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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by mantus on July 12, 2011, at 21:51:15
I haven't posted on here in quite awhile, but I am going through a pretty rough time right now trying to figure out why I am reacting to Nardil in the manner I am. I am currently taking 75mg and have been on 60mg for a few months before also. I definitely went through the insomnia side effect but have seemed to work through it. I also experienced orthostatic hypotension, dizziness and a couple falls, but have also somewhat worked through that. However, I have had the same problem with a very large jump in my heart rate from laying/sitting to standing for basically the entire time I have been on Nardil. I lived with it for a long time just expecting it to go away, but it hasn't. The high heart rate daily when standing effects me in many ways, mind fog, no ability to over exert (exercise/run), leg pains, inability to walk upstairs, general jitteriness and other symptoms. I guess the nardil has worked with my original symptomes anxiety primary/depression secondary, but this constant elevated hr has taken over my life also in a negative way. I know that basically this is an unknown side effect for nardil users, that's why I am so scared right now and don't know what to do. My blood pressure drops, but it is still the severely increased hr that seems to be the biggest problem. I have an appointment soon and will likely start florinet (sp?) to hopefully raise my bp, therefore slowing my pulse. But is this doesn't work I will basically have to give up on Nardil, which is quite scary because I don't want to crash again. My doctor suggested trying viibryd, but I am not a big believer in trying the hot new drug until i see serious results. Please, if someone could help me right now I'd really appreciate it, as I am so lost. It seems like I can't even get back to the original anxiety/depression issues and experiment with Nardil dosages because i am being affected so greatly in a physical way by the nardil. I would really like to have something help me feel stable physically again, so that I could reevaluate the efficacy of the Nardil, and try 90mg considering I have been on it so long, and haven't been up to 90mg just to see what would happen. But I can't do this until I find some way to find stability with my standing hr first. I am begging for any and all advice, because it seems doctors I've visited are incompetent. Also, how often does someone switch off of an MAOI to something like viibryd and it actually does well? It often seems like I here people that switch from MAOI"s to newer drugs regret their decision. But again, I would like to feel normal physically too, and I am quite sure that would happen if i just discontinued the Nardil. Again, as many suggestions as possible would be greatly appreciated.
Thanks,
Mantus
Posted by jono_IN_ADELAIDE on July 13, 2011, at 20:05:13
In reply to Please Help with Nardil Decision, posted by mantus on July 12, 2011, at 21:51:15
Give the florinef a try, also, some extra salt (either as table salt on your food, or as salt pills taken with meals) might help.
Florinef wont work overnight, I'd give it atleast 4 weeks before you decide wether or not it is working.
If your racing heart bothers you, a small dose of beta blocker might be of assistance
Posted by desolationrower on July 15, 2011, at 21:48:19
In reply to Re: Please Help with Nardil Decision, posted by jono_IN_ADELAIDE on July 13, 2011, at 20:05:13
>The high heart rate daily when standing effects me in many ways, mind fog, no ability to over exert (exercise/run), leg pains, inability to walk upstairs, general jitteriness and other symptoms.
could you say more how does the high heart right affect your life in a concrete way?
i think this one sentence is the important thing.
-d/r
Posted by mantus on July 15, 2011, at 23:47:09
In reply to specifics, posted by desolationrower on July 15, 2011, at 21:48:19
Well, I guess the best way to put it is when I stand up my body feels completely different than when I am sitting or resting. When I stand it just automatically jumps to anywhere between 100-120 for absolutely no reason. Actually, if I just stand in one place it tends to be even a little higher than if I'm walking. My normal hr is at least 30-50 bpm less than that while standing previously to this medicine. Some days the symptoms I feel are worse than other days, but again I can feel dizzy, have brain fog, memory problems (could be more due to ativan, I don't know), random aches and pains all over my body, very sluggish and weak legs, inablity to exert myself (running/working out), concentration greatly on this problem which makes evaluating my main issues anxiety with secondary depression very hard to do because my body feels so wrong when I'm standing. I have a doctor's appointment on monday, and will probably talke about florinef or a beta blocker. But if something doesn't "substantially" improve this situation, I will probably discontinue the nardil and try viibryd. I having been dealing with this for about 7 months with absolutely no improvement, I just want to feel normal physically again. I'm just scared of what going off of the nardil might do to my original anxiety/depression. Another question I had is about discontinuing Nardil. My p-doc really like nardil and has prescribed it about as much as anyone else in his career. He said I should just completely stop it at once, then wait the 2 weeks for viibryd. He acts like suddenly stopping wouldn't hurt me, but I never hear that about in psychotropic meds. What do you think?
Posted by deepreason on July 16, 2011, at 5:15:40
In reply to Re: specifics, posted by mantus on July 15, 2011, at 23:47:09
I'd play around with your diet a bit. There is a chance that some of the things you think are "safe" actually aren't for you. What you are describing sounds similar to problems I was having with chocolate whilst on Nardil.
