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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 49. This is the beginning of the thread.
Posted by ChicagoKat on October 25, 2012, at 19:26:26
I have now been on Nardil for 3 1/2 weeks, and feel as terrible as I did before I started it. That never happened the first time I took it. I just know in my gut that it's not gonna work. Oh, and I've been on Nortriptyline too, and that's doing squat for me.
I've tried everything there is. I remember before I started Nardil this time that I told my husband that if it didn't work it was gonna be either suicide or heroin addiction for me. I was only half-joking. I just can't face a life of feeling so awful all the time. Of course, my pdoc will probably put me back on Ritalin, and I will have to fight with it (tolerance builds up to it really quickly in me) for the rest of my miserable existence.
If anyone has any ideas, I'd love to hear them, but I just don't think anything's gonna work anymore.
Posted by jono_in_adelaide on October 25, 2012, at 20:17:19
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
Kat, have you ever considered treatment in a super-specialist center such as the Menninger Clinic in Texas?
It is probably the worlds best center for the treatment of mental illness - if you could, it might be worth considering?
Posted by jono_in_adelaide on October 25, 2012, at 20:21:35
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
Other ideas -
Buprenorphine (suboxone)
Parnate + trimipramine
augmenting with one of the atypical antipsychotics in low doseage
Posted by Phillipa on October 25, 2012, at 20:51:52
In reply to Re: I give up, posted by jono_in_adelaide on October 25, 2012, at 20:21:35
Seriously know quite a few ex-babblers now working feeling great that had been on MAOI's and went back to meds like Prozac and they worked. This is the truth. Phillipa
Posted by schleprock on October 25, 2012, at 21:19:41
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
If you end up discontinuing the Nardil, you should consider increasing your dose of Nortriptyline. It helped me "just enough" when I first took it (I started on 200mg at once), but in less than a year it really started working (and that was basically the only thing I was on at the time.)
Posted by alchemy on October 25, 2012, at 21:22:23
In reply to Re: I give up, posted by jono_in_adelaide on October 25, 2012, at 20:17:19
> Kat, have you ever considered treatment in a super-specialist center such as the Menninger Clinic in Texas?
>
> It is probably the worlds best center for the treatment of mental illness - if you could, it might be worth considering?
>
> http://www.menningerclinic.com/I have never heard of it. How hard is it to get in and hiw good at they at tx resistant cases?
Lets go kat :-)
Posted by jono_in_adelaide on October 25, 2012, at 21:43:27
In reply to Re: I give up, posted by alchemy on October 25, 2012, at 21:22:23
They have been the foremost psychiatric institution in the US, and euqal to the best in the English speaking world for over 60 years. I dont think you could go to a better place if you felt that you had exhausted everything
Posted by jane d on October 25, 2012, at 21:59:58
In reply to Re: I give up, posted by jono_in_adelaide on October 25, 2012, at 21:43:27
> They have been the foremost psychiatric institution in the US, and euqal to the best in the English speaking world for over 60 years. I dont think you could go to a better place if you felt that you had exhausted everything
Huh? Where on earth did you ever get that idea (other than their own website). Their reputation is for having rich patients not for delivering top care. And that's not at all the same thing here especially when you're talking mental illness.
Posted by gilmourr on October 25, 2012, at 22:04:30
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
> I have now been on Nardil for 3 1/2 weeks, and feel as terrible as I did before I started it. That never happened the first time I took it. I just know in my gut that it's not gonna work. Oh, and I've been on Nortriptyline too, and that's doing squat for me.
>
> I've tried everything there is. I remember before I started Nardil this time that I told my husband that if it didn't work it was gonna be either suicide or heroin addiction for me. I was only half-joking. I just can't face a life of feeling so awful all the time. Of course, my pdoc will probably put me back on Ritalin, and I will have to fight with it (tolerance builds up to it really quickly in me) for the rest of my miserable existence.
>
> If anyone has any ideas, I'd love to hear them, but I just don't think anything's gonna work anymore.
Nardil alone, 30 days, same dose. If it's worked before, it should work again. Most likely something is interacting with it or that you haven't been on it long enough or you're not staying on the same level of dose.
