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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by Justherself54 on December 4, 2007, at 6:07:33
My balance seems to be off for some reason..when I turn around I sometimes have to take a step to the side to maintain my balance and also notice that I'm bumping into things more often..
Has anyone else had this happen on Nardil..thanks all..
Posted by Phillipa on December 4, 2007, at 10:47:36
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
From what I've read on the board blood pressure could be down. Do you have a BP cuff? Phillipa
Posted by Maxime on December 4, 2007, at 13:07:16
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
Both Nardil and Parnate turned me into a complete klutz! A friend of mine who is on Parnate experiences the same thing.
Maxime
> My balance seems to be off for some reason..when I turn around I sometimes have to take a step to the side to maintain my balance and also notice that I'm bumping into things more often..
>
> Has anyone else had this happen on Nardil..thanks all..
Posted by FredPotter on December 4, 2007, at 13:41:55
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
You describe what I get perfectly. It went away after a bit but have recently added 10 mg of Nortriptyline, so perhaps this is making it worse.
Posted by gardenergirl on December 4, 2007, at 14:05:48
In reply to Re: Nardil question re: balance problems » Justherself54, posted by FredPotter on December 4, 2007, at 13:41:55
I had that when I first started. It was like a "drunk walk", though I didn't feel at all drunk. It went away after a couple of months, max, however, I'm still the klutz that I was before I started Nardil. And I've noticed that at times when my feet get tangled up for whatever reason, I can have a bit of a balance problem then. I once thought I was going to take a tumble all the way down to the field when I tried to get to my seat in the bleachers at a college football game. Oh well, as long as it doesn't make the highlight film, eh? :)
I think it's less of a blood pressure thing and more of a neurological one, although I don't know any more about what might be going on. I just know it got better.
Good luck!
gg
Posted by Justherself54 on December 4, 2007, at 17:35:21
In reply to Re: Nardil question re: balance problems, posted by gardenergirl on December 4, 2007, at 14:05:48
Thanks all! I feel better knowing it's just a minor annoying side effect..nothing I can't handle!
Posted by stargazer2 on December 5, 2007, at 16:26:58
In reply to Re: Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 17:35:21
JH, I'm on Nardil too and have been having dizziness right along. If I bend over to put my shoes on, it really throws me off balance. It is no longer related to low BP, must just be a side effect of Nardil. I haven't fallen yet though. I used to fall when I was on Lamictal, that really affected my balance.
How much are you on and how often do you take it, perhaps I should take it 3x/day rather than 2x/day. Maybe this would spread out the effect better.
Stargazer
Posted by brooke484 on December 5, 2007, at 17:05:08
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
I was having the same problem with Marplan, but now I take it 4 times a day (8, 11, 2 and 5) and am fine. I just wish it would kick in.
brooke
Posted by stargazer2 on December 5, 2007, at 21:25:43
In reply to Re: Nardil question re: balance problems, posted by brooke484 on December 5, 2007, at 17:05:08
I hope it kicks in soon, there's nothing harder than waiting for an AD to work. I took Marplan in 1992 and got very good results. You are given my thoughts for it to work real soon..thanks for the advice on dividing the dose up more frequently, I will try that tomorrow.
Stargazer
Posted by brooke484 on December 5, 2007, at 22:00:16
In reply to Re: Nardil question re: balance problems/Brooke, posted by stargazer2 on December 5, 2007, at 21:25:43
Do you remember what dose you were on and how long you were on it before it kicked in? I'm going up to 40 tomorrow. When I tried to go to 35 mgs and was taking it 2 times a day I had major lightheadedness. Taking it 4 times a day helped tremendously. I couldn't even go up my stairs without having to sit and put my head between my legs. I almost quit taking it. I'm glad I didn't but I still wish it would do something. Anything.
Thanks for the well wishes. :)
brooke
Posted by Justherself54 on December 6, 2007, at 9:04:55
In reply to Re: Nardil question re: balance problems/JustHerse, posted by stargazer2 on December 5, 2007, at 16:26:58
I'm on 45 mg and take it three times a day..now the dreaded insomnia is getting worse..for some reason if I take it earlier with my last at about 3 in the afternoon, I sleep better, but sometimes I get busy and forget, then pay for it at night..I take 3 different sleep meds, so I can get some sleep..hope that side effect does away!
