![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by mattdds on January 20, 2004, at 13:57:58
Hey all,
Well the subject line pretty much says it all.
I'm tolerating 60 mg like a champ. No orthostatic hypotension...just a little sedation and, of course, the sexual difficulties. The cognitive dysfunction is rapidly going away, as predicted. I can walk and speak again.
Here are some questions perhaps some of you veterans can answer:
1. When Nardil "kicks in", is it easily noticed? Or is it kinda subtle?
2. Is it common for 60 mg to do the trick? Or are higher doses needed?
3. How long? I titrated up to 60 over a couple of weeks? Do I need to be at the 60 for a full 4 weeks?
I'm already noticing some good effects, possibly the strongest antidepressant response I've ever felt (then again, that's not saying much). But it looks promising! I'm just wondering if I'll likely see a real sledgehammer-like "kick in"? Or will it creep up on me?
Thanks in advance,
Matt
Posted by gardenergirl on January 21, 2004, at 7:01:25
In reply to Ideal Nardil Dose Range? Nardil Veterans?, posted by mattdds on January 20, 2004, at 13:57:58
Matt,
Glad to hear that the SE's have abated. I'm still waiting for my mail delivery before I go up to 60 as I don't want to run out if I start now. But I have a really big thing to do tomorrow, my clinical competency oral exam. I was wondering if taking an extra would help or hurt, or do nothing? What was your experinece the first day at 60?Also, do you take one q six hours or two tabs bid?
Regards,
gg
Posted by mattdds on January 21, 2004, at 13:04:33
In reply to Re: Ideal Nardil Dose Range? Nardil Veterans?, posted by gardenergirl on January 21, 2004, at 7:01:25
Hey GG,
>>I was wondering if taking an extra would help or hurt, or do nothing?
Most likely would have no effect. I doubt even more that it would *help* any - most of the time you have to be at the *new* dose 2-3 weeks before you see any additional effects. MAOI's can even take longer.
If it were me, I would wait until the day after your competency to raise your dose. No need to hurry. There is more potential for harm (e.g. sedation or orthostatic hypotension) than good, IMO.
Are you nervous about the competency? Maybe if you have access to a benzo? Klonopin is my mainstay, and has never failed me for events like that. However, they can be rather sedating until you get used to them.
>>What was your experinece the first day at 60?
Not really much different than the day before, surprisingly. I had heard that 60 mg was a threshold of sorts for side effects. That has *not* been the case for me. I went up pretty seamlessly.
>>Also, do you take one q six hours or two tabs bid?
I take 1 tab qid, but not evenly spaced out. Probably closer to 1 every 3-4 hours while awake. I'm kinda nervous to take 2 at once...had a bad experience when I did that with Parnate - namely, that my BP would spike (not food related).
Good luck with your competency! I know how stressful those can be.
Best,
Matt
Posted by gardenergirl on January 21, 2004, at 13:49:58
In reply to Raising the dose » gardenergirl, posted by mattdds on January 21, 2004, at 13:04:33
Thanks Matt,
I figured you would understand about the exam. I'm sure you have had to go through that as well. (I'll avoid making a bad pun about oral exams and dentristy.)I was guessing that upping it now wouldn't help other than perhaps a placebo effect. But I think the chance of SE's is not worth the risk. I don't have access to benzo's, although my doc offered last time I was in. It just didn't feel right.
My nerves about this are more self-doubts and the fear of rejection which would come with failure. I'm not sure there is a pill that can help me with that. I'm taking a lot of CBT-related advice, though, with reframing the situation, relaxation, postitive self-talk, and rehearsal.
I actually feel pretty competent when I am with my clients. It's just the authority figures "judging" me that triggers all kinds of stuff.
I am planning to go qid as well with my tabs. I try to evenly space out my three right now, but I am not always successful as I don't get up early to take the meds on days I can sleep in and I sometimes and late with the afternoon one. Wouldn't it be great if they would come up with an XR for Nardil? Never happen, of course, but we can dream....
