Psycho-Babble Medication Thread 830220

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Re: Nardil Nightmare - very very long Phoenix1

Posted by Phillipa on May 20, 2008, at 22:54:20

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

Phoenix how horrible. I can't believe anyone would not rush the med to you from a different area or pharmacy the manufacturer. I am horrified by what happened to you and I absolutely have no idea of what you should do. I can only offer my deepest empathy to you. Love Phillipa

 

Re: Nardil Nightmare - very very long Phoenix1

Posted by SLS on May 21, 2008, at 4:59:08

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

> And after ALL of that, I miss Nardil terribly. My depression and anxiety are back full force, and no pdoc will ever prescribe me a MAOI again. That's my dilemma. My pdoc is suggesting ECT, but I personally wouldn't ever consent to it. So what next?

Wait 3 months and then restart Nardil.

In the mean time, try Effexor or Cymbalta and combine either one with nortriptyline. Add Wellbutrin and/or Abilify/Geodon if necessary. Adding Lamictal 200mg might not be a bad idea.

You've got some stuff to play with before returning to Nardil. Don't be afraid to combine 4-5 different drugs. If you respond, you can experiment and reduce one drug at a time to evaluate its value in the treatment combination.


- Scott

 

Re: Nardil Nightmare - very very long

Posted by SLS on May 21, 2008, at 5:09:23

In reply to Re: Nardil Nightmare - very very long Phoenix1, posted by SLS on May 21, 2008, at 4:59:08

I forgot to mention Marplan (isocarboxezid) as a substitute for Nardil. You might be able to give it a try if hypotension with Nardil is intolerable the next time you try it. Marplan is milder than Nardil with regard to side effects, and easier on the liver.

Tough decisions.


- Scott

 

Re: Nardil Nightmare - very very long

Posted by undopaminergic on May 21, 2008, at 7:44:11

In reply to Re: Nardil Nightmare - very very long, posted by SLS on May 21, 2008, at 5:09:23

Also, hypotension can be treated, with fludrocortisone or stimulants.

 

Re: Nardil Nightmare - very very long undopaminergic

Posted by SLS on May 21, 2008, at 8:06:10

In reply to Re: Nardil Nightmare - very very long, posted by undopaminergic on May 21, 2008, at 7:44:11

> Also, hypotension can be treated, with fludrocortisone or stimulants.

Which stimulants are better for this purpose? I was under the impression that Ritalin was the most effective.

I have Florinef on hand, but I've never used it.


- Scott

 

Re: Nardil Nightmare - very very long

Posted by blueboy on May 21, 2008, at 8:19:35

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

You need another doctor and you need to see a medical malpractice attorney, IMO. And make sure you haven't had a stroke.

What in the holy hell was that guy thinking?

 

Re: Nardil Nightmare - very very long Phoenix1

Posted by elbee on May 21, 2008, at 11:19:04

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

I am so sorry you went through that. How frightening. I just really feel for you that must have been awful!

I'm sorry you are dealing with depression after all this. Hang it there!

 

Phoenix - thinking of you MUCHLY Phoenix1

Posted by Kath on May 21, 2008, at 12:30:37

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

Hi Phoenix1,

You're very much in my thoughts. I am wondering how you are & hoping you're feeling WAY better.

Plese know you're thought of.

luv, Kath

 

Update - Please read

Posted by Phoenix1 on May 23, 2008, at 11:27:10

In reply to Phoenix - thinking of you MUCHLY Phoenix1, posted by Kath on May 21, 2008, at 12:30:37

Thanks for all your support everyone. Without the Nardil, my depression is worsening daily. My pdoc will not EVER prescribe a MAOI for me again, nor would any other pdoc. My pdoc wants me to go on Zoloft, which is totally useless. I've tried Zoloft and most of the other SSRI's, and they usually worsen things, but have never improved my symptoms. Nardil, on the other hand, was a miracle drug for me.

So my question is what would be the implications of me "self-treating" myself with an MAOI? Supply is not an issue. Would my pdoc fire me as a patient, or have me hospitalized as a danger to myself? I mean, many pdocs continue to treat and monitor patients with addictions to illicit drugs, how would this be different?.

