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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 19 to 43 of 59. Go back in thread:
Posted by ed_uk on March 9, 2006, at 13:07:06
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 8, 2006, at 20:36:25
>And how long have you taken it?
Citalopram? About 3 years.
Ed
Posted by ed_uk on March 9, 2006, at 13:08:11
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 8, 2006, at 20:37:33
>MRI
What sort of symptoms led to the MRI and other tests?
Ed
Posted by ed_uk on March 9, 2006, at 13:14:48
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 8, 2006, at 20:40:43
Let's take drug A. A person on drug A initially believes that drug A is a 'good' drug. The patient goes through good times and bad times while on drug A. Because the patient views drug A as 'good' - all the good times they have are attributed to the power of drug A. Drug A may or may not have been responsible for these good times.
A few years later, the same patient is told that drug A is 'bad'. The patient goes through good times and bad times. Due to the patient's belief that drug A is bad, the patient now attributes all their bad times to drug A. These bad times may or may not have anything to do with drug A.
How one views ones medication is very important. What if drug A was Nardil?
Ed
Posted by ed_uk on March 9, 2006, at 13:16:20
In reply to Re: The 'new' Nardil, posted by forgetful mary on March 8, 2006, at 20:39:32
>Besides those people are crazy....who could believe them.??..they are psychiatric patients right?? That's what you sound like...I thought that attitude went out with Poodle skirts???
I find your post offensive. I have been a psych patient myself.
Ed
Posted by ed_uk on March 9, 2006, at 13:20:36
In reply to I think there's another point, though, posted by Racer on March 8, 2006, at 22:17:11
Hi Racie
>......so many negative posts about drugs can frighten them. I worry that there are people who read a board like this and are frightened away from medications which really would relieve their depression.....
That's very true. Nardil is, as it always was, an effective medication for certain patients suffering from severe depression and/or anxiety. Various p-babblers have responded very well to the 'new' Nardil. People should not be dissuaded from trying it.
>It's probably true, though, that many people out there are continuing to respond to the new formulation, because the bioavailability is the same, and it would be a real shame if they were scared off a drug that is still helping them by reading so many negative reports on sites like this one.
That's one of the reasons I decided to start this thread.
Ed x
Posted by ed_uk on March 9, 2006, at 18:09:50
In reply to Re: I think there's another point, though » Racer, posted by ed_uk on March 9, 2006, at 13:20:36
In some cases, the excipients in a tablet can affect the bioavailability/absorption profile of a drug. The 'new' Nardil is alleged to be bioequivalent to the 'old' Nardil. It is, however, possible that its bioavailability may be slightly different. If so, it should be possible to re-establish efficacy by adjusting the dose.
Some of the symptoms people have reported when transitioning from the 'old' Nardil to the 'new' Nardil resemble withdrawal symptoms. It is possible that the new formulation may have resulted in slightly lower bioavailability. If this is true, increasing the dose or frequency of administration should help. Why is no one discussing this? The 'new' Nardil is all we have. We must learn to optimise its efficacy and usefulness, rather than dismissing it as useless. It might smell bad.........it might taste bad......but it's still phenelzine: a powerful antidepressant and anxiolytic.
Ed
Posted by forgetful mary on March 9, 2006, at 19:27:51
In reply to I think there's another point, though, posted by Racer on March 8, 2006, at 22:17:11
As far as scaring peopl away from a good drug...everyone should be leery of everydrug...No drug is a panacea to everyone.
When prozac first came out I bought the hoopla and although was using Nardil at the time I yearned to lose the weight. What worked extremely well for some caused me to be almost suicidal. That is the case with evevry drug, and every operson is different. What is more alarming to me is the many,many people still out there grappling with symptoms caused by the change in Nardils formula and still totally unaware that the drug they take each and every day is causing that reaction. They were never told, never warned and even there Drs still are not being told. I have told Drs myself even recently who had not a clue thAT PFIZER HAD DONE THIS...that IS SHAMEFUL AND FRIGHTENING THAT THE fda ALLOWED AND STILL ALLOWS THIS. That's what you should be afraid of...
