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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by PilledOut on July 5, 2016, at 15:16:46
I started on 7.5mg Nardil (generic Greenstone) a month and a half ago. It was titrated up until I reached 45mg several days ago.
Nardil seems to have an additive effect - each day's worth builds on the previous day, so you feel the effects increasing. I had this feeling with tricyclics I've taken as well.
Anyway, I had an increase in side effects after going up to 45mg. Yesterday was by far the worst. I felt really weird side effects a few hours after taking it in the morning. I felt really weird overall, like I'm drugged out and spacey. I had trouble standing still; I was gently wobbling around. My face felt sickly and clammy. At times I felt a weird, brief headache, like sharp stabs in temples, but it wasn't painful. My eyes felt dilated and can't open up completely (I'm still feeling that). I was walking really slowly at times. On the bus, the side effects were so weird I thought about going home or calling 911. None of it was painful or unpleasant, though. Nardil seems to make everything feel washed out, without much anxiety or tension.
The weirdest side effect yesterday was that loud noises sounded particularly loud, and they also had a very strange quality - very distinct and "tinny." My friend said he had Novocaine, and he also felt sounds were distant, with an echo. We watched a movie, and the louder sounds felt really loud and "bright." Sometime during the movie, I heard very distinct crackling sounds. My friend said it was part of the movie, but I must have experienced the crackling sounds louder and more obviously than others. i thought I was hallucinating. The loud sounds seemed trippy. My friend said I seemed unusually sedated.
Today, loud sounds no longer have that louder, weird effect. But I'm still feeling sick and out of it. I can't think very clearly. As I type, the taps on the keyboard feel very light and "clicky." My fingers have a strange feel as I tap on the keys.
Has anyone else had any of these strange side effects? I'm pretty sure I need to stop taking Nardil. These side effects are too weird and severe. But I don't feel bad, and the side effects are not painful or overly uncomfortable. Nardil seems to blur things out and "wash out" any anxiety or unpleasantness.
Posted by Lamdage22 on July 6, 2016, at 4:20:54
In reply to Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 5, 2016, at 15:16:46
watch out for psychosis. If you have it you need to stop
Posted by PilledOut on July 6, 2016, at 9:00:08
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by Lamdage22 on July 6, 2016, at 4:20:54
I don't think I have psychosis. But the various side effects were severe and weird enough that I think I need to stop.
Posted by Lamdage22 on July 6, 2016, at 9:33:13
In reply to Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 5, 2016, at 15:16:46
it doesnt sound very good. What does the Dr say?
Posted by PilledOut on July 6, 2016, at 10:20:06
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by Lamdage22 on July 6, 2016, at 9:33:13
I haven't told my doctor about it yet, but I do plan to leave a her voicemail about it today. My next appointment is in a couple of weeks.
I've tried clomipramine and imipramine with my doctor. I had pretty bad side effects with those shortly after I started taking them. The side effects of those 2 meds and Nardil actually have some similarities. Nardil's side effects are the weirdest, though. Hearing loud sounds louder and in a trippy way is the most bizarre side effect I've had on Nardil. Imipramine caused me to almost blackout and feel so sick and faint I was ready to go to the ER.
Anyway, it looks like this is yet another med that has failed me. I've tried many different meds, and they had intolerable side effects or were ineffective.
Posted by SLS on July 6, 2016, at 16:36:23
In reply to Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 5, 2016, at 15:16:46
Hi.
> Anyway, I had an increase in side effects after going up to 45mg. Yesterday was by far the worst. I felt really weird side effects a few hours after taking it in the morning. I felt really weird overall, like I'm drugged out and spacey.
This is probably not a rare occurrence, and may even be a good sign that you will eventually improve. This has been my experience with Nardil. I would continue with Nardil and allow these things a week or two to dissipate. Most people need a minimum of 60 mg/day of Nardil to obtain a positive response.
I can't comment on the remainder of your descriptions, as they are not familiar to me. I know that one's startle-response can be exaggerated. Perhaps someone here can identify one of the things you describe as being somehow dangerous. I would learn something. But for now, I don't see anything to worry about except for dealing with temporarily feeling weird, spacy, and having some changes in perceptions.
- Scott
Posted by SLS on July 6, 2016, at 17:01:14
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 6, 2016, at 10:20:06
> Hearing loud sounds louder
This may be an exaggerated startle-response.
I think much of your "trippy" feeling is part of the weird feelings you are having that could be a startup side effect. This side effect may be some sort of minor dissociation that will resolve once the spacey feelings go away. Nardil can hit you like a ton of bricks once MAO inhibition becomes significant.
