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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by gagesa on October 31, 2009, at 21:22:06
Hello, I'm new to this site in the hopes that I might be able to get an answer or two that other boards aren't able to help me with.
I started Nardil 5 weeks ago. 1 week on 45mg and 4 weeks on 60mg. I feel no difference yet. My next doc appointment is in early December. So I will know for sure whether or not the 60mg will work for me. We had already discussed going up to 75mg if the 60 is not working. Although my doc is familiar with the drug, he has never prescribed it to any other of his patients before, only to me after years of failed med attempts. So neither of us have any real world experience to base some of my questions on, only text book info.
Lets say I do need to go up to 75mg, how long should I be on it to give it the maximum amount of time before I can decide whether or not it is working? I was going to give it either 6 or 8 weeks, mainly due to not wanting any major side effects and giving it the full chance to kick in.
One more quick question, Ive read so much about this maintenance dose thing. Half the posts say they take it, the other half don't take it, just take their regular full dose. I cannot understand this?I would greatly appreciate any info from either current nardil users, or past users with experience with the drug.
Posted by Maxime on October 31, 2009, at 21:43:31
In reply to Nardil dosage questions..., posted by gagesa on October 31, 2009, at 21:22:06
Welcome to Psycho Babble!
I would say at least 3 weeks at the higher dose before moving it up again.
But there are others here with more experience with Nardil than me (I am a Parnata gal)so hopefully they will respond to your post!
Good luck!
Posted by Maxime on October 31, 2009, at 21:50:36
In reply to Re: Nardil dosage questions... » gagesa, posted by Maxime on October 31, 2009, at 21:43:31
Posted by ace on October 31, 2009, at 23:41:51
In reply to Nardil dosage questions..., posted by gagesa on October 31, 2009, at 21:22:06
> Hello, I'm new to this site in the hopes that I might be able to get an answer or two that other boards aren't able to help me with.
Welcome! You are in the right place. Wonderful and very educated people here.
> I started Nardil 5 weeks ago. 1 week on 45mg and 4 weeks on 60mg. I feel no difference yet.Titration far to slow.
My next doc appointment is in early December. So I will know for sure whether or not the 60mg will work for me. We had already discussed going up to 75mg if the 60 is not working. Although my doc is familiar with the drug, he has never prescribed it to any other of his patients before, only to me after years of failed med attempts. So neither of us have any real world experience to base some of my questions on, only text book info.
> Lets say I do need to go up to 75mg, how long should I be on it to give it the maximum amount of time before I can decide whether or not it is working? I was going to give it either 6 or 8 weeks, mainly due to not wanting any major side effects and giving it the full chance to kick in.OK, as I stated you have titrated Nardil far too slowly I feel. Once reaching the dose of 60mg, you have stayed at this for too long.
After much reading and experience with the drug I advise:
1st 3 days: 30mg (15mg bid (twice a day))
Next 4 days: 45mg (15mg tds (thrice daily)Any pronounced side effects drop back to 30mg
Week 2: Stay put on 45mg
Then push dose up to 60mg (15mg QDS (4 times a day), if no response after 6 weeks, go straight to 90mg (not 75mg).
Split the 90mg dose into 30mg tds (3 times daily)
Now this is very important in the initial stages of Nardil therapy:
1. Take your doses at the same time daily.
2. Split your doses as advised above.
3. Do NOT drink any alcohol or take any illicit drugs.In your case, I most certainly would go straight to 90mg now. Please understand that you must be patient, you may have to give it 12 weeks max.
The old MAOI's have to do a lot of work! And they almost always take longer than SSRI's and even TCA's.
I feel the payoff you recieve will be well worth your patience!!!> One more quick question, Ive read so much about this maintenance dose thing. Half the posts say they take it, the other half don't take it, just take their regular full dose. I cannot understand this?
Don't try to understand it. Once you recieve a good response STAY AT THAT DOSE!!!!
> I would greatly appreciate any info from either current nardil users, or past users with experience with the drug.I am the Nardil Champion here!
Please feel free to ask more, and be patient with Nardil.
