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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Jedi on August 9, 2007, at 23:21:49
Hi Guys,
Well I'm back on Nardil after being off for five months for a trial of Parnate. Parnate seemed to help my depression but I had a rare spontaneous hypertensive reaction that stopped that trial two months ago. Rather than going right back on Nardil, I thought I would see if I could make it on clonazepam (2mg) by itself. After two months, I just can't do it anymore.I thought that after being on Nardil for most of the past ten years, that maybe a few months off would give my brain a chance to become accustomed to being without MAOIs. Perhaps normalize the receptors and be able to live without the meds. Alas, the depression and social anxiety were growing worse on a daily basis. It was getting to the point that I could get nothing done at all. My illness again was becoming the center of my entire life. So, I gave in and started titrating back up on Nardil about a week ago. My usual effective dosage is 90mg and I'm up to 75mg today. I'm actually starting to feel a little better already, probably the GABA effect. I know it takes me about four weeks for the antidepressant effect to kick in. At least this has been my pattern the previous three times I've been off Nardil.
I'm using my emergency stash that I saved up when I went off Nardil last February. I've made an appointment with my MD but I haven't told him I've started back on Nardil. When I went off the MAOIs, I had him promise that he would prescribe them again if the major depression returned. They are the only meds out of about forty combinations that have worked for me.
I'm pretty sure the Nardil will knock back the major depression again, but I'm not looking forward to the side effects. I'm really going to have to push the exercise to combat the sweet carbohydrate cravings. They haven't started yet, but from experience, the cravings are inevitable.
I'm still going to be looking for an augmentor. I'm thinking a small dose of lithium might help. This is something I have not used with Nardil. I may also give nortriptyline another shot. I augmented 90mg of Nardil with 100mg of nortriptyline in the past. It didn't seem to do a lot of good, but I may of needed to increase the nortrip. I seem to be a rapid metabolizer of tricyclics. The 100mg did not come close to the therapeutic window for nortrip. I've also augmented Nardil with 300mg of bupropion with mixed results. Modafinil is also an option, but I haven't been able to talk my MD into that one yet.
I will probably drop the clonazepam back to 1mg when the full effect of Nardil kicks back in. I would sure like to hear from anyone that has had a successful experience augmenting Nardil; especially people with atypical depression and social anxiety.
Thanks a lot,
Jedi
Posted by Phillipa on August 10, 2007, at 11:37:14
In reply to Back on Nardil, posted by Jedi on August 9, 2007, at 23:21:49
Jedi didn't Scott add that and a few more things? Love Phillipa
Posted by Jedi on August 10, 2007, at 12:52:10
In reply to Re: Back on Nardil » Jedi, posted by Phillipa on August 10, 2007, at 11:37:14
> Jedi didn't Scott add that and a few more things? Love Phillipa
Hi Phillipa,
Yes, In fact Scott was the one who suggested that raising the dosage of nortriptyline might be a good idea. If memory doesn't fail me, I think he was at 200mg of nortriptyline.
Be Well,
JediYes, that was right.
http://www.dr-bob.org/babble/20070201/msgs/729611.html
Posted by Shanner on August 10, 2007, at 13:20:01
In reply to Re: Back on Nardil » Jedi, posted by Phillipa on August 10, 2007, at 11:37:14
You might want to consider doxepin instead of nortriptyline. According to the following site a small amount would be safe to help with sleep. The patient ratings are quite a bit higher for doxepin than nortriptyline. I've been on Parnate for over 2 months with limited success and I was wondering why you switched back to Nardil and what the differences are for you? I'm trying to increase the dose now again after unsuccessfully upping the dose, then dropping back down in the first month. Did the Parnate help with anxiety?
http://www.psychotropical.com/maois_full.shtml
Posted by Jedi on August 10, 2007, at 20:22:21
In reply to Re: Back on Nardil, posted by Shanner on August 10, 2007, at 13:20:01
Hi Shanner,
Thanks for the ideas. I have used doxepin in the past, but not combined with Nardil.I had a rare spontaneous hypertensive episode while on Parnate. This was the reason I gave up on that trial. Parnate at 80mg seemed to be holding off the major depression.
