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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by brynb on April 8, 2013, at 15:21:34
After a lot of unraveling and recent instability and a hell of a last two weeks (which included a trip to the psych ER), I convinced my pdoc to let me quit Lexapro and switch to Nardil. I had to beg.
I know it's not great to make drastic med changes when a lot is happening and my mood and judgement is clouded, but it dawned on me that after 7 years on Lexapro (alone or combined with every other med) and 16 or so years on other SRIs, NRIs, TCAs and various psych meds (alone or combined with either too many SEs or no success) that I need to make a big change. I realize this BIG change includes a lifestyle overhaul which includes working, exercising and getting out, but these are impossibilities at the moment given my ongoing mental state.
I'd love to be med-free, but I don't think that's possible at the moment. A jump-start and safety net are necessary. So, having never truly explored the MAOIs, I feel Nardil would be best for my most prominent symptoms (depression and anxiety). I should mention that I started Ketamine treatment in January. It was great initially (it jump-started my mood and helped me out of a non-functioning funk), but now seems to just mess with mood stability and cause some mania--hypo or otherwise.
I'll be doing one more Ketamine treatment (I'm realizing my doctor makes a pretty penny off these and I probably should cut the Ketamine out for good, but this was his suggestion during the transition) and then trying TMS, too.
My question is: too many changes at an inopportune time? Or a really good idea as Lexapro--regardless of my recent Ketamine trial--isn't cutting it and I'm worse-off than ever? This year was my first where I can't work at all--not even on a part-time or freelance basis, and has been peppered with very unsavory ER visits, worse than ever mood instability and significantly worse memory and cognitive skills.
I'd love feedback, but please, tread lightly; I'm feeling fragile :/.
-b
Posted by rjlockhart37 on April 8, 2013, at 22:38:08
In reply to Switching meds-feedback?, posted by brynb on April 8, 2013, at 15:21:34
yea....being med free is not an option, nardil is good and will help depression, just its side effects are there. But really I think you would benefit from a stabilizer, zyprexa, lithium, Depakote, it will help those unstable moods with irrtibility, I've had irrtibility and mood swings...im discusted with everything, inside and outside. Seriously, try mood staibliers, they will help you a lot. that or Ativan...
there's Suboxone for depression....its an opioid but is used for addiction treatment with main opioids....its vary good for depression, even its not used for that.....but that would be hard to ask your doctor about that....
does like events make this mood unstablity? or is like just there for no reason....that's how mine is...ill be with merry go round people and hate every minute of it, irrible.
Posted by alchemy on April 8, 2013, at 22:54:13
In reply to Switching meds-feedback?, posted by brynb on April 8, 2013, at 15:21:34
if i am understanding correctly, your big med changes would be quitting lexapro, starting nardil and stopping the ketamine? to me, switching to nardil sounds like a really good idea. i just wonder what happens when stopping ketamine injections, but you probably know. that's good to hear what can happen after some ketamine. kind of like stimulants for me. i have been unsuccessful n getting ketamine.
my guess is that there will be some kind of adjustment for your body after stopping ketamine. and then there is the break period between ssri's and maoi's which might mean another withdrawal. people have had great experiences with maoi's. your dr shouldn't have made you have to beg!
I'm sorry you are going through this. It sounds like it has been a bad year but that it will eventually turn around.
Posted by brynb on April 8, 2013, at 23:36:55
In reply to Re: Switching meds-feedback?, posted by rjlockhart37 on April 8, 2013, at 22:38:08
> yea....being med free is not an option, nardil is good and will help depression, just its side effects are there. But really I think you would benefit from a stabilizer, zyprexa, lithium, Depakote, it will help those unstable moods with irrtibility, I've had irrtibility and mood swings...im discusted with everything, inside and outside. Seriously, try mood staibliers, they will help you a lot. that or Ativan...
>
> there's Suboxone for depression....its an opioid but is used for addiction treatment with main opioids....its vary good for depression, even its not used for that.....but that would be hard to ask your doctor about that....
>
> does like events make this mood unstablity? or is like just there for no reason....that's how mine is...ill be with merry go round people and hate every minute of it, irrible.
