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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 angels78 on May 9, 2010, at 0:23:33
I've been on Nardil for a month and a half and 3 weeks on 60 MG. I have noticed when I still have social anxiety in public enviornments and still very hesitant, my question is, should I ask to increase my dose to 75 mg/day do you think this can have a positive effect or wait out another month at 60mg?
Any help would be greatly appreciated. Thanks
Posted by SLS on May 9, 2010, at 6:06:31
In reply to NARDIL Dosage Increase?, posted by angels78 on May 9, 2010, at 0:23:33
> I've been on Nardil for a month and a half and 3 weeks on 60 MG. I have noticed when I still have social anxiety in public enviornments and still very hesitant, my question is, should I ask to increase my dose to 75 mg/day do you think this can have a positive effect or wait out another month at 60mg?
> Any help would be greatly appreciated. ThanksFrom my own experience, I would say that going from 60mg to 75mg can make a big difference. With Nardil, a little can be a lot. It interferes with its own metabolism, so a small increase in dosage can lead to a larger increase in levels of drug in the body.
How well are you tolerating Nardil? Do you experience dizziness due to low blood pressure? If not, then you might be able to handle 75mg. I would not wait more than another two weeks to raise the dosage if there is no improvement and you can tolerate the higher dosage. You can always try reducing the dosage of Nardil later. In the meantime, you are optimizing your chances of responding. That's my perspective. Others may feel differently based upon their experiences with the drug.
Good luck.
- Scott
Posted by ed_uk2010 on May 9, 2010, at 6:29:59
In reply to Re: NARDIL Dosage Increase? » angels78, posted by SLS on May 9, 2010, at 6:06:31
I agree with Scott. Very sensible advice.
Posted by angels78 on May 9, 2010, at 9:15:57
In reply to Re: NARDIL Dosage Increase? » angels78, posted by SLS on May 9, 2010, at 6:06:31
> How well are you tolerating Nardil? Do you experience dizziness due to low blood pressure? If not, then you might be able to handle 75mg. I would not wait more than another two weeks to raise the dosage if there is no improvement and you can tolerate the higher dosage. You can always try reducing the dosage of Nardil later. In the meantime, you are optimizing your chances of responding. That's my perspective. Others may feel differently based upon their experiences with the drug.
>Thanks Scott! I can tolerate Nardil pretty good actually, the only side effects were Insomnia (which ambien helps with), constipation (which has passed) and weight gain! Weight gain is the only 1 thats a 'stickler'! But as far as tolerable, I can tolerate nardil no problem, I do also adhere to the diet pretty well. I hope a bump from 65 - > 75 MG will do me some well, because 60 right now isn't too effective and my SP is still there. Thanks for the advice.
Posted by angels78 on May 10, 2010, at 5:48:13
In reply to Re: NARDIL Dosage Increase? » angels78, posted by SLS on May 9, 2010, at 6:06:31
Hello Scott or anyone who can help
I have a question and was looking to get it cleared up, maybe someone can share some insight into this for me.
Last night I went to Mothers day dinner, (Happy Mothers day to all mothers out there!) I went to dinner and for the first time in a long time, I didn't have any social phobia around people, or any social anxiety, I was actually shocked at myself, that I didn't get panic attacks or anything. I noticed AFTER I ate dinner, my SP started to come back, I had not really ate much yesterday as I was saving up for dinner, do you think FOOD that was being broke down in my stomach could be a contributing factor why the Nardil (60 MG) was less effective after dinner than it was before eating at the dinner table, or is this a lack of an extra dose, perhaps 15mg, total 75mg? I did notice this and began to wonder why.
Posted by SLS on May 10, 2010, at 6:23:35
In reply to Re: NARDIL Dosage Increase? » SLS, posted by angels78 on May 10, 2010, at 5:48:13
> I noticed AFTER I ate dinner, my SP started to come back,
I have noted a similar phenomenon with antidepressants. This includes MAOIs. Acutally, I think it was most pronounced with Nardil. I don't think it is a matter of food interfering directly with the biological actions of the drug. I just figured it was an autonomic reaction to refined carbohydrates or maybe to the digestive process in general. I really don't know.
- Scott
Posted by pedr on May 10, 2010, at 23:10:40
In reply to Re: NARDIL Dosage Increase? » angels78, posted by SLS on May 9, 2010, at 6:06:31
>> It interferes with its own metabolism, so a small increase in dosage can lead to a larger increase in levels of drug in the body.