Give it time to work it's majic!Peace,
Ace:)
Posted by ace on October 31, 2009, at 23:43:37
In reply to Phillipa, do you know how to get Ace here? (nm), posted by Maxime on October 31, 2009, at 21:50:36
Posted by Phillipa on November 1, 2009, at 0:16:04
In reply to Re: Nardil dosage questions... » gagesa, posted by ace on October 31, 2009, at 23:41:51
Ace is the Nardil Champ if anyone knows nardil it's Ace so listen to Ace. His information is the very best babble has to offer. Hi my Champ how are you thanks for being here!!!!! Love Phillipa
Posted by gagesa on November 1, 2009, at 1:24:34
In reply to Re: Nardil dosage questions..., posted by Phillipa on November 1, 2009, at 0:16:04
Ace, I greatly appreciate your advice!! Not only are you the only one I have come across so far that seems to know what they are talking about, but the others vouch for you, so I trust your opinion.
I understand what you are saying about the titration being too slow, but I just followed the docs orders. But like I said, he's just following text book advice. My next appointment is the first week of December. So it will be eight weeks on 60mg. I'm not sure whether you are suggesting to switch to 90mgs ASAP or during my next appointment. Either way, due to my current situation, I cannot afford to make more appointments than absolutely necessary. But I will definitely talk to him about going straight to 90mg.
This is actually the first time I have heard 12 weeks max. Everyone else claims 8 weeks max. But then again, I suppose everyone is different. That's why I wanted to stay at 60mgs for 8 weeks before moving up. In case the 60mgs happened to work very well and I did not have to raise the dose.
If I do go to 90mgs I will take it in three doses like you mention.
Posted by g_g_g_unit on November 1, 2009, at 2:28:11
In reply to Re: I'm here! (nm) » Maxime, posted by ace on October 31, 2009, at 23:43:37
Ace, are you aware of a point where the insomnia remits? it did eventually during my first 3-month trial, but i'm not sure if that was time-based or dose-based (i was eventually taking around 75mg, *slowly* titrated upwards).
Posted by stargazer2 on November 1, 2009, at 16:56:20
In reply to Re: I'm here! » ace, posted by g_g_g_unit on November 1, 2009, at 2:28:11
Ace, I'm on nardil 30 mg and also take Wellbutrin 150 XL (contraindicated) but need something besides Nardil to give me focus and energy. I also had taken a tad of the generic Adderall to supplement Nardil at one time.
I took the original version of Nardil many moons ago and was on 15 BID with excellent results. As a matter of fact, this was pre-SSRI's and it was only the 2nd AD tried on me and the results were immediate (?),like a key opening a lock. No other medication since than, 25 years ago, ever worked like that, with the exception of Marplan. Parnate never worked for me, go figure.
Obviously with the change in the current formulation, the response I had after years of SSRI/"all other AD's known to man" merry go round, the current response was never as robust as the original version of Nardil. I did go up to 60 mg once, but never higher.
I guess my fear was the side effects that kicked in a higher doses, leg swelling and constipation and lack of effect on my energy level and ADD symptoms (Never offically diagnosed but my biggest obstacle to date).
Do you have an opinion on adding things for ADD to Nardil? My pdoc agreed to adding Wellbutrin XL only after I presented a paper to him that it had been safely given by a group of Harvard trained pdocs at Mclean Hosp. in Boston.
Do you think Nardil at higher doses is associated with improving focus, energy and concentration.
I wasn't sure if you had any knowledge if this occurring at higher doses.I am most afraid of side effects that will destabalize or make mee worse. You have to believe me when I say I have tried every med and have had every side effect, including suicidality associated with Effexor. I have also had a very poor history of pushing higher doses of medications.
Right now, I's able to work and my personal life is relatively stable, so I just wanted your opinion, to use if it becomes necessary. Right now we are not looking for improvement, although there is certainly room for it, but the risk is too great to mess with the status quo.
Thanks for your contributions, it is always good to hear other success stories. I had almost given up many many times, but thankfully never did.