Considering your dwindling alternatives, I would not be so quick to discontinue Nardil. Give things 3 more days to see if the side effects start to dissipate. I can't guarantee anything. I can't know for sure that there aren't any safety issues here. However, I would hate to see you give up on a potentially effective drug prematurely. It could change your life.
What other drugs are you currently taking? Perhaps there is an interaction that is important to consider.
- Scott
Posted by jonhed on July 6, 2016, at 17:16:37
In reply to Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 5, 2016, at 15:16:46
Sometimes low doses of psychotropic substances can make you feel very bad and weird, and high doses usually take that away.
I can explain that tomorrow, cause it happens with a lot of substances, but now i have to sleep.Give it a try and even raise it when you have consulted your doctor is my tip.
But remember that i'm very much not a doctor :-)
Posted by PilledOut on July 6, 2016, at 17:19:04
In reply to Re: Strange side effects from Nardil, eg loud sounds » PilledOut, posted by SLS on July 6, 2016, at 17:01:14
It all felt very severe on Monday. I was on the bus and it was so bad I thought about calling 911. It didn't feel that unpleasant, though. Nardil gets rid of unpleasantness and decreases anxiety.
The sounds that sounded louder than they were lasted a few hours, for the most part. But the next day, when I woke up, I was still hearing louder sounds. I think birds were chirping louder.
I stopped taking Nardil yesterday and today. Yesterday I was still feeling side effects, as I mentioned in a previous post. Today I feel fine. I'm back to normal, with almost none of the side effects I've been feeling since going up to 45 mg. My head feels clear, my eyes are more open, and I can think better. I'm also more motivated to do stuff. I've been feeling really lazy and not caring when I went up to 45mg.
I'm afraid that my psychiatrist will tell me to get off Nardil if I tell her about the side effects. She got me off imipramine and clomipramine after I got the initial side effects.
Over the years, I've tried every med you can think of and more. I have pretty severe depression, generalized anxiety, social anxiety, PTSD, and OCD.
I wouldn't want to repeat what I went through on Monday. It was bad. If anything, I should lower the dose again. I feel that Nardil builds on the previous days worth, so taking 45mg everyday feels like it's too much. That's why I had such bad side effects on Monday.
I take Ativan and Xanax as needed, usually twice a week. I often alternate them. But my city clinic is phasing them out, so they probably won't be prescribing them soon. It will be hard to find a place that will prescribe benzos. That's another challenge that's coming up.
Posted by PilledOut on July 6, 2016, at 17:29:42
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by jonhed on July 6, 2016, at 17:16:37
Is 45mg a low dose? I actually started on 7.5mg and slowly went up to 45mg. It took a little over a month. I didn't really feel side effects until I was on 45mg.
I know 60mg is supposed to be a therapeutic dose, and some people go quite a bit higher.
I wouldn't want to repeat when I went through on Monday, though.
Posted by jonhed on July 6, 2016, at 17:54:03
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 6, 2016, at 17:29:42
Oh sorry, i don't want you to do that either.
Never mind what i wrote, i was just brain storming.
Do what feels right! :-)Just that when i take 10mg of benzedrine i feel paranoid and the noises sounds awful at the bus, like people talking when it's actually is the engine, 200mg i feel crystal clear and no side effects.
That was the thing i was going to say but more specific.I don't know about nardil though, maybe it's because of the gaba-t-inhibitor mechanism that makes you feel foggy and tired.
Maybe Scott can this better than me!
Posted by Horse on July 7, 2016, at 23:36:49
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 6, 2016, at 17:29:42
Hey, sorry things were feeling so weird. If you've already discontinued, disregard my comments. When I was on Emsam, the closest I've come to an maoi, I felt very very odd during start up, difficult to describe, but an unhappy trippy and pounding temples. When that passed I entered what I think was the theraputic phase. When I discontiued abruptly under unfortunate circumstance, I became sightly delusional. I think that's what I'd call that. Nothing like an ssri discontinuation. If circumstance were different, I'd be interested in beginning Emsam again. Or Nardil.
Have you had insomnia?
Posted by PilledOut on July 8, 2016, at 8:29:50
In reply to Re: Strange side effects from Nardil, eg loud sounds » PilledOut, posted by Horse on July 7, 2016, at 23:36:49
My psychiatrist actually told me to take Nardil before bedtime. But like most doctors, she has very little experience prescribing MAOIs. Consumers like us probably know way more about MAOIs because we're reading about it so carefully and thoroughly on the web. I've asked a few doctors in the past, and they refused to prescribe MAOIs for me, though I'd already taken many meds unsuccessfully. Anyway, I usually took Nardil during the day. I've noticed that even when the label says to take it at bedtime, I'd experiment with other times of the day, and it'd often feel better for me.
