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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Barbariana on November 2, 2000, at 21:07:12
Hello,
I have a question involving running.Since upping my dose of Nardil from 15mg to 45 a few months back,
which helped my mood
immensely, I've had some
orthostatic hypotension in bearable amounts. What's
less bearable is a version of the problem I get when
running. Apparently running involves blood pressure
changes that Nardil is slowing down. When I start up,
I have to go very slowly
for a few minutes while my muscles feel (bad)like they're
getting no blood. Then, even after I've been going
fo a while, I can't speed up at a decent acceleration
without starting to blackout. I realize that there
is the obvious solution of changing speed only very
slowly, and that this isn't the worst price to pay for
depression relief. BUT. I really like to race which
usually means starting from a dead halt, and involves doing
mixed speed running for training. So I'm wondering
if anyone has any ideas or experience with this because
I really don't want to stop training/competing until
it is feasible to endure a medication switch (~4mo).
I'm going to try
gradually going down to 45/30 & to 30 which is up to
me although (world's least athletic) Dr.
is advising against.In any case, thanks for reading my tale of minor woe.
Sincerely,
B
Posted by SLS on November 2, 2000, at 23:57:45
In reply to Running and Nardil, posted by Barbariana on November 2, 2000, at 21:07:12
Just a quick note:
I'm not sure, but it might be particularly important for you to use an extended gradual "cool down" period to allow for the heart to retake its necessary output load as the contraction of the large leg muscle are no longer contributing as ancillary pumps to aid the heart in promoting blood flow.
- Scott> Hello,
> I have a question involving running.
>
> Since upping my dose of Nardil from 15mg to 45 a few months back,
> which helped my mood
> immensely, I've had some
> orthostatic hypotension in bearable amounts. What's
> less bearable is a version of the problem I get when
> running. Apparently running involves blood pressure
> changes that Nardil is slowing down. When I start up,
> I have to go very slowly
> for a few minutes while my muscles feel (bad)like they're
> getting no blood. Then, even after I've been going
> fo a while, I can't speed up at a decent acceleration
> without starting to blackout. I realize that there
> is the obvious solution of changing speed only very
> slowly, and that this isn't the worst price to pay for
> depression relief. BUT. I really like to race which
> usually means starting from a dead halt, and involves doing
> mixed speed running for training. So I'm wondering
> if anyone has any ideas or experience with this because
> I really don't want to stop training/competing until
> it is feasible to endure a medication switch (~4mo).
> I'm going to try
> gradually going down to 45/30 & to 30 which is up to
> me although (world's least athletic) Dr.
> is advising against.
>
> In any case, thanks for reading my tale of minor woe.
> Sincerely,
> B
Posted by danf on November 3, 2000, at 3:35:58
In reply to Re: Running and Nardil, posted by SLS on November 2, 2000, at 23:57:45
You may want to try some support hose & see if that makes a difference.
Drugs /meds to counter the partial adrenergic block are likely to be dangerous.
Part of what is most likely happening, assuming that your heart rate is speeding up OK, is that you are getting more of vasodilator effect of epinephrine released with exercise because of partial blockade.
Why it happens probably does not make much difference, as the recommended choices are decrease the dosage or stop the med...
Posted by SLS on November 3, 2000, at 12:28:19
In reply to Re: Running and Nardil, posted by SLS on November 2, 2000, at 23:57:45
While taking Parnate, I was counseled to drink caffeinated coffee to help raise blood pressure during the BP lull that occurs around 4:00pm. I don't know how long you have been on Nardil, but I found that postural hypotension got better with time. I just don't know if it would be by enough to help you.
I would try walking for now. You can adjust your pace to "tolerance". Hopefully, you will be able to increase your pace over time. You will still lose weight by walking, but you will miss the aerobic and cardiovascular benefits in the meantime.
A few thoughts.
- Scott
Posted by JohnM on November 4, 2000, at 17:55:29
In reply to Running and Nardil, posted by Barbariana on November 2, 2000, at 21:07:12
If I can give you my own two cents, don't play with your Nardil dose. I used to take Nardil (45 mg) and it did wonders for me. I later tried to take a "drug holiday" and reduce the amount to zero. Needless to say, I crashed into another depression and to make matters worse going back on Nardil didn't snap me out of it! I began to take 60mg which stabilized me somewhat, but I don't feel where I used to.
In the literature you see references to the effect that scientists are finding that antidepressant effect doesn't seem to be related to simply raising chemical levels in the brain, but seem to be very much connected to the initial "shock" of the drug that snaps the brain into gear.
