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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by pallor on July 25, 2009, at 15:07:05
hello.
in june (after a couple of years on a very high dose of nardil, in combination with other drugs), i began having suicidal ideation, was struggling to get out of bed, etc. my psychiatrist had me taper off of nardil very quickly-- within 2 weeks-- and i took my last dose on july 1st.
*i feel better mentally than i have in years (for any length of time).* physically though, i am going through hell.
i am wondering if anyone else who's gotten off of nardil (or is in a similar situation) has any insight into the withdrawal process. the nausea & headaches are really, really awful, and any tips on getting through this would be appreciated.
thank you!
Posted by SLS on July 26, 2009, at 6:25:26
In reply to getting off of nardil... tips?, posted by pallor on July 25, 2009, at 15:07:05
Are you having vivid dreams - REM rebound?
How did you go about discontinuing Nardil? What dosage had you been taking? When during this process did the withdrawal symptoms emerge?
Unfortunately, I have been on and off Nardil many times. Most recently, I had to come off of taking 90mg. I never had a problem with the things you mentioned during the discontinuation process, but these things affect people so differently. I usually have success withdrawing by feel rather than adhere to a rigid arbitrary schedule.
Now that you are in the midst of some sort of withdrawal syndrome, I really don't know what to recommend to treat the symptoms. Sorry.
- Scott
Posted by pallor on July 26, 2009, at 6:54:04
In reply to Re: getting off of nardil... tips?, posted by SLS on July 26, 2009, at 6:25:26
I am having vivid dreams, "brain zaps", etc.
I was on 90 mg's of nardil for 2 yrs; prior to that, I had been taking it for 6 months (at a slightly lower dosage) and tried to get off... i had a severe bout of depression shortly after, wound up in the hospital, & agreed to go back on it. this past june, i went from bad to suicidal, so my doc took me from 90 mg to zero in less than 2 wks.
i am ...astounded by how much better i feel mentally, and if i have to deal with the physical symptoms of withdrawal forever to feel this way, it will still be worth it. so i really don't want to get back on it, even to alleviate these symptoms, as i really think that it began doing me more harm than good about 6 months ago.
the withdrawal symptoms began almost immediately when i started to taper off of it... but the mood improvement also started at that time. (i also felt much more alert, my skin started to clear up, my thoughts felt much more clear, etc.) my doc said that once it was out of my system i'd feel better(based on its half-life, that would've been around july 15th).
now i'm reading that some people experience protracted withdrawal symptoms for months, & in some cases, years. that concerns me b/c the nausea & headaches are incapacitating at times.
Posted by SLS on July 26, 2009, at 10:49:51
In reply to Re: getting off of nardil... tips?, posted by pallor on July 26, 2009, at 6:54:04
Benadryl (diphenhydramine) is sometimes used to counter SSRI / SNRI withdrawal. Perhaps it would be helpful for Nardil as well.
- Scott
Posted by robotaffliction on August 3, 2009, at 11:17:10
In reply to Re: getting off of nardil... tips?, posted by SLS on July 26, 2009, at 10:49:51
ive been having a hard time getting off the nardil for a while too. not an expert or a doctor, but i hypothesize that there are two effects upon discontinuation:
1) Serotonin, dopamine, norepinephrine levels return to "normal"
2) GABA levels return to "normal"Based on what I read, #1 happens over a course of _at least_ two weeks, and relates to the body making new MAO-A and MAO-B. #2 happens about 48 hours after the last dose (in rats at least), regardless of how big the last dose is, and relates to nardil's metabolite PEH no longer inhibiting GABA transaminases.
So since I am lucky to have a prescription of klonopin, I'm following this strategy- immediate withdrawal (after i've tapered from 60mg to 30mg/day over 2 weeks), beginning clonazepam about 24 hours after the last dose. took my last pill about 72 hours ago and so im on my second day. i'm guessing the nausea and brain zaps is the long-term thing you just have to put up with, but there's no need for me to prolong the increased GABA levels and the sudden drop and onset of anxiety, although quick withdrawal without a supporting medication like a benzo might be dangerous. i have l-theanine as an additional supportive measure.
for the nausea, brain zaps, and general malaise related to drop in neurotransmitter levels, im not sure what to do. i got some magnesium and calcium and they tend to help me personally, and i figured i'd try rhodiola for energy and motivation if it gets bad.
if anyone's had an EASY time getting off nardil, please post and let me know. it's nice to know that there is hope that it could just be easy, or that i might even feel BETTER without the nardil, since it'd pretty much pooped out around month 6-7 (and i was on it 10 months)..
