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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by jonh kimble on September 7, 2005, at 19:17:04
Hi all, its been a while. K, I have a docs appt. tomorow and I was just going to go in and discuss the clonazepam Im taking, and how we'll probably taper off since Im at 3mgs and dont want to go higher, etc..... BUT! I remember and am thinking about trying nardil again. Quickly, heres why.
Ive had what I believe to be apd, my doc calls it social phobia, and we both agree group cbt is a good way to go and Im totally on board with this, but I have been doing 1on1 therapy for 1 1/2 years now and I really havent improved even a smdge over all this time. True, I dont do the exposures as frequently as must be done, but I have for say 2 weeks at a time and any hint of failure shatters my confidence, so I naturally dont continue and without (at least the feeling of) being able to explain this to my therapist try to explain without it making sense to them and then have to lie...
So therapy isnt going to work in this given sit., Im developing a tolerance to the clono. and Ive tried maybe 20-30 drugs with very limited response, incl. Nardil. Not a hopeful situation BUT...
Maybe 3 years ago when I first tried clono. 1mg I said and it did nothing! Didnt even feel like I had had a drink. No tolerance whatsoever. Few years later by chance im given it again and I notice a small effect, take it again remembering what it did and wow! was it effective, not that anything biological happened, I simply changed my expactations, first time expecting to feel comfortable running down the street naked, essentially anti-anxiety effect of 15 drinks while being sober. Also thought this is simply a matter of brain chem. and HAVE to take a pill, only option. In light of clono. working fairly well with new expectations and some thought modification, Im wondering if Nardil could help me, maybe even quite a bit.
C before I took a max of 60mgs for about 2 weeks and not getting blown away by some miracle I tossed it right then and there. I think 1) way to low a dose 2) way to short a trial and most importantly 3) even without 1 and 2, I wouldnt have noticed anything anyway because it would have had to turn me into a social butterfly. How could it have worked? Given its incredible ratings for sp and that general spectrum of disorders, I think its time to do a good 2 - 3 months on 90 or more mgs in conjunction with the gcbt starting in a few weeks.
What are all your thoughts?
My main probs. are severe distress in one on one interaction (interaction in general but this is most dehabilitating), supreme fear of rejection and sensitivity to it, I avoid almost all social interaction even with family because if someone rejects me even mildly, no kidding I take worse than if I lost thousands of dollars, broke a bone, well anything rationally bad. I also obsess about tons of with, worry alot about tons of things, etc...I have noticed that small doses of lsd are the best for my condition as I open up, follw thoughts much more clearly, feel extactic about life, and approach people in a totally rational manner. I Also know that it is a very serotonin based drug, and bezoes and alcihol work well but in a totally differnt way through there effects on gaba. Doesnt Nardil mainly work on these 2 neurotransmitters? Is there any reason to drawing a connection here? And finally, I know my doc. is very liberal and open to these ideas but hes going to need a good schpeel on my part tomorow as it took with getting clono. a year ago. Its not addictive, not very likey to develop tolerance, Im going to do therapy simutaneously, Im very responsible, I now the precise interactions, was on before with no probs. are all good but this is life or death, any other suggestions about this or anything Id appreciate immensly. Articles on it or whatever Id love.Thank you, Tom
Posted by ed_uk on September 8, 2005, at 13:49:18
In reply to Nardil for avoidant personality?, posted by jonh kimble on September 7, 2005, at 19:17:04
Hi Tom,
I'd definately try the Nardil at a higher dose.
Kind regards
~ed
PS. How do you respond to SSRIs?
Posted by jonh kimble on September 8, 2005, at 15:59:28
In reply to Re: Nardil for avoidant personality? » jonh kimble, posted by ed_uk on September 8, 2005, at 13:49:18
Hi, thanks for the response. Well my doc pres. nardil @15mg 1st week, 30 2nd, 45 3rd and wants me to stay there. I mean I guess Im lucky to have got it at all but this simply isnt going to be effective. Maybe he wants to be careful before willing to go much higher (90mg range I guess) but he sounded like he didnt want me on it at all and wanted me off soon cause he wants me doing therapy and nothing else. Ill need to have some great reason why I should be on it, if I say its not working he'll likely say well we tried it, and if I say it is working.. well I dont see that happening. How did you respond to nardil? Be specific if you can. SSRI's did nothing although the only one I gave a full fledged attempt with was effexor for about a month at max dose of 225mg. One day I was insanely euphoric (kinda like ecstacy) and a few days I became practically suicidal. I did parnate at 50mgs day for well over a month with nothing so I dont know if this (nardil) is even worth trying. Thanks again.
Tom
Posted by Tepiaca on September 8, 2005, at 21:55:17
In reply to Nardil for avoidant personality?, posted by jonh kimble on September 7, 2005, at 19:17:04
Posted by Chairman_MAO on September 8, 2005, at 23:53:48
In reply to Re: Nardil for avoidant personality?, posted by jonh kimble on September 8, 2005, at 15:59:28
You cannot say you've given Nardil a trial until you've taken 1mg for each kg of bodyweight per day.
