![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Anna M. on September 6, 2002, at 16:26:19
Can anyone tell me their experience with either of these meds for SP? Is either effective for being more outgoing and confident in social situations? Which has less side effects? Thanks!
Posted by action_jackson on September 6, 2002, at 17:42:45
In reply to Zoloft vs. Nardil for SP???, posted by Anna M. on September 6, 2002, at 16:26:19
Tried both. Zoloft basically just antidepressant.
Posted by cosis on September 6, 2002, at 18:05:45
In reply to Zoloft vs. Nardil for SP???, posted by Anna M. on September 6, 2002, at 16:26:19
My doc told me Nardil was the best drug for SP, I am in my 3rd week and currently at 60g. No change in SP yet, my mood is better though.. I still hope it kicks in during the 4th/5th week like many other people on this board say it did..
Posted by JonW on September 6, 2002, at 18:11:37
In reply to Zoloft vs. Nardil for SP???, posted by Anna M. on September 6, 2002, at 16:26:19
Dr. Liebowitz from Columbia told me Nardil is the single most effective agent for social phobia, but with the most side-effects. For me it helped a little but not much. Seemed to help more than the SSRIs I've been on, but I've never been on an SSRI for 12 weeks which I understand is necessary to evaluate their effect on social anxiety.
Jon
Posted by action_jackson on September 7, 2002, at 1:32:51
In reply to Re: Zoloft vs. Nardil for SP??? » Anna M., posted by JonW on September 6, 2002, at 18:11:37
Few Dr's prescribe Nardil much -
Nardil in monotherapty requires higher dose for SP than for depression. You found a nice antidperessant - but increase dose and likely will find the SP and energy benefit kicking in too!
Ranges for often 75-90, sometimes even 115mg though not usually 115. For me was 90 BTW (taken alone - which I did for 2.5 years).
Chad
http://www.socialfear.com/> Dr. Liebowitz from Columbia told me Nardil is the single most effective agent for social phobia, but with the most side-effects. For me it helped a little but not much. Seemed to help more than the SSRIs I've been on, but I've never been on an SSRI for 12 weeks which I understand is necessary to evaluate their effect on social anxiety.
>
> Jon
Posted by cosis on September 7, 2002, at 8:08:46
In reply to Nardil - Push dose higher for SP, posted by action_jackson on September 7, 2002, at 1:32:51
Thanks Chad I will mention this to my doc on Wed.
I would like to increase my dosage......
Posted by Rick on September 8, 2002, at 0:35:14
In reply to Re: Zoloft vs. Nardil for SP??? » Anna M., posted by JonW on September 6, 2002, at 18:11:37
> Dr. Liebowitz from Columbia told me Nardil is the single most effective agent for social phobia
Based on placebo-controlled studies, nothing -- Nardil included -- is more effective at treating Social Phobia than the anxiolytic Klonopin. Admittedly, just because something is the most effective agent in studies that doesn't mean it's necessarily the most effective in the "real world." Nonetheless, 1 mg/day Klonopin is still working wonders for me after three years.
As for JonW,Nardil didn't help me all that much (nor did a 16 week run of Celexa or a 12 week trial of Neurontin or a short trial of Xanax). Also, the Nardil side effects were extremely difficult for me. BUT...
A) I might not have given Nardil enough time to work(and for side effects to abate)
B) With co-morbid depression (which was not a factor for me) it's important to have an antidepressant (many take both Nardil or another AD, AND Klonopin)
C) Nardil's certainly performed much better in SP trials than any other antidepressant, and most importantly, it has an *extremely* good real world track record for SP. Even if it didn't work for me, it seems to help a majority of Social Phobics a lot.I've posted this a few times in the past, but here's the Medline abstract of the Klonopin (clonazepam) study:
J Clin Psychopharmacol 1993 Dec;13(6):423-8
Treatment of social phobia with clonazepam and placebo.
Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH.
