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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by jms600 on September 24, 2009, at 10:11:33
Everyone seems to say how great Nardil is. Is it really that effective for severe panic disorder and GAD??
Posted by Phillipa on September 24, 2009, at 10:57:34
In reply to Is Nardil REALLY that effective for panic attacks?, posted by jms600 on September 24, 2009, at 10:11:33
I thought it was atypical depression? Does the panic fit in that category? Phillipa
Posted by doxogenic boy on September 24, 2009, at 11:55:32
In reply to Is Nardil REALLY that effective for panic attacks?, posted by jms600 on September 24, 2009, at 10:11:33
> Everyone seems to say how great Nardil is. Is it really that effective for severe panic disorder and GAD??
If you have access to The Journal of Clinical Psychiatry, you may read this:
http://www.ncbi.nlm.nih.gov/pubmed/17335337Nardil is described as a antipanic drug:
http://www.ncbi.nlm.nih.gov/pubmed/10208320: Psychopharmacology (Berl). 1999 Mar;142(3):280-8.Click here to read Links
Task-dependent effects of the antidepressant/antipanic drug phenelzine on memory.
Parent MB, Habib MK, Baker GB.University of Alberta, Department of Psychology, Edmonton, Canada.
Phenelzine (PLZ) is a non-selective monoamine oxidase (MAO) inhibitor commonly used to treat depression and panic disorder. In addition to increasing levels of biogenic amines in the brain, PLZ elevates brain levels of the amino acid gamma-aminobutyric acid (GABA; Baker et al. 1991; present study). Given the extensive evidence implicating biogenic amines and GABA in mnemonic processes, PLZ may affect learning and memory. To investigate this possibility, male Sprague-Dawley rats were given PLZ sulfate (15 or 30 mg/kg, based on free base weight) 2 h prior to training in a continuous multiple trial inhibitory avoidance (CMIA) and spatial water maze task. Retention was assessed 48 h later. The results indicated that PLZ enhanced CMIA and impaired water maze retention performance. Compared to control rats, rats given PLZ took significantly longer to re-enter the shock compartment and swam longer distances before reaching the escape platform on the retention tests. These effects of PLZ did not appear to be the result of PLZ-induced changes in acquisition or retrieval processes, activity levels, or footshock sensitivity. Combined, these findings indicate that PLZ influences memory in a task-dependent manner. These differential effects of PLZ may be the result of contrasting influences of GABA and biogenic amines on memory.
--------------doxogenic
Posted by SLS on September 24, 2009, at 12:42:46
In reply to Re: Is Nardil REALLY that effective for panic attacks? » jms600, posted by doxogenic boy on September 24, 2009, at 11:55:32
I have personally seen Nardil completely wipe out panic attacks in someone.
If you have reached an impass with your doctor regarding the prescribing of Nardil, you can perhaps try combining Neurontin with Klonopin while you search for another doctor.
- Scott
Posted by doxogenic boy on September 24, 2009, at 13:06:25
In reply to Re: Is Nardil REALLY that effective for panic attacks? » doxogenic boy, posted by SLS on September 24, 2009, at 12:42:46
> I have personally seen Nardil completely wipe out panic attacks in someone.
>
> If you have reached an impass with your doctor regarding the prescribing of Nardil, you can perhaps try combining Neurontin with Klonopin while you search for another doctor.
-----Maybe this is a misunderstanding, wasn't it jms600 you meant your answer for? I have had panic attacks in the past, but not for the time being.
Concerning my lithium treatment:
This is my 18th day with 330 mg lithium sulphate. Blood level was measured today.I haven't seen an improvement yet. How long do I need to take lithium before I can say for sure it won't work?
I don't tolerate high doses of lithium, in the past that made me apathetic and indifferent.
doxogenic
Posted by SLS on September 24, 2009, at 15:21:35
In reply to Re: Is Nardil REALLY that effective for panic attacks? » SLS, posted by doxogenic boy on September 24, 2009, at 13:06:25
> > I have personally seen Nardil completely wipe out panic attacks in someone.
> >
> > If you have reached an impass with your doctor regarding the prescribing of Nardil, you can perhaps try combining Neurontin with Klonopin while you search for another doctor.
> -----> Maybe this is a misunderstanding, wasn't it jms600 you meant your answer for?
