![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 44. This is the beginning of the thread.
Posted by Lynne on May 23, 2000, at 17:34:54
Has anyone found anything to help with social phobia. Is Paxil any better than the other SSRI's.What are the side effects? Is Nardil any better? I have heard it causes alot of weight gain.Any suggestions would be greatly appreciated.
Thanks to all who contribute to this board.
Posted by SLS on May 24, 2000, at 7:52:53
In reply to Social Phobia: Nardil or Paxil ????or what??, posted by Lynne on May 23, 2000, at 17:34:54
> Has anyone found anything to help with social phobia. Is Paxil any better than the other SSRI's.What are the side effects? Is Nardil any better? I have heard it causes alot of weight gain.Any suggestions would be greatly appreciated.
>
> Thanks to all who contribute to this board.
Do you ever experience panic-attacks?Paxil is the only SSRI (Selective Serotonin Reuptake Inhibitor) antidepressant that is currently indicated for social phobia in the U.S. It seems to work. Does it work better than all of the other SSRIs? I don't know. However, the others have the potential to help as well.
MAOIs (MonoAmine Oxidase Inhibitors) have also shown to be effective for social phobia. Nardil seems to be the best of them, and has been extensively studied for this indication. It is a powerful and effective drug. The major drawback to using Nardil is that you must follow to a special diet that avoids foods containing a substance called tyramine. Although the diet is not as restrictive as is often described, it must be strictly adhered to. To eat a meal high in tyramine can result in a dangerous increase in blood pressure. In addition, there are many drugs which cannot be used while you are taking an MAOI.
I have been taking MAO inhibitors since 1982, and have never had a problem. It really isn't so bad. I had absolutely no problems with sex after a few months had passed (with the possible exception of wanting more of it).
Moclobemide (Manerix, Aurorix) is a special type of MAOI that for which the danger of a reaction to tyramine-rich foods is reduced. It has been studied for use in social phobia. Most of these studies claim that it is effective. I think that it probably is. Moclobemide is not sold in the U.S. I tried it once to treat my depression. I was able to get it from a pharmacy in Canada. If you eventually decide to try it, just post a question here to ask how to go about it.
There are an awful lot more drugs and strategies available for treating anxiety disorders. You might as well consider social-phobia to be sort of a different type of depression, treatable by the same medications. Statistically, some drugs are just more likely to be effective.
There is some logic in choosing Paxil or one of the other SSRIs first. Take it one step at a time. Like I said, there are quite a few things available to try first. You always have Nardil waiting in the background, available to use as the ultimate weapon should you decide it is time to deploy it.
Don't forget the possibility that some sort of psychological approach may be helpful.
Good luck. Please ask more questions as you progress through treatment and let us know what's going on.
See ya'
- Scott
Posted by Judy on May 24, 2000, at 18:18:53
In reply to Re: Social Phobia: Nardil or Paxil ????or what??, posted by SLS on May 24, 2000, at 7:52:53
>I had absolutely no problems with sex after a few months had passed (with the possible exception of wanting more of it).
Scott - so that this isn't totally off-topic, I'll first cast my vote for Nardil as a wonderful help for social phobia. It would still be my drug of choice if I could get around the nasty edema side effect.
Now - *NO* problems whatsoever with sex after a few months??? Is that a typical response or yours alone? What about before that? Did you lose your libido as well as mechanical ability for the first few months? The reason I ask is because I've been taking Parnate (60 mg/day) for about three months. It's working relatively well for my depression (nowhere near as well for anhedonia) - totally different drug for me than Nardil - except I almost immediately lost all sexual ability and desire.
Just this past weekend, I started to "recall" some of those old feelings and was actually able to reach climax (took a while, but it was a real one!). Of course, being the total pessimist I am about any AD, I panicked that Parnate was pooping out on me. Within the same time frame, I've started to have Cecil B. DeMille-type colorized dreams in the early morning (I've never remembered my dreams, if I had them, while taking an MAOI before). This added to my poop-out fears. What do you think? I feel the same. Have I passed some kind of three-month test, or is Parnate letting me down softly at first?
Judy
Posted by SLS on May 25, 2000, at 16:24:32
In reply to Re: Social Phobia: Nardil or Paxil ? (SLS), posted by Judy on May 24, 2000, at 18:18:53
> > I had absolutely no problems with sex after a few months had passed (with the possible exception of wanting more of it).
> Scott - so that this isn't totally off-topic, I'll first cast my vote for Nardil as a wonderful help for social phobia. It would still be my drug of choice if I could get around the nasty edema side effect.
This must be very demoralizing for you. I believe I ran across your posts regarding this earlier. It frustrates me to see this. What sorts of things did you try to deal with it? Did the severity of edema change with dosage?
Crap. I wish I knew more about this phenomenon to be able to help.