Like you, MAO's have been the only meds that have saved my life. My biggest crash followed the discontinuation of Marplan in 1993 (crashed and burned) and Nardil. I had ZERO side effcts on the original drugs and the doses were very low. Too bad the drug companies only market meds that make lots of money for them (brand names), not the generics. And the generic are never as good as the real stuff. I think we all agree on that.
Stargazer
Posted by ace on November 1, 2009, at 22:59:59
In reply to Re: Nardil dosage questions..., posted by Phillipa on November 1, 2009, at 0:16:04
> Ace is the Nardil Champ if anyone knows nardil it's Ace so listen to Ace. His information is the very best babble has to offer. Hi my Champ how are you thanks for being here!!!!! Love Phillipa
Phillipa- not a problem, it's the least I can do!
Without this board I would have never have found Nardil!
Ace:)
Posted by gagesa on November 1, 2009, at 23:10:24
In reply to Re: Nardil dosage questions... » Phillipa, posted by ace on November 1, 2009, at 22:59:59
Does anyone know if I can PM ACE on this site, or do I just have to hope for him to come back to answer my question? Thanks!!
Posted by ace on November 1, 2009, at 23:32:59
In reply to Re: Nardil dosage questions..., posted by gagesa on November 1, 2009, at 1:24:34
> Ace, I greatly appreciate your advice!! Not only are you the only one I have come across so far that seems to know what they are talking about, but the others vouch for you, so I trust your opinion.
It's not a problem at all! I feel so much empathy for all the people here...very strong brave people, we all share a similar plight!
>
> I understand what you are saying about the titration being too slow, but I just followed the docs orders. But like I said, he's just following text book advice.Text book advice, including the 'MAOI diet' is greatly outdated. MAOI's don't make much $$$$, training psychiatrists only touch on the basics of the in ...It's all the SSRI's- which don't even compare to the MAOI's in terms of efficacy.
My next appointment is the first week of December. So it will be eight weeks on 60mg. I'm not sure whether you are suggesting to switch to 90mgs ASAP or during my next appointment.
I am suggesting switch now!Either way, due to my current situation, I cannot afford to make more appointments than absolutely necessary. But I will definitely talk to him about going straight to 90mg.
Is it possible to phone the MD and ask about this?
I understand the financial situation, and the fact that you would prefer your doctors approval.
>
> This is actually the first time I have heard 12 weeks max.I have heard of a few people needing 12 weeks (including one patient who, at the 12 week mark recieved 100% remission from bothe depression and OCD), and some monographs espouse this idea. 8 weeks is more common, however.
Everyone else claims 8 weeks max. But then again, I suppose everyone is different. That's why I wanted to stay at 60mgs for 8 weeks before moving up. In case the 60mgs happened to work very well and I did not have to raise the dose.
I do see your point here. However, if 60 mg is a sufficient dose I feel that it would have kicked around the 4/5/6 week mark. Some people do indeed require a 90mg dose (for what is called maximum MAOI inhibition), and even after extensive time on 60mg such people would only recieve sub-therapeutic results. As stated, I would indeed jump now to 90mg, certainly based on your statement that you have recieved no response at all.
That being said, if you do stay on to 60mg until December, and recieve no therapeutic effect (as I suspect), pushing up to 90mg, at that point in time, should work. Except for the fact that you could have recieved the possitive effects a lot earlier!
What is your weight?
>
> If I do go to 90mgs I will take it in three doses like you mention.Always split the doses.
Please let me how you are doing, and I am happy to help in any way I can!
Ace:)
Posted by ace on November 2, 2009, at 0:06:06
In reply to Dosage of nardil/Add-ons for ADD/Ace, posted by stargazer2 on November 1, 2009, at 16:56:20
> Ace, I'm on nardil 30 mg and also take Wellbutrin 150 XL (contraindicated) but need something besides Nardil to give me focus and energy.
Hmmmm....at first site I would say drop the Wellbutrin and raise the Nardil....better read the rest of the thread but!
I also had taken a tad of the generic Adderall to supplement Nardil at one time.What sort of response did you get?
