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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by TJ99 on January 26, 2009, at 2:21:30
Hello all,
This is my first post here, but I've been reading for several months now. So let me start by saying "Thank you!" to Dr. Bob and to all the many members who have shared their knowledge and experience.
I have suffered from dysthymia and anxiety for the last 18 years or so, and tried nearly every SSRI with little benefit. I finally found a doctor that was eventually willing to try something besides yet another SSRI in early 2008. I started on Nardil 45 mg back in June of 2008, and gradually increased the dosage to 90 mg in late November/early December (I weigh about 210 lbs). Shortly after moving to 75 mg in August, I had a few days of hypomania (which was quite pleasant) and no anxiety. That ended quickly enough and I was pretty level. Not euphoric, but not thinking about suicide for the first time since, oh, I don't know, Bush 1 maybe? The next few months were ok, but by December I felt like I needed to increase again. Things were going along fairly well at 90 mg until Jan 2, when I started feeling very strange, walked into the kitchen, and passed out. I woke up a few seconds later with my 8 yr old over me, and I asked if she had any idea how I had gotten down there, because I sure didn't.
The ambulance came and my heart rate dropped to around 30 bpm as they were loading me in. I had several instances like that until I was released 4 days later, including two where my heart just stopped for 5-6 seconds. I lost most of my memory of the period starting from a day or two before I went into the hospital up to the day I got out. Maybe 15% wasn't erased.
So my doctor reduced the dosage to 60 mg. It's been twenty-four days now, and I can feel the depression and anxiety starting to come back. I'm trying to figure out what to do. I'm doubting that my doctor will want to go back to 90 mg. He has mentioned augmenting, with lithium in particular. I'm just wondering if it makes sense to augment Nardil when I'm only at about 2/3 the suggested dosage for my weight.
I haven't had any heart issues since I got released. But my head is foggy...hard to concentrate, hard to focus my thoughts. Feel slightly dizzy.
I have a lot of questions at this point...if anyone wants to give me their thoughts I'd be most appreciative:
- Has anyone ever heard of this type of thing happening with Nardil or another MAOI? I thought I had read most everything over the last several months, I don't think I came across anything like this.
- Do you think it is worth even trying to augment with lithium at Nardil 60 mg when 90 mg is what worked for me? Any other augmenting meds you would suggest?
- Is this a risk with ALL MAOIs, or is this just peculiar to Nardil? I'm wondering if it would be worth it to switch to another one. My anxiety is too high to make Parnate attractive, but Marplan sounds like a possibility.
- I was taking 240 mg ginkgo biloba/day because I didn't realize it wasn't recommended for people on MAOIs. I'm wondering if that might have played a role? My prescribing dr and the cardiologist just dismissed it as unimportant.
- On a side note, I'm pretty sure I have some degree of attention deficit disorder. I'm amazed I made it through high school, to say nothing of college. Any suggestions for meds that could be used to address this while I'm on an MAOI? Okay, I admit I'm slacking here, and haven't searched on that topic much yet. I do recall reading someone saying that some of the stimulants could be added in a very careful manner to the MAOIs.
Thanks all!
TJ99
Posted by mav27 on January 26, 2009, at 2:43:24
In reply to Nardil + Bradycardia/Heart Stoppage, posted by TJ99 on January 26, 2009, at 2:21:30
My heart rate drops on nardil, my usual rate is about 90bpm but by 30mg of nardil it was around 50 and i had the fainting thing going on.. never bad enough for my heart to stop though.. or at least if it did it obviously started beating again. Tried loads of caffiene and stuff but could never get it to beat faster.
Posted by TJ99 on January 26, 2009, at 11:28:14
In reply to Re: Nardil + Bradycardia/Heart Stoppage » TJ99, posted by mav27 on January 26, 2009, at 2:43:24
> My heart rate drops on nardil, my usual rate is about 90bpm but by 30mg of nardil it was around 50 and i had the fainting thing going on.. never bad enough for my heart to stop though.. or at least if it did it obviously started beating again. Tried loads of caffiene and stuff but could never get it to beat faster.
Wow...did you continue on Nardil or were you forced to quit? I had noticed my heart rate had gone down from around 90 or so to around 75, but I didn't make the connection to the Nardil. I did notice late in December that I was getting out of breath with most exertion. Now I'm wondering if that was due to the Nardil.Thank you!