Hi Scott,
would you mind elucidating this point, or pointing me at some literature? Nardil fascinates me. The whole new v.s. old debate, the body weight / 2 dosage yardstick (myth?), even its mechanism of action. I don't understand why it must be taken daily when it takes 2 weeks for MAO to regenerate. But I'm not willing to try the suggested technique of dropping back down to a 15mg maintenance dose once sufficient inhibition has been achieved!Pete
Posted by jedi on May 10, 2010, at 23:57:55
In reply to NARDIL Dosage Increase?, posted by angels78 on May 9, 2010, at 0:23:33
> I've been on Nardil for a month and a half and 3 weeks on 60 MG. I have noticed when I still have social anxiety in public enviornments and still very hesitant, my question is, should I ask to increase my dose to 75 mg/day do you think this can have a positive effect or wait out another month at 60mg?
> Any help would be greatly appreciated. ThanksHi Angels78,
I wrote a monster post on your other thread about myself and Nardil augmented with clonazepam. Probably, way more information on myself than anybody needed or wanted to read.Anyway, like you, my depression is accompanied with pretty severe social anxiety. For me, the gold standard is Nardil + clonazepam. Many times, if I have a social event, I will take some extra benzo to get through the occasion. As you probably guessed, I'm not big on social occasions. Anyway, both Nardil and clonazepam have a large affect on GABA. I have a tolerance built up to the tiredness effect of clonazepam. However, it still really helps augment the Nardil for social anxiety. An extra 15mg of Nardil would do nothing, but for a particularly stressful social occasion, an extra 2mg of clonazepam really can take off the edge. With no tolerance built up, this dosage would just put most people to sleep.
Since I seem to be laying out my med strategies to you, my other is small dosages of opioids. My system just works so much more efficiently with about 5mg of oxycodone on board. I only do it rarely, but with my recent hip replacement, I have been experimenting more often (access to the medication). Anyway, it just makes me feel more normal. I do not get nauseated like some people, I do not get the least bit euphoric, I just feel better as far as the depression and social phobia is concerned.
As I mentioned in another thread, those opioid receptors were not put there just to make the drug dealers lots of money. I would really like to see 100 times the research put into why these medications make many of us treatment resistant depressives and social phobics feel so much better. I am just tired of the same big three neurotransmitters getting all of the attention, when there are other major pieces to this very complicated puzzle.
OK, I'll shut up now. Take care,
Jedi
Posted by sigismund on May 11, 2010, at 2:10:24
In reply to Re: NARDIL Dosage Increase? » angels78, posted by jedi on May 10, 2010, at 23:57:55
>My system just works so much more efficiently with about 5mg of oxycodone on board
Without a doubt
Posted by SLS on May 11, 2010, at 6:58:04
In reply to Re: NARDIL Dosage Increase? » SLS, posted by pedr on May 10, 2010, at 23:10:40
> >> It interferes with its own metabolism, so a small increase in dosage can lead to a larger increase in levels of drug in the body.
>
> Hi Scott,
> would you mind elucidating this point, or pointing me at some literature?---------------------------------------------
http://www.druginformation.com/RxDrugs/P/Phenelzine%20Sulfate%20Tablet.htm
Metabolism Phenelzine is extensively metabolized, primarily by oxidation via monoamine oxidase. After oral administration of 13C6-phenelzine, 73% of the administered dose was recovered in urine as phenylacetic acid and parahydroxyphenylacetic acid within 96 hours. Acetylation to N2-acetylphenelzine is a minor pathway.
---------------------------------------------
Once substantial MAO inhibition is achieved, levels of Nardil build up as it is no longer metabolized except through acetylation, which is a minor pathway. It no longer follows the same kinetics as is seen in single-dose investigations.
> I don't understand why it must be taken daily when it takes 2 weeks for MAO to regenerate.
I know. It doesn't seem to make sense. However, I can attest to the fact that skipping even a day can lead to a lowering of mood and withdrawal symptoms, including REM rebound and anxiety.