I weigh 86kg, so I take 90mg/day. It says right there in the monograph: "Doses up to 90mg may have to be used to obtain sufficient MAO inhibition". If your doctor has a problem with your taking 90mg/day, get a new doc. Go to 75mg/day first, though; it may do the trick. I find that 60mg/day even has some anti-anxiey effect on me, it just isn't much of an antidepressant nor is it pro-social. It does help with social ANXIETy, though quite a bit.
Posted by ed_uk on September 9, 2005, at 15:57:54
In reply to Re: Nardil for avoidant personality?, posted by jonh kimble on September 8, 2005, at 15:59:28
Hi Tom!
>Well my doc pres. nardil @15mg 1st week, 30 2nd, 45 3rd and wants me to stay there.
It's often a good idea to start at a low dose.... so long as your doc is willing to prescribe a high dose if necessary.
>How did you respond to nardil?
I've never been on Nardil. At the mo, I'm on 60mg citalopram + 25mg amitriptyline.
>I dont know if this (nardil) is even worth trying.
I strongly believe that it is.
Kind regards
~Ed
Posted by Declan on September 10, 2005, at 2:57:10
In reply to Nardil for avoidant personality?, posted by jonh kimble on September 7, 2005, at 19:17:04
Hi Tom
I'm interested that you have found very low dose LSD useful, especially the more clear more rational bit. I did a reasonable amount of that in the past, and that was my experience too. I have symptoms(?) a little similar to yours.
Declan
Posted by Cecilia on September 10, 2005, at 3:27:31
In reply to Re: Nardil for avoidant personality? » jonh kimble, posted by Chairman_MAO on September 8, 2005, at 23:53:48
Chairman Mao, I`m curious about that 1mg/kg. rule. Is that based on actual or ideal body weight? Because if it`s the former a lot of overweight people would have to take enormous doses. When I tried Nardil many years ago I took 45/mg day for 4 weeks with no side effects or benefits, increased to 60 mg/day with no effects of any sort for 10 days, then I guess the MAO inhibition kicked in and I suddenly had terrifying side effects, the worst headache ever (not associated with BP elevation), eyes so dry I thought I was going blind, a horrible painful "metallic"" feeling in my muscles and joints. I never took another dose-too scared. Obviously 60 mg was too much for me, although I am quite overweight and 1mg/kg would be much more. In retrospect, I regret not going back to 45 mg/day and trying for a few more weeks just to see if it might have had some benefit. Ever so often I consider trying Marplan, but I`m just so scared of experiencing another reaction like with Nardil. It was the out of nowhere suddenness of the reaction that scared me so much-most meds you don`t get sudden bad side effects after tolerating them for 38 days. I only lasted a week on Parnate-it was intolerable from the 1st-basically a week with no sleep. Have you tried Marplan-how does it compare to Nardil and Parnate. I`ve been holding out for the selegilene patch before trying another MAO, but I`ve ceased to believe it will ever be approved. Cecilia
Posted by ed_uk on September 10, 2005, at 7:12:23
In reply to Re: Nardil Dose-Chairman Mao, posted by Cecilia on September 10, 2005, at 3:27:31
Perhaps you'd do well on 52.5mg. You could try 45mg for six weeks and then increase to 52.5mg if necessary.
~ed
Posted by gardenergirl on September 10, 2005, at 14:34:21
In reply to Re: Nardil Dose-Chairman Mao » Cecilia, posted by ed_uk on September 10, 2005, at 7:12:23
I can't take a dose based on the 1mg/kg suggestion. Anything over 67.5 mg gives me really uncomfortable akisthesia and insomnia.
gg
Posted by jonh kimble on September 10, 2005, at 16:27:02
In reply to Re: Nardil Dose-Chairman Mao, posted by gardenergirl on September 10, 2005, at 14:34:21
Re means response doesnt it? Anyway, how are you Tep., havent spoken to you since I was in Florida! Long time ago. My emails stopwhining@email.com so lets talk.
Declan, thats interesting with lsd because what are the things you read about when it comes to acid's effects? Confusion, paranoia, etc. essentially the opposite of clear mindedness. Ok, well they are talking about 200 - 400 mcg. range while Im talking 50 - 100mcg. range, but even so, no one Ive ever spoken too has had what I have. And people I am around say I am a TOTALLY different person and say I speak very elegantly while they hear me and they are sober. (I dont speak most other times.) So we could follow this on the substance page if you care to. Also interesting point is with pot; I get terrible social and general anxiety, I mean I practically freak out around best friends (all 2 of them:) while others report social COMFORT and general RELAXATION! I get anything before those effects. I become more introspective and philosophical, less appetite and cant laugh for the life of me, so my response to some drugs is lets say different. Anyone else with anything here?
Posted by jonh kimble on September 10, 2005, at 18:19:25
In reply to Re: Response, posted by jonh kimble on September 10, 2005, at 16:27:02
Firstly, theres a very interesting idea, imo, at the end of this post which I might make a new thread out of. Please read it if you have a second.