> Now - *NO* problems whatsoever with sex after a few months???
Sorry. None.
> Is that a typical response or yours alone?
Actually, I initially thought it was more typical than atypical. When I began to post statements that any anorgasmia produced by an MAOI would disappear with time, I was bombarded with a shower of angry protests describing the contrary. Prior to visiting this board, I had never encountered long-term anorgasmia as a complaint. I don't know. Maybe there is a bias in the biology of the population here representative of treatment-resistance or the result of exposure to many different antidepressants. I was probably just ignorant.
> What about before that? Did you lose your libido as well as mechanical ability for the first few months?
It is quite difficult to lose a libido that doesn't exist. My depression affects just about everything. >:-(
As far as the mechanics are concerned, I experience a change in the orgasm itself (retrograde ejaculation), but I don't have too much trouble reaching it. This seems to disappear within a week or two. I may be atypical with respect to orgasms, as this seems to be a forte of mine. It's hard to say that without seeming pretentious, but...
A more relevant experience of mine would be with a powerful MAO inhibitor called clorgyline. Initially, I had quite a bit of difficulty reaching orgasm. The drug seemed to be persistant in this regard. I guess I (and my partner) was more persistant than clorgyline. I found that with each successive orgasm reached, it became easier and easier to get there. I wish this were the case with everyone. Perhaps there is a "retraining" of the orgasmic pathways - sort of like constructing new highways. If this is true, I encourage you to have as many orgasms as possible, despite your unwillingness to do so. :-) Masterbate if necessary.
Actually, I would really like to know if others have experienced this same sort of recovery of orgasmia.
> The reason I ask is because I've been taking Parnate (60 mg/day) for about three months. It's working relatively well for my depression (nowhere near as well for anhedonia) - totally different drug for me than Nardil - except I almost immediately lost all sexual ability and desire.
The first thing that comes to mind would be to add a dopaminergic drug with the hope that it will help with anhedonia, libido, and anorgasmia. If you find the right one, perhaps all three will resolve.
Ritalin
Dexedrine
Adderal
Parlodel
Permax
Mirapex
SymmetrelDespite viscious rumors to the contrary, these drugs can be safely combined with MAOIs. As a precaution, it may be a good idea to have your blood pressure monitored for a few hours after taking the first dose of Dexedrine, Adderal, or Ritalin
I think either Ritalin or Mirapex would make a good first choice.
I am looking into the feasibility of adding amisulpride to an MAOI. This may be a drug to put on your list.
> Just this past weekend, I started to "recall" some of those old feelings and was actually able to reach climax (took a while, but it was a real one!).
Hopefully, it will become easier to have the next one, and the one after that, and... Keep pushing.
> Of course, being the total pessimist I am about any AD, I panicked that Parnate was pooping out on me.
That I began to regain my ability to orgasm did not signal the beginning of any kind of "poop-out".
> Within the same time frame, I've started to have Cecil B. DeMille-type colorized dreams in the early morning (I've never remembered my dreams, if I had them, while taking an MAOI before). This added to my poop-out fears. What do you think? I feel the same. Have I passed some kind of three-month test, or is Parnate letting me down softly at first?
This is a very astute observation. The appearance of the type of dreams you describe is very similar to what someone experiences when they discontinue an MAOI, especially if they do so abruptly. I don't know how to interpret this at this point. With some people, the dosage of an MAOI must be adjusted from time to time. The therapeutic dosage range of Parnate is 40mg - 80mg (I don't care what the PDR says). Some people need more than 100mg. I have been as high as 150mg. You have some room yet.
My prescription: Be wary, but not pessimistic.
I would wait to see if any adjustment in your dosage of Parnate is necessary before you start adding things to treat the residual anhedonia or sexual side effects.
- Scott
Posted by SLS on May 26, 2000, at 7:42:23
In reply to Re: Social Phobia: Nardil or Paxil ? (SLS), posted by SLS on May 25, 2000, at 16:24:32
> I would wait to see if any adjustment in your dosage of Parnate is necessary before you start adding things to treat the residual anhedonia or sexual side effects.
Judy - I forgot to ask you if you have ever tried Marplan or moclobemide.Which is more prominent - depression or social-phobia?
Have you tried an SSRI?
Which ones?
Did they help?
Why did you stop them?To what degree has Parnate improved your social-phobia?
I'm not looking to persuade you to look for a substitute for Parnate at this point. I think it makes sense to "stay the course".
- Scott
Posted by Judy on May 26, 2000, at 19:52:14
In reply to Re: Social Phobia: Nardil or Paxil ? - Judy again, posted by SLS on May 26, 2000, at 7:42:23
>>Nardil… would still be my drug of choice if I could get around the nasty edema side effect.
>This must be very demoralizing for you. What sorts of things did you try to deal with it? Did the severity of edema change with dosage?
