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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by DavidLA on September 23, 2011, at 23:36:29
I'm switching from Nardil to Parnate without a washout. I have my doctor's ok to go from 45mg Nardil one day to 30mg Parnate the next.
Does anyone know if this is roughly an equivalent dosage?
I take all my Nardil at once in the am. Should I do the same with the Parnate?
Posted by SLS on September 24, 2011, at 6:54:26
In reply to Nardil and Parnate at same time, posted by DavidLA on September 23, 2011, at 23:36:29
> I'm switching from Nardil to Parnate without a washout. I have my doctor's ok to go from 45mg Nardil one day to 30mg Parnate the next.
>
> Does anyone know if this is roughly an equivalent dosage?
>
> I take all my Nardil at once in the am. Should I do the same with the Parnate?I am told by clinicians at NYU that they have had several cases of stroke when patients switched MAOIs without a 14-day washout period. I am alarmed enough by their accounts and a few abstracts on Medline/Pubmed not to try what your doctor is suggesting. I never heard of such a thing - a doctor prescribing a direct switch from Naardil to Parnate. I hope your doctor has personal experience with this MAOI switching maneuver.
1 pill of Nardil = 1 pill of Parnate. Easy.
- Scott
Posted by atypical on September 24, 2011, at 9:54:25
In reply to Nardil and Parnate at same time, posted by DavidLA on September 23, 2011, at 23:36:29
I've certainly heard of a no washout period with SSRIs but not with MAOIs. Even my doctors at a university med center who push the envelope said if i were to switch MAOIs I would need a washout period.
Be vigilant.
Posted by Phillipa on September 24, 2011, at 10:50:46
In reply to Re: Nardil and Parnate at same time, posted by atypical on September 24, 2011, at 9:54:25
David get another opinion these guys know what they are talking about seriously. Phillipa
Posted by DavidLA on September 24, 2011, at 12:08:50
In reply to Nardil and Parnate at same time, posted by DavidLA on September 23, 2011, at 23:36:29
I am concerned as well, but the problem is that I cannot get off Nardil. I've done it 2x before and I go into deep depression/anxiety...to the point of not being able to function. I could easily lose my job.
I have been on Nardil for the majority of the last 10 years. But I cannot take the side effects anymore. I need to try something else.
Posted by atypical on September 24, 2011, at 13:12:11
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 24, 2011, at 12:08:50
So are you switching because while nardil helps prevent the real lows it doesn't vanquish the depression entirely? Have you tried augmenting nardil with lithium or another med yet? Such as nortriptyline or cytomel?
Posted by SLS on September 24, 2011, at 13:33:56
In reply to Re: Nardil and Parnate at same time, posted by atypical on September 24, 2011, at 13:12:11
> So are you switching because while nardil helps prevent the real lows it doesn't vanquish the depression entirely? Have you tried augmenting nardil with lithium or another med yet? Such as nortriptyline or cytomel?
Perfect choices!
- Scott
Posted by DavidLA on September 24, 2011, at 18:12:32
In reply to Re: Nardil and Parnate at same time » atypical, posted by SLS on September 24, 2011, at 13:33:56
No, I am switching because of the side effects: massive weight gain, constant sweating, extreme tiredness, more. Nardil is modestly effective for my social phobia/depression/generalized anxiety.
I am hoping Parnate will be as effective with fewer side effects. But I am unable to get off Nardil before I switch....I feel like Nardil has me trapped.
Posted by SLS on September 24, 2011, at 18:17:58
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 24, 2011, at 18:12:32
> No, I am switching because of the side effects: massive weight gain, constant sweating, extreme tiredness, more. Nardil is modestly effective for my social phobia/depression/generalized anxiety.
>
> I am hoping Parnate will be as effective with fewer side effects. But I am unable to get off Nardil before I switch....I feel like Nardil has me trapped.
What exactly makes it difficult for you to discontinue Nardil?Parnate can be effective for treating anxiety disorders, even though it hasn't been studied nearly as much as Nardil has for this purpose.
- Scott
Posted by DavidLA on September 24, 2011, at 18:28:41
In reply to Re: Nardil and Parnate at same time » DavidLA, posted by SLS on September 24, 2011, at 18:17:58
> > No, I am switching because of the side effects: massive weight gain, constant sweating, extreme tiredness, more. Nardil is modestly effective for my social phobia/depression/generalized anxiety.
> >
> > I am hoping Parnate will be as effective with fewer side effects. But I am unable to get off Nardil before I switch....I feel like Nardil has me trapped.
>
>
> What exactly makes it difficult for you to discontinue Nardil?
>
> Parnate can be effective for treating anxiety disorders, even though it hasn't been studied nearly as much as Nardil has for this purpose.
