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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by g_g_g_unit on January 10, 2010, at 21:16:07
i just had a couple of questions regarding Nardil. the first time i tried the drug, i was scared off by the side-effects, so don't feel like i gave it a fair chance. i also titrated the dose too quickly, in my opinion.
1) firstly, i was just curious about how the drug impacts short and long-term memory? i remember feeling really fogged out and scattered. would it, for instance, be possible to study for a degree on the drug?
2) secondly, i got really bad restless leg syndrome and mycolonic jerks late into the trial, at around 75mg, which further disrupted my already tragic sleeping patterns. i guessed this might be because it's effect on dopamine transmission eases up? is the side-effect temporary, or at least dose-dependent?
3) finally, is a sleep-aid a necessity while on the drug? again, is the insomnia dose-dependent? it seemed to begin to ease up eventually, but that was only because i was so exhausted from the sleep loss i think.
Posted by jedi on January 11, 2010, at 2:16:14
In reply to questions for experienced Nardil users, posted by g_g_g_unit on January 10, 2010, at 21:16:07
> i just had a couple of questions regarding Nardil. the first time i tried the drug, i was scared off by the side-effects, so don't feel like i gave it a fair chance. i also titrated the dose too quickly, in my opinion.
> 1) firstly, i was just curious about how the drug impacts short and long-term memory? i remember feeling really fogged out and scattered. would it, for instance, be possible to study for a degree on the drug?
>
> 2) secondly, i got really bad restless leg syndrome and mycolonic jerks late into the trial, at around 75mg, which further disrupted my already tragic sleeping patterns. i guessed this might be because it's effect on dopamine transmission eases up? is the side-effect temporary, or at least dose-dependent?> 3) finally, is a sleep-aid a necessity while on the drug? again, is the insomnia dose-dependent? it seemed to begin to ease up eventually, but that was only because i was so exhausted from the sleep loss i think.
Hi ggg,
I'm a long term Nardil user and have tried stopping several times because of the side effects. Over about 12 years I stopped the med about 6 times. Each time my major atypical depression returned. I do have some short term memory loss but I blame that on concurrent use of clonazepam for the same period of time. This benzo is quite noted for disruption of memory. Hard for me to say what Nardil would be like by itself because I have always augmented with something. The one time I raised the dosage up to 90mg in a couple of weeks the side effects were much more pronounced than when I went up slowly.I have never had the restless leg or myoclonic jerks from Nardil. I did have some jaw clenching, but that was controlled with the clonazepam.
The side effects from Nardil are definitely time and dosage dependent. At high doses of 90mg and above (up to 120 in my case); I had pretty severe afternoon tiredness, insomnia, weight gain and delayed orgasm. On my current 60mg these symptoms are much milder. In the past 60mg would not control my major atypical depression. It seems to be doing the job now. I have always used something for sleep. Right now I rotate between 50mg of diphenhydramine hydrochloride(Benadryl) and 12.5mg of Seroquel. In the past I have used Trazodone. I am really sensitive to the histamine receptor medications.
One thing about Nardil, it is the BOMB(IMHO). When the medication works it can be truly amazing. If your depression is atypical, Nardil can work when no other medication does. And when it does kick in, it is not subtle. For me it was like flipping a switch. I did have some hypomania at first. This is not the true antidepressant effect of the drug. It feels good when you have been depressed for a long time and many people will mistake this for the true antidepressant effect. However, the hypomania will soon go away. Don't try to chase it, you won't find it. In fact after being off the medication for up to nine months, when I started it again, the hypomania never returned.
Just my experiences and we are all different,
Be well,
Jedi
Posted by g_g_g_unit on January 11, 2010, at 2:39:19
In reply to Re: questions for experienced Nardil users » g_g_g_unit, posted by jedi on January 11, 2010, at 2:16:14
> Hi ggg,
> I'm a long term Nardil user and have tried stopping several times because of the side effects. Over about 12 years I stopped the med about 6 times. Each time my major atypical depression returned. I do have some short term memory loss but I blame that on concurrent use of clonazepam for the same period of time. This benzo is quite noted for disruption of memory. Hard for me to say what Nardil would be like by itself because I have always augmented with something. The one time I raised the dosage up to 90mg in a couple of weeks the side effects were much more pronounced than when I went up slowly.
>
> I have never had the restless leg or myoclonic jerks from Nardil. I did have some jaw clenching, but that was controlled with the clonazepam.
>
> The side effects from Nardil are definitely time and dosage dependent. At high doses of 90mg and above (up to 120 in my case); I had pretty severe afternoon tiredness, insomnia, weight gain and delayed orgasm. On my current 60mg these symptoms are much milder. In the past 60mg would not control my major atypical depression. It seems to be doing the job now. I have always used something for sleep. Right now I rotate between 50mg of diphenhydramine hydrochloride(Benadryl) and 12.5mg of Seroquel. In the past I have used Trazodone. I am really sensitive to the histamine receptor medications.
