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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 Cseagraves on April 25, 2009, at 12:46:44
Hey to all!
First, for those taking or have taken Nardil, is the weight gain really that bad or can it be controlled. I eat very healthy (no sweets of any kind) and exercise. So will the weight gain really be that be an issue?
Secondly, can you take remeron with Nardil? Trying to think of different meds to help with insominia.Thanks,
Courtney
Posted by Phillipa on April 25, 2009, at 12:58:44
In reply to 2 questions about Nardil, posted by Cseagraves on April 25, 2009, at 12:46:44
Seems a lot take klonopin for sleep. Love Phillipa
Posted by Zana on April 25, 2009, at 16:15:36
In reply to Re: 2 questions about Nardil » Cseagraves, posted by Phillipa on April 25, 2009, at 12:58:44
You can't take remeron with an MAOI. Don't know why but I was told I'd have to do a 2 week wash out of the remeron if I wanted to try an MAOI. Too bad because it is great for sleep.
Zana
Posted by stargazer2 on April 25, 2009, at 17:30:46
In reply to 2 questions about Nardil, posted by Cseagraves on April 25, 2009, at 12:46:44
Weight gain from Nardil was not a major problem as long as I worked out, but as you know working out when depressed was not consistent or energetic enough to really control the weight effects, so yes I gained a few pounds. The worse effects I had were swollen ankles and major gas and constipation. Not exactly easy symptoms to overcome but I did push through them. They did get easier after a few months.
For insomnia, doxepin can be used with MAO's and also Trazedone. The article I have for reference is in "Current Psychiatry", June 2002. It says Mirtazapine (Remeron) can be safely used with MAOs and it also says the agent can be used to treat serotonin syndrome. There are two footnotes next to using Mirtazapine for insomnia and treating serotonin syndrome. (19,20) I do not have the list of reference articles upon which this statement was based. Perhaps you can try and google the article and read it for yourself.
I have taken that article to my pdoc and based on it, he is now prescibing (with my urging) Nardil and Buproprion, which is considered a no-no. Most pdocs will not deviate from the warnings in the drug guides, so don't expect your pdoc (unless very experienced) to prescribe many meds with MAO's, it's just too risky as they could cause someone's death.
Good luck, sounds like the safest would be to try Doxepin or trazedone first. That's what I would do. Benedryl can work well for insomnia too and is very safe.
SG2
Posted by Jedi on April 25, 2009, at 21:02:51
In reply to 2 questions about Nardil, posted by Cseagraves on April 25, 2009, at 12:46:44
> First, for those taking or have taken Nardil, is the weight gain really that bad or can it be controlled. I eat very healthy (no sweets of any kind) and exercise. So will the weight gain really be that be an issue?
Hi Courtney,
The weight gain was the biggest issue for me. People with atypical depression, for which Nardil is the gold standard, will tend to overeat anyway. Nardil somehow seems to make you bypass that part of the brain which tells when you are full. While on a large daily dosage, 90mg in my case, I could overeat and not even think about stopping. The cravings for sweet carbohydrates seems to be the worse.I have lost weight on Nardil, but it required about two hours of daily exercise and a low carb diet. If you can stick to your healthy eating habits, you should have no problem.
Good Luck,
Jedi
Posted by metric on April 30, 2009, at 16:28:53
In reply to 2 questions about Nardil, posted by Cseagraves on April 25, 2009, at 12:46:44
> Hey to all!
>
> First, for those taking or have taken Nardil, is the weight gain really that bad or can it be controlled. I eat very healthy (no sweets of any kind) and exercise. So will the weight gain really be that be an issue?
>Well, "weight gain" (I assume you're concerned about fat mass) can only occur in the presence of a dietary energy surplus. Exercise is never necessary to control weight. Just make sure your caloric intake does not exceed expenditure.
> Secondly, can you take remeron with Nardil? Trying to think of different meds to help with insominia.
Yes you can. Precipitation of 5-HT toxicity is not a concern, but I would be cautious given the adrenergic properties of mirtazapine. Start low and keep an eye on blood pressure. I'd be surprised if you had any problems even at higher doses (30-45 mg), but better safe than sorry.