Posted by mantus on July 16, 2011, at 11:26:32
In reply to Re: specifics, posted by deepreason on July 16, 2011, at 5:15:40
See, I've even considered my diet before. But I have a VERY strict diet and never touch anything even remotely close to the things on the list of things not to eat. I don't drink cola, tea, or eat chocolate or anything that might have any level of caffeine. I truly believe the Nardil is doing something in my body regardless of food or anything I have any control over. I do take ativan (which I hate and don't want to be on) but I know the tapering process will be difficult. That's why I keep trying to wait and wait for general stability before I start. However, I'm convinced that time isn't going to come, because no matter the time of day or night my hr is messed up if I stand up and it keeps me focused on that problem, and unable to reevaluate the original anxiety and depression. I've wanted to try 90mg in the past just to see what would happen, but unfortunately I don't think I can with this continued problem. Any further suggestions would be greatly appreciated. Does anyone believe that if I switched from Nardil by just dropping it, waited 2 weeks and started viibryd I would likely do ok? I know that there is no way to know, but I'm really in need of finding some confidence, becaues I have to make some decision to change the current state of things. It's just nice thinking I could drop Nardil and go back to my normal self physically at least and not mess with another med, dosages, working or not working, I just never know.
Posted by jedi on July 16, 2011, at 17:00:03
In reply to Re: specifics, posted by mantus on July 15, 2011, at 23:47:09
Hi Mantus,
I have been taking Nardil long term (12 years) at dosages between 60 and 90mg. When my depression and anxiety gets a little worse, I will raise the dosage by 15mg. My MD always writes the script for 90mg and 60mg is usually enough for me. I would never stop long term use of Nardil cold turkey; unless some emergency required it. Maybe your PDOC is thinking that even after a sudden 2 week washout, you will still have a degree of MAO inhibition, that could keep you from crashing. Not sure on that one. In the past, when I've discontinued for other med trials, I have tapered slowly.I've never had your problem with the heartbeat, we are all so different. My BP runs borderline high, and Nardil actually lowers it about 20 points. Has kept me off the BP meds, while everybody else-in my extended family, is on them.
I have the memory problems too, which I blame on long term use of clonazepam. I've tapered this down from 2mg to .5mg on the way to zero. I would be nice not to have to use Google for my BRAIN!
Most of my Nardil side effects have greatly reduced with time. I am having some problem with motivation, that I didn't have before. I think this is mainly a learned response from fighting depression for so long. Before my first major depression hit, I owned and managed a data networking company and owned and managed 50 residential rental homes. Then again, I was highly anxious all the time. Not sure I would go back to that, even if I could. I think, in my case, the anxiety was a primary motivator.
Sorry, not too specific to your questions. Just rattling on with my Nardil experience.
Good Luck Mantus,
Jedi
> Well, I guess the best way to put it is when I stand up my body feels completely different than when I am sitting or resting. When I stand it just automatically jumps to anywhere between 100-120 for absolutely no reason. Actually, if I just stand in one place it tends to be even a little higher than if I'm walking. My normal hr is at least 30-50 bpm less than that while standing previously to this medicine. Some days the symptoms I feel are worse than other days, but again I can feel dizzy, have brain fog, memory problems (could be more due to ativan, I don't know), random aches and pains all over my body, very sluggish and weak legs, inablity to exert myself (running/working out), concentration greatly on this problem which makes evaluating my main issues anxiety with secondary depression very hard to do because my body feels so wrong when I'm standing. I have a doctor's appointment on monday, and will probably talke about florinef or a beta blocker. But if something doesn't "substantially" improve this situation, I will probably discontinue the nardil and try viibryd. I having been dealing with this for about 7 months with absolutely no improvement, I just want to feel normal physically again. I'm just scared of what going off of the nardil might do to my original anxiety/depression. Another question I had is about discontinuing Nardil. My p-doc really like nardil and has prescribed it about as much as anyone else in his career. He said I should just completely stop it at once, then wait the 2 weeks for viibryd. He acts like suddenly stopping wouldn't hurt me, but I never hear that about in psychotropic meds. What do you think?
Posted by desolationrower on July 16, 2011, at 21:43:59
In reply to Re: specifics, posted by mantus on July 15, 2011, at 23:47:09
Huh. I really don't know.
Just a thought, do you take a source of vitamin B6?