> I took the original version of Nardil many moons ago and was on 15 BID with excellent results.That's a low dose! I am suprised you neeeded so little.
As a matter of fact, this was pre-SSRI's and it was only the 2nd AD tried on me and the results were immediate (?),like a key opening a lock. No other medication since than, 25 years ago, ever worked like that, with the exception of Marplan.
Your response is very common. Nardil is the bomb!Parnate never worked for me, go figure.
Parnate is a great med, but I don't think it works for as many as Nardil. I have certain suspicions as to why....after my own bad experience with it.
> Obviously with the change in the current formulation,With the regards to the change in the formulation I was informed that this problem was rectified. It only actually involved the incipients....furthermore this was only confined to certain parts of the world.
the response I had after years of SSRI/"all other AD's known to man" merry go round, the current response was never as robust as the original version of Nardil. I did go up to 60 mg once, but never higher.That could be to a myriad of biochemical factors...and it would not be strange to assume that after your Nardil 'break' you needed a higher dose.
>
> I guess my fear was the side effects that kicked in a higher doses, leg swelling and constipationConstipation is treatable, but is a common long-term effect. Edema (leg swelling) is less common, I have heard of some folk using natural methods to help this.
and lack of effect on my energy level and ADD symptoms (Never offically diagnosed but my biggest obstacle to date).
You did not feel any rise in energy level? at 30mg, describe to me exactly what you felt, in terms of Nardil's effect.
>
> Do you have an opinion on adding things for ADD to Nardil? My pdoc agreed to adding Wellbutrin XL only after I presented a paper to him that it had been safely given by a group of Harvard trained pdocs at Mclean Hosp. in Boston.Yes Low dose ( I emphasise LOW) stimulants are fine with Nardil (even thought contrainidicated).
Be careful.Also I have heard of Clonidine used with Nardil for OCD and ADD. Also Remeron I know has been used for ADD (suprising) with Nardil. There is many more, but I would have to get to my records at home.
If it is not ADD, and rather an anxiety problem (I see this a lot) a benzo would be ideal. And the higher dose of Nardil would help if it was an anxiety disorder. It has to be higer but- Nardil's effect on GABA is dose-dependent.
If Wellbutrin is doing much, I would give it the sack!
>
> Do you think Nardil at higher doses is associated with improving focus, energy and concentration.Absolutely 100%!!! Improved energy is one of Nardil's big benefits! It used to get those depressed cancer patients out of bed jumping around as happy as can be!
Focus and concentration- this Is a little harder to assess. i would certainly say it does not impede either, but if you are suffering from bona-fide ADD, loosening of associations, or something a little different that anxiety/depression, you could well need an additional med.
> I wasn't sure if you had any knowledge if this occurring at higher doses.
>
> I am most afraid of side effects that will destabalize or make mee worse. You have to believe me when I say I have tried every med and have had every side effect, including suicidality associated with Effexor. I have also had a very poor history of pushing higher doses of medications.That's all OK friend, please just take it slow, and be cautious. If something is too much, lower the dose immediately. Also, I would advise you get a blood pressure machine (cheap at some places) and have Nifedipine on add (in case of problems) I have had Nifedipine on hand for years and years, and used it twice! I am not trying to scare you, but I don't want you to feel worried about raising doses. This is why I am urging caution so much. Id you are cautious, their is nothing to worry about!
> Right now, I's able to work and my personal life is relatively stable, so I just wanted your opinion, to use if it becomes necessary. Right now we are not looking for improvement, although there is certainly room for it, but the risk is too great to mess with the status quo.My personal philosophy is thus: If you are not getting great benefit from a particular psychiatric drug- change it until you are!
> Thanks for your contributions, it is always good to hear other success stories. I had almost given up many many times, but thankfully never did.
Good on you! Stay fighting!
> Like you, MAO's have been the only meds that have saved my life. My biggest crash followed the discontinuation of Marplan in 1993 (crashed and burned) and Nardil. I had ZERO side effcts on the original drugs and the doses were very low. Too bad the drug companies only market meds that make lots of money for them (brand names), not the generics.Don't get me started on this!!!
