![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 26. Go back in thread:
Posted by missjulie on July 24, 2007, at 15:33:34
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
I wanted to reply to you as I don't have a good answer but feel in such similar straits. After a spectacular recovery on Prozac that lasted for a year it pooped out on me and never worked again despite dosage changes, etc. That was 15 years ago (!!) and I've been looking ever since. (am I remembering this correctly, did you post about the same kind of reaction recently... it really rang a bell with me) I heard parnate was the gold standard and like you struggled for 2 years to find a dr. willing to prescribe it. Been 6 weeks now and I'm maybe 35% better, with lots of bad side effects. Personally I don't know what's next as I've blown through everything: stimulants, lamictal, lithium, wellbutrin, exercising, herbs, etc. At tremendous expense with very little benefit. Just wish I could feel like I did back then... the one year of my life I was "normal." The word "electroshock" keeps coming up for me... going to stick it out on Parnate at higher dosage awhile longer... it was so hard to get, and hard for me (as I'm sure it is for you) to let go of the hope. Did you ever consider switching from Nardil to Parnate... may not help but why not, if you've found someone willing to prescribe MAOIs? best wishes, I totally understand how you feel.
Posted by FredPotter on July 24, 2007, at 16:11:47
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
Though Nardil helps my overall depression and anxiety it doesn't do much for my social awkwardness. This is a highly specific thing with me. I can work as a consultant no problem, but if someone wants to come round my house or if I'm invited to someone's house for dinner I feel like I want to escape. It's the being trapped thing. I can even give seminars and perform on piano and talk to the audience without problems.
If I feel Nardil beginning to fade my next drug will be tianeptine, if I can find a willing Dr
Fred
Posted by linkadge on July 24, 2007, at 16:38:41
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by FredPotter on July 24, 2007, at 16:11:47
This doesn't mean anything. Just cause you don't respond to Nardil doesn't mean other treatments won't have effect.
I tried parnate for a while (MAOI like Nardil), I had wicked insomnia, heart palpitions, increased anxiety, intense bouts of fear, mild psychotic reaction, unexplained severe abdomnial cramping, etc.
Anyhow, I ended up responding later to clomipramine plus low dose SSRI.
You may want to wait a little while longer, but don't feel it is the end of the world if you don't respond.
Linkadge
Posted by Phillipa on July 24, 2007, at 17:29:18
In reply to Re: After Nardil has failed, what else is there?, posted by linkadge on July 24, 2007, at 16:38:41
Linkage really how did you find the combo? I would prefer to stay in SSRI or SNRI category. Anyone try cymbalta or wellbutrin? Love Phillipa never gave them an adequate trial.
Posted by Justherself54 on July 24, 2007, at 18:39:41
In reply to Re: After Nardil has failed, what else is there? » linkadge, posted by Phillipa on July 24, 2007, at 17:29:18
I have never been on Nardil, but I'm currently on Parnate at 20 mgs..I'll be meeting with my pdoc soon to discuss another increase..
side effects: dry mouth, heart palpitations (but I'm prone to them anyway), appitite loss, some hypotension, insomnia (which is controlled with a sleep aid)
benefits: moderate relief from depression, ability to focus and stay on task, more social, less worrying, way more energy (except a spot in the afternoon when I'm really fatigued)
I hope this keeps on working because I'm at the end of the SSRI's with Lexapro being the last one I was on..
Just wondering if switching to Parnate may work for you..
Posted by girlnterrupted78 on July 24, 2007, at 20:13:32
In reply to Re: After Nardil has failed, what else is there?, posted by Justherself54 on July 24, 2007, at 18:39:41
So it's only "moderate" relief from depression with Parnate? I'm also just "moderately" relieved from depression with Nardil, and that means: still depressed. Probably 30% relieved, so not even "half" relieved.
Mostly, I'm emotionally disabled. I can interact with people at work, in school, but try to get me into a friendship or relationship, and I begin to falter and can't function well and I just feel like going into my room by myself. This is no way to live. I'm a robot whose insides are completely destroyed or missing. My first AD made me work internally very well, but Nardil is not doing that, so I don't know what else could help at this point.
Thanks for your input though. If Nardil's side effects keep being such a nuisance (like my syncope, which is really annoying now) I might try Parnate, although I know it will have equally annoying side effects.
Posted by girlnterrupted78 on July 24, 2007, at 20:20:21
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
Does anybody know if Parnate was also altered by the company that manufactures it, just the way Nardil was?
I haven't read anything that indicates it was, so I'm wondering whether it is a better choice than Nardil at this point?
How did people find out that Nardil had been altered by Pfizer? Is there any link out there that talks about these changes?
Thanks in advance
GI78
Posted by girlnterrupted78 on July 24, 2007, at 21:18:11
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by missjulie on July 24, 2007, at 15:33:34
Thanks a lot for your reply, missjulie.
I guess we went through the same experience with a wonderful SSRI and a horrible poop-out that left us knowing what being "normal" feels like, but knowing that we might never feel that way again.
