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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by gilmourr on December 31, 2012, at 17:18:13
New combo. Came off Nardil.
Just started 25 mg of Lamictal.
I need info on ppl that have discontinued a MAOI and added a SSRI. How long did you wait? I know I got away with a 10 day wash out without having any serotonin syndrome issues.
This time I want to start after a 7 day wash out because the whole 14 day washout is kinda ridiculous.
What is the earliest you've gotten away with switching from a MAOI to SSRI?
Posted by baseball55 on December 31, 2012, at 19:04:13
In reply to MAOI to SSRI, what is the avg washout, 7-10 days?, posted by gilmourr on December 31, 2012, at 17:18:13
All docs I saw said a minimum 14 day washout.
Posted by SLS on December 31, 2012, at 22:49:50
In reply to MAOI to SSRI, what is the avg washout, 7-10 days?, posted by gilmourr on December 31, 2012, at 17:18:13
> New combo. Came off Nardil.
>
> Just started 25 mg of Lamictal.
>
> I need info on ppl that have discontinued a MAOI and added a SSRI. How long did you wait? I know I got away with a 10 day wash out without having any serotonin syndrome issues.
>
> This time I want to start after a 7 day wash out because the whole 14 day washout is kinda ridiculous.I think "ridiculous" is a rather strong word for exercising caution in the face of uncertainty.
> What is the earliest you've gotten away with switching from a MAOI to SSRI?If I or someone else were to tell you that waiting two days was sufficient, how would that affect your decision-making process? Would that convince you to wait only two days?
I never tried two days. The reason I never tried two days was because it can take as long as two weeks for the recovery of MAO activity. It takes that long for the body to synthesis new enzymes.
7 days? 10 days?
I don't know what would be safe for you given your individual biology. I just think that you should not make the mistake of taking my word for it. If the 3 days is that important to you, then take the next 7 days to do more research.
I wait 14 days. But that's just me.
- Scott
Posted by Phillipa on January 1, 2013, at 9:37:08
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days? » gilmourr, posted by SLS on December 31, 2012, at 22:49:50
Since havn't taken an Maoi I didn't want to give misinformation but from my reading on here and elsewhere I agree that 14 days is what is recommended. I seriously wouldn't take a chance with your body and health. Phillipa
Posted by jono_in_adelaide on January 1, 2013, at 17:33:35
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days? » gilmourr, posted by SLS on December 31, 2012, at 22:49:50
I'd say waiting 2 weeks would be a damned site better than death
Posted by baseball55 on January 1, 2013, at 18:59:18
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days?, posted by jono_in_adelaide on January 1, 2013, at 17:33:35
I had a friend who was taking an SSRI without success and when I suggested she take an MAOI, she said she couldn't deal with the washout. Which puzzled me. If the SSRI's not working, why not go two weeks without it and try something that might work? The same goes for the opposite situation. If the MAOI's not working, why continue taking it or try to push the envelope on the washout. Just wait it out. You'll be no better or worse off than you already are.
Posted by metamorphosis on January 1, 2013, at 22:09:16
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days?, posted by baseball55 on January 1, 2013, at 18:59:18
Prozac is one exception. Fluoxetine is unique because of its long half-life and the long half-life of its active metabolite norfluoxetine. Fluoxetine has a half-life of 4-6 days and its active metabolite, norfluoxetine, has a half-life of 4-16 days. So, it is usually advised to give Prozac a 25 day washout period.
Posted by gilmourr on January 3, 2013, at 3:39:04
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days? » gilmourr, posted by SLS on December 31, 2012, at 22:49:50
If you said two days I wouldn't but if you said you had in 7 days I probably would since I got away with going from Nardil to Cymbalta last time in 10 days.
Tried 50 mg of Zoloft today (8th day of washout) but it might've caused a mild reaction. After 4 hours of dosing I felt pretty damn restless, anxious, dry heaved a bit and my stomach was growling a lot (probably from serotonin).
Regardless I monitored my temp (which it was fine), no large dilated pupils or confusion. It stopped within 4 hours.
I guess I'll try again in two more days.
Posted by gilmourr on January 3, 2013, at 3:44:01
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days?, posted by metamorphosis on January 1, 2013, at 22:09:16
Right now I'm doing lamictal + zoloft + maybe 1-2 mg of abilify later on for major depression and panic.