> > The change in the drug sure made me more vulnerable...thanks for your concern!!!
> >
> >
> > > Hi Racer
> > >
> > > It is my belief that the anti-new-Nardil hoopla is harmful to patients' wellbeing. It increases anxiety in people who are already very vulnerable.
> > >
> > > Ed
> >
> >
>
>
> This is something that's come up here before, on this board. Sometimes, new people come here who have no experience with these drugs, and seeing so many negative posts about drugs can frighten them. I worry that there are people who read a board like this and are frightened away from medications which really would relieve their depression.
>
> And while I recognize that you believe the new formulation is why Nardil is no longer effective for you, I have experienced similar situations which I have attributed to medications that were later shown to be unrelated. It may be that you really and truly were responding only to the old formula. It may be that you're no longer responding for reasons unrelated to the change in formulation. It's probably true, though, that many people out there are continuing to respond to the new formulation, because the bioavailability is the same, and it would be a real shame if they were scared off a drug that is still helping them by reading so many negative reports on sites like this one. Suggestibility is a real effect, after all, and one's subjective response to these meds really is the most important measure.
>
> And just to confuse myself more, I have experienced situations in which the inactive ingredients of a medication have had a significant effect on me. Lamictal, for instance, contains lactose as an inactive ingredient, and I needed to take lactase tablets with it. It is possible. Have you looked into the inactive ingredients in the new formulation, to see whether something in there has caused you reactions in the past?
>
> Last thought -- ed_uk is just that: a guy named Ed, who lives in the UK. Just wanted to point that out, since you referenced the US as our collective point of reference.
>
>
Posted by forgetful mary on March 9, 2006, at 19:29:18
In reply to Re: The 'new' NardilThanks Willyee » forgetful mary, posted by ed_uk on March 9, 2006, at 13:05:14
No kidding.....I think I learned that over 20 years of taking it...but it never stopped working before it was changed.......
> >And I just happened to have the drug poop out just when it was changed? As did others?? Just a curious coincidence??
>
> People suffering from depression and anxiety frequently find that their symptoms fluctuate in severity over time. There are many reasons for this.
>
> Ed
Posted by forgetful mary on March 9, 2006, at 19:34:04
In reply to Re: The 'new' NardilThanks Willyee, posted by forgetful mary on March 9, 2006, at 19:29:18
I think we can stop discussing this as your arrogance is only exceeded by your ignorance...Do you think maybe, just possibly patients who have taken a drug for 20 years or more have some inkling about their medication on a par that you claim to????
> No kidding.....I think I learned that over 20 years of taking it...but it never stopped working before it was changed.......
> > >And I just happened to have the drug poop out just when it was changed? As did others?? Just a curious coincidence??
> >
> > People suffering from depression and anxiety frequently find that their symptoms fluctuate in severity over time. There are many reasons for this.
> >
> > Ed
>
>
Posted by gardenergirl on March 10, 2006, at 10:20:27
In reply to Re: The 'new' NardilThanks Willyee, posted by forgetful mary on March 9, 2006, at 19:34:04
> I think we can stop discussing this as your arrogance is only exceeded by your ignorance...
and
>Besides those people are crazy....who could believe them.??..they are psychiatric patients right?? That's what you sound like...I thought that attitude went out with Poodle skirts???
Please don't post anything that could lead others to feel accused or put down. If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues, as well as replies to the above post, should be directed to Admin and should of course themselves be civil.
Regards,
gg acting as deputy for Dr. Bob
Posted by gardenergirl on March 10, 2006, at 10:22:51
In reply to Adjusting the dose, posted by ed_uk on March 9, 2006, at 18:09:50
> The 'new' Nardil is all we have. We must learn to optimise its efficacy and usefulness, rather than dismissing it as useless. It might smell bad.........it might taste bad......but it's still phenelzine: a powerful antidepressant and anxiolytic.
Yes, and it works quite well for me. I never took "old Nardil". I didn't worry too much about what was said about the differences, because what I was given was what I was given. I've worked with my pdoc to come up with the right dose for me and the right augmentation when needed.