Thanks for the advice and support! Hoping you continue to have positive experience as well.
gg
Posted by mattdds on January 22, 2004, at 0:43:05
In reply to Re: Raising the dose, posted by gardenergirl on January 21, 2004, at 13:49:58
Hey gg,
> My nerves about this are more self-doubts and the fear of rejection which would come with failure. I'm not sure there is a pill that can help me with that. I'm taking a lot of CBT-related advice, though, with reframing the situation, relaxation, postitive self-talk, and rehearsal.
>Kudos! You're right about there not being a pill for this sort of thing, at least not a silver bullet type pill. I'm sure you'll do extremely well on your competency, sounds like you're doing all the right things to prepare.
> I actually feel pretty competent when I am with my clients. It's just the authority figures "judging" me that triggers all kinds of stuff.
I can totally relate, when I am alone with patients, my hands work beautifully - then the dental faculty with 30 years experience comes around and I all of a sudden develop pseudo-Parkinson's!
> I am planning to go qid as well with my tabs.
I get the feeling that 60 mg is a good trial. And yeah, it's good to space them out.
I really want that ace-like euphoria! Actually, I'd settle for much less. These are stressful times for me.
> Thanks for the advice and support! Hoping you continue to have positive experience as well.
Likewise! Best of luck to you on your exams. Do let me know how they go. Also, let's keep each other informed about this Nardil journey.
Take care,
Matt
Posted by gardenergirl on January 22, 2004, at 11:02:56
In reply to Re: Raising the dose » gardenergirl, posted by mattdds on January 22, 2004, at 0:43:05
Posted by jparsell82 on January 22, 2004, at 21:33:51
In reply to I passed! Even without additional meds. :) (nm), posted by gardenergirl on January 22, 2004, at 11:02:56
Is Nardil the only Maoi or Rima that has GABA activity? Also, what do you think about 45mg a day of Nardil... or do most people go with 60mg/day for SP? Would 45mg be a sufficient dosage for a 150-160lb person?
Note: I have social anxiety, generalized anxiety, ocd, add and depression.
Posted by gardenergirl on January 24, 2004, at 9:06:57
In reply to Nardil/Maoi questions, posted by jparsell82 on January 22, 2004, at 21:33:51
I didn't want your message to go unanswered, but frankly, I don't know about the GABA activity. I suppose I should given that I am on it. I take Nardil for atypical depression. I started at 45mg which is the recommended starting dose. I am going to 60 mg starting today for a trial, in hopes that it helps me in times of extra stress.
I've noticed that many on the board who use Nardil for SP seem to require a higher dose. 60mg is definitely reasonable, but there are some who require more to get the most benefit.
Sorry I couldn't help more,
gg
Posted by mattdds on January 25, 2004, at 12:06:21
In reply to Nardil/Maoi questions, posted by jparsell82 on January 22, 2004, at 21:33:51
Hi,
> Is Nardil the only Maoi or Rima that has GABA activity?
The GABA activity comes from the inhibition of of an enzyme called GABA transaminase, which is an enzyme that inactivates GABA. This enzyme being inactivated, GABA concentrations increase. It is not actually phenelzine, but an active metabolite of phenelzine that has this property.
Actually, one of ther other hydrazine derivatives, isocarboxazid (Marplan) also likely has GABAergic activity. Isocarboxazid is very similar to phenezline, and comes from the same family. called the hydrazines. Tranylcipromine (Parnate) does not inhibit GABA transaminase, but for some other reason *does* increase GABA concentrations in the brain.
So, in short. They all do, but perhaps Parnate does it a bit differently.
>>Also, what do you think about 45mg a day of Nardil... or do most people go with 60mg/day for SP? Would 45mg be a sufficient dosage for a 150-160lb person?In the case of Nardil the dose is not really related to weight. It is more dependent on things that are at this time unmeasurable (e.g. liver enzymes that break down the drug, etc.). The process is largely trial and error. 45 mg is a good starting dose, from what I understand. This is the starting dose listed in the PDR.
