Psycho-Babble Medication Thread 804083

Shown: posts 1 to 24 of 24. This is the beginning of the thread.

 

Nardil Update - Day 9

Posted by Phoenix1 on January 3, 2008, at 20:07:50

Hello Everyone,

I thought I'd give you an update on my Nardil progress. I'm on day 9, and up to a dose of 45 mg. No side effects other than a little physical anxiety, insomnia, and various gastrointestinal issues. And I'm starting to gain weight already - craving carbs...

But the big news is that I'm feeling great! I can see why so many people rave about this med. I'm cautiously optimistic, because I know it's very early in the game, but I think I'm having a positive response to this med. I am still feeling depressed, tired and irritable in the evening, but during the day, my spirit, energy, and motivation are showing signs of coming back. My family notices a change too. So I have high hopes. The plan is to add 15mg/day each week until I get to 90mg (1mg/kg) if I can tolerate it. I don't know what the maintenance phase will be or how long it will last. Any suggestions?

The plan is also to taper me off clonazepam (1.5mg/day) and seroquel (25-75mg at night) once I reach my maintenance dose, and just let me take Zopiclone as needed for sleep.

Anyways, it took me many many months of begging and pleading to find a pdoc who was open-minded enough to let me try it. It was SO worth the fight I think. He recommended against it, preferring a high-dose plasma-monitored course of a tricyclic. But he left the final decision up to me. He's young (in his 40's) and hasn't had experience w/ MAOI's since his residency, but agreed that I was a good candidate. He consulted with some older, MAOI experienced colleagues who agreed, and then wrote me a script.

I'm so surprised. I've NEVER responded to any AD like this, or this quickly. It feels SO different from my very many experience with SSRI's, Tricyclics, and a plethora of other AD's. (I think I counted 9 or 10 last time)

I read that early improvement on an AD is a good prognostic sign, and a sign that this may be the right med for me. I know there are lots of things that could still happen to spoil the fun such as bad side effects requiring discontinuation, poop-out, or only a partial response.

Anyways, I just felt like posting an update. In some ways, I feel guilty for feeling better, because I know how many of you are struggling to find something that works. But hopefully, this can serve as an example that there is something out there for TX resistant depression, it just takes a long while to find the right drug/combo sometimes.

Wow this was long! Am I maybe a bit hypomanic? Don't think so. I'll post another update in a week or so unless I hear objections from anyone.

Phoenix1 - Cautiously optimistic.

 

Re: Nardil Update - Day 9

Posted by Justherself54 on January 3, 2008, at 22:22:05

In reply to Nardil Update - Day 9, posted by Phoenix1 on January 3, 2008, at 20:07:50

So happy to hear it's working! I'm glad you posted your update..It was like that for me too..although I'm still at 45 mg..I know I had some hypomania and ended up spending too much money, but all on projects I finally had the energy to tackle..Nardil is so different from any other AD I've been on (and I've been on everyone except Remeron)..no feelings of apathy..and ENERGY..I had forgotten what it felt like..I'm going to discuss increasing my dosage when I see my pdoc..I know I have to watch the hypomania tho, cause I can't tolerate mood stabilizers..I too hope it doesn't poop out on me..

My pdoc was very supportive and encouraging when I started both Parnate and Nardil..he was the one who suggested it as we had virtually run out of options..I'm so glad I overcame my initial fear of MAOI's..

Good luck to you!

 

Re: Nardil Update - Day 9 Phoenix » Justherself54

Posted by johnj on January 4, 2008, at 0:05:52

In reply to Re: Nardil Update - Day 9, posted by Justherself54 on January 3, 2008, at 22:22:05

Do either of you suffer from anxiety? I have anxiety/panic and ocd and will be talking with my pdoc. I heard Nardil is good for anxiety/ocd but fear the hypomania might cause me anxiety.

johnj

 

Re: Nardil Update - Day 9 Phoenix » johnj

Posted by Phoenix1 on January 4, 2008, at 8:35:40

In reply to Re: Nardil Update - Day 9 Phoenix » Justherself54, posted by johnj on January 4, 2008, at 0:05:52

> Do either of you suffer from anxiety? I have anxiety/panic and ocd and will be talking with my pdoc. I heard Nardil is good for anxiety/ocd but fear the hypomania might cause me anxiety.
>
> johnj

Hi John,

Yes, I have GAD, anxiety has ALWAYS been an issue for me. Nardil is supposed to be good for anxiety. I am experiencing a little more physical anxiety right now, but less "worry" or rumination or psychological anxiety... Whatever you want to call it.