When I started Nardil way back when I felt great, but I was experiencing orgasmic disfunction which required some patience on the part of my girlfriend! I went to my doctor and he simply told me that there is often a trade off in mental health issues. (Easy for him to say!!)
Nevertheless I can respect that comment now and also his other one..."don't be a hero" (and attempt to come off your antidepressant meds).
I wouldn't even lower the dose as there is evidence that the chance of relapse will increase which you DON'T WANT!
Posted by Tori on November 5, 2000, at 9:45:05
In reply to Re: Running and Nardil, posted by SLS on November 3, 2000, at 12:28:19
> While taking Parnate, I was counseled to drink caffeinated coffee to help raise blood pressure during the BP lull that occurs around 4:00pm. I don't know how long you have been on Nardil, but I found that postural hypotension got better with time. I just don't know if it would be by enough to help you.
I have been on Parnate now for almost two months; augmented with Lamictal 150 mg bid (thavee been taking since late February). I'm treatment-resistant and have been on almost every single med since the invention of Prozac. The Parnate causes massive insomnia and finaly I am am taking 20 mg bid at 7 and 11 a.m. which helps but I have to fight, fight like hell, to stay awake after work until at least 10:00 PM and be up at 6. I went to bed at 5 this morning; woke up at 6:30 a.m. (hence my surfing on psychobabble). I had fallen asleep on the couch earlier for an hour and a half, that's how badly my sleep schedule gets screwed if I fall asleep during the day.
Does the _hypo_tension cause the incredible lethargy and sleepiness? I have NOT lost weight on this drug, have NOT been stimulated by it, only have noticed a welcomed increased my cognitive functions (short-term memory, troubleshooting skills at my job (systems tech), can remember names of items; would forget total conversations)....and an increased in inerests in life, hobbies, plus it keeps me from getting suicidal, which is good as the holidays are coming and being three years without mom (background: she died in 1997 from pancreatic cancer at the age of 40) has been horrific around christmas; I hope this year is different.
I have been DYING for a cup of coffee; I am extremely fatigued during the day, I mean I'm atually nodding off during the morning. Even when I work out at 7 am. doing cardio the energy boost lasts an hour but that's that. I nod off at my desk and when I get home I'm ndding off on the couch and will fall asleep immediately should I close my eyes.
QUESTION- > Caffeine is on the food restrictions list for Parnate. I frequently (well, for me every ttwo weeks is enough for me) go hypertensive out of the blue - 170/110, etc, after usualy being HYPO at 80/60 - not because of something I ate or meds I took, just out of the blue (smoking?).
I had a cup of decaf the other day and it didn't bother me.
Anybody else out there able to take caffeine? Should I slowly start with a small cup to see what it causes, then if all hell breaks loose take my Adalat to reduce the BP?
I hope I get a response on this as I am so fatigued it's incredible. When I drive home from work I freeze my butt off with all the windows open to stay awake and refreshed.
:-) Tori
Posted by SLS on November 6, 2000, at 17:42:29
In reply to Re: Parnate and Caffeine - restricted? FATIGUE! » SLS, posted by Tori on November 5, 2000, at 9:45:05
> I have been on Parnate now for almost two months; augmented with Lamictal 150 mg bid (thavee been taking since late February).450mg of Lamictal for the treatment of bipolar depression is very high. I am not familiar enough with its use in unipolar depression or other psychiatric illnesses. I can't imagine that the dosage range of Lamictal should be any greater than that used for bipolar disorder. The average dosage for Lamictal in bipolar disorder is 200mg. I need 300mg. When I try to reduce the dosage from there, I begin to lose the small improvement that it gives me. Have you tried to reduce the dosage of Lamictal methodically to find the lowest effective dosage? When I was taking 120mg of Parnate, I found that 200mg of Lamictal reacted with it to produce a great deal of sleepiness early the next day. Reducing either the Parnate or the Lamictal reduced the sleepiness. If you are taking 150mg more than you really need, it might be contributing to what you are experiencing. However, I think it more likely that your lack of good sleep hygiene is more responsible.
Lamictal for epilepsy = 300-600mg
Lamictal for bipolar = 100-300mg> The Parnate causes massive insomnia and finaly I am am taking 20 mg bid at 7 and 11 a.m. which helps but I have to fight, fight like hell, to stay awake after work until at least 10:00 PM and be up at 6. I went to bed at 5 this morning; woke up at 6:30 a.m. (hence my surfing on psychobabble). I had fallen asleep on the couch earlier for an hour and a half, that's how badly my sleep schedule gets screwed if I fall asleep during the day.
