![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 35. Go back in thread:
Posted by rvanson on January 31, 2005, at 0:24:43
In reply to Interesting info about Nardil, posted by Maxime on January 30, 2005, at 23:20:25
You are lucky that you have a PDoc willing to precribe Nardil for you.
I am still searching for a Dr that doesnt have his head between his legs when I bring the matter up.
For some reason all the Pdocs I have seen lately only want to keep people on the newer expensive medications.
I hope you find something that works for you.
Posted by djmmm on January 31, 2005, at 10:12:23
In reply to Interesting info about Nardil, posted by Maxime on January 30, 2005, at 23:20:25
> I was doing some research on this horrid med Nardil that I am taking ( as oppose to my beloved Parnate which decided to stop working). And it apparently you take Nardil at high dosages (60-90 mg) until your depression is gone and then you lower the dose dramatically to maintain (to about 15 mg a day).
>
> Has anyone else heard about this?
>
> It would make me feel better to know that I don't have to take this stuff forever.
>
> I hate it.
>
>
> MaximeSince Nardil is considered an "irreversible" MAOI-- meaning it formes a permanent covalent bond to MAO enzymes-- MAO activity is consistant until new MAO is manufactured by the mitochondria of your cells.
Parnate is not considered completely irreversible, since new MAO is produced more rapidly, due to the cohesivness of the bond Parnate forms with MAO enzymes.
Nardil is also a hydrazine deravitive. These meds tend to "build up" in your system, often requiring liver function tests (due to potential liver toxicity). Because Nardil is truely "irreversible" and accumulates in your body, taking a "maintenance" dose of as little as 15mg every other day is possible for most people (only after maximum effect is achieved).
Im not too familiar with "poop-out" and MAOIs. My theory is that "poop-out" is mostly a serotonin issue, excess serotonin to be specific.
Posted by Questionmark on January 31, 2005, at 21:19:35
In reply to Re: Interesting info about Nardil, posted by djmmm on January 31, 2005, at 10:12:23
> Since Nardil is considered an "irreversible" MAOI-- meaning it formes a permanent covalent bond to MAO enzymes-- MAO activity is consistant until new MAO is manufactured by the mitochondria of your cells.
>
> Parnate is not considered completely irreversible, since new MAO is produced more rapidly, due to the cohesivness of the bond Parnate forms with MAO enzymes.
>
> Nardil is also a hydrazine deravitive. These meds tend to "build up" in your system, often requiring liver function tests (due to potential liver toxicity). Because Nardil is truely "irreversible" and accumulates in your body, taking a "maintenance" dose of as little as 15mg every other day is possible for most people (only after maximum effect is achieved).
>
> Im not too familiar with "poop-out" and MAOIs. My theory is that "poop-out" is mostly a serotonin issue, excess serotonin to be specific.
In my personal experience with Nardil, the concept of keeping a low maintenence dose after a short "loading" period (usually about four to six weeks i believe) at a higher dose (usu. 60-90mg) does not work at all, despite how it may look on paper. i'm on 60mg/day, and oftentimes if i reduce it to 45mg/day for a few days-- or even 30mg for a day or two-- i notice myself feeling worse... in multiple areas. And if i miss a mere day's worth of Nardil entirely, the following day i end up feeling significant differences in my mood, anxiety levels, and ability to think clearly, for example. i really wish the maintenance-dose theory worked, but i'm certain that it does not for me.
Maybe new MAO enzymes are restored by the body around every 24 hours or less (almost definitely). Maybe phenelzine doesn't really render the MAO enzyme inactive for as long as is believed (doubtful). Maybe the so-called "new" formulation of Nardil is absorbed (and hence, metabolized &/or excreted) much more quickly than the "old" formulation-- so that the "old Nardil" did actually stay in the body long enough for the maintenance-dose-type-theory to hold true, and the "new Nardil" does not stay active in the body long enough for the theory to hold true. Actually, i just thought of some things that don't allow this to make sense, but it doesn't matter. My point is that i don't know, but i do know that i really don't believe the maintenance dose theory could be effective for many people at all, especially or at least on the new Nardil formulation. i would be highly interested to know why this is though (on a pharmacological or pharmakinetic level). Any thoughts?
Posted by Maxime on February 1, 2005, at 19:36:19
In reply to Nardil maintenance dose not effective IMO » djmmm, posted by Questionmark on January 31, 2005, at 21:19:35
Posted by ace on February 1, 2005, at 23:27:40
In reply to Interesting info about Nardil, posted by Maxime on January 30, 2005, at 23:20:25
Posted by Maxime on February 2, 2005, at 11:58:47
In reply to Re: HOW DARE YOU CALL NARDIL 'HORRID'!!!!!!!!!!!!! (nm) » Maxime, posted by ace on February 1, 2005, at 23:27:40
Ace, it's killing me. I can't take the side effect. I keep fainting from it. I don't know what to do. I have no choices left. I want to stick it out and see if it gets better, but by the time evening comes I can't even type properly.
Do you have any suggestions? How is this new Nardil different from the one you take. I am dying from a depression that is going to end in suicide and I don't know what to do.
Parnate pooped out on me.
If you have any suggestions,please I am here to listen.
Maxime
Posted by Maxime on February 2, 2005, at 12:01:27
In reply to Re: Nardil maintenance dose not effective IMO (nm), posted by Maxime on February 1, 2005, at 19:36:19
See I can't even submit a post properly. My question is how is the chemical make up different
with new Nardil compared to the old?Anyone?????