Nardil inhibits GABA-transaminase, the enzyme that destroys GABA in the brain thus elevating GABA levels. Increased GABA levels are associated with less anxiety. My increased physical anxiety could be due to Nardil and may disappear as the dose increases and I get settled. But I have also reduced daytime clonazepam from 3.0mg/day to 1.5mg/day in the last few weeks, which could just as easily explain the anxiety. I don't think I have hypomania. I think if the dosage is ramped up slowly, this can be avoided. The anxiety I'm experiencing isn't bothersome. It's almost nice in a way because I associate it with increased energy. It's not the BAD anxiety that I was dealing with a few weeks ago. It's hard to explain. It just doesn't bother me too much.

Phoenix1

 

Re: Nardil Update - Day 9 » Justherself54

Posted by Phoenix1 on January 4, 2008, at 8:40:03

In reply to Re: Nardil Update - Day 9, posted by Justherself54 on January 3, 2008, at 22:22:05

> So happy to hear it's working! I'm glad you posted your update..It was like that for me too..although I'm still at 45 mg..I know I had some hypomania and ended up spending too much money, but all on projects I finally had the energy to tackle..Nardil is so different from any other AD I've been on (and I've been on everyone except Remeron)..no feelings of apathy..and ENERGY..I had forgotten what it felt like..I'm going to discuss increasing my dosage when I see my pdoc..I know I have to watch the hypomania tho, cause I can't tolerate mood stabilizers..I too hope it doesn't poop out on me..
>
> My pdoc was very supportive and encouraging when I started both Parnate and Nardil..he was the one who suggested it as we had virtually run out of options..I'm so glad I overcame my initial fear of MAOI's..
>
> Good luck to you!
>
>

Hi Jusherself,

Yes, you're right, the apathy from SSRI's is a major thing that I'm not experiencing with Nardil. Interesting that you liked Remeron. For me, it sort of worked, but was nothing like what I'm experiencing now. I'm watching the hypomania, and money spending, and personal interactions carefully. I don't think I have hypomania, but would hate to do something I would later regret as a result. I hope I would have the insight to realize if I were becoming hypomanic, but I'm not totally sure if I would. Is it easy for you to recognize when it happens?

Phoenix1

 

Starting CBT too...

Posted by Phoenix1 on January 4, 2008, at 8:43:53

In reply to Nardil Update - Day 9, posted by Phoenix1 on January 3, 2008, at 20:07:50

Forgot to mention I start CBT next week. I have some misgivings about CBT: seems to lack empathy, seems a bit like dog training, and it ignores causal factors. Nonetheless, I agreed to try my best, so we'll see how it goes. I know this shouldn't be in the meds section, but it should have been part of my update...

 

Re: Nardil Update - Day 9 » Phoenix1

Posted by johnj on January 4, 2008, at 8:49:47

In reply to Nardil Update - Day 9, posted by Phoenix1 on January 3, 2008, at 20:07:50

Thank you for the response, this is what I like about the board.

What have you been doing for the insomnia? or is it not too bad? I slept about 2.5 hours last night and so tired today. Work will be brutal.

I am intrigued by Nardil. Have you ever tried a mood stabilizer? What about Lyrica?

I bet the reduction in the K is what is causing the anxiety. I am sure it will abate. Thank you again and please keep us posted.

johnj

 

One more follow up... » Phoenix1

Posted by johnj on January 4, 2008, at 8:54:25

In reply to Starting CBT too..., posted by Phoenix1 on January 4, 2008, at 8:43:53

I wonder if something like neurotnin or lyrica could help with the sleep/anxiety? The only problem is it is a GABA drug and I don't know if their is a reaction problem because of how nardil works?

