![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by shellie on August 28, 2000, at 7:51:24
I've been successfully on nardil for about twenty years (before ssris existed). I can't take tricyclics. About five years ago, I experienced Nardil poopout, pdoc tried me on various ssris, none successful, went back on nardil, worked again.
Starting last January, same thing again. I've tried to augment the nardil with aricept (shakey, drugged feeling),revia (same reaction), lamictal (good, but large weight gain), ritalin (no benefit), dexadrine (no benefit), provigal (slept all the time) and now I'm stopping tomopax (sleeping 16 hours a day, muscles hurt--got up to 150mg, no benefit for depression).
Basically between the provigal and topomax, I have slept the summer away. I am wondering where to get information on what the odds are if I stop the nardil for a week to ten days then go back on it. How big a chance am I taking. I know I will crash, but it might be worth it if it brings me another 3 to 5 years. I can't find any data on this on the internet.
Any information would be appreciated. Also, if you can think of something I've missed in the augmentation process (I am taking thyroid; I've tried lithium, deserel and sam-e unsuccessfully), but at this point I am really tired of trying different meds. The one thing I might be willing to do is change from nardil to parnate, but my preference would still be to stay
on nardil since I know it so well and it produces very few side effects for me. Thanks, Shellie
Posted by SLS on August 28, 2000, at 13:49:08
In reply to Stopping and Restarting MAOI ----Sunnely, please, posted by shellie on August 28, 2000, at 7:51:24
Stopping and restarting Nardil has been used as a strategy to recapture an antidepressant response. My doctor said that simply lowering the dosage sometimes works. I don't know how long one is to remain off Nardil before restarting it. I would guess that at least a month would be necessary: two weeks to allow MAO activity to return to normal and an additional two weeks to allow the system to reset itself. Just a guess. A doctor at the NIH once described to me a patient for whom a three month period worked.
My doctor has also found it necessary to occasionally switch the same patient back and forth from Nardil to Parnate.
I think either strategy makes sense to try.
How much S-AMe did you take? How long did you take it for? Did it help at all?
- Scott
Posted by shellie on August 28, 2000, at 18:35:48
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please, posted by SLS on August 28, 2000, at 13:49:08
Hey Scott. If I had to get off Nardil for three months, I'd probably kill myself, even though it's doing very little now.
>
> How much S-AMe did you take? How long did you take it for? Did it help at all?I went up to 1600 mg of sam-e, maybe doubling every week from 400. Didn't help at all. That's as high as Dr. Brown says to go up withoutÊa good reaction. If you get a partial good reaction at 1600 then you can try 2400. I felt worse--had an agitated depression. Are you trying sam-e? shellie
Posted by SLS on August 29, 2000, at 10:58:24
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please » SLS, posted by shellie on August 28, 2000, at 18:35:48
> Hey Scott. If I had to get off Nardil for three months, I'd probably kill myself, even though it's doing very little now.
>
> >
> > How much S-AMe did you take? How long did you take it for? Did it help at all?
>
> I went up to 1600 mg of sam-e, maybe doubling every week from 400. Didn't help at all. That's as high as Dr. Brown says to go up withoutÊa good reaction. If you get a partial good reaction at 1600 then you can try 2400. I felt worse--had an agitated depression. Are you trying sam-e? shellie
Hi Shellie.Thanks for answering.
I went out and bought some S-AMe (original abbreviation) two days ago. I have been feeling terrible over the last few weeks, and I might get worse yet. It was my hope that S-AMe would moderate things enough so that I could make it to the appointment I have with a new doctor in mid-September without having to start any new medication.
I took my first dose of 200mg Monday evening. By bedtime, I was experiencing some unfamiliar feelings that included some mild anxiety and a slight increase in energy. The next day, I took 200mg at 7:00AM and 3:30PM. I did feel better during the day, and the original "unfamiliar" feeling disappeared. In the evening, I began to deteriorate, but then picked up a again by 11:00PM. However, the severity of depression has varied in this way prior to taking S-AMe. I was planning to take 400mg for a few days and raise the dosage to 600mg if I didn't experience an improvement. So far, today has been pretty bad. I took 200mg at 5:30AM, and have not experienced any energizing or antidepressant/antianxiety effect.
I am a "gun-shy" about taking anything new or "exotic" right now due to my recent adverse reactions with Neurontin and Provigil. I would rather go in to see this new doctor taking nothing but Lamictal. Right now (10:56AM EDT), I have decided not to take any more S-AMe. My goal at this point is to be able to function well enough to make it into the city to see the doctor. If I can do that without taking S-AMe or Parnate, I'll be able to give him a clean slate to work with.
Did you experience an energizing effect initially when you began taking S-AMe?
I have been resisting the temptation to begin taking a combination of Parnate and desipramine. I usually benefit from this, as it provides me with a mild improvement. Actually, it was this combination that produced my only true remission in 1987. It lasted for about nine months. Since then, I have not responded to this treatment adequately enough to justify its continuation. However, it was the recommendation of my current doctor and a consult to return to this combination and add more stuff to the mix - a strategy that I have already tried without success. Of course, there are a few drugs that I have not tried as adjuncts. My fantasy is that the new doctor will say, "Hey, I would like to try a completely different treatment that I have had great success with in cases like yours. It has no side effects, you only have to take one dose, it works for everyone, and it lasts forever. It is also free because the drug rep gave me some samples." I would find such a statement to be somewhat encouraging.
