Psycho-Babble Medication Thread 814017

Shown: posts 1 to 21 of 21. This is the beginning of the thread.

 

Start Nardil at maximum dose without titrating?

Posted by 4WD on February 21, 2008, at 22:20:37

I saw my pdoc today. He agreed to a trial of Nardil. At first he told me he wanted me to start at 15mg twice a day for two weeks and then go up to 15mg 3 times a day.

Then I got a message from his assistant that he wants me to start at the full 45 mg without titrating. (I weigh 51 kg). Is this a good idea? Won't the side effects be horrific if I start at my maximum dose with titrating upwards.

Than again, maybe he is thinking I need to get it into my system as quickly as possible.

Well, I have a couple of weeks to think about it. Today was my first day off Celexa. I am both scared and excited.


Marsha

 

Re: Start Nardil at maximum dose without titrating? » 4WD

Posted by Phillipa on February 21, 2008, at 22:41:24

In reply to Start Nardil at maximum dose without titrating?, posted by 4WD on February 21, 2008, at 22:20:37

Marsha oh wow!!!! What about the geodon is it compatible? Love Phillipa and of course good luck and keep us posted. Heck just write daily for support in the two weeks before.

 

Re: Start Nardil at maximum dose without titrating?

Posted by squatlover on February 22, 2008, at 5:06:35

In reply to Re: Start Nardil at maximum dose without titrating? » 4WD, posted by Phillipa on February 21, 2008, at 22:41:24

45mg isn't the maximum dose, and to be honest my side effects are horrific - I have everything bar constipation and fluid retention and I titrated slowly.

 

Re: Start Nardil at maximum dose without titrating? » squatlover

Posted by 4WD on February 22, 2008, at 10:08:28

In reply to Re: Start Nardil at maximum dose without titrating?, posted by squatlover on February 22, 2008, at 5:06:35

> 45mg isn't the maximum dose, and to be honest my side effects are horrific - I have everything bar constipation and fluid retention and I titrated slowly.

I figured 45mg was *my* maximum dose since I only weigh 51kg.
I don't know. Maybe I will take 30mg for the first week and then go up to 45. Or maybe I will (for once) follow my doctors orders exactly and see what happens. After all, if the side effects are too horrific I can always go back down to 30 and then titrate.

How slow did you titrate?

Thanks for answering.


Marsha

 

Re: Start Nardil at maximum dose without titrating » 4WD

Posted by medjuggler on February 23, 2008, at 9:00:01

In reply to Start Nardil at maximum dose without titrating?, posted by 4WD on February 21, 2008, at 22:20:37

I dont think it really matters how fast you get to your own theraputic dose. I titrated up slowly & as soon as I reached 60mg it kicked in good & proper, but so did the side effcts. So perhapse this is why your doc wants you to start at 45mg, so as to get side effects over & done with ASAP.

On the other hand it may be wise to start at 30mg as THAT may well be your ideal dose, at least to start with. You'd have less side effcts too. The dose-to-body weight idea isn't set in stone. I weigh around 65-70kg, but I could feel it working at 45mg, though not to its full potential. Maybe if I was more patient 45mg would have been my 'kick-in' dose. And at times I needed to go right up to 135mg to get it working again, then slowly drop back to 90mg.
mj

 

Re: Start Nardil at maximum dose without titrating?

Posted by phoenix1 on February 23, 2008, at 12:16:13

In reply to Re: Start Nardil at maximum dose without titrating? » squatlover, posted by 4WD on February 22, 2008, at 10:08:28

I started at 15mg, and added 15mg each week until I got to 90. The monograph recomends just starting at 60mg, but I think titrating up slowly is probably going to make it a little easier to handle any side effects you may encounter.

