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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 46. This is the beginning of the thread.
Posted by rose45 on April 17, 2013, at 18:35:58
This is my first post on here, though I have been reading many of the existing posts on nardil for a while.
I have suffered from depression pretty much most of my life. I also began to suffer from insomnia at the age of 35. In 1989 I started taking temazepam every 2 days or so, and it really seemed to help with sleep and mood. In 1990, I was becoming more and more anxious and then had what I can only describe as an anxiety breakdown. Couldnt understand what was happening to me, became more and more jittery, confused,depressed,anxious,foggy, spacy, lost my memory and became consumed by panic and bedridden. The temazepam stopped working altogether at that point. I was into holistic medicine, and went to acupuncturists and homeopaths etc. ( was living in California at the time ) and thought I had ME. To cut a long story short, my brother came over and took me back to England as I was incapable of arranging to go on my own. I was eventually admitted to the Maudsley hospital and put on Nardil. It took 7 weeks to work, and when it did , it felt like a miracle. However noone warned me about the manic effects, and I did become very hyper, over talkative and spent more money than I should have. Whenever I lowered the dose, all the old symptoms of depression and anxiety returned and I was told I should probably stay on it for the rest of my life. I tried 3 times to come off it, and landed back in the hospital, as I became so ill.
6 months ago,after being on nardil for 22 years in all, the nardil stopped working altogether and I have been descending into the worst depression ever, with serious cognitive impairment. I cant remember anything, cant cook,totally clumsy,cant make any decisions, cant understand what people are saying to me, can only talk obsessively about myself and my symptoms.. its difficult to explain, but ive become a totally different person, I cant work, cant relate to people and friends tell me I am very negative. My whole life has fallen apart.
Am being treated on the nhs,I asked to increase the nardil,in the hope that it might work at a higher dose, but that made no difference. They then put me on seroquel, which at first, scared me as it really knocked me out at night, and I feel may have contributed to the cognitive problems, but its hard to tell what is what.... the psychiatrist says the problems are from depression, but it feels to me like some kind of brain damage. The psychiatrist wanted to put me on lithium, but I refused, and suggested that I come off the nardil and try parnate,as I suspect the maois might be the only antidepressants which work for me and im scared of just trying one anti depressant after another. Ive been on them for 2 weeks now. The suicidal feelings which I had, have dissipated, but I still have all the cognitive problems and also trouble with sleep. I take oxazepam for that every 2nd day and so far, it hasnt pooped out on me. Basically, I dont have a life, noone wants to be with me, I cant work,cant think straight, cant retain or remember anything, extremely clumsy,cant buy food or clothes in fact I can barely function.If anyone has any feedback it would be very much appreciated, as my fear is that I will be left like this for my whole life and this 'brain damage' will not go away.
Posted by Phillipa on April 17, 2013, at 22:51:46
In reply to nardil tolerance and ensuing cognitive problems, posted by rose45 on April 17, 2013, at 18:35:58
What I can do is welcome you to babble. I have not taken nardil so can't comment on this. But did you receive at any point a diagnosis of bipolar? As you mention both depression & mania? Phillipa
Posted by jono_in_adelaide on April 18, 2013, at 0:22:37
In reply to nardil tolerance and ensuing cognitive problems, posted by rose45 on April 17, 2013, at 18:35:58
If you feel that Parnate is partialy working, but not enough, you could add nortriptyline onto your regimen, starting off with 25mg at night, and increasing it slowly over 2-3 weeks to between 75 and 150mg at night, depending on response and blood levels.
This attacks the depression in a different way to Parnate or Nardil, and for many people with very resistant depression, can be very helpful.
Posted by rose45 on April 18, 2013, at 6:42:30
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by Phillipa on April 17, 2013, at 22:51:46
Hi Phillipa, thank you for the welcome. The psychiatrist Im seeing is, I think, treating me as bipolar, but the truth is it was the nardil that made me manic, and I dont think I was ever manic before taking it. He is keeping me on the seroquel, because he thinks it will keep any 'mania' with parnate at bay.