Have your doctors recommended trying anything to substitute for Nardil? My current doctor and the consult both recommended that I not waste my time with SSRIs based upon my diagnosis of bipolar depression, my symptom profile, and my experiences with Prozac and Paxil. However, I did get a little something from Paxil, and experienced an initial boost from Effexor. I am curious if your doctors have mentioned Celexa and Serzone, possibly in combination.
Effexor + Remeron is supposed to be a potent combination. I once tried Remeron monotherapy for a few days. I thought it was beginning to make me feel a lot worse. I may have discontinued it prematurely, partly because I equated it with a drug that I had previously tried that greatly exacerbated my depression. It was an investigational drug called idazoxan. Both drugs block NE alpha-2 receptors. So when I experienced even a hint of feeling worse, I bailed-out of the Remeron trial.
Given your experience the time when you unintentionally stopped and restarted Nardil, I think it makes sense to try it. Again, I don't know how long a period of discontinuation is necessary, but perhaps you can let your previous experience guide you. If this proves unsuccessful, I would place switching to Parnate, or perhaps Marplan, high on your list. If you have not tried adding a tricyclic to an MAOI, this can be an effective alternative. My experience with this combination is that using Parnate is more tolerable. For me, Nardil plus a tricyclic produces a great deal of orthostatic hypotension and the inability to urinate. (Due to the nature of the latter effect, I found that I didn't get pissed-off as easily). I prefer either using either desipramine (Norpramin) or nortriptyline (Pamelor) as the tricyclic, as these side effects are milder.
- Scott
Posted by shellie on August 31, 2000, at 18:51:53
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please » shellie, posted by SLS on August 29, 2000, at 10:58:24
Hi Scott.
Here are some answers to your questions:> Did you experience an energizing effect initially when you began taking S-AMe?
I wouldn't ever say I had an energizing effect, more of a slightly agitated state.
>
"Hey, I would like to try a completely different treatment that I have had great success with in cases like yours. It has no side effects, you only have to take one dose, it works for everyone, and it lasts forever. It is also free because the drug rep gave me some samples. I would find such a statement to be somewhat encouraging."I like your "somewhat" encouraging. Made me smile.
> Have your doctors recommended trying anything to substitute for Nardil?
I tried a bunch of ssris years ago, and am not willing to lose any more of my life toward a change that either takes a lot of time (getting off nardil) or has little chance of succeeding (ssris). Remeron is known for weight gain also.
I have put parnate high on my list. I can't augment with tricyclics, they totally disorient me. Parnate is probably the only thing I'd give up Nardil for.
My pdoc (who decided I can't take nardil with afrafinil) added a small bit of risperdal to my nardil, but I'm going to New Mexico Sunday (for a week) so she said to wait until I come back. I absolutely can't take 1mg of thorozine so I'm not very hopeful. Meanwhile I've doubled my doze of Nardil, so I'm feeling a little floaty. Santa Fe is a place I feel very comfortable in, so it's okay if I feel some depression out there (although my preference would be to leave it here). I'll also bring a couple of hydrocodone just in case the depression becomes unbearable. (My depression is all in my chest and hurts as if its a physical pain). It's only sometimes tied to my self-image in that I'm more vulnerable, but it definitely feels endogenous at this point. And I continue to work on what little I remember of my physical and sexual trauma in therapy, as well as life coping skills (e.g.,running a business depressed, cleaning a house depressed, mowing my lawn depressed, etc.)Hope you are hanging in there. It's almost the middle of September.
later, Shellie
Posted by stephanie l. on September 9, 2000, at 13:23:17
In reply to Stopping and Restarting MAOI ----Sunnely, please, posted by shellie on August 28, 2000, at 7:51:24
> I've been successfully on nardil for about twenty years (before ssris existed). I can't take tricyclics. About five years ago, I experienced Nardil poopout, pdoc tried me on various ssris, none successful, went back on nardil, worked again.
>
> Starting last January, same thing again. I've tried to augment the nardil with aricept (shakey, drugged feeling),revia (same reaction), lamictal (good, but large weight gain), ritalin (no benefit), dexadrine (no benefit), provigal (slept all the time) and now I'm stopping tomopax (sleeping 16 hours a day, muscles hurt--got up to 150mg, no benefit for depression).
>
> Basically between the provigal and topomax, I have slept the summer away. I am wondering where to get information on what the odds are if I stop the nardil for a week to ten days then go back on it. How big a chance am I taking. I know I will crash, but it might be worth it if it brings me another 3 to 5 years. I can't find any data on this on the internet.
>
> Any information would be appreciated. Also, if you can think of something I've missed in the augmentation process (I am taking thyroid; I've tried lithium, deserel and sam-e unsuccessfully), but at this point I am really tired of trying different meds. The one thing I might be willing to do is change from nardil to parnate, but my preference would still be to stay
> on nardil since I know it so well and it produces very few side effects for me. Thanks, ShellieShellie: I had Nardil poop out 5 years ago, after being on the drug 11 years. I tried many new meds and med combinations, but it wasn't until I put Nardil, Wellbutrin, Vivactil, dexedrine and yohimbe together that I started to get better. (I had figured out in the meantime that Nardil was still doing some small good). I take a very small dose of yobimbe, since it has potential interactions with Nardil. I've had no problems with it, and for me it is stimulating --- a good thing. Also- Vivactil is a tricyclic, but it affects me much differently than the other ones I tried (amitriptyline and despramine. ) They knocked me out and I was sleeping l8 hours a day, even a month into the trial. In contrast, I find Vicactil (protriptyline) to be energizing. ..I hope you find what you need.
