![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Yukio on May 22, 2014, at 13:15:07
Hi, this is my first time posting after registering. I apologize for this long post and thanking in advance anyone who reads this. I am actually posting with concerns for my husband. He is aware I am doing this. Presently he is so anxious, depressed, restless and unable to concentrate that he is unable to reach out himself. I would like to get some feedback, but first would like to give some background history.
Here is his story: He has always been a depressed,anxious socially inept person, but in the past usually controlled with an SSRI. He also has a problem with alcohol. He would binge drink by himself. Always made sure no one was around and he said that this was the only thing that reduced his anxiety. He could go for long periods of time without drinking but in 2007 we moved from the northeast to MI and he began a very stressful job. Things started to spiral downward, he was drinking more and when confronted by me went into treatment. SSRIs no longer worked and his addiction psychiatrist started him on Nardil. Well, his personality changed dramatically, he said he felt great, at one point became too hypomanic, decreased dosage to 60 mg and was on that until March this year. During the 5 years he was on it, our marriage suffered. He was always quiet, but became very confrontational, angry, self centered, bordering on narcissism. Very difficult to live with, but he said he felt better than he had ever felt before and I would just have to deal with it. He has always been a person with high expectations of himself and easily critical of others. Although in his times of depression he would "beat up" on himself for almost everything he did. So one day last June 2013, after being sober for 3 years, he decided out of the blue to go to a bar. First time in our 20 yr marriage he drove to a bar to drink (in the past he would always time his drinking to times I would be away, and drink at home). He ran off the side of the highway, did not injure himself or anyone else. He was arrested with a DUI, but did not go to trial until 6 months later and was given a sentence that included a restricted driving license for 3 months Feb-Apr. He was also having an increasing stressful time at work where he always perceived these two co-workers to be "smarter" than he and always felt intimidated. He had never had a work situation like this, although would at times feel like he was "a fraud" and someone would find out that he doesn't really know what he is doing. (he has 2 master degrees, but feels he should have gotten that PhD).Anyway, getting back to the nardil, he had been saying for some time that it had not been having the same effects and he was feeling more and more depressed, although his obnoxious personality remained. He was also having a difficult time getting any appt with his extremely busy psychiatrist. So he decided on his own to cut back from 60 mg/d to 45mg. He thinks that he did this for about 2 wks, end of Feb, early March. Apparently during those 2 weeks, he began to get paranoid, mild at first, but then to the point he had a complete break while at work and thought his boss was the police and he kept asking to be arrested His boss was compassionate and kept him in his office all day talking to him and then gave him a ride home. My husband and I sometimes work opposite hours and i was not aware of this happening. The next morning he burst into where I sleep and starting ranting and raving bizarre things. I called his therapist who said he had noticed him getting more paranoid lately and to take him to the hospital. In the psych ED, during the 8 hours of deliberating with insurance and finding a bed, he decompensated to the point of not knowing who his was and the next day after being admitted, the hospital psychiatrist called to tell me he was having extreme delusions and hysteria thinking he had killed me and our daughter.
So, while inpatient, they started him on respiradone and titrated it up to 4 mg during his 12 day stay, and took him off the Nardil over 2 days. The psychosis was mostly abated but he did not feel safe there. He became depressed, anxious and somewhat depersonalized. He never understood why he was there. So, after 12 days he came home, saw his OP psychiatrist within 2 days, with the plan they would wait 2 more weeks to further wash out the Nardil and consider an SSNRI or try the Emsam patch.
Well, another bad thing happened before he was able to be seen again....his psychiatrist died the week after seeing him...case of pneumonia leading to sepsis very quickly and he died. My husband was devastated. But I quickly tried to look for another psychiatrist, and since this doc was so popular and saw many patients in multiple sites, everyone was out looking for a new doc. Anyway, my husband was not able to see someone new and get started on an AD until 4/22,(now approx 6 wks from stopping nardil), was rx'd Effexor XR. Started on 37.5mg for 2 wks, then up to 75mg for 2 wks before next appt which was a few days ago, now up to 150mg. Still no effect, although aware he has probably not gotten to therapeutic range yet. He is still on short term disability from work (which is making him even more anxious with decreased money- he's always been overly concerned with finances, a little OCD).