Just a thought

johnj

 

Re: Nardil Update - Day 9 Phoenix

Posted by Justherself54 on January 4, 2008, at 9:13:23

In reply to Re: Nardil Update - Day 9 Phoenix » Justherself54, posted by johnj on January 4, 2008, at 0:05:52

> Do either of you suffer from anxiety? I have anxiety/panic and ocd and will be talking with my pdoc. I heard Nardil is good for anxiety/ocd but fear the hypomania might cause me anxiety.
>
> johnj


I suffer from panic disorder also. I runs in my family..There was a time I could only go into one store as I would have a full blown panic attack in others while standing in the lineups..I perform marriages and would have to drug myself to the nines to be able to do them and even with benzo's in me I would still feel like I might pass out..Before Nardil I was extremely self-isolating, rarely left the house as my anxiety plus depression was so bad..

Since the end of September when I started taking Nardil, I have no problems going anywhere..it's not that I've turned into a social butterfly as that's not my nature, but I am socializing again..
This med just makes you feel like yourself again..the hypomania I experienced was definitely not the anxious or irritable kind..

 

Re: One more follow up... » johnj

Posted by Phoenix1 on January 4, 2008, at 9:18:55

In reply to One more follow up... » Phoenix1, posted by johnj on January 4, 2008, at 8:54:25

> I wonder if something like neurotnin or lyrica could help with the sleep/anxiety? The only problem is it is a GABA drug and I don't know if their is a reaction problem because of how nardil works?
>
> Just a thought
>
> johnj

Hi John,

I'll reply to both of your posts here. For sleep, I take 25-75mg of Seroquel and Zopiclone (similar to Lunesta) 7.5mg as needed. Last night I slept 6 hours, although the last 3 were fragmented. I find I can sometimes skip the zopiclone and my sleep is no worse. Some nights I can get by on just 25 mg of Seroquel. Who knows what will happen as the Nardil dose increases? Some people have more trouble sleeping and others seem to sleep just fine.

On Gabapentin and Lyrica, I have LOTS of experience with each. I was prescribed these drugs for ulnar neuropathy, a side effect from a very badly broken arm. I was on each one for about 2 years separately. I reached max doses for each (3600mg for gabapentin and 600mg for Lyrics). For ME personally, they helped a lot with anxiety, sleep, and believe it or not, I found them to relieve my depression. In fact, I stayed on these meds for so long, not for the intended purpose of relieving pain, but to ease my anxiety. I did this without telling the prescribing doc, and without really admitting to myself what I was doing. But the doses necessary to achieve what I wanted caused the SAME thing for both drugs. Weight gain (20-30lbs), edema, loss of cognitive function, and emotional numbing. I didn't have much of a problem stopping Gabapentin. Stopping Lyrica, even after a long slow taper, was the single worst withdrawal reaction I've ever had in my life. I was incredibly depressed, agitated, restless, couldn't sleep or function. And it went on for weeks. Eventually I had to be put on a diazepam taper to try to deal with the withdrawals. There isn't enough patient experience yet to document this to much of an extent, but Lyrica definitely causes physical and mental dependence, and has abuse potential. I have added it to my mental folder as if it were a benzodiazepine.

Anyways, I probably told you more than you wanted to know, but I think it's important to know what discontinuation effects are possible before starting a new med. And Lyrica is still sort of uncharted waters as it is fairly new...

Phoenix1

 

Re: One more follow up... » Phoenix1

Posted by johnj on January 4, 2008, at 9:51:36

In reply to Re: One more follow up... » johnj, posted by Phoenix1 on January 4, 2008, at 9:18:55

Right now, I am not sleeping (2.5 hrs. last night), numb, and am not functioning very well at all. The anxiety, mind racing, ocd worry, is taking over. I guess I have to weigh the pros and cons that at least I would be sleeping and not have anxiety but at some expense. I still wonder if a little lyrica could help your sleep and the nardil would keep the motivation going? What do you think?

I called and got an appointment today at 4 with my pdoc. I am at my wits end with a lack of quality sleep and the anxiety.

johnj

 

Re: Nardil Update - Day 9 Phoenix » Justherself54

Posted by johnj on January 4, 2008, at 9:52:53

In reply to Re: Nardil Update - Day 9 Phoenix, posted by Justherself54 on January 4, 2008, at 9:13:23

Thank you.

