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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Questionmark on April 14, 2004, at 10:50:12
Question: How does Nardil affect one's quality of sleep-- in terms of physiology and sleep phase durations? Also, which of Nardil's actions (specifically, which neurotransmitter effect) is responsible for which aspect(s) of change in sleep quality? (For example, i believe that increases in serotonin levels/activity result in decreased duration of REM cycles).
Thank you kindly if one of you knowledgable peoples have any ideas on this.
Posted by King Vultan on April 14, 2004, at 12:47:14
In reply to Nardil sleep quality, posted by Questionmark on April 14, 2004, at 10:50:12
> Question: How does Nardil affect one's quality of sleep-- in terms of physiology and sleep phase durations? Also, which of Nardil's actions (specifically, which neurotransmitter effect) is responsible for which aspect(s) of change in sleep quality? (For example, i believe that increases in serotonin levels/activity result in decreased duration of REM cycles).
> Thank you kindly if one of you knowledgable peoples have any ideas on this.
It has some of the same negative effects of the SSRIs, as serotonin is obviously one of the neurotransmitters that MAOIs work on. Combined with that, there is also an insomniac effect from norepinephrine, which reduces the need for sleep in many people. My own experience from taking SSRIs, tricyclics, and Wellbutrin is that for me, in particular, serotonin causes the most problems, than norepinephrine, than dopamine. The worst drug for insomnia I had taken prior to Nardil was Effexor, which I would theorize to be because of its strong effect on serotonin plus its ancillary effects on norepinephrine. The insomnia I suffered on Prozac and Zoloft was nearly as bad; on Strattera, somewhat less; and on the tricyclics, even less, presumably due to their histamine blockades. Wellbutrin for me was similar to the tricyclics and wasn't much of a problem.Another thing I've noticed with the Nardil, which is unique among the 10 drugs I've tried, is that it seems to totally eliminate the ability to recall dreams, and I'm not even certain I'm dreaming at all. I know some of this is from its action on serotonin, but I don't know how much the other neurotransmitters have to do with it. I find it interesting to read that some people who take Paxil, which is an incredibly strong SSRI, have very vivid dreams. I'm afraid I don't have much of an explanation other than perhaps they don't go into a super deep sleep, and it becomes easier to retrieve experiences from the REM stage.
Todd
Posted by zeugma on April 14, 2004, at 13:46:39
In reply to Re: Nardil sleep quality, posted by King Vultan on April 14, 2004, at 12:47:14
Todd/KV's guess is correct, that SSRI's suppress both REM and SWS (slow wave sleep) leading to easy arousal and also for the tendency for dreaming to 'migrate' to lighter stages of sleep where they are easy to recall.
I am not sure about the effect of dopamine on sleep, but norepinephrine appears to be the neurotransmitter that most directly regulates REM: the locus coeruleus must cease firing for the brain to enter a REM state, and selective NE reuptake inhibitors block REM without also blocking SWS.
I read a study which said that Nardil did not interfere with SWS. This would present a strong contrast with SSRI's, and is one reason why I believe MAOI's (and TCA's) to be far superior medications for the long term treatment of depression.
Posted by Flipsactown on April 14, 2004, at 18:18:39
In reply to Re: Nardil sleep quality, posted by zeugma on April 14, 2004, at 13:46:39
I just started Nardil 5 days ago, rx 15mg daily for 2 weeks, 30mg daily thereafter. I noticed the insomnia immediately but I do not seem to miss it. However, as I am still depressed I find myself trying to sleep in order to escape the pain of depression. As I am now suffering from insomnia, I am afraid that I will get even more depressed as sleeping was a coping mechanism I used to cope with depression. When will Nardil kick in? I hope soon as I don't want to get even more depressed because of insomnia. I have unipolar depression from chronic back pain and have been on ADs for over 13 years. Thanks.
FST
> Todd/KV's guess is correct, that SSRI's suppress both REM and SWS (slow wave sleep) leading to easy arousal and also for the tendency for dreaming to 'migrate' to lighter stages of sleep where they are easy to recall.
>
> I am not sure about the effect of dopamine on sleep, but norepinephrine appears to be the neurotransmitter that most directly regulates REM: the locus coeruleus must cease firing for the brain to enter a REM state, and selective NE reuptake inhibitors block REM without also blocking SWS.
>
> I read a study which said that Nardil did not interfere with SWS. This would present a strong contrast with SSRI's, and is one reason why I believe MAOI's (and TCA's) to be far superior medications for the long term treatment of depression.