He is basically non-functioning. He has his full driving license back, and he drives himself to 3 AA meetings per week, but he is consistently complaining of overwhelming feelings of dread, and breaks down crying often, he cannot concentrate on anything and mostly sits and stares into space with a pained expression. I really hate seeing him like this. He is 51 y/o, has never had any psychotic symptoms. Hospital did a brain MRI to rule out organics issues. His diagnosis was MDD, severe with psychotic features.
My questions are....Can any of this be attributed to 1st, cutting back on the Nardil, from 60-45mg -the psychois, and then 2nd still having symptoms of withdrawal from the Nardil. He has been totally off Nardil since March 8. I have not been able to find enough data on this issue, only that withdrawal can include psychosis in worse case scenarios and nothing about other symptoms lasting this long.
Thank you and I look forward to any feedback.
Posted by phidippus on May 22, 2014, at 14:39:30
In reply to Psychosis after decreasing nardil, posted by Yukio on May 22, 2014, at 13:15:07
>Can any of this be attributed to 1st, cutting back on the Nardil, from 60-45mg -the psychois, and then 2nd still having symptoms of withdrawal from the Nardil.
No.
I am of the strong suspicion that your husband is bipolar. You describe a lot of things that point to mixed episodes. The psychotic symptoms are also indicators-I imagine the Nardil triggered these symptoms. You should be familiar with mixed symptoms: "Presently he is so anxious, depressed, restless and unable to concentrate". This is classic mixed symptomology. Your husband has also shown signs of mania: "his addiction psychiatrist started him on Nardil. Well, his personality changed dramatically, he said he felt great, at one point became too hypomanic" and " Very difficult to live with, but he said he felt better than he had ever felt before and I would just have to deal with it."
I would highly recommend your husband be placed on a mood-stabilizer, such as Lithium or Carbemazapine. This willl help with the depression and the anxiety he experiences.
Eric
Posted by Phillipa on May 22, 2014, at 17:20:40
In reply to Re: Psychosis after decreasing nardil » Yukio, posted by phidippus on May 22, 2014, at 14:39:30
I also agree with Eric sure sounds bi polar to me. Lithium would be my first choice. Phillipa
Posted by Yukio on May 23, 2014, at 13:03:41
In reply to Re: Psychosis after decreasing nardil, posted by Phillipa on May 22, 2014, at 17:20:40
Eric and Phillipa,
Thank you both so much for responding. I get what you are both saying, but the only time ever that he had a manic episode was when starting the Nardil and the dose was too high. While on the Nardil for 5 years, he was definitely more productive, but his personality was different, like I described earlier, but now completely off the Nardil, he has sunk into a deeper depression than ever before, even pre-nardil. When I say he is restless, it's more of an agitation, he can't get comfortable, doesn't know what to do, can't motivate himself to do anything. He paces a lot and sits and has intrusive disturbing thoughts of what a "bad person" he is. We are not sure why the psychosis came on, but I believe it had to do with the guilt and shame feelings of the DUI and the license restriction, plus the extra stress at work.
His narcissistic mother raised him telling him he was perfect, and he was smarter and better than all the other kids, and she isolated him. This put immense pressure on him growing up that still is a problem for him relating to people. He was never allowed to develop as a normal person who has flaws for fear of disappointing his mother. Although, it had the opposite effect and he grew up feeling shame and guilt because he knew he wasn't perfect and had to deal with people who were smarter etc, so consequently he developed social anxieties etc. But he is a very kind and gentle person normally, only when he was on the nardil he became confrontational and angry and he acted like he was always the victim. He placed blame for all his behavior on others, (except his mother, never his mother) Now it's the opposite, he internalizes with exaggerated feelings, his guilt, shame and blame.
I too do not really think at this point that what he is experiencing now is nardil withdrawal. It's been too long for a chemical reaction to last. But, I wonder if the nardil had such a profound effect on his mood, that the psychological let down is more the problem. Nardil is such a powerful drug.
I just don't know, but it's tough seeing him suffer. I will bring up to him and his psychiatrist what you both mentioned and see if it resonates at all.