Phoenix1

> > 45mg isn't the maximum dose, and to be honest my side effects are horrific - I have everything bar constipation and fluid retention and I titrated slowly.
>
> I figured 45mg was *my* maximum dose since I only weigh 51kg.
> I don't know. Maybe I will take 30mg for the first week and then go up to 45. Or maybe I will (for once) follow my doctors orders exactly and see what happens. After all, if the side effects are too horrific I can always go back down to 30 and then titrate.
>
> How slow did you titrate?
>
> Thanks for answering.
>
>
> Marsha
>

 

Re: Start Nardil at maximum dose without titrating » medjuggler

Posted by 4WD on February 23, 2008, at 16:07:39

In reply to Re: Start Nardil at maximum dose without titrating » 4WD, posted by medjuggler on February 23, 2008, at 9:00:01

Hi, thanks for the reply. I still ahven't decided whether to start at 30 for a few days and then go to 45 or to start at 45 right away. I' leaning toward starting with the 45 and then if the side effects are too awful I can always go down to 30 for a few days before going back up to 45.

Marsha


> I dont think it really matters how fast you get to your own theraputic dose. I titrated up slowly & as soon as I reached 60mg it kicked in good & proper, but so did the side effcts. So perhapse this is why your doc wants you to start at 45mg, so as to get side effects over & done with ASAP.
>
> On the other hand it may be wise to start at 30mg as THAT may well be your ideal dose, at least to start with. You'd have less side effcts too. The dose-to-body weight idea isn't set in stone. I weigh around 65-70kg, but I could feel it working at 45mg, though not to its full potential. Maybe if I was more patient 45mg would have been my 'kick-in' dose. And at times I needed to go right up to 135mg to get it working again, then slowly drop back to 90mg.
> mj

 

Re: Start Nardil at maximum dose without titrating? » phoenix1

Posted by 4WD on February 23, 2008, at 16:11:50

In reply to Re: Start Nardil at maximum dose without titrating?, posted by phoenix1 on February 23, 2008, at 12:16:13

I;m still undecided. In a way, I'd like to go ahead and start at the full dose, deal with the side effects as best I can and get it over with. I'd also like it to kick in as quickly as possible. I'm in pretty bad shape right now.

Marsha

 

Go for it! - 4WD

Posted by medjuggler on February 23, 2008, at 17:22:45

In reply to Re: Start Nardil at maximum dose without titrating? » phoenix1, posted by 4WD on February 23, 2008, at 16:11:50

>In a way, I'd like to go ahead and start at the full dose, deal with the side effects as best I can and get it over with. I'd also like it to kick in as quickly as possible. I'm in pretty bad shape right now.
>
> Marsha

Marsha, if thats the case then YES go for the full dose your pdoc recommended. But stay at that dose for at least 4 weeks. 'Normally' it kicks in after 3-4 weeks, though some wait ALOT longer. If after 5 weeks there is NO response at all then go to 60. Like I said before, the dosage-to-weight idea is a good one but its not set in stone.
If you start at the full dose then I believe this will speed up the MAO inhibiting process. Ideally you want a 90%+ inhibition for the antidepressant effect, though you should feel it's anxiolytic effects (from GABA) much sooner. I felt that from practically day one at 15mg.

GO FOR IT! GOOD LUCK!
mj

 

Re: Start Nardil at maximum dose without titrating

Posted by cumulative on February 24, 2008, at 4:31:43

In reply to Start Nardil at maximum dose without titrating?, posted by 4WD on February 21, 2008, at 22:20:37

I don't think this is inherently problematic, but you should anticipate a limited period where the side effects may be harsh, and perhaps try addressing them with additional medications if necessary, e.g. sleep aids for instance.

 

Re: Start Nardil at maximum dose without titrating?

Posted by squatlover on February 24, 2008, at 16:42:40

In reply to Re: Start Nardil at maximum dose without titrating? » squatlover, posted by 4WD on February 22, 2008, at 10:08:28

I titrated slowly. I weight 75kg male.
5 days at 15mg
5 days at 30
7 days at 45
30 days at 60

I started getting some really happy feelings at 21 days but they went away after a sleep, and I haven't experienced it again. I think this means that 60mg will be enough, but I just need to give it up to 6 weeks to load up.

 

Re: Go for it! - 4WD » medjuggler

Posted by 4WD on February 24, 2008, at 18:19:32

In reply to Go for it! - 4WD, posted by medjuggler on February 23, 2008, at 17:22:45

Thanks for the thumbs up, Medjuggler. I'm both nervous and excited about starting the Nardil. And I've decided to go for and start at 45mg. I figure the side effects will be harsh. I am going to ask for some Ambien to add to my trazadone if it becomes necessary.