>
>Hey rj,
Thanks for all your feedback. Based on this year, it appears I would benefit greatly from AAPs, AEs, stabilizers, etc., but I pretty much tried the gamut (or enough, anyway) to know that I was just as "off" and/or not right on them as I am med-free. That, or they caused a lot of my symptoms to worsen and it was too unbearable to ride out.
I've tried many of the drugs you mentioned, including Subutex, Suboxone and trust me, EVERY sedative. No dice. So I find myself back to square one, and it seems logical to me that trying one med (albeit a possibly risky one) in a completely different category is the next step.
It's been a rough year, but it's hard for me to pin down whether specific events set me off or what my patterns are.
Based on your posts it's been a tough time for you too, so hang in there. I know all too well what it's like to do anything to get out of your head!
Thanks again.
-b
Posted by brynb on April 8, 2013, at 23:41:56
In reply to Re: Switching meds-feedback?, posted by alchemy on April 8, 2013, at 22:54:13
> if i am understanding correctly, your big med changes would be quitting lexapro, starting nardil and stopping the ketamine?
Hi Alchemy,
Yes, that's the plan.
> my guess is that there will be some kind of adjustment for your body after stopping ketamine. and then there is the break period between ssri's and maoi's which might mean another withdrawal. people have had great experiences with maoi's. your dr shouldn't have made you have to beg!
That's correct. Not something I'm looking forward to, but I'm *trying* to prepare myself.
> I'm sorry you are going through this. It sounds like it has been a bad year but that it will eventually turn around.
Thank you. I really hope so.
-b
Posted by Emme_V2 on April 9, 2013, at 6:43:38
In reply to Switching meds-feedback?, posted by brynb on April 8, 2013, at 15:21:34
Hi Bryn,
I agree with alchemy that stopping ketamine, ditching Lexapro, and starting Nardil isn't all that huge a change. I guess you could wait a little while after stopping ketamine, but it sounds like you are in a bad place and waiting an extra few weeks with a SSRI wash-out on top of that starts to make it a long time.
Good luck with the Nardil. I see reports of success with it on this board, and it's a new avenue for you in terms of type of drug.
You mention unstable moods. Up and down? Cyclic? I can't recall your diagnosis - are you bipolar?
I also can't recall if you've tried Lamictal. In combination with Abilify, I've found it pretty effective for depression. Lamictal might be combined with an anti-depressant as well. Have you tried anything else in the mood stabilizer category?
I agree you shouldn't even think med-free for now. Get well and then give you brain time to heal before you revisit that question.
Good luck.
emme
Posted by brynb on April 9, 2013, at 7:54:08
In reply to Re: Switching meds-feedback? » brynb, posted by Emme_V2 on April 9, 2013, at 6:43:38
> Hi Bryn,
>
> I agree with alchemy that stopping ketamine, ditching Lexapro, and starting Nardil isn't all that huge a change. I guess you could wait a little while after stopping ketamine, but it sounds like you are in a bad place and waiting an extra few weeks with a SSRI wash-out on top of that starts to make it a long time.
>
> Good luck with the Nardil. I see reports of success with it on this board, and it's a new avenue for you in terms of type of drug.
>
> You mention unstable moods. Up and down? Cyclic? I can't recall your diagnosis - are you bipolar?
>
> I also can't recall if you've tried Lamictal. In combination with Abilify, I've found it pretty effective for depression. Lamictal might be combined with an anti-depressant as well. Have you tried anything else in the mood stabilizer category?
>
> I agree you shouldn't even think med-free for now. Get well and then give you brain time to heal before you revisit that question.
>
> Good luck.
> emmeThanks, Emme. I really appreciate your input.
My Dx has never officially been established. It was always MDD (w/GAD) or possibly bipolar 2. The more I learn, the more I believe depression in general is rarely unipolar. Mine has worsened significantly with age and I notice more cycles. I have about 3-4 bad depressive episodes a year (it could be less, I'm not sure, but I'm certainly not in remission in between).
I've also had manic reactions to meds (Neurontin, ironically, is a huge offender) and symptoms of hypomania and mixed states. I've been too unstable as of late and sometimes lack the insight to see what's happening during a situation, but I'm coming around and gaining some clarity in hindsight.