I know that this would be incredibly risky given what happened to me previously on Nardil. But life is not worth living the way I am now, so I feel the risk is justified as the alternative would really only be suicide.

I really feel like these are my only choices right now. I'd like to hear other people's opinions though.

Phoenix

 

Re: Update - Please read Phoenix1

Posted by Kath on May 23, 2008, at 11:42:42

In reply to Update - Please read, posted by Phoenix1 on May 23, 2008, at 11:27:10

(((((((((((((((((you)))))))))))))))

Jeez. I don't know anything about medications at all, except a bit about Celexa, which I took for some years.

I wonder if there are any other medications that act as Nardil did? I can't remember if the doctors understood why you had such a terrible reaction Phoenix??

I am so sorry you are going through this & I wish I could offer some useful input. I DO offer you my support though. For what it's worth, you're in my thoughts.

It sounds like it could be REALLY risky to use Nardil again after what happened?

What are your main symptoms Phoenix?

(Please excuse me if you've already said; my memory is really bad)

luv, Kath

 

Re: Update - Please read Kath

Posted by Phoenix1 on May 23, 2008, at 12:01:43

In reply to Re: Update - Please read Phoenix1, posted by Kath on May 23, 2008, at 11:42:42

Hi Kath,

Thanks for the support, I really appreciate it. Yes, there are other MAOI's like Nardil. Parnate would be the next closest, and then there's Marplan. They are all considered to be too dangerous to prescribe to me after what happerned. There is a safer one called Moclobemide. They won't even prescribe that one to me.

They don't really know what caused the PRES (basically brain swelling from blood pressure changes). There are 2 possibilities in my mind. 1.) I was withdrawn off Nardil too quickly. 2.) I had a hypertensive crisis as a result of something I ate, or else just a spontaneous hypertensive crisis.

I have plain old unipolar treatment resistant depression. It has only ever improved on Nardil.

Phoenix


> (((((((((((((((((you)))))))))))))))
>
> Jeez. I don't know anything about medications at all, except a bit about Celexa, which I took for some years.
>
> I wonder if there are any other medications that act as Nardil did? I can't remember if the doctors understood why you had such a terrible reaction Phoenix??
>
> I am so sorry you are going through this & I wish I could offer some useful input. I DO offer you my support though. For what it's worth, you're in my thoughts.
>
> It sounds like it could be REALLY risky to use Nardil again after what happened?
>
> What are your main symptoms Phoenix?
>
> (Please excuse me if you've already said; my memory is really bad)
>
> luv, Kath

 

Re: Update - Please read Phoenix1

Posted by twinleaf on May 23, 2008, at 14:00:20

In reply to Re: Update - Please read Kath, posted by Phoenix1 on May 23, 2008, at 12:01:43

rTMS is expected to get FDA approval in the US sometime this summer, and will then be available for medication-resistant patients. Would this be a possibility for you? What happened with the brain swelling on an MAOI is SO scary...really not worth taking a chance on again, even though the temptation is definitely great. It's so hard to finally have a medication work, and then have such a rare side effect.

 

Re: Update - Please read Phoenix1

Posted by Kath on May 23, 2008, at 20:13:56

In reply to Re: Update - Please read Kath, posted by Phoenix1 on May 23, 2008, at 12:01:43

Dear Phoenix,

I know you're feeling awful hun, but I think it would be just toooooooo risky to try that family of med again.

This might seem like a stupid question, but have you tried any more natural methods?

5HTP, St. John's Wort, Homeopathic medicines??

luv, Kath

 

Re: Nardil Nightmare - very very long Phoenix1

Posted by Zeba on May 24, 2008, at 11:25:14

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

Would a lower dose of Nardil do the same thing? I am not an expert, and so I don't know. I take 40 mg. of Parnate in the morning. If I were to take Nardil, my pdoc said he would put me on 60 mg. Parnate is working for me at this dose, and so I stay with it. It tends to energize too.