Posted by shellie on September 10, 2000, at 12:26:22
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please, posted by stephanie l. on September 9, 2000, at 13:23:17
Thanks, Stephanie, for the info. That's an interesting combination you're on; I'm glad it's working for you.
Since I had a reaction mixing adrafinil and nardil, I am presently off the nardil, and am up in the air as to whether I will go back on. I did look up all the meds you're on, had never heard of yohimbe or vivictil before. Shellie
Posted by Ant-Rock on September 10, 2000, at 17:55:49
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please, posted by stephanie l. on September 9, 2000, at 13:23:17
> Shellie: I had Nardil poop out 5 years ago, after being on the drug 11 years. I tried many new meds and med combinations, but it wasn't until I put Nardil, Wellbutrin, Vivactil, dexedrine and yohimbe together that I started to get better. (I had figured out in the meantime that Nardil was still doing some small good). I take a very small dose of yobimbe, since it has potential interactions with Nardil. I've had no problems with it, and for me it is stimulating --- a good thing. Also- Vivactil is a tricyclic, but it affects me much differently than the other ones I tried (amitriptyline and despramine. ) They knocked me out and I was sleeping l8 hours a day, even a month into the trial. In contrast, I find Vicactil (protriptyline) to be energizing. ..I hope you find what you need.Stephanie,
I was reading your post and couldn't help wondering how you can handle all those stimulant meds at once(the 4 others beside Nardil).
Do you take small amounts of each, for a synergistic effect?
Anyway, I'm glad they are working for you. You must have had a lot of fatigue related to your depression, much like myself. Did you ever try parnate?
Thanks in advance.
Sincerely,
Anthony
Posted by SLS on September 11, 2000, at 9:58:20
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please, posted by stephanie l. on September 9, 2000, at 13:23:17
Dear Stephanie,
This is a repeat of my post in the above thread. I just wanted to make sure you saw it.
> Shellie: I had Nardil poop out 5 years ago, after being on the drug 11 years. I tried many new meds and med combinations, but it wasn't until I put Nardil, Wellbutrin, Vivactil, dexedrine and yohimbe together that I started to get better. (I had figured out in the meantime that Nardil was still doing some small good). I take a very small dose of yobimbe, since it has potential interactions with Nardil. I've had no problems with it, and for me it is stimulating --- a good thing. Also- Vivactil is a tricyclic, but it affects me much differently than the other ones I tried (amitriptyline and despramine. ) They knocked me out and I was sleeping l8 hours a day, even a month into the trial. In contrast, I find Vicactil (protriptyline) to be energizing. ..I hope you find what you need.
------------------------------------------------------------
I am very interested to know in what way yohimbine has helped you. How much are you taking, and when do you take it?How would you describe the importance of yohimbine in your treatment? How would you describe how it has benefited you? What did you feel?
I recently started a combination of Parnate and desipramine. I was desperate, and things were getting dangerous. This combination was the only thing ever to work for me thirteen years ago. Unfortunately, my doctor at the time decided to discontinue it, and it has never worked since. This time, I am taking Lamictal 300mg along with it. If this combo proves partially effective, I would consider adding yohimbine to it.
Stephanie, hopefully, you will have no need of stimulants. My doctor had no problem with the idea of combining reboxetine with Nardil. I would have tried it had I not reacted badly to the reboxetine alone. What are your reasons for wanting to try reboxetine? Are you dissatisfied with the way you are currently feeling? Are you going to add it to everything you are already taking?
Are you waiting for reboxetine to be approved in the U.S. before trying it?
In what order did you add your medications to Nardil?
With each addition, how did it affect you?
Have you tried any of the dopaminergic anti-Parkinson's drugs?
Parlodel (bromocryptine)
Mirapex (pramipexole)
Permax (pergolide)I experienced a brief improvement with Parlodel while taking Parnate. A research clinician recently suggested that I try Mirapex.
I hope everything works out.
Thanks for any input you can give me.
- Scott
Posted by SLS on September 11, 2000, at 10:07:23
In reply to Re: Stopping and Restarting MAOI » stephanie l., posted by shellie on September 10, 2000, at 12:26:22
> Thanks, Stephanie, for the info. That's an interesting combination you're on; I'm glad it's working for you.
>
> Since I had a reaction mixing adrafinil and nardil, I am presently off the nardil, and am up in the air as to whether I will go back on. I did look up all the meds you're on, had never heard of yohimbe or vivictil before. ShellieDear Shellie,
Stopping and restarting Nardil does work. Since you have decided to discontinue the Nardil in favor of other avenues, you will have a great opportunity to reintroduce it in the future. I would give it at least a month before going back to it. The last time I heard of this strategy working for somebody, they were off it for three months. In addition, switching between Nardil and Parnate often works. My doctor has had a patient for whom he switches between Nardil and Parnate as each begins to poop-out on him.
