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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by bigcat on November 1, 2005, at 17:42:51
This happens to me every time I try Nardil. I initially feel GREAT (virtually immediately) for a few days at 60mg's, then start slipping, and no dose increase will help (up to 105 mgs). In the past, I've always come off it when this apparent "poop-out" happens, but now, as much as it hurts and seems foolish, I'm wondering if I should stay on it for another month, even as it's doing nothing now, to see if it will eventually kick back in slower and less pronounced, but more consistantly.
Is this futile; should I just let it go and try something else (nothing else has ever worked), or should I deny logic and reason and stay on it? I literally went from a 10 last week to a 0 right now. Can't really rely on my pdoc for solving this one, so I'd appreciate any advice.
much love
-matt-
Posted by SLS on November 1, 2005, at 18:26:48
In reply to Should I give Nardil more time??, posted by bigcat on November 1, 2005, at 17:42:51
Hi.
> This happens to me every time I try Nardil. I initially feel GREAT (virtually immediately) for a few days at 60mg's, then start slipping, and no dose increase will help (up to 105 mgs).
Welcome to the club.
> In the past, I've always come off it when this apparent "poop-out" happens, but now, as much as it hurts and seems foolish, I'm wondering if I should stay on it for another month, even as it's doing nothing now, to see if it will eventually kick back in slower and less pronounced, but more consistantly.
I assume you've already tried a bunch of other drugs. How much could it hurt to give it some more time? In my experience, giving Nardil more time has not helped, but you never know. Everyone is different. If I were in your position, I would begin augmenting Nardil with things like lithium or Lamictal now. Other acceptable choices would be desipramine, stimulants, Provigil, and Wellbutrin. A conservative approach would be to allow 3 weeks for any one dosage adjustment to work.
What other drugs have you been partially responsive to?
> or should I deny logic and reason and stay on it?
There is plenty of logic and reason to stay on it. The only thing there isn't is a guarantee.
- Scott
Posted by Declan on November 1, 2005, at 19:54:10
In reply to Should I give Nardil more time??, posted by bigcat on November 1, 2005, at 17:42:51
Matt, I know you said it but I'd just like to check that it's literally from a 10 to a 0. (Or to put it another way is your memory deceiving you and you are chasing hypomania?)
When you come off a dose that no longer seems to work do you feel worse than you did on the ineffective dose?
It would annoy the hell out of me. You'd think that someone would understand why this happens.
Declan
Posted by Chairman_MAO on November 1, 2005, at 20:03:22
In reply to Re: Should I give Nardil more time?? » bigcat, posted by SLS on November 1, 2005, at 18:26:48
I must interject here and add my own experience, FWIW:
buprenorphine potentiates the good effects of phenelzine--A LOT. If you feel you have tried everything, you should put those two drugs together.
At this point, I barely take buprenorphine anymore because of a) side effects b) I can get TOO MUCH therapeutic effect and become emotionally distant, somewhat selfish, overanalytical, driven etc. Now I use the buprenorphine INSTEAD OF COFFEE OR STIMULANTS on the days that I need a pick-me-up. Welcome to the real world of psychopharmacology, where people's prejudces about classes of drugs crumble like the tower of babel ...
Posted by SLS on November 1, 2005, at 20:07:53
In reply to Re: Should I give Nardil more time?? » SLS, posted by Chairman_MAO on November 1, 2005, at 20:03:22
> Welcome to the real world of psychopharmacology, where people's prejudces about classes of drugs crumble like the tower of babel ...
Why, thank you.
- Scott
Posted by WeeWilly on November 1, 2005, at 22:21:34
In reply to Should I give Nardil more time??, posted by bigcat on November 1, 2005, at 17:42:51
After 3 weeks and getting to 90mg on Nardil with no help, I added 15mg of Adderall and within a few minutes had therapeutic response. Has been a few days now with 60mg Nardil and no Adderall.
Severe insomnia limiting antidepressant response.
Hopefully my sleep will improve and also the response. Best wishes
Posted by ace on November 2, 2005, at 2:09:48
In reply to Should I give Nardil more time??, posted by bigcat on November 1, 2005, at 17:42:51
> This happens to me every time I try Nardil. I initially feel GREAT (virtually immediately) for a few days at 60mg's, then start slipping, and no dose increase will help (up to 105 mgs). In the past, I've always come off it when this apparent "poop-out" happens, but now, as much as it hurts and seems foolish, I'm wondering if I should stay on it for another month, even as it's doing nothing now, to see if it will eventually kick back in slower and less pronounced, but more consistantly.
