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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by mantus on February 11, 2011, at 9:57:48
Hello,
I started taking nardil at 60mgs on 12/28 then went up to 75 mgs after about 3 weeks. I have noticed some positive benefits from the Nardil as work has become more manageable and I am able to get out of the house a bit more, but the side effects are still killer. The side effects became much worse at 75mgs including still having insomnia, consistent orthostatic hypotension, and more severe sexual side effects than I have ever had on any other ad. I am really surprised because I am 6'3" 200lbs with a high metabolism and have been able to handle all other ad's even at very high dosages. I have heard of the 1mg/kg idea which should put me at 90mg, but i really don't think my body could handle it. I am very frustrated right now, because it is the physical side effects that I have little to no control over that I feel is holding me back more than anything from more significant improvement. When my insomnia first started I was still able to function somewhat normally during the day. No manic type symptoms, just not passing out like I figure I would with such little sleep. I think now the sleep is catching up to me and feel very tired at points during the day, but still can't sleep at night. Restoril and ambien neither worked, and quite frankly I am becoming frustrated with the whole sleep aid idea. None of the side effects have improved during my month on 75mgs, and I really just want to go back down to 60mgs when I didn't have as much trouble, but I am just worried that it wouldn't give me enough of a therapeutic effect.
I would really appreciate any and all suggestions. I see my doc on Tuesday, and I am really curious as to what is going to happen. What do you think about going down on dose or any of these side effects significantly improving over time if I stayed on 75mgs? The sleep problems and consistent orthostatic hypotension with no improvement is really beginning to worry me.
Thanks,
Mantus
Posted by Conundrum on February 11, 2011, at 11:55:14
In reply to Nardil side effects still a problem, posted by mantus on February 11, 2011, at 9:57:48
> Hello,
>
> I started taking nardil at 60mgs on 12/28 then went up to 75 mgs after about 3 weeks. I have noticed some positive benefits from the Nardil as work has become more manageable and I am able to get out of the house a bit more, but the side effects are still killer. The side effects became much worse at 75mgs including still having insomnia, consistent orthostatic hypotension, and more severe sexual side effects than I have ever had on any other ad. I am really surprised because I am 6'3" 200lbs with a high metabolism and have been able to handle all other ad's even at very high dosages. I have heard of the 1mg/kg idea which should put me at 90mg, but i really don't think my body could handle it. I am very frustrated right now, because it is the physical side effects that I have little to no control over that I feel is holding me back more than anything from more significant improvement. When my insomnia first started I was still able to function somewhat normally during the day. No manic type symptoms, just not passing out like I figure I would with such little sleep. I think now the sleep is catching up to me and feel very tired at points during the day, but still can't sleep at night. Restoril and ambien neither worked, and quite frankly I am becoming frustrated with the whole sleep aid idea. None of the side effects have improved during my month on 75mgs, and I really just want to go back down to 60mgs when I didn't have as much trouble, but I am just worried that it wouldn't give me enough of a therapeutic effect.
>
> I would really appreciate any and all suggestions. I see my doc on Tuesday, and I am really curious as to what is going to happen. What do you think about going down on dose or any of these side effects significantly improving over time if I stayed on 75mgs? The sleep problems and consistent orthostatic hypotension with no improvement is really beginning to worry me.
>
> Thanks,
> MantusIf it is as bad as it sounds, why not go back to 60mg if it was doing something positive at that dose. Not sleeping well is unhealthy. Sometimes a lower amount is enough. Some people get by on just two pills.
Posted by mantus on February 11, 2011, at 12:10:09
In reply to Re: Nardil side effects still a problem » mantus, posted by Conundrum on February 11, 2011, at 11:55:14
Really? Some people respond at that low of a dose? Well, I don't know exactly how much 60mg was doing for the positive, but I also don't think I gave it enough time. But what I do know is that when I went from 45mg to 60mg is when I definitely noticed the med was doing something. When I was on 45mg I had no side effects/positive effects, etc. I guess I guess I never thought that going to 75mg would cause such problems because I have always been so hyper tolerant/resistant to many kinds of meds. But of course this one is different that anything I've ever tried. Also, I had just heard and read about so many people doing well on dosages up to 90mg, so I figured that was the direction I needed to go. But I will definitely talk to my doc about things and see what he thinks.
