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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by jpiper on August 9, 2009, at 11:14:03
My doc gave me a prescription for Nardil for depression, GAD, and SAD. I have some trepidation about taking this medication because of bad experiences with Prozac. I was off and on Prozac for years and in the end the emotional bluntness and inability to concentrate was too much too bear so I got off it, but the withdrawal from Prozac was really quite bad. It included strange bouts of anger and erratic behavior. I do feel like I've had some lasting bad effects from Prozac and I would be worried that the same thing will happen with Nardil.
I'm worried that if I ever want to get off of Nardil, that the withdrawal process would be so bad as to keep me on it. This sort of happened with Prozac - which is really why I was off and on it for so long. Any experiences with withdrawal from Nardil?
Also, I've been reading about the "euphoria" episodes that some people have on Nardil. I really don't want that. I just want to be calm and get a grip on my racing thoughts so I can start thinking in a more logical fashion again. Is there a way to avoid the euphoria? Perhaps some folks never experience this? What if I take a low dose, like 15 mg per day?
Other side effects that troubled me with Prozac (I know they are very different drugs, but Prozac is the only other AD I've ever taken so it's my only point of reference) was slurred speech and difficulty with word recall (that has remained to some degree even after being off Prozac for 2 years). Has anyone had effects like this on Nardil?
Any feedback that you could give for a first time Nardil user would be great.
jpiper
Posted by Phillipa on August 9, 2009, at 12:08:36
In reply to Nardil: first time user, posted by jpiper on August 9, 2009, at 11:14:03
Well first welcome to babble. If I read your thread correctly you've only been on one ad? Why did you chose to switch to an MAOI before trying another SSRI or SNRI? Thanks Phillipa
Posted by jpiper on August 9, 2009, at 12:37:55
In reply to Re: Nardil: first time user » jpiper, posted by Phillipa on August 9, 2009, at 12:08:36
> Well first welcome to babble. If I read your thread correctly you've only been on one ad? Why did you chose to switch to an MAOI before trying another SSRI or SNRI? Thanks Phillipa
Thanks! Yes, that's correct, I've only been on Prozac. I told my doc I didn't want to try any more SSRI's because of the side effects. I did suggest Wellbutrin but my doc wasn't very enthused about it. Also, I have bad headaches and my doc thought Nardil might help.
Posted by floatingbridge on August 9, 2009, at 13:05:48
In reply to Nardil: first time user, posted by jpiper on August 9, 2009, at 11:14:03
Jpiper,
welcome! You've asked some great questions--I'll be following this thread and looking for your posts. (haven't tried MAO yet). Hope you get the answers asap.
fb
Posted by girlnterrupted78 on August 9, 2009, at 14:43:40
In reply to Nardil: first time user, posted by jpiper on August 9, 2009, at 11:14:03
What is your diagnosis, if you don't mind me asking? I'd give some other meds a try before going on Nardil. Celexa is a very clean med, can be very effective, with hardly any side-effects and very mild withdrawal symptoms. I've been on and off it for ~7 years now, and my initial response to it was amazing. It sort of stopped working after 1 year, although it still takes the edge off me and helps me half-way function.
I was on Nardil for a year and I don't recall any withdrawal symptoms. As for side-effects, I had a lot of hypotension, but thankfully that only lasted for the first 2 months on the med. After that, it was gone. The worst side-effect on Nardil was weight gain and feeling a bit dumbed-down. I guess I felt that difficulty with word-recall you mention. On the whole, it did nothing for my depression, though. I'd still try it. You never know. But beware of the diet restrictions.
Posted by bulldog2 on August 9, 2009, at 15:21:02
In reply to Re: Nardil: first time user » jpiper, posted by girlnterrupted78 on August 9, 2009, at 14:43:40
> What is your diagnosis, if you don't mind me asking? I'd give some other meds a try before going on Nardil. Celexa is a very clean med, can be very effective, with hardly any side-effects and very mild withdrawal symptoms. I've been on and off it for ~7 years now, and my initial response to it was amazing. It sort of stopped working after 1 year, although it still takes the edge off me and helps me half-way function.
>
> I was on Nardil for a year and I don't recall any withdrawal symptoms. As for side-effects, I had a lot of hypotension, but thankfully that only lasted for the first 2 months on the med. After that, it was gone. The worst side-effect on Nardil was weight gain and feeling a bit dumbed-down. I guess I felt that difficulty with word-recall you mention. On the whole, it did nothing for my depression, though. I'd still try it. You never know. But beware of the diet restrictions.
