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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Daniell on April 30, 2013, at 15:27:46
I've been on Nardil 45mg for 2 weeks, 60mg for 2 weeks. Then 3 days ago I woke up with chills, diarrhea, high blood pressure, fast pulse, but worst of all extreme agitation e.g. head scratching, face scratching, teeth chattering, and a deep feeling of restlessness in my body. Worse than that I've been extremely depressed, to a point where I have only been once or twice in my life before, but combined with the agitation/inner restlessness I have felt suicidal urges. I have had suicidal thoughts before as part of depression but never planning exactly how I would do it and writing a detailed note. As I wrote it I cried and seemed to have some sort of panic attack or something as I couldn't seem to breathe and was gasping for breath. I started to imagine exactly how I would do it and how difficult it would be, even in an apparently 'peaceful' way. I looked death in the face and I was frightened beyond belief. I want to kill myself so badly on Nardil but I am so scared of death, and also what if I don't suceed I might end up immobile for the rest of my life, mentally tortured but unable to do anything about it.
But I don't have the mood to get the necessary things to kill myself peacefully, so I then in despair as I couldn't take the pain I looked in the kitchen for butchers knives and again, imagined myself doing it, the gruesome way and once again not guaranteed. I rang my hospital and they didn't take me seriously, they said my thoughts were 'of my own volition' and not their problem, then they hung up. I tried two more times but again they told me to just wait until my outpatient appointment, they would not admit me. If they felt this and had this pain themselves, they would know it's an emergency. I always thought serious suicidal thoughts were an emergency anyway, especially when the disturbing 'urge' is there from the extreme agitation on Nardil. I'm in the UK so we only have the NHS which is a public service, this is what it is like.
I used to take venlafaxine before and in the first 2 weeks or so it was very uncomfortable but diazepam solved it. With Nardil, nothing seems to work. I use diazepam and quetiapine to sleep and sometimes in the day, both of them at best take the edge of things but the thoughts and severe depression remain. I had depression before this obviously so I need a strong antidepressant, hence Nardil, but is it right for me? I've heard that it can take a week or two for receptors to downregulate so I should wait it out in theory, what do you guys think?
I would need to be sedated and monitored quite closely if I keep taking Nardil. For the past 2 days I've had to stop. From what I've read I must have had a mild case of serotonin syndrome, which surely means that MAO is inhibited to quite a high degree? I'm only around 55 Kg and I was thinking quite possibly I am sensitive to this medicine such that a lower dose might be better?
Also, people say that once 80-90% MAO inhibition is achieved, therapeutic response will be seen. Obviously that must not be the case for me. I would have thought that once MAO inhibition is maximal and monoamines are at high levels, things actually should get worse for a while after that until receptors downregulate and the brain adapts as a whole?
What should I do? Will Nardil work for me if I wait for the agitation/severe depression to go away then stick it out at a lower dose? Any suggestions would be greatly appreciated...
Posted by Tomatheus on April 30, 2013, at 16:17:21
In reply to Nardil agitation, depression, suicidal thoughts, posted by Daniell on April 30, 2013, at 15:27:46
Daniell,
I think that with the way that the Nardil that you've been taking has been affecting you that a medical professional should be monitoring you closely. Have you spoken with your prescribing doctor since you started getting the suicidal thoughts, agitation, and severe depression? If you haven't, I think that you should.
If I were taking Nardil and experiencing the things that you've reported experiencing in your post, then I don't think that I'd continue to take the medication if I had any choice in the matter. I know that medications sometimes have some unpleasant effects before their therapeutic benefits set in (and that's assuming that they do set in) and that in some cases it might be worth putting up with the unpleasant effects until they fade, but for me when the effects go from being unpleasant to intolerable (and I think that in your case, the effects that you've been noticing definitely sound like they're intolerable) I won't go on with the medication trial.
But seriously, the best person to go to for instructions on how to proceed is your prescribing doctor. And if you feel uncomfortable with what your doctor tells you to do, then do what you can to get another medical professional's opinion. You may understandably feel frustrated with the medical profession after the hospital that you called wouldn't admit you, but with the things that you've been experiencing lately, I think that you need to continue to reach out for help from those who are most qualified to assist you. And those individuals would be your doctor and any other mental health professionals who you may be seeing.
I'm really sorry that you're going through the things that you've written about here, and I hope that you find a way to get the assistance that you need from a medical/mental health professional who can attend to your needs and advise you properly.
