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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Jumpy on January 22, 2003, at 13:22:40
Hey Jon,
I read your posts often and recall you see the "almight" Dr Liebowitz in NY .... known to be an anxiety expert. I would love to see him, but definately can not afford even one session. My question is ...
Does he still feel nardil is the most potent medication for depression with severe anxiety? Or has been able to get the same results with other combinations?
Thanks in advance
Jumpy
Posted by JonW on January 22, 2003, at 17:52:05
In reply to JonW: Question for You, posted by Jumpy on January 22, 2003, at 13:22:40
> Does he still feel nardil is the most potent medication for depression with severe anxiety? Or has been able to get the same results with other combinations?
Hi Jumpy,
He definitely feels Nardil is the most potent for social anxiety, but I'm not sure if he would say that about other forms of anxiety or not. It's my understanding that Nardil is very effective for Atypical Depression, SP, and Panic, but less effective for GAD. So I suppose it depends on what you mean by severe anxiety. To answer your second question, I'll say the following. He had me on Nardil for some time. It was effective, but I couldn't tolerate it. He's been able to give me the same results with a combination of newer meds and CBT. Actually, I would say even better results, but it wasn't a full trial of Nardil so... I'm sure you've heard it before, but there are many meds and combinations of meds to try so I wouldn't automatically assume that Nardil is the only answer to a given set of problems. I know it's a miracle drug for many, and when I asked Dr. Liebowitz about it over the phone once, he called it "special". If you read my posts I must sound like a broken record, but you should definitely consider combining a med that is atleast somewhat helpful with CBT. This combination can be a very real alternative to Nardil. It may even be superior to Nardil alone. Some people respond to medication alone, but most with severe illness (particularly if you have severe anxiety) fair best with a combination of medication and CBT. It's the best of both worlds. If you do live near NYC, you might want to consider the therapist Dr. L works with, Carla Daichman, as an adjunct to your current treatment. She's a lot more affordable but still not cheap($145), but she's definitely one of the best at what she does. Who knows, this might allow you to negotiate a more affordable rate with Dr. L. Just some thoughts... Unfortunately, you get what you pay for in this business and in my case it's made all the difference in the world. If there's any way you could afford Liebowitz or someone more affordable he might refer you to, definitely spend the money. When you're talking about your life, it's worth it. For 24 years, I never dreamed life could be this good and I'm still climbing. Dr. Liebowitz and Carla Daichman working together on my behalf has saved my life. Wow, I've kind of rambled off topic a bit.... oh well, good luck with everything, and if I can answer any more questions or be of any help in any way let me know.
Jon
Posted by Jumpy on January 22, 2003, at 18:07:14
In reply to Re: JonW: Question for You » Jumpy, posted by JonW on January 22, 2003, at 17:52:05
If you do live near NYC, you might want to consider the therapist Dr. L works with, Carla Daichman, as an adjunct to your current treatment. She's a lot more affordable but still not cheap($145), but she's definitely one of the best at what she does. Who knows, this might allow you to negotiate a more affordable rate with Dr. L.
Hey Jon,
Thanks a million ... I know my first pdoc was very good a CBT, and it helped alot. He had me examining the my "illogical" thoughts and ideas. He really had me thinking more positive and functionally ... instead of persistantly worrying and obsessing.
Two more questions if possible ...
What about Nardil couldn't you "not tolerate"? What other medications does Dr. L. advocate for anxiety?Thanks again,
Jumpy
PS I have panic disorder, generalized anxiety disorder, agoraphobia, and depression
Posted by JonW on January 22, 2003, at 22:24:34
In reply to 2 more Questions .... Thank You! » JonW, posted by Jumpy on January 22, 2003, at 18:07:14
> Two more questions if possible ...
> What about Nardil couldn't you "not tolerate"? What other medications does Dr. L. advocate for anxiety?Well, for one, the sexual side-effects were very frustrating -- complete impotence, anorgasmia, and increased libido just for shits and giggles. Dry mouth almost to the point where I couldn't swallow without water. Memory problems -- I told Dr. Liebowitz that Nardil made me forget my checkbook at one of our appointments... kind of funny how he agreed to change my prescription soon after that :) It's hard to explain, but it also made me breathe really heavy while I was at rest, kind of like I was really overweight but I'm not. The biggest problem of all was insomnia. We tried countless things and combinations of things to put me to sleep, but nothing worked. I initially was of the mindset that Nardil would have to be vastly superior to the SSRIs for me to put up with the restrictions and once I encountered all these side-effects it was a fairly easy decision to make to stop it. I've heard it said here that the side-effects take a long time to go away, but I just couldn't take it anymore after 10 weeks. I don't want to sound like I'm discouraging anyone from taking Nardil, but one thing to consider is the withdrawal if it doesn't work. I've been on Nearly all of the ADs and I never experienced withdrawal as bad as with Nardil. It's also frustrating to have to wait 2 weeks before and after it. All things to consider. Dr. Liebowitz is treating me for SP among other things so all I can say is what he thinks of meds for SP. I've gotten the impression that he likes Paxil, Zoloft, Klonopin, Nardil, and Neurontin best. Klonopin + an SSRI might be worth a try for you. It sounds like Nardil might suit you very well, though. If you've tried several other meds without success and are comfortable with the restrictions I would definitely recommend you talk with your pdoc about Nardil. Some people tolerate it OK, so don't let me scare you with the side-effects I experienced. You don't know until you try, but make sure you are ready to dive in. You have to consider the washout period before and after, possible withdrawal when you stop it (I tapered very slow and still had severe symptoms), and obviously the restrictions. If your pdoc does prescribe Nardil, make sure he also prescribes some nifedipine (sp?) to take in the event of a hypertensive crisis and I would purchase a blood pressure monitor from your pharmacy for peace of mind. This is nice to have in the begining and when you may have accidently eaten a forbidden food, etc. You would really have to ask Dr. L himself for his answer to your question, and you might want to do that. You can get his email from the NYSPI website. I'll paste the link to that site below:
http://www.nyspi.cpmc.columbia.edu/
Hang in there,
Jon
Posted by JonW on January 22, 2003, at 22:34:30
In reply to JonW: Question for You, posted by Jumpy on January 22, 2003, at 13:22:40
The med combo Dr. L prescribed after I stopped Nardil was Zoloft + High-dose Neurontin (I was also on depakote). You may want to consider this, but I don't think anything is really a replacement for Nardil. He said Zoloft was the closest SSRI to Nardil, I assume because of its effect on several neurotransmitters. It's also the most potent SSRI. He seemed to imply that Zoloft + Neurontin is a reasonable attempt at an alternative to Nardil. Anyway...
