![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 29. Go back in thread:
Posted by Tomatheus on December 2, 2005, at 19:02:37
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by ace on December 2, 2005, at 9:19:20
> All I can say is you should have been up to 90mg at the 6 week mark. Increase dose to 90mg NOW!!!!
Ace,
I think I'll consider increasing the dose to 90mg if and when I get a poor response at 75mg/day. Some patients respond to Nardil at 60mg/day, others require 75mg/day, and yes, some (like yourself) find that the best dose is 90mg/day. But, with all due respect Mr. Nardil champ, the best dose for you is not necessarily the best dose for everyone. I don't think that it would be a good idea to just jump straight up to 90mg/day without first trying 75mg/day. There's no reason to take extra (and spend extra) if I don't need to.
And (once again with all due respect), don't you think your response was a little demanding. I've read in other posts that you've said that you're planning on becoming a psychiatrist. I don't know if saying things such as "increase dose to 90mg NOW!!!!" would make for good relations with your patients. Then again, it seems like such an approach is really not so far outside the norm in psychiatry. Hmmm. Maybe you would be well-suited for the profession, after all.
Tomatheus
Posted by Jedi on December 3, 2005, at 4:01:23
In reply to Re: Nardil update: Still hasn't kicked in » Jedi, posted by Tomatheus on December 2, 2005, at 18:44:05
Tomatheus,
Here are a few recent abstracts on phenelzine therapy of atypical depression, social anxiety, and dysthymia.
JediPharmacological treatment of social anxiety disorder: a meta-analysis.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12900950&query_hl=8Phenelzine efficacy in refractory social anxiety disorder: a case series.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12888407&query_hl=8Atypical Depression: A Reappraisal (Full Study)
http://ajp.psychiatryonline.org/cgi/content/full/159/9/1470Chronic treatment with the monoamine oxidase inhibitor phenelzine increases hypothalamic-pituitary-adrenocortical activity in male C57BL/6 mice: relevance to atypical depression.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15564336&query_hl=12Modafinil Augmentation of Phenelzine for Residual Fatigue in Dysthymia
http://ajp.psychiatryonline.org/cgi/content/full/161/9/1716-a
Posted by Tomatheus on December 3, 2005, at 9:19:59
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by Jedi on December 3, 2005, at 4:01:23
Thanks!
I think I already have one of the studies that you posted, but I'll definitely take a look at the rest of them.
Tomatheus
Posted by ed_uk on December 3, 2005, at 14:25:39
In reply to Nardil update: Still hasn't kicked in, posted by Tomatheus on December 1, 2005, at 9:49:48
Hi T
>Do you think that there's still a realistic chance that it might kick in at this dose?
I don't think it's likely. 5 1/2 weeks is plenty of time to assess your response to 60mg, especially as you've been on Nardil for a total of nine weeks.
>Paxil........hypomania.......cycling
>negative kind of energy.Given the possibility that you may lie on the 'bipolar spectrum', it might be a good idea to try 67.5mg for a few weeks before increasing to 75mg (if necessary). I think it would be best to see your pdoc regularly as you increase the dose.
>mood stabilisers
How do you respond to.......
Lamictal?
Lithium?
Abilify?>Are there any Nardil users who didn't get the "kick in" feeling at 60mg, but did at a higher dose?
Certainly. Many people require higher doses than 60mg.
Kind regards
Ed
Posted by ace on December 4, 2005, at 7:32:30
In reply to Re: Nardil update: Still hasn't kicked in » ace, posted by Tomatheus on December 2, 2005, at 19:02:37
> > All I can say is you should have been up to 90mg at the 6 week mark. Increase dose to 90mg NOW!!!!
>
> Ace,
>
> I think I'll consider increasing the dose to 90mg if and when I get a poor response at 75mg/day. Some patients respond to Nardil at 60mg/day,
Clinical trials have shown if no response after 4 -6 weeks at 60mg, increase dose.others require 75mg/day, and yes, some (like yourself) find that the best dose is 90mg/day. But, with all due respect Mr. Nardil champ, the best dose for you is not necessarily the best dose for everyone.