It’s like a cruel joke, really. There is a med that makes me feel better than I’ve ever felt – and I can’t tolerate it physically. The edema set in at about 30 mg/day and was pretty severe at 45 mg/day (my maintenance dose). My feet and ankles were elephantine by the end of the day, and when I awoke in the morning, my face was swollen beyond recognition. To add insult to injury, Nardil made me almost dead from the waist down – I was barely able to urinate and my intestines basically shut down (I could go 7 days and not even feel any discomfort!) That ruled out the possibility of trying a diuretic to alleviate the edema since all the fluid would have ended up in my non-functioning bladder. I just couldn’t figure out a way to make Nardil work – there were too many strikes against me. Trust me, I will be the first person in line if and when the Nardil patch makes an appearance on any market in the world!
>Which is more prominent - depression or social-phobia?
Actually, I don’t suffer from social-phobia. My dx is major depression, dysthymia and unrelenting anhedonia (except when taking Nardil). I guess I misled you by recommending Nardil for social-phobia. I did so because when I was taking it, I became more talkative (would have held a conversation with a wooden Indian!) and enjoyed myself so much more.
>Perhaps there is a "retraining" of the orgasmic pathways - sort of like constructing new highways. If this is true, I encourage you to have as many orgasms as possible, despite your unwillingness to do so. :-) Masterbate if necessary.
This makes a lot of sense. I find my teeth clenched even at the thought of what an ordeal attempting an orgasm has become. Maybe if I relaxed a bit and said ‘screw it’ (no pun intended – I swear!) “if not this time, maybe the next time.’ Fortunately I have a partner who is patient and more than willing to help at any given moment.>Actually, I would really like to know if others have experienced this same sort of recovery of orgasmia.
So would I!
>The first thing that comes to mind would be to add a dopaminergic drug with the hope that it will help with anhedonia, libido, and anorgasmia. If you find the right one, perhaps all three will resolve.
Dexedrine
Adderal
Parlodel
Permax
Mirapex
Symmetrel
>I think either Ritalin or Mirapex would make a good first choice.My doctor is a psychiatrist and admits that he is too busy seeing patients to keep up with the latest in the specific science of drug augmentation. In fact, when I mentioned Ritalin to offset the Nardil Nods, he said, “What are you crazy?! You’re taking an MAOI!!!” He has suggested several times that I see one of the “Big Boys” in Boston (meaning a top psychopharm). I haven’t become desperate enough to drive into the ‘big city’ – as silly as it sounds, that would be a major panic attack situation for me.
>With some people, the dosage of an MAOI must be adjusted from time to time. The therapeutic dosage range of Parnate is 40mg - 80mg (I don't care what the PDR says). Some people need more than 100mg. I have been as high as 150mg. You have some room yet.
I don’t think my doctor would have a problem with increasing my dose. (Don’t know what he considers to be over and above therapeutic, but I’m sure he’s willing to prescribe more than the 60 mg I’m now taking. Do you really think I might see a lessening of the anhedonia at a higher dose?
>Judy - I forgot to ask you if you have ever tried Marplan or moclobemide.
Marplan, yes. Same side effects as Nardil, benefits not as great. I tried for a prescription for moclobemide and was treated to a “There’s a reason this drug hasn’t been approved in the U.S. yadda yadda…” Also took 60 mg/day of Selegiline. Best drug I’ve ever taken for mental clarity, virtually no side effects; but didn’t quite get rid of my depression, much less anhedonia. (A couple of archives back, I posed a question on the BB about combining Parnate and Selegiline because I felt great for the first couple of weeks on Parnate and I assumed it was because I still had Selegiline in my system – but I was pretty much shot down on that theory.)
>Have you tried an SSRI?
Which ones?
Did they help?
Why did you stop them?All the SSRI’s made me so fatigued that I couldn’t get up in the morning, couldn’t function for the rest of the day. No benefit at all no matter how much of a trial period I gave them.
Also tried Effexor and Wellbutrin. Both were terrible experiences. I had flu-like symptoms for the entire time I took them – muscle/joint aches, sore back, tremors, jitters – you name it. No benefit whatsoever.
Remeron & Serzone: more terrible experiences. Made me near comatose – couldn’t even be shaken awake in the morning. Also, Serzone brought out a nasty hostility in me that I’ve never felt the likes of before and don’t want to again.
Desiprimine, Clomiprimine: Weight gain, excessive sweating, not enough benefit to make it worth it.
Ritalin: Nothing at all. Maybe more tired than usual.
Lithium: Another bad near-comatose experience.
There are probably more – I wish I had written it all down. Didn’t know I was going to spend 17 years playing ‘find the right drug’.
Scott, if any of this trigger something in your mind, please let me know. In the meantime, thanks for your kind responses.
