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Dr. Bob is Robert Hsiung, MD,
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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
Posted by rose45 on April 23, 2013, at 13:44:59
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 22, 2013, at 9:51:15
Very interesting post, jedi.
I also have had depression pretty much all my life. It was in my family, both my mother and her father suffered from it. I remember as a child of 6, hiding in the toilets at break time at school, because I was afraid of the other children. I always did well academically, but not socially.At the age of 36, I began to have insomnia. I would sleep for 3- 4 hrs and then wake up and not be able to sleep again. It was exhausting, but since I am into meditation and yoga etc. I never thought of taking medication, but tried homeopathy etc. which never really helped.
10 years later, I had a major 'breakdown'... didnt understand what was happening, but became very very anxious, depressed and unable to function at all. There were events in my life which contributed to this, but I often wonder whether it was aggravated by taking temazepam, which I had discovered just about 6 months before.... I took it every 3 days or so for 6 months in total, and it stopped working at the time I had the breakdown .
In my case, when I went on the nardil, I became manic, although I didnt realise it, and none of the doctors mentioned it as a side effect.This was in 1990. It seems that only recently have they started admitting that antidepressants can make you manic- because they can now give you an antipsychotic to balance it out !At least, thats what my psychologist told me when we were discussing it.Anyway, I became very motivated, started a massage business and did very well for 20 years.So in my case, the medication brought more productivity than before.However, when the nardil stopped working 6 months ago, I became a suicidal wreck. The most nardil I have ever taken is 60 mg, and I cant imagine taking more than that, because the side effects are horrendous for me. I would stay on 60 mg for one month or so, and then reduce to 45 mg, and I was able to sleep without meds most of the time on that dose - though in the past 4 years, I had reduced to 30 mg, and that was my ideal dose from the point of view of fewer side effects etc.
Ive been on 30 mg parnate for 3 weeks or so and tomorrow I will suggest to the psychiatrist that we up it to 40 mg. I do feel better on it, and my psychiatrist has never given it to anyone, so he really doesnt have a clue about it. I will show him the documents which dr.ken gillman sent me re. taking your blood pressure etc.
I will keep you updated. Really hoping that parnate will work, but Im still not sure what to do about the sleeping problem, because i dont want to get addicted to benzos. Nothing is simple with this illness, is it ?
Posted by rose45 on April 25, 2013, at 7:01:22
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 23, 2013, at 13:44:59
Well I saw the psychiatrist yesterday, and he refused to increase the dose of parnate to 40 mg, and he also refused to order trazodone, because acc. to his books its dangerous to combine tca with maoi. I have phoned dr. gillman and he told me it is possible to order trazodone on the net, if I want to. Has anyone ordered medications over the net ? Do you know whether desyrel is the same as trazodone ? It cost half of what trazodone does, and as far as I know is the same product. It seems that a lot of people dont like trazodone, but I cant stay on benzos for the rest of my life.
Any feedback would be really helplful.
Posted by rose45 on April 25, 2013, at 7:22:52
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 25, 2013, at 7:01:22
Have just read that if you are bipolar (which my psychiatrist thinks I am) then trazodone will not work for you. Any thoughts on this from anyone?
Posted by Englishman006! on May 12, 2013, at 1:34:07
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 25, 2013, at 7:22:52
> Have just read that if you are bipolar (which my psychiatrist thinks I am) then trazodone will not work for you. Any thoughts on this from anyone?
Hi Rose, I don't for a minute believe you have manic depression or bipolar as its now referred to. I'm surprised that dr's still diagnose people as bipolar, after a 'medication induced' hypomanic episode. My theory is that when you get depressed on an ongoing basis the receptors in the brain are starved of dopamine. In an effort to compensate (and this is purely my belief) the receptors become super sensitive allowing them to mop up any dopamine that is available. Then Nardil is introduced and for the first time in a long time dopamine becomes abundant. But the receptors super sensitive response results in mania. In effect too much dopamine transmission is now at work, until they desensitise gradually (adapt to the drug).