Just about everyone.
I don't think that it would be a good idea to just jump straight up to 90mg/day without first trying 75mg/day.
Man, it's cool for you to do want you and your MD want, but I personally would go straight to 90mg for maximum MAOI inhibition.
There's no reason to take extra (and spend extra) if I don't need to.
>
> And (once again with all due respect), don't you think your response was a little demanding.No.
I've read in other posts that you've said that you're planning on becoming a psychiatrist.
I'm a register in 2 months. So I am not 'planning', I am 'being' a psychiatrist. Arent I so good!!! ha ha!!
I don't know if saying things such as "increase dose to 90mg NOW!!!!" would make for good relations with your patients.I would not say that in a excited or agressive tone, I would strongly reccommend it in a matter of a fact way. In my capacity as a member of psychobabble, I act in a way I would NEVER act with actual patients. You are not my patient. With patients I will be very warm and caring, but at the same time keep a healthy distance from them and be matter of fact about medications. But on this board I am just being my crazy self.
Then again, it seems like such an approach is really not so far outside the norm in psychiatry.
Yes it is. Not many doctors would say "INCREASE TO 90MG!!!!"
Hmmm. Maybe you would be well-suited for the profession, after all.You seem bitter about psychiatry, or psychiatrists? Am i right?
>
> Tomatheus
Posted by willyee on December 4, 2005, at 13:47:26
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by ace on December 4, 2005, at 7:32:30
Ace dont get me wrong but if ur a p doc it seems the ony med u believe really works is nardil,are you gonna be willing to precribe other meds.
Posted by ace on December 4, 2005, at 20:50:46
In reply to Re: Nardil update: Still hasn't kicked in, posted by willyee on December 4, 2005, at 13:47:26
> Ace dont get me wrong but if ur a p doc it seems the ony med u believe really works is nardil,are you gonna be willing to precribe other meds.
Oh yeah. But 90% are going to be the older meds. eg, TCA's, MAOIs, Lithium, etc etc Time has shown them to have greater efficacy than the newer meds.
One exception is the new antipsychotics.....I would always use them as first line as opposed to 1st generation agents.
But, I mean I would prescribe Nardil to everyone...especial Bi-polar patients. Also personality disorders, I'd be very careful.
Posted by ace on December 4, 2005, at 20:53:35
In reply to Re: Nardil update: Still hasn't kicked in, posted by willyee on December 4, 2005, at 13:47:26
> Ace dont get me wrong but if ur a p doc it seems the ony med u believe really works is nardil,are you gonna be willing to precribe other meds.
Oh also, I am very much a benzo fan -- in the RIGHT patient.
Posted by Tomatheus on December 4, 2005, at 21:05:08
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by ed_uk on December 3, 2005, at 14:25:39
Ed,
Thanks for your post. I appreciate your feedback.
Tomatheus
P.S., I sent you a Babble-mail.
Posted by Tomatheus on December 4, 2005, at 21:23:23
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by ace on December 4, 2005, at 7:32:30
Hi Ace,
Thanks for getting back to me. See my responses below.
>> others require 75mg/day, and yes, some (like yourself) find that the best dose is 90mg/day. But, with all due respect Mr. Nardil champ, the best dose for you is not necessarily the best dose for everyone.
>
> Just about everyone.
I'm still not convinced that you're right. Consider some of the other Nardil users on this board. Jedi seems to be responding well at 75mg, and I think I recall Gardenergirl saying that she was responding well at 60mg. And if I remember Tecknohed's posts correctly, I think he was also at 60mg, but I think he said that it was losing some of its effectiveness. So, I hate to bring the some-versus-most debate into this thread, but I'm not entirely convinced that "just about everyone" needs to be at 90mg/day.
> Man, it's cool for you to do want you and your MD want, but I personally would go straight to 90mg for maximum MAOI inhibition.
I guess I understand where you're coming from. I think my initial response was a little harsh. I do appreciate your suggestion and welcome you to give me more in the future.> I'm a register in 2 months. So I am not 'planning', I am 'being' a psychiatrist. Arent I so good!!! ha ha!!