Thanks again.
Posted by phidippus on May 23, 2014, at 18:44:21
In reply to Re: Psychosis after decreasing nardil, posted by Yukio on May 23, 2014, at 13:03:41
> Thank you both so much for responding. I get what you are both saying, but the only time ever that he had a manic episode was when starting the Nardil and the dose was too high.It only takes one episode for the diagnosis to be made. The fact Nardil was being used only clarifies the diagnosis.
While on the Nardil for 5 years, he was definitely more productive, but his personality was different, like I described earlier
How was his personality different?
but now completely off the Nardil, he has sunk into a deeper depression than ever before, even pre-nardil.
Well if he is bipolar and was cruising at high altitude on the nardil and now he's off it, he's going to cycle into a depression
has intrusive disturbing thoughts of what a "bad person" he is.
He is having ocd symptoms, which can happen when depression comes on strong.
We are not sure why the psychosis came on, but I believe it had to do with the guilt and shame feelings of the DUI and the license restriction, plus the extra stress at work.
Guilt, shame and stress did not bring on his psychosis. The imbalance of chemicals in his brain caused the psychosis.
When he was on the nardil he became confrontational and angry and he acted like he was always the victim.
This tells me the nardil was making your husband hypomanic. Antidepressants do this to folk who are bipolar.
>
> But, I wonder if the nardil had such a profound effect on his mood, that the psychological let down is more the problem. Nardil is such a powerful drug.You are more right than you realize. Antidepressants take bipolar folk on a ride that inevitably leads to a crash.
>I will bring up to him and his psychiatrist what you botlh mentioned
Please, please heed my advice: get him off the Antidepressants and on a mood sstabilizer.
Posted by Michael Bell on May 28, 2014, at 21:59:55
In reply to Psychosis after decreasing nardil, posted by Yukio on May 22, 2014, at 13:15:07
Nardil made me completely delusional, paranoid and hallucinate, and it was the only time in my life that this ever happened. I am not bipolar, btw.
Posted by Yukio on May 29, 2014, at 10:36:36
In reply to Re: Psychosis after decreasing nardil » Yukio, posted by Michael Bell on May 28, 2014, at 21:59:55
Michael,
Thanks so much for sharing your experience. Do you remember what you felt like after you came off the nardil? My husband is no longer having any psychosis symptoms, but he is deeply depressed and anxious more so than at any pre-nardil time.
Also how long were you on the nardil before the psychotic symptoms started and at what dose?
I know my husband is not bipolar either. I've been with him for 20 years and I know what mania looks like, and he only had it when he was bumped up to 75 mg of nardil. Came back down to 60mg and was better. Besides negatively changing his personality while on the 60 mg, there were some good aspects where he was more productive, not meaning mania, but before he was so quiet and withdrawn and would not extend himself to help out with household chores etc. On the nardil he started to do more of these things. But I still hated his personality, he was arrogant and always wanted to be recognized for say emptying the dishwasher and it was like he was keeping score.
But now, he just follows me around the house. Afraid to be alone. Doesn't talk, winces a lot, sometimes crys. he continually ruminates on all negative things in the past. I try to remain upbeat and tell him he can't control the past, only the future, etc etc. But he can't hear it.
He's on 150mg Effexor now, but I'm pretty sure it's not working. We had our personal dna tested and he is 7% less likely to respond to ssris and ssnris. So we just have to work with his psychiatrist to see what's next.
Thanks again.
Posted by phidippus on May 29, 2014, at 19:15:06
In reply to Re: Psychosis after decreasing nardil, posted by Yukio on May 29, 2014, at 10:36:36
>I know what mania looks like, and he only had it when he was bumped up to 75 mg of nardil.
You need to understand the diagnosis of bipolar is given even if their is only a single incidence of mania and whether or not an antidepressant is involved. The antidepressant unmasks the illness.
>Besides negatively changing his personality while on the 60 mg,
These negative changes you previously described are textbook hypomania. You stated "he was arrogant", which is a classic display of hypomania. Also the increased productivity.