TJ99
Posted by mav27 on January 26, 2009, at 11:43:46
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by TJ99 on January 26, 2009, at 11:28:14
i was forced to quit, i couldn't be out of bed for more than 10 minutes without fainting and it was doing some pretty bad damage to me and a lot of the property in my house :)
Posted by desolationrower on January 26, 2009, at 11:59:12
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by TJ99 on January 26, 2009, at 11:28:14
hmm, what did the cardiologist say was the cause? yeah i'd not take gingko with an MAOI, either.
just guessing, sounds like insufficient beta agonism, maybe because of octopamine accumulation; i think phenelzine also has a bit of catecholamine inhibiting effect. I'd guess parnate might be better, it tends to cause greater sympathetic activation. and while a amphetamine would probably help, the on/off nature would worry me. you say it would cause too much anxiety, but for people with ADHD stims (and thats the direction parnate would be) usually reduce anxiety.
have you had problems like this before? i think bradycardia is usually because of a physical cuase, often it could be nerve problem; nardil shouldn't do this in someone who is otherwise healthy, only exacerbate it. also has thyroid been checked (including t3/t4, not just tsh)? it can cause all of the problems you've mentioned. same thing with sleep apnea. make sure to get minerals, enough calcium, potassium, magnesium, basically eat your vegetables. and while you should be caution, make sure you'll still excercising.
piracetam could probably help concentration and prevent hypoxia brain damage if you have another incident.
sounds like a serious problem. hope you get it sorted out.
-d/r
Posted by Phillipa on January 26, 2009, at 12:22:44
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by desolationrower on January 26, 2009, at 11:59:12
I agree it sounds serious to me also people's hearts don't stop unless there is a reason. I'd get a good cardiologist to work you up seriously. Without life an ad? That sounds like cardiac arrest. Did they do CPR or Use the Paddles with electric joules? Love Phillipa
Posted by softheprairie on January 27, 2009, at 2:51:15
In reply to Nardil + Bradycardia/Heart Stoppage, posted by TJ99 on January 26, 2009, at 2:21:30
Well, I tend to recommend what has helped me, which is the tricyclic desipramine. SLS has taken it before with MAOIs and recommended it. (I think pharmacy computer programs may put out a general contraindication between MAOIs and all TCAs, but there are some references in medical literature of some being okay. Desipramine is not known to act on seratonin, so doesn't present a seratonin syndrome risk. The only known neurotransmitter desipramine acts on is norepinephrine.) Plus, a side effect of desipramine can be to raise one's heartrate (it does for me). Well, that's just what you could use! Plus, there is some usage of desipramine as a second-line, non-stimulant treatment for ADD. (Although, for me, I haven't noticed any attentional improvement from it, but I'm just passing along what I've read.) Two possible bonuses there!
Posted by TJ99 on January 27, 2009, at 3:15:59
In reply to Re: Nardil + Bradycardia/Heart Stoppage » TJ99, posted by softheprairie on January 27, 2009, at 2:51:15
Thank you, everyone. I need to respond to these, but spent today traveling for work then working late from my hotel room. I must get some sleep. I will respond to these tomorrow (well, later today).
Thank you!
TJ99
Posted by TJ99 on January 27, 2009, at 20:54:00
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by mav27 on January 26, 2009, at 11:43:46
> i was forced to quit, i couldn't be out of bed for more than 10 minutes without fainting and it was doing some pretty bad damage to me and a lot of the property in my house :)
Yikes. Yeah, I can see how that would be a problem. Did you try any other MAOIs and have any success?
TJ99
Posted by TJ99 on January 27, 2009, at 21:16:52
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by desolationrower on January 26, 2009, at 11:59:12
> hmm, what did the cardiologist say was the cause? yeah i'd not take gingko with an MAOI, either.
>
> just guessing, sounds like insufficient beta agonism, maybe because of octopamine accumulation; i think phenelzine also has a bit of catecholamine inhibiting effect. I'd guess parnate might be better, it tends to cause greater sympathetic activation. and while a amphetamine would probably help, the on/off nature would worry me. you say it would cause too much anxiety, but for people with ADHD stims (and thats the direction parnate would be) usually reduce anxiety.
>
> have you had problems like this before? i think bradycardia is usually because of a physical cuase, often it could be nerve problem; nardil shouldn't do this in someone who is otherwise healthy, only exacerbate it. also has thyroid been checked (including t3/t4, not just tsh)? it can cause all of the problems you've mentioned. same thing with sleep apnea. make sure to get minerals, enough calcium, potassium, magnesium, basically eat your vegetables. and while you should be caution, make sure you'll still excercising.
>
> piracetam could probably help concentration and prevent hypoxia brain damage if you have another incident.
>
> sounds like a serious problem. hope you get it sorted out.
