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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by socialphobic on July 27, 2008, at 7:28:03
Hi everyone,
I suffer depression with social phobia. I have pretty much tried all the antidepressants available with no success. I've tried all the SSRI's, a handful of TCA's and a few combos with antipsychotics.
A few years ago I managed to find a GP that gave me nardil. I took one dose then was freaking out for the rest of the day every time I ate something. After that I didn't take any more because the anxiety of getting a hypertensive crisis was too much.
I have done a lot of research into nardil, including these forums. It seems that pretty much everyone who's tried it has raved on about how great it is. I have read many of ace's posts on here and it sounds like a miracle drug for depression and social phobia.
However, I am very concerned about the dietry restrictions. I've read posts where people say they've accidentally ate something wrong which resulted in a bad migrane and a trip to hospital.
It's not just the food interactions i'm worried about either. What if you were in a bad accident and required immediate surgery? From what i've heard you can't have anesthetic while on an MAOI? Is this true? If so, wouldn't you be screwed?
If I did work up the courage to try nardil again, is it possible to get a hypertensive "antidote" to lower your blood pressure? Is this advisable?
Posted by Merge on July 27, 2008, at 8:32:45
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
I had to have emergency surgery while taking Nardil - and I got anesthesia. It's not ideal, of course, but yes it can be done. I was able to tell the hospital staff that I was taking Nardil, but I also ALWAYS wore a medical alert bracelet that stated I was taking an MAOI, just in case I was ever in an accident and wasn't able to tell the hospital that I was taking an MAOI.
I took MAOIs for about 4 years (Nardil, and then Parnate). I believe that your doctor can prescribe something for you to carry with you in the event of a hypertensive crisis (I never did this). I was very careful about what I ate as well as what I took for over-the-counter medications. If you're willing to do your research and act responsibly and VERY diligently, I don't think being on an MAOI should be too worrisome.
Basically, get used to reading labels on EVERYTHING that goes in your body. Honestly, eating out at restaurants is a pain in the *ss because you can never be sure what goes into food that you don't prepare (for example - yeast extract is a no-no if you are taking an MAOI - this stuff is in EVERYTHING! a restaurant might not put yeast extract directly into a certain dish, but it may very well be in a sauce mix, or broth that is added to a recipe, etc.).
The same goes with over the counter medication. I am prone to sinus infections, ear infections, colds, and bronchitis. You can't take most cold/sinus medications while taking an MAOI and this was a big problem for me.
I think being on Nardil is manageable if you're willing to really educate yourself about what you can and cannot consume while taking Nardil. I never had a hypertensive crisis in the 4 years that I took an MAOI because I was very, very careful about what I ate and what I took for over the counter medications. Wearing a bracelet also gave me some peace of mind knowing that if something were to happen to me and I needed emergency treatment, they would know that I was taking an MAOI.
I hope this helps a little bit. Good luck.
Posted by socialphobic on July 27, 2008, at 8:52:40
In reply to Re: Thinking of trying nardil but scared, posted by Merge on July 27, 2008, at 8:32:45
Did you find that nardil helped for you?
I think if I were to take it i'd buy a portable blood pressure machine, and also find a doctor that would prescribe me an antidote in the case of a hypertensive crisis.
Are fast food places like mcdonalds, kfc, hungry jacks etc a problem while on nardil? Would you be able to eat a quarter pounder burger from mcdonalds? It contains cheese but I think its processed cheese?
Posted by Phillipa on July 27, 2008, at 12:04:20
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
Hi let me welcome you to babble. Great knowledge here so many with nardil knowledge hope more are able to help with your concerns. Ace is great!!! May I suggest the babble archieve? Love Phillipa and welcome again!!!!
Posted by socialphobic on July 27, 2008, at 20:04:12
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
If nardil helped me even half as much as it helped people like ace then i'd be happy. Depression and social phobia has literally crippled me. I am a like a prisoner within my own home. I am unable to work and I have very few friends.
If I knew it was garunteed to work for me then i'd try it for sure. However, knowing my luck i'll probably go through all the side effects and food restrictions for nothing, then be even more depressed if it doesn't work.
Is there any way I can contact ace personally? I am also from australia and would like to be the second "nardil champ of australia" lol.