> Note: I have social anxiety, generalized anxiety, ocd, add and depression.Barring possibly the ADD, these are all indications for which Nardil is purportedly very effective, particularly social anxiety and depression.
I'm currently on 60 mg of Nardil, and starting to see some effects.
Good luck!
Matt
Posted by mattdds on January 25, 2004, at 12:09:11
In reply to I passed! Even without additional meds. :) (nm), posted by gardenergirl on January 22, 2004, at 11:02:56
Posted by jparsell82 on January 25, 2004, at 12:23:40
In reply to I knew you'd do well on your exam, congrats!!! (nm) » gardenergirl, posted by mattdds on January 25, 2004, at 12:09:11
Posted by gardenergirl on January 26, 2004, at 4:56:05
In reply to Re: Nardil/Maoi questions » jparsell82, posted by mattdds on January 25, 2004, at 12:06:21
Posted by gardenergirl on January 27, 2004, at 7:21:27
In reply to Thanks Matt, started 60 yesterday, will update (nm), posted by gardenergirl on January 26, 2004, at 4:56:05
So far feeling okay, but a little orthostatic hypotension. I seem to recall that at the beginning of 45mg, so I'm not worried. Also, I had some caffeine yesterday morning, and that was a mistake. I don't drink much at all, and with the added Nardil, I felt really jittery.
Regards,
gg
Posted by Jasmine on January 27, 2004, at 11:01:15
In reply to Day 2 at 60mg Nardil, posted by gardenergirl on January 27, 2004, at 7:21:27
Hey gg,
I'm glad it's going good on 60mg so far. I too found the orthostatic hypotension to be a bit more noticable than on 45mg, but now it's pretty much gone unless I jump out of bed in a rush when I realize I've slept through my alarm. I suppose it's just a way of my body reminding me to take it easy.BTW, thank you so much for responding to my post about urinary retention. You're my lifesaver!! :) I used your little "push and blow" method and it worked!! No more spending 10 minutes in the bathroom for me. Haha! This sounds like an odd conversation doesn't it? :P
Anyway, keep us all posted on how everything goes with your new dose. I may not have been on it as long as some people around here, but I'm always willing to help out if I can :) Take care!
Jasmine @>-->--
Posted by gardenergirl on January 27, 2004, at 13:03:05
In reply to Re: Day 2 at 60mg Nardil » gardenergirl, posted by Jasmine on January 27, 2004, at 11:01:15
Posted by gardenergirl on January 29, 2004, at 23:35:17
In reply to Day 2 at 60mg Nardil, posted by gardenergirl on January 27, 2004, at 7:21:27
Well, feeling pretty good and the orthostatic hypotension seems okay. I'm trying not to hop right out of bed without sitting upright for a bit. But I'm not staggering like I am drunk like I did last time at 45mg.
It's so nice to have the old, goofy me back. My colleagues wonder where the goofy sense of humor came from as they have not seen it before, but they'll get used to it.
Happiness! What a rush. It's been way too long.
gg
Posted by Questionmark on January 30, 2004, at 13:30:19
In reply to Nardil/Maoi questions, posted by jparsell82 on January 22, 2004, at 21:33:51
> Is Nardil the only Maoi or Rima that has GABA activity? Also, what do you think about 45mg a day of Nardil... or do most people go with 60mg/day for SP? Would 45mg be a sufficient dosage for a 150-160lb person?
>
> Note: I have social anxiety, generalized anxiety, ocd, add and depression.i have all your problems except GAD (& OCPD rather than OCD) and Nardil has been an extraordinary, miraculous help to me. i also weigh about the same as you if that means anything (~150 lbs). For me 45mg was definitely a satisfactory dosage-- it cut out so much anxiety, eased so much of my obsessive sh*t, and turned my chronically severe, quasi-suicidal depression into still negative but more-able-to-be-reasonable-and-have-some-hope dysthymia-- if that. 60mg is what really seems to appropriately alleviate my self-deprication and "inferiority complex" and especially make a difference in things, but 45mg certainly makes life livable-- and oftentimes even enjoyable (which was quite a novel experience, let me tell you). ah i'm rambling again, sorry.