Judy
Posted by Judy on May 28, 2000, at 18:46:15
In reply to Re: Social Phobia: Nardil or Paxil ? - Judy again, posted by Judy on May 26, 2000, at 19:52:14
Scott -
Just wanted to make sure you saw my thread above. I forgot to put your name in the subject line.Judy
Posted by SLS on May 28, 2000, at 21:44:28
In reply to Re: Social Phobia: Nardil or Paxil ? - SLS, posted by Judy on May 28, 2000, at 18:46:15
> Scott -
>
> Just wanted to make sure you saw my thread above. I forgot to put your name in the subject line.
>
> Judy
Judy - I saw your post, read it, was thinking about it, got distracted, and then forgot about it. (cowering in shame) I am very sorry.Serotoninergic drugs don't seem to be helpful.
For now, I think you should continue with Parnate and take things one step at a time.
1. Increase the dosage to 80mg.
2. Go get that consultation in Boston - Andrew Nierenberg at Massachussetts General Hospital / Harvard.
3. Get a referral for a new doctor.
4. Get a new doctor if you are comfortable with this.
5. Keep your ears open for other suggestions.
6. Continue to have orgasms in the mean time.Possibilities:
1. Using the stimulant/dopaminergic drugs I listed in the previous post as adjuncts to Parnate.
- Ritalin
- Dexedrine
- Mirapex
2. Add low-dose lithium 300-600mg
3. Add thyroid.
4. Add a tricyclic
5. Add low-dose neuroleptic (Zyprexa, Risperdal, Seroquel)
6. Add amisulpride - I'm looking into this for myself.
Try making a list of all of the drugs that improved your depression - no matter how little, how long, and regardless of side effects.* Is there any history of mental illness in your family?
Sincerely,
Scott
Posted by Judy on May 29, 2000, at 9:29:10
In reply to Re: Social Phobia: Nardil or Paxil ? - SLS, posted by SLS on May 28, 2000, at 21:44:28
Scott,
Thank you very much for taking the time to respond. I've printed out your suggestions and will hang on to them to refer to.
>1. Increase the dosage to 80mg.
Obviously the easiest to try, and this is probably what I will do right away.
>2. Go get that consultation in Boston - Andrew Nierenberg at Massachussetts General Hospital / Harvard.
I know I need to make that trip into Boston. Thanks for the starting point.
>* Is there any history of mental illness in your family?
I honestly don't know. I'm an only child. Most of my relatives were much older than I so even if there were, I wasn't told about. I can, however, bet money on the fact that my late father suffered from depression, or at least dysthymia. The more I think back, the more I realize how many of the same symptoms he exhibited. He took Valium for as long as I can remember for the 'stress' of his job. He never hit the 'black hole' like I do however. Interestingly, maybe, is that I have one daughter with severe OCD and the other has just been diagnosed with ADD.
Again, thank you; and I hope amisulpride turns out to be the augmentation you've been looking for.
Judy
Posted by Peter S. on May 29, 2000, at 16:02:11
In reply to Re: Social Phobia: Nardil or Paxil ? - Judy again, posted by Judy on May 26, 2000, at 19:52:14
> It’s like a cruel joke, really. There is a med that makes me feel better than I’ve ever felt – and I can’t tolerate it physically. The edema set in at about 30 mg/day and was pretty severe at 45 mg/day (my maintenance dose). My feet and ankles were elephantine by the end of the day, and when I awoke in the morning, my face was swollen beyond recognition. To add insult to injury, Nardil made me almost dead from the waist down – I was barely able to urinate and my intestines basically shut down (I could go 7 days and not even feel any discomfort!) That ruled out the possibility of trying a diuretic to alleviate the edema since all the fluid would have ended up in my non-functioning bladder. I just couldn’t figure out a way to make Nardil work – there were too many strikes against me. Trust me, I will be the first person in line if and when the Nardil patch makes an appearance on any market in the world!
>Judy: I have been on Nardil for the last couple of months, and it seems to be the first drug that works on a semi-consistant level- although not as much as I'd like. I'd love to increase the doseage but right now I'm experiencing some of the same side effects that you talk about: not edema but major constipation which I have yet to figure out how to deal with. Next step is to try and guzzle as much mineral oil as I can tolerate. Have you heard of any other ways of dealing with this? Sexual side effects/anorgasmia are definitely present as well. I have heard that gingko biloba can be effective in treating sexual side effects; ever tried it?
> All the SSRI’s made me so fatigued that I couldn’t get up in the morning, couldn’t function for the rest of the day. No benefit at all no matter how much of a trial period I gave them.
I had exactly the same side effects (major fatigue) with all the SSRI's but I would get benefit for a couple of days every 1-2 weeks.