Hooked on Phonics worked for me! :)
Thanks for bringing this point out, ed.
gg
>
> Ed
Posted by ed_uk on March 10, 2006, at 14:56:01
In reply to Re: I think there's another point, though, posted by forgetful mary on March 9, 2006, at 19:27:51
If Nardil worked well for you in the past, it would make sense to try it again - assuming that you still suffer from depression/anxiety. You might need a different dose to the one which you once required, people change.......
Don't be so convinced that the 'new' Nardil is useless. You might just find yourself responding well to it :)
Ed
Posted by ed_uk on March 10, 2006, at 15:04:12
In reply to Re: The 'new' NardilThanks Willyee, posted by forgetful mary on March 9, 2006, at 19:34:04
>your arrogance is only exceeded by your ignorance...
Hmmm, I'm not the one who's being rude.
>Do you think maybe, just possibly patients who have taken a drug for 20 years or more have some inkling about their medication on a par that you claim to????
They may indeed have an inkling, and their inkling(s) may or may not be correct. Many people take multiple medications for decades without understanding much about them.
Ed
Posted by ed_uk on March 10, 2006, at 15:07:17
In reply to Re: Adjusting the dose » ed_uk, posted by gardenergirl on March 10, 2006, at 10:22:51
Hi gg
If the 'new' Nardil was suddenly discontinued and replaced by the 'old' Nardil, we would undoubtedly hear people claiming that Nardil was now ineffective.
Ed
Posted by Last Chance on March 10, 2006, at 20:34:17
In reply to Changing the formulation » gardenergirl, posted by ed_uk on March 10, 2006, at 15:07:17
Ed - give it a rest will you - I don't understand what you are trying to prove? Do you always need to have the last word? Richard
Posted by SLS on March 11, 2006, at 6:50:36
In reply to Changing the formulation » gardenergirl, posted by ed_uk on March 10, 2006, at 15:07:17
> If the 'new' Nardil was suddenly discontinued and replaced by the 'old' Nardil, we would undoubtedly hear people claiming that Nardil was now ineffective.Or possibly that it remain effective with the worsening of side effects or the appearance of additional side effects.
It is difficult for me to ignore the many reports of a therapeutic inequivalency between the old and new preparations of Nardil. If one were to take these reports as accurately reflecting a difference between the two preparations, it seems that the new formulation is not as potent as the old one. Since the active ingredient is the same, any differences must lie elsewhere. It would be nice to see that a simple increase in the dosage of the new formulation recaptures the therapeutic effect for those whom report relapse after switching from the old formulation.
It would be nice to know for sure what's going on. I really don't know what to think. I might be going on Nardil sometime this year. I am not concerned that there will be a lack of efficacy due to a change in formulation. However, I will be prepared to take a higher dosage if necessary so as to offset any change in bioavailability that may exist.
- Scott
Posted by Dr. Bob on March 11, 2006, at 10:45:21
In reply to Re: The 'new' NardilThanks Willyee » forgetful mary, posted by ed_uk on March 10, 2006, at 15:04:12
> I find your post offensive.
> I'm not the one who's being rude.
Please don't post anything that could lead others to feel accused or put down. Even if you feel accused or put down yourself. Two wrongs don't make a right.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Also, for a nice clarification of what constitutes an I-statement, please see:
http://www.dr-bob.org/babble/admin/20040112/msgs/320097.html
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Thanks,
Bob
Posted by Dr. Bob on March 11, 2006, at 10:48:09
In reply to Re: Changing the formulation » ed_uk, posted by Last Chance on March 10, 2006, at 20:34:17
> Do you always need to have the last word?
Please don't jump to conclusions about others or post anything that could lead them to feel accused or put down.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above post, should of course themselves be civil.
Thanks,
Bob
Posted by Michael Bell on March 11, 2006, at 11:41:38
In reply to Bioequivalence, posted by ed_uk on March 8, 2006, at 16:05:06
But that's exactly the problem. Bioequivalency only discusses the absorption rate of the drug into the bloodstream, NOT the rate and completeness of the absorbtio at the site of action. This is the whole reason that the FDA has recognized that there are major problems with the guidelines for bioequivlency, because it may not equal thereapeutic equivalency.