-d/r
Posted by mantus on July 17, 2011, at 0:16:09
In reply to Re: specifics, posted by desolationrower on July 16, 2011, at 21:43:59
Yes, I take a B6 supplement, with a multi, omega-3, and magnesium. There have been times when I have even quit these supplements to see if they somehow contributed, but no luck. Do you think there is any reason to believe that the interaction with ativan may somehow play a role in the heart rate issue? I have a new blood pressue cuff that automatically reads and stores all of my bp's and pulses so that I can show my doctor exactly what I am talking about. Today, I was very relaxed while supine and my pulse was 50. I stood up and it immediately went up to 95 and within 5 minutes of just standing it was up to 105. I have did a good amount of research on POTS (postural orthostatic tachycardia syndrome). Basically, it just means that when you stand your hr jumps and stays high. This article discusses some treatment options, but said if it is somehow caused by meds, the meds should be discontinued. If I were to continue Nardil, I would have to try something like a low dose beta blocker or florinef. But honestly, I don't know if I can keep going through this med cycle, something always seems to go wrong and take forever, and I know if I just stopped Nardil the hr problem would end. My pdoc is very intelligent, I am very glad to have found him, and he seems as stumped as anyone as to why my body is doing this. He said in his career he has prescribed nardil hundreds of times and still does today, and he doesn't seem to have any real idea of how to best approach this other than discontinuing the med. This is a very tough decision for me. I research everyday about nardil issues and any viibryd studies (which basically don't exist) to help come up with an idea. I just know how important it is to have some level of confidence when you make a big change like this. Thank you for your suggestions, I would really appreciate anything else you might advise. Also, does anyone know where I could find quality study results or scholarly papers on viibryd?
Landon
Posted by floatingbridge on July 17, 2011, at 10:19:16
In reply to Re: specifics, posted by mantus on July 17, 2011, at 0:16:09
Did you have any of the symptoms of POTS before Nardil treatment?
I understand your hesitancy to discontinue the Nardil.
Are the other physical symptoms you mention (like aches) relatively new?
(I don't know about viibryd other than seeing stacks of samples on a doctor's desk.)
> Yes, I take a B6 supplement, with a multi, omega-3, and magnesium. There have been times when I have even quit these supplements to see if they somehow contributed, but no luck. Do you think there is any reason to believe that the interaction with ativan may somehow play a role in the heart rate issue? I have a new blood pressue cuff that automatically reads and stores all of my bp's and pulses so that I can show my doctor exactly what I am talking about. Today, I was very relaxed while supine and my pulse was 50. I stood up and it immediately went up to 95 and within 5 minutes of just standing it was up to 105. I have did a good amount of research on POTS (postural orthostatic tachycardia syndrome). Basically, it just means that when you stand your hr jumps and stays high. This article discusses some treatment options, but said if it is somehow caused by meds, the meds should be discontinued. If I were to continue Nardil, I would have to try something like a low dose beta blocker or florinef. But honestly, I don't know if I can keep going through this med cycle, something always seems to go wrong and take forever, and I know if I just stopped Nardil the hr problem would end. My pdoc is very intelligent, I am very glad to have found him, and he seems as stumped as anyone as to why my body is doing this. He said in his career he has prescribed nardil hundreds of times and still does today, and he doesn't seem to have any real idea of how to best approach this other than discontinuing the med. This is a very tough decision for me. I research everyday about nardil issues and any viibryd studies (which basically don't exist) to help come up with an idea. I just know how important it is to have some level of confidence when you make a big change like this. Thank you for your suggestions, I would really appreciate anything else you might advise. Also, does anyone know where I could find quality study results or scholarly papers on viibryd?
>
> Landon
Posted by mantus on July 17, 2011, at 12:48:59
In reply to Re: specifics » mantus, posted by floatingbridge on July 17, 2011, at 10:19:16
Prior to Nardil I did not have any signs or symptoms of POTS. Upon research though I did notice that teenagers who often grew very tall, very quickly sometimes developed POTS but it would usually work its way out over a couple of years. Now I am 26, and I know that my extreme growth spurt when I was younger probably has nothing to do with it, I've just always wondered sometimes that since I am 6'3" it somehow makes me more likely to develop POTS like symptoms with Nardil. I had chest pain for the first few months of taking nardil, then it went away. The aches would stil come back though if I was having a particularly bad hr day, but over the past couple weeks it seems like they stay more constant. It is similar to the aches I felt when I tried to discontinue the ativan too quickly, but I haven't changed any dose of it in awhile, so I don't see it being the culprit but I don't know. I again am just tired of the med cycle, and I'im sure if I take something trying to help the symptomes I am having now it probably won't do what I need it to do, which leaves me more confused on more meds, when it would just be nice to know I could drop Nardil and my hr would go back to normal. But again, I don't know what would happen to my anxiety and such.
Posted by desolationrower on July 17, 2011, at 21:22:27
In reply to Re: specifics, posted by mantus on July 17, 2011, at 12:48:59
it might be worth trying something like desipramine with the nardil, just to see if it helps.
maybe someone here can comment on this from experience.
-d/r
This is the end of the thread.
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