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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by luckyduck on January 12, 2011, at 0:37:50
Here it goes. First off, I have found this forum to be immensely helpful. So here is a little about me before I get to my questions. When I was young, I was hyper, jovial, and an extreme trouble-maker. I was put on Ritalin but taken off of it almost immediately because my parents said it turned me into a walking zombie. So they put up with the un-medicated me and sent me to therapists. They believed it was because I was too bright and not being challenged in school so they put me in an advanced learning program and things got a little better.
Fast forward to Jr High. I was put on Dexadrine and Prozac and found a weird pattern which brings me to my question. I would take this medication Mon-Thurs and on Friday I wouldn't take it because I would experience this intense surge of energy and euphoria for the weekend.
By high school, the stimulants such as Dexadrine and Adderall where no longer helping because I developed depression. So they stuck me on SSRIs. They helped initially but not for long periods of time. I was never as happy as I knew I could be. However, once again, I found that if I was ever on any medication that inhibited norepinephrine or dopamine (Wellbutrin and Cymbalta for example), I was pretty miserable while ON the medication but as soon as I'd come off of them, I would experience the same surge of happiness and energy that could last for weeks.
I fell into a deep depression about 2 years ago and have been on every SSRI, SNRI there is with maybe the exception of Effexor because I was told it was similar in nature to Cymbalta. I have experienced true happiness but never while on a medication...always coming down from one.
I am on Nardil now as kind of a last-hope to fight this depression. (Side note I don't know if I have ever been properly diagnosed. My mom is bi-polar and my dad has depression and I have some mutant hybrid that isn't really one or the other.
Please, if anyone has experienced this euphoric high upon the discontinuation of a medication, let me know if you have found something that works for you. I am only on the first week of Nardil and know I need to give it a few more weeks but I don't feel it would hurt asking.
Sorry if the text is a little discombobulated, trying to squeeze 20+ years into a few paragraphs.
-Zach
Posted by pragmatic-attack on January 12, 2011, at 2:56:19
In reply to Questions On Depression and Nardil, posted by luckyduck on January 12, 2011, at 0:37:50
First off I'd like to say that Nardil is a medication that seems to work amazingly well when nothing else seems too but I would also say it is certainly not your last hope. There are so many treatments in development now(not all medication by the way) that it is only the beginning.
Also, has anybody ever suggested you might have a varient of bipolar? The kind that only manifests itself as primarily depressive symptoms? Early depression at a young age. Comorbid ADHD and a family member with bipolar could make that a possibility.
Have you ever tried a mood stabilizer?
That "surge" of energy could be perhaps a hypomanic state?
If the Nardil doesn't work(which sometimes it even treats bipolar) maybe you might want to try a mood stabilizer. You might as well give it a shot. If you are still depressed after you try one then at least you will know.
Posted by mrtook on January 12, 2011, at 10:00:29
In reply to Questions On Depression and Nardil, posted by luckyduck on January 12, 2011, at 0:37:50
I can't answer your questions, but I just wanted to echo what pragmatic said. This is most certainly not your last hope.
That being said I do hope this works for you.
All the best,
MrTook
Posted by Phillipa on January 12, 2011, at 13:04:26
In reply to Re: Questions On Depression and Nardil, posted by mrtook on January 12, 2011, at 10:00:29
I also agree with pragmatic attack and it does sound like could be bipolar a mood stabalizer might be just the thing. Phillipa
Posted by luckyduck on January 12, 2011, at 15:45:16
In reply to Re: Questions On Depression and Nardil, posted by Phillipa on January 12, 2011, at 13:04:26
I agree that there was no reason for medication when I was little. I may have been loud but I was happy and the "life of the party". However I know that, as of right now, medication is necessary.
I have been on mood stabilizers before. I have been put on Lamitcal on more than one occasion and it does stabilize my mood but it stabilizes it at a very low level.
