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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 mantus on December 4, 2010, at 19:51:22
Over the past several years I have dealt with varying levels of depression and anxiety. At times, I'm able to function at moderate levels and hold a job, while maintaining a resembelance of what my called a social life. At other times, my anxiety seems to peak to levels that become quite debilitating, which leads to feelings of hopelessness, difficulties eating, sleeping, and isolation. During these particularly low times I usually have to leave my job/school. I have tried basically every ssri known to man, with little to no noticeable/long term improvement. Before these issues began, about my junior year in college, I led a very full and enriching life. This past year has been especially difficult and I'm trying my best to figure out what I can do to once again reach the levels of life I once enjoyed. I had been on celexa for several months (40mgs) and ativan at varying levels (1mg-2mg 3 times per day). Still not at all happy with the results I talked with my doctor about nardil. I decided to try nardil, so I went down to 20mg of celexa for 1 week, then off completely for two. During this time I have noticed an extreme increase in irritability and being overly emotional (crying frequently over things I never had in the past). Also, I have noticed an increase in my anxiety levels. I am currently taking ativan 1mg 3xday but I don't seem to be responding at all to it. I have been on 30mgs of nardil for 3 days and will increase to 45 mgs tomorrow. I know that this medicine much like many others, takes awhile to kick in. However, I am really struggling right now and having the fear that things will continue to get worse to the point that i have to leave my job again. I really do not want to increase my dose of ativan as it will make it that much harder to go off of it, which is my ultimate goal if nardil helps significantly. I'm really just looking for some support right now, and positive feedback from people who are taking nardil and how long it took to kick in (also what dosage). Also, any suggestions about the ativan dosage or maybe trying a different benzo like klonopin? Thank you in advance
Posted by ed_uk2010 on December 5, 2010, at 5:48:28
In reply to The SSRI wheel and trying something new, Nardil, posted by mantus on December 4, 2010, at 19:51:22
>I decided to try nardil, so I went down to 20mg of celexa for 1 week, then off completely for two. During this time I have noticed an extreme increase in irritability and being overly emotional (crying frequently over things I never had in the past).
I suppose the issue here is that you withdrew from citalopram very rapidly, and are now experiencing withdrawal symptoms. Hopefully, you will be feeling much better in a few weeks times when the withdrawal symptoms pass and Nardil starts to work. It could be a bumpy ride because you'll have anxiety, withdrawal symptoms from citalopram and adverse effects from Nardil all at once. I'm not sure why your doctor had you come off citalopram so rapidly. Anyway, you can't change that now so you'll need to find ways to make things easier. Like you said, you could try Klonopin instead of Ativan.
Best of luck. I hope you get a really good response to Nardil.
Posted by mantus on December 5, 2010, at 12:15:32
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by ed_uk2010 on December 5, 2010, at 5:48:28
My current doctor has been in the psychiatry business for quite some time, and seems quite confident in Nardil. I have noticed that many people are taking dosages up to around 90mg per day, but when I mentioned that to him, he said that he didn't see any benefit above 60mg/day. As I am only just today starting 45mg/day I know that shouldn't be a concern yet, but I was just curious to know if it often takes dosages higher than 60mg for people to respond? Also, what is your opinion on higher levels of benzo's on a daily basis? As i stated previously, I am now taking 1mg 3x/day, with little benefit. Earlier this year I was on 2mg 3x/day, which seemed to help and I didn't show any signs of fatigue or being spaced out. I am very strict on my use, and never take anything other than prescribed dosages. I'm pretty sure I would never do it even if it helped, because I am too afraid of the addictiveness of Benzo's, but have you ever heard of someone taking say 2mg 3x/day over the long term without significant addictive issues?
Posted by Tomatheus on December 5, 2010, at 14:12:01
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by mantus on December 5, 2010, at 12:15:32
> As I am only just today starting 45mg/day I know that shouldn't be a concern yet, but I was just curious to know if it often takes dosages higher than 60mg for people to respond?