Good luck.
* I had posted an answer to this question to you a few weeks ago. For some reason, it never showed up. I had become too depressed to later follow-up on it.
I have an appointment to see a new doctor on Friday. It was my intention to go in to him taking nothing but Lamictal 300mg. I wanted to give him a clean slate to work with. Two weeks ago, I decided that it was in my best interests to intervene by starting a combination of Parnate and desipramine. I have begun to feel better.
- Scott
Posted by Ant-Rock on September 11, 2000, at 18:49:22
In reply to Re: Stopping and Restarting MAOI » shellie, posted by SLS on September 11, 2000, at 10:07:23
"I have begun to feel better."
> - ScottI'm happy to hear you are feeling better Scott.
Anthony
Posted by stephanie l. on September 23, 2000, at 14:09:55
In reply to Re: Stopping and Restarting MAOI » shellie, posted by SLS on September 11, 2000, at 10:07:23
> > Thanks, Stephanie, for the info. That's an interesting combination you're on; I'm glad it's working for you.
> >
> > Since I had a reaction mixing adrafinil and nardil, I am presently off the nardil, and am up in the air as to whether I will go back on. I did look up all the meds you're on, had never heard of yohimbe or vivictil before. Shellie
>
> Dear Shellie,
>
> Stopping and restarting Nardil does work. Since you have decided to discontinue the Nardil in favor of other avenues, you will have a great opportunity to reintroduce it in the future. I would give it at least a month before going back to it. The last time I heard of this strategy working for somebody, they were off it for three months. In addition, switching between Nardil and Parnate often works. My doctor has had a patient for whom he switches between Nardil and Parnate as each begins to poop-out on him.
>
> Good luck.
>
> * I had posted an answer to this question to you a few weeks ago. For some reason, it never showed up. I had become too depressed to later follow-up on it.
>
> I have an appointment to see a new doctor on Friday. It was my intention to go in to him taking nothing but Lamictal 300mg. I wanted to give him a clean slate to work with. Two weeks ago, I decided that it was in my best interests to intervene by starting a combination of Parnate and desipramine. I have begun to feel better.
>
> - ScottScott: I'm so glad you are starting to feel better. And good for you for taking things into your own hands (Sometimes it is the ONLY way
to get out of the quicksand. I think any depressed person who can advocate for himself in the midst of a depression could be called a hero.)On 9-22 you answered a post of mine on my "stimulating" combination of meds (which includes the herb yohimbe). You asked many questions. But since you are on a new combo, I don't know if you still need the answers; I will be glad to answer them if you do. Just let me know.
Stephanie
Posted by stephanie l. on September 23, 2000, at 14:23:22
In reply to Re: Stopping and Restarting MAOI ---- » stephanie l., posted by Ant-Rock on September 10, 2000, at 17:55:49
>
> > Shellie: I had Nardil poop out 5 years ago, after being on the drug 11 years. I tried many new meds and med combinations, but it wasn't until I put Nardil, Wellbutrin, Vivactil, dexedrine and yohimbe together that I started to get better. (I had figured out in the meantime that Nardil was still doing some small good). I take a very small dose of yobimbe, since it has potential interactions with Nardil. I've had no problems with it, and for me it is stimulating --- a good thing. Also- Vivactil is a tricyclic, but it affects me much differently than the other ones I tried (amitriptyline and despramine. ) They knocked me out and I was sleeping l8 hours a day, even a month into the trial. In contrast, I find Vicactil (protriptyline) to be energizing. ..I hope you find what you need.
>
> Stephanie,
> I was reading your post and couldn't help wondering how you can handle all those stimulant meds at once(the 4 others beside Nardil).
> Do you take small amounts of each, for a synergistic effect?
> Anyway, I'm glad they are working for you. You must have had a lot of fatigue related to your depression, much like myself. Did you ever try parnate?
> Thanks in advance.
> Sincerely,
> AnthonyAnthony: Sorry it's taken me awhile to get back to you. I was out of town...You asked how I handle all those stimulants at once: it's easy! I could easily use more stimulation than I'm getting now. As for the dosage: I am taking all of them at the regular therapeutic dose (except for the yohimbe, which I am taking at a very small dose). As for trying parnate.....yes, I did try it, but I tried it at a time when the MAOs in general just weren't helping much anymore. And yes, I do experience lots of fatique when depressed (even getting out of bed to get to the shower is a major endeavor, just about a full's days' project.)
Hope this helped.Stephanie
Posted by SLS on September 23, 2000, at 20:17:54
In reply to Re: Stopping and Restarting MAOI » SLS, posted by stephanie l. on September 23, 2000, at 14:09:55
> Scott: I'm so glad you are starting to feel better.
Thank you, Stephanie.
> And good for you for taking things into your own hands (Sometimes it is the ONLY way to get out of the quicksand.
> I think any depressed person who can advocate for himself in the midst of a depression could be called a hero.)
I agree. I don't think "hero" or "heroic" are words of hyperbole. Pursuing treatment for depression is a catch-22. Someone who is severely depressed does not function at the level necessary to actively seek and obtain treatment. However, with proper treatment, they would be able to seek treatment.
