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Dr. Bob is Robert Hsiung, MD,
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Posted by deniseuk190466 on January 4, 2007, at 4:31:30
In reply to Re: Nardil + nortriptyline is working. » Tomatheus, posted by SLS on December 25, 2006, at 7:03:07
Hi Scott,
Glad to see you are actually feeling good for a change, hope this is still the case and that the feeling hasn't dissipated.
Is it the addition of Nortiptyline that is helping or just the increase of Nardil? Would the Nardil on it's own be just as good do you know?
I sometimes wonder if people are on more than one drug, how do they know what each one is doing.
Also, what does the abilify do for you?
Thanks.....Denise
Posted by SLS on January 4, 2007, at 6:23:31
In reply to Re: Nardil + nortriptyline is working., posted by deniseuk190466 on January 4, 2007, at 4:31:30
Hi Denise.
> Glad to see you are actually feeling good for a change, hope this is still the case and that the feeling hasn't dissipated.
Yeah. Isn't that always the fear? I felt best around Thanksgiving. Since then, my response indeed has plateaued and mostly dissipated. It hasn't disappeared entirely, though. I encountered problems with side effects after being on 75mg for three weeks. I hypotension that caused me to come close to fainting in public and causing me to fall in my apartment. Additionally, it was almost impossible for me to urinate. I couldn't initiate a stream. Luckily, I had some bethanecol laying around from the last time I had such problems. I temporarily discontinued the Nardil and am now restarting it at a lower dosage. I am going to try to stabilize at 60mg and give it some time, perhaps adding things as augmentors.
> Is it the addition of Nortiptyline that is helping or just the increase of Nardil?
> Would the Nardil on it's own be just as good do you know?
In the past, I have proven to myself that Nardil + desipramine was better than Nardil alone at those points in time that I tried it. At this point in time, it would be difficult to determine if the combination was more helpful than the Nardil by itself without removing the nortriptyline. I remained on the nortriptyline for two reasons. First, it definitely produced a small and stable improvement when combined with Lamictal. Second, it might possibly enhance the effects of Nardil more than desipramine. It is something that I had not tried yet, and I didn't want to skip over the opportunity.
> I sometimes wonder if people are on more than one drug, how do they know what each one is doing.
You either add one drug at a time or attempt to remove one drug at a time. I attempt to remove or lower the dose of a drug from time to time to evaluate its contribution to my treatment regime. At some point, I become convinced that certain drugs are critically important and just leave them alone. Abilify is one drug that I might test at some point. However, I won't touch it until I am able to fully evaluate Nardil. It may be that I can use Abilify periodically during particularly difficult times.
> Also, what does the abilify do for you?When I first started taking it, it gave me more motivation and more mental energy. I think it also helps to prevent the evolution of suicidal states, much the same as Zyprexa does. Zyprexa helps to prevent anxious states of overwhelming catastrophic thinking.
I hope some of this was helpful.
- Scott
Posted by deniseuk190466 on January 5, 2007, at 10:02:05
In reply to Re: Nardil + nortriptyline is working. » deniseuk190466, posted by SLS on January 4, 2007, at 6:23:31
Thanks Scott,
I hope you get the same effect again and hope you are not feeling too bad now, I mean I hope being feels bearable. I think the urinating problem is fairly common with Nardil.
Can I ask you (and you don't have to answer this) but what is a typical bad day for you in thoughts and actions? and how do you cope when the next day and the next day and the next day is just as bad as the day before no matter what you try to do?
Just curious.
Denise
Posted by SLS on January 5, 2007, at 15:57:56
In reply to Re: Nardil + nortriptyline is working., posted by deniseuk190466 on January 5, 2007, at 10:02:05
Hi Denise.
> I hope you get the same effect again and hope you are not feeling too bad now, I mean I hope being feels bearable.
I'm hanging in there. Having restarted Nardil has taken the edge off the depression.
> Can I ask you (and you don't have to answer this) but what is a typical bad day for you in thoughts and actions?
My thoughts are very much slowed down and my actions are few. I am mute. I am lifeless. I am interested in nothing and have no energy to initiate tasks. My affect is flat. I experience very little reward (anhedonia). I have to make it up as I go along. I am not plagued by merciless negative thinking, but I think CBT has helped a great deal with this.
> and how do you cope when the next day and the next day and the next day is just as bad as the day before no matter what you try to do?
That's a big question. I think it involves a great many psychological variables that I can't possibly describe here.
I try to use all of what little God gives me to work with.
I believe there is a possibility that I will get well.
I remember what it was like to be well - to be alive.
Being positive and depressed is better than being negative and depressed.