Posted by King Vultan on April 15, 2004, at 8:03:22
In reply to Re: Nardil sleep quality » zeugma, posted by Flipsactown on April 14, 2004, at 18:18:39
> I just started Nardil 5 days ago, rx 15mg daily for 2 weeks, 30mg daily thereafter. I noticed the insomnia immediately but I do not seem to miss it. However, as I am still depressed I find myself trying to sleep in order to escape the pain of depression. As I am now suffering from insomnia, I am afraid that I will get even more depressed as sleeping was a coping mechanism I used to cope with depression. When will Nardil kick in? I hope soon as I don't want to get even more depressed because of insomnia. I have unipolar depression from chronic back pain and have been on ADs for over 13 years. Thanks.
>
> FST
>
There is one school of thought on Nardil that you need 1 mg/kg body weight/day for an effective dosage (this was based on the old formulation--a person might need more on the one Pfizer/Parke Davis is currently selling). I am about 65 kg--this has been my experience so far:45 mg/day for three weeks: no therapeutic or adverse effects.
60 mg/day for two weeks: insomnia after about a week, decrease in heart rate from about 75 to 65, barely noticeable therapeutic effects.
75 mg/day for two weeks: continuing insomnia, further decrease in heart rate to about 60, decrease in blood pressure, moderate decrease in my chronic headaches, much more noticeable therapeutic effects after about a week.
I would suggest Ambien or trazodone for your insomnia. Trazodone is inexpensive and safe for MAOI users. I've dealt with insomnia myself for years on ADs and have decided it was a mistake to not make more extensive use of sleep aids. The net result was that I wound up limiting the dose of the AD to a lower one that allowed at least some sleep, but even that was not necessarily of that great a quality. I think it would have been far wiser to take a sleep aid so that a higher and more therapeutic dose of the AD could have been tolerated, as well as provide higher quality sleep.
Todd
Posted by sobeit on April 17, 2004, at 3:38:58
In reply to Re: Nardil sleep quality » Flipsactown, posted by King Vultan on April 15, 2004, at 8:03:22
For years I've benefited from Nardil in the treatment of atypical depression and social phobia/social anxiety. By far, the side effect most troubling for me has been insomnia and disruption of a regular sleep pattern. I did happen to participate in a sleep study (PSG and MSLT) within the past year - the first test while taking Nardil (60 mg.) and the second test after suspending med. for 3 weeks. While on Nardil, REM sleep phase was reduced 95% and Phase 4 reduced 75%, primarily compensated for by greater time spent in phases 1 and 2. Total sleep duration was also reduced, with multiple brief awakenings through the night unrelated to air restriction. Ironically, I thought it was one of my better nights of sleep! The lack of REM sleep certainly seems to have an effect on my opportunity for dreaming and/or recall. I also experience occasional orthostatic hypotension and a yearly EKG confirms bradycardia (as low as 47), but I consider these only mildly bothersome. Added benefit is I rarely have headaches, something that was quite common when social phobia ruled the day. I've temporarily suspended the medication several times in the past and typically experienced a "withdrawl" period of approximately 7-10 days in which I would have mild constant headache and an unusual visual disturbance in which any quick movement of my head would create a secondary "jerking" eye movement (reminds me of nystagmus) and momentary loss of balance. I have a current prescription for Ambien, but use it sparingly. I find Todd's history and experiences similar as mine.
Sobeit
Posted by sobeit on July 3, 2007, at 0:38:28
In reply to Re: Nardil sleep quality, posted by sobeit on April 17, 2004, at 3:38:58
Well, it's been over 3 years since I posted the previous message re: sleep quality and Nardil. The chronic insomnia continues to be the most disabling side effect I experience on the med - the others I tolerate quite well. I've temporarily discontinued Nardil to prevent any potential complications with anesthesia for an upcoming surgery and now recall how it feels to sleep through a night after years of staring at the ceiling until 4am.
> For years I've benefited from Nardil in the treatment of atypical depression and social phobia/social anxiety. By far, the side effect most troubling for me has been insomnia and disruption of a regular sleep pattern. I did happen to participate in a sleep study (PSG and MSLT) within the past year - the first test while taking Nardil (60 mg.) and the second test after suspending med. for 3 weeks. While on Nardil, REM sleep phase was reduced 95% and Phase 4 reduced 75%, primarily compensated for by greater time spent in phases 1 and 2. Total sleep duration was also reduced, with multiple brief awakenings through the night unrelated to air restriction. Ironically, I thought it was one of my better nights of sleep! The lack of REM sleep certainly seems to have an effect on my opportunity for dreaming and/or recall. I also experience occasional orthostatic hypotension and a yearly EKG confirms bradycardia (as low as 47), but I consider these only mildly bothersome. Added benefit is I rarely have headaches, something that was quite common when social phobia ruled the day. I've temporarily suspended the medication several times in the past and typically experienced a "withdrawl" period of approximately 7-10 days in which I would have mild constant headache and an unusual visual disturbance in which any quick movement of my head would create a secondary "jerking" eye movement (reminds me of nystagmus) and momentary loss of balance. I have a current prescription for Ambien, but use it sparingly. I find Todd's history and experiences similar as mine.