And the generic are never as good as the real stuff. I think we all agree on that.
>
> Stargazer
All the very best my friend!Ace:)
Posted by gagesa on November 2, 2009, at 0:31:31
In reply to Re: Nardil dosage questions... » gagesa, posted by ace on November 1, 2009, at 23:32:59
Ace, thanks again!! Basically I am in the SSDI process and have no income or insurance. That's why I would prefer to wait until December. Other wise if I make an appointment soon about the nardil dosage raise. I will just have to make another appointment soon after to get refills on my controlled meds. He will not do controlled meds over the phone.
But you did answer my question exactly, I will probably wait until December, But I will go straight to 90mgs. I understand that I could be receiving better effects sooner, but it's just not possible with my situation. My doc will not raise it if I talk to him over the phone. He is very concerned about the side effects etc...
But I am willing to wait another month before possibly getting the full effects. Right now, I do have some time. So I am not in such a rush.
Thanks a million!!
Posted by gagesa on November 2, 2009, at 0:39:25
In reply to Re: Nardil dosage questions... » gagesa, posted by ace on November 1, 2009, at 23:32:59
Sorry, I forgot about the last question. I weigh 235. I am not over weight at all, I am 6'4" and a former weightlifter before my last breakdown.
Posted by blue176 on December 30, 2009, at 21:51:44
In reply to Re: Nardil dosage questions..., posted by gagesa on November 2, 2009, at 0:39:25
Ive been at 75mg for quite sometime now(3 months?). At first it was completely great, but im assuming that was the euphoric stage. It has lessened some I believe. Im still able to do things I never would of done.
I do drink when I go out which is like once a week. Why is this so bad?
As far as side effects go, I get constipation, I wake up a few times during sleep, and anorgasma.
Should I go up to 90mg since the side effects arent that bad for me? will 15mg more be that much different than now?
Posted by greg rizzo on June 3, 2020, at 14:48:31
In reply to Re: Nardil dosage questions... » gagesa, posted by ace on November 1, 2009, at 23:32:59
Hey Ace--quick question: Have you found a good Nardil augmentor that makes Nardil feelsimilar to Parke Davis formula?
Currently using 90mg Nardil in enteric capsules, invert sugar, alcohol, Bioperine for absorption.
Trying lithium (350mg) noopept,L-theanine, caffeine, phenylpiracetam.
Helps a bit maybe, but not as I had hoped.Am I searching for the impossible dream?Thanks!
Greg
Posted by SLS on June 26, 2020, at 8:00:59
In reply to Re: Nardil dosage questions..., posted by greg rizzo on June 3, 2020, at 14:48:31
In my personal experience over the years and observing the dosages used by others, my conclusion is that the effective dosage range is 60 mg/day and 90 mg/day. 45 mg/day usually doesn't cut it. I would never counsel someone to avoid going any higher than 45 mg/day.
A rule of thumb used in the past has been to use a dosage using the formula:
"Our data show that a safe, effective phenelzine dose is 1 mg/kg body weight per day."
https://jamanetwork.com/journals/jamapsychiatry/article-abstract/491925
https://www.wikigenes.org/e/ref/e/365127.html
- Scott
Posted by adiaphora on July 9, 2020, at 13:41:53
In reply to Re: Nardil dosage questions..., posted by greg rizzo on June 3, 2020, at 14:48:31
> Hey Ace--quick question: Have you found a good Nardil augmentor that makes Nardil feelsimilar to Parke Davis formula?
> Currently using 90mg Nardil in enteric capsules, invert sugar, alcohol, Bioperine for absorption.
> Trying lithium (350mg) noopept,L-theanine, caffeine, phenylpiracetam.
> Helps a bit maybe, but not as I had hoped.Am I searching for the impossible dream?
>
> Thanks!
> GregHi Greg,
If you don't mind sharing, how much and what type L-theanine do you use? I also take 90 mg Nardil and am curious about supplementation for still-problematic anxiety.
Thanks.
This is the end of the thread.
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