Posted by Tomatheus on December 2, 2005, at 18:44:05
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by Jedi on December 2, 2005, at 2:51:59
Jedi,
Thanks for your response.
I was originally diagnosed with dysthymia, and then my pdoc decided to diagnose me with bipolar disorder (no specific subtype, although I don't meet the criteria for any of the existing DSM-IV bipolar subtypes) after my moods cycled between mild hypomania and severe depression when on Paxil. Basically, each hypomanic and depressive was about three to four days in length with no euthymia in between. In the 3+ years it's been since I stopped the Paxil, I've experienced nothing but dysthymia. Occasionally, I'd get some partial relief from some of the meds and combos I've tried, but all of my med trials with mood stabilizers, antidepressants, and combos of the two have been largely unsuccessful. I've tried going med free, and when I do so, I go right back to being dysthymic. There's been no hypomania whatsoever since I've stopped the Paxil - not even when I was on Wellbutrin, moclobemide, and Parnate, and not now on this Nardil trial.
As far as the symptoms of atypical depression are concerned, here is how I fit in:
* mood reactivity: yes, to an extent. I've definitely noticed a connection between the severity of my depressive states and my activity levels. Basically, I have a slight tendency to feel a little less depressed than I normally do if I'm more or less active all day (but this connection is not 100 percent absolute).
* increased appetite or weight gain while depressed: no. Usually, my appetite is reduced when I'm depressed.
* oversleeping: yes! Although I'm sometimes able to force myself out of bed after six to eight hours with the help of an alarm, I have always had a tendency to oversleep, and it's always been extremely difficult to wake up in the morning. Without an alarm, I almost always sleep for at least 10 hours.
* leaden paralysis: yes.
* sensitivity to rejection: yes.According to Quitkin et al. (1988), atypical depression is defined by the presence of mood reactivity, in addition to at least two of the remaining four atypical symptoms of hyperphagia, hypersomnolence, leaden feeling, and sensitivity to rejection. Based on this definition, it seems clear that there are some atypical features associated with my depression. I did address the issue of atypical depression with my pdoc at one point, and he said that my depression was not atypcial because I did not overeat while depressed or sleep for at least 18 hours a night. I have never discussed the issue of social anxiety with my pdoc because I have always been iffy about the clinical significance of social anxiety. I wouldn't say that I necessarily experience *fear* in social situations, but I have always been extremely introverted. In fact, I was voted the quietest in my high school graduating class, if that's any indication.
So, that's my long and drawn response to your question about my diagnosis. I'm just taking Nardil right now, but there is a possibility that my pdoc might want to augment it if it does end up working at all. Since I have experienced hypomania before (even if it was only temporary and Paxil-induced), I'll continue to be on the lookout for it if (and probably when) I increase my Nardil dose to 75mg a day. At this point, I'm skeptical of ever feeling euthymic on Nardil, let alone hypomanic, but I'll definitely alert my pdoc and discuss augmentation strategies with him in the unlikely event that the Nardil goes from hardly working to working *too* well. I wasn't aware of the research on the connection between social anxiety and bipolar disorder, but I've read the reports of several research studies that have provided evidence of a link between atypical depression and cyclothymia/bipolar II. So, I definitely understand the need to look out for hypomania (not to mention that I do anyway because of my response to Paxil), and once again, I'll definitely be looking for signs of it. That's really not the effect I'm looking for - just euthymia. But right now, it seems I'm definitely getting a dopaminergic effect from the Nardil and possibly a noradregenic effect (similar to Wellbutrin), but the serotogenic effect that I felt on Paxil (too strongly when hypomanic), 5-HTP, and some B vitamin supplements hardly seems to be there at all right now on Nardil.
Anyway, enough rambling. Thanks again for your reply.
Tomatheus
==
REFERENCE
Quitkin, F. M., Stewart, J. W., McGrath, P. J., Liebowitz, M. R., Harrison, W. M., Tricamo, E., et al. (1988). Phenelzine versus imipramine in the treatment of probable atypical depression: Defining syndrome boundaries of selective MAOI responders. American Journal of Psychiatry, 145, 306-11.
==
> Tomatheus,
> If your depression is atypical with social anxiety and nothing else has worked, I would bounce up to 75mg and see. The reported effective dose is 1mg/kg so a 165 pound man would probably need 75mg to be effective. When I first started Nardil I was also taking several milligrams of clonazepam. Some people say that this benzo depresses them, but some current research shows that it can be used at 3+mg for augmentation. Next to Nardil, clonazepam is the best med I have found for social anxiety. The kick that many people get when Nardil starts to work is probably hypomania. There is some research that suggests social anxiety is on one end of the bipolar scale. If you do experience extended hypomania, a mood stabilizer will probably be required. What is your diagnosis and are you taking anything else with the Nardil?
> Be Well,
> Jedi
>
> > A few weeks ago, I said that I'd keep everyone posted on the results of my Nardil trial.
> >
> > And well, I'm rather disappointed to report that I still haven't felt the noticeable "kick in" that most Nardil users tend to feel after four to six weeks of starting the medication. I've been at 60mg for 5 1/2 weeks now, but it's been nine weeks total. After feeling slightly improved during the first two weeks at 60mg (but still mostly depressed and sedated), I fell into a relatively deep depression after that point. I noticed that my level of energy increased slightly about a week or so ago, but it's basically a negative kind of energy. I still have little drive, and I definitely don't feel the least bit "pro-social." It sort of feels like being on Wellbutrin all over again.
> >
> > So, once again, I've got a few questions...
> >
> > Has anyone else experienced this at 60mg of Nardil? Do you think that there's still a realistic chance that it might kick in at this dose? Or would it be best to go up to 75mg at this point? Are there any Nardil users who didn't get the "kick in" feeling at 60mg, but did at a higher dose? If so, at what dose did it kick in? Do you have any other suggestions to offer?
> >
> > As always, I would appreciate any help any of you could provide.
> >
> > Thanks,
> > Tomatheus
>
>
poster:Tomatheus
thread:584142
URL: http://www.dr-bob.org/babble/20051126/msgs/584739.html