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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by UgottaHaveHope on November 10, 2007, at 13:54:35
You know how sometimes you can't see the forest because you are too far in the trees? That's how I feel about this second Nardil trial, so I decided to write things out and get your opinion. PLEASE, ANY INSIGHT IS GREATLY APPRECIATED.
From the beginning: I took Emsam during the spring, and it made me feel like a 6 on scale 1-10 with anxiety and depression. I then switched to Nardil 45mg (while staying on Seroquel 25-50mg and Klonopin 2-3mg), and after about 10 weeks I felt like I had a major breakthrough right around the beginning of June, lasting until the end of August (feeling like 8-9).
Somewhere in the middle of June, I reduced my dosage of Nardil from 45 and 15. I found an email from my pdoc in June, telling him about my daytime sedation and he said I could "cheat" on Nardil and try it only at 30. But I went to 15 on my own, which was probably a mistake. But I never quit taking it entirely.
OK, flash forward to August: Because I was feeling so much better with Nardil and felt like it was finally "the one" for me, I made some real estate purchases over the summer. Then I started worrying about it, because I felt like I was in "over my head." It was and still is a major stressor. Do you think when you really get worked up, it is hard for any med to calm you down?
I could not calm down at the beginning of Sept. I immediately went back up in my dosage of Nardil to 45, and then asked for 60. Only now after 8 weeks has it calmed me down a little bit, but that also could be attributed to all the time that has passed. I still dont feel like I did from my first Nardil trial, where it just about took away all the anxiety and then made feel "normal" with depression. In other words, I felt like I felt before all of this began in 1997.
The only other resemblance of a breakthrough was when I took Seroquel in July 2005 at 150-200mg. Then I got upset about some life stressors then, the Seroquel couldnt calm me down. Instead of going up in Seroquel dosage, my pdoc added Paxil, which I later quit to try Emsam. Seroquel just calmed my mind, my racing thoughts.
Back to my current situation: During this recent setback, I also talked to my friend from high school, who is a Christian counselor, has spent hundreds of hours with me outside the office, and said that he will "go to his grave thinking I am Bipolar II" because of my behavior (racing thoughts, severe anxiety, no response to SSRIs, etc.). I have mentioned this to my pdoc, who said I am currently on a mood stabilizer with Seroquel (I increased dose to 300) and that we can go in a different direction next month if I am not doing better on Nardil. It just bums me out that I am not having the same reaction to Nardil this time ... so far.
So now I at a crossroads. Do I give Nardil a few more weeks (perhaps a month) to kick in? I am wondering if I really did anything wrong by reducing the Nardil because it was always in my system. Why is it not kicking in like the first time? Did it just "poop out" on me like all the SSRIs? What would you do?
Thanks, Michael
Posted by Phillipa on November 10, 2007, at 16:54:48
In reply to NEED ADVICE: Would you continue on Nardil????????, posted by UgottaHaveHope on November 10, 2007, at 13:54:35
Didn't you say you would return to EMSAM if nardil didn't turn out? You were doing pretty good on that. Didn't you say about a 6? Phillipa
Posted by UgottaHaveHope on November 10, 2007, at 22:36:00
In reply to Re: NEED ADVICE: Would you continue on Nardil???????? » UgottaHaveHope, posted by Phillipa on November 10, 2007, at 16:54:48
Any thoughts?
Posted by brooke484 on November 11, 2007, at 21:13:44
In reply to NEED ADVICE: Would you continue on Nardil????????, posted by UgottaHaveHope on November 10, 2007, at 13:54:35
I don't know how much I can help. Did you mean you have been on 60 mgs for 8 weeks? That should be enough time. Have you thought about trying 75? I took Nardil back in 1996 and it worked great. When I took it this year it didn't work at all and I could not go above 45 mgs without having all kinds of side effects. I'm on Marplan now but it's too soon to tell what it's going to do. Anyway, back to your problem...I've heard of people getting good responses by adding drugs like lithium or lamictal or neurotin to MAO's. But I would try going up to 75 mgs first, if you can handle it.
Wish I could help more!
Good luck.
Posted by cumulative on November 11, 2007, at 23:55:09
In reply to NEED ADVICE: Would you continue on Nardil????????, posted by UgottaHaveHope on November 10, 2007, at 13:54:35
Shoot for 90mg Nardil, which it says right there in the monograph that many people will need for full MAO inhibition, and carefully add something as an adjunct for any cognitive impairment/fatigue that pops up. Provigil, transdermal nicotine, psychostimulants, or galantamine all strike me as excellent options.
Posted by Questionmark on November 15, 2007, at 1:09:08
In reply to NEED ADVICE: Would you continue on Nardil????????, posted by UgottaHaveHope on November 10, 2007, at 13:54:35
I'm always a little mystified by people who say they tried Nardil in the past, it worked great, and then however much time later they are trying it again and with not appreciably positive effects. I've never experienced that (thank Goodness). But I've read maybe a dozen or more accounts of that on Psycho-Babble.
I don't exactly know what to say if on 45mg you were feeling great (so to speak) but now even on 60mg you still aren't feeling well. One thing you have to always remember with these drugs (any generally enhancing serotonin transmission at least; not just MAOIs either) is that the receptor adaptations that occur take awhile to ... stabilize, for lack of a better word. Meaning that whenever you raise or lower (particular lower) your dose, it is going to take some time (usually about a month in my case) to realize what being on that lower dose actually feels like.
I would personally wait a few more weeks at 60mg probably and then decide from there.
Good luck.
This is the end of the thread.
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