>
> One thing about Nardil, it is the BOMB(IMHO). When the medication works it can be truly amazing. If your depression is atypical, Nardil can work when no other medication does. And when it does kick in, it is not subtle. For me it was like flipping a switch. I did have some hypomania at first. This is not the true antidepressant effect of the drug. It feels good when you have been depressed for a long time and many people will mistake this for the true antidepressant effect. However, the hypomania will soon go away. Don't try to chase it, you won't find it. In fact after being off the medication for up to nine months, when I started it again, the hypomania never returned.
>
> Just my experiences and we are all different,
> Be well,
> Jedi
>
>
thanks for your response. indeed i mistook the initial hypomania for an AD response, which i insisted on pursuing, despite the fact that higher doses provoked more anxiety in me. i think if i tried it again i would take it a lot slower this time, or at least hold out at a reasonable dose (60mg or so) before moving ahead. these days, i find euphoria kind of unpleasant (i guess because i don't have much to feel euphoric about?), so i don't think i'd make the same mistake.have you ever tried discontinuing your sleep meds, or is it simply not possible to sleep on the drug?
i guess my biggest concerns are its effects on cognition and sleep architecture, especially given my age. nardil's a hassle to casually trial, i found, given the SE's and withdrawal. i've made a tentative promise to myself that i'm going to stick with the next thing that works, even if it's only a 60/70% improvement over my current situation, so i'm trying to weigh things up more logically.
Posted by julie1977 on January 11, 2010, at 7:24:29
In reply to questions for experienced Nardil users, posted by g_g_g_unit on January 10, 2010, at 21:16:07
i've been on nardil for about 18months, my short term memory is a bit bad, but I can't attribute this definately to the nardil as i've been on a multitude of psycho meds over the last 12 years. I can say that I studied for a degree before my meds commitments, and I don't think I could do it now.
I'm on 75mg and I don't have restless legs
I take olanzapine as it augments well with phenelzine and sends me to sleep. WHen i've been off olanzapine i've found sleeping very difficult.Hope this helps!
Posted by jedi on January 11, 2010, at 12:41:31
In reply to Re: questions for experienced Nardil users, posted by g_g_g_unit on January 11, 2010, at 2:39:19
Hi again ggg,
With it's side effects and potential for hypertensive episodes, Nardil is only for the seriously depressed. I have been on 45+ different combinations of antidepressants. It is the only thing that has worked for me, longterm. Are you treatment resistant with atypical depression? If so, a long term trial with Nardil may be the answer. Meds suck but so does lying on the floor in a fetal position or sleeping all day to avoid the pain of the depression.At the lower dosage of 60mg I have been able to go without sleep aids. I qualify this, in that I use 2mg of clonazepam regularly. It still helps with the social anxiety and Nardil side effects but gives very little in the way of sleep support after long term usage. I consider 50mg of Benadryl a really minor sleep aid. Since I have chronic allergies, it kills two birds with one stone. I have also weaned off the clonazepam at some points, just because of the side effect of memory loss. However, I always seem to start back on it when my anxiety level increases.
Nardil greatly reduces or eliminates REM sleep. I do not know the long term ramifications of this. But, we dream for a reason, kind of scary.
Yes, If you can get a 70% improvement that lets you function; I believe the medication is worth the side effect hassle. Especially if none of the other classes work. Nardil has been around for 50+ years and I have not experienced anything that works better for my treatment resistant, atypical, double depression with social anxiety. The double depression means I always have a level of dysthymia even when the major depression is under control. I have never been at 100% since my first major depression, 12 years ago. But with Nardil I have been able to function. I run a business and seem to keep my head above water. Though sometimes just barely.
My depression is biological; it runs through my entire extended family. My mother has been hospitalized multiple times and I have had three first cousins who have suicided. So, even though the Nardil only controls maybe 80% of my depression, it is worth it to me.
I have quit Nardil multiple times for trials of other medications. It seems to me most of the new meds they come out with now are just variations of the old meds, meant to reobtain patent protection for an existing drug. A classic example is Lexapro which is just the active isomer of Celexa. Same active ingredient, but it is a new medication with additional patent protection. Now, if the inactive isomer had some negative side effects that were eliminated in the "new" medication, that might be justified. But it is not going to work better on depression. It has the same active ingredients.
Have you tried Parnate? My last trial of tranylcypromine seemd to be working until I had a rare autohypertensive episode.