> JH, I'm on Nardil too and have been having dizziness right along. If I bend over to put my shoes on, it really throws me off balance. It is no longer related to low BP, must just be a side effect of Nardil. I haven't fallen yet though. I used to fall when I was on Lamictal, that really affected my balance.
>
> How much are you on and how often do you take it, perhaps I should take it 3x/day rather than 2x/day. Maybe this would spread out the effect better.
>
> Stargazer
Posted by Jedi on December 7, 2007, at 3:05:03
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
Do you take any augmentors with the Nardil? For me the addition of clonazepam to the Nardil made me dizzy for some time. But it did go away.
Jedi
> My balance seems to be off for some reason..when I turn around I sometimes have to take a step to the side to maintain my balance and also notice that I'm bumping into things more often..
>
> Has anyone else had this happen on Nardil..thanks all..
Posted by stargazer2 on December 7, 2007, at 9:22:18
In reply to Re: Nardil question re: balance problems/stargazer, posted by brooke484 on December 5, 2007, at 22:00:16
Checked my old records...Dec 1991 started Marplan 5mg 3x/day. Was on Doxepin with Marplan, then with Ritalin, Dexadrine, Jan 1992 on 30 mg Marplan in morning. Was on 30 mg until end of 1993, when Roche discontinued Marplan and in March of 1994 I was off Marplan entirely and had withdrawl symptoms. By June I was in a full blown crisis and took a leave from work.
So while it worked well for a year and a half, I was devastated and got very sick again while off everything. My depression returned in a flurry of hyperactivity with an ensuing crash and burn, entering the worse period of my depression.
MA
Posted by Justherself54 on December 7, 2007, at 11:46:18
In reply to Re: Nardil question re: balance problems » Justherself54, posted by Jedi on December 7, 2007, at 3:05:03
I have been taking clonazepam, seroquel and zopiclone at bed for a long time..the balance thing is something I can definitely live with..now I'm getting the insomnia, even with all the meds I take at bed..but am prepared to live with that too..cause I am really liking the fact I can now socialize again..if the insomnia gets too bad I may have to take a "holiday" from the zopicone or increase the seroquel to 50 mg at nite from the 25 mg I take..
> Do you take any augmentors with the Nardil? For me the addition of clonazepam to the Nardil made me dizzy for some time. But it did go away.
> Jedi
>
>
> > My balance seems to be off for some reason..when I turn around I sometimes have to take a step to the side to maintain my balance and also notice that I'm bumping into things more often..
> >
> > Has anyone else had this happen on Nardil..thanks all..
>
>
Posted by Jedi on December 7, 2007, at 13:25:36
In reply to Re: Nardil question re: balance problems, posted by Justherself54 on December 7, 2007, at 11:46:18
> I have been taking clonazepam, seroquel and zopiclone at bed for a long time..the balance thing is something I can definitely live with..now I'm getting the insomnia, even with all the meds I take at bed..but am prepared to live with that too..cause I am really liking the fact I can now socialize again..if the insomnia gets too bad I may have to take a "holiday" from the zopicone or increase the seroquel to 50 mg at nite from the 25 mg I take..
Hi again,
Looks like you are taking four meds that can affect anxiety and insomnia. If I have a hard time getting to sleep, I will up my Seroquel to 50mg for one night, but then get it back down to 25mg. The tolerance to the somnolence affect of clonazepam will increase over time. But in my situation the combination of Nardil and clonazepam works well for the social anxiety, and does not seem to exhibit tachyphylaxis (poop-out). I have never taken zopiclone but I've included a case study where it does exhibit dependence and withdrawal symptoms.
