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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Four Feathers on February 5, 2008, at 18:08:42
I have received dx's of both GAD and Dysthymia. I believe that my anxiety is the root cause of the depression symptoms I have experienced. Here is my story, as brief as possible, and I would appreciate any thoughts...
Suffered anxiety my entire life. Used to be much more Social Anxiety in nature, but now is predominately physical symptoms. These symptoms consist of increased blood pressure and headaches in the temple regions. Difficulty concentrating has also been a main issue as well as an uncomfortable restless feeling in my body, and difficulty getting up and going in the morning. I also have constant canker sores currently. All medical tests have been negative.
10 years ago I was put on Atenolol b/c of the high blood pressure, I was 24 at the time. I did not then understand that the feelings I had were anxiety which was likely causing the blood pressure changes. I am in good shape and have previously been very active athletically.
I have tried the SSRIs with the only one I could tolerate being Lexapro, and this has done nothing other than make concentration more difficult. Have tried Effexor which didn't help. Tried the mood stabilizers which really made me not feel well physically and mentally. Stimulants in low doses (i.e. Ritalin at 2.5 or 5mgs) creates the temple headaches and physically uncomfortable feeling. Surprisingly Strattera at doses of 80mg actually calmed me down, and made me tired, and allowed me to decrease my Atenolol dosage. Unfortunately, this created untolerable constipation problems. At low doses, below 60mg it was activating.Recently I tried Wellbutrin SR 50mg per day. I experienced three days of amazing relief (unlike any I had experienced in the last 15 years) at the beginning which all faded quickly and then resulted in headaches, increased blood pressure, etc. I have now stopped this per doc.
Tried Abilify which gave me great motivation, but caused me to get bad muscle cramps at only 2.5mg per day. Lamictal caused panic attacks at 12.5 mg/day. I take Clonazepam at a low dose (.25 to .5 mg per day) as needed.
I had a SPECT scan last summer at the Amen clinic which showed significantly increased activity in the limbic region and slight activation in the basal ganglia.
If I decrease the amount of Atenolol, currently only on 25mg/day, I get increased concentration and mood. Unfortunately, I also get increased blood pressure immediately.
I recently changed pdoc's and the current one is taking the time to help. He is recommending Nardil and I am hesitant to go this route just yet as I am concerned about the diet and other SE's. He states that he feels it would allevaiate all of my symptoms including the headaches and possibly the blood pressure.
I believe that my issues lie in the NE/DA area as the only meds I have received benefit from have been those that affect these. The only ones that I have thought about trying before Nardil are Cymbalta and possibly a dopamine agonist. Could anyone offer any thoughts as to meds to potentially help me moving forward? Does Nardil sound like a logical next step? Are my concerns of this med overexaggerated?
Thank you for any information/ideas. Sorry about the long post.
Posted by Justherself54 on February 5, 2008, at 19:41:55
In reply to Thoughts please...next step Nardil?, posted by Four Feathers on February 5, 2008, at 18:08:42
Nardil was a last ditch resort for me. I'm happy to report it's working great..
It has its own unique side effects: insomnia and slight balance problems have been the ones I have..plus sweet cravings..but I think they are more seroquel induced..
It takes longer to work than others I've been on and I'm just at 60 mg (I'm doing a very slow ramping).
I'm much more social and my anxiety now has been reduced to almost nil..People have remarked that I'm more forgetful but I don't care..I feel more the myself than I have for years..
The diet has not been an issue for me..I follow it and don't play around with experimenting..in fact you end up cutting out a lot of prepackaged foods that have stuff in them I've never heard of..
I feel MAOI's are underused..if your pdoc is willing to prescribe it, I would definitely give it a try..there are regular posters on here with lots of experience with MAOI's..keep posting!
Posted by Phillipa on February 5, 2008, at 23:44:02
In reply to Re: Thoughts please...next step Nardil?, posted by Justherself54 on February 5, 2008, at 19:41:55
Sorry have to comment on this thread as I think it's amazing your pdoc recommended nardil as so many people have trouble finding a doc willing to prescribe it. Is this poc someone famous I mean where and why and how did he gain his knowledge of MAOI's most doc seem to not know about them. Phillipa no I'm not on nardil that's why I said sorry. Sounds like you have a very knowledgeable doc
Posted by Four Feathers on February 6, 2008, at 0:08:29
In reply to Re: Thoughts please...next step Nardil?, posted by Phillipa on February 5, 2008, at 23:44:02
> Sorry have to comment on this thread as I think it's amazing your pdoc recommended nardil as so many people have trouble finding a doc willing to prescribe it. Is this poc someone famous I mean where and why and how did he gain his knowledge of MAOI's most doc seem to not know about them. Phillipa no I'm not on nardil that's why I said sorry. Sounds like you have a very knowledgeable doc
My doc is not someone famous, but has simply been around for a number of years. He actually recommended Nardil during my first visit with him after we went through all of the meds I had tried and their effects. I am not sure if I am willing to take the Nardil "plunge" yet and look forward to others thoughts on my above post. Thanks to those of you that have posted so far!