I try to live in the moment. This is very hard. I can see how my depression affects everything I think and do. However, it really helps to let go of it as much as possible while you are involved in the business of living. It will always be there for you when you get back.
Survival. Part of survival is hope. Part of hope is outlook. For me, having a positive outlook is not a luxury, it is survival. I don't need people telling me that antidepressants don't work when I know they do. I avoid negative energy and participate with positive energy.
As much as you can, try to have fun.
These things are easy to say when they are easy to do. When I am feeling significantly worse than I am right now, I'm not sure how I would answer your questions. Probably the same, now that I think about it. However, I am not able to apply these things with as much success when I am more severely ill. But this is where belief in the system comes in. It is that much more critical to work the plan as a habit when things get bad. It must be second nature and your belief in it must be strong. The best way to build up belief in a system is to see it work. My system works for me.
As much as you can, try to have fun.
- Scott
Posted by Phillipa on January 5, 2007, at 19:15:53
In reply to Re: Nardil + nortriptyline is working. » deniseuk190466, posted by SLS on January 5, 2007, at 15:57:56
Scott again I say you are a remarkable person one I would like to emulate in actions and thoughts. BTW I think of you all the time and wonder how you're doing. Love Jan
Posted by SLS on January 7, 2007, at 11:09:44
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Phillipa on January 5, 2007, at 19:15:53
Woohoo!
I discontinued Nardil for a few days and restarted it at 45mg and moved up to 60mg. It's starting to work again.
I know, I know. I shouldn't get my hopes up too high given my history, but what the hell. I think this might really be it.
Woohoo!
- Scott
Posted by dreamboat_annie on January 7, 2007, at 11:59:04
In reply to Re: Nardil + nortriptyline is working - AGAIN! » Phillipa, posted by SLS on January 7, 2007, at 11:09:44
Woohoo is right!!! I will keep my fingers crossed for you, Scott, that it continues to work even better as the days go by.
Take care.
> Woohoo!
>
> I discontinued Nardil for a few days and restarted it at 45mg and moved up to 60mg. It's starting to work again.
>
> I know, I know. I shouldn't get my hopes up too high given my history, but what the hell. I think this might really be it.
>
> Woohoo!
>
>
> - Scott
Posted by dreamboat_annie on January 7, 2007, at 12:01:12
In reply to Re: Nardil + nortriptyline is working - AGAIN! » Phillipa, posted by SLS on January 7, 2007, at 11:09:44
> I know, I know. I shouldn't get my hopes up too high given my history, but what the hell. I think this might really be it.-- Yes, but sometimes hope is what sustains us through the trying and difficult times. Without it, we would be lost. So, hang on to that hope. My hope is that is translates into success!!
Posted by ed_uk on January 7, 2007, at 13:34:44
In reply to Re: Nardil + nortriptyline is working - AGAIN! » Phillipa, posted by SLS on January 7, 2007, at 11:09:44
That's fantastic Scott :) I hope the effect builds up over the next few days/weeks. Keep us updated!
Ed
Posted by Phillipa on January 7, 2007, at 18:48:12
In reply to Re: Nardil + nortriptyline is working - AGAIN! » Phillipa, posted by SLS on January 7, 2007, at 11:09:44
Yeah!!!!!!!Oh Scott so happy for you. You deserve it and more now will you be my pdoc? I think you have time to go to school and even if you don't I trust you the most. Love Jan
Posted by stargazer on January 7, 2007, at 22:53:10
In reply to Re: Nardil + nortriptyline is working - AGAIN! » SLS, posted by Phillipa on January 7, 2007, at 18:48:12
Scott,
Happy to hear the Nardil is working so well. I may have to try Nardil again if Emsam doesn't start to work soon. I'm only at 6 mg but usually meds will work for me at the lower end of things if they are going to work.
I believe I have alot of he same type of depressive symptoms you have...I have TRD with alot of anergia, some social anxiety, although I havent't been putting myself out there lately so I'm rusty with that... and ADD symptoms, lack of motivation, focus, attention span, distractibility, etc.
My choice was to try Nardil again, but my pdoc wanted me to try EMsam first so thats what I'm doing. Initially I had alot of energy on Emsam but not feeling like I did when Nardil and Marplan worked in the mid to late 80's. That was a normal person type of feeling, where I would never think about what I was doing and wouldjust be living anormal, productive life. All the years on the other meds (SSRI's, etc.) I may have not been depressed but I was still thinking about how I was doing and how I really wasn't comfortable in my life and my relationships with others. It's hard to explain the difference but I'm sure anyone who has TRD knows the difference.