Unfortunately, mood stablizers in general, in particular Lamictal, exacerbate my depression. Abilify and the AAPs all make me feel off in some way without helping the depression. Damned if I do, damned if I don't.
I agree time is crucial right now for me to heal, and of course, patience (especially while in a funk) in not my strong suit.
Thanks again.
-b
Posted by brynb on April 9, 2013, at 11:20:34
In reply to Switching meds-feedback?, posted by brynb on April 8, 2013, at 15:21:34
Another question: I've heard so many varying opinions about the various generics this med has, and the old vs. the new formula.
Should I be asking for brand vs. generic (does it even come in brand)?
Any feedback on which companies seem to have the formula down or where to start w/ this med is much appreciated.
Thanks again.
-b
Posted by Tomatheus on April 9, 2013, at 12:46:02
In reply to Re: Nardil brand vs generic?, posted by brynb on April 9, 2013, at 11:20:34
Bryn,
I know that I've written a lot here about the old and new versions of Nardil, and I do think that many were affected by the 2003 formulation change. Unfortunately, the version of Nardil that was available until the fall of 2003 doesn't seem to be available anywhere, and nobody seems to have found a good way to get any of the new versions of Nardil to perform as well as the old version in those who don't seem to respond as well to the new versions. I had some success with putting the contents of my Nardil tablets into enteric capsules, but for reasons that I'm not 100 percent sure of, even this strategy didn't work out for me in the long run. And even when I did seem to be able to get my Nardil to be both more effective and more tolerable by using the enteric capsules, I found that the medication became both less effective and less tolerable the longer I kept my tablets in the pill bottle on my shelf. So for these reasons, even though I'd wish anybody trying the enteric capsule approach luck, I don't actively promote it.
Even though I think that there was something about the formulation change that caused some people taking Nardil to have problems back in 2003, it does seem that not everybody taking the medication was affected by the formulation change. Some have tried to argue that those affected by the change were in the majority, while others have argued that those affected represent a small minority. I don't think it's entirely clear what portion of those taking Nardil were affected by the formulation change as far as either effectiveness or tolerability were concerned, but it does seem clear from what I've read that many people taking Nardil experienced no problems with the medication when the formulation was changed. Because there is a chance that anybody starting Nardil might respond to the medication just fine (or at least in the same way that they would have responded to the "old" Nardil), I think that starting out with regular film-coated Nardil would be the most advisable thing to do.
As far as the "brands" of Nardil are concerned, it's my understanding that there are three versions available in U.S. pharmacies: the Pfizer name-brand Nardil and generics made by Gavis and Greenstone. Greenstone LLC is a subsidiary of Pfizer, and considering that the inactive ingredients in Greenstone's phenelzine are the same as those in Pfizer's Nardil, it would be my guess that the two versions should not differ in any way. The version of phenelzine made by Gavis Pharmaceuticals does differ from the Pfizer and Greenstone versions as far as the inactive ingredients are concerned. I do recall reading one or two online anecdotal reports saying that the Gavis phenelzine seemed to be better in some way than Pfizer's Nardil, but it did seem that the few individuals who were still posting on the Anxiety Community's Nardil forum (which doesn't seem to exist anymore) around the time the Gavis phenelzine came out did not find the Gavis phenelzine to be any better than Pfizer's Nardil.
I think that I should also note that I stopped taking Pfizer's Nardil after I received what very well might have been a bad batch of the medication from my pharmacy. I responded very differently to that batch of Nardil than I did to any version of the medication that I had tried previously, noticing a loss of effectiveness and the emergence of some extreme agitation. That was back in 2006. Others who were affiliated with both the Anxiety Community's Nardil forum and the Nardil Problems Action Committee had reported receiving bad batches around that time. I don't seem to recall reading as many reports of bad batches of Nardil more recently, compared to the reports that I was reading about up to around 2006, but whether that's due to Pfizer actually producing fewer bad batches of Nardil would be difficult to say. As the case was with the formulation change, I think that it's unclear how widespread the problem with bad batches of Nardil was. It doesn't seem that as many people were affected by bad batches of Nardil as were affected by the formulation change, but that's just my observation based on the anecdotal reports that I've read. I haven't read any reports of bad batches from individuals who've taken the Gavis phenelzine, and I might expect the Gavis phenelzine to be less likely to have problems with bad batches than the other version of the medication since it's made by a completely different company, but then again, I haven't read any reports of bad batches from individuals who've taken the Greenstone phenelzine, nor have I read any recent reports of bad batches from those taking Pfizer's Nardil.