Nardil does affect GABA and that can make a big difference if you have anxiety issues. Nardil combined with clonazepam is the only combination that has worked long term for me. Parnate did not work on my social and generalized anxiety as well as Nardil.
I have titrated the Nardil to 90mg in just over a week. That would be too fast for most people. But I know which side effects affect me and I am willing to accept them to get to my effective dosage faster.
Be Well,
Jedi
> You might want to consider doxepin instead of nortriptyline. According to the following site a small amount would be safe to help with sleep. The patient ratings are quite a bit higher for doxepin than nortriptyline. I've been on Parnate for over 2 months with limited success and I was wondering why you switched back to Nardil and what the differences are for you? I'm trying to increase the dose now again after unsuccessfully upping the dose, then dropping back down in the first month. Did the Parnate help with anxiety?
> http://www.psychotropical.com/maois_full.shtml
Posted by Shanner on August 11, 2007, at 13:34:54
In reply to Re: Back on Nardil » Shanner, posted by Jedi on August 10, 2007, at 20:22:21
I might consider switching to Nardil if I don't get more a response from the Parnate soon. I'm also curious about Remeron as it seems to be quite effective at higher doses. Have you ever tried that? Of course, both can cause a lot of weight gain. I'm thinking either Nardil or Remeron combined with Provigil might prevent some of the weight gain and fatigue. Any opinions?
Posted by Jedi on August 11, 2007, at 15:22:06
In reply to Re: Back on Nardil, posted by Shanner on August 11, 2007, at 13:34:54
Hi,
I had a trial of 45mg Remeron along with 1600mg of gabapentin about seven years ago. As I remember I had a partial response but was knocked out all of the time. It did work well for anxiety. Probably the GABA effect from the gabapentin.I seemed to have a greater degree of afternoon fatigue with Parnate than with Nardil. This seems strange to me since Parnate is suppossed to be more activating. It took almost eight weeks for the afternoon somnolence to lessen with Parnate.
I have talked to my MD about augmenting Nardil with Provigil. I have not been able to talk him into that one yet. A small dose of methylphenidate would be another option, and much cheaper.
Something else I haven't tried is the so called "California Rocket Fuel" which is Effexor combined with Remeron. Or maybe Cymbalta augmented with Remeron. Has anyone tried the duloxetine/mirtazapine combination?
JediReference:
http://www.ijpm.net/content/pdf/327/casemg.pdf> I might consider switching to Nardil if I don't get more a response from the Parnate soon. I'm also curious about Remeron as it seems to be quite effective at higher doses. Have you ever tried that? Of course, both can cause a lot of weight gain. I'm thinking either Nardil or Remeron combined with Provigil might prevent some of the weight gain and fatigue. Any opinions?
Posted by Shanner on August 12, 2007, at 11:07:47
In reply to Re: Back on Nardil » Shanner, posted by Jedi on August 11, 2007, at 15:22:06
Thanks. I know some people go higher than 45mg with Remeron, especially in Europe. Also, Lyrica sounds like it's better and much more potent than neurontin. After almost giving up on Parnate (with partial response) I've upped my dose for one final try on the Parnate to 60mg. The first day I was extremely tired, but the last couple days I've taken 300mg Provigil (modafinil or Alertec in Canada where I'm from). I've taken the whole 300mg at once around noon or even later and I'm feeling awesome. Before I would split it up over 2 or 3 doses. I'm also taking klonopin 0.25mg x 2. Plus lots of vitamins. And the occasional caffeine tablet. I'm keepinig an eye on my blood pressure and I think it's slightly higher with Provigil but still normal. I've had very little trouble sleeping. Anyway I'll see how it goes. Hopefully it's safe. I think the Provigil is a real mood lifter and motivator. It might be good with Nardil too. Also, I've cut out alcohol the last 2 weeks which I'm sure is also helping. Hopefully the Provigil and Parnate combo are safe! I read mostly good but also 2 bad reports. Good luck!
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