As far as I can tell, I am more depressed than I am bipolar. Still, my doctor is stumped by the energy surge and instant mood spike after coming off medication. It happened most recently last fall where after being on Wellburtin with minimal results, I came off of it cold turkey and within a week I was flying high.
Posted by Conundrum on January 19, 2011, at 10:21:05
In reply to Re: Questions On Depression and Nardil, posted by luckyduck on January 12, 2011, at 15:45:16
> I agree that there was no reason for medication when I was little. I may have been loud but I was happy and the "life of the party". However I know that, as of right now, medication is necessary.
>
> I have been on mood stabilizers before. I have been put on Lamitcal on more than one occasion and it does stabilize my mood but it stabilizes it at a very low level.
>
> As far as I can tell, I am more depressed than I am bipolar. Still, my doctor is stumped by the energy surge and instant mood spike after coming off medication. It happened most recently last fall where after being on Wellburtin with minimal results, I came off of it cold turkey and within a week I was flying high.I read an article and I really wish I could find it now, but it had a a column of different things you could be experiencing and one of the things that indicated some time of Bipolar II disorder was feeling a lot better when discontinuing psychmeds.
Posted by Phillipa on January 19, 2011, at 20:01:08
In reply to Re: Questions On Depression and Nardil » luckyduck, posted by Conundrum on January 19, 2011, at 10:21:05
Why did you feel better? Phillipa
Posted by luckyduck on January 25, 2011, at 18:19:44
In reply to Re: Questions On Depression and Nardil » Conundrum, posted by Phillipa on January 19, 2011, at 20:01:08
I have no idea. I was hoping to find someone that has had a similar experience. Does anyone know how long it typically takes for Nardil to kick in? What kind of dosages have people been having success with? I started on 15mg three weeks ago and am now on 45mg. Not feeling much of anything.
Posted by Chairman_MAO on February 2, 2011, at 0:13:39
In reply to Re: Questions On Depression and Nardil, posted by luckyduck on January 25, 2011, at 18:19:44
Dosage should be up to 1mg/kg/day in divided doses.
Posted by pedr on February 3, 2011, at 13:36:45
In reply to Re: Questions On Depression and Nardil, posted by luckyduck on January 25, 2011, at 18:19:44
Hi Zach,
do remember to take everyone's recommendations with a pinch of salt - YMMV. For instance, there is no research whatsoever on the body weight 1kg / 1mg ratio. It's a rule-of-thumb that some psychs employ but certainly not all. My (competent) psych had never heard of it.That said, the very first reference on Nardil's wiki page -http://en.wikipedia.org/wiki/Phenelzine is the FDA labelling - http://www.accessdata.fda.gov/drugsatfda_docs/label/2007/011909s038lbl.pdf
which states, quote
DOSAGE AND ADMINISTRATION
Initial dose: The usual starting dose of NARDIL is one tablet (15 mg) three times a day.
Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly
rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to
90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical
response until treatment at 60 mg has been continued for at least 4 weeks.
Maintenance dose: After maximum benefit from NARDIL is achieved, dosage should be
reduced slowly over several weeks. Maintenance dose may be as low as one tablet, 15
mg, a day or every other day, and should be continued for as long as is required.-- end quote
So unfortunately you have some time yet before you'll know if it's going to have an effect for you. My personal recommendation is that you persevere since Nardil has a good track record of helping when all other meds have not. I had tried pretty much all the classes of med, including combo's, before Nardil and only Nardil has had a prolonged, robust effect on my depression & OCD. For the record I am on 90mg.
HTH,
Pete
Posted by Chairman_MAO on February 3, 2011, at 14:31:15
In reply to Re: Questions On Depression and Nardil » luckyduck, posted by pedr on February 3, 2011, at 13:36:45
>For instance, there is no research whatsoever on the body weight 1kg / 1mg ratio. It's a rule-of-thumb that some psychs employ but certainly not all. My (competent) psych had never heard of it.
You are wrong, and so is your doctor--unless you misrepresented what he said, which is possible.