T.
Posted by rose45 on May 2, 2013, at 17:08:24
In reply to Nardil agitation, depression, suicidal thoughts, posted by Daniell on April 30, 2013, at 15:27:46
I agree that you should speak to your doctor, but in my case, I also felt terrible on nardil for the first 6 weeks, very suicidal etc.... and then suddenly I began to feel better, and it took maybe one week or two, for the mood to change completely. This happened quite often, because I had the tendency to try to reduce the dose from 45mg which was my prescribed maintenance dose,to 30 mg once I was ok, but found that I then had to up the dose again, and go through that hell every time. Im no longer on nardil now, because it stopped working for me after about 22 years. I found it a tricky drug for all those reasons, but when it worked, it really worked well.
Posted by rose45 on May 2, 2013, at 17:11:34
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 2, 2013, at 17:08:24
Re. sleep,even though I have had problems of insomnia for many years,prior to taking nardil, I did find that once the nardil started to work - after about 4 weeks on 60mg, and the dosage was then reduced to 45mg, I was able to sleep most of the time without sleep medication.
Posted by Daniell on May 2, 2013, at 18:05:23
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by Tomatheus on April 30, 2013, at 16:17:21
All I could do was take downers, I rang my hospital 3 times, my GP and my psychologist. Today after stopping the Nardil for 3 days I saw a doctor who said I had a mild psychosis. I was extremely scared at the thoughts I was having, and the intense feeling in my body 'urging' me to do it.
I'm wondering if I go on Lithium to stabilize me and try a very low dose of Nardil eg 30mg for a long time it might work? I don't weigh much at all so 60mg was clearly too much for me. When I was at 45mg I was fine.
Posted by Daniell on May 2, 2013, at 18:14:23
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 2, 2013, at 17:08:24
> I agree that you should speak to your doctor, but in my case, I also felt terrible on nardil for the first 6 weeks, very suicidal etc.... and then suddenly I began to feel better, and it took maybe one week or two, for the mood to change completely. This happened quite often, because I had the tendency to try to reduce the dose from 45mg which was my prescribed maintenance dose,to 30 mg once I was ok, but found that I then had to up the dose again, and go through that hell every time. Im no longer on nardil now, because it stopped working for me after about 22 years. I found it a tricky drug for all those reasons, but when it worked, it really worked well.
Hmm...Rose, that's extremely interesting. It's what I was thinking as well. Thankyou so much for sharing that with me.
I find it interesting though why you said reducing the dose would make you feel suicidal etc., I thought this only occurred at the start of medications where the brain is flooded with neurotransmitters and it takes the brain time to adapt?
Posted by Tomatheus on May 2, 2013, at 18:32:11
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by Daniell on May 2, 2013, at 18:05:23
Daniell,
I think it's conceivable that taking Nardil with lithium might be helpful. I don't know if you would get sufficient antidepressant benefits from 30 mg of Nardil, being that the dose is considered to be sub therapeutic, but at the same time, I wouldn't completely rule out the possibility that you might respond to 30 mg of Nardil with lithium.
What did the doctor that you saw advise for you to do, as far as your medications are concerned?
Some other members here with more knowledge on what medications can be combined with MAOIs might be able to offer you better advice on what to expect from 30 mg of Nardil with lithium and on what to do than I can. I will say that it's my understanding that taking lithium with Nardil is a strategy that seems to make sense, although the likelihood that you'll respond to 30 mg of Nardil (with or without lithium) is probably rather slim.
I wish you the best of luck with finding a medication or combo that you'll find to be both beneficial and tolerable.
T.
Posted by Daniell on May 2, 2013, at 20:02:32
In reply to Re: Nardil agitation, depression, suicidal thoughts » Daniell, posted by Tomatheus on May 2, 2013, at 18:32:11
> Daniell,
>
> I think it's conceivable that taking Nardil with lithium might be helpful. I don't know if you would get sufficient antidepressant benefits from 30 mg of Nardil, being that the dose is considered to be sub therapeutic, but at the same time, I wouldn't completely rule out the possibility that you might respond to 30 mg of Nardil with lithium.
>
> What did the doctor that you saw advise for you to do, as far as your medications are concerned?