I have tried all the medications that you mention along with Moclobemide, amilsulpride and many others and found little benefit. I would love to make Nardil more tolerable (it's my last hope)- if I could just deal with the constipation! Anyway I appreciate hearing about your experiences and wish you the best of luck.Peter S.
Posted by Judy on May 29, 2000, at 20:04:02
In reply to Re: Nardil - Judy , posted by Peter S. on May 29, 2000, at 16:02:11
Hi Peter,
Sorry to hear that you're in the same boat. What a shame that Nardil works for us mentally and then does us in physically, huh?
> I'd love to increase the dosage but right now I'm experiencing some of the same side effects that you talk about...
How much Nardil are you taking now? I suspect once you hit the side effects plateau, they don't get any get any worse (how could they?), but you might see increased AD benefits at higher doses.
>...major constipation which I have yet to figure out how to deal with. Next step is to try and guzzle as much mineral oil as I can tolerate. Have you heard of any other ways of dealing with this?
I couldn't beat it. The mineral oil might be worth a shot - I never even thought to try that! Increased dietary fiber, Metamucil, stool softeners did nothing to help. Enemas work pretty well (and in some circles they're even considered erotic! I don't happen to travel in those particular circles, nor did I have the time to spend when I had to be out of the house at 7 AM - but sometimes you do what you have to do!)
>Sexual side effects/anorgasmia are definitely present as well. I have heard that gingko biloba can be effective in treating sexual side effects; ever tried it?
I had complete and total anorgasmia with Nardil. Like I said - dead from the waist down in all departments. Unfortunately I still had a libido. Another of life's cruel little jokes. I tried Gingko and it merely seemed to increase my postural hypotension. I also tried an antihistimine (the name of which escapes me at the moment) and it just made me tired. I recently tried Viagra - nothing. But that's me - maybe one of them will work for you. Don't ever pass on a possibility based on somebody else's experience.
I assume you've tried Parnate? I've been taking it for several months now and, while it's not Nardil, it's probably the closest I've come. On the plus side, it has very few nasty side effects. Even the anorgasmia is not total - it just takes a loooooong time to get there. I'm planning to increase my dose from 60 mg to 70 or 80 - maybe the side effects are lying in wait there. I won't know until I try.
Good luck, Peter. Let me know if I missed something or you have any more questions.
Judy
Posted by AndrewB on May 30, 2000, at 3:42:10
In reply to Re: Nardil - Judy , posted by Peter S. on May 29, 2000, at 16:02:11
Peter,
Glad to hear that you have had a response to Nardil.
If you don't mind me asking, can you tell me your diagnosis and in what specific ways Nardil has improved your condition.
Also will you please give me any details you can about your amisulpride experience. I am trying to track peoples' responses.
The constipation combined with sexual side effects you describe reminds me of the side effects sometimes seen with certain antidepressants that act on norepinephrine such as reboxetine and some tricyclics. Nardil also acts on NE through its MAO inhibition. Nardil has a complicated action, one which I don't understand. Therefore it isn't for me to say that the constipation and sexual dysfunction is NE related, but it is only my point to suggest it as a one likely cause.
More specifically, it may be agonism of the alpha 2 receptor that is causing your constipation. The side effects of alpha 2 agonist drugs (used for hypertension) include constipation, drowsiness, sedation, dizziness,and hypotension.
This suggests a potential remedy for your condition, an alpha 2 selective agonist. Yohimbine is one such drug. Yohimbine, may people know, can be very effective in assisting some to overcome sexual dysfunction. When you take it, onset of action will take about 2 hours and effects can last for 24 hours. Side effects of yohimbine for many include agitation, insomnia, and a rise in blood pressure. Of course, if you are feeling sluggish, you may welcome these side effects. I would be very interested to know, if you try yohimbine, if it doesn't take away your constipation also.
Yohimex is a prescription medicine that is made of purified yohimbine. It is economical and has less side effects than yohimbine bark. You may want to talk to your psych. about the appropriateness of Yohimex (or another alpha 2 antagonist?) for your condition.
Bethanechol has also been noted to reverse sexual dysfunction of norandrenergic origen.
AndrewB
Posted by Peter S. on May 30, 2000, at 13:22:30
In reply to Re: Nardil - Peter S, posted by Judy on May 29, 2000, at 20:04:02
Hey Judy
> How much Nardil are you taking now? I suspect once you hit the side effects plateau, they don't get any get any worse (how could they?), but you might see increased AD benefits at higher doses.I'm taking 52.5 mg per day and I'd like to get up to 60. As to the constipation; mineral oil doesn't seem to do anything and as you say neither does increasing fiber in the diet. I think what has happened is that the old intestine is just not really doing anything. So I think the way to go is laxatives, which seem to work to some extent. I hate the idea of getting addicted to laxatives though.