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
Publication Types:
Clinical Trial
Randomized Controlled TrialPMID: 8120156 [PubMed - indexed for MEDLINE]
Rick
Posted by cybercafe on September 8, 2002, at 21:58:25
In reply to Re: Zoloft vs. Nardil for SP???, posted by Rick on September 8, 2002, at 0:35:14
hmmm... i understand Nardil is awesome because it increases 5HT, NE and DA ... and also is a GABA transaminase inhibitor... but... i wonder if better side effects might be possible by taking a nice MAOI like parnate with a pure GABA transaminase inhibitor like vigabatrin ...
ooooh if only i could secure funding to conduct a trial
Posted by chad_3 on September 9, 2002, at 1:05:28
In reply to Re: Zoloft vs. Nardil for SP???, posted by cybercafe on September 8, 2002, at 21:58:25
The data I saw stated that Nardil caused significant whole brain SE++, and more moderate DA++ and NE++. Parnate was more equal across all three.I think your point is good - my crude view of it that Parnate, like Wellbutrin and Ritalin, tends to be too axiogenic (NE driven) taken alone for SP, but I have found for example that Xanax combined well with all of those for excellent (fleeting) effect - if someone out there doesn't need to dose Xanax 8 times a day like I do to avoid rebound anxiety - maybe they might like that combination.
There is a sustained release Xanax in Holland - they tested it in the USA a few years ago - it worked better than the short acting - but as with other potentially useful agents like brofaromine and even moclobomide (almost USA specific) - some sort of major fiscal or other powerful forces undermined any of those promising meds from making into the USA.
I notice however the UCLA Dr's do still like to give out Zyprexa samples though (might be a dangerously effective mix with Parnate for SP and other disorders)... ; )
ps: My guess though is Nardil will be the best for quite a while though - actually I have never heard a single personal long term success story with Parnate for primary general SP - but have heard countless with Nardil and also Klonopin (usually not always with some low dose antidepressant)....
Chad
http://www.socialfear.com/
> hmmm... i understand Nardil is awesome because it increases 5HT, NE and DA ... and also is a GABA transaminase inhibitor... but... i wonder if better side effects might be possible by taking a nice MAOI like parnate with a pure GABA transaminase inhibitor like vigabatrin ...
> ooooh if only i could secure funding to conduct a trial> hmmm... i understand Nardil is awesome because it increases 5HT, NE and DA ... and also is a GABA transaminase inhibitor... but... i wonder if better side effects might be possible by taking a nice MAOI like parnate with a pure GABA transaminase inhibitor like vigabatrin ...
> ooooh if only i could secure funding to conduct a trial
Posted by cybercafe on September 9, 2002, at 7:58:41
In reply to Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by chad_3 on September 9, 2002, at 1:05:28
> The data I saw stated that Nardil caused significant whole brain SE++, and more moderate DA++ and NE++. Parnate was more equal across all three.
hmmm... if serotonin is more gooder for anxiety, why do SSRIs do so poorly and MAOIs do so much better?
or theoretically... at least something like moclobemide should be much much better for anxiety than nardil if 5HT = good, and NE and DA = bad
however doesn't evidence seem to suggest that in fact moclobemide is not better than nardil ?
> I think your point is good - my crude view of it that Parnate, like Wellbutrin and Ritalin, tends to be too axiogenic (NE driven) taken alone for SP, but I have found for example that Xanaxyeah... but why does parnate work for me so much better than effexor or paxil?
i find the stimulating properties agitate me, but my SP is definately much much much better
>combined well with all of those for excellent (fleeting) effect - if someone out there doesn't need to dose Xanax 8 times a day like I do to avoid rebound anxiety - maybe they might like that combination.maybe you can try klonopin or trazodone with parnate? ....
the question is... why does nardil have worse side effects (i dunno...hypotension? anorgasma? sedation?) than parnate? ... or than an SSRI... ?
>worked better than the short acting - but as with other potentially useful agents like brofaromine and even moclobomide (almost USA specific) - some sort of major fiscal or other powerful forces undermined any of those promising meds from making into the USA.
i am in canada... my doc has tried moclobemide before... but like others have indicated, moclobemide does not seem to have the same effectiveness on depression or anxiety as parnate (for depression) or nardil (for anxiety)
> I notice however the UCLA Dr's do still like to give out Zyprexa samples though (might be a dangerously effective mix with Parnate for SP and other disorders)... ; )you may be right... but feeling happy is more important to me than a possible movement disorder (and my relationship with my doc) ...... i'm guessing that worst case scenario, dopamine agent or 5HT2A agent or aripipazole or ECT clears up ... or at least covers up.... any irreversible EPS
> ps: My guess though is Nardil will be the best for quite a while though - actually I have never heard a single personal long term success story with Parnate for primary general SP - but have heard countless with Nardil and also Klonopin (usually not always with some low dose antidepressant)....you're probably right that nardil is better than parnate ... i am thinking more along the lines of getting an equal anxiolytic effect and increased antidepressant effect without the side effects of nardil .....
