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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 bbb1993 on September 8, 2017, at 3:25:26
Hey there,
I had a great experience with starting Nardil.
From the first day I took 15mg my anxiety was almost gone (I was still anxious in more intimidating situations, but I could easily get through it and I was very happy with where my SA was at). I experienced the typical symptoms of light headedness, weight gain, constipation, tiredness, but all of which decreased as my body got used to it.This lasted for about 3 weeks (during which I went from 15mg to 30mg) before it pooped out.
I am now taking 45mg (I weigh 50kg) and it hasn't really worked since, so I'm wondering if I should continue with the 45mg for a month or so (my psychiatrist mentioned that it affects the GABA system and some people respond to it very early due to that, so perhaps it hasn't truly kicked in for me.. if that makes sense? just speculating here).
Or I stop for a while and start back at 15mg.Any opinions/experiences appreciated!
Posted by SLS on September 8, 2017, at 5:55:16
In reply to Nardil immediate relief and early poop out, posted by bbb1993 on September 8, 2017, at 3:25:26
In my estimation, the minimum dosage necessary to produce a lasting therapeutic effect for Nardil is 60 mg/day. I need 90 mg/day to get the most out of Nardil. Some people go to 120 mg/day. I would say that 75 mg/day is a good dose. Taking 45 mg/day for weeks and weeks is not a good investment of your time. However, you need to increase the dosage of Nardil gradually. Give 60 mg/day at least 3 weeks to determine its effect on you. Going to 75 mg/day is a big jump.
- Scott
Posted by pedr on September 8, 2017, at 13:31:32
In reply to Re: Nardil immediate relief and early poop out » bbb1993, posted by SLS on September 8, 2017, at 5:55:16
> In my estimation, the minimum dosage necessary to produce a lasting therapeutic effect for Nardil is 60 mg/day.
I'll respectfully disagree with this if the patient presents like I do. I'm unable to get near therapeutic dose on almost all meds and I've taken very many.
However, I'm going to respectfully disagree with my own disagreement now since upon reflection, no med (at these low, low doses I can tolerate) has had a lasting therapeutic effect on me. So you could well be right SLS.
> Give 60 mg/day at least 3 weeks to determine its effect on you. Going to 75 mg/day is a big jump.
I agree with this - if you can tolerate it. Give it your best shot. I've read many times that people find higher doses tough or no help and then boom, the med kicks in and they're very glad they stuck it out at that higher dose.
Posted by pedr on September 8, 2017, at 13:36:00
In reply to Nardil immediate relief and early poop out, posted by bbb1993 on September 8, 2017, at 3:25:26
> Hey there,
>
> I had a great experience with starting Nardil.
> From the first day I took 15mg my anxiety was almost gone (I was still anxious in more intimidating situations, but I could easily get through it and I was very happy with where my SA was at). I experienced the typical symptoms of light headedness, weight gain, constipation, tiredness, but all of which decreased as my body got used to it.
>
> This lasted for about 3 weeks (during which I went from 15mg to 30mg) before it pooped out.This is what happened with me almost exactly. Felt better but then boom, it pooped out pretty early on. Nardil reputedly has a period of potential euphoria, which I believe I experienced mildly.
> I am now taking 45mg (I weigh 50kg) and it hasn't really worked since, so I'm wondering if I should continue with the 45mg for a month or so (my psychiatrist mentioned that it affects the GABA system and some people respond to it very early due to that, so perhaps it hasn't truly kicked in for me.. if that makes sense? just speculating here).
> Or I stop for a while and start back at 15mg.
>
> Any opinions/experiences appreciated!Very hard call. I'd head as high as you can to therapeutic dose (60-75mg) and hold there if you can. I couldn't tolerate it even though I tried desperately. If that doesn't work out you can then go back down in dose.
One diet tip: definitely avoid draft beer. I drank 1/2 a pint and went into hypertensive crisis. Not recommended.
