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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by bigcat on October 23, 2005, at 20:10:54
I've tried everything for a severe, chronic, and debilitating depression, and nothing but Nardil works for me. But every time I go back to it after unsucessful trials of other meds, I go into full remission just days after starting it. And every time, I sink back to an indescribably brutal depression. It's agonizing to finally have peace and posession of my mind and lose it and feel that I'll never have any kind of lasting remission to get a life going. I'm in so much pain and despair. I resent my family, as they're the reason I can't end it myself.
Dexedrine with Nardil worked beautifully for me in the past, but in subsequent trials of this combo, I haven't had much success. There have been times when I've responded well to other meds great initially (Serzone most recently was glorious for a day or two, and then cr*pped out completely. I even felt a decent initial lift from Elavil not too long ago, which was probably another tease).
I'm on 90mg Nardil, 200 mgs Lamictal, and Seroquel for sleep. Marplan, Parnate, Eldapryl, and Moclobomide haven't worked for me. SSRI's and Tricyclics haven't worked for me, though there may be some I didn't stay on too long due to an ititial worsening of the depression. ECT didn't work for me. I'm honestly considering going up to 150mgs of Nardil- if I throw it past my psychiatrist, he may very well may go for it- he's very agressive and commited to bringing me relief. I'm totally undeterred by the risks. My depression is literally paralyzing and all consuming. I have no side effects at 90mg, and I've tried 105mgs before without side effects either. I need suggestions, something to hope for.
Bless You All,
Matt
Posted by ed_uk on October 24, 2005, at 14:07:29
In reply to Nardil Woes- PLEEEEESE HELP!!!!, posted by bigcat on October 23, 2005, at 20:10:54
Hi Matt
>I have no side effects at 90mg, and I've tried 105mgs before without side effects either
Trying a higher dose certainly sounds like a good idea :-)
Which drugs have you combined with Nardil so far?
~Ed
Posted by Declan on October 24, 2005, at 14:34:28
In reply to Nardil Woes- PLEEEEESE HELP!!!!, posted by bigcat on October 23, 2005, at 20:10:54
Hi Matt
You got opinions on the new vs old Nardil? I assume you're from the US and are on the new formulation. What do you think of the Plasminplus encapsulation thing? Or the acacia and kaolin thing that was in Micael Bell's post (now on the alternative board, I think)?
Declan
Posted by bigcat on October 24, 2005, at 22:27:24
In reply to Re: Nardil Woes- PLEEEEESE HELP!!!! » bigcat, posted by Declan on October 24, 2005, at 14:34:28
Ed and Declan: First off, I want to thank you for always responding with informative and supportive posts. You guys are what make this board great, and I appreciate your experience, wisdom, and remarkable dedication to helping others. Yes, I'm in the U.S., and clearly I have nothing to lose by trying the Plasmin Plus option. From what I understand, you crush up the Nardil and put it in empty plasmin(??) encapsulations. Is this type of encapsulation available at my local pharmacy, or do you have to order it online?
I've tried the Nardil with Dexedrine (which worked great for a while), and with Marplan, believe it or not. I felt good on the Marplan/Nardil combo, but I'm almost positive it was the Nardil doing it's thing, and that the Marplan was extraneous. However, I should also mention that after trying the Marplan maybe five times, on the sixth trial it suddenly and strangely kicked in immediately, and I had a couple good months on it by itself. I took the dose quite high, but for economic reasons I couldn't really give it too much time to see if I would gradually improve with super-high doses.
I understand that most types of depression have similar symptom profiles, but since ya'll seem to be very knowledgable about the chemical basis of various manifestations of depression, antidepressants, and what medecines or augmentation strategies target certain receptors resposible for this or that part of the illness, I wish to include the following:
My depression is chronic, severe, and predominantly treatment-resistant (including fruitless ECT sessions). It has gradually worsened over the past ten years (I'm 24 and have been trying antidepressants since age 18). The first symptoms to appear were OCD-related, and I never had a moment free from debilitating worry. I currently have positively no energy whatsoever, and a brand of cognitive impairment that prevents me from being able to express myself, and worst of all, withholds my natural inclination to display love and affection. I believe my horrid social anxiety is a direct result of my mind being asleep (except for racing anxiety and patterns of obsessive self-loathing and worrying), and thus I can't think of anything to say, don't even have the energy to smile, and my timing is lethargic and totally off- I'm on altogether the wrong frequency, wholly exiled from regular human interactions. I can't even sit still to read a book or play my guitar, and I go months without conversation, only responding with "yes and no's" to those closest to me.