? I've been taking it for several months now and, while it's not Nardil, it's probably the closest I've come. On the plus side, it has very few nasty side effects. Even the anorgasmia is not total - it just takes a loooooong time to get there. I'm planning to increase my dose from 60 mg to 70 or 80 - maybe the side effects are lying in wait there. I won't know until I try.
>Yeah I was on Parnate for almost a year and I couldn't get above a certain dose again because of constipation. I also found other side effects unpleasant; like the speedy morning and then the poop out in the afternoon. I also noticed that it affected my sense of taste; weird huh?
But I hope Parnate works for you; sounds like we are both on similar trails.
Good luck,
Peter
Posted by Peter S. on May 30, 2000, at 13:31:09
In reply to Re: Peter S , posted by AndrewB on May 30, 2000, at 3:42:10
> Peter,
>
> If you don't mind me asking, can you tell me your diagnosis and in what specific ways Nardil has improved your condition.Diagnosis is probably dysthymia for most of my life with a healthy dose of social phobia mixed in.
> Also will you please give me any details you can about your amisulpride experience. I am trying to track peoples' responses.
My experience with amisulpride was that I noticed and increase in sleepiness but this was bearable. Other side effects were minimal. However I noticed no therapeutic effects and I think I gave it about a 3-4 week trial.
>
> The constipation combined with sexual side effects you describe reminds me of the side effects sometimes seen with certain antidepressants that act on norepinephrine such as reboxetine and some tricyclics. Nardil also acts on NE through its MAO inhibition. Nardil has a complicated action, one which I don't understand. Therefore it isn't for me to say that the constipation and sexual dysfunction is NE related, but it is only my point to suggest it as a one likely cause.
>
> More specifically, it may be agonism of the alpha 2 receptor that is causing your constipation. The side effects of alpha 2 agonist drugs (used for hypertension) include constipation, drowsiness, sedation, dizziness,and hypotension.
>
> This suggests a potential remedy for your condition, an alpha 2 selective agonist. Yohimbine is one such drug. Yohimbine, may people know, can be very effective in assisting some to overcome sexual dysfunction. When you take it, onset of action will take about 2 hours and effects can last for 24 hours. Side effects of yohimbine for many include agitation, insomnia, and a rise in blood pressure. Of course, if you are feeling sluggish, you may welcome these side effects. I would be very interested to know, if you try yohimbine, if it doesn't take away your constipation also.
>
> Yohimex is a prescription medicine that is made of purified yohimbine. It is economical and has less side effects than yohimbine bark. You may want to talk to your psych. about the appropriateness of Yohimex (or another alpha 2 antagonist?) for your condition.
>
> Bethanechol has also been noted to reverse sexual dysfunction of norandrenergic origen.
Thanks a lot for the information and ideas! I will definitely show this to my pdoc and see what he thinks about it.I'd be interested in hearing the results of your amisulpride poll. Take care.
Peter
Posted by AndrewB on May 30, 2000, at 22:07:51
In reply to Re: Andrew, posted by Peter S. on May 30, 2000, at 13:31:09
Peter,
Thank you for your response. Please give us a follow up after awhile on how you are doing with Nardil. Your results are encouraging.
A couple of more questions:
1) In what specific ways has Nardil improved your condition.
2) What dosag(es) did you use for your amisulpride trial.
Thank you,
AndrewB
Posted by Peter S. on June 2, 2000, at 1:56:31
In reply to Re: Peter, follow up Qs, posted by AndrewB on May 30, 2000, at 22:07:51
>
> 1) In what specific ways has Nardil improved your condition.Hi Andrew;
My depression is definitely reduced and I am feeling much more social in general. I'd still like to increase the dose up to 60mg if possible. Right now it seems a bit early to see or report major changes in my life/relationships. I have had so many experiences where a med would work briefly and then would stop working that I am very gunshy. If this lasts or improves for another couple months I will be able to report more.
>
> 2) What dosag(es) did you use for your amisulpride trial.I'm pretty sure I used the recommended dose of 1/4 of a pill. I don't remember exactly the amount. I could go back into my records and check.
Hope this helps.
Peter S..
Posted by michael on June 2, 2000, at 2:12:50
In reply to Re: Peter, follow up Qs, posted by Peter S. on June 2, 2000, at 1:56:31
Hey Peter -
I don't mean to be difficult, but do you know what the dose was in terms of mg? Are you referring to 1/4 of a 50mg tablet, or 1/4 of a 200mg tablet - the second of which would get you down to the 50mg dose?
I'm also curious, because the 50mg/day dose had me sleeping a minimum of 12 hours... However, from what I've read, that's a response more typical of high doses... Just curious.
> >
> > 1) In what specific ways has Nardil improved your condition.