>
> Some other members here with more knowledge on what medications can be combined with MAOIs might be able to offer you better advice on what to expect from 30 mg of Nardil with lithium and on what to do than I can. I will say that it's my understanding that taking lithium with Nardil is a strategy that seems to make sense, although the likelihood that you'll respond to 30 mg of Nardil (with or without lithium) is probably rather slim.
>
> I wish you the best of luck with finding a medication or combo that you'll find to be both beneficial and tolerable.
>
> T.I was just wondering why exactly MAOIs need such high doses at the start. Surely if I take 30 per day the enzyme will be inhibited sufficiently in the end?
I was hoping to start on 15 per day and increase very cautiously to 30, and if no response after 6 weeks perhaps 37.5, and so on.
Yes, I see that, how do I ask these MAOI specialists?
Posted by Tomatheus on May 2, 2013, at 20:53:03
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by Daniell on May 2, 2013, at 20:02:32
> I was just wondering why exactly MAOIs need such high doses at the start. Surely if I take 30 per day the enzyme will be inhibited sufficiently in the end?
I know that there are studies that found Nardil to be lacking in efficacy that have been criticized for using doses that are too low. It's been a little while since I've read any studies on Nardil, but if I recall correctly, the studies that found Nardil to be an effective antidepressant used high doses of the medication, and I suspect that that's why doctors generally try to get their patients up to higher doses as quickly as they can.
I tend to agree with your logic that if 30 mg of Nardil would work as a maintenance dose, then it would make some sense to just start off at 30 mg instead of starting out at a high dose only to bring the dose down. However, most of the controlled studies that have been done on Nardil have only followed patients for relatively short periods of time (no more than 2-3 months, if my understanding is correct), and I don't think that any of these short-term studies found 30 mg of Nardil to be an effective dose. That's not to say that there's absolutely no chance that you'll respond to 30 mg of Nardil, but the published literature on the medication doesn't seem to support using such a dose, at least not initially.
Other members here with information to add about Nardil or other MAOIs are welcome to contribute to the discussion. I would imagine that if others have some information that they would like to share that they'll share it.
T.
Posted by Daniell on May 2, 2013, at 22:14:36
In reply to Re: Nardil agitation, depression, suicidal thoughts » Daniell, posted by Tomatheus on May 2, 2013, at 20:53:03
Yes, it could be that it takes longer to reach maximal MAO inhibition e.g. 80-90%+
but hopefully while monoamines gradually increase, the brain should have time to make the adaptive changes?
Because in theory, if 15mg or 15mg every other day can maintain that level of inhibition, then 30mg per day will reach there eventually, just a lot slower.
Or is the 80-90% inhibition level the point at which the brain 'suddenly' floods with more monoamines... I can't see that to be true...
Posted by rose45 on May 3, 2013, at 17:11:22
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by Daniell on May 2, 2013, at 22:14:36
The standard way of augmenting nardil, is to start with 15 mg, after one week increase to 30,then after another week to 45,and then after one week to 60 mg. I often found 60 mg pretty unbearable, but they kept me on that dose for 4 weeks appr. and then reduced to 45 mg. This is how they did it in the maudsley hospital in london, which is the leading psychiatric hospital in this country.
I went through that process several times, because , as I mentioned, I kept trying to decrease the dose, because of all the side effects, and because I was feeling so much better - but unfortunately most of the time I had to keep on a maintenance dose of 45 mg. During the last 5 years I was on nardil, I managed to feel good on just 30 mg, I was meditating a lot etc.... however at the end of the 5 years the nardil stopped working and I had a horrendous six months figuring out what to do next. I am now on parnate and feeling much better again.
I will be happy to answer any other questions you may have. I was on nardil for 22 years, so know quite a lot about how it works, for me anyway.
Posted by rose45 on May 3, 2013, at 17:16:53
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 3, 2013, at 17:11:22
ps it was suggested to me by other psychiatrists to go on lithium as well, because the nardil did make me rather manic at times. However, at the Maudsley hospital they always told me that it is better, in principle to stay on one drug, and that is what I chose to do.
When the nardil stopped working and I broke down totally, I was put on seroquel, which I hate. They then said they wanted to put me on lithium but I refused, and insisted on parnate. My present psychiatrist has never prescribed parnate to anyone, and neither have any of his colleagues, but luckily he could see that I have my own personality, and he compromised with me. He is naturally thrilled now, because of the great result with parnate. I was totally suicidal when the nardil stopped working. Unfortunately these drugs dont cure anything, and I suspect that long term use can sometimes lead to problems, but in my case, I didnt have a choice.