Maxime
Posted by djmmm on February 3, 2005, at 10:29:41
In reply to Re: Nardil maintenance dose not effective IMO » Maxime, posted by Maxime on February 2, 2005, at 12:01:27
> See I can't even submit a post properly. My question is how is the chemical make up different
> with new Nardil compared to the old?
>
> Anyone?????
>
>
> Maxime
>The only difference is in the excipients (the fillers, binders, etc) which for some, seems to have an impact on either rate and or amount of absorbtion. The "new" Nardil still contains the exact same amount of the active ingredient Phenelzine.
These changes should not have a significant effect on the drugs efficacy, yet for some, it is "ineffective" Sadly, in forums like this and others, we only really hear about the negative experiences. Most people who have positive experiences don't need a community forum to discuss the positive way the "new" nardil has effected their lives.
My opinion, the difference in excipients can alter the the efficacy of the medication, but not in a statistically significant amount. It doesn't make sense for a drug company to "remake" and effective drug into an "ineffective" drug, especially a MAOI (which, unlike SSRIs, is consistantly superior to placebo).
Posted by djmmm on February 3, 2005, at 10:52:59
In reply to Nardil maintenance dose not effective IMO » djmmm, posted by Questionmark on January 31, 2005, at 21:19:35
> > Since Nardil is considered an "irreversible" MAOI-- meaning it formes a permanent covalent bond to MAO enzymes-- MAO activity is consistant until new MAO is manufactured by the mitochondria of your cells.
> >
> > Parnate is not considered completely irreversible, since new MAO is produced more rapidly, due to the cohesivness of the bond Parnate forms with MAO enzymes.
> >
> > Nardil is also a hydrazine deravitive. These meds tend to "build up" in your system, often requiring liver function tests (due to potential liver toxicity). Because Nardil is truely "irreversible" and accumulates in your body, taking a "maintenance" dose of as little as 15mg every other day is possible for most people (only after maximum effect is achieved).
> >
> > Im not too familiar with "poop-out" and MAOIs. My theory is that "poop-out" is mostly a serotonin issue, excess serotonin to be specific.
>
>
> In my personal experience with Nardil, the concept of keeping a low maintenence dose after a short "loading" period (usually about four to six weeks i believe) at a higher dose (usu. 60-90mg) does not work at all, despite how it may look on paper. i'm on 60mg/day, and oftentimes if i reduce it to 45mg/day for a few days-- or even 30mg for a day or two-- i notice myself feeling worse... in multiple areas. And if i miss a mere day's worth of Nardil entirely, the following day i end up feeling significant differences in my mood, anxiety levels, and ability to think clearly, for example. i really wish the maintenance-dose theory worked, but i'm certain that it does not for me.
> Maybe new MAO enzymes are restored by the body around every 24 hours or less (almost definitely). Maybe phenelzine doesn't really render the MAO enzyme inactive for as long as is believed (doubtful). Maybe the so-called "new" formulation of Nardil is absorbed (and hence, metabolized &/or excreted) much more quickly than the "old" formulation-- so that the "old Nardil" did actually stay in the body long enough for the maintenance-dose-type-theory to hold true, and the "new Nardil" does not stay active in the body long enough for the theory to hold true. Actually, i just thought of some things that don't allow this to make sense, but it doesn't matter. My point is that i don't know, but i do know that i really don't believe the maintenance dose theory could be effective for many people at all, especially or at least on the new Nardil formulation. i would be highly interested to know why this is though (on a pharmacological or pharmakinetic level). Any thoughts?A maintenance dose is possible because of the amount of time it takes to manufacture new MAO. The 2 week period is simply an average (based on your metabolism)..remember, a maintence dose can be as little as 15mg, every other day, or as much as 45mg a day. Remember, MAO inhibition is not 100%, even at an effective dose, MAO enzymes are still effective, as are other metabolizing enzymes, reuptake, etc.
As far as your theory that the "new" nardil may not remain in your system long enough to allow for a maintenance dose... even if this was true, one would only need to take a higher dose for a longer amount of time to acheive adaquate MAO inhibition. The irreversible bond has not changed, regardless of the excipients. If you are having trouble with getting a response from the "new" nardil, simply increase the dose and/or try (i know it's hard-- ive been there) to be patient.
Playing the devils advocate...Just a thought..maybe the new excipients are somehow preventing the development of "active" metabolites..I know that the older version of the drug had a metabolite that had a strong effect on PEA levels. I'm wondering, if there IS a change in parent drug metabolism by the excipients (via absorbtion, etc), then there would certainly be a change in the formation of active metabolites (which may really be why Nardil works so well)..but this doesn't explain the many people who are happy with the "performance" of the "new" nardil.
Posted by Questionmark on February 3, 2005, at 16:31:37
In reply to Re: HOW DARE YOU CALL NARDIL 'HORRID'!!!!!!!!!!!!! » ace, posted by Maxime on February 2, 2005, at 11:58:47
Ace, i am a fellow Nardil lover and have been blessed by its powers, and i have always respected how much you promote it and what not. But take it easy man. "One man's trash is another man's treasure." And one person's miracle pill is another person's horrid one (& vice versa). We should be feeling really bad for her in that even the wonderful Nardil treated her poorly.
i would prefer it if people did not use such negative terms to describe Nardil, since it's such an amazing medicine for so many people and is not nearly as dangerous or hard to follow the diet restrictions with, and is already so demonized by much of psychiatry and medical texts and etc. .. that i do not want anyone who does not know enough about it to be turned off from trying it because they read something negative (shwew). However, we all do our fair share of criticism with meds that treated us dreadfully, and i would not want that to be disallowed. So, really she did nothing at all wrong.