Thanks
Posted by Conundrum on February 11, 2011, at 13:29:35
In reply to Re: Nardil side effects still a problem, posted by mantus on February 11, 2011, at 12:10:09
> Really? Some people respond at that low of a dose? Well, I don't know exactly how much 60mg was doing for the positive, but I also don't think I gave it enough time. But what I do know is that when I went from 45mg to 60mg is when I definitely noticed the med was doing something. When I was on 45mg I had no side effects/positive effects, etc. I guess I guess I never thought that going to 75mg would cause such problems because I have always been so hyper tolerant/resistant to many kinds of meds. But of course this one is different that anything I've ever tried. Also, I had just heard and read about so many people doing well on dosages up to 90mg, so I figured that was the direction I needed to go. But I will definitely talk to my doc about things and see what he thinks.
>
> ThanksThe person I know did well on Nardil for at least 20 years on 2 pills(30mg) a day. In fact 4 was too much.
Posted by jedi on February 12, 2011, at 2:16:22
In reply to Nardil side effects still a problem, posted by mantus on February 11, 2011, at 9:57:48
Hi Mantus,
I have been fighting many of the things you are talking about for much of the past 12 years. Nardil is the only medication that has ever work for my atypical major depression and social anxiety.I originally had to take Nardil up to 90mg and even higher to get relief from my depression. I started on the original Nardil and when the stuff hit my depression it was like nothing else I have ever felt from an AD. One day I was hopelessly depressed. The next day it was like someone flipped the switch. All of the same problems but they were minor and totally manageable. With the newer formula, I have never recaptured that initial feeling again. I'm not sure it had anything to do with the formula change since many people will get that rush, even euphoria, when Nardil first starts working. This is not the true antidepressant effect anyway. It is a switch to hypomania that can result in severe loss of sleep, risky financial decisions, etc. This phase is short lived and the antidepressant effect follows.
My main side effects that still linger on Nardil to this day are insomnia, delayed orgasm and a tendency to gain weight. I did have a little orthostatic hypotension at first, but this soon went away. Another side effect that seems to dissipate is the extreme afternoon tiredness.
I don't believe in the 1mg/kg formula any longer. Everyone is different and the dosage that works for you could be completely different than for me, even if we are the same weight.
I believe, that with Nardil, the insomnia is something that will always have to be treated. I started out with trazodone(nasty drugged feeling) and even used low dose Seroquel for a while. The mainstream sleep aids have never really helped me. Clonazepam still helps some after many years. Now I just use 50mg of diphenhydramine hydrochloride(Benadryl). It works well for me but I am very sensitive to any medication that affect the histamine receptors.
Dosage on Nardil is critical in managing the side effects of the medication. For me, there are very few side effects at 60mg and a load of side effects at 90mg. If you need to stay at 75mg or go to 90mg for a while, to knock back the depression, do it. The depression is worse than any side effect. But then when you are feeling better, try to taper back down to 60mg. For me the side effects are so much better at 60mg.
Good Luck,
Jedi
> Hello,
>
> I started taking nardil at 60mgs on 12/28 then went up to 75 mgs after about 3 weeks. I have noticed some positive benefits from the Nardil as work has become more manageable and I am able to get out of the house a bit more, but the side effects are still killer. The side effects became much worse at 75mgs including still having insomnia, consistent orthostatic hypotension, and more severe sexual side effects than I have ever had on any other ad. I am really surprised because I am 6'3" 200lbs with a high metabolism and have been able to handle all other ad's even at very high dosages. I have heard of the 1mg/kg idea which should put me at 90mg, but i really don't think my body could handle it. I am very frustrated right now, because it is the physical side effects that I have little to no control over that I feel is holding me back more than anything from more significant improvement. When my insomnia first started I was still able to function somewhat normally during the day. No manic type symptoms, just not passing out like I figure I would with such little sleep. I think now the sleep is catching up to me and feel very tired at points during the day, but still can't sleep at night. Restoril and ambien neither worked, and quite frankly I am becoming frustrated with the whole sleep aid idea. None of the side effects have improved during my month on 75mgs, and I really just want to go back down to 60mgs when I didn't have as much trouble, but I am just worried that it wouldn't give me enough of a therapeutic effect.