Posted by chad_3 on September 9, 2002, at 11:04:03
In reply to Re: Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by cybercafe on September 9, 2002, at 7:58:41
Cybercafe -
>
> hmmm... if serotonin is more gooder for anxiety, why do SSRIs do so poorly and MAOIs do so much better?
>
For generalized anxiety disorder by itself, I think that Paxil and Effexor are both superior to the MAOI's, and can work very well at low doses. I agree that for significant generalized SP by itself, Nardil is far superior to SSRI's, and probably even Parnate - because although Parnate doesn't tend to increase a "friendly sociability" like Nardil - Parnate still is usually effective at reducing interpersonal sensitivity, low motivation, and most types of associated depressions. Agressivness or "anti-social" behavior around people (even while not "afraid" to do so) - is more likely with Parnate than Nardil - often people taking Parnate for primary SP are not really "afraid" to be around people - but rather find they would prefer to avoid them - and still end up alone most of the time - not particularly social - but definitely active and productive in more solitary type work or pursuits. Just IMO based on what I've heard out their so far. Perhaps your experience with Parnate has been more succesfull than the ones I've heard about ...> or theoretically... at least something like moclobemide should be much much better for anxiety than nardil if 5HT = good, and NE and DA = bad
I think 5ht, DA, and GABA agonists are they agents shown most effective for SP to date. Nardil boosts all 3. I do think 5ht plays a role - but while the SSRI's boost 5ht, then also decrease whole brain DA (maybe good for depression, but tending to increase passitivtiy at the expense of social and sexual assertivness (initiation), exploratory behavior and disinhibition). Nardil instead of depeleting dopamine rather apparently moderately boosts it, consistent with the above advantages associated with DA++.
> however doesn't evidence seem to suggest that in fact moclobemide is not better than nardil ?
>
Interesting point - but IMO I have yet to see evidence pointing to much efficacy for moclobmoide. I think the moclobomide studies are a great example of how divergent some of these studies can be in their conclusions (how does this happen?). 5 large D/B studies for moclobomide for SP (more than any other med) - 2 of them show NO efficacy, 2 of them show EXTREME (good) efficacy, and 1 shows modest efficacy. Nardil and Klonopin show robust results in all studies for SP. I have yet to hear of any individual reporting long term robust results with moclobomide for primary significant SP - in spite of the fact the this drug is widely used across the world to treat SP. I think moclobomide is a great antidepressant - with little to no side effects, and great for dysthymia as well, but my opinion is that it lacks robust efficacy for SP. Maybe someone will prove otherwise. I hope so - because the side effect profile of moclobomide is practically unsurpassed among psychotropic drugs. IMO, moclobomide does not seem to be particularly effective for the "anxiety" component associated with SP. Coincidentally there are studies that have shown also that MAOI-B + MAOI-A inhibition leads to axiolytic effect, while MAOI-A alone (eg; moclobomide) or MAOI-B alone (selegline low dose) does not.>
> yeah... but why does parnate work for me so much better than effexor or paxil?
> i find the stimulating properties agitate me, but my SP is definately much much much betterI just this part of what you wrote now - but it sounds similar to what I've heard from others and wrote about above (and similar to my experience also) with Parnate...
>
>
> maybe you can try klonopin or trazodone with parnate? ....I was able to tolerate well (still had high energy, cognition, and good sleep) - high Klonopin + Parnate (also high Klonopin + Effexor). But still axiogenic. Xanax definitely reacted differently with Parnate. IMO Xanax preferentially blunts NE over 5h2, (unlike Klonopin IMO) - and is part of what makes Xanax so effective for panic and SSRI-type antidepressant effect (can be depressive too - especially in males I think where significant NE drop can reduce energy and mood).
>
> the question is... why does nardil have worse side effects (i dunno...hypotension? anorgasma? sedation?) than parnate? ... or than an SSRI... ?
>
hypotension usually worse with Parnate (but usually goes away entirely with either MAOI after a couple months anyway). Sexual side effects with Parnate are less than Nardil at comparable dose ranges - but SSRI's (Zoloft, Paxil) - I believe are much greater at comparable doses. As with hypotension - Nardil sexual side effects reduce probably ballpark 80% on average over the first 3-4 months - where SSRI sexual side effects start bad, stay bad, end bad - they rarely if ever improve over time.Sedation - Parnate and Nardil - neither usually a problem with this - yes Parnate more activating but it's tendency to cause insomnia may result in daytime sedation. Overall I think MAOI's are activating - moreso than all SSRi's except Prozac and the SNRI Effexor, to which I think they are more comparable.