Posted by Questionmark on February 3, 2005, at 16:36:48
In reply to Re: HOW DARE YOU CALL NARDIL 'HORRID'!!!!!!!!!!!!! » ace, posted by Maxime on February 2, 2005, at 11:58:47
> Ace, it's killing me. I can't take the side effect. I keep fainting from it. I don't know what to do. I have no choices left. I want to stick it out and see if it gets better, but by the time evening comes I can't even type properly.
>
> Do you have any suggestions? How is this new Nardil different from the one you take. I am dying from a depression that is going to end in suicide and I don't know what to do.
>
> Parnate pooped out on me.
>
> If you have any suggestions,please I am here to listen.
>
> Maxime
> Ace, it's killing me. I can't take the side effect. I keep fainting from it. I don't know what to do. I have no choices left. I want to stick it out and see if it gets better, but by the time evening comes I can't even type properly.
>
> Do you have any suggestions? How is this new Nardil different from the one you take. I am dying from a depression that is going to end in suicide and I don't know what to do.
>
> Parnate pooped out on me.
>
> If you have any suggestions,please I am here to listen.
>
> MaximeMaxime,...
Did you try taking Nardil long enough, and if the side effects are too severe to continue at all...
Did you try any medications or methods to relieve the most troublesome side effects? (Such as increased sodium intake and/or diabetic socks and/or another drug for the postural hypotension; or a low-dose stimulant such as Ritalin for fatigue [and hypotension, too].
Honestly, i would try to give it at least 4 to 6 weeks to see if the side effects lessen before you quit. i know it's easy for me to say, but, yeah-- cuz oftentimes they subside with time.
Also, did you try an NMDA antagonist like memantine to try revamping the Parnate (i don't know if this actually works, but according to what many have said, and some research, it might)? Did you try taking brief, intermittent breaks (however many days until you start to feel depressed and/or whatever else again) from the Parnate to see if this minimized the poop-out effect? (i don't know if this would work either but there's a decent possiblity it would.) i don't know-- just some things to think about.
Good luck. Don't give up. The technology to help is advancing every year-- almost every month. i believe you will find something that helps you-- something that lasts.
Posted by Questionmark on February 3, 2005, at 17:24:00
In reply to Re: Nardil maintenance dose not effective IMO, posted by djmmm on February 3, 2005, at 10:52:59
> > > Since Nardil is considered an "irreversible" MAOI-- meaning it formes a permanent covalent bond to MAO enzymes-- MAO activity is consistant until new MAO is manufactured by the mitochondria of your cells.
> > >
> > > Parnate is not considered completely irreversible, since new MAO is produced more rapidly, due to the cohesivness of the bond Parnate forms with MAO enzymes.
> > >
> > > Nardil is also a hydrazine deravitive. These meds tend to "build up" in your system, often requiring liver function tests (due to potential liver toxicity). Because Nardil is truely "irreversible" and accumulates in your body, taking a "maintenance" dose of as little as 15mg every other day is possible for most people (only after maximum effect is achieved).
> > >
> > > Im not too familiar with "poop-out" and MAOIs. My theory is that "poop-out" is mostly a serotonin issue, excess serotonin to be specific.
> >
> >
> > In my personal experience with Nardil, the concept of keeping a low maintenence dose after a short "loading" period (usually about four to six weeks i believe) at a higher dose (usu. 60-90mg) does not work at all, despite how it may look on paper. i'm on 60mg/day, and oftentimes if i reduce it to 45mg/day for a few days-- or even 30mg for a day or two-- i notice myself feeling worse... in multiple areas. And if i miss a mere day's worth of Nardil entirely, the following day i end up feeling significant differences in my mood, anxiety levels, and ability to think clearly, for example. i really wish the maintenance-dose theory worked, but i'm certain that it does not for me.
> > Maybe new MAO enzymes are restored by the body around every 24 hours or less (almost definitely). Maybe phenelzine doesn't really render the MAO enzyme inactive for as long as is believed (doubtful). Maybe the so-called "new" formulation of Nardil is absorbed (and hence, metabolized &/or excreted) much more quickly than the "old" formulation-- so that the "old Nardil" did actually stay in the body long enough for the maintenance-dose-type-theory to hold true, and the "new Nardil" does not stay active in the body long enough for the theory to hold true. Actually, i just thought of some things that don't allow this to make sense, but it doesn't matter. My point is that i don't know, but i do know that i really don't believe the maintenance dose theory could be effective for many people at all, especially or at least on the new Nardil formulation. i would be highly interested to know why this is though (on a pharmacological or pharmakinetic level). Any thoughts?
>
> A maintenance dose is possible because of the amount of time it takes to manufacture new MAO. The 2 week period is simply an average (based on your metabolism)..remember, a maintence dose can be as little as 15mg, every other day, or as much as 45mg a day. Remember, MAO inhibition is not 100%, even at an effective dose, MAO enzymes are still effective, as are other metabolizing enzymes, reuptake, etc.
