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Re: ... And all things Nardil ... Re: Morning dread... zonked

Posted by Questionmark on June 17, 2011, at 19:12:52

In reply to Re: ... And all things Nardil ... Re: Morning dread... Questionmark, posted by zonked on June 16, 2011, at 20:05:19

> Even the PDR/prescribing information (which is *so* outdated) recommends a titration up to "at least 60" as quickly as the patient can tolerate. Harvard medical school recommends a dose of 1mg per kg of body weight per day (I am NOT going to ask how much you weigh, but it's something to consider.) Why a max of 45 of Nardil until now? How long have you been on it? And even the PDR says it may take 90mg to get sufficient MAO inhibition in some individuals. I think you owe it to yourself to ask your MD to go higher!

I appreciate the suggestions. But there certain things to consider:
Whenever the psychiatric or medical industry make gross overgeneralized, oversimplified claims like that a quick titration to 60mg, or 1mg/kg body weight, are ideal and recommended, it leaves me a little dumbfounded. If everyone who needed Nardil had the exact same neurochemical make-up, then this might have some rationale. Of course, if we lived in a fantasy world where everything was that simple and wonderful, we wouldn't need Nardil in the first place. The reality is, neurochemistry and its manipulation are far too complicated to warrant these kinds of generalizations.
I'm not at all directing this frustration toward you. It's reasonable to believe that something tossed around a lot by the experts should be valid. But if you think about, it's really a gross oversimplification.
I do have no doubt though that it could probably take some people at least 90mg to get sufficient MAO inhibition for their needs.
Also, aside from an opinion (and even that is rare), i rarely ask a psychiatrist anything. i tell him. OK, well i don't mean to sound like i'm that bold and assertive about it -- not at all -- but it's essentially true. It's important for us to remember that they are serving us, not vice versa.
...
But anyway, to your ultimate point... I agree that i am on a sub-par dose for almost anyone [who needs Nardil] -- even at my ~155 lbs. And I am certain i would feel better mood wise and SA wise if i increased my dose. But ... i'm just tired of dealing with the side effects. Not the dietary restrictions, they're an easy trade-off. But the side effects -- esp the one-- ... i just don't wanna deal with anymore. It is strange, i admit: i know there is no drug more helpful for me. And i have been in so much misery and pain this past half-year, esp. And i know where this relief. Yet i still can't get myself to go there. .... i dunno. It's too complicated too adequately discuss i guess. ... Also, though i have no moral objections to it for others, the self-identity confusion that comes from being totally changed by a drug is very psychologically conflicting for me (though i don't seem to care much while consistently ON a full dose of the drug). I dunno. It's a real philosophical dilemma, in any case. ... But that is a minor factor compared to the side effects. Anyhoo....

> My morning dread pre-dated taking Nardil - it's a feature of my depression.

Oh, interesting. OK maybe i was wrong then, in regard to a lot of people. See, i first noticed the "dread" when i withdrew from Paxil years ago. But it wasn't only in the morning, it was whenever i woke from sleep at any time -- including daytime naps. The same has been true w Nardil withdraw or insufficient Nardil. So for me the dread was definitely precipitated by medication.
And due to the subjectively short-acting nature of Nardil, I would still experience the morning dread even on a "fully" effective dose if I slept more than like 8 hours.

> This is *very* helpful information, and I thank you for it.

Oh good! That's very good to know.
Take care, and good luck, with the greatest antidepressant class known to Man.


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poster:Questionmark thread:987723
URL: http://www.dr-bob.org/babble/20110610/msgs/988579.html