I'm glad to hear that the anxiolytic effects kick in right away. I'm currently requiring 4-6mg of Klonopin a day. That is about 60-70 percent of my problem. The anxiety is a large part of what is making me depressed.

I'm a bit worried about hypotension, too. I already have low blood pressure (on a good day it's 110 over 70. On a bad day it's 100 over 60.)
I think the Celexa I've been on lowers my blood pressure though so now that I'm off it maybe it will be higher.

Still, the insomnia is what scares me most. I also worry about the food cravings. I could stand to gain some weight (5'4" and 110 pounds) but I'm a recovering bulimic and I'm afraid the Nardil cravings will send me back into full blown bulimia. I mean I'll eat all the stuff you crave on Nardil but I probably won't gain much weight since I'll just go throw up the doughnuts or whatever.

Just the same, I'm willing to be a constipated, bulimic, anorgasmic, hypotensive if it means I will be "Marsha" again, which I haven't been for almost 4 years now. And I will just have to trust that I will find a way to mitigate the insomnia.

Thanks for answering.

Marsha


> Marsha, if thats the case then YES go for the full dose your pdoc recommended. But stay at that dose for at least 4 weeks. 'Normally' it kicks in after 3-4 weeks, though some wait ALOT longer. If after 5 weeks there is NO response at all then go to 60. Like I said before, the dosage-to-weight idea is a good one but its not set in stone.
> If you start at the full dose then I believe this will speed up the MAO inhibiting process. Ideally you want a 90%+ inhibition for the antidepressant effect, though you should feel it's anxiolytic effects (from GABA) much sooner. I felt that from practically day one at 15mg.
>
> GO FOR IT! GOOD LUCK!
> mj
>

 

Re: Start Nardil at maximum dose without titrating » cumulative

Posted by 4WD on February 24, 2008, at 18:22:01

In reply to Re: Start Nardil at maximum dose without titrating, posted by cumulative on February 24, 2008, at 4:31:43

I'm just trying to gear myself up to expect harsh side effects for the first week or two and hope they lessen a bit at a time. Do you think the side effects may lessen in a week or do you think it will be longer?

Marsha

> I don't think this is inherently problematic, but you should anticipate a limited period where the side effects may be harsh, and perhaps try addressing them with additional medications if necessary, e.g. sleep aids for instance.

 

Re: Start Nardil at maximum dose without titrating? » squatlover

Posted by 4WD on February 24, 2008, at 18:32:22

In reply to Re: Start Nardil at maximum dose without titrating?, posted by squatlover on February 24, 2008, at 16:42:40

I'm not sure I can tolerate 21 days before feeling any effects except side effects so I've decided not to titrate and to start at the 45mg a day my doctor prescribed. I'm hoping that by starting at the higher dose, it will kick in quickly.

What is your dosage schedule? Do you take it every so many hours, 15 mg at a time? My pdoc just prescribed 15mg three times a day. He did tell me I could take 30 mg in the morning and 15 in the afternoon although I got the feeling he'd rather I took it 15mg at a time.

I'm glad to hear about your happy feelings at 21 days. Maybe that happened when you reached an adequate dose? I'd give it another week or two and try raising the dose a bit to see if you can speed up the process.

Are your side effects horrible? Have they abated at all yet? I don't know whether to expect side effects to lessen in a week, two weeks, a month or what. I guess I will just have to wait and see. And hope and pray for the fortitude to get through it.

Thanks for answering

Marsha

> I titrated slowly. I weight 75kg male.
> 5 days at 15mg
> 5 days at 30
> 7 days at 45
> 30 days at 60
>
> I started getting some really happy feelings at 21 days but they went away after a sleep, and I haven't experienced it again. I think this means that 60mg will be enough, but I just need to give it up to 6 weeks to load up.

 

Re: Start Nardil at maximum dose without titrating? » 4WD

Posted by Phillipa on February 24, 2008, at 18:36:58

In reply to Re: Start Nardil at maximum dose without titrating? » squatlover, posted by 4WD on February 24, 2008, at 18:32:22

Marsha we've been here same amount of time I give you a lot of credit to take the plunge and will be here for you as healing from the surgery so check computer when I wake up from napping. Are there any healthy choice snacks that you can eat? Love Phillipa

 

Re: Go for it! » 4WD

Posted by medjuggler on February 24, 2008, at 21:06:30

In reply to Re: Go for it! - 4WD » medjuggler, posted by 4WD on February 24, 2008, at 18:19:32

Hey Marsha.