- Scott
Posted by bulldog2 on May 11, 2010, at 9:49:21
In reply to Re: NARDIL Dosage Increase? » angels78, posted by jedi on May 10, 2010, at 23:57:55
> > I've been on Nardil for a month and a half and 3 weeks on 60 MG. I have noticed when I still have social anxiety in public enviornments and still very hesitant, my question is, should I ask to increase my dose to 75 mg/day do you think this can have a positive effect or wait out another month at 60mg?
> > Any help would be greatly appreciated. Thanks
>
> Hi Angels78,
> I wrote a monster post on your other thread about myself and Nardil augmented with clonazepam. Probably, way more information on myself than anybody needed or wanted to read.
>
> Anyway, like you, my depression is accompanied with pretty severe social anxiety. For me, the gold standard is Nardil + clonazepam. Many times, if I have a social event, I will take some extra benzo to get through the occasion. As you probably guessed, I'm not big on social occasions. Anyway, both Nardil and clonazepam have a large affect on GABA. I have a tolerance built up to the tiredness effect of clonazepam. However, it still really helps augment the Nardil for social anxiety. An extra 15mg of Nardil would do nothing, but for a particularly stressful social occasion, an extra 2mg of clonazepam really can take off the edge. With no tolerance built up, this dosage would just put most people to sleep.
>
> Since I seem to be laying out my med strategies to you, my other is small dosages of opioids. My system just works so much more efficiently with about 5mg of oxycodone on board. I only do it rarely, but with my recent hip replacement, I have been experimenting more often (access to the medication). Anyway, it just makes me feel more normal. I do not get nauseated like some people, I do not get the least bit euphoric, I just feel better as far as the depression and social phobia is concerned.
>
> As I mentioned in another thread, those opioid receptors were not put there just to make the drug dealers lots of money. I would really like to see 100 times the research put into why these medications make many of us treatment resistant depressives and social phobics feel so much better. I am just tired of the same big three neurotransmitters getting all of the attention, when there are other major pieces to this very complicated puzzle.
>
> OK, I'll shut up now. Take care,
> Jedi
>
>
>Norepinephrine,dopamine,serotonin,gaba,opiate receptors and who knows how many are really involved in mood...I get a great response for prednisone
Posted by angels78 on May 15, 2010, at 23:20:22
In reply to NARDIL Dosage Increase?, posted by angels78 on May 9, 2010, at 0:23:33
Hi everyone :)
Does anyone know if there is a Negative drug interaction between these two medications, I've read different things and wasn't sure which is right.. The two drugs are
Ambien and Nardil. Ambien taken for bedtime usage only, usually 25mg/night. 2.5 10 mg tablets.
Posted by jedi on May 16, 2010, at 23:21:03
In reply to Re: NARDIL Dosage Increase? » angels78, posted by angels78 on May 15, 2010, at 23:20:22
> Hi everyone :)
>
> Does anyone know if there is a Negative drug interaction between these two medications, I've read different things and wasn't sure which is right.. The two drugs are
>
> Ambien and Nardil. Ambien taken for bedtime usage only, usually 25mg/night. 2.5 10 mg tablets.The Medscape Drug Interaction Checker I use shows no interaction. I have not researched the topic throughly. I have taken them together with no ill effect.
Jedi
Posted by vaisforlovers on May 20, 2010, at 21:42:37
In reply to Re: NARDIL Dosage Increase? » jedi, posted by bulldog2 on May 11, 2010, at 9:49:21
You are right about there being much more involved beside neurotransmitters in the efficacy of meds. I have been reading about the Cytochrome P450 enzyme system and how our genes can be predictors of how a med will work. This is fascinating but unfortunately, a whole bunch of research has to be done and is of course cost prohibitive. I just read where patients can be deficient in an enzyme that metabolizes a drug and said drug will not work as expected. And that is probably the reason some drugs have to be given at much higher doses than normal. But since this technology is a long way off to be used in every day medicine and the docs are not up to date in this stuff, it is the patient that suffers. How sad. I have a hard time getting my doc to increase any med even tho' I tell him that the drug just isn't working. If it isn't in the PDR, they won't prescribe it.
I am on 15mg 4 times a day of Nardil. My problem is that I forget to take all of the doses and I can feel the effect in my degree of depression. I think I should be on an increased dose. In fact now that I have read this thread, I am going to ask the doc to increase it. I have also taken abilify with good results.
I am also on ambien and the only problem I have from that is occasional amnesia if I don't go right to bed.
This is the end of the thread.
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