That's good news, and I do mean it. Good luck.
> I would not say that in a excited or agressive tone, I would strongly reccommend it in a matter of a fact way. In my capacity as a member of psychobabble, I act in a way I would NEVER act with actual patients. You are not my patient. With patients I will be very warm and caring, but at the same time keep a healthy distance from them and be matter of fact about medications. But on this board I am just being my crazy self.Thanks for your explanation. Feel free to be your "crazy self" here as much as you want.
> Not many doctors would say "INCREASE TO 90MG!!!!"In all seriousness, you're probably right. But unfortunately, far too few pdocs even prescribe Nardil in the first place.
> You seem bitter about psychiatry, or psychiatrists? Am i right?
Partially. I do feel some bitterness at times, but then again, I definitely wouldn't say that I'm anti-psychiatry, either.
Keep rockin' Nardil champ.
Tomatheus
Posted by ace on December 4, 2005, at 21:58:00
In reply to Re: Nardil update: Still hasn't kicked in » ace, posted by Tomatheus on December 4, 2005, at 21:23:23
> Hi Ace,
>
> Thanks for getting back to me. See my responses below.
>
> >> others require 75mg/day, and yes, some (like yourself) find that the best dose is 90mg/day. But, with all due respect Mr. Nardil champ, the best dose for you is not necessarily the best dose for everyone.
> >
> > Just about everyone.
>
> I'm still not convinced that you're right. Consider some of the other Nardil users on this board. Jedi seems to be responding well at 75mg, and I think I recall Gardenergirl saying that she was responding well at 60mg. And if I remember Tecknohed's posts correctly, I think he was also at 60mg, but I think he said that it was losing some of its effectiveness. So, I hate to bring the some-versus-most debate into this thread, but I'm not entirely convinced that "just about everyone" needs to be at 90mg/day.
I actually got that info from an EXTREMELY academic MAOI paper and from personal experience and what I have seen. But sure, some people might need only 60mg. They sometimes recommend dose at 1mg/1kg body weight.>
> > Man, it's cool for you to do want you and your MD want, but I personally would go straight to 90mg for maximum MAOI inhibition.
>
> I guess I understand where you're coming from. I think my initial response was a little harsh.Thats OK!
I do appreciate your suggestion and welcome you to give me more in the future.
Sure!
>
> > I'm a register in 2 months. So I am not 'planning', I am 'being' a psychiatrist. Arent I so good!!! ha ha!!
>
> That's good news, and I do mean it. Good luck.Yeah, i have to prepare myself emotionally very much so. Psychiatry can be extremely taxing on ones emotion and everyone knows psychiatrists have a high suicide rate due to stress.
> > I would not say that in a excited or agressive tone, I would strongly reccommend it in a matter of a fact way. In my capacity as a member of psychobabble, I act in a way I would NEVER act with actual patients. You are not my patient. With patients I will be very warm and caring, but at the same time keep a healthy distance from them and be matter of fact about medications. But on this board I am just being my crazy self.
>
> Thanks for your explanation. Feel free to be your "crazy self" here as much as you want.
Cool dude!! No, I wont call my patients dude!!!!
>
> > Not many doctors would say "INCREASE TO 90MG!!!!"
>
> In all seriousness, you're probably right. But unfortunately, far too few pdocs even prescribe Nardil in the first place.It's a disgrace....throughout their training they are just bamboozled with the SSRI lie. So, hence thats what they believe. But I can see past the smoke and mirrors.
>
> > You seem bitter about psychiatry, or psychiatrists? Am i right?
>
> Partially. I do feel some bitterness at times, but then again, I definitely wouldn't say that I'm anti-psychiatry, either.They can be very rude and unethical. No doubt. They are just human. But if they are this way they shouldn't practice. I am determined to be very caring, warm and considerate to ALL patients -- even forensic ones who call me all nasty names!
>
> Keep rockin' Nardil champ.
>
> Tomatheus
Thanks man! I will!!!!!!!!!!Peace,
Ace, 2005.