Please dont EXPECT anything. That can lead to dissapointment and cofusion - a real mess. I hope you do feel calmer quickly but I simply cant garantee that. Though I think it would be worth starting to titrate down from your Klonopin a little as soon as you start Nardil. Maybe aim for half the dose you're on now.

As for the side effects, they dont usually start strait away but rather they creep up on you, usually after 3-6 weeks. And they last!

I dont think you should be too worried about your bulimia returning. A good number of studies have shown that Nardil can help the condition.
http://archpsyc.ama-assn.org/cgi/content/abstract/41/11/1105
http://www3.interscience.wiley.com/cgi-bin/abstract/112413478/ABSTRACT

Yes you may get more of an appetite with Nardil but there are ways to control it. I suggest you make sure your meals are about 50/50 carbs/protein. The higher protein content will help avoid carb cravings which is normally the culprit for Nardil weight gain. And try and stick with low GI carbs.
L-Glutamine is an amino acid supplement that will also reduce carb craving by providing an alternative fuel for the brain. Try 3g first thing in the morn before breakfast & between meals on empty stomache. Its cheap & good quality here: http://www.1fast400.com/?products_id=2460 I use this company all the time & highly rate them.

And I suggest a high strength multi vit too, or a b-50 complex to include 50mg B6. Nardil can interfere with B6 matabolism so supplements help, but you must balance it with the whole b complex. Taking p-5-p (Pyridoxal-5-Phosphate), the active form of B6 would provide even better protection.

Insomnia shouldn't last long & is 'usually' one of the first side effects to come, and go. Your Trazodone should suffice. Or, I used diphenhydramine effectively which is safe and can be purchased OTC. For constipation simply use laxatives.

The hard ones are hypotension, anorgasmia and (if you're unlucky) urine retention, but thats pretty rare.

For hypotention you can use sodium based salt to help lift blood pressure. For Anorgasmia you can try Horney Goat Weed http://www.1fast400.com/?products_id=1644 (works for both sexes, try 0.5-1g) or meds like Cyproheptadine.

Hope that wasn't all TOO honest & didn't scare you, but I'm just trying to share what I know.

I really hope you can be 'Marsha' again! Good luck!
mj

 

Re: Go for it! » medjuggler

Posted by 4WD on February 24, 2008, at 22:25:05

In reply to Re: Go for it! » 4WD, posted by medjuggler on February 24, 2008, at 21:06:30

Thanks for being such a support for me as I prepare to start Nardil (the date I start is March 6). I do plan to lower my Klonopin dosage as rapidly as possible if the Nardil begins to help with the anxiety. I have been worried for a long time about how much Klonopin I have been requiring. My doctor has given me a prescription for Valium to try and see if I can get by with a lower dose of that but I am kind of reluctant to change horses in midstream. I am trying it this week anyway though.

I am glad to know the side effects don't start right away. I had the idea that I would take Nardil for one day and immediately not be able to sleep that night. I am glad they creep up. I will be better able to handle that.

Thanks for the referral to the abstract. I read and feel much better about it. I will see what happens with the carb cravings. I really need to start eating better (and more). Some days I don't eat anything except drink milk, partly because the anxiety makes me too scared to eat and partly because I have been taking Provigil some days. I will force myself to eat something tonight.

And I will get a b-vitamin complex to start taking when I start the Nardil. Although it's weird, b-vitamins have a tendency to increase my anxiety slightly - maybe because they provide energy?

I'll eat more salt. As far as the anorgasmia goes, I'm not too worried about that at this point. I have had no interest in sex for over a year now. Who am I kidding? For 3-4 years now.

Anyway thanks for all the info and support. I will try to quit bothering you so much with so many questions.

