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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by enndub on October 11, 2012, at 11:26:50
So my Nardil is making me feel mildly bipolar. My anxiety is still significantly better (all the time) than it was before Nardil (but not as good as it had been after about 2 months on Nardil). My dysthimia will go for a few days and then come back for a few days.
I was on 60 mg for 10 weeks and have been on 75 mg for 6 weeks.
I'm not sure if it's a lack of sleep or stress thing (I've been having trouble keeping up with my school and work due to Nardil fatigue) or if the meds just aren't working. I was on Vyvanse prior to starting Nardil for ADD, but I was thinking that the inattention symptoms were caused by anxiety. Now I'm thinking I just have ADD in addition to atypical dysthimia and social anxiety (maybe generalized? not sure).
I had some ideas that I'm hoping to discuss with my psych at my appointment tomorrow, and am looking for some input here since people on this board tend to be pretty knowledgeable about this stuff.
1. Add Nuvigil to hopefully counteract the Nardil fatigue and ADD.
2. Add Lyrica or Baclofen to hopefully take are of the residual anxiety (I get temporary relief from dysthimia after a good social interaction (mood reactivity?) so maybe knocking out my anxiety will knock out the residual dysthimia?)
3. Up the dose to 90 mg, since my side effects are pretty mild and I am dreaming again. Not that I mind dreaming, but I thought you weren't supposed to dream on Nardil?
4. Add Lamictal. Seems like there is a lot of overlap between bipolar II with mixed states and anxiety with atypical dysthimia. I have never been on a mood stabilizer or AP mostly due to fear of anticholinergic side effects (I get bad restless legs/akathisia from ACh antagonists and some antihistamines like mirtazapine) and cognitive side effects.
5. Change meds? I have never tried a TCA or Wellbutrin (but I have been on Strattera + Mirtazapine witch didn't help at all with anything).
Sorry for the scattered thoughts and I would appreciate any input anyone here can give me.
Thanks!
Nick
Posted by phillipa on October 11, 2012, at 12:06:00
In reply to Nardil only working half the time. Appt tommorow., posted by enndub on October 11, 2012, at 11:26:50
Nick not knowing much about the Maois. But with your symptoms maybe wellbutrin. I say this as it would give you a lot more choices with other med choices to add if need be. And didn't you say bipolar? That with a mood stablizer could be a better choic. You are young? Phillipa
Posted by ChicagoKat on October 11, 2012, at 12:35:57
In reply to Nardil only working half the time. Appt tommorow., posted by enndub on October 11, 2012, at 11:26:50
> So my Nardil is making me feel mildly bipolar. My anxiety is still significantly better (all the time) than it was before Nardil (but not as good as it had been after about 2 months on Nardil). My dysthimia will go for a few days and then come back for a few days.
>
> I was on 60 mg for 10 weeks and have been on 75 mg for 6 weeks.
>
> I'm not sure if it's a lack of sleep or stress thing (I've been having trouble keeping up with my school and work due to Nardil fatigue) or if the meds just aren't working. I was on Vyvanse prior to starting Nardil for ADD, but I was thinking that the inattention symptoms were caused by anxiety. Now I'm thinking I just have ADD in addition to atypical dysthimia and social anxiety (maybe generalized? not sure).
>
> I had some ideas that I'm hoping to discuss with my psych at my appointment tomorrow, and am looking for some input here since people on this board tend to be pretty knowledgeable about this stuff.
>
> 1. Add Nuvigil to hopefully counteract the Nardil fatigue and ADD.
>
> 2. Add Lyrica or Baclofen to hopefully take are of the residual anxiety (I get temporary relief from dysthimia after a good social interaction (mood reactivity?) so maybe knocking out my anxiety will knock out the residual dysthimia?)
>
> 3. Up the dose to 90 mg, since my side effects are pretty mild and I am dreaming again. Not that I mind dreaming, but I thought you weren't supposed to dream on Nardil?
>
> 4. Add Lamictal. Seems like there is a lot of overlap between bipolar II with mixed states and anxiety with atypical dysthimia. I have never been on a mood stabilizer or AP mostly due to fear of anticholinergic side effects (I get bad restless legs/akathisia from ACh antagonists and some antihistamines like mirtazapine) and cognitive side effects.