>
>If you liked celexa than you may even have more success on Lexapro which is derived from celexa and is supposed to not have the sedative effect.
Posted by girlnterrupted78 on August 9, 2009, at 15:26:31
In reply to Re: Nardil: first time user, posted by bulldog2 on August 9, 2009, at 15:21:02
Thanks, but I actually tried Lexapro and it was a nightmare. During the year Celexa was working great, my doc decided that Lexapro might be even better, so he switched me. Worst mistake ever.
Lexapro didn't work, and when I went back on Celexa, it wouldn't work anymore either. Pretty unfortunate, as Celexa had been the single only AD to ever work for me, and Lexapro just about killed it.
> If you liked celexa than you may even have more success on Lexapro which is derived from celexa and is supposed to not have the sedative effect.
Posted by jpiper on August 9, 2009, at 15:41:00
In reply to Re: Nardil: first time user » jpiper, posted by girlnterrupted78 on August 9, 2009, at 14:43:40
> What is your diagnosis, if you don't mind me asking? I'd give some other meds a try before going on Nardil. Celexa is a very clean med, can be very effective, with hardly any side-effects and very mild withdrawal symptoms. I've been on and off it for ~7 years now, and my initial response to it was amazing. It sort of stopped working after 1 year, although it still takes the edge off me and helps me half-way function.
>
> I was on Nardil for a year and I don't recall any withdrawal symptoms. As for side-effects, I had a lot of hypotension, but thankfully that only lasted for the first 2 months on the med. After that, it was gone. The worst side-effect on Nardil was weight gain and feeling a bit dumbed-down. I guess I felt that difficulty with word-recall you mention. On the whole, it did nothing for my depression, though. I'd still try it. You never know. But beware of the diet restrictions.
>
>Sure. My diagnosis is depression, general anxiety, and social anxiety. Thanks for the info on Celexa.
Posted by Ron Hill on August 13, 2009, at 0:57:02
In reply to Nardil: first time user, posted by jpiper on August 9, 2009, at 11:14:03
> My doc gave me a prescription for Nardil for depression, GAD, and SAD.
Are you working with a family doc or a p-doc?
> I have some trepidation about taking this medication because of bad experiences with Prozac.
Nardil has completely different effects than Prozac.
> I was off and on Prozac for years and in the end the emotional bluntness
This is known as SSRI Apathy.
> and inability to concentrate was too much too bear so I got off it, but the withdrawal from Prozac was really quite bad. It included strange bouts of anger and erratic behavior. I do feel like I've had some lasting bad effects from Prozac and I would be worried that the same thing will happen with Nardil. I'm worried that if I ever want to get off of Nardil, that the withdrawal process would be so bad as to keep me on it. This sort of happened with Prozac - which is really why I was off and on it for so long. Any experiences with withdrawal from Nardil?
Withdrawal symptoms vary from one person to another. For me, withdrawal from Nardil was difficult. However, I dropped my dosage way too quickly because I wanted to wash out Nardil as fast as possible so I could begin a trial of Parnate. As an aside, Parnate did not work for me and I am back on Nardil. The key to withdrawal is to SLOWLY ramp down.
> Also, I've been reading about the "euphoria" episodes that some people have on Nardil. I really don't want that. I just want to be calm and get a grip on my racing thoughts
You have racing thoughts? Does your doc know this? Nardil will not help your racing thoughts. In fact, it could make them worse. Has anyone tested you for bipolar disorder? Please take the survey tests below. For me, a very good med to control racing thoughts is Trileptal (oxcarbazapine). Racing thoughts can be a symptom of hypomania or mania. Any bipolar patient MUST be on a full dose of moodstabilizer(s) PRIOR to the addition of an antidepressant!!
> so I can start thinking in a more logical fashion again. Is there a way to avoid the euphoria? Perhaps some folks never experience this? What if I take a low dose, like 15 mg per day?
Most people need 1 mg of Nardil for every kg of body weight.
> Other side effects that troubled me with Prozac (I know they are very different drugs, but Prozac is the only other AD I've ever taken so it's my only point of reference) was slurred speech and difficulty with word recall (that has remained to some degree even after being off Prozac for 2 years). Has anyone had effects like this on Nardil?
No, but Nardil does have side effects. Weight gain. I have gained 50 pounds. For me, at 90 mg/day, Nardil causes erectile dysfunction and delayed orgasm.
> Any feedback that you could give for a first time Nardil user would be great.If you take Nardil, follow the MAOI diet.
