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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Uncouth on January 7, 2015, at 19:38:20
Hi,
I've been at 120mg of Nardil for the past two months, up from 90mg where I was for many months. The benefit I received initially at 90 seemed to go away, and now at 120 I am not feeling much additional benefit, especially in the socialization/anxiety dimension. My depression is fairly well managed but there hasn't been the impact on social motivation, focus/attention as I would have liked. I currently feel no detectable side effects with Nardil, and to-date haven't had anything close to a hypertensive reaction from eating things even as risky as raw cacao nibs (a lot of them at once on an empty stomach). Eat as much and as many types of cheese as I want.
SO I'm wondering if for some reason even 120mg is not enough for me and if i would benefit from going even higher.
Have people heard of those who haven't seen benefit with Nardil until they take it even higher than the max recommended dose of 120mg? FWIW, I am also pretty heavy/muscular, and also take Bydureon, which slows digestion (long acting Byetta similar to Victoza, a GLP1 agonist) and which I suspect may be having some impact on how I absorb Nardil (even though I try to always take on an empty stomach).
Basically, how high can I go? Dr. says he doesn't have experience with more than 120mg. What else could I add that would help with the social motivation/anxiety and desire? Wellbutrin was tried at 90mg of Nardil up to 300mg of wellbutrin; didn't really do it.
Thanks
Uncouth
Posted by Tomatheus on January 7, 2015, at 21:34:38
In reply to Nardil (Phenelzine) - Super high dose?, posted by Uncouth on January 7, 2015, at 19:38:20
> ... SO I'm wondering if for some reason even 120mg is not enough for me and if i would benefit from going even higher.
>
> Have people heard of those who haven't seen benefit with Nardil until they take it even higher than the max recommended dose of 120mg? ...Uncouth,
If my recollection is correct, some of those who seemed to respond less favorably to Nardil following the 2003 formulation change, relative to how they responded prior to the change, tried taking abnormally high doses to see if such doses might prove to be as effective as the old version of Nardil without unacceptable side effects. I think I recall doses as high as 135 mg of Nardil being used. Even higher doses might have been used in some instances, but it's hard for me to remember if anyone tried 150 mg or more. To my knowledge, nobody stayed at the higher doses for an extended period of time. Probably, the higher doses either weren't significantly more effective than 90 mg or produced too many side effects for the individuals in question. So, to answer your question, I have not heard of anyone taking 135 mg or more of Nardil and noticing benefits that they didn't notice at lower doses. Maybe there's somebody out there who has heard of someone doing well on 135 mg or more of Nardil, but I can't say that I have.
For the most part, I'll leave your question concerning what you can take with Nardil to boost its effectiveness to those who have more knowledge than I do in the area of medication combos. I think that the add-ons (namely Deplin, Abilify, and Seroquel) that are used with first-line antidepressant treatments are most likely ok to take with Nardil, although my knowledge of drug interactions is limited. Others here may know more about other medications that shouldn't pose problems when taken with Nardil.
Well, I realize that my post may not have given you the answers that you're looking for, but I hope that somehow, you will get the answers that you seek.
Take care,
Tomatheus
Posted by SLS on January 8, 2015, at 5:47:48
In reply to Nardil (Phenelzine) - Super high dose?, posted by Uncouth on January 7, 2015, at 19:38:20
My feeling is that you will not benefit from any further dosage increases.
It seems to me that you are "chasing" after a drug response with Nardil. Nardil is teasing you. I doubt that any one dosage is going to stick. This has happened to me and quite a few other people. Of course, if there were no safety concerns or intolerable side effects, you could keep going higher. However, this is not the case. Overdose can be fatal.
Nardil inhibits its own metabolism, so its kinetics are exponential rather than linear. Each 15 mg/day increase produces an accelerating drug effect. In the case of overdose, symptoms don't occur immediately, so one is tempted to take more. By the time overdose symptoms appear, it is often too late to simply stop taking it and wait it out. Drug levels end up going way too high, and it takes a long time for them to recede. If you begin to experience altered mental status (confusion or incoherence), you need to be taken to a hospital quickly. Driving yourself is not an option.
Based upon my own experience with Nardil, I would be reluctant to go above 120 mg/day. However, I would hate to be responsible for your missing an opportunity to respond to treatment. Before increasing the dosage further, you might opt to get a blood test for MAO inhibition percentage, if they still exist.
- Scott
Posted by ed_uk2010 on January 8, 2015, at 8:44:01
In reply to Re: Nardil (Phenelzine) - Super high dose? » Uncouth, posted by SLS on January 8, 2015, at 5:47:48
> My feeling is that you will not benefit from any further dosage increases.
To be honest, I've not heard of anyone taking more than 120mg/day, and very few people seem to take more than 90mg/day on a long term basis.
Posted by Phillipa on January 8, 2015, at 9:01:28
In reply to Re: Nardil (Phenelzine) - Super high dose? » SLS, posted by ed_uk2010 on January 8, 2015, at 8:44:01
So like the other meds people become tolerant to nardil and feel as if they need increases? Seems like it's like this with most of the meds if not all. Phillipa
Posted by SLS on January 8, 2015, at 12:36:01
In reply to Re: Nardil (Phenelzine) - Super high dose? » SLS, posted by ed_uk2010 on January 8, 2015, at 8:44:01
> > My feeling is that you will not benefit from any further dosage increases.
>
> To be honest, I've not heard of anyone taking more than 120mg/day, and very few people seem to take more than 90mg/day on a long term basis.90 mg/day is the optimum dosage for me. I would never think of going above 120 mg/day - except for one time. I ended up in the hospital.