Posted by metric on April 30, 2009, at 16:37:59
In reply to Re: 2 questions about Nardil, posted by Zana on April 25, 2009, at 16:15:36
> You can't take remeron with an MAOI. Don't know why but I was told I'd have to do a 2 week wash out of the remeron if I wanted to try an MAOI. Too bad because it is great for sleep.
It amazes me how ignore most shrinks are about the drugs they prescribe when that is, after all, the only thing they do. Official drug monographs are legal documents more than anything else.
Ask your doctor why he doesn't know anything about the drugs prescribes.
Posted by desolationrower on April 30, 2009, at 23:32:15
In reply to 2 questions about Nardil, posted by Cseagraves on April 25, 2009, at 12:46:44
> Hey to all!
>
> First, for those taking or have taken Nardil, is the weight gain really that bad or can it be controlled. I eat very healthy (no sweets of any kind) and exercise. So will the weight gain really be that be an issue?
>
> Secondly, can you take remeron with Nardil? Trying to think of different meds to help with insominia.
>
> Thanks,
>
> Courtneywell the insomnia probably has something to do with the increased monoamines, so the most parsimonious approach would be to block their effects, especially receptors like alpha1 or 5ht2 where they can interfere with sleep.
-d/r
Posted by jedi on May 1, 2009, at 0:57:42
In reply to Re: 2 questions about Nardil » Cseagraves, posted by metric on April 30, 2009, at 16:28:53
> Well, "weight gain" (I assume you're concerned about fat mass) can only occur in the presence of a dietary energy surplus. Exercise is never necessary to control weight. Just make sure your caloric intake does not exceed expenditure.
Hi Metric,
I've got to call you on this one. You are obviously very knowledgeable about psychotrophic medications. But it doesn't sound like that knowledge comes from personal experience with Nardil. Though your response is technically correct, there is something about many of these medications that will just cause a person to pack on the pounds.As a Nardil user for over a decade, I know that creating the situation where "caloric intake does not exceed expenditure" can be is very difficult on this medication.
Be Well,
Jedi
Posted by Vincent_QC on May 6, 2009, at 7:52:16
In reply to Re: 2 questions about Nardil, posted by desolationrower on April 30, 2009, at 23:32:15
> > Hey to all!
> >
> > First, for those taking or have taken Nardil, is the weight gain really that bad or can it be controlled. I eat very healthy (no sweets of any kind) and exercise. So will the weight gain really be that be an issue?
> >
> > Secondly, can you take remeron with Nardil? Trying to think of different meds to help with insominia.
> >
> > Thanks,
> >
> > Courtney
>Strange that peoples talk about weight gain on the Nardil. I had morbid obesity before, I had a gastric by-pass in 2001... I had a weight of 450 before my surgery and I always had a obesity problem, even as a child, it was easy for me to gain weight, even if I was eating the same food than the other childs... In my family, we never had "fast food" or things like chocolate or chips, my mom was severe on this... I think I never chew a gum before the age of 10!!! But I was a fat kid.... not linked to genetic cause I Was the only one "fat" person in my familly... Anyway...
I always had extreme gain weight on all the newer AD'S like the SSRI'S, Remeron or Desyrel...but I never gain a single pound on the Nardil... I was on the Nardil from January 2007 until may 2007, I was eating everything I wanted, even cheese or soup or proteine shakes, never had any problems, never gain a single pound... and it was at a period of time where I stop school and I had also stop walking or exercises... and no, I don't gain a single pound on it... Even with my gastric by-pass, I can gain weight easily...
With the Parnate it's the same...neutral for the weight gain...
Some peole will talk about the Gaba effect of the Nardil, who is aparently the cause of the weight gain but I don't see at all the link between the Gaba-ergic effect of the Nardil, who is weak by the way, and the weight gain...
I'm taking huge amount of Benzo meds each day, Valium and Rivotril, who are the most powerfull gaba-agonist drugs... and I never gain a single pound because of them...so why talking of weight gain cause by the Gaba effect? I don't know...
I agree, some AD's make you feel like you want to eat all day long... I understand also that some meds can block the signal in the brains, the signal who told your brain that you have eat enought... but I never experience that feeling on the Nardil or the Parnate. I think it's more another over-exaggerated side-effect example...