So, to give you some feedback, I would say that although none of the versions of Nardil that are currently available in U.S. pharmacies are the same as the "old" Nardil, any one of them would probably be a good place to start. I think that I personally would be inclined to start with the Gavis phenelzine if I were taking the medication for depression and/or anxiety and had a choice as to which version to start out with, but the evidence for any differences between the three versions of Nardil/phenelzine seems to be extremely limited to say the least, and it's entirely anecdotal. Whatever version of Nardil/phenelzine you end up starting out with, assuming that you go ahead with taking the medication, I wish you luck. I know that I've included a lot of information in this post and that it might not necessarily make deciding how to proceed with your Nardil trial any easier, but I hope that it's been of at least some help. Please do feel free to let me know if you have any questions, though.
Tomatheus
Posted by brynb on April 9, 2013, at 13:17:50
In reply to Re: Nardil brand vs generic? » brynb, posted by Tomatheus on April 9, 2013, at 12:46:02
>
> So, to give you some feedback, I would say that although none of the versions of Nardil that are currently available in U.S. pharmacies are the same as the "old" Nardil, any one of them would probably be a good place to start. I think that I personally would be inclined to start with the Gavis phenelzine if I were taking the medication for depression and/or anxiety and had a choice as to which version to start out with, but the evidence for any differences between the three versions of Nardil/phenelzine seems to be extremely limited to say the least, and it's entirely anecdotal. Whatever version of Nardil/phenelzine you end up starting out with, assuming that you go ahead with taking the medication, I wish you luck. I know that I've included a lot of information in this post and that it might not necessarily make deciding how to proceed with your Nardil trial any easier, but I hope that it's been of at least some help. Please do feel free to let me know if you have any questions, though.
>
> TomatheusHi Tomatheus-
Thanks so much for all of the info you provided! Regarding your statement above, I suppose I'll just take what the pharmacy gives me and hope for the best.
I finally have some clarity about my situation and I still think the switch to Nardil could be the right move. But, now I'm double guessing my choice as well. I remember taking Celexa years ago and doing well on it. Perhaps I should just switch back to Celexa from Lexapro and change my benzo from Valium to Ativan? I'll be starting TMS in 2 weeks as well.
I need a change, for sure, but I just don't know anymore, and while my pdoc is patient and working with me, he doesn't give me any concrete or convincing arguments one way or another. I'm really pretty lost at the moment.
Thanks again,
b
Posted by Tomatheus on April 9, 2013, at 14:31:30
In reply to Re: Nardil brand vs generic? » Tomatheus, posted by brynb on April 9, 2013, at 13:17:50
Bryn,
Thanks for your reply. Given the fact that you remember having responded well to Celexa in the past, along with the fact that there are some uncertainties surrounding Nardil, I can see why you're thinking that switching to Celexa (and switching your benzodiazepine from Valium to Ativan) might be better than switching to Nardil. One thing that I can say about Nardil is that it does seem to have a clear record of efficacy in treating depressions that have "atypical" features (e.g., mood reactivity, overeating, oversleeping, leaden paralysis, rejection sensitivity). It also seems to have a good track record in treating individuals who have a mixture of depression and anxiety symptoms. Having the atypical features that I mentioned and/or a mixture of depression and anxiety, I think, would be an argument in favor of giving Nardil a try. Then again, one could also argue that if you could respond to Celexa that it might be best to try that again first before going with Nardil, which carries dietary restrictions and may be at least somewhat riskier. So, I think that arguments could be made in favor of either switching to Nardil or switching to Celexa (along with Ativan). This probably won't make deciding which medication to try any easier, but if nothing else, it might give you some reason to be optimistic about your chances of responding favorably either way.
