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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Im in fourth week of 45mg of Emsam. And I still have major daytime sedation. What do I do about it? The only other meds I take are 25mg of Seroquel at night and 2-3 mg of Konopin as needed.
I have to drink tons of Coke or take No Doz to be able to drive and function each day.
Have you had this experience?
Does it go away?
Do you take anything to augment?
And around what week did you really feel Nardil kick in?
Finally, my pdoc today said my blood tests came in and my MAOI levels were much higher than when I was on Emsam (good news). I told him about fatigue and he suggested going down to 30. I said NO, because I want to tough it out and give Nardil a full trial at what seems to be the minimal theraputic dose for many (45).
Thanks in advance for your insight and opinions, Michael
Posted by Phillipa on April 25, 2007, at 15:20:18
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Michael so glad it's working for you. Love Phillipa
Posted by Quintal on April 25, 2007, at 16:08:31
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Lowering the dose of Seroquel and, better still, the daytime Klonopin would be the best way of relieving daytime sedation, but that and cognitive impairment are part and parcel of GABAergic drugs. Maybe you could talk to your pdoc about adding a small dose of a stimulant like Dexedrine or Ritalin after your Nardil dose is stabilized?
Pleased to hear this combo is working for you.
Q
Posted by FredPotter on April 25, 2007, at 18:37:42
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Michael I've just turned 5 weeks on Nardil. I've put up the dose to 60mg. There's still some sedation but I'm hoping it will go away. Provigil seems to be the answer, but I can't afford it. I agree you should not put the dose down. 30mg is probably sub-clinical anyway, but what do I know?
BTW your last post said EMSAM. I presume you meant Nardil. I've had the feeling of inner peace a couple of times recently, but it didn't last. Perhaps it's a sign of things to come. I wish you inner peace too (the unsedated kind) Fred
Posted by FredPotter on April 25, 2007, at 18:40:38
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
another answer would be to become a Parnatian
Posted by Racer on April 25, 2007, at 18:46:53
In reply to Re: NARDILians: How do I get rid of daytime sedation? » UgottaHaveHope, posted by Quintal on April 25, 2007, at 16:08:31
Ritalin and amphetamines are contraindicated with MAOIs. Provigil is an option, though, to help with excessive sedation.
Posted by Honore on April 25, 2007, at 19:33:48
In reply to Ritalin and amphetamine are contraindicated » Quintal, posted by Racer on April 25, 2007, at 18:46:53
A lot of orthodox resources say that ritalin and adderall are contraindicated, and of course anyone has to check with their pdoc, but I used both of them with Parnate and Emsam. My pdoc didn't seem to think either of them was a problem.
Of course, if I had reacted with any symptom, I would notified him immediately, but he didn't seem to think the prohibition was by any means absolute.
You could ask your pdoc about them, although provigil is also a good option.
Honore
Posted by Quintal on April 25, 2007, at 21:29:55
In reply to Ritalin and amphetamine are contraindicated » Quintal, posted by Racer on April 25, 2007, at 18:46:53
Yes, I'm aware that the official monograph will say amphetamines are contraindicated - along with opiates. As Honore has said, this is not absolute and several people here have been prescribed Ritalin and Dexedrine with Nardil. Obviously this should be done under close supervision. The same goes for opiates - although they're officially contraindicated, many experts consider the use of non-serotonergic opiates like codeine and morphine safe with MAOIs. I think Provigil is officially contraindicated by some sources too.
Kind regards
Q
Posted by UgottaHaveHope on April 25, 2007, at 22:50:31
In reply to Re: Ritalin and amphetamine can be used » Racer, posted by Quintal on April 25, 2007, at 21:29:55
Posted by FredPotter on April 25, 2007, at 23:14:36
In reply to Re: NARDILians: How do I get rid of daytime sedation? » UgottaHaveHope, posted by FredPotter on April 25, 2007, at 18:37:42
I dunno. Over 5 weeks on Nardil. I've had a successful day at work. I've even made a few people laugh. But regardless of how I behave there's still a black pit inside me
Posted by Jedi on April 26, 2007, at 0:15:38
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Michael,
I'm having the same problem on Parnate. I've been at 80mg for one month, thinking that at a higher dosage the stimulant qualities would kick in. They haven't for me. When I was on Nardil, it took a while, but the daytime somnolence did go away. I know GG takes modafinal(Provigil) and she has posted that this seems to help. But it is one more expensive medication, and my insurance really dislikes those. They are even raising the generics on me; I'll probably have to switch to the $4 Wal-Mart specials.If the daytime tiredness does not go away by my next appointment, I'll probably ask for a micro dose of methylphenidate. I have provided my MD with enough research studies on the subject so that he no longer considers augmentation with a stimulant an automatic death sentence.