>
> 5. Change meds? I have never tried a TCA or Wellbutrin (but I have been on Strattera + Mirtazapine witch didn't help at all with anything).
>
> Sorry for the scattered thoughts and I would appreciate any input anyone here can give me.
>
> Thanks!
>
> Nick
>Oh Nick, it's funny you should say that, b/c Nardil is making me feel mildly bipolar now too, but I think it's just normal ups and downs at the start of therapy. I've never been the least bipolar after decades of atypical depression. So mood stabilizers - I've tried Lithium and Lamictal - did jack sh*t for me. Unless you are truly thinking you might be bipolar, personally, I'd stay away fromt them cos they both have potentially dangerous side effects.
How long have you been on Nardil? I'm so scared that it will help and then poop out on me after a while like all drugs seem to do. Do you think that might be what's going on with you?
I think Lyrica is a good idea, but I personally think Neurontin is a better one. I admit I am prone to experience side effects often, but Lyrica made my depression worse. And it didn't work very well for me either. Neurontin had no affect on my depression, and it helped with my anxiety much more. The only problem I've had with it is a rapid build up of tolerance, but again, I'm prone to that.
An AP is certainly not a good option; it doesn't mix with an MAOI, and if you get akathisia from even drugs with antihistaminic properties, you are almost guaranteed to get it from an AP.
Hopefully one of the true experts like Scott will chime in with some better recs than I can offer. But I hope I've helped even a little bit. Good luck with the pdoc tomorrow; be sure to let us know how it turns out.
My best,
Kat
Posted by ChicagoKat on October 11, 2012, at 12:37:16
In reply to Re: Nardil only working half the time. Appt tommorow. » enndub, posted by phillipa on October 11, 2012, at 12:06:00
> Nick not knowing much about the Maois. But with your symptoms maybe wellbutrin. I say this as it would give you a lot more choices with other med choices to add if need be. And didn't you say bipolar? That with a mood stablizer could be a better choic. You are young? Phillipa
Thanks Phillipa! I forgot to mention that Wellbutrin might be a good idea.
Kat
Posted by enndub on October 11, 2012, at 21:35:51
In reply to Re: Nardil only working half the time. Appt tommorow. » enndub, posted by phillipa on October 11, 2012, at 12:06:00
> Nick not knowing much about the Maois. But with your symptoms maybe wellbutrin. I say this as it would give you a lot more choices with other med choices to add if need be. And didn't you say bipolar? That with a mood stablizer could be a better choic. You are young? Phillipa
Thanks Phillipa,
Wellbutrin will probably be my next choice if the Nardil doesn't work out. I would be inclined to try augmenting the Nardil first because I've already been on it for months and don't want to go through a washout and then wait for another antidepressant to start working. Nardil has given me far better results than anything so far, they are just so darn inconsistent.
I have never had any bipolar symptoms unmedicated or hypomania on antidepressants, so I don't know how likely bipolar is. I just have ups and downs on Nardil and had extremely early onset of anxiety and dysthimia, which I have read can be an early warning sign of bipolar II. The anxiety came first and some of my earliest memories are stupid things that I blew way out of proportion and replayed in my mind for years. The dysthimia came later, I think around age 11 and has been slowly getting worse until now. Also I have had one severe major depressive episode at age 19. I am currently 22 years old.
Thanks for your input!
Nick
Posted by enndub on October 11, 2012, at 21:54:14
In reply to Re: Nardil only working half the time. Appt tommorow. » enndub, posted by ChicagoKat on October 11, 2012, at 12:35:57
> Oh Nick, it's funny you should say that, b/c Nardil is making me feel mildly bipolar now too, but I think it's just normal ups and downs at the start of therapy. I've never been the least bipolar after decades of atypical depression. So mood stabilizers - I've tried Lithium and Lamictal - did jack sh*t for me. Unless you are truly thinking you might be bipolar, personally, I'd stay away fromt them cos they both have potentially dangerous side effects.
>
> How long have you been on Nardil? I'm so scared that it will help and then poop out on me after a while like all drugs seem to do. Do you think that might be what's going on with you?
