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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by bigcat on November 3, 2005, at 23:57:50
I'm on 105mgs Nardil, 225mgs Lamictal, and 60 mgs Aderall- had a great initial response (as always happens when I go back on the Nardil). Right now nothing whatsoever (not 30% or 40%- it's doing nothing). While I'm still entertaining augmenting options, "augmenting" implies enhancing an existing, though not complete, response. While my remission last week was very real and powerful, the Nardil is essentially a sugar pill at this point and I've quickly returned to my familiar, severe depression.
I was wondering if anyone with a similar Nardil experience found success with other treatmnet options...TCA's, SSRI's, SNRI's, etc. (This could indicate what might be a good option for my next trial). Marplan worked for a couple months before fading out, the Parnate did nothing but give me insomnia (I was only at 90 mgs). I have considered, as wild as it sounds, taking the Nardil to unheard of doses (+135mgs, closely monitoring blood pressure and other side effects- nothing to lose at this point). I'd appreciate any thoughts or experiences.
Your Friend In Need,
-matt-
Posted by SLS on November 4, 2005, at 7:41:12
In reply to Nardil Poopout Club: What else worked for you?, posted by bigcat on November 3, 2005, at 23:57:50
Hi.
My first reaction would be to say that there is probably no benefit from going above 120mg of Nardil a day. I can empathize with the desperation you must be feeling.
I understand your feelings about the use of the word "augmentor". In general (not medical) usage, it means to increase or enlarge something that already exists. So lets just think of augmentation as really being nothing more that coadministration. Sometimes, two drugs will act together synergistically to produce an effect that neither one alone is capable of. For instance, this occurs when one adds lithium to an antidepressant that has shown no signs of working. If I were in your position, I would try to augment the Nardil before having to discontinue it in order to move on to a serotonin reuptake inhibitor (SRI) drug. Something that I have had limited success with is adding desipramine to Nardil. My only caveat about adding this tricyclic (TCA) drug is that it be titrated very gradually to avoid side effects. There really is not much of a safety issue with desipramine. However, desipramine is the only TCA that I would recommend as it is the only one that does not act as an SRI to some degree. I guess one could make the argument that trimipramine would also fit into this category, but since I have no experience with it, I cannot recommend it.
Among the things you can add to Nardil safely, are:lithium
Lamictal
desipramine (Norpramin)
Wellbutrin
amphetamine (Dexedrine, Adderall)
methylphenidate (Ritalin, Concerta)
Trileptal
RemeronTell me, are there any hints of bipolar disorder in your case or in your family history?
- Scott
-------------------------------------------------> I'm on 105mgs Nardil, 225mgs Lamictal, and 60 mgs Aderall- had a great initial response (as always happens when I go back on the Nardil). Right now nothing whatsoever (not 30% or 40%- it's doing nothing). While I'm still entertaining augmenting options, "augmenting" implies enhancing an existing, though not complete, response. While my remission last week was very real and powerful, the Nardil is essentially a sugar pill at this point and I've quickly returned to my familiar, severe depression.
>
> I was wondering if anyone with a similar Nardil experience found success with other treatmnet options...TCA's, SSRI's, SNRI's, etc. (This could indicate what might be a good option for my next trial). Marplan worked for a couple months before fading out, the Parnate did nothing but give me insomnia (I was only at 90 mgs). I have considered, as wild as it sounds, taking the Nardil to unheard of doses (+135mgs, closely monitoring blood pressure and other side effects- nothing to lose at this point). I'd appreciate any thoughts or experiences.
>
> Your Friend In Need,
> -matt-
>
>
Posted by bigcat on November 4, 2005, at 9:31:21
In reply to Re: Nardil Poopout Club: What else worked for you?, posted by SLS on November 4, 2005, at 7:41:12
> Hi.
>
> My first reaction would be to say that there is probably no benefit from going above 120mg of Nardil a day. I can empathize with the desperation you must be feeling.
>
> I understand your feelings about the use of the word "augmentor". In general (not medical) usage, it means to increase or enlarge something that already exists. So lets just think of augmentation as really being nothing more that coadministration. Sometimes, two drugs will act together synergistically to produce an effect that neither one alone is capable of. For instance, this occurs when one adds lithium to an antidepressant that has shown no signs of working. If I were in your position, I would try to augment the Nardil before having to discontinue it in order to move on to a serotonin reuptake inhibitor (SRI) drug. Something that I have had limited success with is adding desipramine to Nardil. My only caveat about adding this tricyclic (TCA) drug is that it be titrated very gradually to avoid side effects. There really is not much of a safety issue with desipramine. However, desipramine is the only TCA that I would recommend as it is the only one that does not act as an SRI to some degree. I guess one could make the argument that trimipramine would also fit into this category, but since I have no experience with it, I cannot recommend it.
