![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 10 to 34 of 124. Go back in thread:
Posted by ace on May 6, 2008, at 23:35:35
In reply to Re: Nardil- The best AD ever......., posted by maoi_wowee on May 6, 2008, at 21:40:29
> Hey Ace,
>
> Please share the Nardil dose that you are taking and the times of day that you are taking it.
>
> Many thanks!Hey no probs!
I take 60mg now. Sometimes 75mg.
2 in the morning and 2 at night (late afternoon)
Just a couple comments...
Nardil took a long time to kick in....
At 60mg it finally kicked in, but when raised to 90mg, the therapeutic effect it provided me with was outstanding.
I personally alway advice splitting does....
My best plan was...(was on 90mg then)
10am- 30mg
1pm- 30mg
4pm- 30mg
Always take at regular times!
Hope this helps you!!!!!!!!
Ace
Posted by ace on May 6, 2008, at 23:47:00
In reply to Re: Nardil- The best AD ever......., posted by Cecilia on May 6, 2008, at 23:08:43
> Ace, I'm glad Nardil works for you, but I get frustrated when I read your frequent posts about how wonderful it is.
I'm sorry to here this.
For many of us it was not wonderful at all, to say the least.
If Nardil didn't work I would address all issues involved in why it didn't work. It can take up to 12 weeks to work, and s/effects can be a problem. So many variable involved. But anectodal, statistical, etc etc analysis shows Nardil to be the most potent anti-depressant in the MD's arsenal. I stand by this statement.
I just worry that if you do get to be a pdoc, you will be putting everybody on it regardless of whether it is the best thing for them.
That's not true at all. I would certainly use it as a first line treatment but- despite the nonsense med students are taught now (in the SSRI funded institutions) Actually med students, and pysch residents spend about 1.5% focused on MAOI pharmacology/treatment. And that 1.5% is full of nonsense about the MAOI 'scare'!!!
That being said, some patients would not respond. I would find this the exception rather than the rule.
I would then try a TCA
And am curious as to why you think you will no longer need it if you get to be a pdoc, plenty of pdocs are depressed or have other emotional problems.If they are depressed with emotional problems- and I have known many!! -- they should very likely not be treating!!!!
The suicide rate here in NSW for psychiatrists is very concerning. The amount of psychiatrists behaving unethically is very concerning.
Psychiatrists are in a position of extreme responsibility which requires a constant vigilance to their behaviour toward 'patients'...
Cheers!Ace:)
Cecilia
Posted by clipper40 on May 7, 2008, at 0:02:34
In reply to Re: Nardil- The best AD ever....... » Cecilia, posted by ace on May 6, 2008, at 23:47:00
Ace,
Your argument adds weight to why you should STAY on your medications once you become a pdoc. It doesn't explain why you're planning to stop them once you're a doctor who is treating patients. Could it be that you just typed that sentence wrong and you meant that you are NOT planning to stop your medications?
I also wanted to say that I have enjoyed your posts over the years and I'm glad that you have a medication that works so well for you.
Posted by Justherself54 on May 7, 2008, at 0:41:47
In reply to Re: Nardil- The best AD ever....... » Cecilia, posted by ace on May 6, 2008, at 23:47:00
Nardil is a great medication but it was a failed med trial for me. I developed bad urinary issues and a lovely side effect of spontaneously vomiting in my sleep. The danger of that side effect was the reason I went off it. On the other hand Parnate only had two side effects, hypotension and anorexia. What are your views on Parnate?
Posted by simon79 on May 7, 2008, at 3:17:16
In reply to Nardil- The best AD ever......., posted by ace on May 5, 2008, at 23:36:34
Dear Ace
I find your story so inspiring it almost brings tears to my eyes. I wish you all the very best in becoming a psychiatrist.
I myself have suffered from social anxiety (currently severe) and depression (currently moderate) for 14 years.
After trying nurmerous drugs, a few emotional breakdowns, and abusing recreational drugs to escape my pain I have been given clonazepam and nardil. My only query is my doc is titrating me up very slowly on the nardil, i'm currently on 30 and don't feel anything much from it or much in the way of side effects and he says "2 months and u will get full effect at that dose and then we can think about adding another 15mg"... so it's gonna be a long time to get to 60... and god forbid i don't know what i would do if this drug doesn't work for me :(.. anyways.. do u think this is titrating up a bit too slowly? i'm not sure whether to trust him or put my foot down and say i'm only waiting a month for each 15mg until i get to 60 if i'm not hving any problems with side effects.
Anyways sorry to hijack your thread with my problems :) Your story was hugely inspirational for me and I'm sure many other people who are suffering. Good luck with your studies i'm sure you will pass with flying colours!