>
> As far as your theory that the "new" nardil may not remain in your system long enough to allow for a maintenance dose... even if this was true, one would only need to take a higher dose for a longer amount of time to acheive adaquate MAO inhibition. The irreversible bond has not changed, regardless of the excipients. If you are having trouble with getting a response from the "new" nardil, simply increase the dose and/or try (i know it's hard-- ive been there) to be patient.
>
> Playing the devils advocate...Just a thought..maybe the new excipients are somehow preventing the development of "active" metabolites..I know that the older version of the drug had a metabolite that had a strong effect on PEA levels. I'm wondering, if there IS a change in parent drug metabolism by the excipients (via absorbtion, etc), then there would certainly be a change in the formation of active metabolites (which may really be why Nardil works so well)..but this doesn't explain the many people who are happy with the "performance" of the "new" > nardil.
>Okay, i'm still confused about the whole maintenance dose thing. i know that an effective dose of Nardil does not need to result in 100% MAO inhibition (actually most if not all of the literature concerning this says that at least an 80% level of MAO inhibition should be achieved for adequate relief of depressive symptoms, or something along those lines). But, for me at least, i *often and consistently* (so this is not in my head, figuratively speaking) notice a difference in how i feel and think and behave-- including the fact that i get more depressed and anxious, and less hopeful, etc.-- in less than 48 to 72 hours of taking one dose less than normal per day (45mg instead of 60mg)... which would mean that my MAO enzymes are being remanufactured less than every two or three days, right? Is this right or am i missing something?
You said that the 2 week period for making new MAO is about average-- do you know if they have more-or-less proven this with any tests/studies or is this just the amount of time they (scientists; researchers) theorized it takes.
You also mentioned that a maintenance dose can be up to 45mg a day. If that's true, i guess i'm more inclined to believe in this notion. Yeah, i guess it just does all depend on how long it takes for MAO to be regenerated. Is there really a lot of individual variation when it comes to this-- like some can take 72 hours or less and some can take up to two weeks or more? If that's true then i believe that it's possible for the maintenance dose to work in some people-- the slow metabolizers.
i know for myself, however, if i went on a 15mg dose of Nardil for just a few days, i'd start feeling some significant withdrawal symptoms. But, yeah okay, i get it-- it all depends on that one factor.No, i hope i didn't cause confusion with people-- i was never on the "old Nardil," and am still absolutely in love with the "new Nardil;" i was just saying that maybe that's where the difference in plausibility of using the maintenance dose lies, but i don't know.
Yeah, what you said in the last paragraph is a really good point and thought-- that "if there IS a change in parent drug metabolism by the excipients (via absorbtion, etc), then there would certainly be a change in the formation of active metabolites (which may really be why Nardil works so well)." And many people could still be happy with how the new Nardil works if their brains need more help in the 5-HT (and maybe NE) area than with PEA (and hence, dopamine) and/or GABA (and/or alanine?).
Man! i rEAlly wanna know what the deal is with the new Nardil formulation though!-- the pharmacological and pharmokinetic difference(s). Someone (/some group) needs to find out.Thanks for discussing all this with me.
Posted by djmmm on February 4, 2005, at 11:27:26
In reply to Re: Nardil maintenance dose not effective IMO » djmmm, posted by Questionmark on February 3, 2005, at 17:24:00
> > > > Since Nardil is considered an "irreversible" MAOI-- meaning it formes a permanent covalent bond to MAO enzymes-- MAO activity is consistant until new MAO is manufactured by the mitochondria of your cells.
> > > >
> > > > Parnate is not considered completely irreversible, since new MAO is produced more rapidly, due to the cohesivness of the bond Parnate forms with MAO enzymes.
> > > >
> > > > Nardil is also a hydrazine deravitive. These meds tend to "build up" in your system, often requiring liver function tests (due to potential liver toxicity). Because Nardil is truely "irreversible" and accumulates in your body, taking a "maintenance" dose of as little as 15mg every other day is possible for most people (only after maximum effect is achieved).
> > > >
> > > > Im not too familiar with "poop-out" and MAOIs. My theory is that "poop-out" is mostly a serotonin issue, excess serotonin to be specific.
> > >
> > >
> > > In my personal experience with Nardil, the concept of keeping a low maintenence dose after a short "loading" period (usually about four to six weeks i believe) at a higher dose (usu. 60-90mg) does not work at all, despite how it may look on paper. i'm on 60mg/day, and oftentimes if i reduce it to 45mg/day for a few days-- or even 30mg for a day or two-- i notice myself feeling worse... in multiple areas. And if i miss a mere day's worth of Nardil entirely, the following day i end up feeling significant differences in my mood, anxiety levels, and ability to think clearly, for example. i really wish the maintenance-dose theory worked, but i'm certain that it does not for me.
> > > Maybe new MAO enzymes are restored by the body around every 24 hours or less (almost definitely). Maybe phenelzine doesn't really render the MAO enzyme inactive for as long as is believed (doubtful). Maybe the so-called "new" formulation of Nardil is absorbed (and hence, metabolized &/or excreted) much more quickly than the "old" formulation-- so that the "old Nardil" did actually stay in the body long enough for the maintenance-dose-type-theory to hold true, and the "new Nardil" does not stay active in the body long enough for the theory to hold true. Actually, i just thought of some things that don't allow this to make sense, but it doesn't matter. My point is that i don't know, but i do know that i really don't believe the maintenance dose theory could be effective for many people at all, especially or at least on the new Nardil formulation. i would be highly interested to know why this is though (on a pharmacological or pharmakinetic level). Any thoughts?