Oops. Yes.
> I have had panic attacks in the past, but not for the time being.
>
> Concerning my lithium treatment:
> This is my 18th day with 330 mg lithium sulphate. Blood level was measured today.For me, the ideal lithium blood level seems to be 0.3 mmol/L to treat depression. This is also the minimum level that investigators speculate neurotrophic and neuroprotective effects appear. At dosages used as a mood stabilizer (900-1500mg) in bipolar disorder, one looks for blood levels of 0.8 - 1.2 mmol/L.
> I haven't seen an improvement yet. How long do I need to take lithium before I can say for sure it won't work?
From what I have read and in my personal experience, one can expect results within two weeks provided the dosage is high enough. For depression, I don't think you can rule out lithium until you have tried 600mg. The Harvard study used a range of 300-600mg to augment Prozac.
> I don't tolerate high doses of lithium, in the past that made me apathetic and indifferent.My experience mirrors yours. I start feeling crappy at blood levels as low as 0.45 mmol/L. At 600mg, my level is currently 0.3 mmol/L. I feel that it is important for me to remark that I experienced some of these effects at 300-600mg for a few weeks before they disappeared completely.
- Scott
Posted by ace on September 24, 2009, at 22:46:30
In reply to Is Nardil REALLY that effective for panic attacks?, posted by jms600 on September 24, 2009, at 10:11:33
> Everyone seems to say how great Nardil is. Is it really that effective for severe panic disorder and GAD??
In my experience, and from what I have read, both from clinical trials and LOTS of anecdotes- yes!
Specifically for panic disorder it seems very robust.
However, one must be very persistent with this drug and very patient...it almost always takes longer than the others to kick in, and their is generally quite a few side-effects....one must achieve the correct MAO inhibition- this is DOSE and DURATION dependent!!!!
However, when it kicks it...boy is all that worth it!!
Posted by ace on September 24, 2009, at 22:48:04
In reply to Re: Is Nardil REALLY that effective for panic attacks? » jms600, posted by Phillipa on September 24, 2009, at 10:57:34
> I thought it was atypical depression? Does the panic fit in that category? Phillipa
often concurrent- however, usually distict disorders
Posted by ace on September 24, 2009, at 22:50:53
In reply to Re: Is Nardil REALLY that effective for panic attacks? » doxogenic boy, posted by SLS on September 24, 2009, at 15:21:35
A recent post I saw...someone using Nardil for Panic D/O...
"NARDIL (MAO-I) IS THE ONLY MED THAT WORKS ON ME~ I'VE TRIED TRICYCLICS, SSRI'S, BETA BLOCKERS, PROZAC AND NARDIL IS THE ONLY MED THAT WORKS COMPLETELY~I'M STILL TAKING IT, AND AFTER 24 YEARS, IT'S STILL WORKING!!!!! YAY!!
GETTING ON IT IS TRICKY~IT HAS A HYPNOTIC EFFECT, AND IT TAKES GETTING USED TO~BUT A GREAT SIDE BENEFIT IS IF YOU HAVE MIGRANE HEADACHES, THEY GO AWAY, ENTIRELY!!!!! NARDIL TENDS TO GIVE YOU A SWEET TOOTH, AND SOME WEIGHT GAIN, BUT I WOULDNT GIVE IT UP FOR ANYTHING!!!!! IT'S STILL THE BEST~THERE ARE MEDICATIONS AND FOODS & DRINKS YOU MUST AVOID, BUT BY AND LARGE, THEIR THINGS ANYONE COULD DO WITHOUT. IT'S ALSO GOOD FOR LOWERING BLOOD PRESSURE!!! "
http://www.revolutionhealth.com/drugs-treatments/rating/nardil-for-panic-disorder-agoraphobia
Posted by Phillipa on September 24, 2009, at 23:54:32
In reply to Re: Is Nardil REALLY that effective for panic attacks? » Phillipa, posted by ace on September 24, 2009, at 22:48:04
Ace hi hope school is going well for you. Will you be my pdoc one day? Love Phillipa
Posted by doxogenic boy on September 25, 2009, at 9:52:27
In reply to Re: Is Nardil REALLY that effective for panic attacks? » doxogenic boy, posted by SLS on September 24, 2009, at 15:21:35
> From what I have read and in my personal experience, one can expect results within two weeks provided the dosage is high enough. For depression, I don't think you can rule out lithium until you have tried 600mg. The Harvard study used a range of 300-600mg to augment Prozac.