I think it is critical that you take medication to get some sleep, even if you don't use it every day. I would first look into trying trazodone (Desyrel). I think the dosage used for sleep is about 75mg. If you take too much, you might tend to be lethargic early the next day - a sort of hangover. I would have no qualms about taking this drug every day. It is used very often with Parnate. Although theoretical, and rare at most, I would just be aware that serotonin syndrome is a possibility. I would be remiss not to have mentioned that - no need to be alarmed. Trazodone is probably the drug of choice to add to Parnate for sleep.
I would also not hesitate to use a benzodiazepine (Halcion, Ativan, Restoril) or one of the newer drugs (Ambien, Sonata). I have used the strategy of taking both Halcion and Ativan before bed. You may need the strength of the Halcion to put you to sleep and the longer-action of Ativan (or Restoril) to keep you asleep. Hopefully, only one drug will be sufficient. I would not choose Halcion to be used alone. Benzodiazepine is not a four-letter word. You need to do what you need to do. Not sleeping is unacceptable.
> Does the _hypo_tension cause the incredible lethargy and sleepiness?I don't know about incredible, but it can.
> ....and an increased in inerests in life, hobbies,
I wish the SOB (Parnate) would do this for me. I am without interest or motivation or enjoyment. It gives me more mental energy. That's about it.
> plus it keeps me from getting suicidal
Me too.
> which is good as the holidays are coming and being three years without mom (background: she died in 1997 from pancreatic cancer at the age of 40) has been horrific around christmas; I hope this year is different.
Me too. I'll say a little prayer for you.
> I have been DYING for a cup of coffee; I am extremely fatigued during the day, I mean I'm atually nodding off during the morning.My guess is that this is the result of sleep deprivation. Your sleep-cycle has become
> Even when I work out at 7 am. doing cardio the energy boost lasts an hour but that's that. I nod off at my desk and when I get home I'm ndding off on the couch and will fall asleep immediately should I close my eyes.
I think it would be better for your sleep hygeine if you were to work-out in the evening. It will help you sleep better.
> QUESTION- > Caffeine is on the food restrictions list for Parnate.
Caffeine is one of those foods that is of questionable significance. The NIH let me drink regular coffee while I was taking an MAOI that is much more potent than Parnate. However, Parnate is somewhat amphetamine-like. You may find that caffeine makes you feel nervous and otherwise uncomfortable. It doesn't for me.
> I frequently (well, for me every ttwo weeks is enough for me) go hypertensive out of the blue - 170/110, etc, after usualy being HYPO at 80/60 - not because of something I ate or meds I took, just out of the blue (smoking?).
Parnate is known to be capable of this. I don't know if smoking would trigger the event. How do you know when you are hypertensive for you to take your blood pressure?
I think you would be better off taking 20mg in the morning, 10mg at noon, and 10mg at 3:00pm.
> Anybody else out there able to take caffeine? Should I slowly start with a small cup to see what it causes, then if all hell breaks loose take my Adalat to reduce the BP?
What is Adalat?
Many people carry around a Procardia (nifedipine) gel-tab capsule in case of a hypertensive crisis. One can bite into the capsule and release the liquid, and then swirl it under their tongue (sublingually).
Please wait to get more feedback.
- Scott
-----------------------------------------------------------
Coffee is O.K.
Excerpt from the MAO Diet link that can be found on Dr. Bob's Main Page:-=Foods with Insufficient Evidence for Restriction=-
More than 200 foods contain tyramine in small quantities and have been implicated in reactions with MAOI therapy. However, the majority of the previous reactions were due to the consumption of spoiled food. Evidence does not support the restriction of the following foods listed if the food is fresh (McCabe, 1986).
+ Anchovies
+ Beetroot
+ Chips with vinegar
+ Coca Cola(r)
+ Cockles+ Coffee
+ Corn, sweet
+ Cottage cheese
+ Cream cheese
+ Cucumbers
+ Egg, boiled
+ Figs, canned
+ Fish, canned
+ Junket
+ Mushrooms
+ Pineapple, fresh
+ Raisins
+ Salad dressings
+ Snails
+ Tomato juice
+ Wild game
+ Worcestershire sauce-----------------------------------------------------------
Posted by Lisamac on November 6, 2000, at 21:58:37
In reply to Re: Parnate and Caffeine - restricted? FATIGUE! » SLS, posted by Tori on November 5, 2000, at 9:45:05
> > While taking Parnate, I was counseled to drink caffeinated coffee to help raise blood pressure during the BP lull that occurs around 4:00pm. I don't know how long you have been on Nardil, but I found that postural hypotension got better with time. I just don't know if it would be by enough to help you.