> >
> > A maintenance dose is possible because of the amount of time it takes to manufacture new MAO. The 2 week period is simply an average (based on your metabolism)..remember, a maintence dose can be as little as 15mg, every other day, or as much as 45mg a day. Remember, MAO inhibition is not 100%, even at an effective dose, MAO enzymes are still effective, as are other metabolizing enzymes, reuptake, etc.
> >
> > As far as your theory that the "new" nardil may not remain in your system long enough to allow for a maintenance dose... even if this was true, one would only need to take a higher dose for a longer amount of time to acheive adaquate MAO inhibition. The irreversible bond has not changed, regardless of the excipients. If you are having trouble with getting a response from the "new" nardil, simply increase the dose and/or try (i know it's hard-- ive been there) to be patient.
> >
> > Playing the devils advocate...Just a thought..maybe the new excipients are somehow preventing the development of "active" metabolites..I know that the older version of the drug had a metabolite that had a strong effect on PEA levels. I'm wondering, if there IS a change in parent drug metabolism by the excipients (via absorbtion, etc), then there would certainly be a change in the formation of active metabolites (which may really be why Nardil works so well)..but this doesn't explain the many people who are happy with the "performance" of the "new" > nardil.
> >
>
> Okay, i'm still confused about the whole maintenance dose thing. i know that an effective dose of Nardil does not need to result in 100% MAO inhibition (actually most if not all of the literature concerning this says that at least an 80% level of MAO inhibition should be achieved for adequate relief of depressive symptoms, or something along those lines). But, for me at least, i *often and consistently* (so this is not in my head, figuratively speaking) notice a difference in how i feel and think and behave-- including the fact that i get more depressed and anxious, and less hopeful, etc.-- in less than 48 to 72 hours of taking one dose less than normal per day (45mg instead of 60mg)... which would mean that my MAO enzymes are being remanufactured less than every two or three days, right? Is this right or am i missing something?
> You said that the 2 week period for making new MAO is about average-- do you know if they have more-or-less proven this with any tests/studies or is this just the amount of time they (scientists; researchers) theorized it takes.
> You also mentioned that a maintenance dose can be up to 45mg a day. If that's true, i guess i'm more inclined to believe in this notion. Yeah, i guess it just does all depend on how long it takes for MAO to be regenerated. Is there really a lot of individual variation when it comes to this-- like some can take 72 hours or less and some can take up to two weeks or more? If that's true then i believe that it's possible for the maintenance dose to work in some people-- the slow metabolizers.
> i know for myself, however, if i went on a 15mg dose of Nardil for just a few days, i'd start feeling some significant withdrawal symptoms. But, yeah okay, i get it-- it all depends on that one factor.
>
> No, i hope i didn't cause confusion with people-- i was never on the "old Nardil," and am still absolutely in love with the "new Nardil;" i was just saying that maybe that's where the difference in plausibility of using the maintenance dose lies, but i don't know.
>
> Yeah, what you said in the last paragraph is a really good point and thought-- that "if there IS a change in parent drug metabolism by the excipients (via absorbtion, etc), then there would certainly be a change in the formation of active metabolites (which may really be why Nardil works so well)." And many people could still be happy with how the new Nardil works if their brains need more help in the 5-HT (and maybe NE) area than with PEA (and hence, dopamine) and/or GABA (and/or alanine?).
> Man! i rEAlly wanna know what the deal is with the new Nardil formulation though!-- the pharmacological and pharmokinetic difference(s). Someone (/some group) needs to find out.
>
> Thanks for discussing all this with me.The "new" nardil contains:
Each NARDIL film-coated tablet for oral administration contains phenelzine sulfate equivalent to 15 mg of phenelzine base and the following inactive ingredients:
mannitol,USP;
corn starch, NF;
croscarmellose sodium, NF;
povidone, USP;
edetate disodium,USP;
magnesium stearate, NF;
isopropyl alcohol, USP;
purified water, USP;
opadryorange Y30-13242A;
simethicone emulsion, USPThe "older formulation" contains:
Each Nardil tablet for oral administration contains phenelzine sulfate equivalent to 15 mg of phenelzinebase.
Inactive ingredients include:
acacia NF;
calcium carbonate;
carnauba wax, NF;
corn-starch, NF;
FDand C yellow No. 6;
gelatin, NF;
kaolin, USP;
magnesium stearate, NF;
mannitol, USP;
pharmaceuticalglaze, NF;
povidone, USP;
sucrose, NF;
talc, USP;
white wax, NF;
white wheat flour.the difference :
the old version contains 11 excipients that the new version lacks...
-acacia NF;
-calcium carbonate;
-carnauba wax, NF;
-FDand C yellow No. 6;
-gelatin, NF;
-kaolin, USP;
-pharmaceutical glaze, NF;
-sucrose, NF;
-talc, USP;
-white wax, NF;
-white wheat flourThe New version contians 6 excipients that the old version lacks:
-croscarmellose sodium, NF;
-edetate disodium,USP;
-isopropyl alcohol, USP;
-purified water, USP;
-opadryorange Y30-13242A;
-simethicone emulsion, USPThey share only 4 excipients
-mannitol, USP;
-corn-starch, NF;
-povidone, USP;
-magnesium stearate, NF;
Posted by Maxime on February 4, 2005, at 22:13:23
In reply to Re: HOW DARE YOU CALL NARDIL 'HORRID'!!!!!!!!!!!!! » Maxime, posted by Questionmark on February 3, 2005, at 16:36:48
Hi, first of all, thank you for trying to help me. I appreciate it very much. I am not trying to put Nardil down in any way. I know it's an amazing med for some people. But I don't think it is right for me.