Posted by Phoenix1 on February 6, 2008, at 19:45:58
In reply to Thoughts please...next step Nardil?, posted by Four Feathers on February 5, 2008, at 18:08:42
> I have received dx's of both GAD and Dysthymia. I believe that my anxiety is the root cause of the depression symptoms I have experienced. Here is my story, as brief as possible, and I would appreciate any thoughts...
>
> Suffered anxiety my entire life. Used to be much more Social Anxiety in nature, but now is predominately physical symptoms. These symptoms consist of increased blood pressure and headaches in the temple regions. Difficulty concentrating has also been a main issue as well as an uncomfortable restless feeling in my body, and difficulty getting up and going in the morning. I also have constant canker sores currently. All medical tests have been negative.
>
> 10 years ago I was put on Atenolol b/c of the high blood pressure, I was 24 at the time. I did not then understand that the feelings I had were anxiety which was likely causing the blood pressure changes. I am in good shape and have previously been very active athletically.
>
> I have tried the SSRIs with the only one I could tolerate being Lexapro, and this has done nothing other than make concentration more difficult. Have tried Effexor which didn't help. Tried the mood stabilizers which really made me not feel well physically and mentally. Stimulants in low doses (i.e. Ritalin at 2.5 or 5mgs) creates the temple headaches and physically uncomfortable feeling. Surprisingly Strattera at doses of 80mg actually calmed me down, and made me tired, and allowed me to decrease my Atenolol dosage. Unfortunately, this created untolerable constipation problems. At low doses, below 60mg it was activating.
>
> Recently I tried Wellbutrin SR 50mg per day. I experienced three days of amazing relief (unlike any I had experienced in the last 15 years) at the beginning which all faded quickly and then resulted in headaches, increased blood pressure, etc. I have now stopped this per doc.
>
> Tried Abilify which gave me great motivation, but caused me to get bad muscle cramps at only 2.5mg per day. Lamictal caused panic attacks at 12.5 mg/day. I take Clonazepam at a low dose (.25 to .5 mg per day) as needed.
>
> I had a SPECT scan last summer at the Amen clinic which showed significantly increased activity in the limbic region and slight activation in the basal ganglia.
>
> If I decrease the amount of Atenolol, currently only on 25mg/day, I get increased concentration and mood. Unfortunately, I also get increased blood pressure immediately.
>
> I recently changed pdoc's and the current one is taking the time to help. He is recommending Nardil and I am hesitant to go this route just yet as I am concerned about the diet and other SE's. He states that he feels it would allevaiate all of my symptoms including the headaches and possibly the blood pressure.
>
> I believe that my issues lie in the NE/DA area as the only meds I have received benefit from have been those that affect these. The only ones that I have thought about trying before Nardil are Cymbalta and possibly a dopamine agonist. Could anyone offer any thoughts as to meds to potentially help me moving forward? Does Nardil sound like a logical next step? Are my concerns of this med overexaggerated?
>
> Thank you for any information/ideas. Sorry about the long post.
>Hi Four Feathers,
I'm on Nardil and it's been a miracle. I also responded poorly to all the SSRIs: no improvement and lots of side effects. I've had far fewer side effects with Nardil than any other AD i've been on. (and I have tried most of them) I think all the fear around Nardil is greatly exaggerated. As long as you stick to the diet and avoid contraindicated medications, it's pretty darn safe and undeniably effective for many people. And an added benefit for both you and I: it can lower blood pressure significantly.
The diet is very easy to follow once you get the hang of it. I don't really feel deprived or like I'm missing out on anything. And I've made the odd mistake, like eating a taco with some shredded cheese, and have not sufferred any ill effects.
What specifically are your concerns besides the diet?
One question: why atenolol for high blood pressure? If possible, you should steer clear of the beta blockers if you have depression. They can worsen things significantly. You might want to look at switching your antihypertensive to an ACE inhibitor or an ARB. Fewer psychiatric side effects.