I'm glad it is working for you but I don't understand how the combination works. I have had problems with Lamictal, only took Nortrip, briefly, on it's own...think I took Abilify once, no recollection of effect...and is Trileptal an antiseizure/mood stabalizer? Can you say what each one adds to the formula in terms of symptom control?
God bless whoever is handling your psychopharm management. It is an unusual mix but very customized so hope it keeps you out of trouble, I'm keeping my fingers crossed...SG
Posted by SLS on January 8, 2007, at 7:58:10
In reply to Re: Nardil + nortriptyline is working - AGAIN!, posted by stargazer on January 7, 2007, at 22:53:10
Hi.
> Happy to hear the Nardil is working so well.
Thanks. The improvement is mild at this point, but I expect it to grow gradually over the course of months, not weeks.
> My choice was to try Nardil again, but my pdoc wanted me to try EMsam first so thats what I'm doing. Initially I had alot of energy on Emsam but not feeling like I did when Nardil and Marplan worked in the mid to late 80's.
This is exactly what I have observed with others who have tried Emsam.
> That was a normal person type of feeling, where I would never think about what I was doing and wouldjust be living anormal, productive life.
Yes!
> All the years on the other meds (SSRI's, etc.) I may have not been depressed
How do you know that you weren't still somewhat depressed? Often, there is some residual depression after medication that just doesn't feel as bad as before medication. This is often confused for a lack of interest, laziness, lack of desire to socialize, etc.
> but I was still thinking about how I was doing and how I really wasn't comfortable in my life and my relationships with others. It's hard to explain the difference but I'm sure anyone who has TRD knows the difference.
Yes. Responses to medication can be very incomplete.
> I'm glad it is working for you but I don't understand how the combination works.
That's ok. I'm sure very few people would. I don't. Discovering the drugs that work is partly deductive, but mostly empirical.
> and is Trileptal an antiseizure/mood stabalizer?
Yes. I think it's a good drug. It is almost free of cognitive side effects compared to its sister drug, Tegretol. I found that it had a mild antidepressant effect.
> Can you say what each one adds to the formula in terms of symptom control?
Not really.
:-)
All of the drugs possess mild antidepressant effects for me. However, I think the real magic lies in the combination of Nardil + nortriptyline. However, that magic might not exist at all without some or all of the others.
nortriptyline
Nardil
Lamictal
Topamax
AbilifyNortriptyline + Lamictal provides a stable, mild improvement where each alone does little or nothing. Adding Abilify gave me a mild improvement in mental energy and motivation. Adding Topamax provided some further improvements, although mild. However, it gave me hints of something special that I can't put into words. Adding Nardil has produced a more social demeanor, more mental and physical energy, an improvement in anhedonia, interest, motivation, cognition, and memory. Food tastes better. Music sounds better. Stuff like that.
> God bless whoever is handling your psychopharm management.
It has been a combined effort. I am happy that I have a doctor who has been willing to work with me and act on the ideas that I present to him. I am especially grateful that he encouraged me to restart the Nardil. I had been undecided about it.
> It is an unusual mix but very customized so hope it keeps you out of trouble, I'm keeping my fingers crossed...SG
Toes and eyes too?
Thanks.
:-)
- Scott
Posted by stargazer on January 8, 2007, at 10:13:08
In reply to Re: Nardil + nortriptyline is working - AGAIN! » stargazer, posted by SLS on January 8, 2007, at 7:58:10
Toes and eyes remain crossed at all times for extra luck...I'm a site to behold....
Nardil can be the bomb, those MAO's really are the key that I'm still pursuing...hope i can find the answer soon.
I'm 50 this year and haven't really had more than a few years out of the past 20 that have been good, sad but true. But that has only happened on Nardil and Marplan(before they discontinued it) and that was my only real "normal" period although I have been functional, but still depressed, but I can hideit very well.
I haven't given up on Emsam yet though so we may be tweaking it before changing to another med, but if that fails I will insist on Nardil.
Wouldn't it be interesting, if those of you like myself and others that respond so well to the MAO's could be tested chemically and determine what is the biochemical similarities that exist in our blood/ brain, etc. There may be a connection that could really be beneficial to others and a breakthrough in the quantification of certain types of depression.
Thanks for your response. I am only able to read the ones lately that give me some hope and don't confuse an already confusing and long process. I have given up hope on most of the new AD's and find reading about them too frustrating and it justs makes me relive all the drug trials I have been through over the past 20 years. Not fun!