> On 9-22 you answered a post of mine on my "stimulating" combination of meds (which includes the herb yohimbe). You asked many questions. But since you are on a new combo, I don't know if you still need the answers; I will be glad to answer them if you do. Just let me know.
I am still interested in your experiences with yohimbine. Have you ever used it in combination with a tricyclic? It might be worth a try.
I appreciate your concern. Thanks.
- Scott
Posted by stephanie l. on September 30, 2000, at 10:31:16
In reply to Re: Stopping and Restarting MAOI » stephanie l., posted by SLS on September 23, 2000, at 20:17:54
> > Scott: I'm so glad you are starting to feel better.
>
> Thank you, Stephanie.
>
> > And good for you for taking things into your own hands (Sometimes it is the ONLY way to get out of the quicksand.
>
> > I think any depressed person who can advocate for himself in the midst of a depression could be called a hero.)
>
> I agree. I don't think "hero" or "heroic" are words of hyperbole. Pursuing treatment for depression is a catch-22. Someone who is severely depressed does not function at the level necessary to actively seek and obtain treatment. However, with proper treatment, they would be able to seek treatment.
>
> > On 9-22 you answered a post of mine on my "stimulating" combination of meds (which includes the herb yohimbe). You asked many questions. But since you are on a new combo, I don't know if you still need the answers; I will be glad to answer them if you do. Just let me know.
>
> I am still interested in your experiences with yohimbine. Have you ever used it in combination with a tricyclic? It might be worth a try.
>
> I appreciate your concern. Thanks.
>
>
> - ScottScott: Yohimbe has helped me a lot -- it's just as important as the meds I'm taking (Nardil, Vivactil ---a tricyclic-- dexedrine and Wellbutrin.). I don't think dexedrine is helping me much anymore. I initially tried yohimbe to see if it would help sexually. (The antidepressants took that away from me.) Anyway, it did work sexually the first time I tried it, but at a dose that was too large for me( I had dizziness, the sweats). But it is stimulating, so I continued taking it at a smaller dose of 3 drops a day.(The bottle recommends a dose of 30-45 drops a day.) But 3 drops work fine for me, and don't interact with the Nardil. Without yohimbe, in spite of my meds, I would still be sluggish and pretty depressed. I'm hoping that I can try reboxetine when it's approved, and maybe I can stop taking so many meds. (By the way, I have tried about l5 other meds along the way). Hope this helps.
Posted by SLS on September 30, 2000, at 13:04:50
In reply to Re: Stopping and Restarting MAOI----SLS, posted by stephanie l. on September 30, 2000, at 10:31:16
Dear Stephanie,
If the only thing that stands in the way of your trying reboxetine is that you have no source, I can provide information as to a reputable and reasonably priced pharmacy in London, England. If your doctor is willing to use it right now knowing that you are obtaining it from a foreign source, please email me. I had a bad reaction with reboxetine. It made my depression worse, produced anxiety, and provoked thoughts of suicide. This, of course, is a risk of all antidepressants, so I would make a decision based on just one account. But it can happen. I know of two other people for whom reboxetine exacerbated their depression. However, it seems that reboxetine, a SNRI (selective norepinephrine reuptake inhibitor), may be generally more effective than the SSRIs (selective serotonin reuptake inhibitor). I would DEFINITELY try it if I were you. Both yohimbine and reboxetine work on norepinephrine. That yohimbine helps you may be a good indication that reboxetine will hit the target and chase away the beast.
Now for the tricky stuff. It is my speculative opinion that it is most likely safe to combine reboxetine with the Nardil you are currently taking. If I had not had such a bad reaction to reboxetine, my doctor was prepared to add Nardil. Yohimbine is another story. I would urge you to discontinue yohimbine before you begin reboxetine. There is no two-week "wash-out" period, so you can probably begin reboxetine a few days after your last dose of yohimbine. You can try to add it back later if you feel you need it. I know that Vivactil is a potent norepinephrine reuptake inhibitor, but reboxetine is different enough that I would not guarantee that it will mix as safely with yohimbine as does Vivactil. It is most likely that you did not tolerate "normal" dosages of yohimbine PRECISELY because it was potentiated (exaggerated) by Vivactil.
Have you ever tried desipramine (Norpramin)? Desipramine is definitely a SNRI.
- Scott
Posted by stephanie l. on September 30, 2000, at 15:01:37
In reply to Re: Stopping and Restarting MAOI----SLS, posted by SLS on September 30, 2000, at 13:04:50
> Dear Stephanie,
>
> If the only thing that stands in the way of your trying reboxetine is that you have no source, I can provide information as to a reputable and reasonably priced pharmacy in London, England. If your doctor is willing to use it right now knowing that you are obtaining it from a foreign source, please email me. I had a bad reaction with reboxetine. It made my depression worse, produced anxiety, and provoked thoughts of suicide. This, of course, is a risk of all antidepressants, so I would make a decision based on just one account. But it can happen. I know of two other people for whom reboxetine exacerbated their depression. However, it seems that reboxetine, a SNRI (selective norepinephrine reuptake inhibitor), may be generally more effective than the SSRIs (selective serotonin reuptake inhibitor). I would DEFINITELY try it if I were you. Both yohimbine and reboxetine work on norepinephrine. That yohimbine helps you may be a good indication that reboxetine will hit the target and chase away the beast.