Posted by gardenergirl on December 4, 2005, at 23:35:49
In reply to Re: Nardil update: Still hasn't kicked in » ace, posted by Tomatheus on December 4, 2005, at 21:23:23
>
...I think I recall Gardenergirl saying that she was responding well at 60mg.Just a bit to add...I could not tolerate 75 mg of Nardil. I got severe insomnia and akathisia. 67.5 seems to be the max for me, that I can tolerate. I think Lamictal kind of fills in the gap in my case as far as making it effective at 60 mg and sometimes even 45mg.
Hope you get a positive response soon.
gg
Posted by Tomatheus on December 5, 2005, at 0:05:41
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by gardenergirl on December 4, 2005, at 23:35:49
Posted by ace on December 5, 2005, at 6:53:40
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by gardenergirl on December 4, 2005, at 23:35:49
> >
> ...I think I recall Gardenergirl saying that she was responding well at 60mg.
>
> Just a bit to add...I could not tolerate 75 mg of Nardil. I got severe insomnia and akathisia.I cannot imagine how you possibly could have got akathisia from Nardil. There is NOTHING in the literature that states Nardil to cause akathisia. I have never heard from any Nardil user the word akathisia. Please describe your symptoms really clearly. May it have been intense anxiety?
67.5 seems to be the max for me, that I can tolerate. I think Lamictal kind of fills in the gap in my case as far as making it effective at 60 mg and sometimes even 45mg.
>
> Hope you get a positive response soon.
>
> gg
>
Posted by gardenergirl on December 5, 2005, at 14:19:11
In reply to Re: Nardil update: Still hasn't kicked in » gardenergirl, posted by ace on December 5, 2005, at 6:53:40
>> I cannot imagine how you possibly could have got akathisia from Nardil. There is NOTHING in the literature that states Nardil to cause akathisia. I have never heard from any Nardil user the word akathisia. Please describe your symptoms really clearly. May it have been intense anxiety?
I haven't found anything that lists akathisia by name in the Nardil literature either, alhtough I haven't had any need to search. However, I do have the following two sources which list jitteriness and restlessness as less common adverse reactions:
http://www.pfizer.com/pfizer/download/uspi_nardil.pdf"Less common mild to moderate side effects (some of which have been reported in a
single patient or by a single physician) include:
Nervous System—Jitteriness, ... ."http://www.vh.org/adult/provider/psychiatry/CPS/19.html
From TABLE 2: ADVERSE EFFECTS INCIDENCE OF PHENELZINE 60 MG/D VERSUS AMITRIPTYLINE 150 MG/D FOR SIX WEEKS
Restlessness 13% for phenelzineAt 75 mg of Nardil, besides insomnia, I experienced intense restlessness, although I suppose you could attibute the insomnia to being so restless. I felt as if I were going to "jump out of my skin", and I could not sit still. I had no racing thoughts and no somatic or emotional symptoms of anxiety (i.e. NO racing heart, increased respiration, sweating, feeling faint, panic, feeling of fear, dread, etc.). I just felt like I had to MOVE. It was very uncomfortable.
My pdoc had me try Gabitril to try to counter these effects, which she did not question. She has been prescribing MAOI's for 30 years. It did nothing for me but cause me some heartburn, unfortunately.
I have been known to have atypical reactions to some meds. Codeine and benadryl also make me jittery and both interfere with sleep versus make me feel drowsy. I had an almost hypomanic reaction to, believe it or not, Biaxin XL. One might think that SSRI's might be too activating for me, but they do nothing for me. So although I'm certain I'm not the only one who has reacted to Nardil the way I do, I assume it's not a common reaction.
gg
Posted by Jedi on December 5, 2005, at 15:19:12
In reply to akathisia » ace, posted by gardenergirl on December 5, 2005, at 14:19:11
GG,
Akathisia is listed as a rare side effect of Lamictal. It sure is an awful feeling. I tried Abilify for a short time when it was first available in the US. It is the only med that has ever given me that feeling. Then, I've never used any of the typical antipsychotics.What kind of help do you sence Lamictal has given you as an augmentation to Nardil. I would like to add Topomax to combat the weight gain, but I'm stupid enough.