Mantus,
When I took Nardil, I started with the film-coated Australian version of the medication, and I didn't notice any response until I was at 75 mg. The dose of 75 mg brought my depressive symptoms into remission for a while. I later switched to the version of Nardil that Pfizer manufactures for the U.S. (which I altered by putting the contents of my tablets into enteric capsules) and couldn't tolerate it at 75 mg due to back pain, so I backed down to 60 mg and still noticed a strong antidepressant response, but was no longer in remission. So, I would say that based on my experience that there could be added benefits from increasing your Nardil dose beyond 60 mg.
Tomatheus
Posted by sigismund on December 6, 2010, at 11:15:32
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by mantus on December 5, 2010, at 12:15:32
I've never taken Nardil, but if I did I would be keen to minimise side effects by taking the lowest effective dose.
The side effects are such that people often stop it.
I wonder too if moving to a high dose relatively quickly, while giving a more robust response, precludes obtaining eventual relief at a lower one?
Posted by ed_uk2010 on December 6, 2010, at 13:25:07
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by mantus on December 5, 2010, at 12:15:32
>He said that he didn't see any benefit above 60mg/day.
Some need 75mg or 90mg - but it's essentially trial and error. Try the lower doses for several weeks before considering whether an increase is needed/appropriate.
Posted by ed_uk2010 on December 6, 2010, at 13:28:18
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by sigismund on December 6, 2010, at 11:15:32
>The side effects are such that people often stop it.
Overall, Nardil certainly tends to cause more adverse effects than SSRIs, although it can be more effective for some patients. Experimentation is needed to find a suitable dose. Some say that 1mg per kg of body weight is optimal, but I don't believe in this, I think you need to try a range of doses and see what works best for you.
Posted by sigismund on December 6, 2010, at 13:54:02
In reply to Re: The SSRI wheel and trying something new, Nardil » sigismund, posted by ed_uk2010 on December 6, 2010, at 13:28:18
It is natural to take more of stuff that makes you feel better but it may not be the best policy.
When I was 20 something I took a couple of doses (only) of Nardil and I had the best day.
Maybe it was placebo? maybe not?
Posted by ed_uk2010 on December 6, 2010, at 15:01:16
In reply to Re: The SSRI wheel and trying something new, Nardil » ed_uk2010, posted by sigismund on December 6, 2010, at 13:54:02
Who knows Sigi? You could be the poster boy for Prozac.
Posted by mantus on December 8, 2010, at 12:03:46
In reply to Re: The SSRI wheel and trying something new, Nardil » ed_uk2010, posted by sigismund on December 6, 2010, at 13:54:02
Any suggestions on how to go about trying to find the right dose? I am on 45mgs/day right now. I don't want to rush anything, but I also don't want to be in misery longer than I have to, if nardil ends up working. Maybe stay on the 45mg for a month if I can handle it that long then think about going up? Same for 60 if I get to that point? I guess I probably need to talk to my doctor about it, I'm just tired of always questioning whether anything is really working or not. After being on so many different ssri's and never noticing any long term/substantial benefits (if any at all), I'm just frustrated with this whole psychiatry business. I'm sure you all feel the same frustration, but if a medicine is going to work, shouldn't you be able to tell for sure and not always question it? The longer I go, the more I just question the whole thing.
Posted by medtrier on December 10, 2010, at 20:21:52
In reply to Re: The SSRI wheel and trying something new, Nardil, posted by mantus on December 8, 2010, at 12:03:46
Let me encourage you to stick with Nardil!
I am on generic Parnate, which is a similar MAOI. The low dose is 30 mg. for Parnate. I felt nothing from it but started to feel something at 60, the higher dose. I felt even more at 90 mg., where I am now. It's no total cure, but I am at least sure that it is working. Heck, I pay 180 bucks out of pocket for it every month.
Before this, I had tried around 12 different medications with no luck. My doctor said that parnate probably wouldn't work. I didn't listen to him and asked for it anyway. Doctors have a way of always getting it wrong, don't they? :-)
Posted by mantus on December 11, 2010, at 9:39:35
In reply to Re: Stick with Nardil!, posted by medtrier on December 10, 2010, at 20:21:52
> Let me encourage you to stick with Nardil!
