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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 UGottaHaveHOPE on September 26, 2007, at 12:45:08
During the summer, I was feeling better on Nardil at 45mg/day. I went out of town and left it at home for three days. Since I still felt fine, when I resumed taking it, I did at 15mg per day rather than 45. And I guess I did OK on 15mg for about 6-8 weeks.
THEN some life stressors hit me (moving), and I have not been able to handle it too well. My anxiety, which had seen its lowest levels in years, is peaking again.
I told my pdoc about going from 45 to 15mg. He was disappointed that I had adjusted without communication with him, and he instructed me to go from 15 to 45mg.
He said it would take 2-3 weeks to feel it, after going from 15 to 45mg. Anyone else have any guesses or experiences on doing the same thing? How long do you think it will take to kick in again?
Posted by Phillipa on September 26, 2007, at 13:22:20
In reply to Help! Your opinion? I messed up on Nardil, posted by UGottaHaveHOPE on September 26, 2007, at 12:45:08
Ace did the same thing. Contact me. I communicate with him at times. Michael I'm sorry truly I am. But you will do it again remember have faith. Love Phillipa
Posted by tecknohed on September 26, 2007, at 15:06:34
In reply to Help! Your opinion? I messed up on Nardil, posted by UGottaHaveHOPE on September 26, 2007, at 12:45:08
> During the summer, I was feeling better on Nardil at 45mg/day. I went out of town and left it at home for three days. Since I still felt fine, when I resumed taking it, I did at 15mg per day rather than 45. And I guess I did OK on 15mg for about 6-8 weeks.
>
> THEN some life stressors hit me (moving), and I have not been able to handle it too well. My anxiety, which had seen its lowest levels in years, is peaking again.
>
> I told my pdoc about going from 45 to 15mg. He was disappointed that I had adjusted without communication with him, and he instructed me to go from 15 to 45mg.
>
> He said it would take 2-3 weeks to feel it, after going from 15 to 45mg. Anyone else have any guesses or experiences on doing the same thing? How long do you think it will take to kick in again?Here's my theory:
You say its your anxiety causing most problems at the mo? One of Nardils metabolites, PEH (phenylethylidenehydrazine), raises GABA but (I think) only to levels in relation to your Nardil dose. So the more Nardil you take the better the anxiolytic effect will be (within normal dosing ranges of course).But Nardil (may) only need a low maintainance dose for depression alone, which might be why 15mg/day has been enough until now. Thats because once you've 'knocked out' MAO with the higher dose only a small dose is needed to keep MAO inhibited thus relieving depression.
Now your anxiety has increased but there isn't enough PEH (Nardil's main metabolite) in your system for the desired anxiolytic effect.
I think you'll see an improvement sooner than your doc thinks, at least I hope you do.
Just a theory mind! Get well soon.
Posted by stargazer2 on September 26, 2007, at 18:25:36
In reply to Re: Help! Your opinion? I messed up on Nardil » UGottaHaveHOPE, posted by tecknohed on September 26, 2007, at 15:06:34
Michael, great to hear from you but not under these circumstances. I'm also at 45 and I thought you were on a higher dose than that. I tried to go down 30 but felt a bit worse so I went back to 45. Above 45, I have severe hypotension and my GI system shuts down. So I've been at 45 for a few months now.
My combination now includes Nortriptyline (Pamelor) and Synthroid.
I decided to see an endocrinologist to evaluate my depression resistence and she told me my TSH (Thyroid Stimulating Hormone)was within a normal range (0.5 - 5.0) but for someone with severe depression, she wanted to get the TSH down to 1. Mine was in the high 2's and mid 3's, considered "normal" but possibly impacting the severity of the depression or it's lack of response to medications. So that's why she started Synthroid.
Just something else to consider with depression (not sure about anxiety). I was always told my thyroid tests were "normal" but until an expert was seen I have never heard that the TSH should be closer to 1. It might be true for anxiety too, since the two are so closely linked. YOu could ask your doc about this since he is such an expert and would know the impact of thyroid on anxiety.
The Pamelor was added to boost Nardil's effects. Not sure what it is doing but I take it at night with 30 of Nardil and sleep well. I take 15 of Nardil in the AM since more than that makes me too lethargic.Hope you get relief soon, I'll be thinking of you and wishing you a quick response to 45!
