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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by ace on June 12, 2005, at 1:45:31
1. Effexor is like Tramadol, correct???
2. Tramadol makes me feel that old Nardil euphoria
3. Therefore, I'm going to go and try Nardil and Effexor together!
Don't worry, i have Periactin and adalat on hand if any probs crop up!!!
Please comment, experiences, call me an idiot, a lovely man, etc etc!!
Ace!
Posted by linkadge on June 12, 2005, at 3:04:06
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
Who is this doctor of yours ??!!
I think that is fairly risky, but hey, its your body.I think you should take up jogging. Jogging releses massive amounts of PEA (one study showed 450% increase in metabolites after 45min)
Plus MAO-B inhibition will surely give you a boost.
Heck I was proably getting paranoid schitsohprenia levels of PEA when I when jog-aholic on Parnate.
Linkadge
Posted by Tom Twilight on June 12, 2005, at 6:17:55
In reply to Re: Nardil + Effexor...I'm going for it!!!!, posted by linkadge on June 12, 2005, at 3:04:06
Go for it Ace, if thats what you want!
I imagine there could be a risk of serotonin syndrome, so I would "Start low go slow".
I found that a combination of Effexor and Moclobemide made me very agitated, but I know Moclobemide is a very different drug from Nardil.
Linkadge suggests Excersise, this is a good suggestion, but I'm not sure how effective excersise is for severe depression.
When I go for a long bike ride
I feel quite euphoric for about half an hour afterwoods, then I feel just the same.
Posted by SLS on June 12, 2005, at 7:27:39
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
Don't do it.
I understand your plight and your desire to add an SRI to an MAOI.
If you do, you MUST have a comprehensive list of the signs and symptoms of serotonin syndrome so that you catch it as early as possible. Once it appears, I believe you will find it worsen dramatically without some sort of pharmacological intervention, so I hope you have your anti-serotonergics in place. Personally, I could not recommend which one(s) to choose. Cyproheptadine with a muscle-relaxing BZD like lorazepam or diazepam might be the best combination.
I once used a TEST DOSE of venlafaxine in combination with Parnate 120mg that I had taken at the time. The amount of venlafaxine was no more than 10-15mg. I suffered an extreme delirium. I didn't test my vital signs except for temperature, which was a little high.
In my opinion, Nardil is more likely to produce serotonin syndrome than is Parnate. I recommend that you employ a TEST DOSE first, and titrate up very, very gradually if you suffered no ill effects. You must remain vigilent in evaluating your condition. If SS symptoms begin to emerge, you MUST stop the venlafaxine immediately and begin taking your antidotes. Don't sit around hoping the symptoms will simply pass. By that time, it might be too late. Fatality is best avoided by remaining alive.
Read this:http://www.uspharmacist.com/oldformat.asp?url=newlook/files/feat/acf2fa6.htm
- Scott
Posted by ed_uk on June 12, 2005, at 7:47:36
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
Hi Ace!
Nardil + Effexor = potentially life-threatening serotonin syndrome
>Effexor is like Tramadol, correct???
AFAIK, Effexor is a much more potent serotonin reuptake inhibitor. I would expect SS to be much more likely with Effexor.
>Periactin
'Normal' doses of Periactin might not be effective - it might not work.
Kind regards,
Ed.
Posted by Chairman_MAO on June 12, 2005, at 9:47:27
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
DO NOT DO THIS. YOU ARE PLAYING RUSSIAN ROULETTE WITH YOUR LIFE. This is more dangerous than eating tyramine-rich foods on an MAOI, IMHO.
The increase in SE from phenelzine alone is enough to produce a clinical effect. If it is not, do something safer like add l-tryptophan or 5-htp, which at least has SOME documented safety in the literature. Futhermore, it could be possible that you'd be so immersed in delirium that you may not remember that you need to take the cyprohepadine (if your oral dose is even enough to truly counteract that; they use parenteral cyproheptadine in hospitals, probably). If you are going to undertake this (IMO--note the lack of an 'H' here) futile and dangerous experiment, at least have someone else around you to call 911 when your core temperature starts reading like a seismometer during a Tsunami.