Please print and complete the screening test provided immediately below BEFORE looking at the grading criteria:
http://i.cmpnet.com/CME/pt/PDF/MDQ_Quest.pdfGrading criteria:
http://i.cmpnet.com/CME/pt/PDF/MDQ_Instructs.pdfHere is the published paper discussing the above test:
http://ajp.psychiatryonline.org/cgi/content/full/157/11/1873?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=157&firstpage=1873&resourcetype=HWCIT#A1Here is another screening test. Please print and complete this screening test BEFORE looking at the scoring instructions below:
http://imaging.cmpmedica.com/CME/pt/PDF/BSDSScale.pdfScoring instructions:
http://imaging.cmpmedica.com/CME/pt/PDF/BSDSScoring.pdf-- Ron
dx: Bipolar II with ultra rapid cycling and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by jpiper on August 13, 2009, at 16:26:27
In reply to Re: Nardil: first time user » jpiper, posted by Ron Hill on August 13, 2009, at 0:57:02
>
> Are you working with a family doc or a p-doc?A family doc.
> This is known as SSRI Apathy.Good to know. It was really uncomfortable and strange for me because I'm an emotional person and I like myself that way. I guess every drug has its side effects, and I have to evaluate how much and what kind of side effects I can take vs. living with the depression I have now. The one effect I won't tolerate is losing my emotions. Then I'm just not me anymore.
>
> Withdrawal symptoms vary from one person to another. For me, withdrawal from Nardil was difficult. However, I dropped my dosage way too quickly because I wanted to wash out Nardil as fast as possible so I could begin a trial of Parnate. As an aside, Parnate did not work for me and I am back on Nardil. The key to withdrawal is to SLOWLY ramp down.I'll remember to taper when and if I go off of Nardil. I've decided to give the Nardil a go and try it for 2 months.
>
> You have racing thoughts? Does your doc know this? Nardil will not help your racing thoughts. In fact, it could make them worse. Has anyone tested you for bipolar disorder? Please take the survey tests below. For me, a very good med to control racing thoughts is Trileptal (oxcarbazapine). Racing thoughts can be a symptom of hypomania or mania. Any bipolar patient MUST be on a full dose of moodstabilizer(s) PRIOR to the addition of an antidepressant!!
>I'm not bipolar. I have no ups at all. I'm usually pretty low and then at times deeply low. I guess my thoughts are more repetitive than racing.
>
> If you take Nardil, follow the MAOI diet.The diet is pretty easy for me as I try not to eat those foods normally since I also have bad headaches and those foods sometimes make the headache worse.
I've started Nardil 15 mg per day and maybe next week depending on how I feel I will go up to 30 mg. I'm going to go slow. Right now, of course I don't have any effects, except I smell like Nardil - which is strange. And I have a sinking feeling in my body.
Thanks for listening.
Posted by ColoradoSnowflake on August 13, 2009, at 21:25:42
In reply to Re: Nardil: first time user, posted by jpiper on August 13, 2009, at 16:26:27
Hi jpiper:It took over three months for Parnate to kick in for me, in a good way! Now its excellent!!
Good luck on Nardil!!!
Please keep us posted!gayle
Posted by Ron Hill on August 14, 2009, at 21:48:06
In reply to Re: Nardil: first time user, posted by jpiper on August 13, 2009, at 16:26:27
jpiper,
Best wishes on your Nardil trial and in life. Keep us informed regarding your Nardil trial.
-- Ron
Posted by jpiper on September 1, 2009, at 19:15:04
In reply to Re: Nardil: first time user » jpiper, posted by Ron Hill on August 14, 2009, at 21:48:06
Just an update...
I've now been on Nardil for over three weeks. 15 mg per day for 2 weeks, and 30 mg for the past week. Really bad initial side effects caused me to up my dosage slowly, and i do continue to have some of the initial bad side effects.
But I'm starting to feel some benefits of the medication. nothing yet for SA or depression, but a lessening of GAD. For example, I was able to throw out old love letters from my ex without anxiety. :) Well, it's something.
Also, my senses have become somewhat heightened. Food tastes better, music especially sounds more intense, and my sense of smell has altered as well. My muscles are a bit more relaxed.
So I'll continue my Nardil trial...
Posted by Ron Hill on September 1, 2009, at 19:41:40
In reply to Re: Nardil: first time user, posted by jpiper on September 1, 2009, at 19:15:04
> Just an update...