>
> I am on generic Parnate, which is a similar MAOI. The low dose is 30 mg. for Parnate. I felt nothing from it but started to feel something at 60, the higher dose. I felt even more at 90 mg., where I am now. It's no total cure, but I am at least sure that it is working. Heck, I pay 180 bucks out of pocket for it every month.
>
> Before this, I had tried around 12 different medications with no luck. My doctor said that parnate probably wouldn't work. I didn't listen to him and asked for it anyway. Doctors have a way of always getting it wrong, don't they? :-)Medtrier,
Thank you for your response. My biggest problem has always been anxiety, that really does not seem to have any kind of source. I have tried seeing therapists but it never seems to go very far because I tell them, "it's just there." I don't know why, I have a great family, friends and support system. No major life events that should cause any of this, but nonetheless, the anxiety seems to persist. How long were you on the dosages of parnate before you went up? When you describe you can tell it is working, what are the positive benefits you notice? After coming off of celexa rather quickly to try nardil i have been struggling with the return of anxiety and it is very difficult to wait and have any hope that nardil will help. Did you take any other meds to help with your situation while you were increasing your parnate dosage? Just this morning I had too much anxiety to go to work, so I called in took 1 1/2mg and ativan and went back to sleep for awhile. I am going to try to go in now, because I know that is the better choice than siting at home and ruminating about feelings of hopelessness and anxiety. Any suggestions would be greatly helpful!
Thanks,
Landon
Posted by medtrier on December 11, 2010, at 20:12:48
In reply to Re: Stick with Nardil!, posted by mantus on December 11, 2010, at 9:39:35
Hi,
My problems are similar to yours in that they don't seem to have a source either.
Parnate uses lower doses than nardil. from what i recall 10 mg. parnate = 15 mg. nardil
I was started at 30 per day, and stayed there for about 3 weeks. Then, I went up to 60/day, and stayed there for 4 weeks. Then i went up to 90. During this whole increase, parnate was the only thing i was taking.
As you said, it is really tough waiting, becuase you need something to work fast. benzodiazapines like ativan may be your best bet, because stimulants are contraindicated with MAOI's.
Lithium was recommended by someone as something to go with MAOI's. But I don't know how quickly they work. Some antipsychotics may help as well, since they sometimes start to take effect in under a week. Nuvigil/provigil may be worth a shot as well.
I was on 90 mg. of parnate for a week or so when abilify was brought into the equation. It seemed like it was helping, but that was probably the 90 taking more effect. Because going from 2 to 5 mg. of abilify made things worse.
The strange thing about anxiety and depression is that they are two sides of the same coin. Sometimes what appears to be "anxiety" is more the result of "depression," as in my case. I was labeled with "anxiety" but "anxiety" medicines never did anything for me. Then i went on parnate, which is only for "depression" and then things got significantly better.
As far as what it helps, that goes for most of my symptoms: headaches, fatigue, intrusive thoughts, irritable bowel, lethargy, lack of motivation, pain all over my body, chest pain, stomach aches, constipation, irritable/overactive bowels, imbalanced sex drive, trouble breathing, and overall just feeling "crappy." For the first time in years i feel half-alive.
It helps me to concentrate away from obsessive, repetative negative thoughts, but it doesn't remove the thoughts, and doesn't really help me concentrate on reading, tasks, etc. But overall i'm much better off. heck, i pay $170 per month out of pocket for it.
Since stopping ablify, i have been on 90 mg. parnate by itself again for 10 days. I do know it is helping a lot, but I need more help from parnate. So I may just need to give several weeks for it to peak, since so much of my time on the 90 mg. was with abilify.
Sorry that this is so long!
Posted by medtrier on December 11, 2010, at 20:39:48
In reply to Re: Stick with Nardil!, posted by mantus on December 11, 2010, at 9:39:35
And of course, the parnate has helped a lot with general anxiety as well.
Of course, a lot depends on what your particular type of anxiety is.
In my case some of my "anxiety" wasn't really "anxiety," but negative compulsions and negative thoughts that were constant as a result of being worn out (a form of depression).
This is the end of the thread.
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