>
> Is this futile; should I just let it go and try something else (nothing else has ever worked), or should I deny logic and reason and stay on it? I literally went from a 10 last week to a 0 right now. Can't really rely on my pdoc for solving this one, so I'd appreciate any advice.
>
> much love
> -matt-jUST QUICKLY. yes!
BUT YOU WILL NEED POLYPHARMACY TO SUSTAIN AFFECTS
KEEP IT AT 90MG
AND CONSIDER THE FOLLOWING ADD ONS
1. LITHIUM
2. NEW ANTIPSYCHOTIC IN LOW DOSE
3. CLONAZEPAM (OR XANAX)
4. LOW DOSE SELEGILINE
5. STELAZINE
6. A GABBA AGENT....I.E. TOPAMAX, NEURONTIN, ETC
MANY MANY MOREI HAVE A LIST AS LONG AS MY LEG AT HOME
NARDIL REIGNS FOREVER!
ACE
Posted by ace on November 2, 2005, at 2:11:29
In reply to Re: Should I give Nardil more time?? ?bigcat, posted by ace on November 2, 2005, at 2:09:48
Posted by bigcat on November 3, 2005, at 14:53:15
In reply to Re: Should I give Nardil more time??, posted by WeeWilly on November 1, 2005, at 22:21:34
When I say I went from a 10 to a 0, I mean that I went from full remission to severe depression (in the period of 10 days). I'm not chasing a hypomanic high. I'm very versed in what remission and a return to depression feels like. I'm concurrently taking Lamictal as well, and doubt my doctor will go for the buprenorphine thing. Parnate didn't work for me on a lengthy trial, but I was only on 90mgs (and couldn't get a wink of sleep). Marplan, however gave me a good response which faded after a couple months. I HAVE responded to various meds when first starting them up, but this feeling has always gone as quickly as it comes on.
Most recently, I responded great to Serzone virtually immediately, and then was right back to where I started a couple days later. I'm now curious if we dropped many meds too soon due to start-up anxiety and glaring cognitive impairment and/or pushing the dose up too high too fast. Dexedrine worked wonders for me for a couple months, and Aderrall great for about two days. I've had ECT before, but am considering having it done again. Any med suggestions would be greatly appreciated (even meds where you really have to wait it out and improve slowly).
I've had a severe, chronic, treatment-resistant depression which renders me lifeless (I would chop off my balls to get relief, not kidding one bit). I've never experienced a gradual improvement on any med- it's always been a lightswitch that goes on very quickly.
Life is absolute hell. I can't even make it to the shower, am virtually mute, and am so painfully aware of what I'm missing out on. Nardil augmentation strategies seem futile, as it's doing NOTHING right now. It needs a full jumpstart, not a helping hand. Thanks for listening to my sorrows, and I'd be interested in ANY suggestions.
Posted by ed_uk on November 3, 2005, at 17:06:39
In reply to Re: Should I give Nardil more time?? UPDATE..., posted by bigcat on November 3, 2005, at 14:53:15
Hi Matt
How did you respond to ECT?
Kind regards
Ed
Posted by willyee on November 3, 2005, at 18:37:32
In reply to Re: Should I give Nardil more time?? UPDATE..., posted by bigcat on November 3, 2005, at 14:53:15
Hi guy,i see chairman,and to then thousand times the degree ACE promote Nardil.No problem,we need that,when something is found useful to screamit from the roof tops.But there must always be an understanding that not everyone will come to the same conclusions.I cant not even get past a week trial on nardil,as it is too weak,to slow and sedative like,and too many sideeffects.
Parnate acts like a mood stablizer for me,meaning makes me feel at a 0 rather than under a 0,so i try to augment it.Right now im using ritalin,and not forgetting how valuable OTC prodcuts can be i started using l-theanine/klonopin as well,seems like a ok combo thus far.Well have to see it just never ends,i ffeel ur frustration,even though id hate to loose one of my boys!
> When I say I went from a 10 to a 0, I mean that I went from full remission to severe depression (in the period of 10 days). I'm not chasing a hypomanic high. I'm very versed in what remission and a return to depression feels like. I'm concurrently taking Lamictal as well, and doubt my doctor will go for the buprenorphine thing. Parnate didn't work for me on a lengthy trial, but I was only on 90mgs (and couldn't get a wink of sleep). Marplan, however gave me a good response which faded after a couple months. I HAVE responded to various meds when first starting them up, but this feeling has always gone as quickly as it comes on.