Stargazer
Posted by Phillipa on September 26, 2007, at 20:15:05
In reply to Re: Help! Your opinion? I messed up on Nardil, posted by stargazer2 on September 26, 2007, at 18:25:36
Pamelor at l0mg knocked me out and I was glued to the bed til 2 pm the next day. Only took it once but was very sedating for me. Phillipa
Posted by UGottaHaveHOPE on September 28, 2007, at 11:45:58
In reply to Re: Help! Your opinion? I messed up on Nardil » UGottaHaveHOPE, posted by tecknohed on September 26, 2007, at 15:06:34
TH:
It has been two weeks at 45mg, and Im not sure it has completely kicked back in. Thanks for your information below, it is very valuable.
Did you ever go off Nardil and get back on? Any experiences you have to share would be great. Thanks, Michael.
> > During the summer, I was feeling better on Nardil at 45mg/day. I went out of town and left it at home for three days. Since I still felt fine, when I resumed taking it, I did at 15mg per day rather than 45. And I guess I did OK on 15mg for about 6-8 weeks.
> >
> > THEN some life stressors hit me (moving), and I have not been able to handle it too well. My anxiety, which had seen its lowest levels in years, is peaking again.
> >
> > I told my pdoc about going from 45 to 15mg. He was disappointed that I had adjusted without communication with him, and he instructed me to go from 15 to 45mg.
> >
> > He said it would take 2-3 weeks to feel it, after going from 15 to 45mg. Anyone else have any guesses or experiences on doing the same thing? How long do you think it will take to kick in again?
>
> Here's my theory:
> You say its your anxiety causing most problems at the mo? One of Nardils metabolites, PEH (phenylethylidenehydrazine), raises GABA but (I think) only to levels in relation to your Nardil dose. So the more Nardil you take the better the anxiolytic effect will be (within normal dosing ranges of course).
>
> But Nardil (may) only need a low maintainance dose for depression alone, which might be why 15mg/day has been enough until now. Thats because once you've 'knocked out' MAO with the higher dose only a small dose is needed to keep MAO inhibited thus relieving depression.
>
> Now your anxiety has increased but there isn't enough PEH (Nardil's main metabolite) in your system for the desired anxiolytic effect.
>
> I think you'll see an improvement sooner than your doc thinks, at least I hope you do.
>
> Just a theory mind! Get well soon.
Posted by UGottaHaveHOPE on September 28, 2007, at 11:51:54
In reply to Re: Help! Your opinion? I messed up on Nardil, posted by stargazer2 on September 26, 2007, at 18:25:36
StarGazer:
What led you to take Pamelor? Were you taking that before you started Nardil? Or did you add it on afterwards? What led you to the Pamelor + Nardil combo?
How did Pamelor boost the effect of Nardil? Or in other words, how did it make you feel different? Feel different with depression or anxiety or both? That is all very interesting stuff. Thanks, Michael
> Michael, great to hear from you but not under these circumstances. I'm also at 45 and I thought you were on a higher dose than that. I tried to go down 30 but felt a bit worse so I went back to 45. Above 45, I have severe hypotension and my GI system shuts down. So I've been at 45 for a few months now.
>
> My combination now includes Nortriptyline (Pamelor) and Synthroid.
>
> I decided to see an endocrinologist to evaluate my depression resistence and she told me my TSH (Thyroid Stimulating Hormone)was within a normal range (0.5 - 5.0) but for someone with severe depression, she wanted to get the TSH down to 1. Mine was in the high 2's and mid 3's, considered "normal" but possibly impacting the severity of the depression or it's lack of response to medications. So that's why she started Synthroid.
>
> Just something else to consider with depression (not sure about anxiety). I was always told my thyroid tests were "normal" but until an expert was seen I have never heard that the TSH should be closer to 1. It might be true for anxiety too, since the two are so closely linked. YOu could ask your doc about this since he is such an expert and would know the impact of thyroid on anxiety.
>
> The Pamelor was added to boost Nardil's effects. Not sure what it is doing but I take it at night with 30 of Nardil and sleep well. I take 15 of Nardil in the AM since more than that makes me too lethargic.
>
> Hope you get relief soon, I'll be thinking of you and wishing you a quick response to 45!
>
> Stargazer
Posted by stargazer2 on September 29, 2007, at 12:34:43
In reply to Re: Want to hear more about Pamelor » stargazer2, posted by UGottaHaveHOPE on September 28, 2007, at 11:51:54
Michael, I was having inconsistent moods on Nardil 45, with a variety of add-ons including Abilify (nothing), Wellbutrin (nothing with the generic Budeprion, which others have said is useless compared to real generic Buproprion), Amphetamine (hypertensive reaction at 10 mg), hypotension on Nardil 60 mg alone.