Marsha


> Hey Marsha.
>
> Please dont EXPECT anything. That can lead to dissapointment and cofusion - a real mess. I hope you do feel calmer quickly but I simply cant garantee that. Though I think it would be worth starting to titrate down from your Klonopin a little as soon as you start Nardil. Maybe aim for half the dose you're on now.
>
> As for the side effects, they dont usually start strait away but rather they creep up on you, usually after 3-6 weeks. And they last!
>
> I dont think you should be too worried about your bulimia returning. A good number of studies have shown that Nardil can help the condition.
> http://archpsyc.ama-assn.org/cgi/content/abstract/41/11/1105
> http://archpsyc.ama-assn.org/cgi/content/abstract/41/11/1105
>
> Yes you may get more of an appetite with Nardil but there are ways to control it. I suggest you make sure your meals are about 50/50 carbs/protein. The higher protein content will help avoid carb cravings which is normally the culprit for Nardil weight gain. And try and stick with low GI carbs.
> L-Glutamine is an amino acid supplement that will also reduce carb craving by providing an alternative fuel for the brain. Try 3g first thing in the morn before breakfast & between meals on empty stomache. Its cheap & good quality here: http://www.1fast400.com/?products_id=2460 I use this company all the time & highly rate them.
>
> And I suggest a high strength multi vit too, or a b-50 complex to include 50mg B6. Nardil can interfere with B6 matabolism so supplements help, but you must balance it with the whole b complex. Taking p-5-p (Pyridoxal-5-Phosphate), the active form of B6 would provide even better protection.
>
> Insomnia shouldn't last long & is 'usually' one of the first side effects to come, and go. Your Trazodone should suffice. Or, I used diphenhydramine effectively which is safe and can be purchased OTC. For constipation simply use laxatives.
>
> The hard ones are hypotension, anorgasmia and (if you're unlucky) urine retention, but thats pretty rare.
>
> For hypotention you can use sodium based salt to help lift blood pressure. For Anorgasmia you can try Horney Goat Weed http://www.1fast400.com/?products_id=1644 (works for both sexes, try 0.5-1g) or meds like Cyproheptadine.
>
> Hope that wasn't all TOO honest & didn't scare you, but I'm just trying to share what I know.
>
> I really hope you can be 'Marsha' again! Good luck!
> mj
>
>

 

Re: Start Nardil at maximum dose without titrating? » Phillipa

Posted by 4WD on February 24, 2008, at 22:29:03

In reply to Re: Start Nardil at maximum dose without titrating? » 4WD, posted by Phillipa on February 24, 2008, at 18:36:58

Phillippa, I didn't know you had had surgery. ARe you okay now? What was wrong? I will pray for you.

Marsha

> Marsha we've been here same amount of time I give you a lot of credit to take the plunge and will be here for you as healing from the surgery so check computer when I wake up from napping. Are there any healthy choice snacks that you can eat? Love Phillipa

 

Re: Go for it! » 4WD

Posted by medjuggler on February 24, 2008, at 23:10:30

In reply to Re: Go for it! » medjuggler, posted by 4WD on February 24, 2008, at 22:25:05

>I will try to quit bothering you so much with so many questions.

Marsha! You may ask all the questions you want! I'd be most happy to try and help! I'm doing well at the moment & when I'm like this I love helping others out :)

So dont be shy, ask away. And you may Babblemail me ANYTIME!

mj

 

Re: Go for it! » medjuggler

Posted by 4WD on February 25, 2008, at 10:25:16

In reply to Re: Go for it! » 4WD, posted by medjuggler on February 24, 2008, at 23:10:30

Very simply, thank you. How long have you been on Nardil?

Marsha


> >I will try to quit bothering you so much with so many questions.
>
> Marsha! You may ask all the questions you want! I'd be most happy to try and help! I'm doing well at the moment & when I'm like this I love helping others out :)
>
> So dont be shy, ask away. And you may Babblemail me ANYTIME!
>
> mj

 

Re: Go for it! » 4WD

Posted by medjuggler on February 25, 2008, at 11:46:14

In reply to Re: Go for it! » medjuggler, posted by 4WD on February 25, 2008, at 10:25:16

> Very simply, thank you. How long have you been on Nardil?
>
> Marsha

You're welcome! I'm not on Nardil anymore (was on it for 3+ years). Taking another med combo now which includes a different MAOI ;) I sent you a babblemail.

mj


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