- Scott
Posted by baseball55 on January 8, 2015, at 20:15:41
In reply to Nardil (Phenelzine) - Super high dose?, posted by Uncouth on January 7, 2015, at 19:38:20
Maybe your issues with social anxiety/motivation would be most helped through psychotherapy. If nardil has controlled your depression, I'm not sure what more you can ask of it, really. It's just an anti-depressant.
Posted by ed_uk2010 on January 9, 2015, at 9:11:16
In reply to Re: Nardil (Phenelzine) - Super high dose? » Uncouth, posted by baseball55 on January 8, 2015, at 20:15:41
> Maybe your issues with social anxiety/motivation would be most helped through psychotherapy.
Perhaps the psychotherapy could involve exposure to different situations. I think social anxiety often requires a lot of exposure to different social situations before it improves, but the improvement can be lasting. With familiarity, some social situations which were once anxiety-provoking can eventually become enjoyable.
Posted by baseball55 on January 9, 2015, at 19:08:00
In reply to Re: Nardil (Phenelzine) - Super high dose? » baseball55, posted by ed_uk2010 on January 9, 2015, at 9:11:16
> > Maybe your issues with social anxiety/motivation would be most helped through psychotherapy.
>
> Perhaps the psychotherapy could involve exposure to different situations. I think social anxiety often requires a lot of exposure to different social situations before it improves, but the improvement can be lasting. With familiarity, some social situations which were once anxiety-provoking can eventually become enjoyable.
>
> One way to get help with exposure is to do a therapy group.
>
Posted by Lamdage22 on January 10, 2015, at 0:46:15
In reply to Re: Nardil (Phenelzine) - Super high dose? » ed_uk2010, posted by baseball55 on January 9, 2015, at 19:08:00
I didnt notice any additional benefit with more than 90mg Nardil.
Posted by ed_uk2010 on January 10, 2015, at 0:48:14
In reply to Re: Nardil (Phenelzine) - Super high dose? » ed_uk2010, posted by baseball55 on January 9, 2015, at 19:08:00
>One way to get help with exposure is to do a therapy group.
That's a point. I've never done that, have you, and what was it like?
I think medication can often decrease social anxiety enough for exposure to take place - and to be useful. Antidepressants are probably best in this respect because benzos might decrease memory, alertness and learning from the process.
Posted by baseball55 on January 10, 2015, at 20:13:36
In reply to Re: Nardil (Phenelzine) - Super high dose? » baseball55, posted by ed_uk2010 on January 10, 2015, at 0:48:14
> >One way to get help with exposure is to do a therapy group.
>
> That's a point. I've never done that, have you, and what was it like?
I did. It helped me to learn to be present in a group. But I also have been able to get a lot of help from 12-step groups. Groups are very good ways to learn how to interact with people in a safe environment.
Posted by Kirkglen on January 17, 2015, at 12:53:01
In reply to Re: Nardil (Phenelzine) - Super high dose? » ed_uk2010, posted by baseball55 on January 10, 2015, at 20:13:36
test
Posted by Kirkglen on January 17, 2015, at 13:00:32
In reply to Re: Nardil (Phenelzine) - Super high dose? » ed_uk2010, posted by baseball55 on January 10, 2015, at 20:13:36
Uncouth What brand are you using? I tried the Greenstone brand for 6 months and couldn't get anything even at 120 mg. Severe bowel movement disorder with it. Swapped to Gavis brand and at moved the level slowly to 90 mg. Total time was eight weeks and it started to work.
I do have days when I go down and I'll pop another 40mg and watch my hypotension.
Posted by Uncouth on January 17, 2015, at 17:38:42
In reply to Re: Nardil (Phenelzine) - Super high dose?, posted by Kirkglen on January 17, 2015, at 13:00:32
More detail? You mean you switched overnight from Greenstone 120 to gavis 120 then slowly went down to 90?
I tried Gavis, actually thought it didn't work as well for me, but didnt stick with it for more than a two or three weeks before going back. Did you feel worse initially going from greenstone to gavis?
Why would gavis work better?
Note I also take bydureon, long acting GLP-1 agonist which slows stomach emptying. I'm almost positive it has an effect on the nardil. Again it partially is working, but it hasn't been the life changer i'm expecting and i've had a number of tense stress and anxiety driven blowups while on the drug.
Although recently added 2mg abilify (stopped amantadine i had tried augmenting with) and the 2mg abilify def helps.
Posted by Kirkglen on January 19, 2015, at 11:37:33
In reply to Re: Nardil (Phenelzine) - Super high dose?, posted by Uncouth on January 17, 2015, at 17:38:42
Yes 120mg to 120mg Gavis. I do not feel the new version will ever beat anxiety/panic as well as the old Parke Davis formula. Depression is pretty good.
For me, right now it's the best I can find after trying "everything available". If you find something to augment with Nardil for anxiety pls. communicate.
Posted by Lamdage22 on January 30, 2015, at 4:55:09
In reply to Re: Nardil (Phenelzine) - Super high dose?, posted by Kirkglen on January 19, 2015, at 11:37:33
super high dose induced hypertensive crisis in the abcence of food for me.
Posted by Lamdage22 on January 30, 2015, at 5:04:16
In reply to Re: Nardil (Phenelzine) - Super high dose?, posted by Lamdage22 on January 30, 2015, at 4:55:09
absence. sorry
This is the end of the thread.
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