So I said to my doc can I try Nortriptyline (Pamelor) since I knew it was OK to add with Nardil and often is used with insomnia***(YOU)(not an issue for me) "but may be effective when other approaches have failed." ("Current Psychiatry", Vol. 1, No. 6/June 2002).
I started on 25 and went to 75 but came back to 50 due to extremely dry mouth and dizziness. I take the entire dose at bedtime with 30 mg Nardil. I also take 15 mg Nardil in the morning.
"With the exception of Anafranil, TCA's generally are safe with MAOI's, although the PDR warns against adding a TCA to a MAOI...We found all AD's that do not involve significant serotonin reuptake inhibition (e.g. Bupropion,trazadone, and tricylics other than clomipramine) can be safely administered with MAOI's. Combination therapy is worth considering becasue it may be effective when other approaches have failed."
That last statement is why I tried it and it has helped improve my mood variability.
How are you faring? Better I hope. Perhaps Nortriptyline will help with your insomnia,other meds for this symptom and safe with a MAO are Doxepin and Trazadone, check with your esteemed pdoc for his recommendations.
Stargazer
Posted by UGottaHaveHOPE on October 1, 2007, at 22:07:45
In reply to Re: Want to hear more about Pamelor/Ugotta, posted by stargazer2 on September 29, 2007, at 12:34:43
SG:
Thats great you were able to document everything to take to your pdoc, but Im not surprised. You are very sharp and astute. I havent made any suggestions or requests to my pdoc. He just wants me to stay at 45 for the time being (two weeks today) and then see what happens. However, I have read of others, most notably you and SLS, who had success with Nardil + TCA.How are you feeling? Is Nardil + TCA the best youve ever felt? Are you able to resume a "normal life"? Hope and prayers your way, Michael
Posted by UGottaHaveHOPE on October 1, 2007, at 22:10:38
In reply to Re: Want to hear more about Pamelor/Ugotta, posted by stargazer2 on September 29, 2007, at 12:34:43
How long did it take for Nardil/Pamelor combo to kick in? 4-6 weeks? Less? More? Thanks, Michael
Posted by stargazer2 on October 2, 2007, at 12:07:28
In reply to Re: Want to hear more about Pamelor/Ugotta » stargazer2, posted by UGottaHaveHOPE on October 1, 2007, at 22:07:45
Michael, I'm feeling better than I have in over a year and last week I actually went on a job interview. I didn't get one job and haven't heard about the second. But just the idea that I went is a miracle in itself since it's been over a year that I've worked.
I added nortriptyline 25 (aka Pamelor) on 8/17, to the Nardil 30 I was already taking. On 8/15, I began taking Synthroid, after seeing an endocrinologist (actually saw an APRN). On 8/25 I upped the Nardil to 45 mg since I was still feeling depressed. The improvement in my mood could be the result of any of those 3 changes.
Then on 8/23 I increased Nortriptyline to 75, which was the target dosage when starting Nortrip. Due to a severe dry mouth and dizziness, I reduced the Nortrip on 9/7 to 50 mg.
On 9/11 I wrote, "depression stable" and my mood has remained good since then, so the improvement in my mood from when I added Nortriptyline was about 3-4 weeks.
The only remaining side effect is dry mouth but it is better than when I was on 75 mg.
As far as getting on Synthroid goes, I'm not sure how much of my improvement is due to adding that.
So the combination of Nardil 45, Nortriptyline 50 and Synthroid 50 mcg is what has improved my mood. Sometimes we don't know exactly what med is doing what, I bet my pdoc will leave well enough alone for now. I hope this can result in my seeing him less than weekly or every other week (which I just graduated to) and God willing, find a job as long as my mood stays stable. For me, it's never too difficult to finding a job but inevitably my depression returns and I find myself unable to stay in a job. This time I want to make sure I try to do this as best I can since I've been working 30 years and have no pension or stable job record. It is so frustrting since I am a hard worker but my abilities crash when depression returns.
I know you will get back to your level before decreasing the dose of Nardil, as Jedi was saying it has continued to work for him despite trying other meds but always coming back to Nardil.
Stargazer
This is the end of the thread.
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