Take care,
JediReference:
Physical dependence on zopiclone: case reports
Ian R Jones, clinical research fellow,a Gary Sullivan, senior registrar a Division of Psychological Medicine, University of Wales College of Medicine, Cardiff CF4 4XNCorrespondence to: DrJones jonesir2@cf.ac.uk
Over the past few decades there has been a reluctance to prescribe benzodiazepines for insomnia and anxiety, as evidence for dependence and withdrawal has accumulated. Alternative treatments have therefore been sought.
Zopiclone, a cyclopyrrolone, is chemically unrelated to benzodiazepines but acts via the benzodiazepine/-aminobutyric acid receptor complex. It is licensed for the short term treatment of insomnia. Claims that zopiclone does not cause rebound, dependence, or withdrawal phenomena may have led to it being considered a safe option for treating insomnia.1 We present a series showing evidence of zopiclone dependence and problems caused by withdrawal.
Case 1–A 29 year old man who had had a pneumothorax was prescribed zopiclone 7.5 mg nightly. As he was anxious about a recurrence he increased the dose to 22.5 mg supplemented with tablets from other sources. After eight months he realised he was misusing the drug and stopped taking it suddenly. This resulted in severe anxiety with tachycardia, tremor, sweating, and rebound insomnia. He was treated with amitriptyline 25 mg three times daily for several weeks and made a full recovery.
Case 2–AA 26 year old man was prescribed zopiclone 7.5 mg nightly for insomnia. The dose was eventually increased to 7.5 mg four times daily, depending on availability. If he stopped taking zopiclone he experienced anxiety, tremors, sweats, flushes, palpitations, and derealisation. He was stabilised with 7.5 mg zopiclone nightly and 3.75 mg daily and monitored closely. He described a strong craving for the drug, and attempts to reduce the dose further were firmly resisted.
Case 3–A 49 year old woman received zopiclone 7.5 mg for insomnia during inpatient treatment for depression. She was taking this dose at discharge but subsequently increased it to 15 mg and then 22.5 mg. She remained on 22.5 mg one year later. She had tried to stop taking zopiclone twice but experienced severe rebound insomnia and anxiety. She was therefore reluctant to reduce the dose.
Case 4–A 36 year old woman with bipolar affective disorder was prescribed zopiclone 7.5 mg nightly for insomnia. The following year she was taking 7.5 mg four times daily, obtaining supplies by changing doctors. If she reduced her intake suddenly she experienced sweating, palpitations, tremor, and anxiety. Her intake was monitored and the dose was gradually reduced. She had been dependent on benzodiazepines although these were stopped before zopiclone was prescribed. She had no history of alcohol dependence.
All these patients increased their intake of zopiclone above the dose initially prescribed and their withdrawal symptoms included craving, anxiety, and insomnia. Although it has been suggested that zopiclone is not associated with dependence or withdrawal phenomena, rebound insomnia was experienced by normal volunteers after taking the drug for only two weeks.2 One case of zopiclone dependence has been reported, although this was complicated by a misuse of benzodiazepines and alcohol.3 From our series it would seem that dependence is not restricted to people with a history of benzodiazepine or alcohol misuse, as this applied to only one of our patients. The potential for zopiclone misuse has also been reported in three cases.4
Studies of up to four weeks of zopiclone use have not demonstrated evidence of dependence or withdrawal problems.5 Our cases reveal problems with use over a considerably longer period which may more closely resemble clinical practice.
Though zopliclone is a safe and effective treatment for insomnia in the short term, it seems that it can cause dependence with long term use. It would seem reasonable to apply the same caution to prescribing this drug that is applied to the benzodiazepines. Its use should be limited to the short term indications for which it is licensed.
Funding: IRJ is supported by a grant from the Wellcome Trust.
Conflict of interest: None.
Contributors: Both authors were involved in finding the patients, performing the literature review, and writing the paper.
Bianchi M, Musch B. Zopiclone discontinuation: review of 25 studies assessing withdrawal and rebound phenomena. Int Clin Psychopharmacol 1990;5(suppl 2):139-45.
