions between the MAOI and other drugs are fully recognised, but be alert for the rare unpredictable response.
Posted by Michael Bell on January 23, 2005, at 9:58:39
In reply to Re: Nardil kicks @ss!, posted by TheOutsider on January 20, 2005, at 5:21:24
I believe these are the CCK-B antagonists in development. Some may be derivatives of the others listed. I think that GW150013 is in the Phase II clinical trial period and is being developed by GlaxoSmithKline. CR 2945 may also be in Phase I or Phase II. Some of the others may have been discontinued.
L-365,260
CR 2945
PD134308
PD135158
L-736,380
GW150013P.S. Proglumide is a cck-b antagonist that is already on the market, but it has a weak affinity for the receptors, is very difficult to find and is very expensive. Plus it was developed specifically for gastrointestinal disorders (as opposed to anxiety), and although gastro receptors are exactly the same as CCK-B receptors, there is the problem of the blood brain barrier. Nevertheless, my short experience with Proglumide leads me to believe that a more potent and highly specific CCK-B antagonist will be very effective for anxiety if it ever hits the market.
Later.
Posted by Michael Bell on January 23, 2005, at 10:00:34
In reply to Re: Surgery, posted by ed_uk on January 23, 2005, at 9:12:26
Posted by TheOutsider on January 23, 2005, at 11:55:14
In reply to Re: CCK-B antagonists » TheOutsider, posted by Michael Bell on January 23, 2005, at 9:58:39
> I believe these are the CCK-B antagonists in development. Some may be derivatives of the others listed. I think that GW150013 is in the Phase II clinical trial period and is being developed by GlaxoSmithKline. CR 2945 may also be in Phase I or Phase II. Some of the others may have been discontinued.
>
> L-365,260
> CR 2945
> PD134308
> PD135158
> L-736,380
> GW150013Thanks for the Info Michael
Its unfortunate that the most advanced are only in phase II clinical trials, that must mean their years away from release.
That is assuming of course that they ever do get released!
Posted by jasmineneroli on January 23, 2005, at 17:44:57
In reply to Re: Down with serotonin! Up with GABA! » jasmineneroli, posted by Michael Bell on January 23, 2005, at 9:04:01
Hey Michael:
Thanks for the quick response. Your subject line echoes my own thoughts too!
Your "rant" was absolutely to the point, and from it, I can tell that you've been through "the mill" in trying everything (drugs) to beat your SP!
My daughter is only being treated by a GP, and they seem to be the most susceptible physicians to pharmaceutical reps selling SSRI's!! And pretty ignorant on mental health issues, a lot of the time. Which is why they're susceptible to the maketing, I think.I went throught this with my own GP. I always felt I knew more than he did!!! (on this issue). He had me dx'd as depressed, when I was SURE I had GAD. I the end I insisted on being referred to a psychiatrist (we're in Canada).
Half an hour into my 1st psych. app't, after the doc was saying stuff like "and do you feel like _____?" OR " So, you probably have reacted by ____, then?" . Showing so much insight, I wanted to cry, he said "You have GAD that's really become severe recently, and you've had it all your life!" I was SOOOOOO relieved and felt so validated!! Then so frustrated, that I'd spent several years on a whole array of drugs that didn't help and gave me rotten side effects.My daughter's doc, upon being asked for a referral to a Pdoc, told her that it would take an extremely long time to get an app't and she should just up her dose of Celexa!!!! I was so mad, and she was in no shape to be assertive and forceful with the doc.
My turn to rant!! Sorry.Hmmmmm, as regards adding Tianeptine to Klonopin myself, I think I'll hold off for now, but will probably try adding Picamilon.
Thanks for the info Michael. I will forward it to my daughter. I'm going to have to intervene myself, and go visit her, to get things changed.
Again, take care during surgery and after. Hope the Nardil questions get sorted for you - sounds like you just need an experienced anaestheologist, who you can discuss things with, ahead of time.
Keep us posted about how it all goes.
Jas
This is the end of the thread.
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