>
> I've now been on Nardil for over three weeks. 15 mg per day for 2 weeks, and 30 mg for the past week. Really bad initial side effects caused me to up my dosage slowly, and i do continue to have some of the initial bad side effects.
>
> But I'm starting to feel some benefits of the medication. nothing yet for SA or depression, but a lessening of GAD. For example, I was able to throw out old love letters from my ex without anxiety. :) Well, it's something.
>
> Also, my senses have become somewhat heightened. Food tastes better, music especially sounds more intense, and my sense of smell has altered as well. My muscles are a bit more relaxed.
>
> So I'll continue my Nardil trial...
JPiper,The effective dosage is 1 mg/kg of body weight (i.e.; 1 mg of Nardil for every 2.2 pounds of body weight).
Once at the effective dosage, Nardil should kick-in within the sixth week. However, some people take longer and some less.
Hang in there. The benefits might be very good.
Refresh my memory:
1) Are you bipolar?;
2) Bipolar I or Bipolar II?
3) Do you have atypical depression?
4) What is your full dx?
5) What other meds are you currently taking?-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by jpiper on September 1, 2009, at 20:16:27
In reply to Re: Nardil: first time user » jpiper, posted by Ron Hill on September 1, 2009, at 19:41:40
The effective dosage for me then would be 45 mg based on my weight. I'm wondering when I get to that dosage if I can take one in morning and two at night - or, is there any benefit to splitting up the dosage equally through out the day?
I have depression, GAD, and SAD. Im not bipolar and not taking any other meds.
Posted by Ron Hill on September 1, 2009, at 20:22:14
In reply to Re: Nardil: first time user » jpiper, posted by Ron Hill on September 1, 2009, at 19:41:40
> > Just an update...
> >
> > I've now been on Nardil for over three weeks. 15 mg per day for 2 weeks, and 30 mg for the past week. Really bad initial side effects caused me to up my dosage slowly, and i do continue to have some of the initial bad side effects.
> >
> > But I'm starting to feel some benefits of the medication. nothing yet for SA or depression, but a lessening of GAD. For example, I was able to throw out old love letters from my ex without anxiety. :) Well, it's something.
> >
> > Also, my senses have become somewhat heightened. Food tastes better, music especially sounds more intense, and my sense of smell has altered as well. My muscles are a bit more relaxed.
> >
> > So I'll continue my Nardil trial...
>
>
> JPiper,
>
> The effective dosage is 1 mg/kg of body weight (i.e.; 1 mg of Nardil for every 2.2 pounds of body weight).
>
> Once at the effective dosage, Nardil should kick-in within the sixth week. However, some people take longer and some less.
>
> Hang in there. The benefits might be very good.
>
> Refresh my memory:
>
> 1) Are you bipolar?;
> 2) Bipolar I or Bipolar II?
> 3) Do you have atypical depression?
> 4) What is your full dx?
> 5) What other meds are you currently taking?
>
> -- Ron
>
> dx: Bipolar II and mild OCPD
>
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 90 mg/day Nardil
Jpiper,I'm sorry; I should have re-read this entire thread before I wrote my most recent post because you already answered most of my questions. Therefore, forget about my five previous questions.
Instead:
1) Please describe the symptoms of your depression.
2) Please take the screening tests that I provided in my original post and tell me the scores. Please??? I want to help you and the screening tests will only take a few minutes.
Please print and complete the screening test provided immediately below before looking at the grading criteria:
http://i.cmpnet.com/CME/pt/PDF/MDQ_Quest.pdf
Grading criteria:
http://i.cmpnet.com/CME/pt/PDF/MDQ_Instructs.pdf
Here is another screening test. Please print and complete this screening test before looking at the scoring instructions below:
http://imaging.cmpmedica.com/CME/pt/PDF/BSDSScale.pdf
Scoring instructions:
http://imaging.cmpmedica.com/CME/pt/PDF/BSDSScoring.pdf
Thanks you.
I have your best interest in mind. I would not be taking the time if I didn't.
-- Ron
Posted by Ron Hill on September 2, 2009, at 5:15:21
In reply to Re: Nardil: first time user, posted by jpiper on September 1, 2009, at 20:16:27
> The effective dosage for me then would be 45 mg based on my weight. I'm wondering when I get to that dosage if I can take one in morning and two at night - or, is there any benefit to splitting up the dosage equally through out the day?
>
> I have depression, GAD, and SAD. Im not bipolar and not taking any other meds.jpiper,
So, you weight about 99 pounds. Please correct me if I am wrong.