>
> Now for the tricky stuff. It is my speculative opinion that it is most likely safe to combine reboxetine with the Nardil you are currently taking. If I had not had such a bad reaction to reboxetine, my doctor was prepared to add Nardil. Yohimbine is another story. I would urge you to discontinue yohimbine before you begin reboxetine. There is no two-week "wash-out" period, so you can probably begin reboxetine a few days after your last dose of yohimbine. You can try to add it back later if you feel you need it. I know that Vivactil is a potent norepinephrine reuptake inhibitor, but reboxetine is different enough that I would not guarantee that it will mix as safely with yohimbine as does Vivactil. It is most likely that you did not tolerate "normal" dosages of yohimbine PRECISELY because it was potentiated (exaggerated) by Vivactil.
>
> Have you ever tried desipramine (Norpramin)? Desipramine is definitely a SNRI.
>
>
> - Scott
Dear Scott:Thanks for all the great information, especially on quitting yohimbe before I start reboxetine.
I do have some reboxetine, which I got overseas; the only thing that is stopping me from taking it is my doctor. I know he wouldn't like it because it is not yet approved in the US. I can't afford to lose him as my doc. I saw 7 other docs (including the so-called "best" pharmacologists in town) before I found him.
I am sure he is the only doc here who has the experience and willingness to prescribe the kind of combination of meds I am on. It took us 3 years of trying l5 medications (not counting the various combinations of those meds) to find something that worked reasonably well.
I know reboxetine might not work. My experience is that meds that tend to be stimulating are the ones that might work for me.
The SSRIs did nothing. I am also open to trying some of the meds I see mentioned in this board, like amineptine, apomorphine, and amisupride.
You asked about desipramine; I tried it for several weeks and it put me to sleep for l8 hours a day. I was already on Nardil and Wellbutrin when I tried it, and I don't know if that had any effect or not. So... how are you doing on your trial?
Stephanie
Posted by shellie on September 30, 2000, at 16:22:14
In reply to Re: Stopping and Restarting MAOI----SLS, posted by SLS on September 30, 2000, at 13:04:50
So, I also went for a consultation with a new pdoc.
My main question was going to be "do I restart Nardil or change to Parnate?" Anyway, I was in for a surprise. This doctor had earlier this year written an article for The Washington Post health section called "making the three tenors sing", which I had actually read. I had no idea he was the guy who wrote it. It was of course about how the brain's neurotransmitters must "harmonize" and during our session he asked me questions to figure out where I stood with the three. (after which he brought out his visual neurotransmitter pie chart).
Didn't want me on either nardil or parnate. Felt they were too limiting, although he said he used to be a huge MAOI fan. First, as first part of combination suggested either paxil or remeron. I said no to both (didn't want to deal with side effects and ssri withdrawal) and felt that this consultation was going to be over fast. But then he came up with a serzone/adderal combination and said if I couldn't tolerate the adderall, it was fine with him if I substituted adrafinil instead. So I'm on my third day of serzone (no side effects--it's actually energizing for me). Tomorrow I add on adderall. So, not at all what I expected.
(by the way, Scott, what was the result of adding Risperdal to your combination? Did I miss that?) Shellie
Posted by SLS on September 30, 2000, at 17:03:47
In reply to Re: Stopping and Restarting MAOI----SLS, posted by SLS on September 30, 2000, at 13:04:50
I AM SO SORRY!
Typographical error. The sentence should have read:
"This, of course, is a risk of all antidepressants, so I would *NOT* make a decision based on just one account"
----------------------------------------
I had a bad reaction with reboxetine. It made my depression worse, produced anxiety, and provoked thoughts of suicide. This, of course, is a risk of all antidepressants, so I would NOT make a decision based on just one account. But it can happen. I know of two other people for whom reboxetine exacerbated their depression. However, it seems that reboxetine, a SNRI (selective norepinephrine reuptake inhibitor), may be generally more effective than the SSRIs (selective serotonin reuptake inhibitor). I would DEFINITELY try it if I were you. Both yohimbine and reboxetine work on norepinephrine. That yohimbine helps you may be a good indication that reboxetine will hit the target and chase away the beast.
Posted by SLS on September 30, 2000, at 22:27:04
In reply to Re: Stopping MAOI: new game plan » SLS, posted by shellie on September 30, 2000, at 16:22:14
Hi shellie!
> So, I also went for a consultation with a new pdoc.Yay!
> My main question was going to be "do I restart Nardil or change to Parnate?" Anyway, I was in for a surprise. This doctor had earlier this year written an article for The Washington Post health section called "making the three tenors sing", which I had actually read.
Cute.
> I had no idea he was the guy who wrote it. It was of course about how the brain's neurotransmitters must "harmonize" and during our session he asked me questions to figure out where I stood with the three. (after which he brought out his visual neurotransmitter pie chart).
I wish I could see this chart.
> Didn't want me on either nardil or parnate. Felt they were too limiting, although he said he used to be a huge MAOI fan. First, as first part of combination suggested either paxil or remeron.Effexor + Remeron is one hell of a combination. I don't recall if you had tried Effexor. Both Remeron and Wellbutrin make good augmenting agents to just about anything. I don't recall having seen Remeron combined with an MAOI, but I can't think of any reason why it couldn't be. (That I can think has not yet been established using a placebo-controlled double-blind protocol, I don't think).