If this doesn't work I'm going to probably try nardil again (which would be in 3 months if this fails). Reason I might give it a shot is because I think being 4 times over the limit of B6 screwed with it and possibly the amlodipine interaction when I started it might've messed it up.
ANYWAYS, question. On nardil the worst symptom I have is shivers/cold intolerance. This happens usually at 60 mg, but on my 3rd nardil trial it happened at 45 mg.
- Do you think these shivers are caused by norepinephrine or a metabolite of nardil? Cymbalta and Parnate made me extremely cold. And parnate is more NE based I believe.
- Would lithium handle this? I heard it converts Norepinephrine to serotonin. If there's a better balance it would get rid of the coldness and help with any insomnia + give me the great efficacy of nardil.
Thoughts?
Posted by SLS on January 3, 2013, at 7:19:23
In reply to SLS you've tried lithium and nardil right?, posted by gilmourr on January 3, 2013, at 3:44:01
> Right now I'm doing lamictal + zoloft + maybe 1-2 mg of abilify later on for major depression and panic.
Good luck with that. I would not abandon the Zoloft until you also try adding nortriptyline or desipramine. Tricyclic antidepressants (TCA) have long been ascribed anti-panic properties, especially imipramine
> If this doesn't work I'm going to probably try nardil again (which would be in 3 months if this fails).
3 months is an interesting choice. Some of my doctors have found that a 3-month holiday from Nardil after its pooping-out allows for a return of a robust response when the Nardil is restarted.
> Reason I might give it a shot is because I think being 4 times over the limit of B6 screwed with it and possibly the amlodipine interaction when I started it might've messed it up.
I guess it's possible. I am aware of the Nardil - B6 interaction. However, I have yet to actually witness someone lose an antidepressant effect because of it. I would take a rechallenge to confirm such a thing. That said, I agree with you that it makes sense not to take megadoses of B6
> ANYWAYS, question. On nardil the worst symptom I have is shivers/cold intolerance.
For how long did you experience these things? How many weeks did you remain on Nardil once they first appeared. I ask this because I have experienced this transiently with both Nardil and Parnate. I would actually continue to increase the dosage despite the appearance of this phenomenon. You might be caught "in-between" response and relapse.
> - Do you think these shivers are caused by norepinephrine or a metabolite of nardil? Cymbalta and Parnate made me extremely cold.
I think it makes sense to have your thyroid checked.
> And parnate is more NE based I believe.
I agree, although a serotonin syndrome drug interaction is no less a risk with Parnate than it is with Nardil.
> - Would lithium handle this?Taking low-dose lithium wouldn't hurt to try as an augmenter (300 - 600 mg/day).
> I heard it converts Norepinephrine to serotonin.
Lithium does not convert norepinephine into serotonin.
> If there's a better balance it would get rid of the coldness and help with any insomnia + give me the great efficacy of nardil.
Lithium does a great many things in the brain, one of which is an increase in the release of serotonin. So, I guess you could theorize that there might be a better balance. Your reasons for taking lithium are good ones.
> Thoughts?
:-)
- Scott
Posted by SLS on January 3, 2013, at 7:25:13
In reply to Re: MAOI to SSRI, what is the avg washout, 7-10 days?, posted by gilmourr on January 3, 2013, at 3:39:04
Hi Gilmourr.
Thank you for objectively reporting your experience. It will help others a great deal.
> If you said two days I wouldn't but if you said you had in 7 days I probably would since I got away with going from Nardil to Cymbalta last time in 10 days.
>
> Tried 50 mg of Zoloft today (8th day of washout) but it might've caused a mild reaction. After 4 hours of dosing I felt pretty damn restless, anxious, dry heaved a bit and my stomach was growling a lot (probably from serotonin).
>
> Regardless I monitored my temp (which it was fine), no large dilated pupils or confusion. It stopped within 4 hours.
>
> I guess I'll try again in two more days.Good luck. I tolerated Zoloft 200 mg/day pretty well, except for the appearance of "brain-fog". This persisted for a two week period before I decided to discontinue the drug.
- Scott
Posted by gilmourr on January 3, 2013, at 8:25:27
In reply to Re: SLS you've tried lithium and nardil right? » gilmourr, posted by SLS on January 3, 2013, at 7:19:23
> > Right now I'm doing lamictal + zoloft + maybe 1-2 mg of abilify later on for major depression and panic.