>
> i am in canada... my doc has tried moclobemide before... but like others have indicated, moclobemide does not seem to have the same effectiveness on depression or anxiety as parnate (for depression) or nardil (for anxiety)Moboclobomide is milder - I thought it was probably a pretty good antidepressant ... no? I know that when they have tried to use it for SP in studies, they always push the dose extremely high.
>
>
> > I notice however the UCLA Dr's do still like to give out Zyprexa samples though (might be a dangerously effective mix with Parnate for SP and other disorders)... ; )
>
> you may be right... but feeling happy is more important to me than a possible movement disorder (and my relationship with my doc) ...... i'm guessing that worst case scenario, dopamine agent or 5HT2A agent or aripipazole or ECT clears up ... or at least covers up.... any irreversible EPSIf you want Zyprexa - certainly you won't have much trouble in 2002....
>
>
> you're probably right that nardil is better than parnate ... i am thinking more along the lines of getting an equal anxiolytic effect and increased antidepressant effect without the side effects of nardil .....Some people report a lot of side effects with nardil - I believe that these can be managed if they are unavoidable - by reducing the dose and augmenting. Anyway - I would be interested in discussing it with you sometimes in email if you want - I have been a "human gineua pig" in earlier years - have tried different things so maybe we could learn something from each other. Anyway was great to hear you comments on SP and thanks for the input and feedback.
Chad
http://www.socialfear.com/
Posted by cybercafe on September 9, 2002, at 14:29:53
In reply to Re: Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by chad_3 on September 9, 2002, at 11:04:03
>like Nardil - Parnate still is usually effective at reducing interpersonal sensitivity, low motivation, and most types of associated depressions. Agressivness or "anti-social" behavior around people (even while not "afraid" to do so) - is more likely with Parnate than Nardil - often people taking Parnate for primary SP are not really "afraid" to be around people - but rather find they would prefer to avoid them - and still end up alone most of the time - not particularly social - but definitely active and productive in more solitary type work or pursuits. Just IMO based on what I've heard out their so far. Perhaps your experience with Parnate has been more succesfull than the ones I've heard about ...
ummm.. i think any type of stimulating drug is more likely to produce more asocial behaviour ... remember introverts tend to be more stimulated than extroverts? and probably happier, too..
but then maybe i just like parnate because i'm bipolar depressed, and under stimulated more than a pure SP individual with no depression?
it's really convenient to hear your comparisons... how did you arrive at your conclusions re: parnate vs. nardil?
> I think 5ht, DA, and GABA agonists are they agents shown most effective for SP to date.
ahhh... but pure stimulants (dopamine only i think) seem to worsen anxiety no? ....
but you are probably right at least about 5ht and GABA ... that would explain why nardil kicks moclobemides butt ... cuz of the GABA transaminase inhibition ..... give moclobemide some effect on GABA, and it might kick butt too
ummm... i have always found it very very easy to start a conversation with strangers... but after the first 2 seconds are up i tend to get scared ... i always thought that meant i was lacking norepenephrine (reward for continuing behaviours?) ....... or is fear of being looked at/judged caused mainly by GABA?
>Nardil boosts all 3. I do think 5ht plays a role - but while the SSRI's boost 5ht, then also decrease whole brain DA (maybe good for depression, but tending to increase passitivtiy at the expense of social and sexual assertivness (initiation), exploratory behavior and disinhibition). Nardil instead of depeleting dopamine rather apparently moderately boosts it, consistent with the above advantages associated with DA++.
i thought drugs that increase dopamine tend to relieve depression but cause anxiety (i.e. stimulants) .... doesn't that contradict what you are saying above?
> > however doesn't evidence seem to suggest that in fact moclobemide is not better than nardil ?
> >
> Interesting point - but IMO I have yet to see evidence pointing to much efficacy for moclobmoide. I think the moclobomide studies arehmmm... actually i think my point sucked, because it didn't take into account the fact that moclobemide has no effect on GABA (as far as i know) ..... :)
>moclobomide for SP (more than any other med) - 2 of them show NO efficacy, 2 of them show EXTREME (good) efficacy, and 1 shows modest efficacy.
did the studies that show efficacy use a larger dose or longer time period than those that didn't?