>
> Most recently, I responded great to Serzone virtually immediately, and then was right back to where I started a couple days later. I'm now curious if we dropped many meds too soon due to start-up anxiety and glaring cognitive impairment and/or pushing the dose up too high too fast. Dexedrine worked wonders for me for a couple months, and Aderrall great for about two days. I've had ECT before, but am considering having it done again. Any med suggestions would be greatly appreciated (even meds where you really have to wait it out and improve slowly).
>
> I've had a severe, chronic, treatment-resistant depression which renders me lifeless (I would chop off my balls to get relief, not kidding one bit). I've never experienced a gradual improvement on any med- it's always been a lightswitch that goes on very quickly.
>
> Life is absolute hell. I can't even make it to the shower, am virtually mute, and am so painfully aware of what I'm missing out on. Nardil augmentation strategies seem futile, as it's doing NOTHING right now. It needs a full jumpstart, not a helping hand. Thanks for listening to my sorrows, and I'd be interested in ANY suggestions.
Posted by bigcat on November 3, 2005, at 23:34:59
In reply to Re: Should I give Nardil more time?? UPDATE... » bigcat, posted by ed_uk on November 3, 2005, at 17:06:39
> Hi Matt
>
> How did you respond to ECT?
>
> Kind regards
>
> EdEd My Dear,
Fifteen bilateral ECT treatments four years ago, and absolutely no effect. My current (new as of this year) pdoc is kinda' lobbying for the ECT thing again, but if I gave it a full trial once and it was unsucessful, I *think* a second trial would be futile. This is the opinion of my former pdoc (whom I respect and continue to consult). Closing out that avenue is tough to swallow, as my new doc was adamantly praising this brilliant psysician in her psych group who is "regarded as a renowned, leading expert in ECT, and has figured out all these new, more effective, and benign methods". I wish I could cling to this hope, but I've never heard of a full 15-treatment trial failing initially and working wonders the second time around. She's also talking up the new "electro magnetic" therapy, but I'm skeptical of that too.
God Ed, this is impossible. I've been posting quite a bit lately (often redundantly I regret to admit, but this board gives me SOME kind of outlet for an otherwise comprehensive isolation). The terrifying reality of my hopeless predicament makes every moment catclysmically torturous. I'll read about sexual side effects or weight gain causing a patient to discontinue an otherwise effective therapy, and it hits me how bad I truly have it. I don't mean to belittle the suffering of others, but my depression is simply on a different level entirely. To be frightfully honest, I wouldn't hesitate to accept a lifetime of solitary confinement with regular abuse and starvation if it came with a true and lasting remission.
Sorry to vent, but you've been so consistently kind and helpful, casually and humbly displaying a bottomless genius for psychopharmacology that inspires hope and makes all other pdocs seem like dabbling amatuers; are you a liscensed pshychopharmacologist? (Either way, I'm coming to the UK so you can be my official or unoffical doctor. I'll consult you for med advice and hire use a dopey pdoc as my pawn for writing scripts). Does your bottomless med knowledge come from incessant research, longtime experience, or a creatieve and inexplicable inuition...? I'd be very interested to hear the ups and downs of your treatment: your liberating breakthroughs, strange or unanticipated responses, creative cocktailing adventures, and the myths and fallacies you've encountered that restrain psychopharmacological progress and block potentially sucessful treatment options.
With Respect and Admiration,
-matt-
(mlieb@wesleyan.edu)with countless others who express honest selflessnessexpressing my honest
Posted by ed_uk on November 5, 2005, at 11:17:38
In reply to Re: Should I give Nardil more time?? UPDATE... » ed_uk, posted by bigcat on November 3, 2005, at 23:34:59
Dear Matt
>Fifteen bilateral ECT treatments four years ago, and absolutely no effect. My current (new as of this year) pdoc is kinda' lobbying for the ECT thing again, but if I gave it a full trial once and it was unsucessful, I *think* a second trial would be futile.
Was your doc considering a different type of ECT? eg. bifrontal instead of bitemporal. Did you suffer from many side effects when you tried ECT before?
>God Ed, this is impossible. I've been posting quite a bit lately (often redundantly I regret to admit, but this board gives me SOME kind of outlet for an otherwise comprehensive isolation).