If you must do this, you need a scale accurate to 1-2mg, and start at TWO MG. Even 10-20mg of Effexor could cause serotonin syndrome if you're taking a therapeutic dose of phenelzine (1mg/kg or 80% MAO inhibition).
Effexor is WAY stronger than tramadol's reuptake inhibition, which is really weak. I wish to ask, however: Have you used tramadol with Nardil safely? I've always been wondering whether that's possible despite the warnings.
Also, if tramadol works, get buprenorphine prescribed. I guarantee it will do what you are looking for. It is the MU-OPIOID agonism that likely made you feel good, NOT MONOAMINE REUPTAKE INHIBITION.
Posted by Jakeman on June 12, 2005, at 14:12:09
In reply to Re: Nardil + Effexor...I'm going for it!!!! » ace, posted by Chairman_MAO on June 12, 2005, at 9:47:27
I've found that tramadol used occasionally will lift my depression within hours and make me feel more outgoing. Is it prescribed for depression for long-term use? Thanks
~Jake
Posted by linkadge on June 12, 2005, at 15:35:34
In reply to Re: tramadol, posted by Jakeman on June 12, 2005, at 14:12:09
There are quite a number of studies that show that exercise is very effective even in severe depression.
I have been on almost everything. I agree that exercise is extremely hard to do when severely depressed, but I don't doubt its effacacy even in severe depression.
All drugs have pooped out on me, but exercise has never pooped out.
I suppose some say it doesn't work for them. I say throw away the rubber bands, and bump up the intensity.
If the end target of AD treatment is enhanced neurotrophin expression, then exercise has pharmacudicals beat hands down.Shock - 200% increase BDNF in hippocampus
Exercise - 90-120% increase in BDNF (at 1.5 hours)
Parnate - 40% increase in BDNF in hippocampus
Another intresting thing is that the more exercise, the more BDNF, up to about 8 hours of exercise (at least in rats). I agree 8 hours is not tangable though.
Linkadge
Posted by Tom Twilight on June 12, 2005, at 17:27:08
In reply to Re: Nardil + Effexor...I'm going for it!!!!, posted by Tom Twilight on June 12, 2005, at 6:17:55
Sorry wrote my reply as soon as I woke up, and didn't really think it through
> I imagine there could be a risk of serotonin syndrome, so I would "Start low go slow".
Ok, I'll change that to a very high risk of serotonin syndrome!
What I would also like to challange is the similarity between Effexor and Tramadol
Apparently they are very similar chemicaly , but they felt like very different drugs to me.
Just because you respond well to one doesn't mean you will respond well to the other!In particular, as others have already said Effexor has a much more powerful effect on Serotonin and Noradrenaline than Tramadol.
I don't think this combination is a good idea, now that I've thought it through
Posted by 4WD on June 12, 2005, at 22:19:58
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
> 1. Effexor is like Tramadol, correct???
>
> 2. Tramadol makes me feel that old Nardil euphoria
>
> 3. Therefore, I'm going to go and try Nardil and Effexor together!
>
> Don't worry, i have Periactin and adalat on hand if any probs crop up!!!
>
> Please comment, experiences, call me an idiot, a lovely man, etc etc!!
>
> Ace!Effexor is like tramadol? Huh?
When I took Effexor, I was calm and smooth and not anxious. When I took tramadol, I was tense, jittery and nervous, like too much coffee.
Marsha
Posted by Dr. Bob on June 14, 2005, at 22:18:48
In reply to Exercise for severe depression, posted by linkadge on June 12, 2005, at 15:35:34
> There are quite a number of studies that show that exercise is very effective even in severe depression.
Sorry to interrupt, but I'd like to redirect follow-ups regarding exercise to Psycho-Babble Health. Here's a link:
http://www.dr-bob.org/babble/health/20050411/msgs/512835.html
Thanks,
Bob
Posted by SLS on June 15, 2005, at 7:04:50
In reply to Redirect: Exercise for severe depression, posted by Dr. Bob on June 14, 2005, at 22:18:48
> > "No magic pill in sight?"
> I beg to differ. The effect I experience from the meds I am on now is truly magical.> I feel blessed by God to have access to them, and now know that I must get my act together and contribute something magnificent and useful to humanity because I have been given this profound gift...