Nardil is good for GAD, SAD, and atypical depression.
I take 45 mg at noon and 45 at bedtime. For me, if I take Nardil (phenelzine) first thing in the morning, I can get sleepy-tired during the day. But, that is just me.
As for you, spreading out the daily dosage into three equal doses might be the best approach for two reasons.
First, the mean elimination half-life for a single 30 mg dose is 11.6 hours. Therefore, if you take 15 mg when you get up each morning and wait until bedtime to take the rest, your brain may be eager for more Nardil in the late afternoon and evening. But, it really is just trial-and-error to see what works best for you.
Second, some of the Nardil side effects can be minimized by spreading out the daily dosage. For example, most patients experience postural hypotension (an abnormal decrease in blood pressure when the patient stands up which may lead to fainting) at least for a while as a start-up side effect. The severity of this side effect might be minimized by spreading out the dosage.
But, having said that, postural hypotension while you are sleeping should not be a problem unless you get up in the middle of the night.
Like I said above, I take 45 mg of Nardil at bedtime. Many times I have gotten up to use the restroom in the middle of the night, and have almost lost my balance and fell down.
Ms. J. Piper, Nardil has a lot of side effects: weight gain (belly fat), carb craving, sexual dysfunction, sleepiness during the day, and etc. Some go away with time, but some do not.
I wish you were working with a p-doc instead of a family doc.
I know I keep going back to the bipolar thing, and I sense that you would prefer that I get off that topic. I just want you to make double sure.
Bipolar disorder is not an on-or-off kind of thing. Instead, it is a spectrum from very mild to very severe. My concern is that if a bipolar patient is given an antidepressant without moodstablizers fully on-board beforehand, the antidepressant can induce mania or hypomania (either euphoric or dysphoric).
Two things you have said in this thread make me think it is worth a double check for bipolar:
> Also, I've been reading about the "euphoria" episodes that some people have on Nardil. I really don't want that. I just want to be calm and get a grip on my racing thoughts so I can start thinking in a more logical fashion again.
> I'm not bipolar. I have no ups at all. I'm usually pretty low and then at times deeply low. I guess my thoughts are more repetitive than racing.
Your repetitive thoughts could be a marker, and your mood fluctuations from a usually pretty low and then at times deeply low could also be a marker. As a bipolar, I have had times when I have cycled from bad depression to worse depression with no hypomanic ups for long periods of time.
Id like to send you links to a couple of documents that I think you will find of interest. However, I do not want to overwhelm you with a bunch of reading all at once. So, Ill start by sending you the Nardil Prescribing Information document:
http://www.pfizer.com/files/products/uspi_nardil.pdf
Please note that the dosing information provided on page 11 in the Nardil Prescribing Information document (above) is wrong in most doctors opinion. It should be 1 mg/kg (1 mg Nardil/ 2.2 pounds of body weight) and maintained at that level.I could provide you with a ton of references to support the 1mg/kg dosage, but Ill just send one unless you want more. In the following document, on page three, in the center column, read the short section on Nardil (phenelzine):
http://www.thecarlatreport.com/documents/general/TCR.pdf
We crossed over each other on our last post exchange. Apparently, I was writing my post while you already posted yours.At any rate, if you are willing, Id still like to see the results of the screening tests, and a list of your symptoms of depression. But, if you dont want to, I will understand. Side note: Id also like to see your husband/significant-other take the screening test while pretending to be you. But, you know whats best.
Lastly (for this time), please remember that when you say I just want to be calm and get a grip on my racing thoughts so I can start thinking in a more logical fashion again that kind of feeling is what I use Trileptal to treat. It mellows my thoughts, eases my pressured speech, and allows me to focus on one thing at a time.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
90 mg/day Nardil
Posted by Ron Hill on September 2, 2009, at 5:48:42
In reply to Re: Nardil: first time user » jpiper, posted by Ron Hill on September 2, 2009, at 5:15:21
jpiper,
For some reason, when I compose a post in Word, and then block, copy, and paste it into the PB message box, I lose parenthesis and apostrophes.
In the case of my prior post to you, this problem made my last paragraph very difficult to read. Therefore, let me rephrase it:
Lastly (for this time), please remember that when you say: I just want to be calm and get a grip on my racing thoughts so I can start thinking in a more logical fashion again; that kind of feeling is what I use Trileptal to treat. It mellows my thoughts, eases my pressured speech, and allows me to focus on one thing at a time.
-- Ron
This is the end of the thread.
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