Posted by 49er on August 8, 2009, at 8:56:56
In reply to getting off of nardil... tips?, posted by pallor on July 25, 2009, at 15:07:05
Hi Pallor,
I have tapered off of what was a 4 med cocktail down to one med (Doxepin 3.04mg).
The key is to taper 10% of current dose every 3 to 6 weeks or longer depending on how your body feels. I can hear people groaning on this board but sticking to this schedule has enabled me to have some quality of life. For example, I have been able to work which wouldn't have happened if I had tapered too quickly.
I keep posting about this but for some reason, not too many people on this board believe me. To be honest, I was reluctant to reply but I keep hoping someone will listen.
I would slowly reinstate the dose. I don't know what doses Nardil comes in but for example, if the lowest is 10mg, try that and stop at the dose you feel good at. Once you are stable, then slowly taper as I suggest.
If you are really interested in tapering slowly, I can tell you how to do it.
I have nothing to sell as I am just tired of people suffering needlessly. But just understand I am not a medical professional.
Posted by SLS on August 8, 2009, at 11:13:12
In reply to Re: getting off of nardil... tips? » pallor, posted by 49er on August 8, 2009, at 8:56:56
> The key is to taper 10% of current dose every 3 to 6 weeks or longer
So, this is a universal recipe regardless of the drug to be discontinued?
I am not groaning. However, I would not tell people that there is only one way to discontinue all medications.
Obviously, people would like to discontinue their medications without experiencing adverse withdrawal effects. It is ideal to taper a medication at a rate that mirrors the body's capacity to compensate for the reduced dosages. However, some people simply don't want to follow a protocol that requires years to accomplish.
Do you think that a more flexible dosing protocol would be more efficient? Afterall, you did recommend taking into account how one feels at a given dose.
I'm sure you have come across some people who can't tolerate even a 10% reduction in a benzodiazepine. What do you do in these cases?
Nardil is not a benzodiazepine and ought not be compared to one. A 10% decrease in the dosage every 3-6 weeks is unnecessary and a huge expenditure of time, since the individual cannot start another drug or discontinue the food and drug restrictions during this type of extended taper period.
I am not a medical professional, but, like you, I read. Like you, I have found ways to discontinue drugs using a strategies that avoid the suffering of a withdrawal syndrome.
I do agree that it might be desirable to bring Nardil back on board. It might take 30mg to achieve enough MAO inhibition to allow the withdrawal effects to disappear. I would never stop Nardil abruptly. However, doing so produces a withdrawal syndrome that often disappears within a week.
- Scott
Posted by SLS on August 8, 2009, at 20:24:26
In reply to Re: getting off of nardil... tips?, posted by pallor on July 26, 2009, at 6:54:04
> if anyone's had an EASY time getting off nardil, please post and let me know. it's nice to know that there is hope that it could just be easy, or that i might even feel BETTER without the nardil, since it'd pretty much pooped out around month 6-7 (and i was on it 10 months)..
With Nardil, I think it helps to understand its mechanism of inhibiting the MAO enzyme system. When Nardil attaches itself to and inhibits MAO, it remains there indefinitely. If the blood levels of Nardil were to drop precipitously, the inhibition of MAO would continue until the body manufacturers brand new MAO to replace the old disabled MAO. As was noted, Nardil does other things in the brain that are more tied to blood levels. I believe GABA transaminase inhibition is one. Abrupt discontinuation of Nardil would very quickly produce anxiety and tremulousness. My guess is that the electric shock "brain zaps" phenomenon along with nausea and feelings of flu-like malais is more tied to MAO inhibition; being produced by a sudden drop in serotonin as the new enzymes come online.
How exactly did you taper the Nardil?
- Scott
Posted by SLS on August 8, 2009, at 20:26:20
In reply to Re: getting off of nardil... tips?, posted by robotaffliction on August 3, 2009, at 11:17:10
This is a far better explanation that I offered. Sorry I didn't read it first.