Posted by rose45 on April 18, 2013, at 6:47:08
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by jono_in_adelaide on April 18, 2013, at 0:22:37
when i was in the Maudsley hospital, they told me it was better to stick to one medication if possible - and now Im already taking two, plus oxazepam for sleep. Have you had good experiences adding noritryptiline? I looked it up and it is an ssri, so I would have thought it would be contraindicated for use with an maoi?
Posted by Tyrannosaur on April 18, 2013, at 11:55:51
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 6:47:08
> when i was in the Maudsley hospital, they told me it was better to stick to one medication if possible - and now Im already taking two, plus oxazepam for sleep. Have you had good experiences adding noritryptiline? I looked it up and it is an ssri, so I would have thought it would be contraindicated for use with an maoi?
SSRIs are as you say contraindicated with MAOIs, but Nortriptyline is a TCA and a very potent norepinephrine reuptake inhibitor. I've read a couple of success stories on this site when Parnate and Nortriptyline was combined. But i would personally wait and see how Parnate works out for you before adding any other medications.
Posted by vanvog on April 18, 2013, at 13:58:00
In reply to Re: nardil tolerance and ensuing cognitive - rose4, posted by Tyrannosaur on April 18, 2013, at 11:55:51
"The older TCAs (and some other antidepressants, e.g. mianserin, trazodone) have been shown to cause more impairment than the newer antidepressants (including lofepramine) in laboratory tests of cognitive and psychomotor function (Hindmarch et al, 1992).
The older tricyclics have also been shown to cause impairment in driving tests, whereas SSRIs, reversible inhibitors of monoamine oxidase A (RIMAs) and nefazodone cause little or no impair ment (Louwerens et al, 1986; Raemaekers et al, 1994; Robbe & O'Hanlon, 1995; Van Laar et al, 1995). Although these findings support the use of the newer drugs for long-term treatment, the predictive validity of psychomotor tests has been questioned (Parrott, 1987;Freeman &O'Hanlon, 1995).Many skilled tasks can be performed without undue effort and with spare processing capacity left available, and it has been suggested that information-processing tasks are measures of competence (potential) rather than actual performance (Parrott, 1991).
Furthermore, most of the investigations were carried out after short-term administration of drugs (sometimes in single doses), rather than during longer-term treatment, when adaptation may occur. Adaptation to the effects of TCAs on driving has, in fact, been demonstrated (Ramaekers et al, 1994; Robbe & O'Hanlon, 1995; van Laar et al, 1995). Perhaps these considerations explain why TCAs were found in the body fluids of only 0.2% of people who died in traffic accidents, compared with alcohol in 35% and other drugs liable to affect the CNS in 7.4% (Everest et al, 1989).
Consistent with the observations that older TCAs cause psychomotor impairment, is the finding that elderly drivers treated with these drugs have an increased risk of vehicle crashes in which injuries are sustained, and that there is a relationship between the risk and dose of drug (Ray et al, 1992; Leveille et al, 1994). This suggests that the drugs contribute to the accidents, although inability to control for all potentially confounding variables does not allow for definite conclusions to be reached. The extent to which antidepressants cause or contribute to road traffic and other accidents is not known. Nevertheless, the aforementioned concerns should be taken into account in the choice of drug for long-term treatment. Although the risk may be greater when treatment is first introduced, it should also be considered when the dose is increased or when antidepressants are taken with other substances that affect cognition and psychomotor performance. For patients thought to be at high risk of accidents, including those who experience persistent sedation when taking TCAs or drug combinations, it is sensible to err on the side of safety and prescribe non-sedative antidepressants.
http://apt.rcpsych.org/content/3/1/52.full.pdf
Also:
Edwards, J. G. (2004) Unwanted effects of psychotropic drugs. 1. Effects on human physiological systems, mechanisms and methods of assessment. In Seminars in Clinical Psychopharmacology (2nd edn) (ed. D. J. King), pp. 573600.
Posted by jono_in_adelaide on April 18, 2013, at 17:45:09
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 6:47:08
> when i was in the Maudsley hospital, they told me it was better to stick to one medication if possible - and now Im already taking two, plus oxazepam for sleep.