For the sleep problem... Seroquel is the first to try... but loose a lot his powerfull effect after one or two months... so mean dose increasement... Remeron can be also a good choice, but I think a possible "interraction" can occur with it, related to the 5HTP2... and the Desyrel (Trazodone) is also not recommended because of the "potential" interraction... but I think some PDoc or Doctor will let you have that one in RX, in a smaller dose just as a sleep aid... PErsonnaly, I found the Trazodone to be the worst for the "next day dizness effect"... The seroquel is ok... take maybe one week before getting used to the next day sedation or dizness effect but that don't last for a long time...
Naturals products are not very helpfull... or safe either... Sleep aid pills OTC don't worth the trail for me... and the Melatonin don't help either, in fact it's have a strange interraction (migraine) on me...
Posted by desolationrower on May 13, 2009, at 3:09:52
In reply to Re: 2 questions about Nardil, posted by Vincent_QC on May 6, 2009, at 7:52:16
just thinking - perhaps fatigue from MAOIs is from the increase in melatonin levels, messing with sleep cycle. too bad theres no melatonin antagonist
-d/r
Posted by Vincent_QC on May 14, 2009, at 12:15:37
In reply to MAOI fatigue, posted by desolationrower on May 13, 2009, at 3:09:52
> just thinking - perhaps fatigue from MAOIs is from the increase in melatonin levels, messing with sleep cycle. too bad theres no melatonin antagonist
>
> -d/rMaybe the fatigue is also caused by the effect of the MAOI on the heart...hypotension, sometimes hypertension and high blood pressure not related to food interraction...
One thing is sure, the Parnate was the one who caused the more fatigue. I write only on me because we are all different... maybe it can do the opposite effect on others peoples... but for what I read , it's seem to not be the case...no wonder why a lot of peoples ask to have something to augment it (Ritalin...remember Jadekelly...), that's one of the best example of the fatigue caused by the MAOI's...
It's certainly not a stimulant MAOI (Parnate), like a lot of peoples think... the fatigue I had while I try it was more a physical ones, muscles fatigue with weird effect on my heart... I notice the same effect(hypotension orthostatic) on the Nardil as well but only at 90mg...not at 75mg...at 75mg, I was able to eat what I wanted, never monitered my BP, I was taking my pills 3 times a day and forget it...and the diet...
On the Parnate it was another story... I had a GOOD reaction on it for the social phobia... in fact, that's the only one med who do something on my social phobia...but I had so many side-effects to deal with, that even if everyone told me to stick on it at the small 40mg dose that I taked for 3 weeks... it was impposible for me to continue it... It's the kind of experience I don't wish to my worst ennemy!!! I total nightmare... making all the newer AD's very innofensive for me...
For no reasons I had hypertensives crisis and I had also in the same day hypotension orthostatic...so I guess the Parnate hit a place in the brain who control the heart...but where? I don't know... I'm not a Pharmacist and a PDoc or a Doctor so I can't answer... even the GSK compagny don't seem to know what the Parnate do in the brains... so the heart effect is probably linked a lot to the fatigue... That's what I think...
For the Marplan, I will never know, because it was approved for me as an importation drug, approved by Health Canada, BUT, I had to pay for it...180 $ (Canadian) for a 56 pills bottle... In fact, the PDoc had to send the payment to health Canada, who will send the command to the compagny in the New-Jersey. BUT because it's not manifacturing in the States but in Finland, I will have to pay for the Marplan...Normally, Health Canada deal with the USA compagny and pay the bill...but not this time... So when HC receive the payment, they send the RX to the USA compagny and that compagny will send the product back to HC who will inspect it and send it to my PDoc. The PDoc have to produce a report after the trail of the Marplan...it's like I will became a study subject for the drug...like I will test it and make a report to Health Canada...but I have to pay it...mean 60mg/day (target dosage), mean 6 pills a day, mean 9 days for a bottle , mean a total of more than 540$ each month!!! I don't work and it's not cover by any inssurance plan...so forget it... The Emsam patch will be less expensive I think...and I Can't afford it...