Posted by blueboy on July 28, 2008, at 10:58:00
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
> Hi everyone,
>
> I suffer depression with social phobia. I have pretty much tried all the antidepressants available with no success. I've tried all the SSRI's, a handful of TCA's and a few combos with antipsychotics.
>Sounds like me, LOL. I'm still trying, I hope you won't give up hope. I was rediagnosed bipolar a couple of months ago, so I have a whole new series of drugs to try.
> A few years ago I managed to find a GP that gave me nardil. I took one dose then was freaking out for the rest of the day every time I ate something. After that I didn't take any more because the anxiety of getting a hypertensive crisis was too much.
>Yeah, my sympathy. Having anxiety problems sucks, although mine aren't apparently as bad as yours.
> I have done a lot of research into nardil, including these forums. It seems that pretty much everyone who's tried it has raved on about how great it is. I have read many of ace's posts on here and it sounds like a miracle drug for depression and social phobia.
>Let me put Nardil into perspective. I took it for almost two years, 60/mg day.
The side effects were awful for me. However, it was the only drug I ever took that would lift my depression, so I put up with them.
It did not help my social anxiety very much. I have found that 1mg clonazepam (klonopin), taken half an hour before I leave the house, is a huge help for this. It sounds like your problem is more severe than mine, but that's the best I can tell you.
> However, I am very concerned about the dietry restrictions. I've read posts where people say they've accidentally ate something wrong which resulted in a bad migrane and a trip to hospital.
>There's no need to worry, as long as you are vigilant. Most times if you get some tyramine in your food, you will not have a dangerous reaction. A lot of sites say that the standard restrictions are too severe and are unneccesary. You can definitely ingest some tyramine with no ill effect.
The restrictions are a pain in the neck but are pretty easy to avoid. Since you can tolerate a certain amount, if you try to avoid them completely, accidental ingestion of a moderate amount shouldn't hurt you.
Personally, I just didn't eat cheese, period. I also wouldn't eat avocado or especially guacamole, for example, but I would eat a firm banana where I could see that there were no brown spots. Especially if you are anxious, I would just get a hamburger without cheese at McDonalds, although as your say, American cheese is probably safe.
A home blood pressure monitor is fairly inexpensive and enormously comforting if you tend towards anxiety. If you get a bad headache and start to freak out, just take a reading. If it is tyramine related, your blood pressure will be extremely high. My systolic pressure is in the 120-130 range normally, and I think my pdoc told me to get worried at 160 and seek emergency attention at 180, which is below the point that I'd fear a stroke or something.
> It's not just the food interactions i'm worried about either. What if you were in a bad accident and required immediate surgery? From what i've heard you can't have anesthetic while on an MAOI? Is this true? If so, wouldn't you be screwed?
>My biggest fear, like yours, was getting knocked out in a car accident or having anesthesia from an idiot. Very serious results are extremely uncommon -- the only death I have heard about came from large injections of demerol, but I haven't done research. I would be VERY careful with cold medication (I just stopped taking anything for colds expect Advil).
However, there are plenty of anesthetics at all levels that do not interact with Nardil. Or, if the anesthetist is not comfortable (usually in a long surgery or for an unusual patient), you can stop taking Nardil a couple of weeks before the procedure.
I got a medic alert necklace and refused to have anesthesia without an anesthesiologist, and I insisted on meeting him and telling him, face to face, that I was taking phenelzine. (Okay, I did have a colonoscopy using a nurse-anesthetist but both he and the doctor seemed to be on top of the situation.)
> If I did work up the courage to try nardil again, is it possible to get a hypertensive "antidote" to lower your blood pressure? Is this advisable?
There are people on this board who say that this was their approach. Personally, if I had ever had a major hypertensive crisis, I would have gone straight to the emergency room.
On the other hand, having some drug in your kit might be a good idea if you're traveling to an area without good hospitals.
Posted by mickapoo on August 1, 2008, at 19:03:16
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
> Hi everyone,
>
> I suffer depression with social phobia. I have pretty much tried all the antidepressants available with no success. I've tried all the SSRI's, a handful of TCA's and a few combos with antipsychotics.
>
> A few years ago I managed to find a GP that gave me nardil. I took one dose then was freaking out for the rest of the day every time I ate something. After that I didn't take any more because the anxiety of getting a hypertensive crisis was too much.