You already have.
- Scott
Posted by Questionmark on June 15, 2005, at 18:41:48
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
i believe Effexor is a much more potent SRI (serotonin reuptake inhibitor) than Tramadol is. i could see how a little extra 5-HT reuptake inhibition would make you feel "that old Nardil euphoria," but i question whether it would be worthwhile. Even if it is, you should definitely be extremely cautious and start w/ a very very low dose of SSRI. But as ChairmanMAO said, i think you might be better off using 5-HTP or tryptophan (and/or maybe even something like inositol as well)-- while still being cautious w/ those.
After experimenting w/ minimally low doses of Paxil w/ my Nardil (very rarely & occasionally) to determine how much i might be able to safely take that would also be effective in the way i desired,... i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day. i did this for various reasons, but primarily just when i wanted to be in a highly prosocial and happy state for whatever particular reason. (((i STRONGLY RECOMMEND AGAINST THIS PRACTICE FOR ANYONE HOWEVER, FOR A # OF REASONS))).
i would use about 2.5mg - 7mg-- maybe a bit higher (up to 10mg?), but i can't remember for sure-- when on either 45 or 60mg Nardil per day (those are the Nardil doses i have always been on). i have only done this several times or so.
So, firstly, you might be able to go above the absolute maximum doses of Effexor that Chairman MAO mentions (since Paxil is more potent than Effexor, by weight)-- depending on your current dose of Nardil and % MAO inhibition-- but, i really strongly caution against this... (unless maybe you know some brilliant psychopharmacologist who insists that it is fine and explains why).
...
The reasons for this: (1)Who knows what this does to your brain and neurochemistry, especially doing it daily {{[E.g., what if it eventually results in profound apathy and/or inhibition of DA transmission; what if it eventually results in profound 5-HT receptor adaption and tolerance; what if it results in 5-HT neurotoxicity and neuron death (similar to MDMA?)?]}}, (2)Your libido will be eradicated, (3)It may be damaging to your muscles and kidneys, if not more (read about physical effects of serotonin syndrome-- of which your med combo may be a constant at-least-mild form), (4)coma or death due to serotonin syndrome, (5)etc. (?).
Therefore, i advise against it.
Good luck though.> 1. Effexor is like Tramadol, correct???
>
> 2. Tramadol makes me feel that old Nardil euphoria
>
> 3. Therefore, I'm going to go and try Nardil and Effexor together!
>
> Don't worry, i have Periactin and adalat on hand if any probs crop up!!!
>
> Please comment, experiences, call me an idiot, a lovely man, etc etc!!
>
> Ace!
Posted by ed_uk on June 15, 2005, at 18:59:40
In reply to Nardil + Effexor...I'm going for it!!!!, posted by ace on June 12, 2005, at 1:45:31
Hi Andrew!
>Please comment, experiences, call me an idiot, a lovely man, etc etc!!
Didn't you once combine Nardil with Anafranil and suffer terrible side effects? Well.........
Effexor + Nardil would be worse!!!
Kind regards,
Ed.
Posted by ed_uk on June 15, 2005, at 19:02:05
In reply to Re: Nardil + Effexor...I'm going for it!!!! » ace, posted by Questionmark on June 15, 2005, at 18:41:48
Hi!!!
>i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day.
That's interesting. What were the psychological effects of this combination?? What side effects did you have?
Kind regards,
Ed.
Posted by ConfuzyQ on June 16, 2005, at 7:09:37
In reply to Re: tramadol, posted by Jakeman on June 12, 2005, at 14:12:09
> I've found that tramadol used occasionally will lift my depression within hours and make me feel more outgoing. Is it prescribed for depression for long-term use? Thanks
> ~Jake
>It works that way for me too, and also helps with my organization and prioritizing. The research that has been done has found it helps with OCD too, which is one of the things I may have some variant of. I have used it as a pinch-hit for most of the past two years, limiting myself to the lowest dose that seems capable of helping me (25 to 75 mg/day).