 

How ya doin?? Phoenix1

Posted by Kath on May 24, 2008, at 12:18:55

In reply to Update - Please read, posted by Phoenix1 on May 23, 2008, at 11:27:10

Thinkin about you hunnee.

I care about you. love, Kath

 

Re: Nardil Nightmare - very very long

Posted by undopaminergic on May 24, 2008, at 15:09:41

In reply to Re: Nardil Nightmare - very very long undopaminergic, posted by SLS on May 21, 2008, at 8:06:10

> > Also, hypotension can be treated, with fludrocortisone or stimulants.
>
> Which stimulants are better for this purpose? I was under the impression that Ritalin was the most effective.
>

I would expect that anything with a noradrenaline reuptake inhibiting action would have the most stabilising effect. An extended release forumulation of methylphenidate would be a good choice unless its dopaminergic properties cause side effects, in which case atomoxetine or reboxetine may be better choices.

Some theories about MAOI hypotension propose that it results from false neurotransmission by endogenous (and dietary) trace amines that are normally deactivated by MAO; these amines may displace noradrenaline from neuronal storage vesicles, and be released in place of the real neurotransmitter; to the extent that they lack adrenergic agonist activity, they would interfer with the normal activity of NA in regulating blood-pressure. Reuptake inhibitors would reduce the uptake of these amines into neurons and perhaps promote a healthy storage and release of noradrenaline.

 

Re: Update - Please read Phoenix1

Posted by 4WD on May 25, 2008, at 14:03:01

In reply to Update - Please read, posted by Phoenix1 on May 23, 2008, at 11:27:10

Phoenix,

I didn't think it was ever actually the Nardil that caused your problem. You were doing fine on it until you couldn't get it and had to switch to Parnate. So then you had both of them in your system at the same time. I thought that was the source of the problem.

If suicide is the only other option, I wouldn't hesitate to try Nardil again.

Love,
Marsha

> Thanks for all your support everyone. Without the Nardil, my depression is worsening daily. My pdoc will not EVER prescribe a MAOI for me again, nor would any other pdoc. My pdoc wants me to go on Zoloft, which is totally useless. I've tried Zoloft and most of the other SSRI's, and they usually worsen things, but have never improved my symptoms. Nardil, on the other hand, was a miracle drug for me.
>
> So my question is what would be the implications of me "self-treating" myself with an MAOI? Supply is not an issue. Would my pdoc fire me as a patient, or have me hospitalized as a danger to myself? I mean, many pdocs continue to treat and monitor patients with addictions to illicit drugs, how would this be different?.
>
> I know that this would be incredibly risky given what happened to me previously on Nardil. But life is not worth living the way I am now, so I feel the risk is justified as the alternative would really only be suicide.
>
> I really feel like these are my only choices right now. I'd like to hear other people's opinions though.
>
> Phoenix

 

WOW - interesting point!!!! 4WD

Posted by Kath on May 25, 2008, at 20:55:24

In reply to Re: Update - Please read Phoenix1, posted by 4WD on May 25, 2008, at 14:03:01

I never thought of it like that! You're right - both meds in system/system overload etc.

Thx for pointing that out. :-) Kath

 

Re: Update - Please read

Posted by Justherself54 on May 26, 2008, at 18:07:54

In reply to Update - Please read, posted by Phoenix1 on May 23, 2008, at 11:27:10

> Thanks for all your support everyone. Without the Nardil, my depression is worsening daily. My pdoc will not EVER prescribe a MAOI for me again, nor would any other pdoc. My pdoc wants me to go on Zoloft, which is totally useless. I've tried Zoloft and most of the other SSRI's, and they usually worsen things, but have never improved my symptoms. Nardil, on the other hand, was a miracle drug for me.
>
> So my question is what would be the implications of me "self-treating" myself with an MAOI? Supply is not an issue. Would my pdoc fire me as a patient, or have me hospitalized as a danger to myself? I mean, many pdocs continue to treat and monitor patients with addictions to illicit drugs, how would this be different?.
>
> I know that this would be incredibly risky given what happened to me previously on Nardil. But life is not worth living the way I am now, so I feel the risk is justified as the alternative would really only be suicide.
>
> I really feel like these are my only choices right now. I'd like to hear other people's opinions though.
>
> Phoenix

I think your pdoc may be upset with you but as far as "firing" you I sure hope that wouldn't happen..as far as involuntarily admitting you..that's something I would worry about...I am familiar with my own province's Mental Health Act as I've issued many warrants when I was an active Magistrate. You may want to go online and peruse the criteria a physician in your province must meet to hospitalize you. In your reading, remember there is a difference between the words "may" and "shall"..may means there is leeway..shall..no leeway.