Take care,
Jedi
Posted by gardenergirl on December 5, 2005, at 15:35:33
In reply to Re: akathisia » gardenergirl, posted by Jedi on December 5, 2005, at 15:19:12
> GG,
> Akathisia is listed as a rare side effect of Lamictal. It sure is an awful feeling.I agree, and I think I read that it can lead to suicide if it gets severe enough.
I've never had akathisia while on Lamictal, alhtough I only take 75 mg. Initially I did feel a bit more activated, and I had some sleep problems at 75 mg Lamictal and 67.5 mg Nardil at first. I dropped back down to 50mg of Lamictal and that went away. I also dropped Nardil as I started to feel better (I can't stand the peripheral edema that comes with higher doses.) The sleep problems that happened at first with Lamictal seem to have gone away. I'm doing well now at 60 Nardil and 75 Lamictal. I've always had frequent waking in the night, and an occasional 5-10 mg of Ambien helps with that.
>
> What kind of help do you sence Lamictal has given you as an augmentation to Nardil.It seems to sort of fill in the gap that Nardil leaves with depression. I seem to get a more complete effect with the two than with Nardil alone. Although, I've also made some good progress in therapy lately, so it's hard to sort out which is responsible for what.
>I would like to add Topomax to combat the weight gain, but I'm stupid enough.
I tried Topomax before the Lamictal. It seemed to make me more depressed, so I stopped it after about eight weeks. I was also hoping it would help with weight gain. Recently I've been taking chromium picolinate to try to help with carb cravings. Now's not a good time of the month to assess that, though, as I seem to have the "hollow leg" syndrome. Everything I eat seems to go into some black hole, versus fills me up. I'm constantly hungry just before my period.
Hope that's not tmi.
gg
Posted by ed_uk on December 5, 2005, at 15:58:47
In reply to Re: akathisia » Jedi, posted by gardenergirl on December 5, 2005, at 15:35:33
Hi GG
It's not particularly surprising to me that Nardil might cause akathisia, since akathisia has been associated with other strongly serotonergic drugs eg. the SSRIs.
Ed x
Posted by Jedi on December 5, 2005, at 22:16:21
In reply to Re: akathisia » Jedi, posted by gardenergirl on December 5, 2005, at 15:35:33
...
> > What kind of help do you sence Lamictal has given you as an augmentation to Nardil.
>
> It seems to sort of fill in the gap that Nardil leaves with depression. I seem to get a more complete effect with the two than with Nardil alone. Although, I've also made some good progress in therapy lately, so it's hard to sort out which is responsible for what.
>
> >I would like to add Topomax to combat the weight gain, but I'm stupid enough.
>
> I tried Topomax before the Lamictal. It seemed to make me more depressed, so I stopped it after about eight weeks. I was also hoping it would help with weight gain. Recently I've been taking chromium picolinate to try to help with carb cravings. Now's not a good time of the month to assess that, though, as I seem to have the "hollow leg" syndrome. Everything I eat seems to go into some black hole, versus fills me up. I'm constantly hungry just before my period.
>
> Hope that's not tmi.
>
> ggGG,
Thank you. Great information. My residual dysthymia seems to have gotten a bit worse lately and I'm searching for a better augmentation than the 1mg clonazepam I'm taking. I did read a recent abstract about chromium picolinate and the carb cravings. The atypical depression seems like a double edge sword. I gain weight from the depression, then I gain weight from the medication. The only thing I've been able to beat the Nardil carb cravings with is exercise. I'm talking two hours a day. It is hard to stay that motivated long term so thus my weight goes up and down. Does the chromium picolinate seem to help at all? A magic pill sure would be nice, especially if the weight gain is medication related. Sometimes I feel like a total binge eater, the cravings just don't go away. Thanks again.