Posted by Daniell on May 3, 2013, at 21:58:02
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 3, 2013, at 17:16:53
Hi Rose,
Thanks for your input.
I was wondering if 60mg was more than 1mg/kg for you? It was just over that for me and was too much.
Wow, you're lucky to have got into the Maudsley hospital, I would but I don't live in that area. I don't have the funds to get the right treatment there.
What is your diagnosis if you don't mind me asking? Mine is bipolar ii so it's not a surprise Nardil made me agitated.
When you started on Nardil, particularly higher doses, was there a period you felt worse before you got better? If so, how long?
Over the years, was the effect of Nardil pretty consistent? For some people I hear it's quite temperamental.
Cheers,
Daniell
Posted by rose45 on May 4, 2013, at 16:23:56
In reply to Re: Nardil agitation, depression, suicidal thoughts » rose45, posted by Daniell on May 3, 2013, at 21:58:02
Hi Daniell,
I got into the maudsley in 1990,on the nhs, and i didnt even live in that area. It was all much easier in those days. When I broke down again recently, after the nardil stopped working, my gp wasnt even sure where to send me because the whole system has been divided into various teams, with different names, and there was no way I would be admitted into hospital as there arent enough beds.
There was no talk at the maudsley re mg/weight... it was just as i described it to you. I weigh approx 70 kg.
My diagnosis at the time was depression. But since I have become ill again, I told the latest psychiatrist (at the Chelsea and Westminster, which is my local hospital) that nardil made me very manic, so they have decided that Im bi- polar, but I dont think I am.It was just that the nardil affected me that way. Parnate doesnt seem to be having the same effect re. making me manic. Yes nardil made me agitated also, and many friends complained that I talked too much when on the nardil......
I felt terrible on the nardil all the way up to 60 mg. It was only after being on 60 mg for 3-4 weeks that I would feel better, and then decrease to 45 mg. You may react differently, but that was my experience every time, and unfortunately, as you say, it is a temperamental drug, in that its not easy to just reduce the dose if you feel you are getting agitated or hyper, because just reducing by one tablet can make you really very anxious and depressed again - at least it did for me. And also the effect is not constant, so there is a tendency to want to play around with the dosage, but it isnt easy to handle at all. Having said all that, it did change my life for the better, and I dont know how I would have survived without it. Now Im on parnate, and if that ever gives up on me I really dont know what I will do, because only the MAOIs seem to work for me.. Do let me know how things go for you.. I do find it interesting.
Posted by rose45 on May 4, 2013, at 16:32:59
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 4, 2013, at 16:23:56
I have just re-read your post and note that you are also taking seroquel. They put me on seroquel at the chelsea and westminster, and I swear that drug made me suicidal. I hate it. They want me to stay on it, because they think Im bipolar, but I have been steadily decreasing the dose, and feel much much better, and want to stop taking it altogether soon.
The insomnia is a problem on nardil at the beginning. At the maudsley, they refused to give me anything for sleep, which increased my agony, but I did find that once the nardil started working, I managed to sleep without meds. It was just always a difficult 6-7 weeks leading up to that point.
Posted by rose45 on May 4, 2013, at 16:37:55
In reply to Re: Nardil agitation, depression, suicidal thoughts » rose45, posted by Daniell on May 3, 2013, at 21:58:02
PS If nardil doesnt work out for you , you might try parnate. It seems to have far fewer side effects, and stopped my suicidal feelings within a couple of weeks. You would have to come off the nardil for 2 weeks before starting on parnate.
By the way, Im surprised any psychiatrist in the uk has put you on maois... my psychiatrist, and all his colleagues say this was a first for them. I was lucky that he was open minded enough to let me try, and he was really quite amazed at the quick result.
Posted by Daniell on May 5, 2013, at 4:13:13
In reply to Re: Nardil agitation, depression, suicidal thoughts, posted by rose45 on May 4, 2013, at 16:23:56
Hi Rose,
I can't believe they didn't give you anything to sleep at Maudsley, I would die if that happened as I can't get to sleep at home enough as it is let alone at a hospital.
Seroquel makes me depressed in the morning, sometimes suicidal, yes. You're not the only one. Doctors seem to think it works for depression or bipolar or something, I don't know, it makes me worse but it is the best for sleep.