Did you have sleep problems with the panic disorder? Do you have insomnia with nardil? If so, how do you handle it?

johnj

 

Re: One more follow up... » johnj

Posted by Phoenix1 on January 4, 2008, at 10:28:02

In reply to Re: One more follow up... » Phoenix1, posted by johnj on January 4, 2008, at 9:51:36

> Right now, I am not sleeping (2.5 hrs. last night), numb, and am not functioning very well at all. The anxiety, mind racing, ocd worry, is taking over. I guess I have to weigh the pros and cons that at least I would be sleeping and not have anxiety but at some expense. I still wonder if a little lyrica could help your sleep and the nardil would keep the motivation going? What do you think?
>
> I called and got an appointment today at 4 with my pdoc. I am at my wits end with a lack of quality sleep and the anxiety.
>
> johnj

Hi John,

2.5 hours of sleep is not enough, I know that very well from experience. It makes everything else worse, especially depression. Could you remind me what you are diagnosed with and what meds you are on? I don't see any reason why Nardil and Lyrica couldn't be taken together. Nardil MIGHT amplify the sedative effect of Lyrica a little bit.

I didn't find the Lyrica sedating at low doses, only at higher doses, but your mileage may vary. It definitely helps with sleep, and doctors see it as less dangerous than benzos, so give it a shot if your doctor goes for it. I would think that you would need at least 50-150mg at night to help with sleep. As with all drugs, it's better to start low, and increase slowly.

John, what else have you tried for sleep, and why are you interested in Lyrica specifically? There are better choices for sleep meds in my opinion. I posted a response on this thread that outlines my experiences, and what options I know of:

http://www.dr-bob.org/babble/20071225/msgs/803404.html

Also, Lyrica is horrendously expensive unless you have good insurance.

I really hope you find something to help you get a reasonable nights sleep. I have lots of personal insomnia experience so I'm happy to give advice if I can be of any assistance.

Phoenix1

 

Re: One more follow up... » Phoenix1

Posted by johnj on January 4, 2008, at 11:07:21

In reply to Re: One more follow up... » johnj, posted by Phoenix1 on January 4, 2008, at 10:28:02

My dx is anxiety/ocd (pure O), and I have had panic attacks. My mind races a lot so some type of bipolar is a possibility. I worry so much. Right now I am on no meds and it has been up and down. Recently, things have gotten worse and I cannot break the pattern of worry and sleep has gone down hill.

I cannot take ssris as they cause a 10 fold anxiety increase but I have only tried luvox and paxil. I used to take tranzene but after 10 years it started causing depression. I tried klonopin and xanax and I felt terrible and the washout caused a huge jump in anxiety. Seroquel caused akathisia, pure hell that was. So, I am looking at other options and lyrica seems to be one people here have discussed. If my anxiety and rumination stop I can sleep.

After taking Lunesta I would wake up after 6 hours abruptly and it actually made me anxious. The taste wasn't that big of thing but I would rather take care of the anxiety and hope the sleep issues improve. I was thinking of possibly a low dose TCA and may even consider anafranil for the ocd. I am just med sensitive.

 

Re: One more follow up... » Phoenix1

Posted by Phillipa on January 4, 2008, at 12:39:05

In reply to Re: One more follow up... » johnj, posted by Phoenix1 on January 4, 2008, at 9:18:55

Seriously lyrica definitely causes dependance as my pdoc said I could try it during the day. Don't need more physical dependance though. Is there a study and weight gain forget it then don't need that but glad you nardil is working well for you. Phillipa

 

Re: One more follow up...

Posted by Phillipa on January 4, 2008, at 12:46:47

In reply to Re: One more follow up... » Phoenix1, posted by Phillipa on January 4, 2008, at 12:39:05

Sorry read ahead and didn't see the old thread but in your opinion lyrica is better dependance wise than say valium and gives better sleep and then during the day for you nardil wakes you up? Any BP problems? Thanks for your kind answers if able to give them. Phillipa

 

Re: Nardil Update - Day 9 » Phoenix1

Posted by Maxime on January 4, 2008, at 12:53:00

In reply to Nardil Update - Day 9, posted by Phoenix1 on January 3, 2008, at 20:07:50

I responded to both Nardil and Parnate in just over a week. I think it's a MAOI thing. Seriously.