Posted by jane d on October 25, 2012, at 22:04:35
In reply to Menninger » jono_in_adelaide, posted by jane d on October 25, 2012, at 21:59:58
> > They have been the foremost psychiatric institution in the US, and euqal to the best in the English speaking world for over 60 years. I dont think you could go to a better place if you felt that you had exhausted everything
>
> Huh? Where on earth did you ever get that idea (other than their own website). Their reputation is for having rich patients not for delivering top care. And that's not at all the same thing here especially when you're talking mental illness.
>To be fair I admit I'm talking more about their historical reputation. I haven't heard much one way or another about their quality of care recently. Their target market seems to have remained the same however.
Posted by jono_in_adelaide on October 25, 2012, at 22:13:36
In reply to Re: Menninger, posted by jane d on October 25, 2012, at 22:04:35
Well, they cured Richard Carpenter of his Qualude habit, and its where they sent the posessed kid in The Exorcist!
Posted by phidippus on October 25, 2012, at 22:15:28
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
What's the longest period of time you've ever been on an AD?
Eric
Posted by SLS on October 25, 2012, at 22:45:35
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
Hi Kat.
Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
- Scott
Posted by gilmourr on October 26, 2012, at 0:20:50
In reply to Re: I give up » ChicagoKat, posted by SLS on October 25, 2012, at 22:45:35
> Hi Kat.
>
> Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
>
>
> - Scott
Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some. 60 mg can actually undo the work.Some may need really high dosages but Nardil is powerful. It's the one drug you want to titrate slowly from 45 mg giving at least 6 weeks before you up it 15 mg.
It's a bitch to wait, and even harder when you have major depression. But when you rush it, you're shooting yourself in the foot 9 times out of 10.
Usually I try and just sleep until it kicks in by taking a low dose of remeron one night, then maybe klonopin one night. Try and sleep it through. And switch up your sleep aids to prevent any tolerance whatsoever.
Posted by SLS on October 26, 2012, at 0:30:09
In reply to Re: I give up, posted by gilmourr on October 26, 2012, at 0:20:50
> > Hi Kat.
> >
> > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> >
> >
> > - Scott
>
>
> Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.Yes. I have read your posts.
> 60 mg can actually undo the work.
How so? What do you experience when the work is undone?
- Scott
Posted by gilmourr on October 26, 2012, at 0:55:14
In reply to Re: I give up » gilmourr, posted by SLS on October 26, 2012, at 0:30:09
> > > Hi Kat.
> > >
> > > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> > >
> > >
> > > - Scott
> >
> >
> > Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.
>
> Yes. I have read your posts.
>
> > 60 mg can actually undo the work.
>
> How so? What do you experience when the work is undone?
>
>
> - Scott
>I experience severe mood swings that remind me exactly of major depression (they lasted for 4 hours, and didn't get better) over 3 weeks.
Lessening of the effect of anxiety relief, more anxiety to sounds (kind of like a very heightened reflex), MAJOR COLD INTOLERANCE (still waiting for it to go away), urinary retention where I almost needed a cathedar.
At 45 mg after 70-75 days I only had constipation and a 70% relief of anxiety and depression.
Few days after taking 60 mg it started messing it all up and continued to get worse.
Maybe there is a balanced SERT/NE ratio at 45 mg and at 60 mg it is way more NE based? Would explain the coldness, urinary retention, reflexes etc. Iunno, it was bad though.
Posted by TemporarilyBob on October 26, 2012, at 2:55:37
In reply to I give up, posted by ChicagoKat on October 25, 2012, at 19:26:26
Old-timer jumping in after a long time away so obviously not familiar with your history, Kat, tho it's apparent from people's responses you're a well-known and respected Babblelonian. So, for my sake (and maybe the sake of others), what's your dx?
Posted by SLS on October 26, 2012, at 5:39:39
In reply to Re: I give up, posted by gilmourr on October 26, 2012, at 0:55:14
> > > > Hi Kat.
> > > >
> > > > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> > > >
> > > >
> > > > - Scott
> > >
> > >
> > > Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.
> >
> > Yes. I have read your posts.
> >
> > > 60 mg can actually undo the work.
> >
> > How so? What do you experience when the work is undone?
> >
> >
> > - Scott
> >
>
> I experience severe mood swings that remind me exactly of major depression (they lasted for 4 hours, and didn't get better) over 3 weeks.
