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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 49. Go back in thread:
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..... ;)
Posted by Hugh on October 26, 2012, at 15:57:48
In reply to Re: Menninger, posted by jono_in_adelaide on October 25, 2012, at 22:13:36
> Well, they cured Richard Carpenter of his Qualude habit, and its where they sent the posessed kid in The Exorcist!
It's where Elmer Green, author of Beyond Biofeedback, did his pioneering work in the '60s and '70s. William Gibson, author of The Miracle Worker, wrote a novel based on the Menninger Clinic called The Cobweb. Both books are well worth reading.
Posted by phidippus on October 26, 2012, at 17:10:44
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 26, 2012, at 14:46:10
Did it poop out?
Eric
Posted by ChicagoKat on October 26, 2012, at 20:28:07
In reply to Re: I give up » ChicagoKat, posted by TemporarilyBob on October 26, 2012, at 15:44:49
> > 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..... ;)Yes, anxiety is an issue for me. That is the one thing the Nardil is helping with, thank goodness. I still get 'breakthrough' anxiety though, but I have gabapentin for that and it really helps.
Kat
Posted by ChicagoKat on October 26, 2012, at 20:29:40
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 17:10:44
> Did it poop out?
>
> EricDo you mean the Nardil? If so, yes, it seems to be not working :(
Posted by phidippus on October 26, 2012, at 21:23:50
In reply to Re: I give up » phidippus, posted by ChicagoKat on October 26, 2012, at 20:29:40
The Lexapro-did it poop out?
Eric
Posted by phidippus on October 26, 2012, at 21:28:07
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 20:28:07
Let me get this straight, Nardil helps with the anxiety but not the depression.
What is the nature of your depression?
Eric
Posted by TemporarilyBob on October 27, 2012, at 9:23:51
In reply to Re: I give up » TemporarilyBob, posted by ChicagoKat on October 26, 2012, at 20:28:07
> > > 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..... ;)
>
> Yes, anxiety is an issue for me. That is the one thing the Nardil is helping with, thank goodness. I still get 'breakthrough' anxiety though, but I have gabapentin for that and it really helps.
> KatWell, just sharing my experiences then. Been diagnosed as Major Depressive Disorder longer than I can remember, but eventually got into treatment because of my anxiety. Still, was treated for depression with meds, not anxiety. Got manic, got paranoid, got psychotic, had anxiety so bad I was hallucinating -- I recall walking down Central Park South in NYC ... southern border of Central Park with highrises on the side opposite of the park ... and recall seeing the building bending over from the top as if they were out to collapse on top of me. Had to run to a subway entrance to get underground and safe. Then, about 7 years ago, finally had a pdoc up with current research who suggested bipolar. Not I or II but bipolar spectrum. It's evolved somewhat over the years, docs don't quite agree on the terminology, from "there is a spectrum of types of bipolar disorder" to right now some calling for a bipolar III and even a bipolar IV classification. I'm not up on the literature myself, I'm mostly just sharing what my latest pdoc has said to me about me. (1) That there are types of bipolar disorder that do not involve mania, unless it's triggered by substance use (including prescription meds). (2) That some docs still scoff at this, the research base is that thin. (3) That people who fall into this category and get medicated as traditionally done for either depression or anxiety can wind up worse for it, no matter the good intentions of their pdocs.
So, with me hearing familiar things in your story I just wanted to raise this idea of a bipolar dx as a possibility for you. For me, right now, it's meaning nortriptyline and seroquel. I also have clonazepam because it's helped with my anxiety in the past but my current pdoc is really hesitant about using benzos to treat my anxiety -- seroquel has been shown to be effective against anxiety but the FDA won't approve it for single drug therapy against anxiety because of it's side-effect profile compared to traditional anti-anxiety meds. As always, YMMV, but it sounds like you're at the end of your rope so I thought I'd toss out a different one.
Posted by ChicagoKat on October 27, 2012, at 16:34:17
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 21:23:50
> The Lexapro-did it poop out?
>
> EricAs far as helping my depression yes, it pooped out. But it still helps my anxiety.
Posted by ChicagoKat on October 27, 2012, at 16:36:22
In reply to Re: I give up » ChicagoKat, posted by phidippus on October 26, 2012, at 21:28:07
> Let me get this straight, Nardil helps with the anxiety but not the depression.
>
> What is the nature of your depression?
>
> EricI have major depression, treatment-resistant. I was at one time told my depression is of the atypical variant, even though I now have trouble sleeping...it used to be the opposite for me, I could sleep forever.
Posted by ChicagoKat on October 27, 2012, at 16:40:41
In reply to Re: I give up, posted by TemporarilyBob on October 27, 2012, at 9:23:51
Thanks for sharing your experience. I will broach the possibility of some sort of bipolar thing going on with me, but I can tell you I've used Lithium in the past and it did nothing for me. All the pdocs and therapists I've ever seen for decades now say I have unipolar depression
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