It's such a horrible thought, to know how much others are enjoying life, and to know we have to live with this debilitating depression instead. My year on Celexa will be forever remembered as the best year of my life and probably the only great year of my life.
I might try Parnate after giving Nardil at least a few months trial. It's barely been a month and a week. I'll see what happens after 2-3 months, and if it's the same, I will definitely try Parnate.
Do you happen to know if Parnate was also reformulated by its manufacturer, the way Nardil was?
Thanks a lot for the support, I appreciate it.
Sincerely,
GI78
Posted by girlnterrupted78 on July 24, 2007, at 21:31:52
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by FredPotter on July 24, 2007, at 16:11:47
Thanks for your response, Fred.
Well, that's impressive. I could never address an audience or play the piano (I've had to do both in the past, and it was pretty painful.) I used to play the piano as an adolescent, and I remember forgetting one song in my recital and god knows what I did to continue with the rest. As for speaking in public--I will avoid it at all costs. I will never be able to do those things.
My main issue is an inability to become involved emotionally or in groups. I loved being around groups when I was on Celexa (the only AD that ever worked for me.)
I could be loud and make jokes and all that goes along with being "normal." Now I prefer to be on my own 99% of the time and I'm never in the mood to go out and have fun. People from work keep asking me to join them in going to a bar, and I refuse every time because I'm too afraid that the depression will come out and it will be a traumatic event. I'm also never in the mood to get emotionally involved with anyone because I'm too afraid that my depression/SA will destroy the balance--and that would be so hard to overcome, that I'd rather not even try in my current situation.
So I guess I can call myself disabled. It's a disability that the majority of people don't know about, and they think of it as being weird/awkward/anti-social, etc. Just bad adjectives to call you, which again, makes depression even worse. It's a terrible cycle that can't be stopped.
Thanks a lot for your input,
GI78
Posted by girlnterrupted78 on July 24, 2007, at 22:08:53
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by FredPotter on July 24, 2007, at 16:11:47
I forgot to ask you, Fred, how did you decide that your next med will be tianeptine? I'm unfamiliar with it, is it an AD, and how does it work?
How good has Nardil been so far?
Thanks,
GI78
Posted by Jedi on July 24, 2007, at 22:29:32
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
...
> I had high hopes for Nardil. But it's not doing what it was supposed to. It's not dealing with my SA or depression fully. It's giving me around a 30% relief only.
>
> If someone out there knows of a different drug that could work in the way Nardil was supposed to work for depression and social anxiety, please comment here.Hi GI,
My memory fails me after fighting depression and medication side effects for over ten years. Are you augmenting Nardil with any other medications? If you are getting a 30% improvement, then I would make sure the dosage is right for you. Then look at augmentation. The combination of Nardil and clonazepam(Klonopin) is very good for social anxiety. Some docs don't like benzos but I believe there is a good synergism for social anxiety when Nardil is combined with clonazepam. Another option would be a mild stimulant such as modafinil(Provigil). Then, there is the old standby, lithium. This is the most researched and proven of all of the augmentors.You could switch to Parnate. Some people who do not respond to Nardil will respond to Parnate. A generic version of tranylcypromine came out about a year ago. This sure helps on the cost.
Good Luck,
Jedi
Posted by FredPotter on July 24, 2007, at 22:29:44
In reply to Re: After Nardil has failed, what else is there? » FredPotter, posted by girlnterrupted78 on July 24, 2007, at 22:08:53
I think because it seems to be flavour of the month and is different from all other ADs. It's a selective serotonin reuptake accelerator so God knows how it works
Posted by FredPotter on July 24, 2007, at 23:43:01
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by Jedi on July 24, 2007, at 22:29:32
Someone has suggested that nortriptyline (Pamelor) can augment Nardil
Posted by Jedi on July 25, 2007, at 2:13:28
In reply to Re: After Nardil has failed, what else is there? » Jedi, posted by FredPotter on July 24, 2007, at 23:43:01
> Someone has suggested that nortriptyline (Pamelor) can augment Nardil
Fred,
I have augmented 90mg of Nardil with 100mg of nortriptyline. For me, it didn't seem like the TCA added that much. It did seem to help with the insomnia induced by Nardil. There is even some research that suggests some protection from a tyramine hypertensive reaction when adding a non-serotonergic TCA to a MAOI. I did not test this myself. I have had one tyramine reaction, that was enough.
Take care,
Jedi
Posted by Sentience on July 25, 2007, at 4:33:46
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
Visit this link & address your question to David F.H. re: Nardil alternatives.
Cheers
Posted by Sentience on July 25, 2007, at 4:35:31
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by Sentience on July 25, 2007, at 4:33:46
Ooops here's the link :o)
Posted by Maria3667 on July 25, 2007, at 15:49:43
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
Hello Girl,
Not sure if someone has already considered this, but as a last resort you could always try TMS (Transcranial Magnetic Stimulation). I tried this last year and it was very good in disintegrating my depression.
Spend a whole year happy without having to take AD's.Just a thought.