Lader M, Frecka G. Subjective effects during and on discontinuation of zopiclone and of temazepam in healthy subjects. Pharmacopsychiatry 1987;20:67-71. [Medline]
Thakore J, Dinan TG. Physical dependence following zopiclone usage: a case report. Hum Psychopharmacol 1992;7:143-5.
Sullivan G, McBride AJ, Clee WB. Zopiclone abuse in South Wales: three case reports. Hum Psychopharmacol 1995;10:351-2.
Wadworth AN, McTavish D. Zopiclone: a review of its pharmacological properties and therapeutic efficacy as an hypnotic. Drugs and Aging 1993;3:441-59. [Medline]
Posted by Justherself54 on December 7, 2007, at 18:58:40
In reply to Re: Nardil question re: balance problems » Justherself54, posted by Jedi on December 7, 2007, at 13:25:36
Thanks for the info Jedi..much appreciated..I've never taken more than 7.5 mg..I read a post where the person stopped it for a few days as he/she had developed tolerance to Zopiclone and it then worked well again..just a bit concerned about the insomnia as sleep hygiene is critical for me not only for my bipolar but also my fibromyalgia..I'm sure I've developed a tolerance to both clonazapam and zopiclone as I've taken them for so long, so will probably end up increasing the seroquel, but will have to discuss it with pdoc before I do anything..
I'm very careful with both the clonazapam and zopiclone as my brother abused both of them..but that's a whole 'nother story!
Posted by Phillipa on December 7, 2007, at 19:26:38
In reply to Re: Nardil question re: balance problems - Jedi, posted by Justherself54 on December 7, 2007, at 18:58:40
Took 3mg of lunesta with 20mg of valium and .5 of xanax and just stopped the lunesta and xanax. No problem no withdrawal and now have dropped to l5mg of valium. No problem with that either wonder why? Phillipa
Posted by Jedi on December 7, 2007, at 23:07:26
In reply to Re: Nardil question re: balance problems - Jedi » Justherself54, posted by Phillipa on December 7, 2007, at 19:26:38
> Took 3mg of lunesta with 20mg of valium and .5 of xanax and just stopped the lunesta and xanax. No problem no withdrawal and now have dropped to l5mg of valium. No problem with that either wonder why? Phillipa
Hi Phillipa,
I've titrated off clonazepam several times along with many other medications. Some of us just don't have addictive personalities. It is fairly easy for me to come off most any med. It is when my body needs that med when the troubles start. Four or five titrations off Nardil have all lead to serious major depression after about a month. Baring a scientific breakthrough, I'm a lifer. The Major depressions have all been life threatening.
Be Well,
Jedi
Posted by Nardilstarted2007 on December 8, 2007, at 1:45:45
In reply to Nardil question re: balance problems, posted by Justherself54 on December 4, 2007, at 6:07:33
> My balance seems to be off for some reason..when I turn around I sometimes have to take a step to the side to maintain my balance and also notice that I'm bumping into things more often..
>
> Has anyone else had this happen on Nardil..thanks all..Hey guys, Ya im at 7 weeks of nardil and it sure does make me dizzy to, So We All get dizzy! But it has kicked in for me! I upped it tp 90mg a week ago, and now it works even better but the side effects that were subsidinghave increased again, thats ok , because they will decrease very soon again.
I am clumsy and do feel like a drunk throughout the day from nardil, worse at time like when you get up, feelike I could fall over, but I catch my self.......Not that bad considering its WORKING! I did a Presentation at school yesterday!, and I could do even though my eyes were a little blurry and I was walking with the drunkin nardil walk, so I just had to be very careful to walk normal and not to seem dizzy. Im also on zanax and I took Betablocker before the oral presentation, But without the nardil I definately would not even gone to school that day no matter how much betablocker or zanax I was on... Good luck with side effects subsiding, I have lots to, But its worth it if they get better.
Posted by Phillipa on December 8, 2007, at 19:21:06
In reply to Re: Nardil question re: balance problems - Jedi » Phillipa, posted by Jedi on December 7, 2007, at 23:07:26
Thanks Jedi seems like any depression I get is when anxiety is too high. Phillipa
This is the end of the thread.
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