The secondary topic of my tramadol use recurs throughout a thread I have going here right now, started as "Depression getting on Strattera?" (FYI, during the thread I changed my posting name from Spoc.) You probably wouldn't learn much new from reading it, but hey, if you're bored... ;-)
I'm guessing that even if Effexor is a much more potent SRI than tramadol, if the smaller gun is working it would be the better choice...
I soooo wish tramadol would be looked into more (but I haven't been paying attention to whether it has). As much as it keeps me pasted together in low dose, I would love to see how much it could help at a higher dose. But I won't go that far on my own, and have accepted that it will probably never be anything more than something I use on my own as a pinch hit when I am not seeing any docs or trying/taking anything else. I would love to hear that I'm wrong on that.
Posted by Jakeman on June 16, 2005, at 10:36:42
In reply to Re: tramadol: wish it would be researched more!! » Jakeman, posted by ConfuzyQ on June 16, 2005, at 7:09:37
> > I've found that tramadol used occasionally will lift my depression within hours and make me feel more outgoing. Is it prescribed for depression for long-term use? Thanks
> > ~Jake
> >
>
> It works that way for me too, and also helps with my organization and prioritizing. The research that has been done has found it helps with OCD too, which is one of the things I may have some variant of. I have used it as a pinch-hit for most of the past two years, limiting myself to the lowest dose that seems capable of helping me (25 to 75 mg/day).
>
> The secondary topic of my tramadol use recurs throughout a thread I have going here right now, started as "Depression getting on Strattera?" (FYI, during the thread I changed my posting name from Spoc.) You probably wouldn't learn much new from reading it, but hey, if you're bored... ;-)
>
> I'm guessing that even if Effexor is a much more potent SRI than tramadol, if the smaller gun is working it would be the better choice...
>
> I soooo wish tramadol would be looked into more (but I haven't been paying attention to whether it has). As much as it keeps me pasted together in low dose, I would love to see how much it could help at a higher dose. But I won't go that far on my own, and have accepted that it will probably never be anything more than something I use on my own as a pinch hit when I am not seeing any docs or trying/taking anything else. I would love to hear that I'm wrong on that.
>I didn't know about the other thread- thanks. I agree, I would also like to see more information about Tramadol being used as ongoing treatment for depression. I've read anecdoctal reports that its used off-label in Europe for atypical depression. Maybe Ed-UK knows something about that? I initially got Tramadol for back pain and found it didn't help much there. But in that short trial it did give me more energy, and mood and focus improved. I've only taken it intermittently since then. I've read long-time users have some nasty withdrawal effects. But that's true with many widely used meds for depression and anxiety.
~J
Posted by Chairman_MAO on June 17, 2005, at 12:43:13
In reply to Re: tramadol: wish it would be researched more!! » Jakeman, posted by ConfuzyQ on June 16, 2005, at 7:09:37
mu-opioid agonists are proven to help with OCD. It is likely that this is why tramadol helps. It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
Posted by ConfuzyQ on June 17, 2005, at 13:34:31
In reply to Re: tramadol: wish it would be researched more!! » ConfuzyQ, posted by Chairman_MAO on June 17, 2005, at 12:43:13
Thank you chairman! I'll be up front about my ignorance...
> mu-opioid agonists are proven to help with OCD.
As a point of reference, what other drugs are examples of that class?
> It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
And that means it probably isn't clinically significant in helping with ______?
Thanks again; and if possible, it would be great if you could comment on these tramadol questions I posted today:
http://www.dr-bob.org/babble/20050617/msgs/514240.html
Posted by Questionmark on June 17, 2005, at 17:52:31
In reply to Paxil/Nardil » Questionmark, posted by ed_uk on June 15, 2005, at 19:02:05
> Hi!!!
>
> >i got to the point of using a low dose of Paxil every now and then (again, very very rarely) to powerfully augment my Nardil and get a strong serotonergic effect for a day.
>
> That's interesting. What were the psychological effects of this combination?? What side effects did you have?
>
> Kind regards,
> Ed.
Hey.