>
> -d/rThe cardiologist has no knowledge of Nardil, but believes it was the cause. My PDoc seems to defer to whatever the cardiologist says.
I've never had a problem like this...I did notice that my heart rate was a little slower in December than before, but not lower than 70 or so. And I didn't have any lightheadedness or anything until the night I just passed out. I had been at 90 mg for about a month or so. I had thyroid checked earlier in 2008, and it was normal. I take supplemental magnesium and on some days (depending on food intake) calcium. I do have sleep apnea though -- have to use a CPAP.
I've never heard of piracetam; I will have to look it up.
My Pdoc wanted me to call after I saw the cardiologist. I told him about how I hadn't had any more heart issues but was starting to feel like the nardil wasn't working anymore. He said to wait for another two weeks to see if the trend continues, then I could come in to see him and he would prescribe me lithium. Somehow I don't much like the idea of just waiting to see if the trend continues.
Thank you for your input, I appreciate it.
TJ99
Posted by mav27 on January 27, 2009, at 21:23:44
In reply to Re: Nardil + Bradycardia/Heart Stoppage » mav27, posted by TJ99 on January 27, 2009, at 20:54:00
> > i was forced to quit, i couldn't be out of bed for more than 10 minutes without fainting and it was doing some pretty bad damage to me and a lot of the property in my house :)
>
> Yikes. Yeah, I can see how that would be a problem. Did you try any other MAOIs and have any success?
>
> TJ99I tried both parnate and nardil and they both did the same thing to me unfortunatly. I got so desperate for them to work that i even started taking everything on the don't eat list of things that are meant to cause a hypertensive crisis in the hope of it raising my blood pressure and heart rate so i wouldn't faint and it still didn't work.
Posted by TJ99 on January 27, 2009, at 21:31:35
In reply to Re: Nardil + Bradycardia/Heart Stoppage, posted by Phillipa on January 26, 2009, at 12:22:44
> I agree it sounds serious to me also people's hearts don't stop unless there is a reason. I'd get a good cardiologist to work you up seriously. Without life an ad? That sounds like cardiac arrest. Did they do CPR or Use the Paddles with electric joules? Love Phillipa
(Kind of) funny story there...the first time my heart stopped for 5.5 sec, I was asleep in the hospital bed, and my brother was in the room watching me. My HR went down to zero, and he rushed out of the room and was met by a bunch of people rushing in. They started putting the big patches on my chest and side to zap me, and I woke up and started cursing at them because the patches were so cold, and asking my brother what the hell these people were doing in my room. I was so incoherent -- I had NO idea what was going on. I asked "Jesus, do you think you could get those things any colder???" A nurse said, "Well, we were just hoping the shock of the cold would help start your heart up." I said, "WELL, MISSION ACCOMPLISHED!" I didn't even remember any of it until my brother told me about it later. Ah, good times.
TJ99
Posted by TJ99 on January 27, 2009, at 21:49:10
In reply to Re: Nardil + Bradycardia/Heart Stoppage » TJ99, posted by softheprairie on January 27, 2009, at 2:51:15
> Well, I tend to recommend what has helped me, which is the tricyclic desipramine. SLS has taken it before with MAOIs and recommended it. (I think pharmacy computer programs may put out a general contraindication between MAOIs and all TCAs, but there are some references in medical literature of some being okay. Desipramine is not known to act on seratonin, so doesn't present a seratonin syndrome risk. The only known neurotransmitter desipramine acts on is norepinephrine.) Plus, a side effect of desipramine can be to raise one's heartrate (it does for me). Well, that's just what you could use! Plus, there is some usage of desipramine as a second-line, non-stimulant treatment for ADD. (Although, for me, I haven't noticed any attentional improvement from it, but I'm just passing along what I've read.) Two possible bonuses there!
>
>
>
Thank you, that sounds interesting...my concern, though, is that I had a pretty bad experience with desipramine before I started with Nardil. Desipramine was the first non-SSRI that I ever tried. I had serious anger problems when I was taking it. Really REALLY angry, far more than anything that was normal for me. After a couple of weeks I quit. My doctor wanted me to continue on for a couple more weeks, but I said I was quitting and wanted to try Nardil because it had worked for my father in 1994. He also had suffered from depression and anxiety and Nardil worked like a charm for him. My wife told me a few months later that she had come very close to asking for a restraining order against me.TJ99
Posted by TJ99 on January 27, 2009, at 22:01:15
In reply to Re: Nardil + Bradycardia/Heart Stoppage » TJ99, posted by mav27 on January 27, 2009, at 21:23:44
> >
> > Yikes. Yeah, I can see how that would be a problem. Did you try any other MAOIs and have any success?