I'll try to gather my remaining brain cells together and see what I can find out. Keep us posted..

 

Re: Nardil Nightmare - very very long

Posted by blueboy on May 28, 2008, at 8:27:51

In reply to Nardil Nightmare - very very long, posted by Phoenix1 on May 20, 2008, at 20:57:08

> Hi, anyone here still remember me? I've been gone for a while.
>
> Anyways, I started Nardil in December '07 afer failing to benefit from many, many other AD's and combos. Nardil was a miracle drug, and I was feeling better within a couple of weeks.
>
> Everything went smoothly until my supply of Nardil ran out in March or April due to the manufacturers ineptitude. I was forced to switch to parnate for 2 days rather than suffer withdrawal from stopping 90mg Nardil cold turkey. NOTE: this is technically a no-no, but is infrequently done by pdocs under close medical supervision)

That is the biggest load of crap I have ever heard.

#1 -- What is a "technical no-no"? You mean, the drug manufacturer states (for a good reason) that it should not be done under any circumstances and you did it anyway and decided to rationalize this foolish action by calling it "technical" and a "no-no" instead of a well-known dangerous drug combination.

Starting parnate directly on top of 90mg/day of phenelzine is a near guarantee of disaster. I don't see why an MD would do such a thing unless he was just tired of having a medical license. Doctors do it "infrequently" because doctors "frequently" want to keep practicing medicine and avoid malpractice suits.

There is no way that the abrupt discontinuation of Nardil risks the same degree of severe damage as dumping Parnate on top of a high blood level of Nardil.

And then, what, you just started taking Nardil on top of the Parnate?

#2 -- How did your "supply of Nardil run out"? Did you not notice that you only had 5 or 10 pills left? I ran out of Nardil once on vacation and it took me the better part of two days to find some more, but I didn't blame the manufacturer. It just isn't THAT rare of a drug.

I am sorry to be so harsh, and I'm extremely sorry about your terrible ordeal and illness as a result of this. But your blaming everyone except the two responsible people -- yourself and your doctor -- means that you are at risk of repeating the behavior.

 

Re: Nardil Nightmare - very very long

Posted by 4WD on May 28, 2008, at 10:12:41

In reply to Re: Nardil Nightmare - very very long, posted by blueboy on May 28, 2008, at 8:27:51

I disagree. Phoenix was unable to get Nardil from the manufacturer. He has posted about calling numerous pharmacies, none of which had any Nardil.

I do agree that starting Parnate with a high level of Nardil in your system was a dangerous move. I think that is what caused Phoenix's trouble. I don't think the Nardil is to blame at all.

That's why I said that if it were me, I'd go back on Nardil with no hesitation. I think the whole issue was because of mixing Parnate and Nardil.

The problem is that his pdoc is not going to let him go back on Nardil because he is seeing the narrow view (and probably trying to cover his *ss).

Again, I think Nardil alone would be the best idea for Phoenix. He should be receiving our support and our prayers that he can get back on it. He just needs to explain to/convince his pdoc that the Nardil + Parnate caused the problem, not the Nardil itself.

