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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Questionmark on March 12, 2006, at 20:35:57
Okay, i know i'm probably a fool for even contemplating this kind of thing. And i know i'm probably a greedy moron for saying the following, but, ... i'm kind of sick of Nardil's complications. No, i'm not even talking about the dietary restrictions-- big deal. Yeah i miss blue cheese, but who cares?
But i am really tired of my low libido and quasi-anorgasmia (& reduced pleasure). And i'm really tired of what i feel are significant cognitive side effects (such as extremely poor word recall and, i think, a worse anterograde memory [er, can't remember experiences in my life while on Nardil, as well, in the future]). SOOO, anyway...
i've been wondering, how much better would Nardil be than, say, a combination of an SSRI, a low or semi-low dose of some dopaminergic, and/or a low to moderate dose of some norepinephrine enhancer, and/or a low dose of some benzo or GABAergic med (probably even just a combination of the SSRI and one or two of those other substances, depending on what the individual needed)?
i mean, Nardil's primary action is to increase serotonin levels, so could an SSRI and, say low-dose selegeline be just as effective for me as Nardil? Probably not-- i know (from experience). But why?
Help me out here.
Posted by Chairman_MAO on March 12, 2006, at 22:21:56
In reply to Nardil vs. SSRI w/ augmentation, posted by Questionmark on March 12, 2006, at 20:35:57
No dice. I'm sorry. :(
I wish I could say otherwise, but MAO inhibition has a markedly different effect than that of uptake blockers. For instance, MAO-A can be found intraneuronally. This increases the amount of monoamines available for release. I have taken an SSRI+selegiline+clonazepam, SSRI+d-amphetamine+benzodiazepine, etc, etc, and all were nowhere near as effective as Nardil has been.
As always, your mileage may vary.
Posted by JaclinHyde on March 12, 2006, at 23:29:04
In reply to Nardil vs. SSRI w/ augmentation, posted by Questionmark on March 12, 2006, at 20:35:57
Instead of augmenting with an ssri why not go with Parnate instead of Nardil?
JH
Posted by Questionmark on March 12, 2006, at 23:32:42
In reply to Re: Nardil vs. SSRI w/ augmentation » Questionmark, posted by Chairman_MAO on March 12, 2006, at 22:21:56
Thank you for your response.
Yeah, that is dissappointing (CRAP is that one S or 2; one P or 2?), though not surprising. It's crazy though. i don't understand pharmacologically how a sufficient dose of SSRI or SNRI (plus augmentation in whatever area is needed) cannot be therapeutically similar to Nardil or another hydrazine MAOI. But, you've got to be right. Nardil is not the great treatment-resistant depression and social phobia medication for nothing. Damn.Oh, i do wonder how an SSRI/SNRI with agomelatine (that new 5-HT2C antagonist & melatonin receptor agonist) might be, however (though i still do certainly doubt that it would be nearly as effective as Nardil).
Thanks for preventing me from having an idiotic treatment goal.> No dice. I'm sorry. :(
>
> I wish I could say otherwise, but MAO inhibition has a markedly different effect than that of uptake blockers. For instance, MAO-A can be found intraneuronally. This increases the amount of monoamines available for release. I have taken an SSRI+selegiline+clonazepam, SSRI+d-amphetamine+benzodiazepine, etc, etc, and all were nowhere near as effective as Nardil has been.
>
> As always, your mileage may vary.
Posted by med_empowered on March 13, 2006, at 1:48:55
In reply to Re: Nardil vs. SSRI w/ augmentation » Chairman_MAO, posted by Questionmark on March 12, 2006, at 23:32:42
I think it really depends on your condition and response. Some people have benefited from well-augmented SSRIs: for example, the TCA+SSRI combo isn't done often, but can be beneficial for some...also, augmenting an MAOI, though difficult, can be done; dexedrine added to your MAOI might be helpful. I think TCAs can also be added to MAOIs, but that seems awfully tricky.