>
> I would really appreciate any and all suggestions. I see my doc on Tuesday, and I am really curious as to what is going to happen. What do you think about going down on dose or any of these side effects significantly improving over time if I stayed on 75mgs? The sleep problems and consistent orthostatic hypotension with no improvement is really beginning to worry me.
>
> Thanks,
> Mantus
Posted by mantus on February 12, 2011, at 9:50:54
In reply to Re: Nardil side effects still a problem » mantus, posted by jedi on February 12, 2011, at 2:16:22
> Hi Mantus,
> I have been fighting many of the things you are talking about for much of the past 12 years. Nardil is the only medication that has ever work for my atypical major depression and social anxiety.
>
> I originally had to take Nardil up to 90mg and even higher to get relief from my depression. I started on the original Nardil and when the stuff hit my depression it was like nothing else I have ever felt from an AD. One day I was hopelessly depressed. The next day it was like someone flipped the switch. All of the same problems but they were minor and totally manageable. With the newer formula, I have never recaptured that initial feeling again. I'm not sure it had anything to do with the formula change since many people will get that rush, even euphoria, when Nardil first starts working. This is not the true antidepressant effect anyway. It is a switch to hypomania that can result in severe loss of sleep, risky financial decisions, etc. This phase is short lived and the antidepressant effect follows.
>
> My main side effects that still linger on Nardil to this day are insomnia, delayed orgasm and a tendency to gain weight. I did have a little orthostatic hypotension at first, but this soon went away. Another side effect that seems to dissipate is the extreme afternoon tiredness.
>
> I don't believe in the 1mg/kg formula any longer. Everyone is different and the dosage that works for you could be completely different than for me, even if we are the same weight.
>
> I believe, that with Nardil, the insomnia is something that will always have to be treated. I started out with trazodone(nasty drugged feeling) and even used low dose Seroquel for a while. The mainstream sleep aids have never really helped me. Clonazepam still helps some after many years. Now I just use 50mg of diphenhydramine hydrochloride(Benadryl). It works well for me but I am very sensitive to any medication that affect the histamine receptors.
>
> Dosage on Nardil is critical in managing the side effects of the medication. For me, there are very few side effects at 60mg and a load of side effects at 90mg. If you need to stay at 75mg or go to 90mg for a while, to knock back the depression, do it. The depression is worse than any side effect. But then when you are feeling better, try to taper back down to 60mg. For me the side effects are so much better at 60mg.
> Good Luck,
> Jedi
>
>
> > Hello,
> >
> > I started taking nardil at 60mgs on 12/28 then went up to 75 mgs after about 3 weeks. I have noticed some positive benefits from the Nardil as work has become more manageable and I am able to get out of the house a bit more, but the side effects are still killer. The side effects became much worse at 75mgs including still having insomnia, consistent orthostatic hypotension, and more severe sexual side effects than I have ever had on any other ad. I am really surprised because I am 6'3" 200lbs with a high metabolism and have been able to handle all other ad's even at very high dosages. I have heard of the 1mg/kg idea which should put me at 90mg, but i really don't think my body could handle it. I am very frustrated right now, because it is the physical side effects that I have little to no control over that I feel is holding me back more than anything from more significant improvement. When my insomnia first started I was still able to function somewhat normally during the day. No manic type symptoms, just not passing out like I figure I would with such little sleep. I think now the sleep is catching up to me and feel very tired at points during the day, but still can't sleep at night. Restoril and ambien neither worked, and quite frankly I am becoming frustrated with the whole sleep aid idea. None of the side effects have improved during my month on 75mgs, and I really just want to go back down to 60mgs when I didn't have as much trouble, but I am just worried that it wouldn't give me enough of a therapeutic effect.