-------Thanks for your advice.
I have some lithium side effects (tremor, somewhat lax bowels, polyuria and frequent urinating) at the current dose, so I think it can be hard to go through a dose twice as high. It seemed like I got more anxiety the first two weeks.> > I don't tolerate high doses of lithium, in the past that made me apathetic and indifferent.
>
> My experience mirrors yours. I start feeling crappy at blood levels as low as 0.45 mmol/L. At 600mg, my level is currently 0.3 mmol/L. I feel that it is important for me to remark that I experienced some of these effects at 300-600mg for a few weeks before they disappeared completely.
-------The side effects disappeared, or the pharmacologic effect disappeared?
From my knowlegde, augmentation for treatment resistant depression, lithium hasn't a very impressing response rate. (When it is about treatment resistant depression, there are few (if any) options with a favourable outcome for most of the patients). In one study, T3 had just as good or better outcome than lithium; fewer discontinued T3.
http://www.ncbi.nlm.nih.gov/pubmed/19594193
CNS Drugs. 2009;23(8):627-47. doi: 10.2165/00023210-200923080-00001.Links
STAR*D: revising conventional wisdom.
Rush AJ, Warden D, Wisniewski SR, Fava M, Trivedi MH, Gaynes BN, Nierenberg AA.Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA. john.rush@duke-nus.sg
The STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study used a series of sequenced, randomized treatment trials following a first and, if needed, subsequent treatment steps to define the tolerability and effectiveness of various options in both acute and longer term treatment. Adult outpatients (n=4041) with nonpsychotic major depressive disorder, substantial chronic and recurrent depression, and co-morbid psychiatric and general medical conditions were enrolled in 41 representative primary and specialty care settings. About one-third of participants remitted in first step treatment with citalopram, 50% of these within 6 weeks.
Poorer outcomes were associated with minority status, socioeconomic disadvantage, more axis I and III co-morbid disorders, lower function and quality of life, and anxious and melancholic features.In step 2 medication switch, there were no significant differences in remission among within-class, out-of-class or dual-action agents: sertraline (27%), bupropion-sustained release (26%) and venlafaxine-extended release (25%). In step 2 medication augmentation of citalopram, there was no significant difference in remission between bupropion-sustained release (39%) and buspirone (33%), although participants using bupropion-sustained release had greater symptom reduction and better tolerability. There were no significant differences in remission in step 2 between cognitive therapy and medication treatment in either the switch (31% vs 27%) or augmentation (31% vs 33%) strategies, although participants in cognitive therapy augmentation had a longer time to remission than those in medication augmentation (55 vs 40 days).
In step 3, there were no differences in remission between a switch to mirtazapine (8%) or nortriptyline (12%), or between augmentation with lithium (13%) or T(3) (triiodothyronine, liothyronine) [25%], although more participants discontinued lithium due to adverse effects than discontinued T(3).
In the fourth step, there was no difference in remission between tranylcypromine (14%) or venlafaxine-extended release plus mirtazapine (16%), although the combination treatment had fewer adverse effects and had the advantages of not requiring a washout period or diet restrictions.
Participants requiring more than two well delivered treatments may be characterized as treatment resistant given the substantially lower remission rates after that point. Treatment resistance was associated with more concurrent axis I or III co-morbid conditions, socioeconomic disadvantage, chronicity and melancholic or anxious features. However, if participants remained in treatment for up to four steps, about 67% reached remission. Times to remission were not substantially longer for later treatment steps. The importance of reaching remission is highlighted by the lower relapse rates in naturalistic follow-up for participants entering in remission compared with those entering with response but not remission (step 1: 34% vs 59%; step 2: 47% vs 68%; step 3: 42% vs 76%; step 4: 50% vs 83%).
Clinical decision making based on the itemized measurement of symptoms and adverse effects at each treatment visit was feasible in STAR*D's real world settings and resulted in adequate dosages and durations of treatment that generally exceeded those typically found in practice settings. Although switch and augmentation strategies could not be directly compared due to the equipoise stratified randomized design, the higher remission rates at step 2 with medication augmentation are intriguing and merit further study.