PX1
Posted by Four Feathers on February 7, 2008, at 17:20:16
In reply to Re: Thoughts please...next step Nardil? » Four Feathers, posted by Phoenix1 on February 6, 2008, at 19:45:58
> Hi Four Feathers,
>
> I'm on Nardil and it's been a miracle. I also responded poorly to all the SSRIs: no improvement and lots of side effects. I've had far fewer side effects with Nardil than any other AD i've been on. (and I have tried most of them) I think all the fear around Nardil is greatly exaggerated. As long as you stick to the diet and avoid contraindicated medications, it's pretty darn safe and undeniably effective for many people. And an added benefit for both you and I: it can lower blood pressure significantly.
>
> The diet is very easy to follow once you get the hang of it. I don't really feel deprived or like I'm missing out on anything. And I've made the odd mistake, like eating a taco with some shredded cheese, and have not sufferred any ill effects.
>
> What specifically are your concerns besides the diet?
>
> One question: why atenolol for high blood pressure? If possible, you should steer clear of the beta blockers if you have depression. They can worsen things significantly. You might want to look at switching your antihypertensive to an ACE inhibitor or an ARB. Fewer psychiatric side effects.
>
> PX1
Hello Phoenix1,Thank you for taking the time to respond. From what I have heard, those that choose to make the switch to an MAOI often achieve dramatic results that they had not seen previously from other meds.
My pdoc said that many of the side effects are exaggerated as well. The diet is one of the main side effects I am concerned about, is there a good MAOI diet list avaiable online or elsewhere that you are aware of. Additionally, have you experienced any sexual side effects as compared to other ADs (I am male)? What about weight gain and ability to exercise regularly? I am active in athletics and want to remain so.
I am on a beta blocker b/c I didn't know any better 10 years ago when they put me on this for hypertension. It is now obvious to me that, while this is preventing blood pressure headaches and keeping bp in check, it is also negatively impacting concentration, organization, mood, etc. The root cause of my hypertension is, as I and my current pdoc believe, anxiety and potentially dysthymia. I had brought this up to at least three different physicians over the years (at least two diff pdocs) and they all told me that "the low dose you are on would not create depressive side effects". I now know differently and this is one of the first things my new pdoc pointed out.
I have an appt tomorrow with my prescribing physician to look at switching over to an ACE inhibitor and slowly discontinue the BB.
4F
Posted by squatlover on February 8, 2008, at 5:41:52
In reply to Re: Thoughts please...next step Nardil? - Phoenix1, posted by Four Feathers on February 7, 2008, at 17:20:16
B blockers aren't recommended for blood pressure control as first line now anyway - in fact they are 4th line because of risks of diabetes and stroke, unless you have heart disease.
Posted by Phoenix1 on February 8, 2008, at 8:03:41
In reply to Re: Thoughts please...next step Nardil? - Phoenix1, posted by Four Feathers on February 7, 2008, at 17:20:16
> > Hi Four Feathers,
> >
> > I'm on Nardil and it's been a miracle. I also responded poorly to all the SSRIs: no improvement and lots of side effects. I've had far fewer side effects with Nardil than any other AD i've been on. (and I have tried most of them) I think all the fear around Nardil is greatly exaggerated. As long as you stick to the diet and avoid contraindicated medications, it's pretty darn safe and undeniably effective for many people. And an added benefit for both you and I: it can lower blood pressure significantly.
> >
> > The diet is very easy to follow once you get the hang of it. I don't really feel deprived or like I'm missing out on anything. And I've made the odd mistake, like eating a taco with some shredded cheese, and have not sufferred any ill effects.
> >
> > What specifically are your concerns besides the diet?
> >
> > One question: why atenolol for high blood pressure? If possible, you should steer clear of the beta blockers if you have depression. They can worsen things significantly. You might want to look at switching your antihypertensive to an ACE inhibitor or an ARB. Fewer psychiatric side effects.
> >
> > PX1
>
>
> Hello Phoenix1,
>
> Thank you for taking the time to respond. From what I have heard, those that choose to make the switch to an MAOI often achieve dramatic results that they had not seen previously from other meds.
>
> My pdoc said that many of the side effects are exaggerated as well. The diet is one of the main side effects I am concerned about, is there a good MAOI diet list avaiable online or elsewhere that you are aware of. Additionally, have you experienced any sexual side effects as compared to other ADs (I am male)? What about weight gain and ability to exercise regularly? I am active in athletics and want to remain so.
>
> I am on a beta blocker b/c I didn't know any better 10 years ago when they put me on this for hypertension. It is now obvious to me that, while this is preventing blood pressure headaches and keeping bp in check, it is also negatively impacting concentration, organization, mood, etc. The root cause of my hypertension is, as I and my current pdoc believe, anxiety and potentially dysthymia. I had brought this up to at least three different physicians over the years (at least two diff pdocs) and they all told me that "the low dose you are on would not create depressive side effects". I now know differently and this is one of the first things my new pdoc pointed out.