>Nardil and Klonopin show robust results in all studies for SP. I have yet to hear of any
hey klonopin alone shows robust results in studies for SP no? (i'm guessing)
>lacks robust efficacy for SP. Maybe someone will prove otherwise. I hope so - because the side effect profile of moclobomide is practically unsurpassed among psychotropic drugs. IMO,
there was a lady in a support group i went to who said moclobemide was very good for her anxiety -- much better than SSRIs .... but then what isn't better than SSRIs? :)
>with SP. Coincidentally there are studies that have shown also that MAOI-B + MAOI-A inhibition leads to axiolytic effect, while MAOI-A alone (eg; moclobomide) or MAOI-B alone (selegline low dose) does not.
cool.. do you have a link?
oh btw wouldn't high dose of either one have both MAOI-A and MAOI-B effect?
> I was able to tolerate well (still had high energy, cognition, and good sleep) - high Klonopin + Parnate (also high Klonopin + Effexor). But still axiogenic. Xanax definitely
parnate made you more anxious?
>but it's tendency to cause insomnia may result in daytime sedation. Overall I think MAOI's are activating - moreso than all SSRi's except Prozac and the SNRI Effexor, to which I think they are more comparable.
wow if what you say is true i would much rather be on nardil..... basically you are saying that people who report bad side effects on nardil are those who have just started the drug and not those who have been on it for a while?
and they probably overreact because their experience on SSRIs is that side effects don't get better which is not valid to apply to MAOIs?> Moboclobomide is milder - I thought it was probably a pretty good antidepressant ... no? I know that when they have tried to use it for SP in studies, they always push the dose extremely high.
yeah my doc doesn't use high dosages... right now i'm sitting at 30 mg parnate (bottom of therapeutic window) and getting a great effect -- and i've always taken high dosages of paxil and effexor with much less effect (40 mg and 300 mg, respectively) ...
> If you want Zyprexa - certainly you won't have much trouble in 2002....
is there a better drug for someone who "thinks too much"
to take enough klon to get me to stop thinking puts me in a "stupor" or puts me to sleep
> Some people report a lot of side effects with nardil - I believe that these can be managed if they are unavoidable - by reducing the dose and augmenting. Anyway - I would be interested in
i guess i'm just anti-benzo... i want an anxiolytic cocktail that does not cause drowsiness or cognitive effects.... also don't like the ups and downs i had on klon
>discussing it with you sometimes in email if you want - I have been a "human gineua pig" in earlier years - have tried different things so maybe we could learn something from each other. Anyway was great to hear you comments on SP and thanks for the input and feedback.
yes i find you to be quite informative and enjoy discussing things with you very much, thanks :)
Posted by Dr. Bob on September 9, 2002, at 17:21:34
In reply to Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by chad_3 on September 9, 2002, at 1:05:28
> Chad
Please don't post under different names at the same time, thanks.
Bob
Posted by chad_3 on September 9, 2002, at 17:48:35
In reply to Re: posting under different names » chad_3, posted by Dr. Bob on September 9, 2002, at 17:21:34
Sorry - won't do that anymore.
I did it only to match up with my website name - but I'll be careful - no more changes.
Chad
> > Chad
>
> Please don't post under different names at the same time, thanks.
>
> Bob
>
Posted by chad_3 on September 9, 2002, at 18:06:30
In reply to Re: Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by cybercafe on September 9, 2002, at 14:29:53
Hi Cyber - long post I have time to pick a couple...
>
> ummm.. i think any type of stimulating drug is more likely to produce more asocial behaviour ...Nardil is pretty stimulating...and good for SP!
>
> > I think 5ht, DA, and GABA agonists are they agents shown most effective for SP to date.
>
> ahhh... but pure stimulants (dopamine only i think) seem to worsen anxiety no? ....most of the parkinson's meds - probably yes...
>
> ummm... i have always found it very very easy to start a conversation with strangers... but after the first 2 seconds are up i tend to get scared ... i always thought that meant i was lacking norepenephrine (reward for continuing behaviours?) ....... or is fear of being looked at/judged caused mainly by GABA?I think I would go by what works for you over pharmacologic theory ...
>
> > > however doesn't evidence seem to suggest that in fact moclobemide is not better than nardil ?correct.
> > >
>
>
> hey klonopin alone shows robust results in studies for SP no? (i'm guessing)
>
yes - I believe in those without comorbidies (ie; depression or dysthymia)Pubmed you can check maoi-a + maoi-b for axiolytic effect, link from my webpage.
