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Re: 6 weeks on Nardil » 4WD

Posted by SLS on April 19, 2008, at 5:18:29

In reply to Re: 6 weeks on Nardil » SLS, posted by 4WD on April 18, 2008, at 21:33:14

Hi Marsha.

> Thanks for responding.

For you, I'll always try to respond.

> I don't think I can tolerate a dosage increase right now.

I find that the side effects of Nardil dissipate over time. I'm currently taking 90mg. But then again, my brain was a tough nut to crack.

> I think I'll try to stay at 45 for another few weeks and then if I'm not in complete remission maybe I'll be able to go up to 60mg by then.

The best you could ever hope for given your treatment resistance is a saw-tooth improvement instead of a linear one. You might not really need more, as some people do respond to 45mg. It is the exception rather than the rule. Nardil is purported to be useful at dosages up to approximately 1mg/1kg of body weight.

> But I'm doing pretty great on 45. Just a little breakthrough depression now and then.

"Great" is an awefully big word. Perhaps you should give 45mg longer than just a week. Either way, you will arrive at an optimal dosage through trial-and-error. Breakthrough depression is expected early in treatment. I do not refer to these periodic worsenings as breakthrough depression nor partial relapse. Rather, I like to call them recessions during the initial stages of response. One of my doctors at the NIMH thought that these infrequent episodes were almost like the brain resetting itself.

> I keep thinking it will continue to build in my system and after a full ten week trial at 45, I will not need to increase the dosage.

Good thinking. :-)

> I have considered Deplin. I even asked my pdoc about it but he had never heard of it. I guess I need to look up the web page and print it out for him. But I may not need it. (I am already on 5 meds).

Deplin is nothing more than a super-charged folic acid. It induces an increase in the amounts of DA, NE, and 5-HT synthesized (as described by its manufacturer). If you get a little insomnia (or more insomnia), that might mean that Deplin is doing its work.

> If I continue to improve on the Nardil I may not need to augment it.

Absolutely.

> What do you think about what my other doctor reading to me from the PDR that once full remission on Nardil is achieved, the dosage should slowly be lowered by one pill a day over a period of time?

Yes, I have heard of this phenomenon. It sometimes does indeed take a higher dosage to achieve sufficient MAO inhibition than it does to maintain it. However, I don't think that the magnitude of dosage decrease as is described by the PDR is particularly smart. It is a very old idea that evolved in the late 1970s and early 1980s.

> The PDR actually says this.

I know.

> It says that you should be able to maintain remission on as little as 15mg a day - once you have achieved full remission. I told this to my pdoc and he said he had heard that too. But no one on this board that I know of has ever tried going this route. It's something I would consider trying. of course if the depression returned I'd up the dose again in a heartbeat.

You darn well better!


- Scott

 

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