P-babble is certainly a great place to come for support :-)
>Sorry to vent, but you've been so consistently kind and helpful, casually and humbly displaying a bottomless genius for psychopharmacology that inspires hope and makes all other pdocs seem like dabbling amatuers; are you a liscensed pshychopharmacologist?
I'm definitely no genius.....but thank you for your kindness :-) I'm not a doctor, I'm a dispensing assistant in a pharmacy.
>I'm coming to the UK so you can be my official or unoffical doctor.
Have you ever been? It's not bad here I suppose. You won't find many good pdocs here though! There *are* a few but they're *difficult* to find. Nice weather at the moment though....cool but sunny today in Yorkshire. I have a mild headache, the house is full of relatives.....mum's cousins etc, there's billions of them :-) Most of them I don't know, I've escaped to the computer room and switched the music on.
>med knowledge
I've learnt a bit about pharmacology by reading and by following people's experiences with psychotropics. P-babble can be very educational, I've learnt a lot here.
>I'd be very interested to hear the ups and downs of your treatment: your liberating breakthroughs, strange or unanticipated responses, creative cocktailing adventures, and the myths and fallacies you've encountered that restrain psychopharmacological progress and block potentially sucessful treatment options.
My health is fairly good at the moment, better than it's been in a long time. I haven't been severely ill for about 3 years now (I'm 21 by the way). Creative cocktail adventures almost never occur in the UK I'm afraid (except down the bar!). Most pdocs here are *very* limited in what they prescribe. SSRIs, Effexor and the (older) atypical APs are popular.
I've always responded very gradually to SSRIs for anxiety. High doses have been effective after prolonged periods. Unfortunately, high doses do make me rather apathetic. Anxiety has been my main problem, specifically OCD-type anxiety, but only rarely classical OCD. I did suffer one episosde of depression when I was about 17, which lasted for several months, lofepramine (Gamanil) was helpful. My anxiety was severe from the age of ~3 until I was ~15. It was very chronic, but improved significantly with paroxetine (Paxil) 40mg after several months of treatment. I've taken medication ever since (almost), usually an SSRI.
Career-wise, I'm not aiming high. I originally wanted to be a doctor but eventually accepted that I'd never be able to cope the stress. I think I'll eventually end up working as a pharmacy tech in a hospital. I did start the pharmacy degree but left because it was so dreadfully boring and irrelevent, it was getting me down. I like my job, although the pay is very poor.
Kind regards
Ed
Posted by denise1966 on November 6, 2005, at 8:45:56
In reply to Should I give Nardil more time??, posted by bigcat on November 1, 2005, at 17:42:51
Matt,
Do you get much anxiety and stress with your depression or is it total apathy? I completely relate when you say each moment feels torturous. I was thinking that myself the other day.
Also have you tried antipsychotics? What about Deep Brain Stimulation, or is that too drastic?
I admire your persistance when you're obviously feeling really bad. But then I suppose there is nothing else for you too do.
Denise
Posted by bigcat on November 6, 2005, at 23:40:52
In reply to Re: Should I give Nardil more time??, posted by denise1966 on November 6, 2005, at 8:45:56
> Matt,
>
> Do you get much anxiety and stress with your depression or is it total apathy? I completely relate when you say each moment feels torturous. I was thinking that myself the other day.
>
> Also have you tried antipsychotics? What about Deep Brain Stimulation, or is that too drastic?
>
> I admire your persistance when you're obviously feeling really bad. But then I suppose there is nothing else for you too do.
>
>
>
> Denise
Denise,
I sometimes think my depression involves racing/obsessive thoughts of anxiety/ENDLESS WORRY/hopelessness/loathing and aversion to consciousness. Yes, apathy goes along for the ride too. Can't even read a book or sit still and do one activity for more than a couple minutes. I become mute, unable to think of anything to say, NO INTEREST IN ANYTHING, all consumed with SELF, obsessively introspective, very timid, and looking forward to my bed as (drug-induced) sleep brings semi-oblivion.I think many of my symptoms are add-related, as I can't focus, concentrate, fuse words or thoughts into sentences, express myself, communicate (which leads to social withdrawal, self-loathing, and cripplingly low self-esteem, along with horrrible boredom and a pressure, but inability to *do* anything). My mind is asleep (yet agitated simultaneously); I have no access to the useful parts of my brain which would allow me to become involved in an activity (rather than *dreading* and having an aversion to EVERYTHING), or allow me to connect with someone or something (a state of total exile).
