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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by myco on February 14, 2009, at 11:13:08
Hey, I'm noticing the increasing prevalence of nardil induced apathy at 75mg. Apathy tends to be a common characteristic among the medicated. Do you think this is best treatable with behavioural adjustment or are there successful augments for it?
thnx
myco
Posted by raisinb on February 14, 2009, at 11:26:55
In reply to AD Apathy: behavioural or medicateable?, posted by myco on February 14, 2009, at 11:13:08
Depends on what you mean by apathy--motivation can certainly be increased with dopamine increasing meds (like Wellbutrin for example). If you mean you're tired or feeling sluggish all the time, though, that might be a side effect that will pass (are you sleeping on the Nardil?)
Posted by myco on February 14, 2009, at 11:54:11
In reply to Re: AD Apathy: behavioural or medicateable? » myco, posted by raisinb on February 14, 2009, at 11:26:55
> Depends on what you mean by apathy--motivation can certainly be increased with dopamine increasing meds (like Wellbutrin for example). If you mean you're tired or feeling sluggish all the time, though, that might be a side effect that will pass (are you sleeping on the Nardil?)
>
>my moods are slowly changing from the smiling happy person I was when ramping up and playing with dosing on nardil (which is propably just a very welcome side actually but not sure - I was never an exciteable person but then again I cant remember in my life, apart from being a kid, when I wasnt stressed or depressed) to more of an unemotional, appearingly uncaring (although this isnt me inside it comes from others looking in) kind of just blah..no real anxiety though, still boughts of the downs. Ya motivation is seriously lacking...i'm tired and lethargic all the time (I understand thats somewhat med induced) but i'm also sleeping 2-4h at best. Having a rough time getting a decent sleep med(an actual med designed for sleep) from my gp so im balancing on herbal teas, melatonin, the occasional trazodone (not working with nardil the way it used to on effexor) and doxylamine (again not as effective as once was since I raised nardil dose to 75mg).
Not sure how long a persons body/mind can hold out on almost no sleep for months - bags under my eyes, complexion white as a ghost - body says shut down and nardil says nope stay awake.thnx for listenin
myco
Posted by Phillipa on February 14, 2009, at 12:21:12
In reply to Re: AD Apathy: behavioural or medicateable? » raisinb, posted by myco on February 14, 2009, at 11:54:11
Insomnia is horrible. I thought nardil was sedating as for social anxiety? Is this a cause for a call to your pdoc for a new sleep med. I do know insomnia. Think it's the cause of the apathy Phillipa
Posted by Phillipa on February 14, 2009, at 12:22:18
In reply to Re: AD Apathy: behavioural or medicateable? » myco, posted by Phillipa on February 14, 2009, at 12:21:12
Correction contributing to the apathy. Phillipa
Posted by Justherself54 on February 14, 2009, at 13:53:25
In reply to Re: AD Apathy: behavioural or medicateable? » raisinb, posted by myco on February 14, 2009, at 11:54:11
A lot of people on Nardil have trouble sleeping. I had to double my nightly med cocktail when I was on it. Your apathy could be from sleep deprivation. I took 50 mg. seroquel, .05 clonazapam and 7.5 zopiclone and that seemed to do the trick.
Posted by myco on February 14, 2009, at 14:15:37
In reply to Re: AD Apathy: behavioural or medicateable?, posted by Justherself54 on February 14, 2009, at 13:53:25
>Is this a cause for a call to your pdoc for a new sleep med. I do know insomnia. Think it's the cause of the apathy Phillipa
> A lot of people on Nardil have trouble sleeping. I had to double my nightly med cocktail when I was on it. Your apathy could be from sleep deprivation. I took 50 mg. seroquel, .05 clonazapam and 7.5 zopiclone and that seemed to do the trick.
my gp is not cooperative when it comes to sleep meds...he has no issue with giving a rx for ad's (including maois) just dont talk to him about benzo's or pseudobenzo's for sleep..."well ya, you dont want to get involved in sleeping pills". His opinion is that if you are taking this med primarily for anxiety and you cant sleep then, dear myco, you are on the wrong med. I'm semi affraid to leave this guy and go out on the gp hunt again as I will (or am affraid to) run across a gp who will say 'ya im not comfy with maois therefor i dont want to renew your script from your old dr...please try this ssri' or something like this.
God im exhausted lolthnx
myco
Posted by Justherself54 on February 14, 2009, at 14:43:02
In reply to Re: AD Apathy: behavioural or medicateable?, posted by myco on February 14, 2009, at 14:15:37
Can you get your gp to refer you to a pdoc..trying to have a successful trial with Nardil and not being prescribed meds for sleep makes it difficult to say the least..