----> Thats very true, but the key words are "where possible" - in your case, it isnt possible right now
I'd drop the Seroquel and substitute the nortriptyline taken in a single dose at bedtime
Have you had good experiences adding noritryptiline?
I looked it up and it is an ssri, so I would have thought it would be contraindicated for use with an maoi?
-----------> Nortriptyline is a tricyclic, not an SSRI, it has been commonly used *ss a booster with MAOI's and SSRI's for decades, it mainly works on noradrenalin, with minimul effects on seretonin reuptake
Posted by rose45 on April 18, 2013, at 18:04:38
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by jono_in_adelaide on April 18, 2013, at 17:45:09
is noritryptiline good for sleep ? Why would you stop the seroquel ? I just ask because my psychiatrist seems to be very keen on seroquel,and says he wants to keep me on it to stop me going manic on the parnate. I cant say ive felt much benefit from the seroquel, apart from helping with sleep, but in a strange kind of way.
Posted by jedi on April 18, 2013, at 23:11:59
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 18:04:38
Hi Rose, we are similar in a lot of ways. I have been on Nardil for most of 15 years. No combination of other meds (45+) has ever worked for me. I have stopped Nardil at least a half dozen times over the years, the major depression has always returned. I am lucky in that going back on Nardil has always stopped the major depression. I have had a level of dysthymia since my teenage years, and this has never gone away. But at least Nardil stops the major depression for me.
I was hypomanic, maybe manic, the first time I used Nardil in 1998. I made some very bad financial decisions at the time. Luckily, the mania went away, and has never returned; even after restarting Nardil after 9 months off.
I have some memory impairment also, I blame this mostly on the concurrent use of of clonazepam. I am currently in a very slow taper off the benzo, down to .5 mg per day.
I have been on every medication that you mention in your posts. I have taken Seroquel with Parnate. Unfortunately, for me, Parnate caused a rare spontaneous hypertensive reaction. So that trial ended. I have also used Nortriptyline in combination with Nardil. This can work well in some people, but for me, it did not really add very much.
Seroquel is an atypical antipsychotic, which in low doses, can work very well for sleep. Your Dr. is right in that it can help stop a med induced hypomania or mania. I believe that atypical depression does lie somewhere on the bipolar spectrum, and that is why we can be vulnerable to the med induced mania. Just my opinion. It is strange to me why the mania has never returned after it hit me when first starting Nardil. I'm wondering if the formula change in 2003? had something to do with it?
I am so sorry that the Nardil quit working for you. The MAOIs are a category of meds that can work for major depression when all others fail. Good luck with the Parnate. I know how painful major depression is. Worst pain I have ever had, including all physical pain!
Good luck and be well,
Jedi
Posted by rose45 on April 19, 2013, at 13:41:58
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 18, 2013, at 23:11:59
Thank you all, and especially Jedi for that long and detailed explanation. When I was on Nardil, I would take the dose up to 60 mg and stay on that for one month or so, and then go down to 45 mg, which was supposed to be my mainteance dose.But because of the side effects etc... I was always trying to reduce it slightly, and for the last 4 years, actually managed ok on 30mg per day... so there were minimal side effects, and i didnt need to take sleeping meds, as I managed to sleep ok. But the tendency to get manic, talk too much, get irritable etc, was always there.
The psychiatrist I am seeing on the NHS is being very flexible and agreed to put me on parnate, although he doesnt seem to know anything about maois. Is there anyone on these boards who knows a psychiatrist in London who does know about them ?I ve been told i can apply to the maudsley for a second opinion, but it would cost £600 for a 2 hr appt. and Im not sure they would have that much to add.The younger doctors seem to not know maois at all. Im on 30 mg parnate now..... they are stimulating and Im wondering if I could ever manage to sleep without sleeping pills, whilst on parnate. According to my psychiatrist, 30 mg is a therapeutic dose, though I notice that the americans on this board take much larger amounts. I still have no memory and my cognitive skills are zero, and I still couldnt work, but my mood has lifted, although Im still as spacy, and dont really feel myself. If this medication does work, how much longer should I give it ?I also take 100 mg seroquel at night and 50mg extended release, and am wondering if I should try to get off it, as maybe it is adding to the very spacy , passive, and unmotivated mood I am in. The one thing I remember about nardil is that once it worked, I became very motivated. The psychiatrist doesnt believe that its just the medication that stopped working, but it was also the kind of late mid life crisis I was going through. All I know is that when nardil worked at the beginning, I went through so many crises, but was able to see them through, thanks to the medication. Maybe sometimes its hard to know what is due to the illness, and what is due to the medication.