Good Luck and Be Well,
Jedi
Augmentation can help with the residual depress
> >
> thanks for your response. indeed i mistook the initial hypomania for an AD response, which i insisted on pursuing, despite the fact that higher doses provoked more anxiety in me. i think if i tried it again i would take it a lot slower this time, or at least hold out at a reasonable dose (60mg or so) before moving ahead. these days, i find euphoria kind of unpleasant (i guess because i don't have much to feel euphoric about?), so i don't think i'd make the same mistake.
>
> have you ever tried discontinuing your sleep meds, or is it simply not possible to sleep on the drug?
>
> i guess my biggest concerns are its effects on cognition and sleep architecture, especially given my age. nardil's a hassle to casually trial, i found, given the SE's and withdrawal. i've made a tentative promise to myself that i'm going to stick with the next thing that works, even if it's only a 60/70% improvement over my current situation, so i'm trying to weigh things up more logically.
>
>
Posted by g_g_g_unit on January 11, 2010, at 17:50:21
In reply to Re: questions for experienced Nardil users » g_g_g_unit, posted by jedi on January 11, 2010, at 12:41:31
> Are you treatment resistant with atypical >depression? If so, a long term trial with Nardil >may be the answer.
i do suffer from atypical depression, social anxiety, chronic dysthmia and OCD. the OCD isn't necessarily treatment resistant - it seems to respond well enough to SSRI's, which basically just mute my brain entirely - but they also make the dysthymia and depression worse because they kill my drive + personality. the exception might be prozac, which i was only on briefly, but which i might return to before trying nardil again.
>
> The double depression means I always have a >level of dysthymia even when the major depression >is under control.that's basically how i feel. dysthymia is pretty insidious because it prevents me from enjoying life on an ordinary level, leaving me open to addictive tendencies, etc. it would be nice to find a med which just left me comfortable in me own skin (which is not what i felt on SSRI's). however, like i say, i do need to take into account the cognitive s/e's given that i'm still relatively young, and it's hard to construct an identity with a failing memory. i feel so foggy as it is that i don't want to make things worse. i am curious though about augmenting with something like memantine for the cognitive difficulties. maybe then i could get the best of both worlds
>
>
> Have you tried Parnate? My last trial of tranylcypromine seemd to be working until I had a rare autohypertensive episode.yeah, i did, but unfortunately my pdoc was really cautious with the dose, and never really addressed the insomnia. regardless, my mood felt a lot worse than it did on Nardil.
>
> Good Luck and Be Well,
> Jedi
>
thanks, and you too
>
Posted by atypical on January 12, 2010, at 4:22:43
In reply to questions for experienced Nardil users, posted by g_g_g_unit on January 10, 2010, at 21:16:07
The Nardil side effects can be very intimidating. I had every single one during the first few months taking Nardil. However, I held on and now it's been about 8 months. I have maybe only one or two side effects right now. I take 60mg. On 75mg the side effects were aggravated (sleepiness, fogginess).
1) In my experience, the side effects of Nardil initially as well as on a higher dose made it very difficult for me to focus because I was sleepy all the time. My vision was blurrly. I did go to work all this time, but my productivity was low. Now, on 60mg, and barely any side effects, my productivity is excellent.
2) I never got restless leg. I guess that side effect escaped me. I thought I had all of them. Anyway, my guess is that it is dose dependent.
3) I did not experience any insomnia on Nardil at any point. Then again I am atypical in that through my entire depression history, I never had problems sleeping or oversleeping.
Atypical
>
> 1) firstly, i was just curious about how the drug impacts short and long-term memory? i remember feeling really fogged out and scattered. would it, for instance, be possible to study for a degree on the drug?
>
> 2) secondly, i got really bad restless leg syndrome and mycolonic jerks late into the trial, at around 75mg, which further disrupted my already tragic sleeping patterns. i guessed this might be because it's effect on dopamine transmission eases up? is the side-effect temporary, or at least dose-dependent?
>
> 3) finally, is a sleep-aid a necessity while on the drug? again, is the insomnia dose-dependent? it seemed to begin to ease up eventually, but that was only because i was so exhausted from the sleep loss i think.