I already have insomnia, so I could not tell if Nardil gave me any more insomnia.
What I like about Nardil, at least at 45mg, is that it does decrease painful, negative feelings and trauma. I could feel the Nardil running through me, like a "wet" feel. Maybe it's the serotonin. I felt a similar feeling on Ativan sometimes.
I've stopped Nardil for the past few days. The side effects have pretty much gone away. My head is clear again, my eyes are opening up again, and typing doesn't feel weird. But I'm getting more of the emotional pain and trauma again.
I'm wondering if I could go back to a lower dose of Nardil and keep taking it to see if it would help. I called my doctor yesterday and explained all that's been going on. We agreed to stay off Nardil for the time being until my next appointment in a few days. Then we'll discuss some more and consider other options, like combinations of meds. Yeah, I've taken every med out there and more, so my options are really running out.
Posted by rose45 on July 8, 2016, at 13:37:28
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 8, 2016, at 8:29:50
When I took nardil, I would feel really terrible for the first 6 weeks. I could barely function, and would not have carried on if I hadnt been in hospital and forced to stay on the medication. The Nardil was titrated up to 60 mg. Then suddenly, after 7 weeks, I began to feel better. It does take that long to work and for me it was really unpleasant until then. Since you are not in hospital, it will be even more of a challenge for you, but you cant really tell whether it will work or not, unless you are prepared to give it 8 weeks, and go up to 60 mg.
Posted by rose45 on July 8, 2016, at 13:39:20
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by rose45 on July 8, 2016, at 13:37:28
Once it does begin to work, it is like a miracle. You will feel wonderful - like a different person.
Posted by PilledOut on July 8, 2016, at 14:18:09
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by rose45 on July 8, 2016, at 13:39:20
That's good to know, rose45.
I took a break from Nardil the past 3 days. Today I started on it again, but I took 30mg instead of 45. Again, I'm getting the following symptoms: dilated eyes, eyes can't open completely, feeling hazy, sick feeling, some shaking, bit of headache here and there, cold hands, sickly feeling in face, face drained of color, and ringing in ears at one point. And now, typing feels weird as well. The side effects are relatively mild compared to what happened on Monday, though.
When I was initially on 30mg, I hadn't felt these symptoms because I had been taking it everyday, but today I'm feeling them, probably because I skipped 3 days.
I'm not working or in school right now, so I can wait out the horrible side effects. I'd definitely need to take some days off if I were working or in school!
If I had Monday's severe symptoms on any other med, I would've stopped it immediately. But Nardil is known to be such an amazing med that I'm giving it another chance. I'm kind of scared to go through all these side effects, but I hope they'll go away soon.
To avoid Monday's extreme side effects, I'm going to try taking Nardil in divided doses, spaced throughout the day. Also, if I feel that I have too much Nardil in my system, I'm going to skip or lower the dose for a day or two, and then go up to the regular dose again. I talked to my doctor, and she advised that.
Posted by rose45 on July 8, 2016, at 17:02:19
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 8, 2016, at 14:18:09
I wish I could say something to help. And I wish your doctor was more of an expert in MAOIs. In my case, I was in hospital and the doctors were not that interested in my symptoms. They were focused on making me stay on the medication and to keep increasing the dose up to 60 mg. I was on that dose for 4 weeks before I felt better. I had insomnia, constipation and felt totally suicidal. But I was not on any other medications - so I dont know whether that is an issue, in your case. I could barely function, but I was in hospital, so meals were prepared for me etc but it was really grim in that hospital. I went through this process on 3 several occasions, because every time I decreased the medication too much, on future occasions, I became ill like that again, and again had to go through the entire 8 weeks of misery, titrating it up again. But I honestly have not read of anyone having as hard a time as I did with that medication. However, once it worked, it did really work.
Posted by SLS on July 8, 2016, at 17:37:25
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 8, 2016, at 14:18:09
I don't think you are going to avoid experiencing these startup cognitive side effects and secure an antidepressant response by jumping up and down in dosage or skipping days. You can only make things worse. Now, you say that you are experiencing problems at 30 mg/day? How do you interpret this? I would recommend against "pulsing" Nardil on and off. You are probably sensitizing the brain and autonomic nervous system to some of the pharmacological effects of Nardil.