Unless you have experienced mania which was not drug induced, my guess is they have mis-diagnosed you. I would try stabilising the dose of parnate at it's minimal effective dose and VERY SLOWLY introduce Lamotrigine beginning at 25mg (any sign of rash discontinue immediately) for first week or so then slowly taper up over six weeks - under medical guidance, to 200mg. Provided lamotrigine doesn't interact with maois this should provide an antidepressant effect, it even acts as a mood stabiliser for resistant bipolar. The side effects are pretty benign. If all goes well perhaps you could reduce or wean off the the other meds..?
Posted by rose45 on May 20, 2013, at 16:56:36
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Englishman006! on May 12, 2013, at 1:34:07
hi Englishman,
I agree with you - I dont think I am bipolar either. In fact I am weaning off the quetiapine, and at the moment just on 25 mg for sleep. The parnate has been amazing, completely got rid of my depression. Im taking 40 mg and might reduce to 30 mg, and really dont feel the need to take anything else, except to sleep, and hopefully will wean off sleeping tablets also. I was so surprised that parnate had no other side effects, as nardil was a far more complex drug with loads of side effects for me.
Posted by Venielle on May 27, 2013, at 5:47:43
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on May 20, 2013, at 16:56:36
Hi Rose. My husband takes trazodone for insomnia and it works well for him. He can't take benzos as he gets disinhibited on them. He does not, however, take MAOIs. I found this info on trazodone that might help.
Trazodone (also sold under the brand names Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, and Mesyrel) is an antidepressant of the serotonin antagonist and reuptake inhibitor (SARI) class.
Because it is not known whether an interaction will occur between trazodone and monoamine oxidase inhibitors (MAOI's), administration of trazodone should be initiated very cautiously with gradual increase in dosage as required, if an MAOI is given concomitantly or has been discontinued shortly before medication with trazodone is instituted.
Posted by Linderthered on May 28, 2013, at 11:06:00
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Venielle on May 27, 2013, at 5:47:43
I've been on MAOIs since the early 1990s (with two breaks of 1-2 years). Something I just noticed is that nobody has suggested replacing Nardil with Marplan (isocarboxazid).
I was initially treated for severe agoraphobia with Marplan, which worked amazingly well. In less than a week my agoraphobia was 90% gone. The only reason I was moved to Nardil is that Marplan was discontinued by its then-manufacturer (Roche). I understand it is available again.
Posted by rose45 on January 25, 2014, at 7:31:46
In reply to Re: nardil tolerance and ensuing cognitive problems » jedi, posted by Phillipa on April 22, 2013, at 18:59:46
Just thought I would write about what has been happening in the past year. Have been on Parnate 30 mg since last april 2013. It does make me feel tired but Im willing to put up with that side effect. The main problem is the insomnia. I use 4 sleeping pills in rotation, so as not to get accustomed to any one of them , but they seem to work less and less well. They are: temazepam, oxazepam, zopiclone, melatonin.
I use one for 4-5 days and then switch them. But they are working less well and Im becoming more and more irritable. Not sure how I can carry on like this for the rest of my life. But MAOIs are the only antidepresant which have ever worked for me.
Posted by SLS on January 25, 2014, at 8:28:41
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on January 25, 2014, at 7:31:46
> Just thought I would write about what has been happening in the past year. Have been on Parnate 30 mg since last april 2013. It does make me feel tired but Im willing to put up with that side effect. The main problem is the insomnia. I use 4 sleeping pills in rotation, so as not to get accustomed to any one of them , but they seem to work less and less well. They are: temazepam, oxazepam, zopiclone, melatonin.
> I use one for 4-5 days and then switch them. But they are working less well and Im becoming more and more irritable. Not sure how I can carry on like this for the rest of my life. But MAOIs are the only antidepresant which have ever worked for me.What happens when you increase the Parnate to 40 - 80 mg/day? If you are going to get tired and have insomnia anyway, you might as well take a modern accepted dosage of Parnate and have a much better chance of making the depression vanish. Both side effects are treatable. I've been there. You could use Focalin or Provigil for the daytime sleepiness. For insomnia, you can use lorazepam or zopiclone and use the same drug every night. You are unlikely to need an escalating dose after a certain point. I once combined two benzodiazepines for Parnate insomnia. This treatment worked well for several years until I no longer needed it.
- Scott
Posted by rose45 on January 25, 2014, at 12:38:03
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by SLS on January 25, 2014, at 8:28:41
Scott,
I dont really want to take additional stimulants.That would not help with the insomnia.