I spent the day at the hospital receiving "gravol" by IV and being rehydrate. I have been throwing up since I started it. It is ironic how I was worried that I would gain weight and now I can't eat anything without throwing up. I told my pdoc that I would give it one more week and that was last week. I still have few days to go. But if a med is making me so sick that I am missing work because I am at a hospital hooked up to an IV I think there is a problem.
I am going to try some of your suggestions. Actually I take 30 mg of Adderall XR with the Parnate. I tried ritalin but would end in a crashing depression. I would like to stop taking the Adderall because I don't think it's helping at the end of the day. Memantine. I have never heard of combining it with Parnate. I have only heard about taking Pamelor with it. I have often heard people say that if one MAOI works then that is the one for you. I think Parnate is the one for me ... I just have to figure out how to improve it.
Again, thanks for your suggestions and if you think of anything else please, pass it on. I don't think my body can take 4 more weeks of this. And I certainly can't afford to miss any more work because of it.
Maxime
>
> Maxime,...
> Did you try taking Nardil long enough, and if the side effects are too severe to continue at all...
> Did you try any medications or methods to relieve the most troublesome side effects? (Such as increased sodium intake and/or diabetic socks and/or another drug for the postural hypotension; or a low-dose stimulant such as Ritalin for fatigue [and hypotension, too].
> Honestly, i would try to give it at least 4 to 6 weeks to see if the side effects lessen before you quit. i know it's easy for me to say, but, yeah-- cuz oftentimes they subside with time.
> Also, did you try an NMDA antagonist like memantine to try revamping the Parnate (i don't know if this actually works, but according to what many have said, and some research, it might)? Did you try taking brief, intermittent breaks (however many days until you start to feel depressed and/or whatever else again) from the Parnate to see if this minimized the poop-out effect? (i don't know if this would work either but there's a decent possiblity it would.) i don't know-- just some things to think about.
> Good luck. Don't give up. The technology to help is advancing every year-- almost every month. i believe you will find something that helps you-- something that lasts.
Posted by cubbybear on February 5, 2005, at 9:41:28
In reply to Re: HOW DARE YOU CALL NARDIL 'HORRID'!!!!!!!!!!!!! » Questionmark, posted by Maxime on February 4, 2005, at 22:13:23
>
I have often heard people say that if one MAOI works then that is the one for you. I think Parnate is the one for me ... I just have to figure out how to improve it.
>
Maxime,
I'd very much like to turn this thread around to hear more about your Parnate poopout. As it is, relatively few people take MAOIs, and very few report poopout problems, especially Parnate. As you may know, I've been a believer in this wonder drug for 20 years now. It has knocked out my depression and anxiety every time and the side effects were always tolerable for me.If you've seen my posts over the past month, I've been grappling with come and go anxiety for the first time in ages. I don't have depression symptoms, but the old clawing anxiety has come back to upset my (unrealistic?) belief that I could remain stabilized and 100% happy on Parnate forever. My biggest terror is poopout, and I remain scared to death of the drug losing any potency. Two or three pdocs believe that the drug is not pooping out on me despite the intermittent anxiety spells. I increased my mtnce. dose from 30 mg. to 40 mg. about 3 wks. ago. I felt great for 5 days last week, but then started feeling anxious again today. This may or may not be arising from some apprehensions and fears about my mother's health.
Well, it's taken me a long time to get to the question, but you're in the uncommon position to be able to tell me: did you find that Parnate effectively killed off anxiety for you(or does that issue not apply?) More importantly, how did you know that the Parnate was pooping out on you? How long were you on it and at what dose? What were your symptoms when the poopout was occuring? I've been taking low-dose Klonopin, particularly for sleep, during the last few weeks, but would rather not have to.
Could it be that no anti-depressant, even a great MAOI like Parnate, is not perfect and breakout anxiety can occur from time to time? Is that all it is? Just what's your (and anyone else's!) opinion on Parnate poopout after a period of 20 years?
Thanks for all your help (and any others' too).
Posted by Maxime on February 5, 2005, at 20:08:47
In reply to Re: Please tell me about the Parnate problem » Maxime, posted by cubbybear on February 5, 2005, at 9:41:28
Hi,
In 2002 when I was FINALLY prescribed Parnate, I cried. I cried because I had been trying to get a PDOC to prescribe it for over a year. No one would listen to me. Finally one pdoc did.
I noticed the change this past summer. However, I was under a lot of stress from work. I don't suffer from anxiety. Even under stressful situations, anxiety has never been a problem so I can't really address that portion of your question.
First exhaustion returned and so I augmented the Parnate with Adderall and that worked for about 6-8 weeks. Then I was crying all the time. I would cry at nothing in particular. But I would cry on the bus, in stores ... it didn't matter. My suicidal thoughts returned.
The above are symptoms of depression. I continued to blame it on the stress of my job. Then I lost my job. Then I spent Nov. and Dec. umemployed and in a deep depression. My pdoc was positive that if I could start working again that all would be well. I did find a job but my mood didn't change. I just felt worse. I take 80-100 mg of Parnate BTW.