The Dexedrine/Nardil combo allowed me to express myself with calm, confident composure and creative insight. I didn't have to futilely "plan" my fragmented, flailing sentences and responses; words came out naturally, and I became an "effective" person for a while. Basically I returned to being bright, as I was as a child before the depression struck so powerfully.
I apologize for including what may be wholly extraneous information, but I have read many of your posts and wanted to give you as much material as possible to highlight anything which may key you in to possible options to combat these symptoms.
Ed, I think it was you who posted a while back concerning a chemist friend of yours who explained how you could isolate the active element of Nardil using common ingedients. I would be very interested in learning more about this. My email is mlieb@wesleyan.edu if you care to discuss this further. I've always been undeterred by negative press or purely speculative risks in trying "unheard of" options to combat this exhausting depression.
As far as what I've combined with the Nardil, this list is rather short. Lamictal and Lithium are pretty much all, and of course the Dexedrine. I'd like to run some of my ideas past you to get your opinion:
(1) Add Wellbutrin
(2) Add Adrafinil (generic Provigil, right?)
(3) Stimulant juggling (work with and switch between dexedrine, desoxyn, adderal etc., since I'll probably work up a tolerance to each).
(4) Flip back and forth between the Nardil and Marplan, giving each maybe two weeks so the other med has some vacation time before switching back to it. (Sounds crazy, right?)
(5) I had a great initial resonse to Serzone recently, which after a week or so, left me worse off when I started, so I discontinued it. I do still wonder if had I stayed on it, the exacerbated, panicky depression would eventually pass and I would gradually find some sort of relief.These ideas may be far-fetched, but Nardil has been such a brilliant (and ultimately devastating/frustrating drug for me), that I'd consider ANYTHING, including natural supplements or alternative treatments to augment or keep the Nardil working effectively. My doctor is quite agressive as I've mentioned, and would be willing to combine Nardil with other classifications of antidepressant, going very slowly to guard against possibly dangerous interactions.
Wow- that was extremely long-winded, but I felt the need to put everything on the table to give you crafty fellows as much material to work with as possible. If you have any other questions about my med history or how I've reacted to different medications, please ask. Unfortunatley my memory is very poor, and I'm often totally confused about how I responded to trials of this or that. Most drugs did nothing or made me worse.
Finally, I'd like to express my admiration and loving appreciation for your commitment to sharing what you know in an effort to educate others, and provide hope and crucial information that could potentially lead to the relief we all seek so desperately. This is a selfless dedication and instinct you possess, and I often feel guilty that despite my years of med trials, I feel that I have so little to offer on this board, as I can't seem to add anything up into some type of consistant insight, or helpful recollection of my experience.
I remain in awe of your relentles efforts to educate yourselves and come up with new, hope-inspiring ideas and options to fight this horrible illness with all your might and power. Thanks once again, and I look froward to hearing from you.
Your Bud,
Matt
Posted by ed_uk on October 25, 2005, at 14:21:54
In reply to Re: Nardil Woes- PLEEEEESE HELP!!!!, posted by bigcat on October 24, 2005, at 22:27:24
Dear Matt,
Gosh. So many compliments, I'm blushing!!!
>Ed, I think it was you who posted a while back concerning a chemist friend of yours who explained how you could isolate the active element of Nardil using common ingedients.
I believe it was Chairman_MAO. You can send him a message - his babblemail is on :-)
>The Dexedrine/Nardil combo allowed me to express myself with calm, confident composure and creative insight.