>
>
> wow if what you say is true i would much rather be on nardil..... basically you are saying that people who report bad side effects on nardil are those who have just started the drug and not those who have been on it for a while?Very common.
> and they probably overreact because their experience on SSRIs is that side effects don't get better which is not valid to apply to MAOIs?
>Particularly Nardil yes.
>
>
> > If you want Zyprexa - certainly you won't have much trouble in 2002....
>
> is there a better drug for someone who "thinks too much"don't know.
>
> to take enough klon to get me to stop thinking puts me in a "stupor" or puts me to sleep
>
add parnate of effexor or nardil why not?
> i guess i'm just anti-benzo... i want an anxiolytic cocktail that does not cause drowsiness or cognitive effects.... also don't like the ups and downs i had on klonis up to you. everybody is different and makes their own choices.
>
>
> yes i find you to be quite informative and enjoy discussing things with you very much, thanks :)sure - write anytime. I do suggest to you however 1 thing more than anything right now. You can only theorize so much. Get a clear diagnosi(s) - and do good trials with meds proven most effective for your case. That is really the bottom line - to try some things. Thinking doesn't get it done... Is up to you if you want good results...
Posted by JohnQ on September 9, 2002, at 21:04:34
In reply to Nardil v Parnate, Klonopin, Xanax, gabaergic, SP, posted by chad_3 on September 9, 2002, at 1:05:28
Chad,
Do you have any idea of what the "poop-out" rate for Nardil would be? It seems like most of the people here that have tried Nardil have had it quit on them eventually. I'm thinking of trying it, but that seems to be the major sticking point for me. Thanks.
Posted by cosis on September 9, 2002, at 21:41:41
In reply to Re: Nardil » chad_3, posted by JohnQ on September 9, 2002, at 21:04:34
Most of the posts I read never mention the drug stop working, they mostly can't deal with the side-effects and quit.....
Posted by chad_3 on September 9, 2002, at 23:54:24
In reply to Re: Nardil » chad_3, posted by JohnQ on September 9, 2002, at 21:04:34
JohnQ -
I believe that many people stop taking Nardil due to it "stopping to work" - but the only cases of that I've ever heard occur early on - in the first few months. It is actually very common for Nardil to work good initially at a low dose, only to "stop working" for SP - this is when the dose is raised (this is much the same as Klonopin is ramped up for long term use). In my case for example, I started Nardil (my first time ever) - at 45mg to good effect quite soon. After 2 or 3 weeks - nothing. My Dr. raised to 60. Again - euporia and anti-SP. 2-3 weeks goes by. Suddenly nothing. In my case - which was very severe since about age 19 - I ended up going to 90mg, at which point lasting effect was maintained. By that time, I had sexual side effects which I complained about. My Dr. reassured me, weeks on end. And he was right. But the literature (which is hard to find for this underutilized but old drug) - does indicate this is the norm.
The main problem is Dr's stopped prescribing MAOI's after a cheese scare and also the SSRI's and still today most Dr's don't know even the basics of how to prescribe it correctly - including that SP may require higher doses than mild depression - (true with SSRi's as well - though their efficacy is much lower and in long term side effects of Paxil and Zoloft significantly worse IMO).
It is a little bit risky to look for advice on "what works" on a board like this - as those getting the most effective results are busy elsewhere. That is why I suggest the books at the base of my webpage - and I admit data on Nardil is hard to find - there is simply no $$$ whatsoever in promoting this drug for SP. Drug companies are billion dollar businesses.
Oh - BTW, most a/d's I don't hear of "poop out" - except 1. I've heard several people tell me that Paxil "worked really well" for their SP for usually about 1 year or so - then "pooped out". I have no idea why that occurs. But most of the results I have heard from Paxil for pure generalized SP have not been good.
Nardil is kind of like a benzo - and maybe tricyclic (not sure - I never took those) - but the dose tends to go medium to high - and requires slow increase - if it works a few weeks and stops - then it is time to increase the dose.
Anyway - this is my view. Thanks for the feedback and best wishes!
Chad
http://www.socialfear.com/> Chad,
>
> Do you have any idea of what the "poop-out" rate for Nardil would be? It seems like most of the people here that have tried Nardil have had it quit on them eventually. I'm thinking of trying it, but that seems to be the major sticking point for me. Thanks.