>
> I think Lyrica is a good idea, but I personally think Neurontin is a better one. I admit I am prone to experience side effects often, but Lyrica made my depression worse. And it didn't work very well for me either. Neurontin had no affect on my depression, and it helped with my anxiety much more. The only problem I've had with it is a rapid build up of tolerance, but again, I'm prone to that.
>
> An AP is certainly not a good option; it doesn't mix with an MAOI, and if you get akathisia from even drugs with antihistaminic properties, you are almost guaranteed to get it from an AP.
>
> Hopefully one of the true experts like Scott will chime in with some better recs than I can offer. But I hope I've helped even a little bit. Good luck with the pdoc tomorrow; be sure to let us know how it turns out.
> My best,
> Kat
>
>Hi Kat, thanks for your input.
I did have the up-downs in the first two months of Nardil treatment (and the literal up-downs with the orthostatic hypotension :)). I've been on Nardil for 4 months now, and on month three I had pretty consistently good results. Still occasional twitching in group settings and quivering voice when talking which I why I upped to 75 mg, but my dysthimia was completely gone (maybe it was just the novelty of having less anxiety? after all, I do have mood reactivity).
I too have feared the poop out. In fact, having a Flowers for Algernon regression after getting my first taste of living a normal life is probably my biggest fear right now. I feel like my depression could be worse if it comes back in full force since I now know what I'm missing. Hopefully this is just a stepping stone on the road to full therapeutic results and not a poop out, but I'm not really sure.
I'll ask my doc about Neurontin. I have experienced rapid tolerance build up with Strattera and stimulants, and have a pretty high natural tolerance for most drugs, theraputic and recreational. I also experienced rapid tolerance to benzos, but those never helped with anything but sleep so it wasn't too big of a deal to me.
Thanks for the advice on the mood stabilizers and APs. I had the same thoughts on APs but wasn't sure about mood stabilizers, so it's good to know that they didn't help you.
Thanks for the input and I'll be sure to let you all know what happens tomorrow.
Nick
P.S. Still welcoming any more input or random thoughts.
Posted by ChicagoKat on October 12, 2012, at 13:04:45
In reply to Re: Nardil only working half the time. Appt tommorow., posted by enndub on October 11, 2012, at 21:35:51
I think Wellbutrin may be one of the drugs you actually can safely add to therapy with an MAOI, but I'd need confirmation on that.
You could also augment your MAOI with a TCA or low dose stimulants.
Kat> > Nick not knowing much about the Maois. But with your symptoms maybe wellbutrin. I say this as it would give you a lot more choices with other med choices to add if need be. And didn't you say bipolar? That with a mood stablizer could be a better choic. You are young? Phillipa
>
> Thanks Phillipa,
>
> Wellbutrin will probably be my next choice if the Nardil doesn't work out. I would be inclined to try augmenting the Nardil first because I've already been on it for months and don't want to go through a washout and then wait for another antidepressant to start working. Nardil has given me far better results than anything so far, they are just so darn inconsistent.
>
> I have never had any bipolar symptoms unmedicated or hypomania on antidepressants, so I don't know how likely bipolar is. I just have ups and downs on Nardil and had extremely early onset of anxiety and dysthimia, which I have read can be an early warning sign of bipolar II. The anxiety came first and some of my earliest memories are stupid things that I blew way out of proportion and replayed in my mind for years. The dysthimia came later, I think around age 11 and has been slowly getting worse until now. Also I have had one severe major depressive episode at age 19. I am currently 22 years old.
>
> Thanks for your input!
>
> Nick
Posted by ChicagoKat on October 12, 2012, at 13:11:29
In reply to Re: Nardil only working half the time. Appt tommorow., posted by enndub on October 11, 2012, at 21:54:14
Nick,
You do sound SO much like me, with your history of building up tolerance to so many drugs so easily. I'm really afraid now that I might develop tolerance to Nardil too. I really have no other options left. :(Anyways, this post is supposed to be about YOU. As I said in my post re Phillipa's suggestions, I really do think Wellbutrin is a drug that can be added safely to MAOIs, but again, I would need confirmation on that. But I definitely know that one can safely add either a TCA (except Clomipramine, I've been told) or a low dose stimulant. The best of luck to you! I truly hope you can find a solution and that the appt with your pdoc goes well.