Jedi
Posted by gardenergirl on December 8, 2005, at 7:20:30
In reply to Re: akathisia » gardenergirl, posted by ed_uk on December 5, 2005, at 15:58:47
Posted by gardenergirl on December 8, 2005, at 7:22:36
In reply to Re: Nardil augmentation » gardenergirl, posted by Jedi on December 5, 2005, at 22:16:21
> I did read a recent abstract about chromium picolinate and the carb cravings. The atypical depression seems like a double edge sword. I gain weight from the depression, then I gain weight from the medication.
I've decided the chromium picolinate does squat for me, so I'm dropping it. I think you're right, exercise is the way to go.
My pdoc recently suggested I consider Provigil. I'm thinking about it, but I'm going to try upping my caffeine a tiny bit first. I wonder if Provigil would help with the weight gain?
gg
Posted by Jedi on December 10, 2005, at 4:28:03
In reply to Re: Nardil augmentation » Jedi, posted by gardenergirl on December 8, 2005, at 7:22:36
...
> My pdoc recently suggested I consider Provigil. I'm thinking about it, but I'm going to try upping my caffeine a tiny bit first. I wonder if Provigil would help with the weight gain?
>
> ggHi,
I could find limited research on Provigil treatment for weight gain. Here is one abstract which shows it may have some benefit.
Take care,
JediWake-promoting agents with different mechanisms of action: comparison of effects of modafinil and amphetamine on food intake and cardiovascular activity.
Appetite. 2004 Apr;42(2):185-95.
Makris AP, Rush CR, Frederich RC, Kelly TH.Weight and Eating Disorders Program, Suite 3121, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA. makrisa@mail.med.upenn.edu
Despite efforts to achieve a desirable weight, two-thirds of the population has an elevated body weight. Medications are useful in supporting weight loss, but produce adverse effects. This study compared the effects of amphetamine and modafinil on food intake and cardiovascular activity in healthy men and women. Participants (n = 11) completed 11 sessions. In random order, participants received placebo on five separate sessions and single oral doses of modafinil (1.75, 3.5, or 7.0 mg/kg) and amphetamine (0.035, 0.07, 0.14 mg/kg). Free time between hourly performance testing intervals gave participants the opportunity to eat. Like amphetamine, modafinil reduced the amount of food consumed and decreased energy intake, without altering the proportion of macronutrients consumed. Although both medications significantly increase heart rate and blood pressure at higher doses, the dose of modafinil that was efficacious in decreasing food intake did not significantly increase heart rate. Modafinil may be well suited for the treatment of obesity, although further studies with repeated dosing in overweight populations are warranted. Modafinil may have less adverse health consequences than some anorectic agents and greater treatment efficacy.
Posted by gardenergirl on December 10, 2005, at 11:10:08
In reply to Re: Nardil augmentation » gardenergirl, posted by Jedi on December 10, 2005, at 4:28:03
Posted by that_guy23 on November 2, 2008, at 15:47:29
In reply to Nardil update: Still hasn't kicked in, posted by Tomatheus on December 1, 2005, at 9:49:48
Do not jump more than 15 mgs at atime, and do it at aslow rate, If you feel, you need to be raised , move up just to 75, and stay at that level for 2 to 3 weeks. Im at 8 weeks and like 3 days, and I jumped way to high. I was up to 105, from 75. I know thats not normal, i't was bad, and now Im dow n, which I came gradually, to 75.
75 mgs fom week 4 to six, I was feeling a change, but scewed that up with the unusual jum to 105. Either way who know's it could be just as bad, jumping from 60 to 90, if I were you I would just go to 75, stay there I would expect you to notice something at that dose , if your patient.
Posted by that_guy23 on November 2, 2008, at 15:54:51
In reply to Re: Nardil update: Still hasn't kicked in » Tomatheus, posted by ace on December 2, 2005, at 9:19:20
I don't think you shoud listen to ace. The best results I've heard, is the ones, who took there time. It doesn't always work until up to 3 months. But for you 5 1/2 weeks at 60, maybe thats patient enough, to move up just to 75 now or wait for the 6 week mark. But I think that you will have effects pretty soon after moving to 75.
This is the end of the thread.
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