Posted by bbb1993 on September 9, 2017, at 5:29:11
In reply to Re: Nardil immediate relief and early poop out, posted by pedr on September 8, 2017, at 13:36:00
Thanks for the advice guys. I will try to go up to 60mg in the few days.
Just another question on dosage, would you say that its ok to take 2x in the morning and 2x in the arvo? I would prefer to spread it out but I always get insomnia when I take it near bedtime.
Posted by SLS on September 9, 2017, at 7:20:30
In reply to Re: Nardil immediate relief and early poop out, posted by bbb1993 on September 9, 2017, at 5:29:11
> Thanks for the advice guys. I will try to go up to 60mg in the few days.
>
> Just another question on dosage, would you say that its ok to take 2x in the morning and 2x in the arvo? I would prefer to spread it out but I always get insomnia when I take it near bedtime.Just don't take any Nardil after 3:00 PM. You can take 30 mg in the morning and 30 mg in the early afternoon.
- Scott
Posted by linkadge on September 9, 2017, at 14:51:33
In reply to Re: Nardil immediate relief and early poop out, posted by SLS on September 9, 2017, at 7:20:30
Hey SLS,
How much nortriptyline did you take with an MAOI?
Did you notice any differences in combining it with one MAOI vs. another?
Linkadge
Posted by SLS on September 9, 2017, at 18:51:23
In reply to Re: Nardil immediate relief and early poop out, posted by linkadge on September 9, 2017, at 14:51:33
Hi, Linkadge.
> How much nortriptyline did you take with an MAOI?
I have taken 150 mg/day of nortriptyline in combination with Parnate 120 mg/day and Nardil 90 mg/day. However, I subsequently found that 100 mg/day of nortriptyline is optimal for me. 150 mg/day brought on brain-fog and a less robust antidepressant response. After awhile, no side effects were evident. I would rather be on nortriptyline than a SSRI with respect to side effects.
> Did you notice any differences in combining it with one MAOI vs. another?
That's a really good question. I wish I could give you a definite answer. My first impression is that there really wasn't anything special about one combination over another. As an aside, I find nortriptyline to be more of a mood-brightener than desipramine. Likewise, I find Nardil to be more of a mood-brightener than Parnate.
- Scott
Posted by linkadge on September 10, 2017, at 15:43:41
In reply to Re: Nardil immediate relief and early poop out » linkadge, posted by SLS on September 9, 2017, at 18:51:23
I am currently taking nortriptyline and lithium. I am prescribed Effexor, but for some reason it isn't agreeing with me.
I have been cautiously adding some MAO inhibiting herbs, which seem to make a major difference.
I'd like to try a MAOI again - but I think the chances are pretty slim of finding a doc willing to prescribe. I had a some form of hypertensive response to parnate, but other than that, I was having a very good response (40mg). The doc took me off and have never been able to try again.
Linkadge
Posted by SLS on September 10, 2017, at 19:19:42
In reply to Re: Nardil immediate relief and early poop out, posted by linkadge on September 10, 2017, at 15:43:41
> I am currently taking nortriptyline and lithium. I am prescribed Effexor, but for some reason it isn't agreeing with me.
I saw that you are on a very low dosage. I found Effexor 300 mg/day + nortriptyline 75 mg/day to be moderately effective. I wish I had thought to increase the nortriptyline to 100-150 mg/day. I might have had a robust response. It is possible that you would have less trouble tolerating Pristiq than Effexor. My guess is that the venlafaxine molecule does things that the desvenlafaxine metabolite does not - things that make venlafaxine problematic for you.
> I have been cautiously adding some MAO inhibiting herbs
Which ones?
> which seem to make a major difference.
That is good to hear. A friend of mine might profit from this.
> I'd like to try a MAOI again - but I think the chances are pretty slim of finding a doc willing to prescribe. I had a some form of hypertensive response to parnate,
That sometimes occurs spontaneously at the beginning of Parnate treatment, and does not necessarily have a dietary trigger. I think it more often than not resolves with continued treatment.