>
> Good luck with that. I would not abandon the Zoloft until you also try adding nortriptyline or desipramine. Tricyclic antidepressants (TCA) have long been ascribed anti-panic properties, especially imipramine
>
> > If this doesn't work I'm going to probably try nardil again (which would be in 3 months if this fails).
>
> 3 months is an interesting choice. Some of my doctors have found that a 3-month holiday from Nardil after its pooping-out allows for a return of a robust response when the Nardil is restarted.
>
> > Reason I might give it a shot is because I think being 4 times over the limit of B6 screwed with it and possibly the amlodipine interaction when I started it might've messed it up.
>
> I guess it's possible. I am aware of the Nardil - B6 interaction. However, I have yet to actually witness someone lose an antidepressant effect because of it. I would take a rechallenge to confirm such a thing. That said, I agree with you that it makes sense not to take megadoses of B6
>
> > ANYWAYS, question. On nardil the worst symptom I have is shivers/cold intolerance.
>
> For how long did you experience these things? How many weeks did you remain on Nardil once they first appeared. I ask this because I have experienced this transiently with both Nardil and Parnate. I would actually continue to increase the dosage despite the appearance of this phenomenon. You might be caught "in-between" response and relapse.
>
> > - Do you think these shivers are caused by norepinephrine or a metabolite of nardil? Cymbalta and Parnate made me extremely cold.
>
> I think it makes sense to have your thyroid checked.
>
> > And parnate is more NE based I believe.
>
> I agree, although a serotonin syndrome drug interaction is no less a risk with Parnate than it is with Nardil.
>
> > - Would lithium handle this?
>
> Taking low-dose lithium wouldn't hurt to try as an augmenter (300 - 600 mg/day).
>
> > I heard it converts Norepinephrine to serotonin.
>
> Lithium does not convert norepinephine into serotonin.
>
> > If there's a better balance it would get rid of the coldness and help with any insomnia + give me the great efficacy of nardil.
>
> Lithium does a great many things in the brain, one of which is an increase in the release of serotonin. So, I guess you could theorize that there might be a better balance. Your reasons for taking lithium are good ones.
>
> > Thoughts?
>
> :-)
>
>
> - Scott
Thanks for all of the responses SLS!I actually have nortryptiline on hand, I'm just hesitant to use it to augment anything (and waste anymore time) because of my past history with norepinephrine meds. Cymbalta made me suicidal, effexor gave me 165/120 BP at 75 mg I believe, parnate made me hypothermic. And nortryptiline is pretty potent on NE if I recall correctly.
I like that you've heard about a 3 month break from nardil. Because I was on it... and it was working 80% on anxiety, 60% on depression. I literally thought I was going to be in remission, but then I bumped it up to 60 mg, and in 2 weeks major major depression came back and I was so cold I had to go see my doctor because of my limbs being like blue. I don't think higher is an option for me.
When I came off nardil for 15 days and restarted it didn't work that well, and it stopped working completely for the first time ever while I was still on 45 mg.
(But then again, this was the only time I took B6 everyday, and my levels were 4 times above the limit). There was a thread you participated in a while back with ron hill and two other users where they said they became suicidal or depressed after using B6 or something too.As for the shivers...they started on day 10 and went until day 50. I wasn't cold, I just kept shivering and having chills 24/7. Very odd. This happens to me at 60 mg+, but never on 45 mg, which was why I was confused this past Nardil trial.
Checked my thyroid twice, not sure if one was while taking nardil (can nardil affect my thyroid) but the tests were around 2.0 (can't remember if they were while I was on nardil).
True, I just remember this from wiki "interacts with a number of neurotransmitters and receptors, decreasing norepinephrine release and increasing serotonin synthesis." So it doesn't convert it like you said. But the end result will be more serotonin and less NE then right? You commented on the serotonin part but not the NE part.
Thanks SLS big time. Really trying to kick this mental health issue to the curb. It's been almost 2 years since it started out of nowhere.. just horrible genes I guess? I do have a spot for rTMS very soon. I know it helps release SERT and dopamine, but I'm not sure if it affects your vagus nerve for more GABA, because that would be an incredible treatment.
This is the end of the thread.
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