Posted by chad_3 on September 10, 2002, at 0:07:54
In reply to Re: Nardil, posted by cosis on September 9, 2002, at 21:41:41
In my last post at end, I didn't mean to say that Nardil's effect is like a benzo - but rather the dosing scheme for long term use - it tends to need to ramp up several times over a period of a few months.... but levels out at a "therapeutic dose" where it continues to work without further increase. With Nardil, after more time side effects go away or diminish greatly with efficacy maintained (I remember asking my initial Dr. how that could be - didn't make sense at all to me - but he said yes side effect go down and efficacy maintains - and he was right about that also...). Fortunately I managed to be patient enough to find out - probably because for the first time in my life I was free of my life-crippling SP!
Chad
http://www.socialfear.com/
> Most of the posts I read never mention the drug stop working, they mostly can't deal with the side-effects and quit.....
Posted by cosis on September 10, 2002, at 19:43:29
In reply to Nardil lasts - but like benzo, taper up 3 months, posted by chad_3 on September 9, 2002, at 23:54:24
What if it stopped working after you max out at 90mg? Is this uncommon? I am at 60mg for 3 1/2 weeks, no change in my social anxiety.. I am counting on it so much to work......
Posted by chad_3 on September 11, 2002, at 0:08:19
In reply to Re: Nardil lasts - but like benzo, taper up 3 months, posted by cosis on September 10, 2002, at 19:43:29
Cosis -
I don't mind if you write me anytime at my email - I will help you if I can ...
For others to help you here, there are surely many who can - if you can share your primary dx and any other primary or secondary dx, treatment history and what worked and how, etc... people will better be able to comment I think ...
And I am happy to answer email privately which works much quicker for me overall ...
Good luck hope to hear from you ...
Chad
http://www.socialfear.com/
> What if it stopped working after you max out at 90mg? Is this uncommon? I am at 60mg for 3 1/2 weeks, no change in my social anxiety.. I am counting on it so much to work......
Posted by BK on September 12, 2002, at 23:41:10
In reply to Nardil lasts - but like benzo, taper up 3 months, posted by chad_3 on September 9, 2002, at 23:54:24
> JohnQ -
>
> I believe that many people stop taking Nardil due to it "stopping to work" - but the only cases of that I've ever heard occur early on - in the first few months. It is actually very common for Nardil to work good initially at a low dose, only to "stop working" for SP - this is when the dose is raised (this is much the same as Klonopin is ramped up for long term use). In my case for example, I started Nardil (my first time ever) - at 45mg to good effect quite soon. After 2 or 3 weeks - nothing. My Dr. raised to 60. Again - euporia and anti-SP. 2-3 weeks goes by. Suddenly nothing. In my case - which was very severe since about age 19 - I ended up going to 90mg, at which point lasting effect was maintained. By that time, I had sexual side effects which I complained about. My Dr. reassured me, weeks on end. And he was right. But the literature (which is hard to find for this underutilized but old drug) - does indicate this is the norm.
>
> The main problem is Dr's stopped prescribing MAOI's after a cheese scare and also the SSRI's and still today most Dr's don't know even the basics of how to prescribe it correctly - including that SP may require higher doses than mild depression - (true with SSRi's as well - though their efficacy is much lower and in long term side effects of Paxil and Zoloft significantly worse IMO).
>
> It is a little bit risky to look for advice on "what works" on a board like this - as those getting the most effective results are busy elsewhere. That is why I suggest the books at the base of my webpage - and I admit data on Nardil is hard to find - there is simply no $$$ whatsoever in promoting this drug for SP. Drug companies are billion dollar businesses.
>
> Oh - BTW, most a/d's I don't hear of "poop out" - except 1. I've heard several people tell me that Paxil "worked really well" for their SP for usually about 1 year or so - then "pooped out". I have no idea why that occurs. But most of the results I have heard from Paxil for pure generalized SP have not been good.
>
> Nardil is kind of like a benzo - and maybe tricyclic (not sure - I never took those) - but the dose tends to go medium to high - and requires slow increase - if it works a few weeks and stops - then it is time to increase the dose.
>
> Anyway - this is my view. Thanks for the feedback and best wishes!
>
> Chad
> http://www.socialfear.com/
>
> > Chad,
> >
> > Do you have any idea of what the "poop-out" rate for Nardil would be? It seems like most of the people here that have tried Nardil have had it quit on them eventually. I'm thinking of trying it, but that seems to be the major sticking point for me. Thanks.