>
> I have been on Parnate now for almost two months; augmented with Lamictal 150 mg bid (thavee been taking since late February). I'm treatment-resistant and have been on almost every single med since the invention of Prozac. The Parnate causes massive insomnia and finaly I am am taking 20 mg bid at 7 and 11 a.m. which helps but I have to fight, fight like hell, to stay awake after work until at least 10:00 PM and be up at 6. I went to bed at 5 this morning; woke up at 6:30 a.m. (hence my surfing on psychobabble). I had fallen asleep on the couch earlier for an hour and a half, that's how badly my sleep schedule gets screwed if I fall asleep during the day.
>
> Does the _hypo_tension cause the incredible lethargy and sleepiness? I have NOT lost weight on this drug, have NOT been stimulated by it, only have noticed a welcomed increased my cognitive functions (short-term memory, troubleshooting skills at my job (systems tech), can remember names of items; would forget total conversations)....and an increased in inerests in life, hobbies, plus it keeps me from getting suicidal, which is good as the holidays are coming and being three years without mom (background: she died in 1997 from pancreatic cancer at the age of 40) has been horrific around christmas; I hope this year is different.
>
> I have been DYING for a cup of coffee; I am extremely fatigued during the day, I mean I'm atually nodding off during the morning. Even when I work out at 7 am. doing cardio the energy boost lasts an hour but that's that. I nod off at my desk and when I get home I'm ndding off on the couch and will fall asleep immediately should I close my eyes.
>
> QUESTION- > Caffeine is on the food restrictions list for Parnate. I frequently (well, for me every ttwo weeks is enough for me) go hypertensive out of the blue - 170/110, etc, after usualy being HYPO at 80/60 - not because of something I ate or meds I took, just out of the blue (smoking?).
>
> I had a cup of decaf the other day and it didn't bother me.
>
> Anybody else out there able to take caffeine? Should I slowly start with a small cup to see what it causes, then if all hell breaks loose take my Adalat to reduce the BP?
>
> I hope I get a response on this as I am so fatigued it's incredible. When I drive home from work I freeze my butt off with all the windows open to stay awake and refreshed.
>
> :-) ToriHi Tori,
I am on Parnate and take my all my doses with coffee . I also drink cokes all day. My Dr. gave me Xanax to take at night to sleep, after I complained about not being able to sleep. It sure helps me!!! (I also used to have panic attacks, and the Xanax at night has improved this 98%)
Best of luck to you.
Lisa
Posted by Judy on November 8, 2000, at 11:52:27
In reply to Re: Parnate and Caffeine - restricted? FATIGUE! » SLS, posted by Tori on November 5, 2000, at 9:45:05
Hi Tori - As Scott said, coffee seems to be one of those 'in moderation' foods/beverages on the MAOI diet. What I wanted to add was that I'm not sure chewing coffee beans right off the tree is going to help with your fatigue during the day - at least that was my experience. On the plus side, I also experienced that more at the beginning than I do now (and it was also much worse for me when I took Nardil, but the way.)
Nobody can appreciate what that fatigue is like is they haven't been there. I have fallen asleep sitting straight up at my desk, I've nodded off a couple of times at a conference table full of people when there was a lull in the conversation AND twice I've fallen asleep while driving my 50-mile commute home. (I too always had the windows wide open, the radio blasting and I had bruises on my legs from pinching myself to try to stay awake at the wheel). Oddly, I always knew when the lethargy was about to strike because my leg would start moving rhythmically as if I were rocking myself to sleep, and my left eye would start to close (only the left one) - strange?
You might want to check with your doctor and see if the lamictal is adding to the somnolence. If so, maybe there's a way you could retime your doses to capitalize on that fatigue when it's bedtime. I wish I had something more helpful to add other than 'been there, done that, know how awful it is.'
Judy
Posted by anita on November 8, 2000, at 18:59:17
In reply to Running and Nardil, posted by Barbariana on November 2, 2000, at 21:07:12
Hi,
I don't know if it would be good for running, but when I had severe orthostatic hypotension from Nardil, a drug called Florinef completely eliminated the problem w/ no side effects. Perhaps you can ask your doc about it...
anita
> Hello,
> I have a question involving running.