I wish you well with whichever decision you end up making. Maybe somebody else here will be able to offer some more feedback to help persuade you one way or the other. Unfortunately, with the process of selecting medications being one of trial and error, it's usually difficult to say with much certainty which course of action would be best, and that can leave us patients feeling lost and confused.
Tomatheus
Posted by brynb on April 9, 2013, at 15:21:46
In reply to Re: Nardil brand vs generic? » brynb, posted by Tomatheus on April 9, 2013, at 14:31:30
Thanks again, Tomatheus. It's been so long since I've felt well/right/normal that I truly don't know how I'm supposed to feel anymore. I'm also beginning to think that my various med trials have tinkered with my brain far too much, so perhaps Celexa once worked at a time when my brain wasn't so altered by everything I've tried.
I just spoke to my pdoc and he's onboard with either idea. I just need to time to weigh the options right now and the courage to be decisive with either option.
Thanks again.
-b
Posted by Emme_V2 on April 10, 2013, at 6:48:31
In reply to Re: Switching meds-feedback? » Emme_V2, posted by brynb on April 9, 2013, at 7:54:08
Hi Bryn,
It does sound suspiciously like you're in the bipolar spectrum. However, regardless of your diagnosis, you've been trying the meds for both unipolar depression and bipolar. Good luck with the Nardil.
If your doctor is willing to try something a little more experimental, minocycline has been getting attention for possible treatment for several psychiatric and neurologic conditions. I've been taking it for several months now. It's been very very helpful. I did have some startup side effects and needed to titrate up, but I now seem to have no side effects. If you google "minocycline depression" you should get a number of interesting hits, including a short paper titled "Does minocycline have antidepressant effect?" Might be worth discussing with your doctor if Nardil doesn't cut it.
Other weird things that I have found helpful include Aricept and memantine.
emme
> > Hi Bryn,
> >
> > I agree with alchemy that stopping ketamine, ditching Lexapro, and starting Nardil isn't all that huge a change. I guess you could wait a little while after stopping ketamine, but it sounds like you are in a bad place and waiting an extra few weeks with a SSRI wash-out on top of that starts to make it a long time.
> >
> > Good luck with the Nardil. I see reports of success with it on this board, and it's a new avenue for you in terms of type of drug.
> >
> > You mention unstable moods. Up and down? Cyclic? I can't recall your diagnosis - are you bipolar?
> >
> > I also can't recall if you've tried Lamictal. In combination with Abilify, I've found it pretty effective for depression. Lamictal might be combined with an anti-depressant as well. Have you tried anything else in the mood stabilizer category?
> >
> > I agree you shouldn't even think med-free for now. Get well and then give you brain time to heal before you revisit that question.
> >
> > Good luck.
> > emme
>
> Thanks, Emme. I really appreciate your input.
>
> My Dx has never officially been established. It was always MDD (w/GAD) or possibly bipolar 2. The more I learn, the more I believe depression in general is rarely unipolar. Mine has worsened significantly with age and I notice more cycles. I have about 3-4 bad depressive episodes a year (it could be less, I'm not sure, but I'm certainly not in remission in between).
>
> I've also had manic reactions to meds (Neurontin, ironically, is a huge offender) and symptoms of hypomania and mixed states. I've been too unstable as of late and sometimes lack the insight to see what's happening during a situation, but I'm coming around and gaining some clarity in hindsight.
>
> Unfortunately, mood stablizers in general, in particular Lamictal, exacerbate my depression. Abilify and the AAPs all make me feel off in some way without helping the depression. Damned if I do, damned if I don't.
>
> I agree time is crucial right now for me to heal, and of course, patience (especially while in a funk) in not my strong suit.
>
> Thanks again.
>
> -b
Posted by brynb on April 10, 2013, at 7:07:12
In reply to Re: Switching meds-feedback? » brynb, posted by Emme_V2 on April 10, 2013, at 6:48:31
Thanks, Emme.