>
> I have done a lot of research into nardil, including these forums. It seems that pretty much everyone who's tried it has raved on about how great it is. I have read many of ace's posts on here and it sounds like a miracle drug for depression and social phobia.
>
> However, I am very concerned about the dietry restrictions. I've read posts where people say they've accidentally ate something wrong which resulted in a bad migrane and a trip to hospital.
>
> It's not just the food interactions i'm worried about either. What if you were in a bad accident and required immediate surgery? From what i've heard you can't have anesthetic while on an MAOI? Is this true? If so, wouldn't you be screwed?
>
> If I did work up the courage to try nardil again, is it possible to get a hypertensive "antidote" to lower your blood pressure? Is this advisable?Hi there, I am also new to this board, and just started Nardil a couple of days ago. Like you, I suffer from depression and severe social phobia. I've tried every drug on the planet, and nothing has worked for me. Although like you say, there are many dietary restrictions, to me it is worth the extra responsibility and sacrificing a few foods in order to get a life (I'd say "get my life back" but there never was one to begin with). Like you, I feel like a prisoner in my own home. I have missed out on and lost so many things in life, I finally decided to try this so-called risky MAOI as a last-ditch effort.
What I'm doing in regards to your concerns is this- being diligent about what I'm eating...making sure I go the extra mile, especially at restaurants. I had my dr prescribe an antidote for an accidental hypertensive episode (you can always take this and still go to the hospital if you desire, but at least it may provide you with peace of mind). As some others have suggested, for added protection you can wear a medical id bracelet that states you're on an MAOI.
Good luck to you, and I hope this helps!
Posted by mickapoo on August 1, 2008, at 19:07:26
In reply to Re: Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 8:52:40
> Are fast food places like mcdonalds, kfc, hungry jacks etc a problem while on nardil? Would you be able to eat a quarter pounder burger from mcdonalds? It contains cheese but I think its processed cheese?
>
>
As far as I am aware, it is only aged cheeses that you have to avoid. Cheeses such as American and Velveeta are fine. Check the food list on this website, or go to medline, which is a reliable resource for medical professionals.
Posted by socialphobic on August 2, 2008, at 5:59:50
In reply to Re: Thinking of trying nardil but scared, posted by mickapoo on August 1, 2008, at 19:03:16
mickapoo, what antidote did your doctor prescribe? was it nifedipine?
What is the best dose to start on? I've heard its best to get up to 60mg as soon as you can? Though i'm not sure if i'll be able to tolerate the side effects.
Posted by mickapoo on August 2, 2008, at 6:48:18
In reply to Re: Thinking of trying nardil but scared, posted by socialphobic on August 2, 2008, at 5:59:50
> mickapoo, what antidote did your doctor prescribe? was it nifedipine?
>
> What is the best dose to start on? I've heard its best to get up to 60mg as soon as you can? Though i'm not sure if i'll be able to tolerate the side effects.
>
>
I was prescribed Procardia, but we also discussed Chlorpromazine (brand name "Thorazine").I'm not sure what would be considered the "best" dose to start on, but my dr prescribed me 45 mg/day. Something else I forgot to mention, my pharmacist recommended having a blood pressure monitor at home.
I was thinking about your post last night- maybe if it is the food interactions that are worrying you, you can take Clonazepam in the beginning until you feel more comfortable with the drug over time. That should help with your anxiety. But if you suffer from social phobia to the extent that I do, almost anything is worth sacrificing. So, I would try not to let the dietary restrictions scare you- you just have to be very diligent about what you are eating. I finally realized what an extreme toll it has taken on my life, and after trying every medication known to man, resorted to asking my dr for an MAOI.
Posted by socialphobic on August 2, 2008, at 8:59:29
In reply to Thinking of trying nardil but scared, posted by socialphobic on July 27, 2008, at 7:28:03
Have you tried cymbalta? It is really the only other antidepressant I haven't tried. So at the moment its either cymbalta or nardil.
I did a search on here and there seems to be mixed results on cymbalta when it comes to social anxiety. Some say it made their anxiety worse, some say no difference, others say it helped their anxiety. *shrug* not exactly as conclusive as nardil.