Given your current Dexedrine side effects, I think it would be best to discontinue the Dexedrine and replace it with something else. I was wondering whether you might respond to Abilify, at a low dose. Have you ever tried it?
>Wellbutrin
Have you tried it on its own? Wellbutrin tends to improve depression, but not anxiety. Are you suffering from a lot of anxiety at the moment?
>Add Adrafinil (generic Provigil, right?)
Provigil is modafinil. Adrafinil is not marketed in the US, it's a French drug. Modafinil and adrafinil are chemically related to one another. Provigil is often a good med to relieve daytime drowsiness.
I remember you saying that you haven't responded well to the TCAs or SSRIs. Which TCAs have you tried? How did you respond? Btw, have you ever tried Remeron?
>Serzone
Have you ever taken trazodone? Trazodone is related to Serzone, but tends to be quite a bit more sedating. Nardil + trazodone was formerly a popular combination. The trazodone was used to treat the MAOI-induced insomnia and increase its antidepressant efficacy. Unfortunately, trazodone tends to cause more side effects than Serzone. I find it very difficult to predict how you'd react to trazodone.
>Basically I returned to being bright, as I was as a child before the depression struck so powerfully.
Your intelligence shines through, despite your depression.
>Parnate.........haven't worked for me.
What dose did you try? Any side effects?
Kind regards
~Ed
Posted by Chairman_MAO on October 25, 2005, at 19:58:46
In reply to Nardil Woes- PLEEEEESE HELP!!!!, posted by bigcat on October 23, 2005, at 20:10:54
If you are having severe cognitive problems, I suggest adding (start *LOW* because you have depression) galantamine + levetiracetam. Levetiracetam has a decent antidepressant effect in many people. Another option is nefiracetam, but that isn't really on the market anywhere, just a research chemical. Galantamine is an EXCELLENT, motivating, cognitive enhancer. Studies in AD patients don't show anything remarkable, but my impression from trying other cholinesterase inhibitors is that it is profoundly different in effect.
BTW, have you considered precursor loading (l-phenylalanine)? That could help with the stimulant "poop-out". So could memenatine.
The most underutilized drug for treatment-resisitant depression is buprenorphine.
Bupe + MAOI + Dexedrine would be excellent. It really works marvelously for many people, myself included. Too bad I can't get it up on it.
Posted by bigcat on October 25, 2005, at 23:08:04
In reply to Re: Nardil Woes- PLEEEEESE HELP!!!! » bigcat, posted by ed_uk on October 25, 2005, at 14:21:54
Hey Ed:
Great to hear back from you.> Given your current Dexedrine side effects, I think it would be best to discontinue the Dexedrine and replace it with something else. I was wondering whether you might respond to Abilify, at a low dose. Have you ever tried it?
I think I gave Abilify a VERY brief trial. Is it an atypical antispsychotic in the same family as Geodon? I definitely didn't give it much time to work (it may have kicked up the obsessing/social paranoia initially, but my memory is lost in a whirlwind of years riding the med merry-go-round. I do remember being in the hospital one time, and a psych patient there was put on Abilify, and within hours he was quite impressed with the calming effect it produced and felt as if the mental haze and clutter were somewhat alleviated. I think the main reason I went off the Abilify was for economic reasons. The good news is that I'll have health insurance in a month (I currently pay out of pocket for my scripts). So without monetary restrictions, I'll lobby hard with my doc to try that option. Does it combine safely with the Nardil?
> Wellbutrin... Have you tried it on its own? Wellbutrin tends to improve depression, but not anxiety. Are you suffering from a lot of anxiety at the moment?