Maria
Posted by missjulie on July 25, 2007, at 15:51:17
In reply to Re: After Nardil has failed, what else is there? » missjulie, posted by girlnterrupted78 on July 24, 2007, at 21:18:11
GI78 - Yes, we totally had the same experience... isn't it dreadful to think maybe one good year is all we'll get? I refused to accept that for a long time... hence the many, many trials... also, isn't it terrible to try to explain to pdocs just how traumatic is was to be "cured" then nothing ever works again? It's hard to put into words how frustrating it is. I dont know if Parnate was ever reformulated... search old threads there was quite a discussion about this topic a few weeks ago... many think yes as its properties have changed. (I just started so hard to say) Nardil, most definitely, it ruined many lives when they changed the formulation, they have support groups, want to file lawsuits, everything. Very well documented all over the internet. BTW, I tried tianeptine before Parnate - NOTHING. I still have tons of boxes of it left - hard to get from overseas. More time/money/effort wasted. I do believe that people like you and me have a seritonin problem (given our excellent reaction to SSRIs at one point) so am not that surprised MAOIs may not be the exact right thing... but still, as you say, I expected more from the gold standard. But have accepted they just don't do it for me anymore. I have spent YEARS thinking, researching, trying to find the answer... so if you ever want to chat let's do. We are in the same boat, right down to not wanting to go out after work! best missjulie
PS) I once read about a young woman who did very well on Lamictal after pooping out on Celexa... don't know how many drs you've seen and wonder if you're playing the BPII/ BPIII / atypical labeling game?? been there done that :)
Posted by girlnterrupted78 on July 26, 2007, at 19:03:05
In reply to Re: After Nardil has failed, what else is there? » girlnterrupted78, posted by missjulie on July 25, 2007, at 15:51:17
Hi missjulie,
Thanks a lot for your response. I've also spent years doing research till a point where I lost hope. But I'm still looking and will continue looking probably for the rest of my life.
I'd love to chat sometime. We could babble-mail sometime too. I'll continue on Nardil and if it doesn't give me enough relief, I'll try Parnate.
Heck, I've even thought about studying some pharmacology to figure out what on earth is so wrong with me. Maybe I'll do it in the near future.. who knows..All the best,
GI78
Posted by brooke484 on July 27, 2007, at 7:40:46
In reply to Re: After Nardil has failed, what else is there? » Girlnterrupted78, posted by FredPotter on July 24, 2007, at 16:11:47
"If I feel Nardil beginning to fade my next drug will be tianeptine, if I can find a willing Dr"
What does that mean? I thought this drug was available all over, except in the US.
brooke
Posted by FredPotter on July 29, 2007, at 15:36:30
In reply to question for Fred, posted by brooke484 on July 27, 2007, at 7:40:46
It's just that I always get some resistance from my Dr if he hasn't heard of the drug I'm suggesting. He won't have heard of this I'm quite sure
Posted by brooke484 on July 29, 2007, at 20:49:08
In reply to Re: question for Fred » brooke484, posted by FredPotter on July 29, 2007, at 15:36:30
But it is available in England right?
Posted by FredPotter on July 29, 2007, at 23:54:16
In reply to Re: question for Fred, posted by brooke484 on July 29, 2007, at 20:49:08
I don't know much about availability of tianeptine. The only place I'd be sure of is France - where they invented it. It must work in some unknown way and maybe this has no connection to SSR Acceleration
Posted by Oppycat on July 30, 2007, at 12:47:30
In reply to Re: After Nardil has failed, what else is there? » missjulie, posted by girlnterrupted78 on July 26, 2007, at 19:03:05
> Hi missjulie,
>
> Thanks a lot for your response. I've also spent years doing research till a point where I lost hope. But I'm still looking and will continue looking probably for the rest of my life.
> I'd love to chat sometime. We could babble-mail sometime too. I'll continue on Nardil and if it doesn't give me enough relief, I'll try Parnate.
> Heck, I've even thought about studying some pharmacology to figure out what on earth is so wrong with me. Maybe I'll do it in the near future.. who knows..
>
> All the best,
> GI78
One advantage of trying Parnate next is that most people notice some benefit within a couple of days of starting it, although full remission of the depression symptoms will probably take 3-4 weeks.If you don't any relief after a week or so, you can start washing out and then try a different AD. When I first took it about 19 years ago, I felt something almost immediately. Hopefully, you will respond to either Nardil or Parnate.
Posted by Ron Hill on July 31, 2007, at 19:57:08
In reply to After Nardil has failed, what else is there?, posted by Girlnterrupted78 on July 24, 2007, at 13:30:29
Girlnterrupted78,
The full benefit of Nardil typically does not kick in until you reach a dosage of 1 mg/day per kg of body weight, and maintain this daily dosage for at least four weeks. Are you at this dosage?
Do you have atypical depression (low energy, low motivation, excessive sleeping, etc), or do you have the type of depression that causes you to have difficulty sleeping?
What is your dx (diagnosis)?
What other meds are you taking?
-- Ron
Bipolar II with ultra rapid cycling, and Obsessive Compulsive Personality Disorder (OCPD)
600 mg/day Trileptal
200 mg/day Lamictal
1125 mg/day Keppra
90 mg/day Nardil
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.