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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Questionmark on May 29, 2004, at 3:48:19
2 questions that i have yet to get answered:
1) Is there any truth to the suggestion that one should eventually lower his/her dose of Nardil to a "maintanence dose"? i've heard/read this so many times but based on personal experience, lowering the dose results in decreased effects very quickly (i.e., the next day or so). Because of this and how quickly i can feel withdrawal-like symptoms (that are reminiscent of Paxil withdrawal) after missing a full day's dose or so, or, say, two half- days' doses, i've also started to become really skeptical of the claim that Nardil's inhibition of MAO (or reduction of MAO enzymes at least) lasts for days or even weeks.
What say yous? What's the truth?2) What is the physiological and/or pharmacological reason for it being preferable to split the Nardil dose to 2 or 3 times per day?
(Especially if that is true about MAO reduction/inhibition lasting for days or weeks-- about which, again, i now have my doubts). Is it just due to the GABA-increasing and (maybe) anticholinergic effects of Nardil? Please explain.ThAAAAnk YoUUUsss.
Posted by harryp on May 31, 2004, at 0:45:24
In reply to Knowledgeable brothers and sisters in Nardil..., posted by Questionmark on May 29, 2004, at 3:48:19
My suspicion is that MAO is restored much faster in the brain than in the gut. I have seen some charts in a psychpharm book (not sure if these are accurate) that indicate that one has to go to 90 mg. of Nardil to approach 100% inhibition of MAO in the brain.
The "maintainance dose" issue (for me) is just a matter of using the minimum amount of drug to get the effect you need. If you lower the dose and your depression gets worse, you should go back to the dose that was working.
As my life has improved (lots of sun helps too!), I've found that I could reduce my Parnate dose from a high of 50mg to a present 30mg. This has dramatically improved my sex drive. If I start to get consistently more depressed, I'll just up the dose again.
Posted by bobbiedobbs on June 6, 2004, at 17:03:24
In reply to Re: Knowledgeable brothers and sisters in Nardil... » Questionmark, posted by harryp on May 31, 2004, at 0:45:24
I took Nardil for 15 years. I think the prevailing theory was the "maintenance dose" idea - that you needed to achieve a certain brain chemistry change, then could get away on less. But think this has been disputed more recently. I remember reading one poster - whose experience mirrored mine - who found reasoned dose adjustments - up and down - the best medicine. For me the best result was to take a certain mid-range dose, say 30-45 mg, then increase it when things got bad and decrease it when the side effects became intolerable - you can take holidays for a day (maybe two) to restore some of the lost sexual tarnish. When I say increase I'm talking about several days.
Posted by Questionmark on June 10, 2004, at 21:54:50
In reply to Re: Knowledgeable brothers and sisters in Nardil..., posted by bobbiedobbs on June 6, 2004, at 17:03:24
Bobbiedobs, i find your following statements really interesting:
"I remember reading one poster - whose experience mirrored mine - who found reasoned dose adjustments - up and down - the best medicine. For me the best result was to take a certain mid-range dose, say 30-45 mg, then increase it when things got bad and decrease it when the side effects became intolerable - you can take holidays for a day (maybe two) to restore some of the lost sexual tarnish. When I say increase I'm talking about several days."
That's a really interesting method of taking Nardil. How long did it take you to feel worse/bad after a dose reduction? How long did it take for you to feel the beneficial effects (on mood & anxiety, particularly) of an increased dose? If/when you took a holiday for a day or two, how long did it take for you to feel the Nardil normalcy (normal, sustained beneficial effects) after restarting it again? Cuz with me it feels like it takes awhile for a Nardil dose modification to stabilize (like 4 to 8 days usually-- more or less, depending on the duration and dosage change). i could be wrong though-- maybe it's just in my head for the most part.
i'm interested in trying this. (btw, i'm on 60mg Nardil). Thank you.
Posted by bobbiedobbs on June 10, 2004, at 23:23:17
In reply to Nardil specific dosing (thanks you two)- more Q., posted by Questionmark on June 10, 2004, at 21:54:50
For me the response time for changes in dose were generally shorter than the 4-8 days that you note. It would generally take about 2-3 days before I would experience the effect of a dose adjustment, whether up or down. It is possible there was some placebo effect here, however.
That said, I seemed to be highly sensitive to changes in dose in 15 mg increments.
Re the "holidays", I was realliy just referring to skipping a day (at most), to help with constipation, urinary retention or sexual difficulties. There was no noticable change in anxiety given such short hiateses, but others I've spoken to are leery about this. I'd be more inclinced to just adjust doseage rather than skip.
By the way, the other poster that I earlier mentioned, as I recall, would go up to say 60 mg until he felt benefit, then drop down to 30-45 once things stabilized- particuarly to help with side effects. Then, when things got knotty, he's go back up to 60 mg. That seemed to work in his case. My adjustments tended to much shorter.
I don't think onc should tinker too much, but as anxiety worsens and or side effects become more pronounced, some medication management may be in order. Hope that helps.
This is the end of the thread.
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