Well I think I'll go ahead and try the nardil. Thanks for the responses and I have some Q's. Does an antidepressant kick in like you expect a benzo to once it does? I mean I know it takes from 2 - 5? weeks for the effect to begin but is it essentially all its going to be once you notice any effect? Also what should I expect to feel? Maybe you cant really answer that one.
Now how about interactions? I take d-amphetamine 30mgs in bursts(periodically) to help with school, and to make me more social, and just plain feel good, and I have to admit, I am beggining to see isnt such a hot idea, as 45 mgs feels better than 30mgs and now 30mgs feels better than 15 did and so on. But is dex completely contradicted? The monograph says so but I know they wanna cover there butts and tend to go too far, just as they say NEVER can you drink, and I know some alcohol is fine. There are defintly others such as NO cheese while cream cheese in moderation is fine etc.
Finally, I have an interesting theory about nardils effecicy being lowered if you are a smoker(I was when I took it before) and taking ginkgo biloba. See Nardils anti anxiety effects are thought to be somewhat (at least) related to its ability to cause a large increase in brain gaba levels. Now get this. Nardils ability to enhance brain gaba levels is dependant on the pre existence of mao a and b, as phenelzine passes through these, it inhibits them but also a new compound is formed that is responsible for these effects on gaba. In other words, the more nardil passes through mao, the more gaba, is how i understand it. If mao is being inhibited any other way, this gaba effect is lost. It is also known, or at least strongly, believed that something in tobacco and something in ginkgo both have have non selective maoi activity. Considering I was smoking and taking lots of gingko back then, that may have reduced its positive effects. Take all this into account when you read this study http://www.biopsychiatry.com/phengaba.htm
Does anyone know of other common substances that could affect nardil in this or any other way? I know this was long, but Im pretty tantalized by this thought that really just came to me while typing.
Thanks, Tom
Posted by ed_uk on September 11, 2005, at 6:05:23
In reply to Re: Nardil questions and interesting thought!, posted by jonh kimble on September 10, 2005, at 18:19:25
Hi Tom,
>Does an antidepressant kick in like you expect a benzo to once it does?
Some people find that they do but I've never had that experience myself. ADs have always affected me very gradually, so gradually that I'd hardly even notice until one day I'd wake up and realise that I'd been feeling quite good for the last few weeks.
>Finally, I have an interesting theory about nardils effecicy being lowered if you are a smoker(I was when I took it before)........
You could be right - I'm glad you've stopped smoking.
~ed
Posted by Declan on September 11, 2005, at 22:12:19
In reply to Re: Response, posted by jonh kimble on September 10, 2005, at 16:27:02
My response to marijuana is similar to yours, which is to say that at equivalent doses I find it much more of a challenge than acid.
Declan
Posted by Jedi on September 12, 2005, at 2:24:58
In reply to Nardil for avoidant personality?, posted by jonh kimble on September 7, 2005, at 19:17:04
> Hi all, its been a while. K, I have a docs appt. tomorow and I was just going to go in and discuss the clonazepam Im taking, and how we'll probably taper off since Im at 3mgs and dont want to go higher, etc..... BUT! I remember and am thinking about trying nardil again. Quickly, heres why.
Hi Tom,
Because so much research indicates that phenelzine is the most effective treatment for social anxiety, some scientists say that no patient should be considered treatment restistant without a trial of phenelzine. I use 75 to 90mg of phenelzine along with 1 mg of clonazepam and most all of my social anxiety symptoms are gone.
I am thinking of lowering my dosage of phenelzine to 60 mg and raising my clonazepam dosage to 3mg to try to minimize the weight gain and delayed ejaculation from phenelzine. If this does not work, I may try adding bupropion SR or a mild timed released stimulant.If you try phenelzine, I'd be very careful with the LSD, since both drugs stimulate serotonin. You don't want to mess with serotonin syndrome.
Be Well,
JediNord J Psychiatry. 2003;57(4):313-5.
Phenelzine efficacy in refractory social anxiety disorder: a case series.
Link:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12888407&query_hl=1
Posted by Chairman_MAO on September 13, 2005, at 14:19:46
In reply to Re: Nardil Dose-Chairman Mao, posted by Cecilia on September 10, 2005, at 3:27:31
The 1mg/kg is not absolutely set in stone; it is a result of extrapolating data from studies of MAO inhibition in test subjects based upon varying doses.
I have often thought about what overweight people do, especially those who gain weight from the medication! Do you gain weight, up the dose ,and gain more weight? ;)
All I can say is that perhaps the body weight rule doesn't apply as absolutely if your body composition is mostly fat, etc. This is total conjecture based in no scientific fact. What I CAN say is that the therapeutic dose for me seems to correlate almost exactly to the mg for 1mg/kg. 75mg/day worked somewhat, but nowhere near as well as 90mg/day. I weigh 86kg.
This is the end of the thread.
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