>
> Since upping my dose of Nardil from 15mg to 45 a few months back,
> which helped my mood
> immensely, I've had some
> orthostatic hypotension in bearable amounts. What's
> less bearable is a version of the problem I get when
> running. Apparently running involves blood pressure
> changes that Nardil is slowing down. When I start up,
> I have to go very slowly
> for a few minutes while my muscles feel (bad)like they're
> getting no blood. Then, even after I've been going
> fo a while, I can't speed up at a decent acceleration
> without starting to blackout. I realize that there
> is the obvious solution of changing speed only very
> slowly, and that this isn't the worst price to pay for
> depression relief. BUT. I really like to race which
> usually means starting from a dead halt, and involves doing
> mixed speed running for training. So I'm wondering
> if anyone has any ideas or experience with this because
> I really don't want to stop training/competing until
> it is feasible to endure a medication switch (~4mo).
> I'm going to try
> gradually going down to 45/30 & to 30 which is up to
> me although (world's least athletic) Dr.
> is advising against.
>
> In any case, thanks for reading my tale of minor woe.
> Sincerely,
> B
Posted by Tori on November 15, 2000, at 1:27:12
In reply to Re: Parnate and Caffeine - restricted? FATIGUE! » Tori, posted by SLS on November 6, 2000, at 17:42:29
>
> > I have been on Parnate now for almost two months; augmented with Lamictal 150 mg bid (thavee been taking since late February).
>
> 450mg of Lamictal for the treatment of bipolar depression is very high. < < snipped > >I'm only on 300 mg a day and have been since late February, not 450.
> I think it is critical that you take medication to get some sleep, even if you don't use it every day. I would first look into trying trazodone (Desyrel). < < snipped > >
I'm allergic to trazodone and found out the bad way -- thunderclap headaches -- not fun!
> I would also not hesitate to use a benzodiazepine (Halcion, Ativan, Restoril) or one of the newer drugs (Ambien, Sonata).
I have a high tolerance for meds and become easily addicted to benzos where I have to take a higher dosage to get the same effect. I stopped the Restoril; tried Zoplicone (didn't work); right now I'm at a lower dosage of Parnate (see my post near the end), 20 mg, and it has changed things -- although I am drowsy during the evening as long as I stay awake I can sleep through the night, most of the time without the 6 to 10 mg of clonazepam.
> Caffeine is one of those foods that is of questionable significance. The NIH let me drink regular coffee while I was taking an MAOI that is much more potent than Parnate. However, Parnate is somewhat amphetamine-like. You may find that caffeine makes you feel nervous and otherwise uncomfortable. It doesn't for me.
Maybe I should try a half a cup at first to see if it causes any problems. I normally didn't drink coffee that much but the urge now is pretty bad.
> > I frequently (well, for me every ttwo weeks is enough for me) go hypertensive out of the blue - 170/110, etc, after usualy being HYPO at 80/60 - not because of something I ate or meds I took, just out of the blue (smoking?).
> Parnate is known to be capable of this. I don't know if smoking would trigger the event. How do you know when you are hypertensive for you to take your blood pressure?My throat/chest feels extremely tight; or I will develop a sudden intense headache.
> I think you would be better off taking 20mg in the morning, 10mg at noon, and 10mg at 3:00pm.
Now I'm at 20@ 6 a.m., from 40 originally. I hope that if it works at this dose that I will stay with it, in conjunction with my psychiatrists visits, to get better.
> > Anybody else out there able to take caffeine? Should I slowly start with a small cup to see what it causes, then if all hell breaks loose take my Adalat to reduce the BP?
>
> What is Adalat?Adalat is a anti-hypertensive drug - I'm in Canada so maybe it's under a different name elsewhere. 30 to 60 mg usually works as needed.
The food restrictions list you supplied was 14 years old; I have been consulting more recent lists; even items that are deemed OK cause hypertension in me. So pretty much my diet is bland, but I'm losing weight now! :-)
Thanks Scott :-)
Posted by Tori on November 15, 2000, at 1:30:13
In reply to Re: Parnate and Caffeine - restricted? FATIGUE!, posted by Judy on November 8, 2000, at 11:52:27
Hi Judy,
your post makes a lot of sense ... I will look into the Lamictal to see if it is aggravating the symptoms. Thanks!
> Hi Tori - < < snipped > >
> You might want to check with your doctor and see if the lamictal is adding to the somnolence. If so, maybe there's a way you could retime your doses to capitalize on that fatigue when it's bedtime. I wish I had something more helpful to add other than 'been there, done that, know how awful it is.'
>
> Judy
This is the end of the thread.
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