Posted by baseball55 on April 19, 2013, at 19:23:36
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 19, 2013, at 13:41:58
I take 30mg parnate a day and that is enough for me. My doc won't prescribe high doses and I haven't felt I needed them. However, even after 3-1/2 years, insomnia is still an issue and I need sleep aids. I use xanax and trazadone and those seem to put me out most nights. When I've tried to go without, I don't sleep at all. Insomnia is the only lasting side effect I have from parnate. Others -- like postural hypotension -- went away after several months on the drug.
Posted by rose45 on April 20, 2013, at 18:51:01
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by baseball55 on April 19, 2013, at 19:23:36
I dont like the idea of having to depend on a benzo forever, which taking parnate implies.
Also, noone has mentioned severe cognitive difficulties, which I have had since the nardil stopped working. I literally have no memory, and cannot count the change in coins if I buy something, and havent been able to buy food, remember dishes I used to cook, buy clothes..... its as if im in a fog, and a totally different person really scary. Has anyone else experienced this to that degree?
Posted by rose45 on April 21, 2013, at 5:40:44
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 20, 2013, at 18:51:01
i also spoke to dr. ken gillman on skype last night. He said that the usual dose on parnate is 30-50 mg and he recommends trazodone for sleep. Is anyone using trazodone as a sleeping medication with maois?
Ive been useing a low dose of seroxat, and also seroquel, but am pretty sleepy and tired during the day.
Posted by jedi on April 21, 2013, at 12:59:46
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 5:40:44
> i also spoke to dr. ken gillman on skype last night. He said that the usual dose on parnate is 30-50 mg and he recommends trazodone for sleep. Is anyone using trazodone as a sleeping medication with maois?
> Ive been useing a low dose of seroxat, and also seroquel, but am pretty sleepy and tired during the day.I've used Traz in the past, but it gives me a very unpleasant drugged feeling. I'm lucky that I'm really sensitive to the histamine meds and 50mg of diphenhydramine hydrochloride(Benadryl) usually knocks me right out. I also usually use my .5mg of clonazepam at night.
The insomnia is one side effect of Nardil that has not gone away over the years. I have always had to treat it somehow. Parnate is a lot more stimulating than Nardil and the insomnia may have to be treated more aggressively.
Be Well,
Jedi
Posted by rose45 on April 21, 2013, at 17:05:46
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 21, 2013, at 12:59:46
thats interesting jedi, I thought benadryl was not allowed with maois. When I was on nardil, when it was working, I did manage to sleep ok without meds most of the time, but parnate feels much more stimulating... So far though, the insomnia seems to be the main side effect. I had loads of side effects with nardil and kept changing the dose and it often took quite a lot of time to get it back up and working after lowering the dose even slightly. I am praying that parnate will work, because I really dont know what I can do if it doesnt.
Does anyone know whether with parnate, you need to boost it to a higher dose, before lowering it to a maintenance dose as you do with nardil. When I was on nardil in hospital, the dose would go up to 60 mg. for a month or so, and would then be reduced to 45 mg maintenance dose. Is that how Parnate works too?
Posted by baseball55 on April 21, 2013, at 19:26:25
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 17:05:46
Raising then lowering the dose isn't how it worked for me. They just started me on 30mg and kept me there. Fortunately, 30mg has been enough most of the time and when it hasn't been, I have found that 200mg lamictal helps.