My obsessive mind is wholly consumed and fatigued with LOUD, perpetually racing thoughts of negativity, "If Only...", despair, and a longing for life as I see other people live it. I become very petty, selfish, and judgemental as well. Having felt remission, I compare every waking moment and thought with how it would be if I was in remission. It's a feeling (or painfully real UNDERSTANDING OF THE REALITY) of my powerlessness; I'm the most ineffective "dud" of a person. As a child I was bright, exciteable, funny, athletic, excelled in school, was a leader, and had a total social ease and comfort. The Big D creeped in slowly, and I didn't even realize how much I loathed life until my first Nardil remission. Thanks for your concern Denise. Much Love Me Lady...
-matt-
Posted by denise1966 on November 7, 2005, at 10:02:49
In reply to Re: Should I give Nardil more time?? » denise1966, posted by bigcat on November 6, 2005, at 23:40:52
Matt,
I can soooo relate but you still haven't answered my question about antipsychotics, have you tried them at reasonable doses?
Also, would you consider Deep Brain Stimulation? Not that I'm offering to perform it on you :-)
Denise
Posted by bigcat on November 7, 2005, at 13:02:55
In reply to Re: Should I give Nardil more time??, posted by denise1966 on November 7, 2005, at 10:02:49
Denise:
Six years of med-merry-go-rounding at a frantic pace (I would become terribly depressed/confused upon starting a new med and would ditch it quickly, not allow for a withdrawal period, and jump on another one immediately, starting at mega-high doses) has made it impossible to recollect how I felt or responded to virtually any medication (all I remember is that I tried it and it didn't work). My pdoc's charts are insufficient to say the least, as my incessant pressurizing and state of panic and desperation led to weekly med changes, and a far-from calculated or consistent strategy or treatment plan.So, to answer your question, I have (very briefly) tried Geodon, Strattera, and Abilify, but I neither remember the experience, and cannot separate any one of them into "it did this or that". Do you have reason to suspect that one of these, or other anti-psychotic medications, may be worth a fair trial for attacking my symptoms? I know I never lasted more than 1-2 weeks on any of these, and I do seem to remember an initial increase in anxiety/agitation/amplification of symptoms/social phobia upon starting at least one of these. I have samples of Risperidal right now, debating whether to add it into the mix. Never really gave Zyprexa a full fling either. Do you think any of them would ease the fearful, crowded, loud, frantically obsessive/cycling thoughts, and vegetative stagnation of my mind?
Tried ECT, but Deep-Brain Stimulation no, haven't heard anything about it. Not an option now, as I need another 4 months for insurance to kick in, but I'd be interested to find out more. Thanks for trying to help. (I'll really try to keep future posts more succinct).
Thanks Darling..-matt-
Posted by ed_uk on November 7, 2005, at 14:31:35
In reply to Re: Should I give Nardil more time?? » denise1966, posted by bigcat on November 6, 2005, at 23:40:52
Hi Matt
Did you read my post? I sent you an email.
Kind regards
Ed
Posted by bigcat on November 7, 2005, at 18:33:49
In reply to Re: Should I give Nardil more time?? » bigcat, posted by ed_uk on November 7, 2005, at 14:31:35
> Hi Matt
>
> Did you read my post? I sent you an email.
>
> Kind regards
>
> EdEd,
I'm very confused. Did I miss something? I just read the email you sent asking if you had offended me. The answer is of course not, you couldn't possibly. I just can't imagine what would make you think this? Perhaps you sent a prior email that I deleted not realizing who the sender was, because I'm not sure what you're talking about. The email I did get said something about a photograph, but it didn't have any attachment to open. I'm anxious to find out what is concerning you or what you think may have happened, as you have been nothing but a helpful and supportive ally. I greatly appreciated your post regarding how and what you're doing these days- it's great to make an interpersonal connection and develope a friendship, rather than simply swapping med stories and advice. Please post or email me back.Your Bud,
-matt-
Posted by ed_uk on November 8, 2005, at 15:28:19
In reply to Re: Should I give Nardil more time?? » ed_uk, posted by bigcat on November 7, 2005, at 18:33:49
Hi Matt
>I'm very confused. Did I miss something?
I'm sorry - was having a bad day LOL. I just wondered whether you read my post above.....
>The email I did get said something about a photograph, but it didn't have any attachment to open.
I'll send it again :-)
Kind regards
Ed
This is the end of the thread.
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