Acording to the FDA, for a drug to be bioequivalent, it must. "deliver the same amount of active ingredients into a patient's bloodstream in the same amount of time as the innovator drug"
However, what happens to the drug after it enters the bloodstream is not assessed. How well is it absorbed at the site of action, which in this case is mainly the small intestine.
The FDA equates bioequivalence with therapeutic equivalence, but the Dept. of Pharmaceutics and Pharamaceutical chemistry noted that this leaves out major important determining factors, by stating:
"It is important to note that the FDA designation of thera-peutic equivalence does not consider several formulation char-acteristics, including packaging, scoring configuration, shape, or pharmaceutical excipients (e.g., colors, preservatives, fla-vors)."
The theory has always been that the new nardil is not being absorbed as well at the site of action of the drug.
> In order for the 'new' Nardil formulation to be approved, it would have had to have been shown to be bioequivalent to the 'old' formulation.
>
> Excipients can affect the rate and extent of absorption of a drug. Two formulations are considered to be bioequivalent when their absorption parameters are the same.
>
> Ed
Posted by ed_uk on March 11, 2006, at 13:03:58
In reply to Re: Changing the formulation » ed_uk, posted by Last Chance on March 10, 2006, at 20:34:17
Who are you?
Ed
Posted by ed_uk on March 11, 2006, at 13:07:30
In reply to Re: please be civil » ed_uk, posted by Dr. Bob on March 11, 2006, at 10:45:21
Hi Bob
>Please don't post anything that could lead others to feel accused or put down. Even if you feel accused or put down yourself. Two wrongs don't make a right.
I don't think I did anything wrong. Forgetful Mary stated that I was arrogant and ignorant, which was, frankly, rude.
Regards
Ed
Posted by ed_uk on March 11, 2006, at 13:08:51
In reply to Re: Changing the formulation, posted by SLS on March 11, 2006, at 6:50:36
Hi Scott
>I am not concerned that there will be a lack of efficacy due to a change in formulation. However, I will be prepared to take a higher dosage if necessary so as to offset any change in bioavailability that may exist.
Good idea.
Regards
Ed
Posted by ed_uk on March 11, 2006, at 13:17:42
In reply to And that's the problem » ed_uk, posted by Michael Bell on March 11, 2006, at 11:41:38
Hi M
>Bioequivalency only discusses the absorption rate of the drug into the bloodstream, NOT the rate and completeness of the absorbtio at the site of action.
Phenelzine exerts its antidepressant and anxiolytic efficacy by acting on the brain. Its 'site of action' is the brain, not the intestine.
>However, what happens to the drug after it enters the bloodstream is not assessed.
Excipients do not affect the pharmacological properties of a drug molecule once it reaches the blood stream.
>The theory has always been that the new nardil is not being absorbed as well at the site of action of the drug.
That doesn't make sense to me. Phenelzine's site of action is the brain. The excipients do not influence the ease at which the drug can cross the blood-brain barrier.
Regards
Ed
Posted by ed_uk on March 11, 2006, at 13:21:00
In reply to Re: Changing the formulation, posted by SLS on March 11, 2006, at 6:50:36
Hi Scott
>I am not concerned that there will be a lack of efficacy due to a change in formulation. However, I will be prepared to take a higher dosage if necessary so as to offset any change in bioavailability that may exist.
Anyone who is encountering problems with the new formulation should be willing to adjust the size, timing and frequency of doses. If they are not willing to do this, they are effectively shooting themself in the foot!
Kind regards
Ed
Posted by forgetful mary on March 11, 2006, at 20:45:35
In reply to Re: please be civil » Dr. Bob, posted by ed_uk on March 11, 2006, at 13:07:30
The truth shall set you free!!!
> Hi Bob
>
> >Please don't post anything that could lead others to feel accused or put down. Even if you feel accused or put down yourself. Two wrongs don't make a right.
>
> I don't think I did anything wrong. Forgetful Mary stated that I was arrogant and ignorant, which was, frankly, rude.
>
> Regards
>
> Ed
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