> >
> > I would really appreciate any and all suggestions. I see my doc on Tuesday, and I am really curious as to what is going to happen. What do you think about going down on dose or any of these side effects significantly improving over time if I stayed on 75mgs? The sleep problems and consistent orthostatic hypotension with no improvement is really beginning to worry me.
> >
> > Thanks,
> > Mantus
>
>
Jedi,I think I already went through the time when people sometimes show symptoms of hypomania as I was able to function for a few weeks with very little sleep. However, I wanted to sleep and never showed any signs of euphoria or bad decisions making, just able to function half way normally. I think now my body is finally starting to feel the effects of not sleeping. Did your insomnia improve at all when you went back down to 60? I do feel better in some ways, and feel like the lingering significant side effects (insomnia, orthostatic hypotension) are holding me back in some ways from making major steps forward. When you said that the orthostatic hypotension went away did you just stop feeling dizzy, or did you actually monitor your blood pressure with posture changes and the drop in bp and spike in hr stopped happening? Sometimes I don't get dizzy, but my bp will still significantly drop and hr spike every single time I stand up. Did you ever do the mao platelet test that some people talk about to see how well the nardil is inhibiting the mao? As far as the insomnia goes I have tried benadryl, ambien, and restoril with no luck. How many hours of sleep do you average a night with benadryl and clonazepem? I'm hoping that if I go down in dose (which I am definitely leaning towards) then the insomnia will improve or at least make it more likely that a sleep aid will be beneficial. Thank you for your time and I'd really appreciate any responses you could give.
Thanks,
Mantus
Posted by jedi on February 12, 2011, at 13:38:11
In reply to Re: Nardil side effects still a problem, posted by mantus on February 12, 2011, at 9:50:54
Hi again Mantus,
My insomnia has improved over the years and is much better at my current dosage of 60mg of Nardil. I'm just lucky in that I will respond with tiredness to the medications that are H1 receptor antagonists such as Benadryl. If I build up tolerance to the effect, I can just lay off for a few days, and they knock me out again. The insomnia is better than when I initially started Nardil, but has never gone away. For me, it will always have to be treated. Right now, I average 7 to 8 hours of sleep nightly.Nardil does reduce REM sleep and that is a bummer since I like to dream. I have had a sleep study in a sleep clinic and I do have some REM sleep, just reduced.
Another thing that Nardil does is reduce the level of B6(pyridoxine) in the body. This can lead to peripheral neuropathy, among other things, if not supplemented. Be careful with B6 dosage since ironically, too much B6, can also cause peripheral neuropathy.
The late afternoon tiredness has almost completely gone away. At first, I could not get through that period of the day without a Nardil nap! Of course, any two hour nap in the late afternoon will disrupt your sleep even more. This side effect does pass.
You must have got me thinking about my BP when I read your post yesterday. I have had some really bad tinnitus lately that relates back to a 1985 sudden hearing loss in my left ear. I know that an increase in BP will make the tinnitus worse, so I checked my BP this morning. My BP will normally run borderline high and Nardil will actually lower it somewhat. My entire extended family is on beta-blockers. The Nardil has kept me from going there. Anyway, this morning my BP was 136/75. Then because you had me thinking about the orthostatic hypotension, I stood up real fast and took it again. It was about 115/61. So I still have some orthostatic hypotension but not enough to make me dizzy. If my BP normally ran low, this postural change may have been enough to have an effect.
I have asked my MD to do the test to find my level of MAO inhibition. He didn't want to do it and it is probably unnecessary at this point for me. I have been on the medication for so long and up and down in dosage that I can feel the MAO inhibition level in my body. It will always take several weeks for a dosage change to cause changes for me, but I can always tell. If my mood does not change significantly, then I can tell by my side effects that the MAO inhibition has changed. I am assuming the side effects, like delay in orgasm, are directly related to the level of MAO inhibition in my body. The length of delay correlates almost exactly with my dosage when I give the dosage change several weeks to adjust the MAO inhibition. By the way, the delayed orgasm is another side effect that improves with time, at least for me.