Marsha

 

Re: Nardil Nightmare - very very long

Posted by Justherself54 on May 28, 2008, at 11:14:20

In reply to Re: Nardil Nightmare - very very long, posted by blueboy on May 28, 2008, at 8:27:51

> > Hi, anyone here still remember me? I've been gone for a while.
> >
> > Anyways, I started Nardil in December '07 afer failing to benefit from many, many other AD's and combos. Nardil was a miracle drug, and I was feeling better within a couple of weeks.
> >
> > Everything went smoothly until my supply of Nardil ran out in March or April due to the manufacturers ineptitude. I was forced to switch to parnate for 2 days rather than suffer withdrawal from stopping 90mg Nardil cold turkey. NOTE: this is technically a no-no, but is infrequently done by pdocs under close medical supervision)
>
> That is the biggest load of crap I have ever heard.
>
> #1 -- What is a "technical no-no"? You mean, the drug manufacturer states (for a good reason) that it should not be done under any circumstances and you did it anyway and decided to rationalize this foolish action by calling it "technical" and a "no-no" instead of a well-known dangerous drug combination.
>
> Starting parnate directly on top of 90mg/day of phenelzine is a near guarantee of disaster. I don't see why an MD would do such a thing unless he was just tired of having a medical license. Doctors do it "infrequently" because doctors "frequently" want to keep practicing medicine and avoid malpractice suits.
>
> There is no way that the abrupt discontinuation of Nardil risks the same degree of severe damage as dumping Parnate on top of a high blood level of Nardil.
>
> And then, what, you just started taking Nardil on top of the Parnate?
>
> #2 -- How did your "supply of Nardil run out"? Did you not notice that you only had 5 or 10 pills left? I ran out of Nardil once on vacation and it took me the better part of two days to find some more, but I didn't blame the manufacturer. It just isn't THAT rare of a drug.
>
> I am sorry to be so harsh, and I'm extremely sorry about your terrible ordeal and illness as a result of this. But your blaming everyone except the two responsible people -- yourself and your doctor -- means that you are at risk of repeating the behavior.


I'd like to answer question #2:

No, it's not that rare a drug however, the drug distributor in Canada shorted their supply not once but twice...I know because I was taking Nardil at the time. Both Phoenix and I were fortunate to find a meager supply the first time after days of phone calls to pharmacies...the second time I was able to but he wasn't...so it wasn't that he suddenly discovered he only had X number of pills left...he was frantically searching for it...

As to your closing paragraph, IMO you are way too harsh..his post may say 'very long" but it's the Reader's Digest version of how things went down.

What happened to him is terrible...and I am worried sick about him...if you decide to respond to this post, may I suggest that you read some previous posts between Phoenix and myself regarding the shortages before you insert your other foot..if not..at least have some emphathy for his situation...

This is a support forum and your opening line of "this is the biggest load of crap I have ever heard" just blew me away...

 

Re: Nardil Nightmare - very very long blueboy

Posted by Phoenix1 on May 28, 2008, at 18:09:11

In reply to Re: Nardil Nightmare - very very long, posted by blueboy on May 28, 2008, at 8:27:51

> That is the biggest load of crap I have ever heard.

Wow, that post felt like a slap in the face. I either didn't make myself clear, or else you totally misinterpreted my post. First of all, I'm not blaming everyone else for what happened. Where in either of my posts did I say anything that implied blame, please show me. I do take responsibility for the treatment decisions I made under the guidance of my psychiatrist. I switched to Parnate after very short washout because I ran out of Nardil. I want to state very very clearly, that this WAS caused by ERFA Canada, who was out of stock of Nardil for close to 3 months. I did everything in my power to prevent running out. I called over 50 pharmacies in my city, and was on the phone daily with ERFA trying to get them to ship me some. Nardil is NOT at all common in my geographcal area, so it isn't stocked by pharmacies. Other posters on this board are also aware of the issues with ERFA Canada, and cn vouch for the fact that there was no stock available for a long period of time.

What do I mean by a "technical no-no"? The monograph states that a 15 day washout is required when switching from one MAOI to another. My washout as in the order of 2 days, or 4 half lives. There is literature to support this type of switch in cases where the full washout would be more dangerous than the risk of the interaction of 2 MAOIs. By dangerous, I'm referring to the risk of suicide or return of a full blown depressive episode. This switch was made fully under the supervision of my pdoc. My blood presure was monitored constantly, and never rose to indicate a hypertensive crisis during this time. I was NEVER on both Nardil and Parnate at the sane time, as you state in your post. I'm not sure where you got that impression.