My psychiatrist never uses it, has only used it once or twice in the past and that was on the advice of someone else, it's great that he was willing to let me try. Now after this bad episode I am afraid he won't let me try MAOIs again because they are 'too dangerous'. So if I can update you with regard to my MAOI usage, I will. But it may not be until after I have gone on Lithium.
:(
Posted by rose45 on May 5, 2013, at 14:57:03
In reply to Re: Nardil agitation, depression, suicidal thoughts » rose45, posted by Daniell on May 5, 2013, at 4:13:13
Yes do let me know how you get on with lithium. They kept wanting me to go on it, but I refused... just instinctively - maybe I was wrong.
Im decreasing the seroquel and hoping that I will somehow be able to sleep with the occasional benzo.
Yes the maudsley refused to give me anything to sleep. In those days, it was benzos, and my doctor malcolm lader was the one who became famous for exposing the dangers of benzos.
For me, I always found that temazepam works best for sleep - but you cant take it all the time, as it will stop working.
Good luck with everything and do keep me informed.
Posted by ed_uk2010 on May 26, 2013, at 9:40:30
In reply to Nardil agitation, depression, suicidal thoughts, posted by Daniell on April 30, 2013, at 15:27:46
Your reaction on 60mg Nardil does resemble serotonin syndrome. Have you taken any other antidepresssants recently? Or tramadol (Zydol, a painkiller), or any other prescription medicines, over the counter medicines (esp. cough/cold medicines), supplements or herbal medicines?
On the day you woke up so unwell, or in the days before, had you taken any other tablet/capsule of any type? The apparently abrupt onset of your severe symptoms is suggestive of a drug interaction. Might you have taken a venlafaxine or SSRI tablet by mistake? That might cause a similar reaction for a person on Nardil.
Nardil has some serious drug interactions so you need to be very careful before taking other medications whilst on it, and for 2 to 3 weeks after stopping it. Similarly, certain other medicines such as SSRI antidepressants need to be stopped for several weeks before starting Nardil (the exact time depending on the specific medication).
>I must have had a mild case of serotonin syndrome, which surely means that MAO is inhibited to quite a high degree?
Yes, I expect that it was.
>I'm only around 55 Kg and I was thinking quite possibly I am sensitive to this medicine such that a lower dose might be better?
Your reaction to 60mg suggests that 45mg would be the maximum safe dose for you to take, unless your reaction to 60mg was due to a drug interaction.
>Also, people say that once 80-90% MAO inhibition is achieved, therapeutic response will be seen.
They do, but I wouldn't really consider that too much because it's impossible to know exactly what Nardil is doing in your brain. You can only assess response according to your symptoms.
>Will Nardil work for me if I wait for the agitation/severe depression to go away then stick it out at a lower dose?
Your symptoms on 60mg suggest either of 2 possibilities:
1. That 60mg was far too much for you personally.
2. You experienced a drug interaction.You should not have to endure such severe symptoms. If you wish to restart Nardil, you should start at a low dose such as 15mg twice a day and then increase gradually up to a maximum of 15mg three times a day. Considering your low bodyweight and previous reaction, I would not take more than 15mg three times a day during your initial trial. Avoid other medicines before, during and for 2-3 weeks after your trial of Nardil unless you have checked with your doctor and pharmacist that they are safe.
Posted by tecknohed on May 28, 2013, at 19:27:41
In reply to Re: Nardil agitation, depression, suicidal thoughts » Daniell, posted by ed_uk2010 on May 26, 2013, at 9:40:30
You are spot on I think Ed. Definitely a med interaction. Even excess of foods containing lots of tryptophan (eg potatoes) has caused mild excitement, tingles on scalp and spine, headaches, jaw clenching/teeth grinding and trail visions in me. YES, POTATOEs lol. also some dry fruits high in tryptophan too. And beer is full of the stuff, tho ive never had SS drinking beer. Its even more likely if you eat a high carb diet as the tryptophan ratio compaired to other aminos increases and so theres far less competition to cross the Blood-brain barrier. more tryptophan gets in, more serotonin produced(?). Tryptophan has many other roles to play too. It can be used by your body to make vit B3, melotonin, DMT, and countless other tryptamines.
Once converted to 5-HTP its destiny is to make mainly serotonin, melotonin & probably just a few other tryptamines.