>
> Lessening of the effect of anxiety relief, more anxiety to sounds (kind of like a very heightened reflex), MAJOR COLD INTOLERANCE (still waiting for it to go away), urinary retention where I almost needed a cathedar.
>
> At 45 mg after 70-75 days I only had constipation and a 70% relief of anxiety and depression.
>
> Few days after taking 60 mg it started messing it all up and continued to get worse.
>
> Maybe there is a balanced SERT/NE ratio at 45 mg and at 60 mg it is way more NE based? Would explain the coldness, urinary retention, reflexes etc. Iunno, it was bad though.
With Nardil, I experienced an antidepressant effect when I either increased or decreased the dosage. The improvement was, however, extremely short-lived. It would last from a few hours to a few days. I found myself adjusting the dosage of Nardil daily in order to stay in the "zone" of response. Did you know that one can feel better transiently when the dosages of various drugs are decreased? These include, but are not limited to, TCA, MAOI, Depakote, and Lamictal. Those are just the ones that affected me that way. In fact, severe mania can result from drug discontinuation. I experienced my worst mania as the result of Nardil discontinuation.To me, it sounds like you might not have allowed your CNS to reach an equilibrium at the higher dosage of Nardil. For having followed a pattern of continually adjusting the dosage of Nardil up and down, you have become sensitized to many of its side effects. Urinary retention is an example of a side effect that can worsen by jumping up and down in dosage. You are not allowing time for the drug to produce its therapeutic antidepressant effect and only make side effects worse.
If you can't maintain an acceptable antidepressant response to 45 mg/day of Nardil taken daily for 4 - 6 weeks, I would suggest that you remain at that dosage steadily for 1 - 2 weeks before making any changes. You could then increase the dosage by 7.5 mg/day every 1 - 2 weeks as tolerated until you find an effective dosage in the range of 60 - 90 mg/day.
How much time and effort you invest in using Nardil to treat your illness might depend upon how many drugs you have left to try. If there a bunch of treatments yet untried, then perhaps it makes sense to change drugs now. If your alternatives are now limited because of previous treatment failures, it makes sense to give Nardil more time, particularly since you are at least partially responsive to it.
When one hits an effective dosage of Nardil, they often feel weird for a few days to a week. It is not a return of depression, but rather a brain fog that can flatten affect and produce cognitive difficulties. It just doesn't feel "right". However, this can be a good sign that biological events are occurring that are producing a more complete antidepressant response.
- Scott
Posted by alchemy on October 26, 2012, at 10:13:02
In reply to Re: I give up » gilmourr, posted by SLS on October 26, 2012, at 5:39:39
Hi scott. When you say that there can be a weird flattened feeling for a while, can you explain that a little more? Can it feel like a depressing flattened effect?
Thx
Posted by gilmourr on October 26, 2012, at 13:03:25
In reply to Re: I give up » gilmourr, posted by SLS on October 26, 2012, at 5:39:39
> > > > > Hi Kat.
> > > > >
> > > > > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> > > > >
> > > > >
> > > > > - Scott
> > > >
> > > >
> > > > Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.
> > >
> > > Yes. I have read your posts.
> > >
> > > > 60 mg can actually undo the work.
> > >
> > > How so? What do you experience when the work is undone?
> > >
> > >
> > > - Scott
> > >
> >
> > I experience severe mood swings that remind me exactly of major depression (they lasted for 4 hours, and didn't get better) over 3 weeks.
> >
> > Lessening of the effect of anxiety relief, more anxiety to sounds (kind of like a very heightened reflex), MAJOR COLD INTOLERANCE (still waiting for it to go away), urinary retention where I almost needed a cathedar.
> >
> > At 45 mg after 70-75 days I only had constipation and a 70% relief of anxiety and depression.
> >
> > Few days after taking 60 mg it started messing it all up and continued to get worse.
> >
> > Maybe there is a balanced SERT/NE ratio at 45 mg and at 60 mg it is way more NE based? Would explain the coldness, urinary retention, reflexes etc. Iunno, it was bad though.