I understand that you can't afford to experience cognitive impairments right now. You can either stop Nardil now and wait for a better time to give it a full trial or go up in dosage very slowly. Cut the pills in half. Try to keep your dosages steady. Perhaps you can restart Nardil at 15 mg/day and increase the dosage by 7.5 mg every week or two.
Please continue to post as you progress through your Nardil trial. I hope people here can help you through it or give you sufficient reason to end it. My period of cognitive impairment weirdness lasted for roughly 3 days once I reached 60 mg/day. I believe it was a sign that Nardil was doing to the brain what it was supposed to. For the most part, the drugs that worked for me gave me some sort of changes in cognition or perception temporarily.
I'm not in your head, so I really don't know what you are experiencing. I may be wrong in my interpretation of your words. Perhaps my suggestions are not appropriate for you. All I can say is that the cognitive side effects that occur briefly at the beginning of treatment is not uncommon.
- Scott
Posted by PilledOut on July 8, 2016, at 21:41:14
In reply to Re: Strange side effects from Nardil, eg loud sounds » PilledOut, posted by SLS on July 8, 2016, at 17:37:25
Hi Scott, sorry, this might be difficult to follow because I've been writing about my experiences over several days. If you like, you can re-read all my posts in this thread to get a better understanding of what's been happening.
Actually, I wrote that I was not working or in school right now, so I can afford to go through bad side effects, like rose45 did in the hospital.
I was not purposely starting Nardil on and off. On Monday, I had the extreme side effects that I wrote about in the first post. That's why I stopped it for 3 days. I was actually going to stop Nardil until my next dr's visit next week, but I decided to start it up again today.
Yes, I had side effects at 30mg, but they were much milder than the extreme effects I got on Monday when I was on 45mg.
---------------------
I actually got an EXTREME, TERRIFYING experience this afternoon. All of a sudden, I could barely breathe, I was going to faint, my heart was beating super fast, my face was sickly, and my hands were cold and clammy. I thought I needed to be rushed to the ER asap. But I sat down and got better. It was over in less than 10 minutes. But it was horrific, and I really thought I was dying. I had a similar experience when I was on clomipramine a few months ago.Was that a hypertensive crisis? Didn't sound like it. It does fit into the description of panic attack. Nothing seemed to lead it on; I was just calmly reading when it suddenly happened. I had taken the 30mg Nardil in the morning. For lunch, I had a pizza slice and a Drumstick ice cream cone. (I had pizza quite a few times on Nardil with no effects.) Then I got a headache right afterwards. Then a couple of hours later, the "attack" came on.
Did it have anything to do with Nardil? It was absolutely terrifying, and I wouldn't want it to happen again. Anyway, I'm stopping Nardil until my dr's appt next week.
Posted by jonhed on July 9, 2016, at 2:25:05
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 8, 2016, at 21:41:14
I'm sorry to say this and i hope you can do something about it, maybe add an benzo or something.
But i think you are experiencing full blown panic attacks with dissociative elements (it's usual..).I think they will go away, but you need an add on until the nardil start to work.
I have had this feeling many times to and it is panic attacks, extreme ones.
I really feel with you cause it's the worst thing you could go through, but it gets better, and please, tell your doctor and make him/her put you on a strong benzo for some weeks..
(just my opinion)
It makes me sad to read that..
Posted by SLS on July 9, 2016, at 7:04:49
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by PilledOut on July 8, 2016, at 21:41:14
> I actually got an EXTREME, TERRIFYING experience this afternoon. All of a sudden, I could barely breathe, I was going to faint, my heart was beating super fast, my face was sickly, and my hands were cold and clammy. I thought I needed to be rushed to the ER asap. But I sat down and got better. It was over in less than 10 minutes. But it was horrific, and I really thought I was dying. I had a similar experience when I was on clomipramine a few months ago.
Do you think it was an attack of low blood pressure? This is not uncommon with Nardil when getting up from a seated position (orthostatic hypotension). This was a big problem for me when I take Nardil, but it got about 50% better over time. When the blood pressure drops, the heart must beat faster and more forcibly to compensate for this. This can result in rapid heartbeat and palpitations. Tricyclics can do this too, but not as bad.
Anyway, I think you are doing the right thing by stopping Nardil and talking to your doctor. Despite your very detailed descriptions, I don't think anyone here can guarantee that you can safely take this drug. If your doctor is unfamiliar with MAOIs, he will probably want you to stop taking it indefinitely.