>
>
> Among the things you can add to Nardil safely, are:
>
> lithium
> Lamictal
> desipramine (Norpramin)
> Wellbutrin
> amphetamine (Dexedrine, Adderall)
> methylphenidate (Ritalin, Concerta)
> Trileptal
> Remeron
>
>
>
> Tell me, are there any hints of bipolar disorder in your case or in your family history?
>
>
> - ScottThanks for the reply, Scott. Adding the desipramine and/or wellbutrin is going to be my next move. I think you're right that it would be futile to push the Nardil anywhere past 120mgs. I'm currently on Nardil 105mgs, Lamictal 225mgs, Adderall 60mgs, (and a little Dex here and there). I've read some encouraging reports about using Buprenorphine in conjunction with an MAOI, so I'll research that route some more.
Remeron is an interesting suggestion, as it's one of the few drugs that I've never given a full trial. Don't know much about the Trileptal (an anticonvulsant, I believe), but I'll run it past my pdoc as well. It seems that I have often improved quite a bit upon starting various meds, but I soon sink quickly back down, ending up worse than when I started. I sometimes wonder if I should have stayed on these meds to see if the initial response wasn't a total fluke, and that whethering the storm may have led to a calm around the corner (easier said than done). Most recently, Serzone gave me a great initial lift, but we soon abandoned it after the boost subsided and the anxiety/social paranoia increased.
To answer your question, my grandfather may have been mildly bipolar, but no other alarming psych history in my family. The first time the Nardil worked, I was hypomanic for a week (after 10 years of severe depression, I would expect something like this), and when the Marplan worked (on the fourth trial after three failed attempts), I was DEFINATELY hypomanic for a couple weeks. Dexedrine made me somewhat speedy and manicky as well, but this eventually wore off, and a wonderful calm and open access to my perpetually sleeping mind followed. I even had a psychotic, delusional mania on high dose Dex + the most potent THC powder I've ever come across (the likely culprit). But all these episodes have been drug-induced, and I've never experienced a spontaneous mania.
Could you expand on your own experience a little, the highs, lows, and what you're taking or considering to be your next move?
much love,
-matt-p.s: what do you think about an extended, slowly titrated Effexor trial?
Posted by ed_uk on November 5, 2005, at 12:25:19
In reply to Re: Nardil Poopout Club: What else worked for you? » SLS, posted by bigcat on November 4, 2005, at 9:31:21
Hi Matt
>Right now nothing whatsoever (not 30% or 40%- it's doing nothing)
I agree that there's not generally much point in going over 120mg Nardil. Even so, haven't you only been on 105mg Nardil for a few days? Nardil can take several weeks to kick in after a dose increase.
>To answer your question, my grandfather may have been mildly bipolar, but no other alarming psych history in my family.
I remember you saying that you'd tried lithium, but didn't respond well. How do you find the other mood stabilisers and atypical antipsychotics?
Do you have a list of all the meds you've tried so far?
Kind regards
Ed
Posted by tecknohed on November 8, 2005, at 10:29:31
In reply to Re: Nardil Poopout Club: What else worked for you?, posted by SLS on November 4, 2005, at 7:41:12
Hi SLS
I'm curious to how you think these two are safe together. Have you tried them? Can you point me to any reports? I've often thought of this combo but have never found much positive info on it, only warnings. I would like to try it though.
I've also thought about adding low dose selegiline. Have any thoughts on that?
Regards,
teck
Posted by Jedi on November 9, 2005, at 2:01:41
In reply to Wellbutrin with Nardil? Really? » SLS, posted by tecknohed on November 8, 2005, at 10:29:31
Hi tech,
To add my two cents worth; I've used Nardil with WellbutrinSR up to 300mg. I had no significant side effects, except some initial aggression from the Wellbutrin. It did help with the weight gain from Nardil. The combination is officially contraindicated and I won't say it is safe for everybody. It worked for me.
Take care,
Jedi
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