>
>
> With Nardil, I experienced an antidepressant effect when I either increased or decreased the dosage. The improvement was, however, extremely short-lived. It would last from a few hours to a few days. I found myself adjusting the dosage of Nardil daily in order to stay in the "zone" of response. Did you know that one can feel better transiently when the dosages of various drugs are decreased? These include, but are not limited to, TCA, MAOI, Depakote, and Lamictal. Those are just the ones that affected me that way. In fact, severe mania can result from drug discontinuation. I experienced my worst mania as the result of Nardil discontinuation.
>
> To me, it sounds like you might not have allowed your CNS to reach an equilibrium at the higher dosage of Nardil. For having followed a pattern of continually adjusting the dosage of Nardil up and down, you have become sensitized to many of its side effects. Urinary retention is an example of a side effect that can worsen by jumping up and down in dosage. You are not allowing time for the drug to produce its therapeutic antidepressant effect and only make side effects worse.
>
> If you can't maintain an acceptable antidepressant response to 45 mg/day of Nardil taken daily for 4 - 6 weeks, I would suggest that you remain at that dosage steadily for 1 - 2 weeks before making any changes. You could then increase the dosage by 7.5 mg/day every 1 - 2 weeks as tolerated until you find an effective dosage in the range of 60 - 90 mg/day.
>
> How much time and effort you invest in using Nardil to treat your illness might depend upon how many drugs you have left to try. If there a bunch of treatments yet untried, then perhaps it makes sense to change drugs now. If your alternatives are now limited because of previous treatment failures, it makes sense to give Nardil more time, particularly since you are at least partially responsive to it.
>
> When one hits an effective dosage of Nardil, they often feel weird for a few days to a week. It is not a return of depression, but rather a brain fog that can flatten affect and produce cognitive difficulties. It just doesn't feel "right". However, this can be a good sign that biological events are occurring that are producing a more complete antidepressant response.
>
>
> - Scott
Yeah, it makes sense what you say about feeling better and decreasing the dose. It has happened each time I've come off Nardil. But then like 10-14 days off Nardil I usually go back into depression (on day 7 @ 0 mg and I feel like I have lost a lot of my interests again and am lazy, yet I don't feel majorly depressed yet. It'll come though).I definitely didn't give it an adequate amount of time at 60 mg, but it was 3 weeks of straight like daily 4 hour mood swings where I felt majorly depressed. The ones that happened at midnight I'd have to wander the streets because I couldn't be inside, I just felt too bad. I'm just not a big fan of side effects that are major depression.
The 45 mg didn't stop working at a 70% effect level for anxiety and 60-70% for depression. So I'm going back there after restarting which I'm doing and then I'll augment it. I actually have tried 60 mg twice now. The first time was for 6 weeks and I felt like crap too :/ 45 mg is much more magical.
I'll let this get back to Kat's thread, if I have any q's, I'll definitely post later on, but right now I'm just waiting 2-3 weeks for the MAO to regenerate and then start Nardil @ 45 mg again.
Posted by ChicagoKat on October 26, 2012, at 14:46:10
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 25, 2012, at 22:15:28
> What's the longest period of time you've ever been on an AD?
>
> EricProbably Lexapro. I was on it for about 4yrs, at least.
Posted by ChicagoKat on October 26, 2012, at 14:48:14
In reply to Re: I give up » ChicagoKat, posted by SLS on October 25, 2012, at 22:45:35
Hi Scott, thanks for the advice, but I have already increased my dose to 60mg/day, did so about 2wks ago. As you suggested, I had planned to return to 45mg/day if/when the Nardil kicked in. But not only is the Nardil kicking in, the ataxia has not returned.
> Hi Kat.
>
> Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
>
>
> - Scott
Posted by ChicagoKat on October 26, 2012, at 14:51:28
In reply to Re: I give up » ChicagoKat, posted by TemporarilyBob on October 26, 2012, at 2:55:37
Hi, nice of you to post. My official diagnosis is major depressive disorder. And I'm treatment resistant.
> Old-timer jumping in after a long time away so obviously not familiar with your history, Kat, tho it's apparent from people's responses you're a well-known and respected Babblelonian. So, for my sake (and maybe the sake of others), what's your dx?
Posted by ChicagoKat on October 26, 2012, at 14:59:45
In reply to Re: I give up » gilmourr, posted by SLS on October 26, 2012, at 5:39:39
> > > > > Hi Kat.