Posted by jedi on January 12, 2010, at 9:06:34
In reply to Re: questions for experienced Nardil users » jedi, posted by g_g_g_unit on January 11, 2010, at 17:50:21
> that's basically how i feel. dysthymia is pretty insidious because it prevents me from enjoying life on an ordinary level, leaving me open to addictive tendencies, etc. it would be nice to find a med which just left me comfortable in me own skin (which is not what i felt on SSRI's). however, like i say, i do need to take into account the cognitive s/e's given that i'm still relatively young, and it's hard to construct an identity with a failing memory. i feel so foggy as it is that i don't want to make things worse. i am curious though about augmenting with something like memantine for the cognitive difficulties. maybe then i could get the best of both worldsHi again,
I've never tried memantine. I saw in one of your other posts that you were going to try a stimulant, Dexedrine. I have wanted to add a small dose of a stimulant to Nardil, but I don't have an experienced PDOC and my MD is afraid to go that route. My insurance sucks, $10,000 deductible, to just cover anything catastrophic; so memantine at $3 a pill would just add to my already insane monthly outlay for medication.I think, with enough research to support it, I could talk my MD into a small dose of methylphenidate or modafinal to augment the Nardil. That along with a reduction in my clonazepam to 1mg might help with my memory problems. I'm 52 years old so I'm going to have some CRS(Can't Remember S**t) no matter what.
One thing about my chronic depression & dysthymia is it has affected my motivation. If you can get it under control at a young age you will be so much better off. Before my first major depression hit at age 40, I studied goal setting and motivation constantly. I never listened to my car radio. I always had in a motivational book by Jim Rohn(just passed - he was the best) or some other motivational speaker. I owned an $850,000 per year computer networking business and owned and managed 50 residential rentals. Since the first major depression hit, it has been way too easy to procrastinate (I will feel better tomorrow, then get it done). After a few years of this, it becomes a habit that is hard to break.
Good luck in your battle. I know it is hard. Try not to use the depression as an excuse not to pursue your goals. This is so easy to do. You sound highly intelligent. Use that to your advantage in putting this insidious disease behind you.
Be Well,
Jedi
Posted by g_g_g_unit on January 12, 2010, at 16:35:28
In reply to Re: questions for experienced Nardil users » g_g_g_unit, posted by jedi on January 12, 2010, at 9:06:34
> Hi again,
> I've never tried memantine. I saw in one of your other posts that you were going to try a stimulant, Dexedrine.yeah, for cognitive/attention-related problems. i suspect it might make my OCD a lot worse, so it's more just a way of clearing my conscience - that i've done all i can to help myself - before committing to an AD. dex is really hard to get a hold of where i live, so having a script would be good, and at the very worse maybe i can add it to an AD (though i wouldn't risk it with Nardil).
> memantine at $3 a pill would just add to my >already insane monthly outlay for medication.yeah, the good thing about Memantine is that it's indicated for OCD. i trialled it briefly, and at lower doses it helped a lot with focus, etc. problems but wrecked my mood, so i think the combination could be good, and it would be safer than a traditional stimulant. it is though, like you say, expensive.
>
> One thing about my chronic depression & dysthymia is it has affected my motivation. If you can get it under control at a young age you will be so much better off. Before my first major depression hit at age 40, I studied goal setting and motivation constantly. I never listened to my car radio. I always had in a motivational book by Jim Rohn(just passed - he was the best) or some other motivational speaker. I owned an $850,000 per year computer networking business and owned and managed 50 residential rentals. Since the first major depression hit, it has been way too easy to procrastinate (I will feel better tomorrow, then get it done). After a few years of this, it becomes a habit that is hard to break.
>
> Good luck in your battle. I know it is hard. Try not to use the depression as an excuse not to pursue your goals. This is so easy to do. You sound highly intelligent. Use that to your advantage in putting this insidious disease behind you.
>
> Be Well,
> Jedi
>thanks, i really appreciate the advice. unfortunately, the one good asset i have - my brain - doesn't seem to be working so good lately. i've never put my consideration into my future - i just figured everything would fall into place - but i've promised myself that if i make it out of this, i'm going to get some kind of qualification that holds more real-world use
Posted by g_g_g_unit on January 12, 2010, at 16:38:50
In reply to Re: questions for experienced Nardil users, posted by atypical on January 12, 2010, at 4:22:43
> The Nardil side effects can be very intimidating. I had every single one during the first few months taking Nardil. However, I held on and now it's been about 8 months. I have maybe only one or two side effects right now. I take 60mg. On 75mg the side effects were aggravated (sleepiness, fogginess).
yeah, i noticed above 60mg everything got worse, including my anxiety strangely. i guess 60mg is the magic dose then.
>
> 1) In my experience, the side effects of Nardil initially as well as on a higher dose made it very difficult for me to focus because I was sleepy all the time. My vision was blurrly. I did go to work all this time, but my productivity was low. Now, on 60mg, and barely any side effects, my productivity is excellent.so you don't notice any memory problems?
>
> 2) I never got restless leg. I guess that side effect escaped me. I thought I had all of them. Anyway, my guess is that it is dose dependent.yeah it only came with higher dosing.
>
> 3) I did not experience any insomnia on Nardil at any point. Then again I am atypical in that through my entire depression history, I never had problems sleeping or oversleeping.
This is the end of the thread.
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