Posted by Questionmark on March 13, 2006, at 3:30:41
In reply to Re: Nardil vs. SSRI w/ augmentation, posted by JaclinHyde on March 12, 2006, at 23:29:04
> Instead of augmenting with an ssri why not go with Parnate instead of Nardil?
>
> JHGood question. The explanation is in a post i just wrote today (not that you want to read necessarily, but..):
www.dr-bob.org/babble/20060310/msgs/619707.html
Posted by Questionmark on March 13, 2006, at 3:36:40
In reply to MAOIS vs other meds, posted by med_empowered on March 13, 2006, at 1:48:55
> "...dexedrine added to your MAOI might be helpful...."
med_empowered, first, thanks for responding.
Is dextroamphetamine easier & better to augment Nardil with than say, Adderall? Because even small doses of Adderall affect me quite negatively on Nardil and it feels nothing like its normal effect. Methylphenidate does feel the same however (though maybe a bit more potent, maybe). i've never tried the dextro-amph though, on or off Nardil.
Thanks for any responses.
Posted by med_empowered on March 13, 2006, at 9:23:52
In reply to regarding Nardil + d-amphetamine » med_empowered, posted by Questionmark on March 13, 2006, at 3:36:40
hi! I just said dexedrine b/c dexedrine seems like the standard amphetamine for depression, while adderall is the standard for ADD/ADHD (although there's a lot of overlap, obviously). Anyway, I imagine Dexedrine would be easier to handle; Adderall seems to be "felt" more, so maybe dex's "cleaner" feel would make it more tolerable in combo with an MAOI? Just a guess. There's also Ritalin, Provigil, and possibly Desoxyn, so if you go the MAOI+stimulant route, there are a number of options.
Posted by Phillipa on March 13, 2006, at 19:50:35
In reply to MAOIS plus amphetamines, posted by med_empowered on March 13, 2006, at 9:23:52
Why is everything about the MAOI's? I guess the rest got better on SSRI's or SSNRI's hummm. Fondly, Phillipa
Posted by Questionmark on March 14, 2006, at 4:04:52
In reply to MAOIS plus amphetamines, posted by med_empowered on March 13, 2006, at 9:23:52
Posted by Chairman_MAO on March 15, 2006, at 16:02:51
In reply to Re: Nardil vs. SSRI w/ augmentation » Chairman_MAO, posted by Questionmark on March 12, 2006, at 23:32:42
D-amphetamine or d-meth will be a lot more tolerable than Adderall, most likely (adderall just has more side effects, as that makes for a better anorectic, which is what it was).
D-amphetamine increases libido on Nardil, definitely. It is the best treatment next to prohibitively high doses of testosterone I have tried. It is not a panacea, but it's a lot better than going without.
My doctor is really frustrating me. Now he wants me to try clomipramine after cymbalta was a failure (he does not know I am taking Nardil + d-amphetamine, but i cannot function otherwise). As if that will work for social phobia after failure with EVERY SSRI (and TCAs barely work for my depression). Then he wants to try the selegiline patch, because it is WEAKER as an MAOI than Nardil. Great, that's just what I need. I told him I tried selegiline in the past, but no go because it was the tablet. So I have to waste my time for god knows how long until I exhaust every conceivable option under the sun. How long, years? I am so frustrated; I have zero complications from taking this combination, and the side effects of each drug are mitigated by the other. I am just going to play along and hope I can get him to agree to this within 7 weeks from now, which is how much Nardil I have left (including refill).
It is utterly inane that we need permission slips from physicians to take remedies for depression. This is my body, and I will take care of it the way I see fit. It is legal for me to go to the corner store and buy 24 beers and a carton of cigarettes, but not Nardil. Fantastic.
Posted by jedi on March 16, 2006, at 19:16:25
In reply to Re: MAOIS plus amphetamines, posted by Phillipa on March 13, 2006, at 19:50:35
> Why is everything about the MAOI's? I guess the rest got better on SSRI's or SSNRI's hummm. Fondly, Phillipa
Hi Phillipa,
I think you are probably right. Most of the people who post on this board are treatment resistant. A large number of depressed people respond to SSRIs and get better. They are really not represented here, to a great degree. Then there are the rest of us. Those that have been on 30 different meds with few or no results. These are the people that risk the MAOIs. I can confidently say that without Nardil, I would not be here today. It is the only medication that has brought me out of 3+ major depressions. I'm currently in partial remission, taking Omega-3s and Wellbutrin. But, if the major depression hits again, I will go right back to the "Big" gun.