>
> Hi Andrew;
>
> My depression is definitely reduced and I am feeling much more social in general. I'd still like to increase the dose up to 60mg if possible. Right now it seems a bit early to see or report major changes in my life/relationships. I have had so many experiences where a med would work briefly and then would stop working that I am very gunshy. If this lasts or improves for another couple months I will be able to report more.
> >
> > 2) What dosag(es) did you use for your amisulpride trial.
>
> I'm pretty sure I used the recommended dose of 1/4 of a pill. I don't remember exactly the amount. I could go back into my records and check.
>
> Hope this helps.
>
> Peter S..
Posted by Peter S. on June 2, 2000, at 20:14:01
In reply to Re: Peter, follow up Qs » Peter S., posted by michael on June 2, 2000, at 2:12:50
Hi Michael
> I don't mean to be difficult, but do you know what the dose was in terms of mg? Are you referring to 1/4 of a 50mg tablet, or 1/4 of a 200mg tablet - the second of which would get you down to the 50mg dose?
Yes after checking my notes, it was 1/4 of a 200mg tablet, or 50mg.
> I'm also curious, because the 50mg/day dose had me sleeping a minimum of 12 hours... However, from what I've read, that's a response more typical of high doses... Just curious.
I also noticed an increase in sleep which wasn't unbearable. The issue or why I stopped (after 9 weeks) was a complete lack of therapeutic response.
Peter
> > > 1) In what specific ways has Nardil improved your condition.
> >
> > Hi Andrew;
> >
> > My depression is definitely reduced and I am feeling much more social in general. I'd still like to increase the dose up to 60mg if possible. Right now it seems a bit early to see or report major changes in my life/relationships. I have had so many experiences where a med would work briefly and then would stop working that I am very gunshy. If this lasts or improves for another couple months I will be able to report more.
> > >
> > > 2) What dosag(es) did you use for your amisulpride trial.
> >
> > I'm pretty sure I used the recommended dose of 1/4 of a pill. I don't remember exactly the amount. I could go back into my records and check.
> >
> > Hope this helps.
> >
> > Peter S..
Posted by AndrewB on June 3, 2000, at 8:46:29
In reply to Re: Michael, follow up Qs, posted by Peter S. on June 2, 2000, at 20:14:01
Peter,
Your diagnosis of dysthymia and social phobia indicates dopaminergic D2-3 hypofunction. A recent study indicated low D2 receptor binding potentials in social phobia. Nardil has long thought to be effective for social phobia due to its dopaminergic action. Therefore one would think that the D2-3 dapaminergic activity enhancing amisulpride would be a drug that you would be responsive to. But this obviously wasn't the case. All you experienced was sleepiness. Michael experienced the same thing at 50mg. Sleepiness indicates that one is taking too much amisulpride and the postsynaptic, rather than the targeted presynaptic D2-3 receptors, are being stimulated. Intuitively the solution would be to lower the dose. Michael has done this, lowered his dose to 12.5 mgs., with some initially promising results. You may therfore wish to retry amisulpride at a lower dose (such as 25mgs) as an augmenting agent to nardil. Let me know if you find this effective. Indeed, if you are able to find effective dopaminergic augmenting agents for Nardil (like amisulpride), you should be able to lower the effective dose of nardil and thus lower your side effects.
Posted by SLS on June 3, 2000, at 9:37:20
In reply to Re: Amisulpride, Peter S, posted by AndrewB on June 3, 2000, at 8:46:29
Dear Fellow Sufferers,
I am confused here.Who is currently taking Nardil + amisulpride in combination?
Is there a trend towards amisulpride producing sleepiness or sedation when it is added to Nardil?
Is anyone combining amisulpride with Parnate?
Thanks.
- Scott
------------------------------------
> Peter,
>
> Your diagnosis of dysthymia and social phobia indicates dopaminergic D2-3 hypofunction. A recent study indicated low D2 receptor binding potentials in social phobia. Nardil has long thought to be effective for social phobia due to its dopaminergic action. Therefore one would think that the D2-3 dapaminergic activity enhancing amisulpride would be a drug that you would be responsive to. But this obviously wasn't the case. All you experienced was sleepiness. Michael experienced the same thing at 50mg. Sleepiness indicates that one is taking too much amisulpride and the postsynaptic, rather than the targeted presynaptic D2-3 receptors, are being stimulated. Intuitively the solution would be to lower the dose. Michael has done this, lowered his dose to 12.5 mgs., with some initially promising results. You may therfore wish to retry amisulpride at a lower dose (such as 25mgs) as an augmenting agent to nardil. Let me know if you find this effective. Indeed, if you are able to find effective dopaminergic augmenting agents for Nardil (like amisulpride), you should be able to lower the effective dose of nardil and thus lower your side effects.
Posted by Seamus2 on June 3, 2000, at 9:56:42
In reply to Who is taking Amisulpride + Nardil or Parnate ? » AndrewB, posted by SLS on June 3, 2000, at 9:37:20
Scott,
I'll be giving the Parnate a two week washout, then trying the amisulpride. It gets but a two week shot itself, then I'll add the Parnate again.