> Was that a hypertensive crisis?If it were a common headache, I doubt it. However, if your headache presented as a rhythmic and painful pounding in the back of your head, then a hypertensive reaction is the likely explanation for your reaction.
It is important to recognize that the effect on total MAO inhibition produced by Nardil is latent and involves a lag time. This happens both on the way up and on the way down in dosage. That said, I am all but sure that Nardil has properties other than MAO inhibition. It seems to be an acute stimulating effect that is different from Parnate. I experienced this 0.5 to 1.5 hours after dosing. I really screwed around with Nardil more than I should have because I was misinterpreting this effect. Because of this, I may have more experience with the personality of this drug than most other people. When I was going up and down in dosage, I experienced changes in the size of my pupils (I think they became bigger), sweating without feeling hot, tachycardia and palpitations. In other words, I experienced a kind of transient dysautonomia when I raised the dosage after having reduced it.
A few ideas:
1. Restart Nardil at 15 and increase the dosage by 7.5 mg every 2 weeks. Some people do respond to 30-45 mg/day, but not many. I would say that 45 mg/day might be a good dosage to target first. You could maybe give it 3 or 4 weeks to work. From there, you could then try to move up to 60 mg/day; increasing the dosage by 7.5 mg at a time.
2. Try taking Marplan (isocarboxazid). It is similar to Nardil, but much more tolerable.
3. While taking Nardil, take a beta-blocker to prevent or lessen the intensity of sympathetic nervous system stimulation. You can take propranolol, atenolol or pindolol. Atenolol might be best, as it does not cross the blood brain barrier and has fewer side effects. You could then discontinue it gradually once you are able to establish a therapeutic dosage of Nardil.
I guess you need to weigh cost versus potential benefit of taking Nardil - or any other drug.
Other than clomipramine, what other tricyclics have you tried, and what were the results?
Do you think you need to take a break from trying medication at this point?
Is perfectionism or obsessiveness a problem?
- Scott
Posted by jonhed on July 9, 2016, at 8:39:04
In reply to Re: Strange side effects from Nardil, eg loud sounds » PilledOut, posted by SLS on July 9, 2016, at 7:04:49
So just to be clear, it is totally ruled out that it was a panic attack?
The symptoms he describes is the symptoms of, at least mine, panic attacks.I know that it could be other things to, but i hope that we don't rule out the possibility that it was a panic attack.
Then, atenolol could make the anxiety worse.
I'm NOT saying your wrong, the things you purpose sounds that it could be right to, but have in mind that i could be other things to.
As i have said, it is good that it is discussions about things. That is how we can help each other :-)
Kind regards. J
Posted by SLS on July 9, 2016, at 10:17:01
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by jonhed on July 9, 2016, at 8:39:04
> I know that it could be other things to, but i hope that we don't rule out the possibility that it was a panic attack.
>
> Then, atenolol could make the anxiety worse.I didn't know that. Do you know why?
Oh, you don't want to take a beta-blocker if you have asthma.
I would say that a panic attack would include hyperventilation. I don't remember that happening with me. Interestingly, Nardil can effectively treat GAD and panic attacks. It may be that a panic attack emerged as the result of extreme worrying about the upsetting side effects produced by Nardil.
This is a bit of a conundrum. If I had not known about startup side effects, I doubt that I would have continued taking Nardil, even though it would have ultimately improve my condition.
I think the severity of the side effects should be taken into consideration. If the side effects were intense, I don't think it makes sense to continue with Nardil.
- Scott
Posted by jonhed on July 9, 2016, at 10:26:29
In reply to Re: Strange side effects from Nardil, eg loud sounds » jonhed, posted by SLS on July 9, 2016, at 10:17:01
It's something with it, even if it's to a little extent, reduces noradrenaline, and that can, in some individs, trigger depressive symptoms. Maybe not anxiety, but depression i know.
I know i got depressive on atenolol, metoprolol and def on clonodine (i know, that is something else but anyway),
and my pdoc even told me that i could.But as for everything, some are very helped from beta-blockers, some are don't.
I was gonna write that, cause my most extreme panic attacks have occurred after excessive worrying about a medication that i take.
Even if it is an axiolytic, (read buspar).But i agree with you, the severity of the symptoms must be taken seriously.
Posted by jonhed on July 9, 2016, at 10:37:54
In reply to Re: Strange side effects from Nardil, eg loud sounds, posted by jonhed on July 9, 2016, at 10:26:29
I still have 99 of 100 pills of Parnate left just because of that worry.
2 weeks i was in panic. But i am very anxious in that way..
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