So i'm on the Pristiq since 2 days... sample bootle of course... if it's work, I will be pushed by the compagny, so it will cost nothing for me... Since I start it, I don't have any side-effect. It's the first time I experience an AD without any side-effect...that's weird cause it's the active metabolite of the Effexor-XR, and the Effexor was very bad for me, increasing my anxiety level in general and make me totally not sociable...and craving for MORE benzo drugs... The Pristiq seem to be a clean med to me... I will see the result , I give it a try for 1 month...
If it's not doing anything for the SAD or the GAD, I will switch again on the Nardil...and ask to use off-label meds to help me more...Sabril or valporic acid will be my next move I think... I will see... for now I take my small pill of 50mg of Pristiq and forget it... sometimes, when I feel my BP is high, I take a clonidine pill (0,1mg)...and my BP return to the normal 120/70...
Life cant be worst for me...I continue to hit the gym 4 evening a week, even if I have panic attack sometimes and that I have a big difficulty to stay in my own bubble... I tend to look around me and at all the peoples and I can't concentrate, so I begin to be shy, my heart beat increase and BANG it's the panic attack... I have to learn how to control myself and forget the others peoples around me...
At daytime I feel a lot tired and return in my bed often...I just smooke, eat and answer to my emails, sometimes visit facebook site...but not for a long period of time....
Ho and I forget... I use 30mg of Valium (10 morning, 10 afternoon and 10 evening) + 2 mg of Rivotril on purpose... I don't use the Rivotril each day...just in extreme emergency case and in special exposure social events, like at the gym or if I go out in a bar or something like this... I found out that the use of this 2 benzo drugs together have a more strong effect for the social phobia and general anxiety than just use the Valium or the Rivotril alone...and in that way , I keep the control over my high tendancy to developp an addiction on the Rivotril, like I had before... I feel in control over my benzos intake, that's a major step in the good way for me...
Thanks!
VIncent ;-)
Posted by garnet71 on May 14, 2009, at 12:55:55
In reply to MAOI fatigue + Pristiq + others » desolationrower, posted by Vincent_QC on May 14, 2009, at 12:15:37
That's great you are keeping up with the gym!!!! It's difficult enough w/o having the social anxiety problems-that's a huge accomplishment :)
Sorry if I said this before/being repetitive..but i think you should try the D-Ribose. It might just help.
http://www.anti-aging-guide.org/d-ribose.html
"D-ribose. Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism some kind of disorder in the way your cells do their work may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms of chronic fatigue syndrome, with particular benefit in study participants' energy level and overall well-being."
http://www.mayoclinic.com/health/chronic-fatigue-syndrome/DS00395/DSECTION=treatments-and-drugs
http://dietarysupplements.nlm.nih.gov/dietary/ingredDetail.jsp?contain=D-Ribose&id=1376
Posted by Vincent_QC on May 14, 2009, at 14:48:34
In reply to Re: MAOI fatigue + Pristiq + others, posted by garnet71 on May 14, 2009, at 12:55:55
> That's great you are keeping up with the gym!!!! It's difficult enough w/o having the social anxiety problems-that's a huge accomplishment :)
>
> Sorry if I said this before/being repetitive..but i think you should try the D-Ribose. It might just help.
>
> http://www.anti-aging-guide.org/d-ribose.html
>
> "D-ribose. Also called ribose, this form of sugar is an essential energy source for your cells. Scientists believe that impaired cellular metabolism some kind of disorder in the way your cells do their work may play a role in chronic fatigue syndrome. Some research has found that natural D-ribose supplements may significantly improve the symptoms of chronic fatigue syndrome, with particular benefit in study participants' energy level and overall well-being."
>
> http://www.mayoclinic.com/health/chronic-fatigue-syndrome/DS00395/DSECTION=treatments-and-drugs
>
> http://dietarysupplements.nlm.nih.gov/dietary/ingredDetail.jsp?contain=D-Ribose&id=1376Hi !
Thanks for your answer... did you know if it's avaible in the Canada? Natural products here are well controled and not always avaible...YEs, I continue with the gym, even if it's hard and sometimes I don't want to go ... that's hard but it will pay one of these days...
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