I'm really happy for you!

Maxime

 

How much weight?

Posted by Maxime on January 4, 2008, at 14:11:53

In reply to Nardil Update - Day 9, posted by Phoenix1 on January 3, 2008, at 20:07:50

Hi!

You mentionned that you are gaining weight. How much weight do you think you have gained?

I'm curious because a friend of mine wants to take it but she has bulimia and is scared of weight gain.

Maxime

 

Re: One more follow up... » Phillipa

Posted by Phoenix1 on January 4, 2008, at 15:22:38

In reply to Re: One more follow up..., posted by Phillipa on January 4, 2008, at 12:46:47

> Sorry read ahead and didn't see the old thread but in your opinion lyrica is better dependance wise than say valium and gives better sleep and then during the day for you nardil wakes you up? Any BP problems? Thanks for your kind answers if able to give them. Phillipa

Sorry Phillipa, I'm not exactly sure what you are asking, but I'll try to answer your question. In the US, Lyrica is a C-IV scheduled drug meaning there is abuse potential. The research I read said that it has lower abuse potential than benzo's but this is interesting, straight from the monograph:

"In a study of recreational users (N=15) of sedative/hypnotic drugs, including alcohol, LYRICA (450mg, single dose) received subjective ratings of "good drug effect," "high" and "liking" to a degree that was similar to diazepam (30mg, single dose)."

In terms of the weight gain, the monograph says:

"LYRICA treatment may cause weight gain. In LYRICA controlled clinical trials of up to 14 weeks, a gain of 7% or more over baseline weight was observed in 9% of LYRICA-treated patients and 2% of placebo-treated patients. Few patients treated with LYRICA (0.3%) withdrew from controlled trials due to weight gain. LYRICA associated weight gain was related to dose and duration of exposure, but did not appear to be associated with baseline BMI, gender, or age. Weight gain was not limited to patients with edema."

Anyways, in my opinion, it was harder than the benzos to quit. The withdrawal was terrible. Also from the monograph:

"In clinical studies, following abrupt or rapid discontinuation of LYRICA, some patients reported symptoms including insomnia, nausea, headache or diarrhea [see Warnings and PRECAUTIONS], suggestive of physical dependence."

This, in my personal experience is a vast understatement, and doesn't describe the terrible withdrawal I went through, even after tapering slowly. But it did help with anxiety, insomnia and depression. None of these are official reasons to use the drug, it is only approved for neuropathy. It does not FEEL like a benzo when you take it. I can't explain it, the sedation is just different. It really wrecked my cognitive abilities at higher doses, more so than clonazepam. I really can't tell you if it would work in place of Valium. It might be worth a try. I would personally avoid it in the future just based on my experience with it. I'm sure it has lot's of potential, but I really didn't like it in retrospect. Just my opinion though...

I hope this is helpful.

Phoenix1

 

Re: One more follow up... » johnj

Posted by Phoenix1 on January 4, 2008, at 15:32:07

In reply to Re: One more follow up... » Phoenix1, posted by johnj on January 4, 2008, at 11:07:21

> My dx is anxiety/ocd (pure O), and I have had panic attacks. My mind races a lot so some type of bipolar is a possibility. I worry so much. Right now I am on no meds and it has been up and down. Recently, things have gotten worse and I cannot break the pattern of worry and sleep has gone down hill.
>
> I cannot take ssris as they cause a 10 fold anxiety increase but I have only tried luvox and paxil. I used to take tranzene but after 10 years it started causing depression. I tried klonopin and xanax and I felt terrible and the washout caused a huge jump in anxiety. Seroquel caused akathisia, pure hell that was. So, I am looking at other options and lyrica seems to be one people here have discussed. If my anxiety and rumination stop I can sleep.
>
> After taking Lunesta I would wake up after 6 hours abruptly and it actually made me anxious. The taste wasn't that big of thing but I would rather take care of the anxiety and hope the sleep issues improve. I was thinking of possibly a low dose TCA and may even consider anafranil for the ocd. I am just med sensitive.

