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Re: nardil or parnate? creepy

Posted by SLS on November 23, 2020, at 20:25:52

In reply to nardil or parnate?, posted by creepy on September 24, 2020, at 3:00:02

A drug is only as good as your response to it is.

Nardil has been more effective for me than Parnate, although both drugs have worked on and off for many years.

Some people like Parnate because it spares you from certain startup side effects that Nardil is known for.

1. Anorgasmia
2. Urinary retention / micturition
3. Anorgasmia
4. Hypotension

I specified "startup" side-effects because I found that, for me, all four side effects disappeared entirely after three months. My advice is to titrate gradually on Nardil in order to avoid *triggering* side effects that would become significant obstacles otherwise. This time, I purposely started with 7.5 mg/day (1/2 tablet) and went up much slower than on previous trials. Side effects have not been nearly as severe. I think the key is that you not titrate so quickly as to trigger the side effects in the first place. In previous trials, once the side effects appeared, they lingered for months. I became dizzy very easily and sometimes had to sit on the ground to avoid fainting. I had to sit on the toilet for 30 - 45 minutes in order to urinate. Each time, I was scared that I would have to go to the emergency room to be catheterized. Fortunately, sitting 45 minutes was a worthwhile investment of time.

I know this is simplistic, but I think Nardil is more potent than Parnate at inhibiting MAO-A. My subjective experience is that both clorgyline (irreversible specific inhibitor of MAO-A) and moclobemide (reversible selective inhibitor of MAO-A) produced improvements for me that EMSAM (transdermal seligiline - irreversible selective inhibitor of MAO-B) did not. Most importantly, selegiline doesn't really help much with depression until the dosage is high enough to begin inhibiting MAO-A.

Reversible inhibitors of MAO-A (RIMAs), of which only one remains available, are not very effective antidepressants. Moclobemide almost always requires dosage escalation from 300 mg/day to 1200 mg/day - which is where doctors will stop. The initial response to moclobemide is often potent and approaches remission. I don't think it lasts for more than a few weeks until another dosage increase is required. Ultimately, moclobemide exacerbated my depression beyond anything I had experienced previously. It took a few weeks for it to wear off.

Anyway, I would say that Nardil gives me a more complete - a broader scope - antidepressant response. My guess is that Nardil is better suited to treat depressions where anhedonia or social anxiety predominate. Nardil inhibits another enzyme that Parnate does not: GABA transaminase(s). These enzymes are responsible for breaking down GABA - much like MAO is responsible for breaking down dopamine, serotonin, and norepinephrine. The result is the same. Nardil causes GABA levels to increase. This might contribute to Nardil's reputation for being better than Parnate for treating anxiety.

One other thing. For people who experienced childhood adversity (physical abuse, emotional abuse, or neglect), Nardil might yield better results than Parnate.

There are people who respond to one drug, but not the other. There are people who respond well to both drugs. Despite the different reputations that Parnate and Nardil each have - again: A drug is only as good as your response to it is. However, if you are willing to try both drugs if necessary, I would choose Parnate first.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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