>
>
Chad,I took Nardil some fifteen years ago and initially it was an absolute godsend in terms of relieving my SP. Unfortunately, after three months it completely pooped-out. I tried increasing the dosage (I believe to 90 mg) and I got hand tremors so severe that I couldn't feed myself. My SP worsened considerably at this point. Regrettably, I had to give up on the drug at that point. Several years later I retried the drug and I just didn't experience anywhere near the benefits that I had initially.
I truly believe from reading the postings herein that there is indeed a high incidence of Nardil poop-out, and in my particular case, increasing the dosage did little to stop that. I'd be very interested (and very appreciative) if anyone knew of a safe and effective agent that could be taken in conjunction with Nardil to increase its efficacy.
Posted by cybercafe on September 14, 2002, at 1:35:01
In reply to Re: Nardil lasts - but like benzo, taper up 3 months, posted by BK on September 12, 2002, at 23:41:10
> > > Do you have any idea of what the "poop-out" rate for Nardil would be? It seems like most of the people here that have tried Nardil have had it quit on them eventually. I'm thinking of trying it, but that seems to be the major sticking point for me. Thanks.
> >
> >
> Chad,
>
> I took Nardil some fifteen years ago and initially it was an absolute godsend in terms of relieving my SP. Unfortunately, after three months it completely pooped-out. I tried increasing the dosage (I believe to 90 mg) and I got hand tremors so severe that I couldn't feed myself. My SP worsened considerably at this point. Regrettably, I had to give up on the drug at that point. Several years later I retried the drug and I just didn't experience anywhere near the benefits that I had initially.
>
> I truly believe from reading the postings herein that there is indeed a high incidence of Nardil poop-out, and in my particular case, increasing the dosage did little to stop that. I'd be very interested (and very appreciative) if anyone knew of a safe and effective agent that could be taken in conjunction with Nardil to increase its efficacy.i don't know if it would be a safe combination... but maybe you could add an anticonvulsant with anxiolytic properties...... or if depression is more of a problem, you could go for the typical augmentation strategies -- lithium, thyroid, possibly stimulant (with caution), maybe buspar or pindolol .........
Posted by chad_3 on September 14, 2002, at 12:49:48
In reply to Re: Nardil lasts - but like benzo, taper up 3 months, posted by cybercafe on September 14, 2002, at 1:35:01
I think Nardil works for most with primary generalized SP - if they stay with and get the dose high enough.
Do you have any other conditions accompanying Social Phobia. This is very common - and changes the picture of how to treat.
To take an extreme example, many people with primary schitzophrenia also have negative symtpoms which are much like "social phobia + mild depression" - so they can say they have "social phobia" - but certainly Nardil is NOT the drug to be used in this case - and could not be expected to work or to be safe!
As for severe hand tremors - that does not sound good - are you sure there is not something else going on besides Social Phobia?
Chad
http://www.socialfear.com/
> > > > Do you have any idea of what the "poop-out" rate for Nardil would be? It seems like most of the people here that have tried Nardil have had it quit on them eventually. I'm thinking of trying it, but that seems to be the major sticking point for me. Thanks.
> > >
> > >
> > Chad,
> >
> > I took Nardil some fifteen years ago and initially it was an absolute godsend in terms of relieving my SP. Unfortunately, after three months it completely pooped-out. I tried increasing the dosage (I believe to 90 mg) and I got hand tremors so severe that I couldn't feed myself. My SP worsened considerably at this point. Regrettably, I had to give up on the drug at that point. Several years later I retried the drug and I just didn't experience anywhere near the benefits that I had initially.
> >
> > I truly believe from reading the postings herein that there is indeed a high incidence of Nardil poop-out, and in my particular case, increasing the dosage did little to stop that. I'd be very interested (and very appreciative) if anyone knew of a safe and effective agent that could be taken in conjunction with Nardil to increase its efficacy.
>
> i don't know if it would be a safe combination... but maybe you could add an anticonvulsant with anxiolytic properties...... or if depression is more of a problem, you could go for the typical augmentation strategies -- lithium, thyroid, possibly stimulant (with caution), maybe buspar or pindolol .........
>
Posted by cee on December 27, 2007, at 13:42:46
In reply to Nardil for SP - Do you have anything besides SP?, posted by chad_3 on September 14, 2002, at 12:49:48
I HAVE HEARD OF SOME PEOPLE TAKING 105 MG TO 120
WITHOUT TO MUCH TROUBLE ,IS THERE ANYONE WHO HAS TRIED THIS MUCHCEE
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