SG
Posted by corafree on January 24, 2007, at 16:10:48
In reply to Re: Scott how did you come up with this combo? » UGottaHaveHope, posted by SLS on December 18, 2006, at 6:21:01
Scott I can't find the last discussion I had with you. I think you asked me if I had ever tried Nardil. Can you jog my memory?
tks, cf
Posted by SLS on January 25, 2007, at 5:26:49
In reply to Re: Scott how did you come up with this combo?, posted by corafree on January 24, 2007, at 16:10:48
> Scott I can't find the last discussion I had with you. I think you asked me if I had ever tried Nardil. Can you jog my memory?
>
> tks, cf
Several years of trial and error. I chose to remain on the drugs that gave me a steady partial response. Of course, being on Nardil, that excludes any of the serotonin reuptake inhibitors. Topamax produces positive effect, which might be indicative of the bipolar nature of my illness. Lamictal helps, but only when combined with nortriptyline, and at a dosage of 150mg. The most positive effect of Nardil occurs when the dosage of nortriptyline is brought up to 100mg. I might not need Abilify, but I prefer to attempt its discontinuation when I get stabilized and progress substantially more in my recovery. It initially helped with mental energy and motivation, but I cannot tell if these benefits have persisted. One thing that probably has persisted is an anti-suicide effect. It may not be as potent as Zyprexa in this regard, but I feel Abilify is a cleaner drug with respect to side effects.I recently ran into complications. I developed hypotension which causes me to fall to the floor and the inability to urinate, which sometimes requires bethanecol to correct so that I can avoid going to the hospital for a catheterization. I have been playing with dosages, but so far have not been able to obviate the problems without reducing the dosages to the point where I lose the antidepressant effect. I'll get it.
- Scott
Posted by corafree on January 26, 2007, at 17:55:30
In reply to Re: Scott how did you come up with this combo? » corafree, posted by SLS on January 25, 2007, at 5:26:49
X
(That silly X means, "Yeah, I got ya', and tks!"', for further reference.)
I'm so piss*d! I just 'lost' a long response to your much appreciated post 'accidentally' .. becuz' my fingers are so freakin' tired I hit the wrong key.
I'm callin' P b4 he heads up to slopes for weekend!
CF is pissed enuf' to stand up for self!
I'll re-respond Scott.
cf
Posted by corafree on January 26, 2007, at 21:19:45
In reply to Re: Scott how did you come up with this combo? » corafree, posted by SLS on January 25, 2007, at 5:26:49
Oh Scott, I'm sorry. I give up! I did it three times, and now, well I'm dazed and confused.
U'd asked me if I'd tried Nardil some time back.
I asked my P about it. He said, "Oh, that's an MAOI. They've come out w/ it in a patch form called Ensam, which bypasses your gut so as not to tie you to dietary restrictions."
That's incorrect, isn't it?
Anyway, just now (Or, has it been hours now?), excited @ your news, feeling strong, I felt pro-active and quickly called my P.
I've had awful anxiety. Two wks off Eff-XR. "No" to prn lorazepam. P thinks starting Lexapro next week will help.
I've had a NB. I now have ongoing anxiety probs' w/ panic attacks. Man ... I'm suffering.
This is just too long of a story for me to not accidentally delete and wipe out this entire post again!
At a point a few yrs back, I too became anti-suicide. I thought it was a blessing/miracle.
Thought of Enablex for inability to urinate. Dunno. I've had it and it's awful! Otherwise, pray u stay the course.
cf
ps Control copy that!
Posted by TehDizzyBroad on January 30, 2007, at 14:49:51
In reply to Re: Scott how did you come up with this combo? » corafree, posted by SLS on January 25, 2007, at 5:26:49
Scott,
Thank you so much for being so lucid and forthcoming in everything you write here. I am a newcomer, but have found your post among most others as being the most informative and hope-inspiring. Not so much because you've found success in better living through modern chemistry - this most recent thread showing the pains you're going through to find the perfect blend - but that you're so well informed and patient!
Too often I've found that people, both here and at other boards, are too quick to lambast this or that medication because of what it did for them after only a day or three. You are patient and thorough and hopeful throughout all of it. It's refreshing, and hope-inspiring to someone who is desperately looking for an objective view and experience while on their first real venture into Pharmaceutical-Land!
Thanks, and thanks again.
Posted by SLS on January 30, 2007, at 15:06:10
In reply to Re: Scott how did you come up with this combo?, posted by TehDizzyBroad on January 30, 2007, at 14:49:51
:-)
- Scott
Posted by corafree on January 31, 2007, at 6:38:47
In reply to Re: Scott how did you come up with this combo?, posted by TehDizzyBroad on January 30, 2007, at 14:49:51
Yep UR definitely 'patient' Scott. Next time somebody calls me a patient, I'll say no, I'm not Scott.
