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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by sanshin on July 2, 2006, at 22:12:21
Hi,
I've used 60 mg/day of Nardil since approx 1985. Overall, it worked for my atypical depression. I do believe the formulary change in '03 compromised the quality of Nardil.
Three wks ago, my excellent pdoc suggested I try Emsam. I did a very abbreviated withdrawl from the Nardil (going to nil in about 5 days) but stuck on the patch the same day I heard about Emsam; therefore running both at once for a few days. I checked my BP during this dual drug therapy and it was lower than normal (101/71). I am hypertensive and take Atenelol.
With the 20/6 patch and a couple of Nardil, I felt great. However, I am now only using the Emsam. Things are unwinding rapidly and I am getting back into some heavy depression.
The Emsam (or rapid Nardil withdrawl) has brought some extreme fatigue and constant need for sleep. However, sleep brings disturbing dreams similar to other Nardil withdrawls.
Any ideas? I honestly wish I'd just stuck with the Nardil. The phenelzine was consistently helpful. Perhaps I need a heavier load of the Emsam. I wonder if someone who needed 60 mg of Nardil can really get enough MAO inhibition with this patch.
Other meds I use: Ambien, Xanax. (And Atenelol).
Thanks for any thoughts.
Posted by Phillipa on July 2, 2006, at 22:28:25
In reply to Moving from Nardil to Emsam., posted by sanshin on July 2, 2006, at 22:12:21
Sorry I don't know but could the BP med have anything to do with it? Love Phillipa
Posted by sanshin on July 2, 2006, at 22:50:19
In reply to Re: Moving from Nardil to Emsam. » sanshin, posted by Phillipa on July 2, 2006, at 22:28:25
I wondered about that. I might skip the Atenelol for a few days. Thanks for the note.
-------------------> Sorry I don't know but could the BP med have anything to do with it? Love Phillipa
Posted by Phillipa on July 2, 2006, at 22:57:46
In reply to Re: Moving from Nardil to Emsam., posted by sanshin on July 2, 2006, at 22:50:19
I'm not a doctor. I would definitely ask a real doc. Don't know your medical history and even then I am not in a professional capacity to answer the question. Love phillipa
Posted by Jakeman on July 3, 2006, at 19:53:49
In reply to Moving from Nardil to Emsam., posted by sanshin on July 2, 2006, at 22:12:21
> Hi,
>
> I've used 60 mg/day of Nardil since approx 1985. Overall, it worked for my atypical depression. I do believe the formulary change in '03 compromised the quality of Nardil.
>
> Three wks ago, my excellent pdoc suggested I try Emsam. I did a very abbreviated withdrawl from the Nardil (going to nil in about 5 days) but stuck on the patch the same day I heard about Emsam; therefore running both at once for a few days. I checked my BP during this dual drug therapy and it was lower than normal (101/71). I am hypertensive and take Atenelol.
>
> With the 20/6 patch and a couple of Nardil, I felt great. However, I am now only using the Emsam. Things are unwinding rapidly and I am getting back into some heavy depression.
>
> The Emsam (or rapid Nardil withdrawl) has brought some extreme fatigue and constant need for sleep. However, sleep brings disturbing dreams similar to other Nardil withdrawls.
>
> Any ideas? I honestly wish I'd just stuck with the Nardil. The phenelzine was consistently helpful. Perhaps I need a heavier load of the Emsam. I wonder if someone who needed 60 mg of Nardil can really get enough MAO inhibition with this patch.
>
> Other meds I use: Ambien, Xanax. (And Atenelol).
>
> Thanks for any thoughts.Your're in a transition period so you may need some time to readjust. But I agree, a larger dose of Emsam may be needed to get an equivalent amount of MAO inhibition. Just my guess.
good luck, Jake
Posted by sanshin on July 5, 2006, at 10:01:05
In reply to Re: Moving from Nardil to Emsam. » sanshin, posted by Jakeman on July 3, 2006, at 19:53:49
Thanks for the thoughts. Ramped up to 1 1/2 of the 6 mg patch. Three days now. Prb will need whatever the Emsam max is.