My anxiety is inseparable from my depression. When I go into true remission as I have with the Nardil, it clears the whole board, the light switch goes on and my anxiety dissapears. I must confess that I've cut MANY med trials short because of severely increased anxiety/social paranoia/mental incompetancy upon starting a new drug. The tricyclics all seemed to kick my anxiety into high gear. In hindsight, I'm curious if I may have started with doses that were too high, or if we titrated the dose too rapidly for my brain to adjust. Klonapin, Xanax, and Valium don't touch my anxiety, though it's concievable I need an extremely high dose, as I seem to be rather med-tolerant. Wellbutrin is a bit of a question mark for me. Once again my memory is very poor and my psychiatrist has wholly insufficient charts on me, so I have little to go on but a memory that can't be trusted, as I was racing through med trials because of my panicking and dangerously severe state of despair. I know my mom says she recognizes the "wellbutrin look" in my eyes (maybe dilated pupils are a side effect?) On my most recent trial of Wellbutrin, I took it on it's own, and I had this radically disjointed and pressurized speech, where I would start a sentence with a rush of anxious excitement and force, and then find myself flailing and frequently unable to finish my ideas or find basic words or phrases. It was very embarrasing to become flustered and freeze up mid-sentence, forgetting what I was saying or how to link ideas together intelligibly. I was so noticeably out there and profoundly confused. I'd say it gave me inflection in my voice, which is a positive change from the monotone of a deep depressive state, but I felt somewhat agitated and restless on it, and am not sure where it was leading me.
> Provigil is modafinil. Adrafinil is not marketed in the US, it's a French drug. Modafinil and adrafinil are chemically related to one another. Provigil is often a good med to relieve daytime drowsiness.
I read a few posts where people seemed to prefer Adrafinil to Modafinil and I believe I can order both online, so which would you consider my best bet? I have severe lethargy and positively no energy, napping constantly.> I remember you saying that you haven't responded well to the TCAs or SSRIs. Which TCAs have you tried? How did you respond? Btw, have you ever tried Remeron?
TCA's: Elavil, Tofranil, Anafranil, Pamelor, Vivactil, Gamanil (imported), Desipramine, Nortiptaline...I just became a wasted zombie upon starting most of these. It wasn't so much the side effects that interrupted trials as it was an exacerbation of the depression (I summoned attention to myself as I radiated and reeked of such profound misery and anxiety. I was astonishingly unable to function on the most basic levels). All my instincts would betray me, and I became insanely self-consious/socially phobic.
>Have you ever tried Remeron?
Remeron has actually been one of my big question marks and frequently sparks my curiosity, as I'm SURE I never gave it a fair trial. I was in bed most of the day at the time we considered using it, and since I'm aleady very lethargic and low energy, I shied away because of the notorious sedation issue. But it is high on my list of meds to try if I can't work out an effective Nardil combo.
> >Regarding Serzone difficulties...Have you ever taken trazodone? Trazodone is related to Serzone, but tends to be quite a bit more sedating. Nardil + trazodone was formerly a popular combination. The trazodone was used to treat the MAOI-induced insomnia and increase its antidepressant efficacy. Unfortunately, trazodone tends to cause more side effects than Serzone. I find it very difficult to predict how you'd react to trazodone.
Hey, it's another option I wouldn't rule out. On it's own, Trazodone didn't seem to touch me, just the sedation which was definately bearable, and I welcomed the restful sleep at the time. I wouldn't write it off as I never tried it with the Nardil, and I'm a novice in the field of combining meds with Nardil, so I figure you never know, and that they could potentially play off eachother to reduce the negative side effects of eachother and produce a solid and LASTING antidepressant effect.
Parnate and other MAOI's haven't worked for me.
> What dose did you try? Any side effects?I was on 90 mgs of Parnate for approximately 3 months (I'm 225 lbs, in case that is a consideration).. The insoimnia was nasty. I tried hitting it with Klonapin, Haldol, and Chloral, none of which worked very well. HOWEVER, I never tried using Seroquel at the time to help the insomnia, and it has now proven to be a great sleep med for me. The Parnate did nothing for my depression or anxiety, but it did make me rather creative. Drawings and writing from this time support that belief. Since I unpredicatably resonded to Marplan after four or five fruitless trials, I could see myself back on the Parnate at a higher dose with an effective sleep med in conjunction.