> >
> > TJ99
>
> I tried both parnate and nardil and they both did the same thing to me unfortunatly. I got so desperate for them to work that i even started taking everything on the don't eat list of things that are meant to cause a hypertensive crisis in the hope of it raising my blood pressure and heart rate so i wouldn't faint and it still didn't work.
>Good lord. As extreme as doing something like that sounds, I can understand your wanting to try it. Did you ever find anything that worked for you?
TJ99
Posted by softheprairie on January 27, 2009, at 22:09:35
In reply to Re: Nardil + Bradycardia/Heart Stoppage » softheprairie, posted by TJ99 on January 27, 2009, at 21:49:10
> > Well, I tend to recommend what has helped me, which is the tricyclic desipramine. SLS has taken it before with MAOIs and recommended it. (I think pharmacy computer programs may put out a general contraindication between MAOIs and all TCAs, but there are some references in medical literature of some being okay. Desipramine is not known to act on seratonin, so doesn't present a seratonin syndrome risk. The only known neurotransmitter desipramine acts on is norepinephrine.) Plus, a side effect of desipramine can be to raise one's heartrate (it does for me). Well, that's just what you could use! Plus, there is some usage of desipramine as a second-line, non-stimulant treatment for ADD. (Although, for me, I haven't noticed any attentional improvement from it, but I'm just passing along what I've read.) Two possible bonuses there!
> >
> >
> >
>
>
> Thank you, that sounds interesting...my concern, though, is that I had a pretty bad experience with desipramine before I started with Nardil. Desipramine was the first non-SSRI that I ever tried. I had serious anger problems when I was taking it. Really REALLY angry, far more than anything that was normal for me. After a couple of weeks I quit. My doctor wanted me to continue on for a couple more weeks, but I said I was quitting and wanted to try Nardil because it had worked for my father in 1994. He also had suffered from depression and anxiety and Nardil worked like a charm for him. My wife told me a few months later that she had come very close to asking for a restraining order against me.
>
> TJ99
Wowza! I'm sorry the desipramine trial went so badly; I'm glad the anger subsided after you discontinued it.
Posted by Phillipa on January 28, 2009, at 0:00:47
In reply to Re: Nardil + Bradycardia/Heart Stoppage » Phillipa, posted by TJ99 on January 27, 2009, at 21:31:35
That was funny your reaction and that of the staff. Well no shocking. I'm sorry you're having such a bad time. Phillipa
Posted by mav27 on January 28, 2009, at 2:11:49
In reply to Re: Nardil + Bradycardia/Heart Stoppage » mav27, posted by TJ99 on January 27, 2009, at 22:01:15
> > >
> > > Yikes. Yeah, I can see how that would be a problem. Did you try any other MAOIs and have any success?
> > >
> > > TJ99
> >
> > I tried both parnate and nardil and they both did the same thing to me unfortunatly. I got so desperate for them to work that i even started taking everything on the don't eat list of things that are meant to cause a hypertensive crisis in the hope of it raising my blood pressure and heart rate so i wouldn't faint and it still didn't work.
> >
>
> Good lord. As extreme as doing something like that sounds, I can understand your wanting to try it. Did you ever find anything that worked for you?
>
> TJ99
>
>I'e tried every AD now, those two MAOI's are the only ones that have actually treated me but the fainting thing makes it impossible to live life... it left me in hospital 6 times in the last 18 months so now my pdoc has asked me to stay away from them. I tried everything possible but no luck so back to square one now... i'm starting from the ssri's again.
Problem is my main prolem is lack of energy which needs a noradrenaline boost... but anything that touches noradrenaline in my body leads to the fainting.
Posted by TJ99 on January 30, 2009, at 22:12:59
In reply to Re: Nardil + Bradycardia/Heart Stoppage » TJ99, posted by mav27 on January 28, 2009, at 2:11:49
>
> I'e tried every AD now, those two MAOI's are the only ones that have actually treated me but the fainting thing makes it impossible to live life... it left me in hospital 6 times in the last 18 months so now my pdoc has asked me to stay away from them. I tried everything possible but no luck so back to square one now... i'm starting from the ssri's again.
>
> Problem is my main prolem is lack of energy which needs a noradrenaline boost... but anything that touches noradrenaline in my body leads to the fainting.
>
>Six times in 18 months? I'm sorry to hear that. Have to admire your determination, though. Yeah, I'd agree, with that kind of thing going on it would be hard to live a normal life. I wonder if you tried some kind of combination of several things like some people here if it might help.
This is the end of the thread.
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