Finally I asked him if I could try Nardil.
However, here are some nagging thoughts I have:
- is the Adderall actually making me more depressed. And if so, then why the exhaustion. Extreme exhaustion. Why did that start to occur?
- I have thyroid problem. I am hypothyroid. I take synthroid and my levels are fine .... but I am worried that I still have a thyroid problem. The doctor says since my levels are okay then my thyroid is fine (with the help of synthroid). But I don't think he is doing all the tests he should. I don't know if my body is converting the Syntroid properly in my body. I still have many of the symptoms of hypothyroidism. So maybe the depression is really a thyroid problem.So I guess my point is that it could be my thyroid that is causing these problems. There are tests that my endocrinologist could run to see if my body is using the Synthroid properly. But like many doctors these days he is lazy. I live in Canada and I need a referral if I want to see another endocrinologist. But I can't get one and the wait list is so long.
I'm going back on the Parnate. I can't take the Nardil and I don't believe that Parnate would poop out on me like this.
What if any, side effect from the Parnate do you get?
Maxime
> >
> I have often heard people say that if one MAOI works then that is the one for you. I think Parnate is the one for me ... I just have to figure out how to improve it.
> >
> Maxime,
> I'd very much like to turn this thread around to hear more about your Parnate poopout. As it is, relatively few people take MAOIs, and very few report poopout problems, especially Parnate. As you may know, I've been a believer in this wonder drug for 20 years now. It has knocked out my depression and anxiety every time and the side effects were always tolerable for me.
>
> If you've seen my posts over the past month, I've been grappling with come and go anxiety for the first time in ages. I don't have depression symptoms, but the old clawing anxiety has come back to upset my (unrealistic?) belief that I could remain stabilized and 100% happy on Parnate forever. My biggest terror is poopout, and I remain scared to death of the drug losing any potency. Two or three pdocs believe that the drug is not pooping out on me despite the intermittent anxiety spells. I increased my mtnce. dose from 30 mg. to 40 mg. about 3 wks. ago. I felt great for 5 days last week, but then started feeling anxious again today. This may or may not be arising from some apprehensions and fears about my mother's health.
> Well, it's taken me a long time to get to the question, but you're in the uncommon position to be able to tell me: did you find that Parnate effectively killed off anxiety for you(or does that issue not apply?) More importantly, how did you know that the Parnate was pooping out on you? How long were you on it and at what dose? What were your symptoms when the poopout was occuring? I've been taking low-dose Klonopin, particularly for sleep, during the last few weeks, but would rather not have to.
> Could it be that no anti-depressant, even a great MAOI like Parnate, is not perfect and breakout anxiety can occur from time to time? Is that all it is? Just what's your (and anyone else's!) opinion on Parnate poopout after a period of 20 years?
> Thanks for all your help (and any others' too).
Posted by Optimist on February 5, 2005, at 23:16:50
In reply to Re: Please tell me about the Parnate problem » Max » cubbybear, posted by Maxime on February 5, 2005, at 20:08:47
Maxime, I noticed you said the Parnate/Adderall combo pooped out after 6-8 weeks. Is it possible you may have been experiencing some kind of adrenal exhaustion or something? I was wondering if some tyrosine may help with restoring some of your adrenal function as well as supplying more raw material of norepinephrine/dopamine for the Parnate to do it's job. I know tyrosine/phenylalanine is given for AD poopout sometimes. It's stimulating as well which may help with the energy problems.
Brian
Posted by Willyee on February 6, 2005, at 1:04:00
In reply to Re: Please tell me about the Parnate problem » Maxime, posted by cubbybear on February 5, 2005, at 9:41:28
I actualy see the opposite,i see a common trend of parnate being effective,but almost in every case ending up pooping out.
I doubt we can answer it unless we know why its happening,does our body adapt to a foreign substance,does constant changing of chemicals cause the med to start having a different action.
I once read upon start of a Maoi dopamine is increased,however when Maois levels are raised too much dopamine production halts,i dont rember where i read this,but i rember because it was quite a shock.
I know i cant take parnate alone i have to augment it,and although its a great med latly i find myself asking where is it taking me,my condition is no better,if i stopped the med tommorrow id be no better off overall,so am i on a med im addicted to,and in the long run gonna end up in bad shape,or is has my condition just worsended natural over the years and the med is just the only one succesfull at keeping it at bay,and regardless if i took it or not id still be sick.I dont know,but i know i did go the natural route,and never did i spend so much money on certain foods,drinking water,doing this doing that,life was totaly hard,and i got no better,at least now i have some form of a normal life,but you are not alone i get soooooo frustrated when it doesent work.
P.S I personaly will augment with an herb or drug before i mess with aminos.People tout they are natural,that means nothing,they alter brain activity as meds do,and an abundance of one will sooner or later result in a decrease in another,then you have your vitamns that can get screwed up.
We use the meds to try to balance these guys correctly,messing with aminos ,the building blocks of the body and MIND are not something to take lightly.As in meds we cant test our specific amino levels,so we have no idea whats needed,so were truly playing with fire doing that.A drug wears off,creating an imbalacne in chemicals takes a while to level up,and look it up very few people ever have true progress doing it,yeah take l phen and youll feel pumped the first few days,then youll feel pissed of agitated and sleepless.I actualy think taking an amino complex with an even amount of all aminos with a med is a smart thing,but of course this is simply my opinion,all i know is i have done he amino thing and its much worse than meds,nothing natural feeling about it.