- Scott
> ive been having a hard time getting off the nardil for a while too. not an expert or a doctor, but i hypothesize that there are two effects upon discontinuation:
>
> 1) Serotonin, dopamine, norepinephrine levels return to "normal"
> 2) GABA levels return to "normal"
>
> Based on what I read, #1 happens over a course of _at least_ two weeks, and relates to the body making new MAO-A and MAO-B. #2 happens about 48 hours after the last dose (in rats at least), regardless of how big the last dose is, and relates to nardil's metabolite PEH no longer inhibiting GABA transaminases.
>
> So since I am lucky to have a prescription of klonopin, I'm following this strategy- immediate withdrawal (after i've tapered from 60mg to 30mg/day over 2 weeks), beginning clonazepam about 24 hours after the last dose. took my last pill about 72 hours ago and so im on my second day. i'm guessing the nausea and brain zaps is the long-term thing you just have to put up with, but there's no need for me to prolong the increased GABA levels and the sudden drop and onset of anxiety, although quick withdrawal without a supporting medication like a benzo might be dangerous. i have l-theanine as an additional supportive measure.
>
> for the nausea, brain zaps, and general malaise related to drop in neurotransmitter levels, im not sure what to do. i got some magnesium and calcium and they tend to help me personally, and i figured i'd try rhodiola for energy and motivation if it gets bad.
>
> if anyone's had an EASY time getting off nardil, please post and let me know. it's nice to know that there is hope that it could just be easy, or that i might even feel BETTER without the nardil, since it'd pretty much pooped out around month 6-7 (and i was on it 10 months)..
Posted by SLS on August 8, 2009, at 20:48:50
In reply to Re: getting off of nardil... tips? - Oops » robotaffliction, posted by SLS on August 8, 2009, at 20:26:20
Whenever I have had to discontinue an MAOI, I would do it stepwise according to the appearance and intensity of the witdrawal symptoms. I literally do it by "feel". I don't feel that it is necessary to follow a rigid schedule. However, it is important to know that some of the withdrawal effects are latent, and do not show up right away as it takes some time for a drop in dosage to translate into an increase in MAO activity. When the withdrawal effects emerge, I will sometimes increase the dosage again temporarily. I think 30mg was the dosage I remained at for awhile before continuing. I had no reservations in splitting pills.
Basically, I try to remain flexible and dose according to need. Understanding the personality of a drug helps. I have used a flexible dosing strategy to discontinue SSRIs, SNRIs, MAOIs, and BZDs. It is almost embarrassingly easy.
I don't expect this to work for everyone. However, I am not immune to withdrawal syndromes. I have been able to compare different discontinuation protocols for the same drug. I find that I am much better off remaining flexible.
- Scott
Posted by SLS on August 9, 2009, at 6:05:19
In reply to getting off of nardil... tips?, posted by pallor on July 25, 2009, at 15:07:05
How are you doing?
- Scott
Posted by ace on August 17, 2009, at 2:47:30
In reply to getting off of nardil... tips?, posted by pallor on July 25, 2009, at 15:07:05
> hello.
>
> in june (after a couple of years on a very high dose of nardil, in combination with other drugs), i began having suicidal ideation, was struggling to get out of bed, etc. my psychiatrist had me taper off of nardil very quickly-- within 2 weeks-- and i took my last dose on july 1st.
>
> *i feel better mentally than i have in years (for any length of time).* physically though, i am going through hell.
>
> i am wondering if anyone else who's gotten off of nardil (or is in a similar situation) has any insight into the withdrawal process. the nausea & headaches are really, really awful, and any tips on getting through this would be appreciated.
>
> thank you!Can I just confirm: you are having no periods of the original depression that you took Nardil for?
How quick was the onset of your physical symptoms?
Hang in there!
Posted by trainspotter on August 21, 2009, at 10:57:07
In reply to Re: getting off of nardil... tips? » pallor, posted by ace on August 17, 2009, at 2:47:30
Hi Ace, please don't mind if this is not supportive, I'm telling my true story. Nardil is an irreversible MAO-I (A and B). After stopping you have to wait atleast 14 days before you can have any meds that increase neurotransmitters(No SSRI). Because it's irreversible inhibition MAO enzyme has to be synthesized new. After 1 week I fell into a shadow of depression (as before), that progressed so bad day 7-14(including suicidal efforts in the ER) I was started Remeron 15mg.(This REALLY helped nausea superb being a 5HT-3 antagonist) . IF YOU TAKE TCA DURING WASHOUT IT'LL INCREASE NAUSEA) After 14 days of No Nardil, I was added Prozac 40mg, Lithium 150mg, Fluxanol, Elavil 75, Inderal 10, Lyrica 150, Ativan 2mg (The last obviously made me feel better). Today 3 months have past, the extreme suicidal ideation I felt those 14 days of Sweet nothings has gone, my Mirtazapine is 45mg now and I've been able to join my job. My doc may change Prozac 40 to Venlafaxine 225mg.(This will increase nausea but help jittery hands)I don't take any more MAOIs. I've taken OTC melatonin (still am) and Vit B6, B12 pills. So be there, hang in, I'm sure your doc will prescribe you other antidepressants, do take the courage for the 1st step.