>
>
> - ScottDiscontinuing Nardil is a terrible experience for me and those around me. As soon as I drop my dose even a little I go into a deep depression and my anxiety sykrockets. As a result I can't even talk to people or perform my job. I just want to crawl into a hole by myself. And this goes on for weeks during the tapering. And then I have to wait for 14 days before even starting something else.
Trapped.
Posted by SLS on September 24, 2011, at 18:42:53
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 24, 2011, at 18:28:41
> > > No, I am switching because of the side effects: massive weight gain, constant sweating, extreme tiredness, more. Nardil is modestly effective for my social phobia/depression/generalized anxiety.
> > >
> > > I am hoping Parnate will be as effective with fewer side effects. But I am unable to get off Nardil before I switch....I feel like Nardil has me trapped.
> >
> >
> > What exactly makes it difficult for you to discontinue Nardil?
> >
> > Parnate can be effective for treating anxiety disorders, even though it hasn't been studied nearly as much as Nardil has for this purpose.
> >
> >
> > - Scott
>
> Discontinuing Nardil is a terrible experience for me and those around me. As soon as I drop my dose even a little I go into a deep depression and my anxiety sykrockets. As a result I can't even talk to people or perform my job. I just want to crawl into a hole by myself. And this goes on for weeks during the tapering. And then I have to wait for 14 days before even starting something else.
>
> Trapped.
Perhaps you can try taking Zyprexa in the interim. I bet it would work. You might not be too happy to gain more weight, but it would only be a temporary incumbrance during taper and washout periods. Once you have stabilized on Parnate, you can then discontinue the Zyprexa.It ain't easy.
- Scott
Posted by europerep on September 25, 2011, at 6:27:14
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 24, 2011, at 18:28:41
> Discontinuing Nardil is a terrible experience for me and those around me. As soon as I drop my dose even a little I go into a deep depression and my anxiety sykrockets. As a result I can't even talk to people or perform my job. I just want to crawl into a hole by myself. And this goes on for weeks during the tapering. And then I have to wait for 14 days before even starting something else.
>
> Trapped.I'd say there is a middle ground between a slow taper and then 14 days wash-out on the one hand, and an immediate one-day-to-the-next switch. You could cut your dose in half, then do a week wash-out, and then start tranylcypromine (Parnate). That sounds a lot safer than no taper or wash-out at all.
However, if phenelzine (Nardil) is an effective treatment for you, it may be better to find a strategy to deal with side effects such as weight gain. Maybe jedi (another board member) is going to jump in here, he has quite some experience with dealing with those types of side effects I think.
Posted by DavidLA on September 25, 2011, at 13:46:41
In reply to Re: Nardil and Parnate at same time » DavidLA, posted by europerep on September 25, 2011, at 6:27:14
> > Discontinuing Nardil is a terrible experience for me and those around me. As soon as I drop my dose even a little I go into a deep depression and my anxiety sykrockets. As a result I can't even talk to people or perform my job. I just want to crawl into a hole by myself. And this goes on for weeks during the tapering. And then I have to wait for 14 days before even starting something else.
> >
> > Trapped.
>
> I'd say there is a middle ground between a slow taper and then 14 days wash-out on the one hand, and an immediate one-day-to-the-next switch. You could cut your dose in half, then do a week wash-out, and then start tranylcypromine (Parnate). That sounds a lot safer than no taper or wash-out at all.
>
> However, if phenelzine (Nardil) is an effective treatment for you, it may be better to find a strategy to deal with side effects such as weight gain. Maybe jedi (another board member) is going to jump in here, he has quite some experience with dealing with those types of side effects I think.
>
>There is no way to eliminate the worst side effects of Nardil.
Would it be a safer switch if I transitioned slowly?
Week 1 = 30mg Nardil / 15mg Parnate
Week 2 = 15mg Nardil / 30mg Parnate
Week 3 = 45 mg Parnate
Posted by SLS on September 25, 2011, at 17:56:46
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 25, 2011, at 13:46:41
> Would it be a safer switch if I transitioned slowly?
>
> Week 1 = 30mg Nardil / 15mg Parnate
> Week 2 = 15mg Nardil / 30mg Parnate
> Week 3 = 45 mg ParnateHow safe do you want to be?
- Scott
Posted by DavidLA on September 25, 2011, at 18:22:32
In reply to Re: Nardil and Parnate at same time » DavidLA, posted by SLS on September 25, 2011, at 17:56:46
> > Would it be a safer switch if I transitioned slowly?
> >
> > Week 1 = 30mg Nardil / 15mg Parnate
> > Week 2 = 15mg Nardil / 30mg Parnate
> > Week 3 = 45 mg Parnate
>
> How safe do you want to be?
>
>
> - ScottAs safe as I can be without a washout from Nardil.
Posted by SLS on September 25, 2011, at 18:37:40
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 25, 2011, at 18:22:32
> > > Would it be a safer switch if I transitioned slowly?