Finally, Tranylcypramine, another MAOI, is known to cause throbbing headaches due to a spike in bp spontaineously, without a know trigger. Perhapse This SS from Nardil was just a bizzare one-off too
so maybe increase your protein intake to keep any possible Serotonin spikes at bay. And dont worry about meaty or high protein foods that contain lots of tryptophan, as once digested the other amino ratio increases meaning less tryptophan gets through. And eating more protein is a good way to gain back some energy and serotonin levels stay low but consistent. The amino acid ratios in your blood depends greatly on insulin levels as it effects the levels of all aminos. Its mechanism is above my explination abilities. I'll try to find a link.
teck.
Posted by gilmourr on June 7, 2013, at 9:35:38
In reply to Nardil agitation, depression, suicidal thoughts, posted by Daniell on April 30, 2013, at 15:27:46
> I've been on Nardil 45mg for 2 weeks, 60mg for 2 weeks. Then 3 days ago I woke up with chills, diarrhea, high blood pressure, fast pulse, but worst of all extreme agitation e.g. head scratching, face scratching, teeth chattering, and a deep feeling of restlessness in my body. Worse than that I've been extremely depressed, to a point where I have only been once or twice in my life before, but combined with the agitation/inner restlessness I have felt suicidal urges. I have had suicidal thoughts before as part of depression but never planning exactly how I would do it and writing a detailed note. As I wrote it I cried and seemed to have some sort of panic attack or something as I couldn't seem to breathe and was gasping for breath. I started to imagine exactly how I would do it and how difficult it would be, even in an apparently 'peaceful' way. I looked death in the face and I was frightened beyond belief. I want to kill myself so badly on Nardil but I am so scared of death, and also what if I don't suceed I might end up immobile for the rest of my life, mentally tortured but unable to do anything about it.
>
> But I don't have the mood to get the necessary things to kill myself peacefully, so I then in despair as I couldn't take the pain I looked in the kitchen for butchers knives and again, imagined myself doing it, the gruesome way and once again not guaranteed. I rang my hospital and they didn't take me seriously, they said my thoughts were 'of my own volition' and not their problem, then they hung up. I tried two more times but again they told me to just wait until my outpatient appointment, they would not admit me. If they felt this and had this pain themselves, they would know it's an emergency. I always thought serious suicidal thoughts were an emergency anyway, especially when the disturbing 'urge' is there from the extreme agitation on Nardil. I'm in the UK so we only have the NHS which is a public service, this is what it is like.
>
> I used to take venlafaxine before and in the first 2 weeks or so it was very uncomfortable but diazepam solved it. With Nardil, nothing seems to work. I use diazepam and quetiapine to sleep and sometimes in the day, both of them at best take the edge of things but the thoughts and severe depression remain. I had depression before this obviously so I need a strong antidepressant, hence Nardil, but is it right for me? I've heard that it can take a week or two for receptors to downregulate so I should wait it out in theory, what do you guys think?
>
> I would need to be sedated and monitored quite closely if I keep taking Nardil. For the past 2 days I've had to stop. From what I've read I must have had a mild case of serotonin syndrome, which surely means that MAO is inhibited to quite a high degree? I'm only around 55 Kg and I was thinking quite possibly I am sensitive to this medicine such that a lower dose might be better?
>
> Also, people say that once 80-90% MAO inhibition is achieved, therapeutic response will be seen. Obviously that must not be the case for me. I would have thought that once MAO inhibition is maximal and monoamines are at high levels, things actually should get worse for a while after that until receptors downregulate and the brain adapts as a whole?
>
> What should I do? Will Nardil work for me if I wait for the agitation/severe depression to go away then stick it out at a lower dose? Any suggestions would be greatly appreciated...
>
>
Could be adrenergic storm. Nardil is potent on norepinephrine. Serotonin syndrome always is considered first but people never bring up the chance of AS.High blood pressure, fast heart beating, chills, extreme agitation seem like signs of an overactive CNS.
It might be of benefit to try Clonidine with Nardil and see if the reduction in NE helps. Or maybe try a benzo to see if it helps as well since benzos are usually known to calm a person down.
Plus serotonin syndrome is quite difficult to get, or at least some doctors I've spoke with in ER's or other locations have said.
I also get symptoms like this when I go too high on Nardil, but I believe it's the NE effect rather than serotonin just because you say "CHILLS" and normally I get those ALWAYS with NE based meds like cymbalta or parnate.
This is the end of the thread.
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