Given that i'm very anxious about a hypertensive crisis, would you guys recommend I try cymbalta first, then move onto nardil if there is no benefit? However, I could be wasting a few months of no benefit on cymbalta when nardil could have been working in that time.
So given my situation, should I try cymbalta first, or just go straight for nardil?
Posted by Justherself54 on August 2, 2008, at 10:26:01
In reply to Re: Fast food + cheeseburgers, posted by mickapoo on August 1, 2008, at 19:07:26
> > Are fast food places like mcdonalds, kfc, hungry jacks etc a problem while on nardil? Would you be able to eat a quarter pounder burger from mcdonalds? It contains cheese but I think its processed cheese?
> >
> >
> As far as I am aware, it is only aged cheeses that you have to avoid. Cheeses such as American and Velveeta are fine. Check the food list on this website, or go to medline, which is a reliable resource for medical professionals.Almost all fast food places, McDonalds, Burger King and the like use processed cheese on their burgers. Processed and cream cheese are safe. So you can indulge!
>
>
Posted by West on August 2, 2008, at 11:43:43
In reply to Re: Fast food + cheeseburgers, posted by Justherself54 on August 2, 2008, at 10:26:01
For what it's worth the majority of patients cannot tolerate phenelzine. It's a question of severity - how bad is your depression?
From a side-effect point of view you're (much) better off taking cymbalta. My brother had TR depression and he tried SSRIs/TCAs/Effexor/Moclobemide/Lamotrigine/Lithium before he started taking Nardil w. Lamotrigine and a thyroid hormone, thankfully he's much better. He struggles with staying awake in the day, has put on a lot of weight and doesn't have much energy though.
If you're issues are primarily associated with social phobia with secondary depression you might look into moclobemide (600mg + b.i.d), prozac + nortriptyline, paroxetine, even tianeptine, first- optionally augmenting with gabapentin/clonazepam. The tianeptine and moclobemide are statistically the least likely to cause burdensome side effects, something worth considering when choosing a drug you might potentially have to take for life, although I don't think the efficacy of Tianeptine in S.A is proven, CBT is obviously very useful in treating unhelpful thought patterns and unlearning bad learnt behaviours too so you might try that.
Improving self-image by exercising, getting to a place where you are happy and confident in your appearance, whether its your body or dress, sorting out acne, hair, whatever, eliminating any hang-ups you might have which are holding you back will be important in improving your self-esteem and progressing socially. Learn to know your mind and discriminate: what do you value? What sort of qualities do you think are important/attractive in a person and which of these would you wish to find in friends?
Remember you are not alone: that apprehension, nerves, are an intrinsic part of human conditioning and essential to our survival, however natural and gregarious some people's behaviour might seem- chances are they have just had more practice than you. Put cynically, by improving how you look on the outside you will in turn learn to improve how you feel on the inside. Outward health usually induces a positive response in others, a positivity which is quickly transferred to you, one which you begin to foster in yourself- the cycle perpetuates itself- and eventually you will have greater confidence and a more stable social group to show for it.
Sorry for the lecture. Most of it is really autobiographical. Get the anxiety fixed first, the rest should come.
B Wishes
West
Posted by mickapoo on August 3, 2008, at 11:16:53
In reply to Re: cymbalta or nardil?, posted by socialphobic on August 2, 2008, at 8:59:29
> Have you tried cymbalta? It is really the only other antidepressant I haven't tried. So at the moment its either cymbalta or nardil.
>
> I did a search on here and there seems to be mixed results on cymbalta when it comes to social anxiety. Some say it made their anxiety worse, some say no difference, others say it helped their anxiety. *shrug* not exactly as conclusive as nardil.
>
> Given that i'm very anxious about a hypertensive crisis, would you guys recommend I try cymbalta first, then move onto nardil if there is no benefit? However, I could be wasting a few months of no benefit on cymbalta when nardil could have been working in that time.
>
> So given my situation, should I try cymbalta first, or just go straight for nardil?
>
>I have not tried Cymbalta, but after researching it in the past, have not seen where it is very effective in treating SP. Someone earlier had mentioned Moclobemide, but when I did some research, I found that now they are finding that studies are showing it isn't as effective as once thought.
This is the end of the thread.
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