Will let you know.
Seamus
> Dear Fellow Sufferers,
>
>
> I am confused here.
>
> Who is currently taking Nardil + amisulpride in combination?
>
> Is there a trend towards amisulpride producing sleepiness or sedation when it is added to Nardil?
>
> Is anyone combining amisulpride with Parnate?
>
> Thanks.
>
>
> - Scott
>
Posted by Peter S. on June 3, 2000, at 12:06:56
In reply to Re: Amisulpride, Peter S, posted by AndrewB on June 3, 2000, at 8:46:29
Andrew:
Thanks for the information and advice. I have never heard of amisulpride being used with a MAOI but admittedly I've never done any research in the area. Has any research been done that demonstrates the safety and effectiveness of doing this? I'm going to check Medline and see what I come up with. I'm curious to see how Seamus does with it. Anyway thanks again.
Peter
> Peter,
>
> Your diagnosis of dysthymia and social phobia indicates dopaminergic D2-3 hypofunction. A recent study indicated low D2 receptor binding potentials in social phobia. Nardil has long thought to be effective for social phobia due to its dopaminergic action. Therefore one would think that the D2-3 dapaminergic activity enhancing amisulpride would be a drug that you would be responsive to. But this obviously wasn't the case. All you experienced was sleepiness. Michael experienced the same thing at 50mg. Sleepiness indicates that one is taking too much amisulpride and the postsynaptic, rather than the targeted presynaptic D2-3 receptors, are being stimulated. Intuitively the solution would be to lower the dose. Michael has done this, lowered his dose to 12.5 mgs., with some initially promising results. You may therfore wish to retry amisulpride at a lower dose (such as 25mgs) as an augmenting agent to nardil. Let me know if you find this effective. Indeed, if you are able to find effective dopaminergic augmenting agents for Nardil (like amisulpride), you should be able to lower the effective dose of nardil and thus lower your side effects.
Posted by AndrewB on June 5, 2000, at 18:31:55
In reply to Re: Amisulpride, Andrew, posted by Peter S. on June 3, 2000, at 12:06:56
> Andrew:
>
> Thanks for the information and advice. I have never heard of amisulpride being used with a MAOI but admittedly I've never done any research in the area. Has any research been done that demonstrates the safety and effectiveness of doing this? I'm going to check Medline and see what I come up with. I'm curious to see how Seamus does with it. Anyway thanks again.
>
Peter,Can amisulpride be combined with an MAOI? That is an important question. I think I can get an answer but give me some time. Keep checking back.
AndrewB
Posted by michael on June 5, 2000, at 18:54:06
In reply to Re: Amisulpride, Andrew, posted by AndrewB on June 5, 2000, at 18:31:55
This is not entirely, but at least in part, the same question as amisulpride & selegiline thread was addressing. As I think I mentioned, I was wondering about that combo specifically, because both of these meds target the dopamine system.
I was referring to only 10mg selegiline daily, which, at this low dosage, preferentially inhibits MAOI-B. (MAOI-B the one that is supposed to break down dopamine). I've decided to give it a try, however, I am also taking a lower than usual dose of amisulpride - only approx. 12.5mg per day - just a quarter of a 50mg tablet (due to the fact that 50mg/day had me sleeping at least 12 hours/day).
Btw, tried going up to 25mg amisulpride/day, and was tired and lethargic & apathetic... not good. Don't know if that would've been the case w/o the selegiline. I had been taking the selegiline for about 10 - 14 days at the time, and the amisulpride for about 4 - 8 days when I tried the 25mg dose. Sorry, I guess I should've been making notes...
I don't have anything to contribute about other maoi's...
> > Andrew:
> >
> > Thanks for the information and advice. I have never heard of amisulpride being used with a MAOI but admittedly I've never done any research in the area. Has any research been done that demonstrates the safety and effectiveness of doing this? I'm going to check Medline and see what I come up with. I'm curious to see how Seamus does with it. Anyway thanks again.
> >
> Peter,
>
> Can amisulpride be combined with an MAOI? That is an important question. I think I can get an answer but give me some time. Keep checking back.
>
> AndrewB
Posted by AndrewB on June 5, 2000, at 23:47:44
In reply to Re: Amisulpride MAOI, posted by michael on June 5, 2000, at 18:54:06
Thanks for the new info. on your amisulpride experience.Recently read a study abstract that indicates 5mg. of selegiline does the same as 10mg.
Have you noticed any improvement on your seligiline, amisulpride combo.
I've had nice results with entacapone as a dopaminergic agent of arousal. I want to wait until I get a chance to combine it with Sinemet before I say anything more about it though.
AndrewB
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