I could eliminate the 25mg of Seroquel as suggested by missliz, but it sure is nice to get a whole nights sleep. Maybe I'll try this, but I'm pretty sure it is something in the MAOI, since I have had the same symptoms with Nardil and Parnate.
I really don't want to eliminate my 2mg of clonazepam at this time. I had my MD raise it from 1 to 2mg when I went to Parnate. I believe the GABA receptors have something to do with the social anxiety and Parnate does not affect these like Nardil.
Take care,
Jedi
Posted by UgottaHaveHope on April 26, 2007, at 2:53:27
In reply to Ritalin and amphetamine are contraindicated » Quintal, posted by Racer on April 25, 2007, at 18:46:53
Thanks, Racer. Provigil is probably the best option but I hate adding another drug. I dont want to be one of those taking like 6-7 drugs, but maybe I will have to. Thanks for everything, Michael
Posted by UgottaHaveHope on April 26, 2007, at 2:54:54
In reply to Re: NARDILians: How do I get rid of daytime sedation? » UgottaHaveHope, posted by Jedi on April 26, 2007, at 0:15:38
Except Im taking Nardil and youre on Parnate.
We both take Klonopin and Seroquel.
What is methylphenidate?
Posted by Jedi on April 26, 2007, at 12:47:26
In reply to Re: Seems like we're almost on same combo » Jedi, posted by UgottaHaveHope on April 26, 2007, at 2:54:54
> Except Im taking Nardil and youre on Parnate.
>
> We both take Klonopin and Seroquel.
>
> What is methylphenidate?Michael,
Yes our cocktails are very similar. I'm with you, the less medication the better. But sometimes, with treatment resistance, we are forced to add more. That's where a good psychopharmacologist comes in handy. Too bad I don't have one!
Take care,
Jedi(From Wikipedia)
Methylphenidate hydrochloride (MPH) is an amphetamine-like prescription stimulant commonly used to treat Attention-deficit hyperactivity disorder (ADHD) in children and adults. It is also one of the primary drugs used to treat symptoms of traumatic brain injury and the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome. Brand names of drugs that contain methylphenidate include Ritalin (Ritalina, Rilatine, Ritalin LA (Long Acting)), Attenta, Concerta (a timed-release capsule), Metadate, Methylin and Rubifen. Focalin is a preparation containing only dextro-methylphenidate, rather than the usual racemic dextro- and levo-methylphenidate mixture of other formulations. A newer way of taking methylphenidate is by using a transdermal patch (under the brand name Daytrana), similar to those used for hormone replacement therapy and nicotine release.
(From PubMed)
J Clin Psychiatry. 2004 Nov;65(11):1520-4.
Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.Feinberg SS.
Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA. Shalomf@aol.comBACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.
PMID: 15554766 [PubMed - indexed for MEDLINE]
Posted by football on April 27, 2007, at 23:19:49
In reply to NARDILians: How do I get rid of daytime sedation?, posted by UgottaHaveHope on April 25, 2007, at 14:42:38
Come on dude, don't make me say it again. Just try it already.
Posted by UgottaHaveHope on April 28, 2007, at 0:21:55
In reply to Re: NARDILians: How do I get rid of daytime sedati, posted by football on April 27, 2007, at 23:19:49
Maybe thats what making you have to take a shower every time to wizzzzzzzz.
Posted by Phillipa on April 28, 2007, at 18:29:23
In reply to LOL, Im poor, cant afford Provigil ... » football, posted by UgottaHaveHope on April 28, 2007, at 0:21:55
Football still having that problem I still would get it checked out or did you already? Love Phillipa
Posted by football on April 28, 2007, at 22:35:45
In reply to LOL, Im poor, cant afford Provigil ... » football, posted by UgottaHaveHope on April 28, 2007, at 0:21:55
> Maybe thats what making you have to take a shower every time to wizzzzzzzz.
Maybe, but thats a small price to pay.
This is the end of the thread.
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