Posted by Ron Hill on October 3, 2007, at 2:23:27
In reply to Attn all Nardil users!, posted by ace on October 1, 2007, at 23:09:54
Ace – The Nardil Champion,
Hello Mate. Springtime coming down-under, aye Mate?
Why did you reduce your Nardil dosage down from 90 mg/day in the first place? Why have you been screwing around with the dosage?
Could part of the problem be that you have your circadian clock out of sync by staying up until 4 or 5 am, and sleeping until 1 pm?
I’m the same way, Ace. I like to work in my home office until about 5 am and then go to bed. My energy kicks in at about 10 pm and stays good, until 5 am. Further, no phones ringing, wife has gone to bed, and I can totally focus on my work.
However, in doing this, I’ve got my circadian clock out of sync with the rotation of the earth, and as a result, I have lower energy during the day. Ace, could this be part of the reason for your bout with breakthrough depression? I don’t presume to know, I’m just asking.
For reasons that I will identify further down, the following tx is probably not appropriate for you. But, can I tell you about it anyway? Was that a yes? Good. Thanks Mate! Here goes:
Perhaps you could add-on between 20 mg/day to 60 mg/day of 2-phenylethylamine (PEA). Small open studies show that there is about an 80% chance that PEA will instantly snap you out of depression.
Ace, are you familiar with 2-phenylethylamine? PEA is a trace neurotransmitter endogenous to the brain. The trace amine is released in higher than usual amounts when people fall in love. You know the PEA feeling that I'm taking about, right? The love-sick sap walks around happy and smiling ear-to-ear all day long. All he can think about is the new love of his life. This is PEA.
For people NOT on an MAOI, the MAO-B (and to a much smaller extent, the MAO-A) metabolize PEA very quickly. Therefore, PEA cannot be used as an antidepressant for people that are NOT on an MAOI because the PEA does not last long enough in the brain. However, for a patient on a full dose of Nardil, the MAO-B and MAO-A are inactivated and, therefore, are not available to metabolize PEA. Under these conditions, PEA can be used as an add-on antidepressant. It should be noted that 5 to 10 mg/day of l-deprenyl is typically used as the MAOI, but studies show that Nardil also works.
I am a rapid cycler, and I cycle with a period of 15 days, consisting of three days of atypical depression (no energy, no motivation, sleep too much, etc), followed by 12 days of normal mood state (3 + 12 = 15). Then the cycle repeats over, and over, and over, on an ongoing basis.
Last week, during my most recent 3-day depressive phase, I added 30 mg/day of PEA to my current cocktail of Nardill (90 mg/day) and three AED’s (Trileptal, Lamictal, and Keppra). It was absolutely amazing how fast PEA took away my depression. I found it best to split the daily dosage in half and take the first half when I got up and the second half around mid-afternoon.
Unfortunately, my PEA trial was unsuccessful because withdrawal from the PEA, after my three days of use, was absolutely horrendous!! In the long run, the "cure" was worse than my usual three days of depression.
So, why not use the PEA all the time and, thereby, avoid the withdrawals? Well, for a few reasons. The endogenous levels of PEA are abnormally low during depression, but the PEA levels return to normal when the patient is not depressed. Therefore, it would raise my PEA levels too high if I were to add exogenous PEA during the 12 days per cycle when I am not depressed.
Further, PEA acts like an endogenous amphetamine. The endogenous amphetamine is less mood destabilizing than an exogenous amphetamine. But none-the-less, some patients taking PEA on a long-term basis can experience anxiety and irritability.
Ace, if I recall correctly, I think that I remember that you have an anxiety disorder in addition to your OCD and atypical depression dx. So, long-term use of PEA might end up being problematic for you. Therefore, PEA is not likely not for you. But, thanks for letting me tell the story, Mate!!
You are a smart man, Ace. You will figure out the solution to this breakthrough depression.
Bipolar II with ultra rapid cycling (15 day cycle), and mild Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
875 mg/day Keppra
90 mg/day Nardil