Some psychological and other effects of this combination were a strong sense of happiness (wouldn't exactly say euphoria-- not sure why, just didn't "feel" like "euphoria" usually does);
high prosociability w/ lots of talking, smiling, and moderate laughing-- almost pressured speech at times-- with a strong desire to talk to people... so strong in fact that i actually i had to restrain myself to some extent;
physical restlessness;
muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);
excessive sweating and feelings of warmth;
having lots of physical energy and maybe strength;
and, occasional periods of obnoxiousness and giddiness (not in the sense of automatic laughter-- as cannabis often gives or as does experiencing something truly hilarious-- but not exactly forced laughter either).
i also had feelings of mostly physical anxiety, but the psychological lessening of inhibitions overpowered these feelings.
i remember thinking how 'i wish i could always feel like this,' but i'm not really sure if it would be the best state for certain situations (e.g., giving a speech (?), a close & serious one-on-one conversation, etc.). i do think there are certain situations where this sort of state would probably be detrimental though. And i strongly question whether or not this sort of practice is good for oneself.
Posted by Questionmark on June 17, 2005, at 18:04:57
In reply to Re: tramadol: wish it would be researched more!! » ConfuzyQ, posted by Chairman_MAO on June 17, 2005, at 12:43:13
> mu-opioid agonists are proven to help with OCD. It is likely that this is why tramadol helps. It's monoamine reuptake inhibition is simply too weak to be clinically significant in that regard, IMHO.
Hi. Do you think that mu-opioid agonists would or might also be helpful for OCPD??
Also, do you know if there are any effective ways to use mu agonists to help OCD (or OCPD) in a long-term and continual or semi-continual manner (i.e., mostly, in a way that will not result in tolerance to this effect)?
Thanks.
Posted by ed_uk on June 17, 2005, at 18:21:42
In reply to Re: Paxil/Nardil » ed_uk, posted by Questionmark on June 17, 2005, at 17:52:31
Hi QM,
Thanks for the detailed reply :-)
>Some psychological and other effects of this combination were a strong sense of happiness.......
:-)
>physical restlessness; muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);excessive sweating and feelings of warmth.......
All common 'serotonergic' effects. Celexa makes me sweat a lot and clench my jaw.
>And i strongly question whether or not this sort of practice is good for oneself.
Keep the Paxil dose very low!
Kind regards,
Ed.
Posted by willyee on June 20, 2005, at 19:44:37
In reply to Re: Paxil + Nardil » Questionmark, posted by ed_uk on June 17, 2005, at 18:21:42
> Hi QM,
>
> Thanks for the detailed reply :-)
>
> >Some psychological and other effects of this combination were a strong sense of happiness.......
>
> :-)Exessive sweating was always a marker for me that i was heading for an interaction.There is also unresltleness,u lay down but pop back up.There is ehnanced sociability,and energy,but it is maniac like.Last when u do chrash,theres a terrable depression that follows.This of course is only my opinion.
>
> >physical restlessness; muscle tension (e.g., tight clenching of certain muscles especially my fists, arms, and jaw);excessive sweating and feelings of warmth.......
>
> All common 'serotonergic' effects. Celexa makes me sweat a lot and clench my jaw.
>
> >And i strongly question whether or not this sort of practice is good for oneself.
>
> Keep the Paxil dose very low!
>
> Kind regards,
> Ed.
>
Posted by ed_uk on June 20, 2005, at 20:18:41
In reply to Re: Paxil + Nardil, posted by willyee on June 20, 2005, at 19:44:37
Hi William,
>Exessive sweating was always a marker for me that i was heading for an interaction.
Which drugs did you take with Parnate which caused this reaction?
~Ed
Posted by 4WD on June 20, 2005, at 22:58:36
In reply to Re: Exercise for severe depression » linkadge, posted by SLS on June 13, 2005, at 21:55:09
>
> I thank you for your concern regarding my unrealistic expectations. However, they are based in the reality I have seen all around me for the last 23 years. Sick people get very well with biological intervention. For each of these individuals, whatever got them that way is to them magic. I was fortunate enough once to have been awakened by such magic for 6 months. I intend to awaken again - this time for 6 decades. Actually, I might now be in the midst of that process without the benefit of exercise.
>
Scott,I guess you mean from the addition of Trileptal? I hope it works for you. I know how hard you've struggled and I hope you've finally found something that will give you the magic.
What difference is the Trileptal making? How do you feel differently?
Please keep us posted.
Marsha
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