--------------------------------------------
http://www.ncbi.nlm.nih.gov/pubmed/19684420Neuropsychobiology. 2009;60(1):23-30. Epub 2009 Aug 14.Click here to read Links
Long-term outcome after lithium augmentation in unipolar depression: focus on HPA system activity.
Adli M, Bschor T, Bauer M, Lucka C, Lewitzka U, Ising M, Uhr M, Mueller-Oerlinghausen B, Baethge C.Department of Psychiatry and Psychotherapy, Charité - Universitatsmedizin Berlin, Campus Charité Mitte, Berlin, Germany. mazda.adli@charite.de
BACKGROUND: Lithium augmentation is a first-line strategy for depressed patients resistant to antidepressive therapy, but little is known about patients' subsequent long-term course or outcome predictors. We investigated long-term outcomes of unipolar depressed patients who had participated in a study on the effects of lithium augmentation on the hypothalamic-pituitary-adrenocortical system using the combined dexamethasone/corticotrophin-releasing hormone (DEX/CRH) test. METHODS: Twelve to 28 months (mean 18.6 +/- 4.6 months) after lithium augmentation, 23 patients were assessed with a standardized interview, of which 18 patients had complete DEX/CRH test results. Relapse was diagnosed by DSM-IV criteria (Structured Clinical Interview for DSM-IV; SCID I). RESULTS: Only 11 patients (48%) had a favorable follow-up, defined as absence of major depressive episodes during the observation period. Patients with a favorable and an unfavorable course did not differ in clinical or sociodemographic parameters, endocrinological results or continuation of lithium. However, fewer previous depressive episodes tended to correlate (p = 0.09) with a favorable course. CONCLUSION: Results from studies using the DEX/CRH test to predict relapse in depressed patients treated with antidepressants were not replicated for lithium augmentation. Our finding could reflect the elevation of DEX/CRH results by lithium, independent of clinical course. Limitations of the study are its small sample size, the heterogeneous clinical baseline conditions and the lack of lithium serum levels. The fact that lithium continuation did not predict the course might be related to the difference between the efficacy of lithium in controlled studies and its effectiveness in naturalistic settings. Copyright 2009 S. Karger AG, Basel.
------------doxogenic
Posted by SLS on September 25, 2009, at 10:41:37
In reply to Re: Is Nardil REALLY that effective for panic attacks? » SLS, posted by doxogenic boy on September 25, 2009, at 9:52:27
Even if lithium works in 30% of cases, wouldn't it be worth a quick two-week trial? The thing about statistics is that they generally don't reflect the robustness of an antidepressant response when a drug does work.
When I first started taking lithium at 300mg, I experienced many of the same side effects that you did, including the "washed-out" feeling. The side effects have disappeared completely at 600mg.
I am not recommending that you either continue or discontinue lithium. Only you know how you feel.
What other ideas are you playing with?
- Scott
Posted by doxogenic boy on September 25, 2009, at 12:17:24
In reply to Re: Is Nardil REALLY that effective for panic attacks? » doxogenic boy, posted by SLS on September 25, 2009, at 10:41:37
> Even if lithium works in 30% of cases, wouldn't it be worth a quick two-week trial?
Yes, 30 % is worth a try. But I think after so many drugs, the chance probably is less than 10 %.
> The thing about statistics is that they generally don't reflect the robustness of an antidepressant response when a drug does work.But isn't the robustness of the response lower for each new depressive episode?
> When I first started taking lithium at 300mg, I experienced many of the same side effects that you did, including the "washed-out" feeling. The side effects have disappeared completely at 600mg.
I just got the result for litium blood level: 0,1 mmol!(As mentioned before, I take 330 mg litium sulphate, which is 42 mg Li+ and 6 mmol).
Do you think that taking twice of the above, to reach 0,3 mmol can give fewer side effects than the current dose?
> I am not recommending that you either continue or discontinue lithium. Only you know how you feel.
>
> What other ideas are you playing with?
1) To stop experimenting for a long time if lithium doesn't work, or:
2) Adding modafinil
3) Increasing tianeptine
4) Trying SAM-e
5) Adding DexedrineBut I am not sure if any of those options are something that can give me hope.
doxogenic
This is the end of the thread.
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