Also 60mg is when all the side effects started to become a real pain in the *** (anticholinergic effects and anorgasmia), although even at 45 the anorgasmia is still annoying as sh*t. It does seem, however, that most people need-- or aren't satisfied until-- they stay at 60mg. Not sure though.i have never read or heard of any other MAO inhibiting compound that increases GABA levels/activity besides phenelzine (Nardil). Maybe isocarboxazid (Marplan) would somewhat, as Mattdds said, since they are such similar drugs, but i've never read that. And i'm especially skeptical that tranylcypromine (Parnate) does. Do you anything to back this up Matt (not saying you're lying i think you just might be mistaken though)?
Anyway, i hope Nardil blesses you and everyone else on this board taking it as much as it has me (and Ace, and all the rest). Best wishes.
Posted by jparsell82 on January 30, 2004, at 16:57:05
In reply to Re: Nardil/Maoi questions, posted by Questionmark on January 30, 2004, at 13:30:19
> > Is Nardil the only Maoi or Rima that has GABA activity? Also, what do you think about 45mg a day of Nardil... or do most people go with 60mg/day for SP? Would 45mg be a sufficient dosage for a 150-160lb person?
> >
> > Note: I have social anxiety, generalized anxiety, ocd, add and depression.
>
> i have all your problems except GAD (& OCPD rather than OCD) and Nardil has been an extraordinary, miraculous help to me. i also weigh about the same as you if that means anything (~150 lbs). For me 45mg was definitely a satisfactory dosage-- it cut out so much anxiety, eased so much of my obsessive sh*t, and turned my chronically severe, quasi-suicidal depression into still negative but more-able-to-be-reasonable-and-have-some-hope dysthymia-- if that. 60mg is what really seems to appropriately alleviate my self-deprication and "inferiority complex" and especially make a difference in things, but 45mg certainly makes life livable-- and oftentimes even enjoyable (which was quite a novel experience, let me tell you). ah i'm rambling again, sorry.
> Also 60mg is when all the side effects started to become a real pain in the *** (anticholinergic effects and anorgasmia), although even at 45 the anorgasmia is still annoying as sh*t. It does seem, however, that most people need-- or aren't satisfied until-- they stay at 60mg. Not sure though.
>
> i have never read or heard of any other MAO inhibiting compound that increases GABA levels/activity besides phenelzine (Nardil). Maybe isocarboxazid (Marplan) would somewhat, as Mattdds said, since they are such similar drugs, but i've never read that. And i'm especially skeptical that tranylcypromine (Parnate) does. Do you anything to back this up Matt (not saying you're lying i think you just might be mistaken though)?
> Anyway, i hope Nardil blesses you and everyone else on this board taking it as much as it has me (and Ace, and all the rest). Best wishes.Hey, thanks for the information. I'm a little unsure about my OCD, it could be OCPD or an obsessive thinking disorder... not sure. I frequently daydream and get thoughts stuck in my head, having trouble shifting attention. Anyways though, I think I'm actually going to try moclobemide(Manerix) first. It won't have the anti-cholinergic side effects and supposedly it's helpful for attention too. I think most people who give moclobemide a trial don't use a high enough dosage and for a long enough time. Doses for Social Phobia are supposed to be 600-900mg and it's recommended to keep with it for atleast 12 weeks. There was a study I read that showed moclobemide becoming most effective after 8 weeks. Plus I think it's pretty similar to Nardil minus the Gaba activity. If Manerix doesn't work, then I guess I'll be next to give Nardil a try. I'm almost positive Nardil would work for me but I'm not ready for the cognitive side effects... does it make your attention worse? Thanks again,
Josh
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.