I'm supposing it is in your character.
Fire is in my character ... a lot of fire/passion. I could never do what you do w/o someone to hold me.
cf
Posted by Jedi on February 4, 2007, at 2:44:49
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
Hi Scott,
I've mixed 100mg nortriptyline with 90mg Nardil with no problems. It worked for me, but after a while it seemed like the nortriptyline was not adding anything over and above the Nardil. It was a good combo for me though with absolutely no sign of serotonin syndrome. However, I wasn't taking all of the other augmentors that you take. The only thing I was adding to the mix was 1mg of clonazepam for the social anxiety.My depression is treatment resistant atypical with social and generalized anxiety. I also have a bipolar component as several medications have put me in a hypomanic state, almost manic. In fact, when I first used Nardil in 1997, when it kicked in, it put me in an almost manic state. It sure felt good at the time, but I'm really careful to watch for it now. Nardil + Geodon did the same thing for a while.
How does your system handle the Topamax? I would like to add something to the Nardil to counteract the severe carbohydrate cravings and associated weight gain. I can't handle any more lowering of my mental capabilities, though. I'm stupid enough already.
Good Luck,
Jedi
> Hi all.
>
> I increased my dose of Nardil from 60mg to 75mg a few days ago.
>
> I am beginning to respond. The antidepressant effect is unmistakable.
>
> Yay!
>
> I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
>
>
> Currently:
>
> Nardil 75mg
> nortriptyline 100mg
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> - Scott
Posted by SLS on February 4, 2007, at 11:16:48
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Jedi on February 4, 2007, at 2:44:49
> I've mixed 100mg nortriptyline with 90mg Nardil with no problems.I've had to increase the dosage of nortriptyline to 200mg. Interestingly, the side effects have mitigated at this higher dosage.
> It worked for me, but after a while it seemed like the nortriptyline was not adding anything over and above the Nardil.
Maybe you needed a higher dosage of nortriptyline.
> It was a good combo for me though with absolutely no sign of serotonin syndrome. However, I wasn't taking all of the other augmentors that you take. The only thing I was adding to the mix was 1mg of clonazepam for the social anxiety.
> How does your system handle the Topamax?It has not affected me negatively cognitively at all. I started low and increased the dosage very slowly to 150mg. I then backed off to 100mg. I find that Topamax has a mild energizing effect for me and actually improves me cognitively at 100mg.
> I would like to add something to the Nardil to counteract the severe carbohydrate cravings and associated weight gain. I can't handle any more lowering of my mental capabilities, though. I'm stupid enough already.
Perhaps you can try a stimulant like Ritalin or Adderall first. What was your appetite like when you were taking Nardil + nortriptyline?
> Good Luck,
Thanks.
You too.
Currently:Nardil 75mg
nortriptyline 200mg
Lamictal 150mg
Topamax 100mg
Abilify 10mg
- Scott
Posted by Michael on July 25, 2007, at 18:19:03
In reply to Nardil + nortriptyline is working., posted by SLS on December 16, 2006, at 6:36:52
> Hi all.
>
> I increased my dose of Nardil from 60mg to 75mg a few days ago.
>
> I am beginning to respond. The antidepressant effect is unmistakable.
>
> Yay!
>
> I am afraid, of course, that I will stop responding. It is so early. I'm already preparing my doctor to let me go up to 90mg when I see him next in a few weeks. His only trepidation is that combining Nardil with nortriptyline might produce serotonin syndrome. It is a valid concern, but I doubt it will occur. I am very impatient.
>
>
> Currently:
>
> Nardil 75mg
> nortriptyline 100mg
> Lamictal 150mg
> Topamax 100mg
> Abilify 10mg
>
>
> - Scott
Hey Scott,Just wondering how the combo is working for you now...? (just came across this thread)
Still well, I hope!
Btw, I'd be interested in any thoughts/insights you might have (if any, & if you're up to it) regarding abilify, as it relates to the questions in the following post:
http://www.dr-bob.org/babble/20070719/msgs/771945.html
Thanks for all your feedback & help in the past, & hope your good news is persisting!
michael
Posted by Phillipa on July 25, 2007, at 20:18:04
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Michael on July 25, 2007, at 18:19:03
Michael sorry I forgot a few of his meds but so glad you found the thread. Love Phillipa
Posted by Fivefires on August 1, 2007, at 13:10:10
In reply to Re: Nardil + nortriptyline is working. » SLS, posted by Michael on July 25, 2007, at 18:19:03
Don't stop believing Scott!
Gosh it's good to hear good.
sending miracle vibes, 5f
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