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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by David Hanifin on January 10, 2014, at 23:43:20
I suffer from anxiety with PTSD and depression. Since September 2013 I've been on parnate and reached a maximum dose of 60mg in december (after a slow upwards tiltration)where I stayed for 4 weeks. At 60mg I did feel clouded somewhat and had low energy from the medication. I'm now down to 40mg which strangely is somewhat more stimulating than the 60mg due to the 5ht receptor playing a bigger role at 60mg. Overall this antidepressant has been quite good and has made me somewhat more assertive however I don't think I have gotten near full remission of my symptoms and sometimes feel a little flat and the memory is somewhat affected. I've also had zero hypertensive episodes but the occasional orthostatic hypotension at 60mg.
After having been in this forum and hearing user reviews and reading psychiatry journals online I strongly feel that Nardil will easily give me more of a therapeutic response. Afterall it is labelled the 'anxiety gold standard'. The problem: Nardil causes weight gain 'significantly' in most people in the real world and in 'subjects' through studies. The reason I stopped Ssris in the first place was the Significant Weight gain (I'm already overweight) and to some degree the eventual numbness and apathy. In the past I have tried Reboxetine on its own and the weight loss and appetite control is nothing short of amazing over 'ANY agent I have ever tried. I have even combined a low dose Reboxetine with Zoloft and still had amazing results in the weight department but only partial remission of symptoms. I know it is 'likely' safe to combine a low dose Reboxetine (erdonax, prolift) (NRI) with Nardil and have read on forums that people taking this combination have limited side effects of weight gain, sexual dysfunction, hypotension, hypertension and low energy.
How do I convince my Australian psychiatrist to trial me on such a combination? Are there are 'any' studies or journals where this has been tried (he likes evidence)?
In the past I have tried moclobemide (RIMA) for about 3 weeks but I feel this isn't the ideal drug as one minute I'm depressed the next minute I'm happy and the next minute I'm disorientated. Also there isn't any evidence moclobemide works for anxiety and/or PTSD. Most people on forums for many years have also stated it wasn't an ideal drug for full remission even though side effects were somewhat limited.
Do you think my psychiatrist may bite the bullet and give me a shot at the Nardil + low dose Reboxetine combination? Any user reviews and/or case studies journals that people know about the combination would be GREATLY appreciated.
Thanks heaps Folks :)
David
Posted by SLS on January 11, 2014, at 8:10:02
In reply to Switch from parnate to Nardil with low Reboxetine, posted by David Hanifin on January 10, 2014, at 23:43:20
Hi David.
Comment: Moclobemide sucks.
Although there shouldn't be any untoward reaction from combining reboxetine with Nardil, I am unsure as to why you chose reboxetine over other NRIs. I'm sure you know that, theoretically, a NRI can reduce one's sensitivity to tyramine. Personally, I prefer nortriptyline in combination with Nardil. The side effects are among the mildest of the TCAs. Do not combine Nardil with imipramine or clomipramine. The danger of developing serotonin syndrome is a likely with these drugs, particularly clomipramine.
- Scott
Posted by Phillipa on January 11, 2014, at 9:24:44
In reply to Re: Switch from parnate to Nardil with low Reboxetine » David Hanifin, posted by SLS on January 11, 2014, at 8:10:02
Right now a poster Jono is in remission on nardil and lives in Australia? I wish he would see this. I might be able to contact him Phillipa
Posted by David Hanifin on January 12, 2014, at 12:18:06
In reply to Re: Switch from parnate to Nardil with low Reboxetine, posted by Phillipa on January 11, 2014, at 9:24:44
Thanks for the response guys. Now I just have to convince my psychiatrist which will be rather challenging. Scott my main reason for wanting to augment was due to Nardil weight gain which is likely since I pile it on with the ssris. I've been reading that weight gain not loss is a common side effects of amitriptyline. Reboxetine however makes the weight fall off me more than anything I have ever tried. It could mean I won't have to stop and start the drug due to weight gain as many people do making it a more attractive and sustainable option. I found Reboxetine on it's own not so great as an antidepressant but excellent for weight loss and similar results with ssri augmentation with less fatigue. Hopefully this too works in the maoi world. I found this 2007 study which I will print out for my psychiatrist. It basically concludes that as you said Scott that an maoi combination of Reboxetine or amitriptyline is safe and can even be safer to block Tyramine.
Posted by SLS on January 12, 2014, at 12:44:09
In reply to Re: Switch from parnate to Nardil with low Reboxetine, posted by David Hanifin on January 12, 2014, at 12:18:06
Thanks for posting the article.
Supposedly, with TCA-MAOI combinations, it is recommended that the two drugs be started together or that the MAOI be added to an ongoing treatment with TCA. I have added the TCA to ongoing MAOI on several occasions without any problems.
- Scott
This is the end of the thread.
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