Posted by Phillipa on April 21, 2013, at 21:01:08
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by baseball55 on April 21, 2013, at 19:26:25
Isn't seroxat a combo of serquel & prozac? Or am I comfused? Phillipa
Posted by Phillipa on April 21, 2013, at 21:03:41
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 5:40:44
Google says seroxat is paxil? Are you taking an Maoi with an SSRI if so contraindicated. Phillipa
Posted by jedi on April 21, 2013, at 22:39:01
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Phillipa on April 21, 2013, at 21:03:41
> Google says seroxat is paxil? Are you taking an Maoi with an SSRI if so contraindicated. Phillipa
Rose, Phillipa is right on the paroxetine (which is a SSRI) with Parnate. Was this combination prescribed by a Dr. SSRIs with MAOIs are a strict contraindication. Serotonin syndrome and death can result.
I've never had any problems with Benadryl and MAOIs. I've also used nortriptyline and bupropion with Nardil, no problem.
But serotonin syndrome is nothing to mess with.
Jedi
PS Here is a post on serotonin syndrome from Elisabeth, an old poster on here who I consider the guru of treatment resistant depression.
http://www.dr-bob.org/babble/20020402/msgs/101847.html
Google some of her posts on MAOIs. A wealth of accurate information.
Posted by jono_in_adelaide on April 22, 2013, at 0:17:18
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 18:04:38
I'd stop the Seroquel because it isnt working
Nortriptyline does help with sleep, yes
If you realy do need somthing to stop you going manic, then Tegratiol, Lamactil or Lithium would be better choices than low dose Seroquel
Posted by rose45 on April 22, 2013, at 4:27:34
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Phillipa on April 21, 2013, at 21:01:08
Sorry, I didnt mean seroxat... that is typical of what is happening to me, my memory and cognitive skills are zero.... I meant that im taking oxazepam for sleep... and i take it every 2nd day, but am getting worried because I dont want to get addicted to it, and I have never reacted well to tricyclics, so that is going to be a problem re. sleep if I stay on parnate long term.. I havent been able to work since the nardil pooped out on me, so Im praying that parnate will help.
Posted by rose45 on April 22, 2013, at 5:05:17
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by jedi on April 21, 2013, at 22:39:01
Thanks for the links, jedi. Does Elizabeth no longer post ? Sounds like she didnt stay on parnate for very long.... wish there were more long term parnate users - it would give me some encouragement.
Posted by jedi on April 22, 2013, at 9:51:15
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 22, 2013, at 5:05:17
> Thanks for the links, jedi. Does Elizabeth no longer post ? Sounds like she didnt stay on parnate for very long.... wish there were more long term parnate users - it would give me some encouragement.
Not sure what became of Elisabeth. If anyone knows, please post. She had severe treatment resistant depression and I believe was doing trials with buprenorphine when she last posted. Her posts were highly knowledgeable, on the SLS level or beyond. Even the MAOIs don't work for everyone. I still believe they are wonder drugs for atypical depression and social anxiety. I have heard of more long term success on Nardil than any other medication.
That being said, I often wonder where I would be if I could have gotten beyond my first major depression without having to use the MAOIs. I'm not sure I would have survived. I've had the dysthymia since my teenage years, but my major depressions have been life threatening. Still, I look at my level of success before the first major depression hit, and wonder if the medications caused some of the lost productivity since or if I just put it all on depression. Before the first "Big One" hit, when I was 40, I owned and managed a small computer & networking company, grossing over a half million per year. Also owned and managed 50 residential rentals. With major depression and the side effects of the medications, I know I could not do that now. I have missed what should have been the most productive years of my life.
I just have to play the hand I was dealt. So many people have it so much worse. Because I know what the pain is like, I feel deeply for people that can never control the major depression.
What is the highest dosage of Nardil that you have been on, Rose? I have always needed 60mg for maintenance. Sometimes, in low anxiety times, I can survive on 45mg. On the other hand, I have routinely used 90mg per day, and have been on doses as high as 120mg to kick back a major black hole. If the Parnate does not work, I would suggest high dosage Nardil. The medication worked well for you for many years.
Good Luck,
JediPS I am still thinking my long term use of clonazepam has really been the main factor in my cognitive decline. I sure hope it is not permanent! Sometimes feels like the early stages of dementia. I sure don't want to go there!
Posted by Phillipa on April 22, 2013, at 18:59:46
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 22, 2013, at 9:51:15
Jedi excellent post!!!! Phillipa
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