> > > > >
> > > > > Since you are already there, I would consider increasing the dosage of Nardil to 60 mg/day and wait for the ataxia to show up. If ataxia does emerge, you can always abort the experiment immediately. I must stress that most people who respond well to Nardil need a minimum of 60 mg/day to do so. 60 is the magic number for some reason.
> > > > >
> > > > >
> > > > > - Scott
> > > >
> > > >
> > > > Not necessarily true, there have been quite a few people at SAS.com including myself where 45 mg has done wonders even full remission for some.
> > >
> > > Yes. I have read your posts.
> > >
> > > > 60 mg can actually undo the work.
> > >
> > > How so? What do you experience when the work is undone?
> > >
> > >
> > > - Scott
> > >
> >
> > I experience severe mood swings that remind me exactly of major depression (they lasted for 4 hours, and didn't get better) over 3 weeks.
> >
> > Lessening of the effect of anxiety relief, more anxiety to sounds (kind of like a very heightened reflex), MAJOR COLD INTOLERANCE (still waiting for it to go away), urinary retention where I almost needed a cathedar.
> >
> > At 45 mg after 70-75 days I only had constipation and a 70% relief of anxiety and depression.
> >
> > Few days after taking 60 mg it started messing it all up and continued to get worse.
> >
> > Maybe there is a balanced SERT/NE ratio at 45 mg and at 60 mg it is way more NE based? Would explain the coldness, urinary retention, reflexes etc. Iunno, it was bad though.
>
>
> With Nardil, I experienced an antidepressant effect when I either increased or decreased the dosage. The improvement was, however, extremely short-lived. It would last from a few hours to a few days. I found myself adjusting the dosage of Nardil daily in order to stay in the "zone" of response. Did you know that one can feel better transiently when the dosages of various drugs are decreased? These include, but are not limited to, TCA, MAOI, Depakote, and Lamictal. Those are just the ones that affected me that way. In fact, severe mania can result from drug discontinuation. I experienced my worst mania as the result of Nardil discontinuation.
>
> To me, it sounds like you might not have allowed your CNS to reach an equilibrium at the higher dosage of Nardil. For having followed a pattern of continually adjusting the dosage of Nardil up and down, you have become sensitized to many of its side effects. Urinary retention is an example of a side effect that can worsen by jumping up and down in dosage. You are not allowing time for the drug to produce its therapeutic antidepressant effect and only make side effects worse.
>
> If you can't maintain an acceptable antidepressant response to 45 mg/day of Nardil taken daily for 4 - 6 weeks, I would suggest that you remain at that dosage steadily for 1 - 2 weeks before making any changes. You could then increase the dosage by 7.5 mg/day every 1 - 2 weeks as tolerated until you find an effective dosage in the range of 60 - 90 mg/day.
>
> How much time and effort you invest in using Nardil to treat your illness might depend upon how many drugs you have left to try. If there a bunch of treatments yet untried, then perhaps it makes sense to change drugs now. If your alternatives are now limited because of previous treatment failures, it makes sense to give Nardil more time, particularly since you are at least partially responsive to it.
>
> When one hits an effective dosage of Nardil, they often feel weird for a few days to a week. It is not a return of depression, but rather a brain fog that can flatten affect and produce cognitive difficulties. It just doesn't feel "right". However, this can be a good sign that biological events are occurring that are producing a more complete antidepressant response.
>
>
> - ScottHi Scott, as I said in a previous post, I went ahead and upped my dose to 60mg/day, which was the dose that led to remission the first time I was on Nardil. At that time I had very quickly been ramped up to that dose, increasing my dose by 15mg/day until I reached 60mg/day, so it was just a matter of days.
I do plan to remain on the Nardil, at 60mg/day, plust the Nortriptyline, until I see my pdoc in a week and a half. We'll see what he has to say at that point. And to answer your post, I have absolutely no other drugs left to try. :(
Thanks for all the advice, advice from you really means a lot cos I know you really know your stuff.
Kat
Posted by TemporarilyBob on October 26, 2012, at 15:44:49
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 14:51:28
> Hi, nice of you to post. My official diagnosis is major depressive disorder. And I'm treatment resistant.
Been there, been called that. That's why I asked. And anxiety is an issue for you if I remember correctly? Just want to check again before I open my mouth. Or unleash my fingers. Whatever..... ;)
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