> I said no to both (didn't want to deal with side effects and ssri withdrawal) and felt that this consultation was going to be over fast.
You don't have to withdraw a drug that works, right? As bad as some of the posters here describe their experiences when discontinuing Paxil or Effexor, I don't feel that these peoples' experiences can be extrapolated to you. In most of these cases, the weaning period was too short and/or no methods were used to minimize the withdrawal syndrome.
Some of the things I have seen used:
1. Substitution with Prozac.
2. Benadryl or some other CNS antihistamine.
3. Benzodiazepines such as Ativan> But then he came up with a serzone/adderal combination
Interesting. I can see how this combination might act synergistically to get the dopaminergic pathways of the prefrontal cortex (the hypoactivity of which is suspected of playing a major role in the pathophysiology of depression) to become more active.
In other words, these two drugs might work to increase brain activity in an area needing it via different routes. The end result is greater than the sum of the two parts.Have you ever tried Serzone (nefazodone), Desyrel (trazodone), Remeron (mirtazapine), Zyprexa (olanzapine), Seroquel (quetiapine) or Norval (mianserin)?
> and said if I couldn't tolerate the adderall, it was fine with him if I substituted adrafinil instead.
Why wouldn't you tolerate Adderal? Adrafinil is certainly worth a try, but it wouldn't act at the same site (prefrontal cortex) as do Adderal, Dexedrine, Ritalin, Cylert, Parlodel, Mirapex, or Symmetrel. Actually, it makes sense to try adrafinil first, as it is the only drug (aside from Provigil) of these that works only on non-dopaminergic neurons, yet eventually causes dopaminergic pathways to become activated. On the other hand, you can buy Adderal at the corner drug store without the necessity of wrestling your way through a pack of Customs agents with Napoleonic complexes.
> So I'm on my third day of serzone (no side effects--it's actually energizing for me).
This sounds like an excellent sign of things to come. You should feel encouraged. I think that I will put Serzone on my short-list. I have been contemplating this quite a bit recently. My old doctor (who had conducted clinical trials of Serzone) was adamant that it would not be worth a try. We'll see.
> Tomorrow I add on adderall.
Good luck.
> So, not at all what I expected.
Yay!
> (by the way, Scott, what was the result of adding Risperdal to your combination? Did I miss that?) Shellie
What a coincidence that you should ask this question. Today, I decided not to continue with it. I was beginning to show signs of an abnormal gate and a lack of foot dorsi-flexion while walking, tremors, and leg weakness. Gone. I get the feeling that, of the newer "atypical" neuroleptic antipsychotics, Risperdal carries the greatest risk of producing EPS (extrapyramidal symptoms) and perhaps tardive-dyskinesia. Unfortunately, you are another example of this.
I don't believe that Risperdal was helping at all. Sometimes it's hard to tell, especially when the changes are subtle or come on gradually. It's when you stop taking the drug that you find out that it was helping after all. If I feel that I have lost some kind of improvement for having stopped Risperdal, I might try Zyprexa in its place. I am not afraid of Zyprexa. I was of Risperdal when the doctor first suggested it.
Thanks for asking.
Love,
Scott
Posted by stephanie l. on October 1, 2000, at 16:40:42
In reply to Re: Stopping and Restarting MAOI ----Sunnely, please » stephanie l., posted by SLS on September 11, 2000, at 9:58:20
> Dear Stephanie,
>
> This is a repeat of my post in the above thread. I just wanted to make sure you saw it.
>
> > Shellie: I had Nardil poop out 5 years ago, after being on the drug 11 years. I tried many new meds and med combinations, but it wasn't until I put Nardil, Wellbutrin, Vivactil, dexedrine and yohimbe together that I started to get better. (I had figured out in the meantime that Nardil was still doing some small good). I take a very small dose of yobimbe, since it has potential interactions with Nardil. I've had no problems with it, and for me it is stimulating --- a good thing. Also- Vivactil is a tricyclic, but it affects me much differently than the other ones I tried (amitriptyline and despramine. ) They knocked me out and I was sleeping l8 hours a day, even a month into the trial. In contrast, I find Vicactil (protriptyline) to be energizing. ..I hope you find what you need.
>
> ------------------------------------------------------------
>
>
> I am very interested to know in what way yohimbine has helped you. How much are you taking, and when do you take it?
>
> How would you describe the importance of yohimbine in your treatment? How would you describe how it has benefited you? What did you feel?
>
> I recently started a combination of Parnate and desipramine. I was desperate, and things were getting dangerous. This combination was the only thing ever to work for me thirteen years ago. Unfortunately, my doctor at the time decided to discontinue it, and it has never worked since. This time, I am taking Lamictal 300mg along with it. If this combo proves partially effective, I would consider adding yohimbine to it.
>
> Stephanie, hopefully, you will have no need of stimulants. My doctor had no problem with the idea of combining reboxetine with Nardil. I would have tried it had I not reacted badly to the reboxetine alone. What are your reasons for wanting to try reboxetine? Are you dissatisfied with the way you are currently feeling? Are you going to add it to everything you are already taking?