> but other than that, I was having a very good response (40mg). The doc took me off and have never been able to try again.
Do you think that your responsivity to MAO inhibiting herbs indicates successful treatment with a MAOI?
It is too bad that you are limited by what comes from a conservative doctor's pen and pad. You probably know enough to cure yourself. I wish I could be of more help to you, but your scope of knowledge is more extensive than mine.
Out of curiosity, how do you react to Wellbutrin? Many people respond when it is combined with a SRI. A friend of mine has achieved full remission with Pristiq + Wellbutrin. She has been well for as long as Pristiq has been available - 9 years. Interestingly, she was a partial responder to Parnate.
- Scott
Posted by linkadge on September 10, 2017, at 20:13:24
In reply to Re: Nardil immediate relief and early poop out » linkadge, posted by SLS on September 10, 2017, at 19:19:42
Hi SLS,
Strangely enough, I have never tried Wellbutrin. I was on a combination of Effexor and methylphenidate, which worked fairly well, but the methylphenidate was a bit harsh.
For herbs, turmeric, rhodiola, cocoa and quercetin are fairly potent MAOIs. I did use fo-ti (contains emodin - a relatively selective MAO-B inhibitor), but backed off of it due to reports of possible liver issues. I remember reading an article suggesting that rhodioloa could inhibit ~50% of MAOA with a standard dose.
Cocoa powder is one of my mainstays. I find it has an effect on depression, cognition, anxiety and stability. Epicatechin (in cocoa) is a MAOI (more selective towards MAOB) and also has some monoamine reuptake effects (selective towards norepinephrine reuptake). Harmaline (in coffee and cocoa) is selective towards MAO-A and has some serotonin reuptake inhibition as well. Interestingly harmaline is a gaba-a antagonist as well. Some research suggests that gaba-a antagonists can have antidepressant effects (but perhaps increasing anxiety).
I found the combination of turmeric and quercetin fairly potent. Interestingly, I had serotonin syndrome when combining citalopram with a few grams of turmeric. Tumeric is probably one of the most potent herbal antidepressants IMHO.
Quercetin, however, is also a COMT inhibitor. Rambling here but, COMT inhibitors also have antidepressant properties which (surprisingly) have never much been explored pharmacologically.
Linkadge
Posted by linkadge on September 10, 2017, at 20:19:38
In reply to Re: Nardil immediate relief and early poop out, posted by linkadge on September 10, 2017, at 20:13:24
Just to add, thyroid inhibits MAO as well as being a NET/DAT inhibitor. Interesting eh?
Linkadge
Posted by porkpiehat on September 12, 2017, at 14:18:51
In reply to Re: Nardil immediate relief and early poop out, posted by pedr on September 8, 2017, at 13:36:00
>
> Very hard call. I'd head as high as you can to therapeutic dose (60-75mg) and hold there if you can. I couldn't tolerate it even though I tried desperately. If that doesn't work out you can then go back down in dose.
>
> One diet tip: definitely avoid draft beer. I drank 1/2 a pint and went into hypertensive crisis. Not recommended.Curious...what did you find intolerable? I'm contemplating a switch from parnate to nardil. I found the apathy, daytime tiredness, and withdrawl the toughest. I came down from 40 to 20 mgs. Sleep was a bitch until trazodone.
Posted by pedr on September 13, 2017, at 16:02:25
In reply to Re: Nardil immediate relief and early poop out » pedr, posted by porkpiehat on September 12, 2017, at 14:18:51
> Curious...what did you find intolerable? I'm contemplating a switch from parnate to nardil. I found the apathy, daytime tiredness, and withdrawl the toughest. I came down from 40 to 20 mgs. Sleep was a bitch until trazodone.
>I just felt massively over-medicated and my depression seemed to worsen. I think also the somnolence worsened.
Which did you get the apathy & tiredness on, Nardil?