Ed, you really can't understand how much hope you have given to a desperate person. I am no longer in a state of utter despair and fear, as you confidently present options which neither me nor my doctor would ever come up with. I can't even fathom the amount of research you have done to asrrive at your level of expertise. I find it an unfortunate irony (though I can't say I'm surprised) that you could radically upstage any psychiatrist out there just based on wour iron will, keen intuition, and uncanny ability to synthesize information and experience while offering informed and enlightening advise. I truly believe my mood has recently improved as find myself excited to return to my computer, finding solace and hope as I absorb the many viable options you (and others) present. What a phenomenal resource. I feel empowered, a great feeling which depression and med failures have so often washed away. Not to gush, but your a bit of a miracle maker. I'm curious how YOU have you been doing lately, what meds your on, and what treatment-related ideas are most pressing on your mind?
One Love My Brother,
Matt(Sorry about the length, but writing to a responsive audience is therapuetic in itself).
Posted by ed_uk on October 26, 2005, at 14:39:07
In reply to Re: Nardil Woes- PLEEEEESE HELP!!!!, posted by bigcat on October 25, 2005, at 23:08:04
Hi Matt
Before you try any new meds, experimenting with higher doses of Nardil sounds like a good option. Given your lack of side effects, it's a logical next step.
>I think I gave Abilify a VERY brief trial. Is it an atypical antispsychotic in the same family as Geodon?
Yes, it's an atypical neuroleptic.
>Does it combine safely with the Nardil?
Evidence it very limited. SLS (Scott) takes Abilify + an MAOI and finds it beneficial.
>In hindsight, I'm curious if I may have started with doses that were too high, or if we titrated the dose too rapidly for my brain to adjust.
That's often a problem with TCAs eg. clomipramine (Anafranil) and amitriptyline (Elavil) are best started at 5-10mg/day. The dose must be increased gradually (as necessary/as tolerated).
Anafranil cannot be combined with Nardil under any circumstances. Certain other TCAs can be combined with Nardil with great caution and close monitoring.
>I read a few posts where people seemed to prefer Adrafinil to Modafinil and I believe I can order both online, so which would you consider my best bet? I have severe lethargy and positively no energy, napping constantly.
I'd recommend trying Provigil once you've got medical insurance. Provigil is a better studied drug than adrafinil.
>Gamanil (imported)
I used to take lofepramine (Gamanil) myself. It's quite popular in the UK. It's not marketed in the US though. How did you come to take it?
>I'm curious how YOU have you been doing lately, what meds your on, and what treatment-related ideas are most pressing on your mind?
I'm not too bad lately thank you :-) I'm a dispensing assistant in a pharmacy. I've been working 6 days a week lately so I'm quite tired. I do like my job though. At the moment, I'm taking citalopram 80mg and amitriptyline 20mg. The citalopram helps my anxiety, amitriptyline helps me sleep.
Kind regards
~Ed
Posted by bigcat on October 27, 2005, at 10:56:16
In reply to Gamanil » bigcat, posted by ed_uk on October 26, 2005, at 14:39:07
Ed,
My doc really runs the gamut when prescribing. He's often telling me stories of the nature "we couldn't get anything to work for this patient and then we finally tried so and so, and it worked wonderfully for them. You just never know". He has prescibed many "underutilized" meds not out of desperation, but because of his empirical clinical experience. Noveril and Marsalid were some other imports I tried, and I know there were others.
When I went on the Gamanil, it was directly following another med trial that really put me in the pits. I'm convinced that when we started the Gaminil, I simply returned to my normal state of depression, but he thought it could have been doing something. Either way, I eventually had such bad constipation that I wound up in the hospital needing an enima. In the past, I would combat this issue with magnesium citrate which always worked very well. It's reassuring that he's always thinking about new options, often explaining how certain meds are popular in other parts of the world, even as America has brushed off these drugs for whatever reasons (I imagine economic futility ranks way up there).
-matt-
Posted by bigcat on October 27, 2005, at 14:16:26
In reply to Re: Nardil Woes- PLEEEEESE HELP!!!! » bigcat, posted by Chairman_MAO on October 25, 2005, at 19:58:46
> If you are having severe cognitive problems, I suggest adding (start *LOW* because you have depression) galantamine + levetiracetam. Levetiracetam has a decent antidepressant effect in many people. Another option is nefiracetam, but that isn't really on the market anywhere, just a research chemical. Galantamine is an EXCELLENT, motivating, cognitive enhancer.