> > >
> > > Week 1 = 30mg Nardil / 15mg Parnate
> > > Week 2 = 15mg Nardil / 30mg Parnate
> > > Week 3 = 45 mg Parnate
> >
> > How safe do you want to be?
> >
> >
> > - Scott
>
> As safe as I can be without a washout from Nardil.
Who said that such a choice exists?Maybe you ought to research this thing yourself and pay little attention to the laymen on this site, including me. You want to hear that a direct switch is safe. Sorry... I could do the research for you, but it's not my safety that is at stake.
Why not just follow your doctor's orders? Don't you trust his expertise in this matter? Why question him now?
- Scott
Posted by Chairman_MAO on September 29, 2011, at 19:09:33
In reply to Nardil and Parnate at same time, posted by DavidLA on September 23, 2011, at 23:36:29
You could make things easier on yourself and try Marplan first.
Probably nothing will happen. I switched from Parnate to Nardil with no washout and was fine. However, these guys are right: something extremely bad could happen. Perhaps you should insist on doing this in an inpatient setting?
Posted by DavidLA on September 30, 2011, at 21:09:57
In reply to Re: Nardil and Parnate at same time » DavidLA, posted by Chairman_MAO on September 29, 2011, at 19:09:33
> You could make things easier on yourself and try Marplan first.
>
> Probably nothing will happen. I switched from Parnate to Nardil with no washout and was fine. However, these guys are right: something extremely bad could happen. Perhaps you should insist on doing this in an inpatient setting?
>It's stories like this of having no issues that made me ask about it. But I will not make the switch. I don't trust my doc and finding another is very difficult. Stuck on Nardil forever I guess.
Posted by SLS on October 1, 2011, at 6:41:45
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on September 30, 2011, at 21:09:57
> > You could make things easier on yourself and try Marplan first.
> >
> > Probably nothing will happen. I switched from Parnate to Nardil with no washout and was fine. However, these guys are right: something extremely bad could happen. Perhaps you should insist on doing this in an inpatient setting?
> >
>
> It's stories like this of having no issues that made me ask about it. But I will not make the switch. I don't trust my doc and finding another is very difficult. Stuck on Nardil forever I guess.Maybe there is another way?
- Scott
Posted by Questionmark on October 1, 2011, at 13:01:53
In reply to Re: Nardil and Parnate at same time » DavidLA, posted by SLS on October 1, 2011, at 6:41:45
Sorry to be the bearer of bad news, but I've tried tiny amounts of Parnate (like bits of pill - maybe as low as 0.5 or 1mg) while on Nardil just to see if I could possibly augment the Nardil with it, and even that small amount made me feel very physically uncomfortable and strange and dysphoric - a very nervous and restless feeling but also still very lethargic. Very similar to how I've felt when i tried a tiny pinch of Adderall on Nardil (though for some reason methylphenidate feels pretty normal). I feel that it's an excess of norepinephrine activity in some way, but either way I think it would be quite risky to take normal doses of Parnate while on Nardil. I'm sorry.
I know fully well how hard it is to get off Nardil. It's very discouraging.
...
But if you ever did really want to wean off to try something else, the thing that helps me (but is also extremely risky and requires **extreme caution** and precision) is to take tiny, tiny amounts of some sort of SRI (whether a tiny, tiny pinch of an SSRI or a small sip of some DXM cough syrup) every morning or every other morning-- preferably after a couple days or so of being off completely.
This gradually reduces the level of MAO inhibition in your body while still preventing the unbelievable despair and fatigue from arising. And then after a couple weeks or so you can try cautiously introducing the different drug you want to try.
Tryptophan also helps too - though still requires some caution - but is not nearly as reliably helpful as an SRI.
Posted by SLS on October 1, 2011, at 19:28:34
In reply to Method for Weaning From and Replacing Nardil » SLS, posted by Questionmark on October 1, 2011, at 13:01:53
> I know fully well how hard it is to get off Nardil. It's very discouraging.
What do you think of the idea of using Zyprexa as a bridge between the two drugs?
- Scott
Posted by DavidLA on October 9, 2011, at 17:40:47
In reply to Nardil and Parnate at same time, posted by DavidLA on September 23, 2011, at 23:36:29
I'm not sure how, but I am now off Nardil and am still (mostly) functioning. I think decreasing it quickly actually made it easier than my past attempts.
I am now pondering what is next...but that is for another post.
Posted by SLS on October 9, 2011, at 18:44:17
In reply to Re: Nardil and Parnate at same time, posted by DavidLA on October 9, 2011, at 17:40:47
> I'm not sure how, but I am now off Nardil and am still (mostly) functioning. I think decreasing it quickly actually made it easier than my past attempts.
Yes. It is not uncommon to experience an improvement in depression from discontinuing MAOIs abruptly. It can even trigger mania.
- Scott
This is the end of the thread.
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