Posted by bbb1993 on September 13, 2017, at 16:35:56
In reply to Nardil immediate relief and early poop out, posted by bbb1993 on September 8, 2017, at 3:25:26
I'm currently still on 45mg and have been for about 2 weeks (taken Nardil for about 5.5 weeks total now). Having trouble increasing due to daytime tiredness. Going to bed at 7-8 as I just can't stay awake.. not good for trying to get uni work done! Coffee doesn't help much. I know a lot of people go off it because of this but has it improved for others? Does Modafinil help?
Also, some days feel too intense like I'm on a low dose of MDMA.Some other strange side effects include being short of breath and having a tight chest even when I haven't eaten anything wrong. I have a significantly decreased appetite, also have trouble focusing my eyes and they keep twitching to get in focus. I also get strange bodily sensations, like once I woke up in the middle of the night feeling really odd, and out of nowhere my arms stretched out tight in front of me. something to do with the stimulant effect maybe.
Besides the tiredness none of these are unbearable just thought I might report as they were unexpected.
Posted by porkpiehat on September 13, 2017, at 20:51:01
In reply to Re: Nardil immediate relief and early poop out, posted by pedr on September 13, 2017, at 16:02:25
> >
>
> I just felt massively over-medicated and my depression seemed to worsen. I think also the somnolence worsened.
>
> Which did you get the apathy & tiredness on, Nardil?Parnate. I'm still on it but at 20-30 mgs. The trazodone and gabapentin has given me better sleep than I had even before parnate (I could never take trazodone before it made me feel freaky and I couldn't sleep).
The trazodone, through it's 5ht2 antagonism may have even helped with some of the zoney sense of disconnection. It may be from going down, or I wonder if it just took 4 months for my body to acclimate.
Because the trazodone works so well for sleep I am able to take the parnate toward the end of the day and I don't really get the daytime sedation much.
I still get hyper focused on hobbies and less conscientious about everything else. Drinking and smoking has gone up almost compulsively. I certainly care less about friends and family, which I gather might be improved on Nardil.
Posted by pedr on September 15, 2017, at 8:39:20
In reply to Re: Nardil immediate relief and early poop out, posted by bbb1993 on September 13, 2017, at 16:35:56
> I'm currently still on 45mg and have been for about 2 weeks (taken Nardil for about 5.5 weeks total now). Having trouble increasing due to daytime tiredness. Going to bed at 7-8 as I just can't stay awake.. not good for trying to get uni work done! Coffee doesn't help much. I know a lot of people go off it because of this but has it improved for others? Does Modafinil help?
I can't recall if I took it with Nardil but it's definitely worth a shot because coffee/tea did nothing for me as well and I've generally found Modafinil/Nuvigil to be helpful with somnolence. But ultimately sadly the somnolence didn't let up for me.
> Also, some days feel too intense like I'm on a low dose of MDMA.
>
> Some other strange side effects include being short of breath and having a tight chest even when I haven't eaten anything wrong. I have a significantly decreased appetite, also have trouble focusing my eyes and they keep twitching to get in focus. I also get strange bodily sensations, like once I woke up in the middle of the night feeling really odd, and out of nowhere my arms stretched out tight in front of me. something to do with the stimulant effect maybe.
>
> Besides the tiredness none of these are unbearable just thought I might report as they were unexpected.Hah, I definitely had lots of "fun" events when asleep on Nardil. I dreamt I was playing soccer and "headed" the ball in my dream such that I headed myself off the bed. I also would randomly punch and kick and had the most incredibly vivid dreams. I'd yell out stuff as well.
Posted by porkpiehat on October 23, 2017, at 10:28:27
In reply to Re: Nardil immediate relief and early poop out » bbb1993, posted by pedr on September 15, 2017, at 8:39:20
None of this has happened on Marplan for me. Strangely the sleep meds that worked wonders on Parnate do little for me now.
This is the end of the thread.
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