>
> I have an appt tomorrow with my prescribing physician to look at switching over to an ACE inhibitor and slowly discontinue the BB.
>
> 4F
>Hi Four Feathers,
I agree with your pdoc, people tend to exagerate MAOI side effects. My experience has been that they are minor and very different than SSRI's in some ways.
Here are a couple good links to MAOI diet issues:
www.dr-bob.org/tips/maoi.html
www.dr-bob.org/babble/20010814/msgs/75408.html
Sexual side effects? Unfortunately, yes, anorgasmia (but otherwhise normal functioning) is a common side effect, but many people say if you wait long enough it will go away.
Weight Gain? I've gained much less weight than on other ADs. Maybe 10lbs over 3 months. But I could have controlled that a lot better too. I haven't been watching what I eat too carefully, except to pay attention to the MAOI diet.
Excercise? You may have to put up with some hypotension initially which can cause dizziness. Although if you are hypertensive like me, all it did was lower my blood pressure to normal levels. And some people experience some tiredness on Nardil. I experienced more energy, and I can excercise without problem. The one side effect I have that might impact serious athletics is a bit of loss of balance and clumsiness. I only noticed this at higher doses.
I hope this helps. If all else has failed, give Nardil a try. It isn't as bad as many people expect it to be. And good for you for pushing to get off the BB! Hopefully that will improve things all by itself.
Phoenix
Posted by 4WD on February 20, 2008, at 19:08:17
In reply to Re: Thoughts please...next step Nardil?, posted by Four Feathers on February 6, 2008, at 0:08:29
> My doc is not someone famous, but has simply been around for a number of years. He actually recommended Nardil during my first visit with him after we went through all of the meds I had tried and their effects. I am not sure if I am willing to take the Nardil "plunge" yet and look forward to others thoughts on my above post. Thanks to those of you that have posted so far!
>Hi,
I think I'm about to take the Nardil plunge myself. I've tried everything else and am pretty desperate at this point. I'm also terrified of the side effects but some posters here have said that the physical side effects don't bother them much simply because they feel so much better on Nardil.I see my Pdoc tomorrow and am going to ask for a trial of Nardil. I'll never know until I try...
Marsha
Posted by Four Feathers on February 21, 2008, at 10:02:08
In reply to Re: Thoughts please...next step Nardil? » Four Feathers, posted by 4WD on February 20, 2008, at 19:08:17
> Hi,
> I think I'm about to take the Nardil plunge myself. I've tried everything else and am pretty desperate at this point. I'm also terrified of the side effects but some posters here have said that the physical side effects don't bother them much simply because they feel so much better on Nardil.
>
> I see my Pdoc tomorrow and am going to ask for a trial of Nardil. I'll never know until I try...
> Marsha
>
>Marsha,
While I have not yet gone the Nardil route I am getting to the same point of desperation that you mention. I know what is inside my head and that I can feel much better, my brian just needs the help from the right med to get me there.
I am considering starting Nardil in March as I have been impressed with the results that many posters on this and other sites have achieved. While the side effects (specifically the diet) scare me, many have said the restrictions are blown out of proportion.
Please post your experience with this med if you choose to try it.
4F
Posted by 4WD on February 21, 2008, at 11:41:51
In reply to Re: Thoughts please...next step Nardil?, posted by Four Feathers on February 21, 2008, at 10:02:08
> > Hi,
> > I think I'm about to take the Nardil plunge myself. I've tried everything else and am pretty desperate at this point. I'm also terrified of the side effects but some posters here have said that the physical side effects don't bother them much simply because they feel so much better on Nardil.
> >
> > I see my Pdoc tomorrow and am going to ask for a trial of Nardil. I'll never know until I try...
> > Marsha
> >
> >
>
> Marsha,
>
> While I have not yet gone the Nardil route I am getting to the same point of desperation that you mention. I know what is inside my head and that I can feel much better, my brian just needs the help from the right med to get me there.
>
> I am considering starting Nardil in March as I have been impressed with the results that many posters on this and other sites have achieved. While the side effects (specifically the diet) scare me, many have said the restrictions are blown out of proportion.
>
> Please post your experience with this med if you choose to try it.
>
> 4F
Hi,
I see my doctor today. I'm not so worried about th diet as I am about the possible insomnia and food cravings. The diet scares me too but I have reachedthe point where I am willing to do whatever it takes to feel better.I will be posting a Nardil experience thread when I go on it.
Marsha
This is the end of the thread.
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