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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by jerrympls on September 12, 2003, at 23:04:28
Nardil has been good for me - but after a couple months on it - it seems to have lost its luster. I'm on 75mgs. I feel less depressed - but still have a lot of lethargy (can't get up the energy to clean my apt., do dishes, laundry, etc), a LOT of daytimes sleepiness and a big lack of motivation. I'm a musician and although some of my "want" to listen to music has returned, I don't feel the passion to perform music. I still don't have any interest in my former hobbies and can barely get off the couch some days. Work has been better - but I just feel like giving up many days because I'm so apathetic.
I asked my psych doc (a 4th year resident) if we could add a small amount of Ritalin (even though I provided her some info about it being safe) - but she stays away from anything her PDA says is contraindicated with MAOIs. What about Provigil? I just need a small amount of a stimulant but how to convince her that any are safe? Maybe a switch to Parnate? My other choice is to go to high doses of Effexor + lithium and perhaps a stimulant.
Anyone at all out there have any insight into this issue of augmenting Nardil?? There has to be SOMETHING.
Please please please -- anyone with any experiences??? knowledge?????
Thanks MUCH in advance!!
Jerry
Posted by Ame Sans Vie on September 15, 2003, at 12:48:10
In reply to What can they use to augment Nardil?, posted by jerrympls on September 12, 2003, at 23:04:28
Go for the Provigil, I say. That is, if you still find yourself unable to knock some sense into your pdoc's head and get her to allow a trial of a real stimulant. :-)
Really though, it is a good thing she's being prudent about this issue... perhaps she would value the opinions of her fellow psychiatrists more than some facts and figures pulled off the 'net? Just a thought. Ask her if she might consult with her colleagues on the idea. Of course, starting off at a low dose (1.125mg-2.5mg) and keeping nifedipine/chlorpromazine on hand should also ease her mind.
Anyways, if you end up having to try something else, I would suggest trying the Provigil, increasing the dose once or twice a week until benefit is obtained -- it takes three days after initiation of modafinil or raising the dosage for it to reach maximum effect. While Provigil is most often perfectly safe taken with MAOIs, doses starting around 800mg have been shown to cause mild hypertension, so doses exceeding 600mg would probably be risky territory. Perhaps, if you gain a partial response from Provigil, a low-normal dose of Mirapex, Requip, Parlodel, Dostinex, Symmetrel, or even Sinemet-CR as an augmentor would provide additional help with motivational difficulties and anhedonia.
The Parnate idea is a good one also, though I assume you'd rather find a quick fix than switch meds entirely. Was your depression characterized by hypersomnolence, lack of motivation and/or overeating *before* it was treated? If so, then Parnate may have been the better choice for you from the start.
Unless the Effexor has worked for you in the past to some degree, I might be inclined to just scratch that option off the list for now. Even if it were somewhat helpful, the washout period would sure be a b*tch. :-\
On a more personal note, I'm also a musician, and I can completely sympathize with you that the passion just seems conspicuously absent. Just very recently I finally bought a new guitar and began to write again... it's better than sex, lol. Very sickening though... I used to own several $100,000 worth of gear -- custom guitars, basses, amps, drums, synths, recording equipment, live sound equipment, etc, etc, etc. But I pawned every last bit of it in favor of self-medication early last year. Well, not all of it... I still have a worn-out MXR Disortion + stomp box that the pawnbrokers wouldn't take. But I think I got somewhere in the realm of 15 grand for all of it... if only you knew how many beautiful musical accoutrements and apparatus I threw away for a three-month relief from my depression/anxiety. When I think about all the stuff I hocked, I really do get physically ill. I figured at the time that I'd never use them again -- that the passion was gone, I was too jaded, whatever. So now I'm starting over with nothing but a Harmony acoustic I bought from a friend for 40 bucks.
Moral of the story: that sonic bliss *will* come back to you one day, so whatever you do, don't be a complete moron like me and get rid of all your sh*t! lol
Posted by djmmm on September 16, 2003, at 9:46:43
In reply to What can they use to augment Nardil?, posted by jerrympls on September 12, 2003, at 23:04:28
> Nardil has been good for me - but after a couple months on it - it seems to have lost its luster. I'm on 75mgs. I feel less depressed - but still have a lot of lethargy (can't get up the energy to clean my apt., do dishes, laundry, etc), a LOT of daytimes sleepiness and a big lack of motivation. I'm a musician and although some of my "want" to listen to music has returned, I don't feel the passion to perform music. I still don't have any interest in my former hobbies and can barely get off the couch some days. Work has been better - but I just feel like giving up many days because I'm so apathetic.
>
> I asked my psych doc (a 4th year resident) if we could add a small amount of Ritalin (even though I provided her some info about it being safe) - but she stays away from anything her PDA says is contraindicated with MAOIs. What about Provigil? I just need a small amount of a stimulant but how to convince her that any are safe? Maybe a switch to Parnate? My other choice is to go to high doses of Effexor + lithium and perhaps a stimulant.
>
> Anyone at all out there have any insight into this issue of augmenting Nardil?? There has to be SOMETHING.
>
> Please please please -- anyone with any experiences??? knowledge?????
>
> Thanks MUCH in advance!!
>
> Jerry
>My theory is that apathy/lack of motivation is caused by overmedicating...too much serotonin can cause as many problems as decreased serotonin levels... 75mg is a high dose of Nardil...for me at least, I felt strange whenever I increased my dose from 60 to 75....for what it's worth, most people respond to 45mg...ask you psychiatrist what she thinks about this....on the other hand, many peole have added a mild stimulant (ritalin, etc) to an MAOI with no problems. Parnate is a bit more stimulating than Nardil (probably because of Nardil's effect on GABA)...
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