>
> Are you waiting for reboxetine to be approved in the U.S. before trying it?
>
> In what order did you add your medications to Nardil?
>
> With each addition, how did it affect you?
>
> Have you tried any of the dopaminergic anti-Parkinson's drugs?
> Parlodel (bromocryptine)
> Mirapex (pramipexole)
> Permax (pergolide)
>
> I experienced a brief improvement with Parlodel while taking Parnate. A research clinician recently suggested that I try Mirapex.
>
> I hope everything works out.
>
> Thanks for any input you can give me.
>
>
> - ScottHi Scott:
It's stephanie l. again, and I decided to take advantage of your knowledge regarding
what specific meds do (in the brain), etc.
In your 9-11 post to me, you asked if I had
ever tried any dopaminergic meds.I haven't but I'm very interested in them, along with other ones mentioned frequently on this board -- adderal, apomorphine, amineptine, etc.. I am not very familiar with these drugs; it's pretty much a whole new world to me.
Can you tell, with what you know about the meds I am taking and my need for STIMULATION, which of these drugs might be a good fit for me?
Also, when I have tried dexedrine and ritalin, they don't work for very long. And I quickly become tolerant to an ever-larger amount. Does my quick tolerance of these meds mean I would react the same way to the meds mentioned above (the dopaminergic ones, adderal, etc}? I need to see my doctor soon, and I want to educate myself before seeing him. Thanks for any input you have.
Stephanie.
Posted by SLS on October 3, 2000, at 17:43:33
In reply to Re: Stopping and Restarting MAOI ----SLS, posted by stephanie l. on October 1, 2000, at 16:40:42
Hi Stephanie.I apologize for not responding to your post sooner. I just noticed it. You are asking the right questions. Your treatment needs seem quite sophisticated, and I don't think I would want to give much input at this point. The work you and your doctor have done in putting together your current combination therapy is impressive.
Off of the top of my head, I am curious if you had tried combining Ritalin with Nardil.
Questions:
1. Are you bipolar, or is there any history of bipolar disorder in your family?
2. Do you have any siblings who also suffer with depression? If so, what drugs are they taking, and how are they feeling?
3. Regardless of diagnosis, have you ever tried adding lithium or Depakote to your current combination?
4. What did you depression look like before you ever began treatment for it?
5. How old were you when you first developed mood disturbances?
Sorry I couldn't give you any concrete suggestions. The only thing I will say is that based upon your history of drug responses, you can look forward to getting well. It just might take a little longer than either of us would like.
- Scott
Posted by stephanie l. on October 3, 2000, at 21:54:33
In reply to Re: Stopping and Restarting MAOI ----SLS » stephanie l., posted by SLS on October 3, 2000, at 17:43:33
>
> Hi Stephanie.
>
> I apologize for not responding to your post sooner. I just noticed it. You are asking the right questions. Your treatment needs seem quite sophisticated, and I don't think I would want to give much input at this point. The work you and your doctor have done in putting together your current combination therapy is impressive.
>
> Off of the top of my head, I am curious if you had tried combining Ritalin with Nardil.
>
> Questions:
>
> 1. Are you bipolar, or is there any history of bipolar disorder in your family?
>
> 2. Do you have any siblings who also suffer with depression? If so, what drugs are they taking, and how are they feeling?
>
> 3. Regardless of diagnosis, have you ever tried adding lithium or Depakote to your current combination?
>
> 4. What did you depression look like before you ever began treatment for it?
>
> 5. How old were you when you first developed mood disturbances?
>
>
> Sorry I couldn't give you any concrete suggestions. The only thing I will say is that based upon your history of drug responses, you can look forward to getting well. It just might take a little longer than either of us would like.
>
>
> - ScottHi Scott:
Thanks for the quick response. I am so glad to have someone who is knowledgeable to talk with. I have usually been isolated, doing my research on my own, with no one to compare notes or share experience with.
So to your questions:
1. Yes, I am bipolar II
2. My mom has depression, and finds help with zoloft. One of my brothers also has it; he took prozac which didn't help. He doesn't want to try any other meds and would rather cope on his own. Their depressions have been far more moderate than mine.
3. Yes, I have added both lithium and depakote to my regime, but at the point when I was only taking Nardil, or Nardil and Wellbutrin. They, like every other mood stabilizer I have tried , made me depressed (even at small doses.)
4. before I got treatment, my depression manifested itself in a number of ways: 'breakdowns" with disassociation and an inability to leave my apartment; panic attacks ; inertia; lots of sadness.
5. I was in my early 20s when I first had mood disturbances, although I remember being very sad and crying a lot when I was younger.And yes, I have tried combining ritalin with Nardil but the Ritalin only helped for a few weeks. I quickly developed tolerance to it.
As far as those "other meds" we've discussed...I am of course not looking to you for treatment (although you probably know more than 90% of the PDs I've seen ) I have to see my doctor soon, and I have found over the years that the best way to keep things moving towards a cure was to bring to him a concrete idea of what I want to try next (and sometimes bringing some written materials on it.) I am going to bring up these meds with him on this upcoming visit; , and any input you have would be valuable (although of course I will do my usual research.)
And many thanks for your positive feeling that I can get well. People have told me that, but you are the only person with an understanding of depressive illlness who has told me that!
This is the end of the thread.
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