Parnate is stimulating enough... dont understand why it makes me so tired and sleepy during the day, but I cant sleep at night. Also promised my psychiatrist that I wouldnt increase the dose of sleeping pills, because that could become dangerous. So Im sticking to one sleeping pill, and changing from one brand to another. I did start off with 40 mg of parnate, but reduced it to 30 mg. I take the whole dose in the morning and it does make me feel rather nauseous. Dont know that increasing the dose would make much difference and it could possibly increase the insomnia.
Posted by SLS on January 25, 2014, at 13:42:12
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on January 25, 2014, at 12:38:03
> Scott,
>
> I dont really want to take additional stimulants.That would not help with the insomnia.
> Parnate is stimulating enough... dont understand why it makes me so tired and sleepy during the day, but I cant sleep at night. Also promised my psychiatrist that I wouldnt increase the dose of sleeping pills, because that could become dangerous. So Im sticking to one sleeping pill, and changing from one brand to another. I did start off with 40 mg of parnate, but reduced it to 30 mg. I take the whole dose in the morning and it does make me feel rather nauseous. Dont know that increasing the dose would make much difference and it could possibly increase the insomnia.Okay.
- Scott
Posted by phinxeezaDr on February 9, 2014, at 20:39:42
In reply to nardil tolerance and ensuing cognitive problems, posted by rose45 on April 17, 2013, at 18:35:58
Hi. For what its worth I've been on MAOIs for 10yrs. Started on Nardil. WOW! It was amazing at 1st. I even asked my pdoc if I seemed hypo-manic to him but he simply replied that I had just come outa my box for the 1st time since very early childhood. I was on a high- a natural high. After this faded I still got a lot from Nardil. It made it easier to meet and blend with people esp at work. Then it became less effective and despite several addons it never worked as well as at the start. So I switched MAOIs. Marplan (isocarboxazid) certainly does not have that 'soul changing' effect of Nardil but it is still a very potent antidepressant. It just needs proper dosing, which unfortunately is a lot higher than the txt suggests. I take 90mg whilst the max remains at 60mg. The best thing about it tho is that it can be combined with a lot more meds than Nardil. I also take Seroquel which definitely accentuates my ADs (isocarboxazid, amitriptyline & bupropion). Yes, BUPROPION! Not a rout many docs would would consider going, but its actually quite safe. In fact several NRIs have been shown to protect from Hypertensive Crisis rather than precipitate them.
Basically, try Marplan before taking the plunge with Parnate. I'm very surprised your doc didn't move to Marplan next. You can manipulate Marplan a lot more than the other 2. Also you might do better on a short acting benzo like Xanax which has a short half life meaning less addictive, if taken as needed. Best wishes
Posted by Linderthered on February 10, 2014, at 0:14:31
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by phinxeezaDr on February 9, 2014, at 20:39:42
Even though MAOIs treated my agoraphobia when nothing else would, I would like to add that cognitive therapy was extremely beneficial. Even when MAOIs were working well for me, I would still have anxiety attacks - some for an extended period of time.
I began cognitive therapy after going through a particularly horrible breakup. I learned some effective self-help methods that I still use some 15 years later. Although I still have short anxiety attacks 2-3 times a year, I never have that "hanging on by the fingernails" feeling again.
Increasing my exercise intensity also helped as well.
Ultimately, I've learned that although meds are very important, they work even better if they aren't the only thing you're relying on.
Posted by berry on February 10, 2014, at 19:43:11
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by SLS on January 25, 2014, at 13:42:12
> > Scott,
> >
> > I dont really want to take additional stimulants.That would not help with the insomnia.
> > Parnate is stimulating enough... dont understand why it makes me so tired and sleepy during the day, but I cant sleep at night. Also promised my psychiatrist that I wouldnt increase the dose of sleeping pills, because that could become dangerous. So Im sticking to one sleeping pill, and changing from one brand to another. I did start off with 40 mg of parnate, but reduced it to 30 mg. I take the whole dose in the morning and it does make me feel rather nauseous. Dont know that increasing the dose would make much difference and it could possibly increase the insomnia.
>
> Okay.
>
>
> - ScottI had a similar experience with Nardil, although it pooped out after about 6 months. I would suggest trying lamictal which is the only other medication which gave me any kind of relief. hang in there and best of luck.
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