If your doctor started you right out at 60mg of Nardil and you went to 75mg in three weeks, you are going to have some pretty severe side effects for a while. This is one medication that takes the body some time to get used to. I know it is hard, but you must take the dosage up slowly to avoid the severe side effects of this medication. In later years, when I've been off Nardil for several weeks, I have been able to taper up faster since my body knows what to expect from the med and I still have some residual MAO inhibition.
If I was in your shoes, I would reduce the Nardil to 60mg or even 45mg and give it several weeks before going back up again. This is one medication that can work when nothing else does, so work with it to get the right dosage for you. It takes time. I have used high dosage clonazepam, up to 4 or 5mg daily, to get me through the pain until the Nardil has a chance to kick in. MAO inhibition is not instant, it takes time, but can be a major miracle for some of us. I know it has saved my life at least a couple of times. From the sound of your posts, it appears to me that Nardil will work for you. Taper slower and don't give up because of the side effects. Better days are coming.
Be Well,
Jedi
Posted by Sailboat77 on February 12, 2011, at 16:56:28
In reply to Re: Nardil side effects still a problem » mantus, posted by jedi on February 12, 2011, at 13:38:11
I've taken Nardil before but right now I currently take 60mg of Parnate (a different MAOI with similar side effects). I've experience almost of all the negative symptoms you have to one degree or another. After 6 weeks now, my doctors and I have found some remedies to counter the persistent issues.
(Insomnia): 50mg of Seroquel is the only thing that seems to work for me. Ambien and Lunesta were largely inefficient and helped very little. I also take Xanax on occasion to slow down racing thoughts.
(Orthostatic Hypotension): This has been a HUGE issue for me. I would stand up and fall over or get extremely dizzy within minutes due to falling blood pressure. You can take either Florine or Midodrine to alleviate symptoms. The Florinef gave me insomnia so I recommend Midodrine instead.
I hope my own experience helps some- I know the side effects can be difficult to endure.
Posted by jedi on February 13, 2011, at 0:19:15
In reply to Re: Nardil side effects still a problem, posted by Sailboat77 on February 12, 2011, at 16:56:28
Hi Sailboat,
I have had a couple of trials with Parnate. Unfortunately, on the last trial, I had a rare spontaneous hypertensive episode which kept me from giving it the fair trial it deserved. I liked Parnate because it is much less likely than Nardil to cause weight gain and has less sexual side effects. I don't believe it is as good for social anxiety as Nardil. Nardil seems to be more of a relaxing medication, after an initial chance of hypomania; while Parnate seems to be more activating.I have and still do take Seroquel occasionally for insomnia. Among its many other pharmacological actions it is a potent H1 receptor antagonist. At low dosages, of less than 25mg, that is one of it's primary functions. In other words, it is an antihistamine, similar to diphenhydramine hydrochloride(Benadryl). I have found doses as low as 12.5mg to be affective for my insomnia. In the initial stages, I found insomnia on Parnate to be worse than Nardil. You may need the 50mg now and be able to reduce it later on. Dosages of quitiapine for bipolar disorder and schizophrenia range from 200 to 800mg and affect many other receptors. Watch out for rebound insomnia after taking Seroquel long term.
Thanks for the information on orthostatic hypotension. I know this is a very serious problem for many using MAOIs. Some people can't even continue their trials because of this side effect.
Wishing you the Best,
Jedi
> I've taken Nardil before but right now I currently take 60mg of Parnate (a different MAOI with similar side effects). I've experience almost of all the negative symptoms you have to one degree or another. After 6 weeks now, my doctors and I have found some remedies to counter the persistent issues.
>
> (Insomnia): 50mg of Seroquel is the only thing that seems to work for me. Ambien and Lunesta were largely inefficient and helped very little. I also take Xanax on occasion to slow down racing thoughts.
>
> (Orthostatic Hypotension): This has been a HUGE issue for me. I would stand up and fall over or get extremely dizzy within minutes due to falling blood pressure. You can take either Florine or Midodrine to alleviate symptoms. The Florinef gave me insomnia so I recommend Midodrine instead.
>
> I hope my own experience helps some- I know the side effects can be difficult to endure.
This is the end of the thread.
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