Take care,
Jedi
Posted by Questionmark on March 22, 2006, at 0:28:35
In reply to Re: Nardil vs. SSRI w/ augmentation » Questionmark, posted by Chairman_MAO on March 15, 2006, at 16:02:51
> D-amphetamine or d-meth will be a lot more tolerable than Adderall, most likely (adderall just has more side effects, as that makes for a better anorectic, which is what it was).
>Good. This is encouraging news.
> D-amphetamine increases libido on Nardil, definitely. It is the best treatment next to prohibitively high doses of testosterone I have tried. It is not a panacea, but it's a lot better than going without.
>
Awesome. Thank you. Hm, so you could not handle the testosterone needed to help these Nardil side effects? That's too bad. i remember you mentioned testosterone some time ago and always had that in my mind as a possible remedy to try in the future (when i get enough $ and insurance, and appropriate doctors). Man, i really thought that would be a good remedy, barring some slightly frusterating & frightful yet bearable side effects. i'd like to hear more about your experience with this if you wouldn't mind-- sometime when you have time.
But at least i can hopefully look forward to d-amphetamine. Do you think it would be significantly better than methylphenidate? Cuz the latter works the same for me as it did, but it doesn't really help my libido or anything that noticeably. And although the enhanced focus is nice & helpful at times, it often causes me to overfocus and can really aggravate my perfectionism. (Sorry i'm rambling).
> My doctor is really frustrating me. Now he wants me to try clomipramine after cymbalta was a failure (he does not know I am taking Nardil + d-amphetamine, but i cannot function otherwise). As if that will work for social phobia after failure with EVERY SSRI (and TCAs barely work for my depression). Then he wants to try the selegiline patch, because it is WEAKER as an MAOI than Nardil. Great, that's just what I need. I told him I tried selegiline in the past, but no go because it was the tablet. So I have to waste my time for god knows how long until I exhaust every conceivable option under the sun. How long, years? I am so frustrated; I have zero complications from taking this combination, and the side effects of each drug are mitigated by the other. I am just going to play along and hope I can get him to agree to this within 7 weeks from now, which is how much Nardil I have left (including refill).
>
Man that's ridiculous. i definitely sympathize with you. That would be a terrible situation. Actually it's frusterating just to read.
Can't you find a new pdoc??? This guy is obviously incompetent. Ugh, so irritating!!
i would really advise shopping for a good pdoc who will give you what you need. Don't give up. Try every avenue. Search for and contact organizations
that may be able to help. i admit this is so much easier for me to say since i would not even know where to begin in applying those suggestions, other than calling pdocs in the phonebook (and even then you can't get any information from them until you pay for an initial visit for 100+ dollars, only to be most likely told that they will not prescribe an MAOI.. sorry, i'm not helping). But seriously, try try try to do those things. Heck, even email pdocs whose names you see in abstracts if you have to-- ask them if they know of anyone.> It is utterly inane that we need permission slips from physicians to take remedies for depression. This is my body, and I will take care of it the way I see fit. It is legal for me to go to the corner store and buy 24 beers and a carton of cigarettes, but not Nardil. Fantastic.
So true. Such a good point. It is absolutely ridiculous. ... YOU"RE RIGHT!!! YOU CAN DRINK YOURSELF TO DEATH FROM A DRUG AT THE CORNER STORE BUT YOU CAN"T GET A DRUG THAT COULD SAVE YOU FROM CONSTANT DESPAIR OR EVEN DEATH!!! It's RIDICULOUS!!
("You" in previous paragraph was rhetorical "you").
i don't get it.
i wish i had the power to change so many things.Anyway, good luck. Let me or us know if you have any questions or suggestions needed.
This is the end of the thread.
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