Posted by Questionmark on February 6, 2005, at 2:15:07
In reply to Re: Please tell me about the Parnate problem » Maxime, posted by cubbybear on February 5, 2005, at 9:41:28
Although it seems like-- as Willyee also said-- Parnate poopout seems to be a relatively common occurrence, as far as medications go, i really have a hard time believing that after working so well for you for 20 years (esp. without increasing your dose at all or hardly at all), it would just suddenly start to poopout. If there is nothing different about your dietary or nutritional intake you can find that might have had any influence, then i would personally be inclined to believe it is life circumstances more than anything that is causing you this pseudo-poopout (if it is "pseudo-", of course).
If not a low-dose stimulant or NMDA antagonist (?), then maybe a lower dose of lithium may help rekindle its effects? Good luck.
Posted by cubbybear on February 6, 2005, at 2:32:42
In reply to Re: Please tell me about the Parnate problem » Max » cubbybear, posted by Maxime on February 5, 2005, at 20:08:47
.
>
> What if any, side effect from the Parnate do you get?
>
> MaximeMy side-effects from Parnate are very much opposite to what most people report: increased appetite, particularly craving for carbohydrates and sweets, which leads to (much desired!) weight gain; hypotension during the first couple of weeks of re-starting, dry mouth, and reduced need for sleep. I wouldn't call that insomnia; it's just that I ordinarily don't sleeo very much and with Parnate, and I can get by easily on only 5 hrs. per night. I've never found it to adversely affect libido. I consider myself lucky that my side effects are largely different from most people.
> From your description of the poopout, I see that we come from entirely different "places" and your poopout sympoms are quite different from what I'm experiencing now ( which hopefully are not poopout related at all). cubbybear
Posted by cubbybear on February 6, 2005, at 2:35:33
In reply to Re: Please tell me about the Parnate problem » Max » cubbybear, posted by Maxime on February 5, 2005, at 20:08:47
Maxime,
I forgot to ask you, have you considered trying Marplan? I don't know if it's available in Canada, but maybe that particular MAOI would suit you, as another option.
Posted by cubbybear on February 6, 2005, at 2:52:35
In reply to Re: Please tell me about the Parnate problem » cubbybear, posted by Questionmark on February 6, 2005, at 2:15:07
>
>
then i would personally be inclined to believe it is life circumstances more than anything that is causing you this pseudo-poopout (if it is "pseudo-", of course).
> If not a low-dose stimulant or NMDA antagonist (?), then maybe a lower dose of lithium may help rekindle its effects? Good luck.I know very little about the pharmacology of augmentations, but bear in mind that my uncomfortable symptoms involve anxiety--the mildly agitated kind-- so wouldn't that mean supplementng/augmenting with a sedative (e.g. benzo) rather than stimulant? It seems that adding a stimulant would just blow me sky high,and with the exception of Lithium, stimulants are probably contraindicated with Parnate anyway. Your thoughts? cubbybear
Posted by cubbybear on February 6, 2005, at 5:56:27
In reply to Re: Please tell me about the Parnate problem » Maxime, posted by Willyee on February 6, 2005, at 1:04:00
>
>
> I actualy see the opposite,i see a common trend of parnate being effective,but almost in every case ending up pooping out.
>
forgot to comment on this-- you say that you see a common trend of parnate being effective but almost in every case ending up pooping out.
I know that one can't pluck figures out of the air, but I'd venture to say just the opposite trend--that there are much fewer poopouts with MAOIs (and esp. Parnate over Nardil) RELATIVE to the SSRIs.
You can check that yourself by doing a search with the words poopout and the name of the antidepressant. Part of my problem in trying to assess what's going on with my Parnate is that there's just so little info to go on. I concluded that Parnate poopout is probably UNcommon. Boy,would I like to talk to an expert in this field, but I doubt that one exists.
Posted by Maxime on February 6, 2005, at 19:19:03
In reply to Re: Please tell me about the Parnate problem » Willyee, posted by cubbybear on February 6, 2005, at 5:56:27
Hi
I just want to answer some of the questions that were asked in this thread on Feb 6.
- No Marplan is not available in Canada
- I am begining to think I should not started the Adderall to begin with.
- I would like to speak with an expert in psychopharmacology and ask him or her about all these problems because I can't play around with meds anymore. I can't do it.Maxime
Posted by Willyee on February 7, 2005, at 13:09:56
In reply to Re: Please tell me about the Parnate problem » cubbybear, posted by Questionmark on February 6, 2005, at 2:15:07
>
> I need a little education here,i know NMDA is pretty much the opposite of gaba,i believe.......more importantly what would be the easiest Nmda antagonist to get a hold of,any over the counter supplments ? I know mematine but i dont have time or resources to order over the net pharms,any adivce on a simple NMDA antganoist.> Although it seems like-- as Willyee also said-- Parnate poopout seems to be a relatively common occurrence, as far as medications go, i really have a hard time believing that after working so well for you for 20 years (esp. without increasing your dose at all or hardly at all), it would just suddenly start to poopout. If there is nothing different about your dietary or nutritional intake you can find that might have had any influence, then i would personally be inclined to believe it is life circumstances more than anything that is causing you this pseudo-poopout (if it is "pseudo-", of course).
> If not a low-dose stimulant or NMDA antagonist (?), then maybe a lower dose of lithium may help rekindle its effects? Good luck.
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