>He's on 150mg Effexor now, but I'm pretty sure it's not working
He's not going to do well on antidepressants-he's either going to have personality changes you won't like or he may even become more depressed like he is now or he's going to become manic and may experience psychotic symptoms like he did on the Nardil.
What's it going to hurt to try him on Lithium?
Otherwise you're going to continue the rollercoaster ride you're on.
Eric
Posted by Chris O on June 2, 2014, at 3:44:04
In reply to Psychosis after decreasing nardil, posted by Yukio on May 22, 2014, at 13:15:07
Yukio:
I hope your husband is doing better. What a terrible time you two have been having! I don't know much about bipolar disorder, but Eric is a great resource for that. I tend to agree with him in the sense of what have you got to lose in trying a mood stabilizer at this point. If it helps, bingo. If it does nothing or makes things worse (which seems unlikely at this point), then at least you've got something crossed off your list of things to try.
I have never taken Nardil, but whenever I have stopped SSRIs and SNRIs I did get withdrawal symptoms (which often manifested themselves as anxiety, paranoia, depersonalization, etc.) The longer I took the drugs, the longer the withdrawal symptoms lasted.
From what you said about his mother, it sounds like the addiction issues are related to that in some respect. Probably a ridiculous question at this point, but has he ever done any type of extended therapy where he tried to confront and quiet that voice in his head (the voice of his mother)? It certainly seems like it is still very active at this point. It sounds like at this point, that is not possible, but maybe once he stabilizes....
Chris
Posted by rose45 on June 3, 2014, at 19:32:32
In reply to Re: Psychosis after decreasing nardil » Yukio, posted by Chris O on June 2, 2014, at 3:44:04
Yuko, I do sympathise with what you are going through. I dont have any suggestions, but you might find it interesting to hear my experience with nardil.
I had a 'breakdown' approx 25 years ago, and was put on nardil. It took 8 weeks to work, with horrible side effects during those 8 weeks, but once it began to work, it was like a miracle. Just like your husband, I felt so much energy, was much more social, and like your husband also, I became manic, arrogant, angry, argumentative, and people found me hard to be with... I couldnt stop talking, lost a lot of money by overspending etc.... re. the dosage, I would be taken up to 60 mg, and then be on a maintenance dose of 45 mg.
One year ago, the nardil stopped working,(after 23 years of being on it) and I went right back to my original state when I had the breakdown, totally anxious, suicidal and unable to function. It is a horrible scary experience. I was convinced that the nardil had ruined my brain. The psychiatrists also thought I was bipolar because I became manic on the nardil, but I had never been like that before, and I am convinced that it was caused by the nardil. Anyway, they put me on quetiapine which is supposed to be recommended if you are bipolar. It didnt work for me at all,and made me even worse and finally after 6 months of this agony,the dr. agreed to put me on parnate - as I had concluded that the maois are probably the only drugs that work for me. I think I still have the arrogance and anger which I believe are maoi induced, but the 'manic' side is no longer there. Parnate does cause insomnia, which is a problem. Even though Im aware of my anger, it is very difficult to control. I dont drink, and I have been meditating for most of my life, so am used to 'witnessing' my moods - I try to deal with it as best I can, but have lost most of my friends as a result of all this, so I know what you must be going through and truly sympathise. I wish I knew what to suggest. In my case, I was also told to take lithium etc, but I didnt want to. Hopefully you will find a doctor you can work with and whom you can trust. I havent found one yet. Having said all that, I never had a 'psychotic' episode, like your husband, and during the 23 years I was on nardil, I frequently would lower the dose. Lowering the dose would bring on the extreme agitation, and anxiety, but NOT psychotic symptoms as you describe them. Hope that gives you some comfort.
Posted by Lamdage22 on June 6, 2014, at 10:21:47
In reply to Re: Psychosis after decreasing nardil, posted by Yukio on May 23, 2014, at 13:03:41
Same thing happened to me with Nardil. Although i was already psychotic on it.
It all sounds very unstable and i would be careful with antidepressants. It sounds like he had an "high" with borderline or actual psychotic features and this is his low now.
He should seek for Medication to make him more stable.
Antidepressants can destabilize.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.