In any event my problems did not start until well after I was back on Nardil and off the Parnate. As far as I'm concerned The PRES was a result of the rapid Nardil withdrawal.

Anyways, I really shouldn't feel the need to defend myself against what feels like totally unprovoked abuse.

Phoenix


> > Hi, anyone here still remember me? I've been gone for a while.
> >
> > Anyways, I started Nardil in December '07 afer failing to benefit from many, many other AD's and combos. Nardil was a miracle drug, and I was feeling better within a couple of weeks.
> >
> > Everything went smoothly until my supply of Nardil ran out in March or April due to the manufacturers ineptitude. I was forced to switch to parnate for 2 days rather than suffer withdrawal from stopping 90mg Nardil cold turkey. NOTE: this is technically a no-no, but is infrequently done by pdocs under close medical supervision)
>
> That is the biggest load of crap I have ever heard.
>
> #1 -- What is a "technical no-no"? You mean, the drug manufacturer states (for a good reason) that it should not be done under any circumstances and you did it anyway and decided to rationalize this foolish action by calling it "technical" and a "no-no" instead of a well-known dangerous drug combination.
>
> Starting parnate directly on top of 90mg/day of phenelzine is a near guarantee of disaster. I don't see why an MD would do such a thing unless he was just tired of having a medical license. Doctors do it "infrequently" because doctors "frequently" want to keep practicing medicine and avoid malpractice suits.
>
> There is no way that the abrupt discontinuation of Nardil risks the same degree of severe damage as dumping Parnate on top of a high blood level of Nardil.
>
> And then, what, you just started taking Nardil on top of the Parnate?
>
> #2 -- How did your "supply of Nardil run out"? Did you not notice that you only had 5 or 10 pills left? I ran out of Nardil once on vacation and it took me the better part of two days to find some more, but I didn't blame the manufacturer. It just isn't THAT rare of a drug.
>
> I am sorry to be so harsh, and I'm extremely sorry about your terrible ordeal and illness as a result of this. But your blaming everyone except the two responsible people -- yourself and your doctor -- means that you are at risk of repeating the behavior.

 

Re: Nardil Nightmare - very very long Phoenix1

Posted by 4WD on May 28, 2008, at 18:29:25

In reply to Re: Nardil Nightmare - very very long blueboy, posted by Phoenix1 on May 28, 2008, at 18:09:11

Phoenix,
I agree with everything you wrote. You did the very best you could in a situation that really had no good solution. I felt like the above post was a slap in the face to you as well. Just consider the source and let it go. Don't let it get to you. Everyone who has posted to you about this is on your side and no one blames you except whoever it was who wrote that post (I can't remember).

So know that I support you 100%. I pray for you daily that God remove your depression and that you be able to get back on Nardil or at the very least some drug that will actually bring you out of your suidcidal depression.

So what are you going to do? I know the feeling when the pdoc wants to put you on some drug (you said Zoloft) and you know already that it won't work. It feels like nothing will work and I understand and sympathize and *emphasize* with your suicidal depression.

On thing is clear. You have to get back on something quick. I think Nardil is the best drug for you since you were doing so well on it before all this crap happened. This is just my opinion. You will have to make your own decision.

Know that I think about you every day and you have my full support and heartfelt prayers.

Love,
Marsha

 

Please be civil/follow site guidelines Justherself54

Posted by Deputy 10derHeart on May 28, 2008, at 18:33:33

In reply to Re: Nardil Nightmare - very very long, posted by Justherself54 on May 28, 2008, at 11:14:20

> ...you are way too harsh..
>
>... before you insert your other foot..
> This is a support forum and your opening line of "this is the biggest load of crap I have ever heard" just blew me away...

Please don't post anything that could lead others to feel accused or put down, and please follow site guidelines, i.e., if you think there is a civility issue with a post, please use the Notify the Administrators button instead of posting your comments on the boards.

If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ: http://www.dr-bob.org/babble/faq.html#civil

Follow-ups regarding these issues should be directed to Admin and should of course be civil. Dr. Bob has oversight over deputy decisions, and he may choose a different action.

-- 10derHeart, posting as deputy for Dr. Bob


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