---------------------------
> > hello.
> >
> > in june (after a couple of years on a very high dose of nardil, in combination with other drugs), i began having suicidal ideation, was struggling to get out of bed, etc. my psychiatrist had me taper off of nardil very quickly-- within 2 weeks-- and i took my last dose on july 1st.
> >
> > *i feel better mentally than i have in years (for any length of time).* physically though, i am going through hell.
> >
> > i am wondering if anyone else who's gotten off of nardil (or is in a similar situation) has any insight into the withdrawal process. the nausea & headaches are really, really awful, and any tips on getting through this would be appreciated.
> >
> > thank you!
>
> Can I just confirm: you are having no periods of the original depression that you took Nardil for?
>
> How quick was the onset of your physical symptoms?
>
> Hang in there!
>
>
Posted by mnsu44 on September 11, 2009, at 12:55:13
In reply to Re: getting off of nardil... tips? » pallor, posted by SLS on August 8, 2009, at 20:24:26
Three months later and I'm still slowly withdrawing from Nardil. I've taken it for chronic daily headaches for 10+ years now and I hate to tell you, it's not easy. The worst is the anxiety that I suffer from - especially when I wake up in the morning. It got so bad that now I'm on an anti-anxiety medication. I used to take 4 Nardil a day (15mg/tablet) and I'm finally down to one Nardil a day.
My only tips are to do this very, very slowly. But on a positive note - since Nardil causes weight gain, I've lost 40 pounds! I'm about 10 pounds away from my goal weight and I look/feel like a different person, so that has helped me so much, even when the anxiety is at its worst.
Good luck and keep us posted on your progress.
> > if anyone's had an EASY time getting off nardil, please post and let me know. it's nice to know that there is hope that it could just be easy, or that i might even feel BETTER without the nardil, since it'd pretty much pooped out around month 6-7 (and i was on it 10 months)..
>
> With Nardil, I think it helps to understand its mechanism of inhibiting the MAO enzyme system. When Nardil attaches itself to and inhibits MAO, it remains there indefinitely. If the blood levels of Nardil were to drop precipitously, the inhibition of MAO would continue until the body manufacturers brand new MAO to replace the old disabled MAO. As was noted, Nardil does other things in the brain that are more tied to blood levels. I believe GABA transaminase inhibition is one. Abrupt discontinuation of Nardil would very quickly produce anxiety and tremulousness. My guess is that the electric shock "brain zaps" phenomenon along with nausea and feelings of flu-like malais is more tied to MAO inhibition; being produced by a sudden drop in serotonin as the new enzymes come online.
>
> How exactly did you taper the Nardil?
>
>
> - Scott
Posted by ross2009 on September 29, 2009, at 9:21:04
In reply to Re: getting off of nardil... tips?, posted by mnsu44 on September 11, 2009, at 12:55:13
hi, there's a supplement called amphetarestore incase you haven't heard of it yet. It acts as a detoxifying agent and decreases dependency from drugs. I'm taking it along with my other meds so it will maintain my tolerance level with the drugs i'm taking. so far, it is working for me. you might want to try it out, it can help you cope with your nardil withdrawal.
Posted by mnsu44 on September 29, 2009, at 9:23:48
In reply to Re: getting off of nardil... tips?, posted by ross2009 on September 29, 2009, at 9:21:04
Posted by ross2009 on September 29, 2009, at 9:24:12
In reply to Re: getting off of nardil... tips?, posted by trainspotter on August 21, 2009, at 10:57:07
hi, there's a supplement called amphetarestore incase you haven't heard of it yet. It acts as a detoxifying agent and decreases dependency from drugs. I'm taking it along with my other meds so it will maintain my tolerance level with the drugs i'm taking. so far, it is working for me. you might want to try it out, it can help you cope with your nardil withdrawal.
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