Jon
Posted by Ritch on January 23, 2003, at 0:03:09
In reply to Additional thought..., posted by JonW on January 22, 2003, at 22:34:30
> The med combo Dr. L prescribed after I stopped Nardil was Zoloft + High-dose Neurontin (I was also on depakote). You may want to consider this, but I don't think anything is really a replacement for Nardil. He said Zoloft was the closest SSRI to Nardil, I assume because of its effect on several neurotransmitters. It's also the most potent SSRI. He seemed to imply that Zoloft + Neurontin is a reasonable attempt at an alternative to Nardil. Anyway...
>
> JonHi Jon, what does your pdoc think about sibutramine? Just curious since it blocks the reuptake pumps fairly strongly for NE, 5-HT, and DA. The major metabolite for sibutramine is in clinical trials now for ADHD. I got decent response from Zoloft (+Neurontin/Klonopin) in the past..(pdoc goes: "this is the best I have seen you"), but I can't hack the nausea/diarrhea, restless legs, and sleep disruption, and hypomania of Zoloft (probably)due to its metabolite O-desmethyl-sertraline (ODV). What I am wondering about is a trial of sibutramine with Neurontin+Klonopin+Depakote... Mitch
Posted by Jumpy on January 23, 2003, at 14:05:53
In reply to Re: 2 more Questions .... Thank You! » Jumpy, posted by JonW on January 22, 2003, at 22:24:34
> Well, for one, the sexual side-effects were very frustrating -- complete impotence, anorgasmia, and increased libido just for shits and giggles. Dry mouth almost to the point where I couldn't swallow without water. Memory problems -- I told Dr. Liebowitz that Nardil made me forget my checkbook at one of our appointments... kind of funny how he agreed to change my prescription soon after that :) It's hard to explain, but it also made me breathe really heavy while I was at rest, kind of like I was really overweight but I'm not. The biggest problem of all was insomnia.
Hey Jon,
Thank you so much. I have had the same exact side effects with nardil ... sexual problems, insomnia, memory problems and yes "heavy breathing" too! Add in the weight gain, feet swelling as well. Well, I have been on virtually all the ADs, several mood stablizers, klonopin and ECT. Neurontin + klonopin + selegiline worked pretty well .... but my anxiety is sooooo bad that even 50 to 60% improvement is non functional for me. ECT worked, by I think I would need monthly maintenance for it to stick and the memory loss would be too much.
So I guess Nardil is it for me. As I alway say, back to being "fat, dumb and impotent."
Thanks again.
Jumpy
Posted by BekkaH on January 23, 2003, at 21:36:25
In reply to Re: JonW: Question for You » Jumpy, posted by JonW on January 22, 2003, at 17:52:05
Hi JonW,
Is Carla Daichman an M.D.? If not, what is her training? I was interested to see that you go to Dr. Liebowitz. I was told that if you get an appointment with one of the big names at Columbia (like Liebowitz, Klein or Quitkin), you get one very expensive consultation, and then they farm you out to one of their trainees, who are often still wet behind the ears. I am glad to see that I was misinformed.
Bekka
Posted by JonW on January 25, 2003, at 0:57:04
In reply to Re: JonW: Question for You - JonW, posted by BekkaH on January 23, 2003, at 21:36:25
> Is Carla Daichman an M.D.? If not, what is her training? I was interested to see that you go to Dr. Liebowitz. I was told that if you get an appointment with one of the big names at Columbia (like Liebowitz, Klein or Quitkin), you get one very expensive consultation, and then they farm you out to one of their trainees, who are often still wet behind the ears. I am glad to see that I was misinformed.
Hi Bekka,
I don't know the details of her background, but I believe she's a social worker and among other things has trained under Richard Heimberg from Temple. Dr. Liebowitz has a lot of respect for her, and that's a pretty big compliment. I highly recommend both of them.
Jon
This is the end of the thread.
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