Posted by Questionmark on July 8, 2006, at 22:58:44
In reply to Moving from Nardil to Emsam., posted by sanshin on July 2, 2006, at 22:12:21
Nardil is significantly more serotonergic (and less catecholaminergic) than selegeline/Emsam, and you may be having extremely reduced serotonin transmission and a possible catecholamine overload (esp dopamine?), which can make your emotions much more unstable and sensitive and can result in a return of depression. Can you try some 5-HTP (or, possibly even better, tryptophan [if you can get it]) along with it? I would try this. And/or try to get some tryptophan. (Under your doctor's supervision, preferably, of course.)
If he/she would be willing, maybe you could even maintain low doses of Nardil and Emsam, while gradually reducing the former and raising the latter. However, my personal theory is that those who do well with Nardil will not do as well with Parnate or selegeline, and vice versa. But hopefully I'm wrong about this.
In any case, good luck.> Hi,
>
> I've used 60 mg/day of Nardil since approx 1985. Overall, it worked for my atypical depression. I do believe the formulary change in '03 compromised the quality of Nardil.
>
> Three wks ago, my excellent pdoc suggested I try Emsam. I did a very abbreviated withdrawl from the Nardil (going to nil in about 5 days) but stuck on the patch the same day I heard about Emsam; therefore running both at once for a few days. I checked my BP during this dual drug therapy and it was lower than normal (101/71). I am hypertensive and take Atenelol.
>
> With the 20/6 patch and a couple of Nardil, I felt great. However, I am now only using the Emsam. Things are unwinding rapidly and I am getting back into some heavy depression.
>
> The Emsam (or rapid Nardil withdrawl) has brought some extreme fatigue and constant need for sleep. However, sleep brings disturbing dreams similar to other Nardil withdrawls.
>
> Any ideas? I honestly wish I'd just stuck with the Nardil. The phenelzine was consistently helpful. Perhaps I need a heavier load of the Emsam. I wonder if someone who needed 60 mg of Nardil can really get enough MAO inhibition with this patch.
>
> Other meds I use: Ambien, Xanax. (And Atenelol).
>
> Thanks for any thoughts.
Posted by sanshin on July 9, 2006, at 1:15:49
In reply to Re: Moving from Nardil to Emsam. » sanshin, posted by Questionmark on July 8, 2006, at 22:58:44
Thanks for the thoughtful considerate post.
That's an interesting conjecture; someone doing well with Nardil may not do as well with selegeline or Parnate.
My pdoc seems willing to do a little prescribe and pray by exploring some combo of Emsam and Nardil. I'll post whatever result I might have.
Note to file: I am ramped back up on 75 mg a day of phenelzine. It was another accelerated med change as I dropped Emsam, peeled the last patch away and went back to the red Nardil pills.
I did not give Emsam enough time to draw fair conclusions. Just too much depr and anxiety during the changeover.
+++++++++++++++++++++++++++++++++++Nardil is significantly more serotonergic (and less catecholaminergic) than selegeline/Emsam, and you may be having extremely reduced serotonin transmission and a possible catecholamine overload (esp dopamine?), which can make your emotions much more unstable and sensitive and can result in a return of depression. Can you try some 5-HTP (or, possibly even better, tryptophan [if you can get it]) along with it? I would try this. And/or try to get some tryptophan. (Under your doctor's supervision, preferably, of course.)
> If he/she would be willing, maybe you could even maintain low doses of Nardil and Emsam, while gradually reducing the former and raising the latter. However, my personal theory is that those who do well with Nardil will not do as well with Parnate or selegeline, and vice versa. But hopefully I'm wrong about this.
> In any case, good luck.
>
>
>
Posted by pulse on July 9, 2006, at 9:30:32
In reply to Re: Moving from Nardil to Emsam., posted by sanshin on July 9, 2006, at 1:15:49
<.....someone doing well with Nardil may not do as well with selegeline or Parnate. >
i wholeheartedly agree.
This is the end of the thread.
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