"Clinical response to phenelzine is related to platelet MAO inhibition and dosage per unit body weight."
http://www.ncbi.nlm.nih.gov/pubmed/365127
And that's from 1978! Nothing earth-shattering here.
Yes, it is a heuristic, and clinical response matters most. However, it is based on research: unless you get blood work done and follow platelet MAO, one should titrate to desired effect, which seems to happen around 1mg/kg/day. People with abnormal liver function, etc., need not apply.
I have no medical degree, but I can read and understand concepts.
"No research whatsoever" is a strong statement!
Posted by pedr on February 3, 2011, at 14:45:27
In reply to Re: Questions On Depression and Nardil » pedr, posted by Chairman_MAO on February 3, 2011, at 14:31:15
> >For instance, there is no research whatsoever on the body weight 1kg / 1mg ratio. It's a rule-of-thumb that some psychs employ but certainly not all. My (competent) psych had never heard of it.
>
> You are wrong, and so is your doctor--unless you misrepresented what he said, which is possible.
>
> "Clinical response to phenelzine is related to platelet MAO inhibition and dosage per unit body weight."
>
> http://www.ncbi.nlm.nih.gov/pubmed/365127
>
> And that's from 1978! Nothing earth-shattering here.
>
> Yes, it is a heuristic, and clinical response matters most. However, it is based on research: unless you get blood work done and follow platelet MAO, one should titrate to desired effect, which seems to happen around 1mg/kg/day. People with abnormal liver function, etc., need not apply.
>
> I have no medical degree, but I can read and understand concepts.
>
> "No research whatsoever" is a strong statement!
>Hah! and it's the top hit if you google "phenelzine body weight" too. I stand very much corrected - apologies for the incorrect information. I've participated in several threads where the 1mg / 1kg rule has been generally acknowledged as an unproven/unfounded rule-of-thumb. I guess I just incorrectly concluded that as a fact.
In that case, thanks to my "Nardil belly" I should be on 105mg <gulp>
Pete
Posted by Chairman_MAO on February 4, 2011, at 1:18:18
In reply to Re: Questions On Depression and Nardil » Chairman_MAO, posted by pedr on February 3, 2011, at 14:45:27
No need to raise it if you feel OK.
Posted by pedr on February 4, 2011, at 9:05:57
In reply to Re: Questions On Depression and Nardil » pedr, posted by Chairman_MAO on February 4, 2011, at 1:18:18
OK-ness is a tricky quantity to measure. And even harder to know when to stop trying to get just that bit better.
I'm in a different league of well-being compared to before Nardil but my health, outlook, OCD, IBS, energy levels and sleep vary constantly. It's pretty demoralizing.
One week I can be relatively awake, upbeat, effective and feel "OK". The next (like this week tuned out) I can feel like my limbs are made of lead, I can't put two thoughts together, I have no motivation, feel sad and my gut feels like someone's pulling a steel scrubbing pad through it. Sticky-taped to a beach ball.
Posted by medamorphosis on February 9, 2011, at 20:40:26
In reply to Re: Questions On Depression and Nardil, posted by luckyduck on January 25, 2011, at 18:19:44
> I have no idea. I was hoping to find someone that has had a similar experience. Does anyone know how long it typically takes for Nardil to kick in? What kind of dosages have people been having success with? I started on 15mg three weeks ago and am now on 45mg. Not feeling much of anything.
Start of week 4 when I upped dose to 60mg. Kicked in beautifully! Tho I did start at 15mg, so week 1- 15mg, week 2- 30mg, week 3- 45mg. Mind you I did eventually need to increase to 90mg in the end to keep efficiacy. Even tried 120mg for a month, which kicked in almost instantly then dwindled after a couple of weeks. That meant time to augment & eventually switch.
NEVER had body wieght increase, tho I never gave in to carb craving either. Weight seems down to the individual's eating habits, not the drug alone.
This is the end of the thread.
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