Now I'm at a major crossroads as my pdoc is letting me decide whether I want to switch to Nardil (I'm currently washing out the Lexapro) or just switch to and start taking Celexa (I took it years ago and remember liking it; I can't say if it's because I was in a better place and my depression has just worsened over time, but perhaps my severe anhedonia is related to SRIs). We're also switching my Valium to Ativan for sleep and acute situations.
To add another confusing variable in the mix, I'll be starting TMS soon as well.
I'm so confused. Well, glad to hear you're finding success with Minocycline. I'll look into it.
Thanks again.
-b
Posted by brynb on April 10, 2013, at 7:23:53
In reply to Switching meds-feedback?, posted by brynb on April 8, 2013, at 15:21:34
My pdoc agreed to let me switch to Nardil (I've been reducing my Lexapro) or let me switch to Celexa, a seemingly easier option as I've taken it before (albeit a long time ago) and I won't need to washout.
I'm also starting TMS in less than 2 weeks. It's clear that Ketamine caused mood instability that sent me into a tailspin.
My choices are:
1. Keep washing out of Lexapro and start Nardil in 2 weeks (the washout has been hellish as I'm so unstable at the moment)
2. Just switch to Celexa and hope I feel a difference in side effects from Lexapro (and not have to deal with going through a washout)
Another variable is I'm starting TMS in less than two weeks, so I think there are too many variables in general and I'm really grasping at straws here.
I don't know what to do and my pdoc isn't helping me decide.
Thoughts?
Posted by Twinleaf on April 10, 2013, at 11:39:32
In reply to I'm so confused!, posted by brynb on April 10, 2013, at 7:23:53
I think it's very important to make one change at a time, so you will be able to evaluate just what is occurring. I think you could make the Lexapro- Celexa change, if you want, as they are so silmiliar, and then try the TMS. Nardil really needs to be started without other changes, so you'll know if it helps you
Posted by brynb on April 10, 2013, at 13:09:55
In reply to Re: I'm so confused! » brynb, posted by Twinleaf on April 10, 2013, at 11:39:32
> I think it's very important to make one change at a time, so you will be able to evaluate just what is occurring. I think you could make the Lexapro- Celexa change, if you want, as they are so silmiliar, and then try the TMS. Nardil really needs to be started without other changes, so you'll know if it helps you
Thanks, Twinleaf. That makes sense. I'm just curious, my pdoc's office told me that I would start to see a response (if I do respond) to TMS in 2-3 weeks. Did you find this to be true in your case?
Thanks,
b
Posted by jono_in_adelaide on April 10, 2013, at 17:44:32
In reply to I'm so confused!, posted by brynb on April 10, 2013, at 7:23:53
I'd try the nardil bryn - lexapro and celexa are so closely related, i wouldnt expect miracles from switching them.
Are you taking a mood stabaliser?
Posted by Twinleaf on April 10, 2013, at 19:02:43
In reply to Re: I'm so confused! » Twinleaf, posted by brynb on April 10, 2013, at 13:09:55
I noticed quite a big improvement after two treatments, but I know not everyone is as responsive to it as I am. I do hope you have good luck with it if you decide on it.
Posted by brynb on April 11, 2013, at 9:20:53
In reply to Re: I'm so confused!, posted by Twinleaf on April 10, 2013, at 19:02:43
Posted by brynb on April 11, 2013, at 9:23:26
In reply to Re: I'm so confused!, posted by jono_in_adelaide on April 10, 2013, at 17:44:32
> I'd try the nardil bryn - lexapro and celexa are so closely related, i wouldnt expect miracles from switching them.
>
> Are you taking a mood stabaliser?Thanks, jon.
My pdoc decided to switch to Celexa and Ativan since I'm starting TMS and was afraid Nardil would add another variable to the mix. It's my back-up plan if this fails (and I'm keeping my fingers crossed it doesn't)!
Thanks again.
-b
Posted by Phillipa on April 11, 2013, at 9:42:52
In reply to Re: I'm so confused! » jono_in_adelaide, posted by brynb on April 11, 2013, at 9:23:26
Brynb so is this the decision. Celexa, ativan, and TMS? Also will you continue with the ketamine? You inferred it kind of wasn't helping? Phillipa
This is the end of the thread.
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