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Psychosis after decreasing nardil

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 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.




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