My best,
Kat
Posted by enndub on October 14, 2012, at 5:11:40
In reply to Re: Nardil only working half the time. Appt tommorow. » enndub, posted by ChicagoKat on October 12, 2012, at 13:11:29
OK, so my pdoc is looking up Nuvigil because he wasn't sure if it was safe to take with the Nardil and in the meantime he recommended that I try to take my entire 75 mg dose at night to avoid fatigue in the daytime. At my next appointment I will have been on 75 mg for over 8 full weeks so we can discuss augmentation options then if I'm still not feeling better.
Friday was a good day, today I was feeling down again, maybe because I skipped my usual morning and afternoon doses to get ready for taking the entire dose at nighttime.
Just took my full 75 mg 5 hours ago and now my insomnia is back in full force, which is a shame because I declined sleep meds on my appointment on Friday. Might try a low dose of Mirtazapine to knock me out tomorrow night, hopefully it won't cause restless legs at a low dose.
Anyways, I'm feeling pretty good right now, so hopefully my mood carries over to tomorrow.
Thanks Kat and Phillipa for the input and wishes.
Nick
Posted by ChicagoKat on October 14, 2012, at 12:25:26
In reply to Re: Nardil only working half the time. Appt tommorow., posted by enndub on October 14, 2012, at 5:11:40
> OK, so my pdoc is looking up Nuvigil because he wasn't sure if it was safe to take with the Nardil and in the meantime he recommended that I try to take my entire 75 mg dose at night to avoid fatigue in the daytime. At my next appointment I will have been on 75 mg for over 8 full weeks so we can discuss augmentation options then if I'm still not feeling better.
>
> Friday was a good day, today I was feeling down again, maybe because I skipped my usual morning and afternoon doses to get ready for taking the entire dose at nighttime.
>
> Just took my full 75 mg 5 hours ago and now my insomnia is back in full force, which is a shame because I declined sleep meds on my appointment on Friday. Might try a low dose of Mirtazapine to knock me out tomorrow night, hopefully it won't cause restless legs at a low dose.
>
> Anyways, I'm feeling pretty good right now, so hopefully my mood carries over to tomorrow.
>
> Thanks Kat and Phillipa for the input and wishes.
>
> NickHi Nick,
Thanks for the update; I was wondering how things went. I honestly don't know about Nuvigil with Parnate, but it's great that your pddoc is looking it up. And it was a good idea he had to take all your 75mg at night to avoid daytime fatigue. Too bad though that you declined sleep meds (lol, I would NEVER decline an offer of sleep meds, but then I have the world's worst insomnia) But I'm sure you could call him and say you need them after all and he could phone them in to your pharmacy.I truly hope the change helps, and that if he finds Nuvigil is OK with Parnate, that it helps too. My experience with Nuvigil was that it did not help much. But then, everyone's different. I found Ritalin helped much, much better. And it can be added to an MAOI, as can amphetamines. Even a low dose makes a difference. Something to consider, should the nuvigil not work out.
Good luck, and keep us posted!
Kat
Posted by Erewhonian on October 21, 2012, at 1:25:52
In reply to Nardil only working half the time. Appt tommorow., posted by enndub on October 11, 2012, at 11:26:50
Hmm... The way you're describing this (the ups and downs, only working part of the time) sounds like it might be low blood pressure. Somewhat common side effect with Nardil. I experienced the same thing until I lowered down to 45mg. The fatigue from low blood pressure can do more than just make you tired, it can also give you a feeling rather similar to being mildly depressed.
Have you measured your BP when you feel down and tired? I start to feel like that when I dip below 110/65. If this is indeed the problem, then reduce your dosage and/or drink more fluids to increase blood volume and add salt to your diet.
There aren't any drugs out there to increase your BP that won't interact with the Nardil, but it wouldn't surprise me if they'd be safe if taken at a very low dose. (Except your pdoc would probably never be willing to try something like that.)
This is the end of the thread.
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