>
> Sobeit
Posted by Sentience on July 3, 2007, at 10:16:11
In reply to Re: Nardil sleep quality, posted by sobeit on July 3, 2007, at 0:38:28
Hi Sobeit.
I had been on Nardil for 17 years until Feb 2007 when I decided to discontinue treatment. It took 3 months of very slow titration off the drug and I've now been completely free of all medication for 2 months. My experience with Nardil in relation to sleep, has to be split up into the time during the pre-2003"old Nardil " and the post 2003 "new Nardil"
I was on a 45 mg/day dose. I actually felt much better on higher doses of say 60 and 75 mg of Nardil, but at these levels the side-effects were intolerable and I found that 45 mg was the optimal dose of benefit/cost trade-offOriginal pre-2003 Nardil
I found that the 'kick' of the dose would usually kick in around 4 hours after taking it. (this agrees well with the peak plasma levels being observed at the 4 hour point in the literature, that I later read about)
As I find Nardil to be a very stimulating & energising drug, and I was experiencing very slow sluggish mornings prior to Tx, I decided to take the 45 mg as a single dose the last thing at night before going to bed. As I usually retired around 1:00 am, it meant that the peak effect was kicking in while I was fast asleep around the 5:00 am mark. I would awaken around 7:00 am and literally JUMP out of bed full of energy.
New post 2003 Nardil
Unfortuately, with the new Nardil, I was beginning to experience more side-effects and the benefits had lost a lot of their edge too. I was now feeling the 'kick' of the dose around 1.5 hours after taking it, and it had much less "kick" in it. I was awakening earlier, and not feeling as energised as I used to. Sleep onset was becoming a problem and to make things worse, I was developing gastric pain about 20 minutes after laying down to sleep at night. After much investigation, I was able to work out that it was due to increased gas. I began to feel very sleepy during the day, particularly in the afternoon. Overall I was feeling less energised, more irritable and sleep problems were starting to dominate my life.
These issues made me decide to discontinue the Nardil. Its been 5 months since I began the withdrawal process and now my sleep has returned to 'normal'
Posted by sobeit on July 5, 2007, at 17:10:40
In reply to Re: Nardil sleep quality, posted by Sentience on July 3, 2007, at 10:16:11
I just returned to this web site after more than 3 years away, so I am not up-to-speed on the issue of "old" vs "new" formulated Nardil what exactly people have been experiencing. Since I am currently doing well off the Nardil (finally moved beyond the protracted withdrawl phase) other than what I would call hypersomnolance/sleep interia that interferes with my job, I may agree to a short-term trial of Provigil (modafanil) to see if it can arouse me from undue sleepiness. I think I've essentially overcome the social anxiety after 20+ years and my mood is stable post-nardil. I don't know if you experienced a similar occurence, but I've lost 25 pounds since discontinuing the phenelzine.
Posted by malcolm664 on July 8, 2007, at 16:54:49
In reply to Re: Nardil sleep quality, posted by sobeit on July 5, 2007, at 17:10:40
> I just returned to this web site after more than 3 years away, so I am not up-to-speed on the issue of "old" vs "new" formulated Nardil what exactly people have been experiencing. Since I am currently doing well off the Nardil (finally moved beyond the protracted withdrawl phase) other than what I would call hypersomnolance/sleep interia that interferes with my job, I may agree to a short-term trial of Provigil (modafanil) to see if it can arouse me from undue sleepiness. I think I've essentially overcome the social anxiety after 20+ years and my mood is stable post-nardil. I don't know if you experienced a similar occurence, but I've lost 25 pounds since discontinuing the phenelzine.
You may want to consider taking a combo on Lunesta and Klonopin. I'm on Parnate (80 mgs) and the insomnia and daytime fatigue were really a problem. However, ever since my doc prescribed the Lunesta and Klonopin combo, I sleep like a baby and wake up well-rested.
I still experience daytime fatigue, but even that has diminished considerably. And that can be counteracted to a large extent by several cups of VERY strong coffee.
This is the end of the thread.
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