Unfortunately, Galantimine is too expensive for me right now, and I'm not sure if I could get my doctor to prescribe it. However, cognitive impairment has been a HUGE part of my depression. When the Dexedrine was working, I became 100X more acute mentally, I was able to speak "in the moment" rather than meekly and lifelessly responding to what other people said in a removed and forced manner, flailing for words and unable to link thoughts or EXPRESS MYSELF whatsoever. My coordination improved drastically (I work in a kitchen and became increadibly more fluid, in control, efficient and effective). My memory allowed me to synthesize thoughts with clarity and insight. In turn, this did wonders for my confidence and social anxiety. I went from being an incompetent imbecile, constantly frustrating others because my stupidity bred submissiveness and the need for constant direction, to being well-coordinated, focused, and independant. My timing was finally on the mark rather than always being jumpy and mundane, and my ability to articulate myself basically sped up. I became MUCH "smarter" and able to communicate without the incessantly obsessive, anxious, and blank mind which was dormant for my 10+ years of depression. I was finding the right words, my vocabulary was astonishingly improved, and I was able to pick up Spanish, something I was unable to accomplish after 6 years of schooling. I believe this "speeding up" was the cognitive impairment lifting, not an amphetamine high. Simply put, I was COMING THROUGH and had acess to an otherwise lifeless brain. I went from getting fired from minimum wage small-parts assembly jobs due to incompetency, to feeling that I could tackle sustained intellectual involvement and be able to pursue a real career.
I've been quite skeptical about herbal and dietary supplements in the past (believing them to be scams and only providing a placebo effect). However, I'd be very interested in finding out about any other (cheap or readily available) "smart" drugs. If you and others are convinced that galantamine gives a powerful and proven cognitive kick on a par with ADD meds like Dex, I may have to break down and give it a try. Do you have any other herbal or alternative suggestions to boost the Nardil?
>Studies in AD patients don't show anything remarkable, but my impression from trying other cholinesterase inhibitors is that it is profoundly different in effect.
>
> BTW, have you considered precursor loading (l-phenylalanine)? That could help with the stimulant "poop-out". So could memenatine.If I rememeber correctly, you recently mentioned this tactic as a way to enhance the effects of Nardil, as l-phenylalanine is one of the active chemicals in Nardil (which is working for me right now, but always poops out when taken on it's own). You mentioned a chemist friend of yours who told you how to isolate this
compound using common, cheap ingredients and a small amount of wit. I'm very curious about this idea. (My email is mlieb@wesleyan.edu if you care to discuss this further).
>
> The most underutilized drug for treatment-resisitant depression is buprenorphine.
> Bupe + MAOI + Dexedrine would be excellent. It really works marvelously for many people, myself included. Too bad I can't get it up on it.Is it easy to become tolerant and/or addicted to Bupe? (Basically, am I flirting with the devil if I go this route?). Do doctors frequently prescribe it for depressive symptoms without FDA harassment? (I've heard it's used for heroin withdrawal, which scares the sh*t out of me). Oh yeah, my unit is so withered and atrophied by now (I've been too depressed to get a girlfriend) so living without that luxury don't deter me none. (I'm sorry for you though :(
Thanks Master MAO,
-matt-
Posted by ed_uk on October 28, 2005, at 14:38:20
In reply to Re: Gamanil » ed_uk, posted by bigcat on October 27, 2005, at 10:56:16
Hi Matt,
Thank you for your kind words. I really appreciate your kindness :-)
Your doc sounds excellent - willing do try anything to get you well.
I was a bit constipated on Gamanil but not very much. I did sometimes take laxatives.
Some babblers have suggested that combining Dexedrine with memantine might help to prevent tolerance to it's therapeutic effects. Would you like you experiment with this strategy?
Warm regards
~Ed
This is the end of the thread.
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