Hi John,

Wow, sounds like you've tried all the usual things that I would suggest. If you are in the US, Rozerem is an option for sleep. I've never tried it, and haven't seen any rave reviews.

Sounds like trying Lyrica or Neurontin might be an OK option for you. It did alleviate most of my anxiety and insomnia at higher doses. I just worry that you might experience the awful rebound anxiety and insomnia when you stop it, like I did. I found it to be worse than the benzos in that respect.

I really don't want to vilify Lyrica, because it clearly has some potential in anxiety disorders. It's just that I personally, had a terrible experience with it, and for me, the period of benefit wasn't worth the side effects and then the discontinuation syndrome. But for others, it might be a great solution.

Let me know what your doc says, and what you decide to do. And before starting, make sure your doc agrees to a long slow taper if and when you decide to discontinue it.

I'm not sure if I'm being of any help here. On one hand I'm saying it works for anxiety, and on the other hand I'm saying I hated it and it wasn't worth it. I have mixed feelings...

Phoenix1

 

Re: Nardil Update - Day 9 » Maxime

Posted by Phoenix1 on January 4, 2008, at 15:35:26

In reply to Re: Nardil Update - Day 9 » Phoenix1, posted by Maxime on January 4, 2008, at 12:53:00

> I responded to both Nardil and Parnate in just over a week. I think it's a MAOI thing. Seriously.
>
> I'm really happy for you!
>
> Maxime

Thanks Maxime! The MAOI's really are different than any other AD aren't they? Just a totally different feeling subjectively. I was trying to explain this to my pdoc, but couldn't put it into words.

I hope your pdoc appointment goes well on Monday. You deserve to feel well too, and I hope you find a solution to your current symptoms. I'll be thinking of you.

Phoenix1

 

Re: How much weight? » Maxime

Posted by Phoenix1 on January 4, 2008, at 15:45:17

In reply to How much weight?, posted by Maxime on January 4, 2008, at 14:11:53

> Hi!
>
> You mentionned that you are gaining weight. How much weight do you think you have gained?
>
> I'm curious because a friend of mine wants to take it but she has bulimia and is scared of weight gain.
>
> Maxime

Hi Maxime,

I knew someone was going to ask... I'm not sure if it's Nardil, Seroquel, holiday season, or a combination of all three, but I've gained almost 10lbs in 2 weeks. I'm over 6' tall, and my ideal weight (BMI based) would be 180-190 and I'm over 200 right now. I'm not happy about this, but I'll take it if the depression goes away. I just hope it slows down or levels off at some point...

I don't think I'm eating differently. I've been busy at work and often skip breakfast and/or lunch.

BTW, the BMI numbers for men are really strange in my opinion. If I were at my "ideal" BMI, I would look very very very thin. I've been there before.

Phoenix1

 

Re: Nardil johnj

Posted by Justherself54 on January 4, 2008, at 16:40:56

In reply to Re: Nardil Update - Day 9 Phoenix » Justherself54, posted by johnj on January 4, 2008, at 9:52:53

> Thank you.
>
> Did you have sleep problems with the panic disorder? Do you have insomnia with nardil? If so, how do you handle it?
>
> johnj

I had sleep issues with panic disorder and have insomnia from Nardil, although it seems to be getting a bit better..I take 50 mg of seroquel up from 25 mg, .05 clonazapam and 11.5 mg of zopiclone up from 7.5 mg..it was increasing the zopiclone that finally helped me get at least 6 hours of sleep, although still waking through the nite, but able to fall back asleep..haven't discussed with pdoc the increase in zopiclone but hope he says it's OK..cause it works..

 

Re: One more follow up... » Phoenix1

Posted by Phillipa on January 4, 2008, at 19:24:51

In reply to Re: One more follow up... » Phillipa, posted by Phoenix1 on January 4, 2008, at 15:22:38

Phoenix l yes exactly what I was looking for perfect answer as to why I asked it my pdoc had suggested I try a small let's say 25mg dose of it during the day as valium has lost it's ability to relax as it did those 35 years ago. Well I did get a lot of mileage out of it and not that hard for me to lower the dose. So I may try the low dose to see if I feel a thing at all. Thanks again. Phillipa


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