Posted by raisinb on February 14, 2009, at 16:14:06
In reply to Re: AD Apathy: behavioural or medicateable?, posted by myco on February 14, 2009, at 14:15:37
Yeah, I agree--try to get a psychiatrist. I know I'd be in a bad place without sleep meds. There are a lot of things available--Ambien for the short term, or Lunesta for the longer term. And benzodiazapines can help as well--Xanax is currently helping me sleep a lot.
Posted by bleauberry on February 14, 2009, at 17:05:05
In reply to AD Apathy: behavioural or medicateable?, posted by myco on February 14, 2009, at 11:13:08
The sleep issues are serious. You gotta do whatever it takes to tackle that head on. Not just mood, but everything else in your body will...and already is...breaking down from lack of good sleep. Premature aging. At risk for other diseases. Your immune system and hormones are taking a beating and setting you up for new problems you never had before.
If your GP is uncooperative, then you have to see another doc who is cooperative. Their motto is do no harm. If he isn't getting you to sleep, then he is participating in doing you harm. Just the way I see it. Whether you keep your GP and get a second one in addition, or switch completely, is a tough decision, but it has to be done. Finding the right one is also a chore, but has to be done. At the very least, you need to confront your current GP with some respectful seriousness about the issue.
Apathy could be med induced. It usually happens with increased serotonin, but in a minority of people...like me...it can also happen with increased dopamine. Numb numb numb.
Ever since Nardil's reformulation, there have been hundreds of reports of problems with it. Just a possibility.
I think Parnate is far less likely to allow apathy to exist. You might consider switching to it. Insomnia is common with Parnate too though, so that brings us back to that issue. That has to be taken care of immediately, no ifs, ands, or buts. Our board expert SLS recently said in a post that AD insomnia has to be treated as aggressively as the depression itself.
Posted by myco on February 16, 2009, at 17:05:33
In reply to Re: AD Apathy: behavioural or medicateable? » myco, posted by bleauberry on February 14, 2009, at 17:05:05
Thank you to all those you posted. Thank you bleauberry for giving me a real straight forward reality check of the sleep situation man, a good dose of reality is what I needed to give me more motivation to lose this dr. For the record I did go again today and spill my bloody guts out to him like the pdoc I had once while a university student and it made no difference...
what a prick:
"doc please look at me im exhausted"
we talk for about 10 mins. I feel as if he's listening and I open up more and discuss my past drug and alcohol addictions as a self medication attempt for anxiety...he looks genuinely concerned, listens...please I'm tired, knock me out any way you want. traz isnt working, heres a sheet on hypnotics...
"look you're overreacting. we dont want to add more 'drugs'. go home and rest"
"what? excuse me? i just spent the last 10 mins spillin my guts to you and basically begging you to let me sleep...how am i supposed to rest when I cant sleep. 1h sleep last night, man come on"
half a smile..."then go home and just sit there"
WTF!!! serious
"oh by the way.."
my little tough my finger walk on your heels then tiptoes etc indicates I have this subtle (unnoticeable to me unless pointed out) shake or tremor as he called it.
"did you know you have a tremor?"
"huh? is that bad?"
"oh its a side effect of the med"
"are you sure its not because im seriously exhausted?"
"youre overreacting myco."
LOL ugh
"listen ok, can you refer me to a pdoc please, i have no health insurance but i really need to settle this up and continue getting better?"
"if you go to a phyciatrist myco you will only end up taking more 'DRUGS'"
LOL ugh
*mumbles* *ssh*l*!
so i'm done with him now. away I go on my neverending quest deep into the semi disfunctional world of canadian socialized medicine looking for that understanding gp.
apparently here you can 'self refer' to a pdoc
bleauberry....you mentioned apathy as a possible or common problem with seratonin (although for you dopamine). Is there anything I can do about that? I dont know if I actually need much seratonin...my issue is anxiety predominantly...think 75mg nardil can be lowered to 60 then with augmentation I could potentiate nardil response to give it a so needed kick back into working better like it used to?this useless gp is also open to me changing to parnate LOL just dont ask for a sleep med with that parnate...god help me if I change under him.
thnx
the former happy and smilin myco
Posted by Phillipa on February 16, 2009, at 21:20:53
In reply to thanks bleauberry and friends, posted by myco on February 16, 2009, at 17:05:33
Myco how horrible. I do feel for you tremendously. Hope there is something anything you can do to get some sleep. Can you go to an emergency room there? Love Phillipa
Posted by myco on February 16, 2009, at 21:54:39
In reply to thanks bleauberry and friends, posted by myco on February 16, 2009, at 17:05:33
guys do I sound like a "drug seeker" from this convo? I need your opinion. Was it a mistake to tell him about my history knowing that he's judgemental and disinterested in psychiatry? Not sure what to make of this. I know that previous substance abuse problems make rx'ing certain meds a little iffy but really? Dont get it.
thnx
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