Posted by undopaminergic on May 7, 2008, at 14:51:50
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 7, 2008, at 3:17:16
>
> After trying nurmerous drugs, a few emotional breakdowns, and abusing recreational drugs to escape my pain I have been given clonazepam and nardil. My only query is my doc is titrating me up very slowly on the nardil, i'm currently on 30 and don't feel anything much from it or much in the way of side effects and he says "2 months and u will get full effect at that dose and then we can think about adding another 15mg"... so it's gonna be a long time to get to 60... and god forbid i don't know what i would do if this drug doesn't work for me :(.. anyways.. do u think this is titrating up a bit too slowly? i'm not sure whether to trust him or put my foot down and say i'm only waiting a month for each 15mg until i get to 60 if i'm not hving any problems with side effects.
>Some Nardil experts say it's not a matter of dose, but time. However, since you aren't experiencing any prominent effects of it, the dose may well be too low.
Posted by Phillipa on May 7, 2008, at 19:02:47
In reply to Re: Nardil- The best AD ever....... » Phillipa, posted by ace on May 6, 2008, at 23:26:20
Ace I feel that if nardil is what it takes for you to function and feel well it would be detrimental for you to stop your med. I think you know what I mean If I remind you of a time you did? Remember? Anyway if it's a chemical balance which is not proven how will you not need the med as soon as your a pdoc? And there was a pdoc where I worked that himself was on lithium as he was bipolar and always smiling feeling very well. He did prescribe lithium first to most of his patients. He always said they had been misdiagnosed. So since most of his patients loved him and the staff as well I feel you not taking something that works could possibly be a mistake. How will you know if you no longer need nardil? Love Phillipa
Posted by ace on May 7, 2008, at 23:07:44
In reply to Re: Nardil- The best AD ever......., posted by undopaminergic on May 7, 2008, at 14:51:50
> >
> > After trying nurmerous drugs, a few emotional breakdowns, and abusing recreational drugs to escape my pain I have been given clonazepam and nardil. My only query is my doc is titrating me up very slowly on the nardil, i'm currently on 30 and don't feel anything much from it or much in the way of side effects and he says "2 months and u will get full effect at that dose and then we can think about adding another 15mg"... so it's gonna be a long time to get to 60... and god forbid i don't know what i would do if this drug doesn't work for me :(.. anyways.. do u think this is titrating up a bit too slowly? i'm not sure whether to trust him or put my foot down and say i'm only waiting a month for each 15mg until i get to 60 if i'm not hving any problems with side effects.
> >
>
> Some Nardil experts say it's not a matter of dose, but time. However, since you aren't experiencing any prominent effects of it, the dose may well be too low.
I would agree very much with these sentiments posted by undopaminergic.I also will answer this post, as to why I agree.......just in hurry!
Ace!
Posted by ace on May 7, 2008, at 23:12:57
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 7, 2008, at 3:17:16
> Dear Ace
Thankyou so very much! I will absolutely reply in full to your post (and all others)- just crazy busy today....I hope this doesn't make me sound like a snob!!?Be back really soon
God Bless,
Ace:)
Posted by ace on May 8, 2008, at 0:02:09
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 7, 2008, at 3:17:16
> Dear Ace
Hey- I felt a tad rude writing the quick message, so just back!
> I find your story so inspiring it almost brings tears to my eyes.
This is great! I hope that it did indeed lift your spirits.
I wish you all the very best in becoming a psychiatrist.Many thanks for this too!
> I myself have suffered from social anxiety (currently severe) and depression (currently moderate) for 14 years.When you say "severe" are you home-bound? What sort of symptoms do you get?
> After trying nurmerous drugs, a few emotional breakdowns, and abusing recreational drugs to escape my pain I have been given clonazepam and nardil.
In my opinion, this is a great combination.
My only query is my doc is titrating me up very slowly on the nardil, i'm currently on 30 and don't feel anything much from it or much in the way of side effects and he says "2 months and u will get full effect at that dose and then we can think about adding another 15mg"...
I disagree very strongly to what your doctor stated. Firstly, the titration regime is far too slow. The dose of 30mg will NOT, I feel strongly, produce any strong therapeutic effect regardless of time or any other variable. My sentiments are reinforced by your statement of having no side-effects, let alone therapeutic reaction.
Nardil typically has a slow onset, even at doses such as 60mg. The (rare) exceptions I have found are where people recieve an early response on a low dose, but then quickly need to higher the dose to retain benifits. I have seen this type of reaction to be rare.
MAOI's essentially have a lot of 'work' to do before they start to work therapeutically. Each person needs a certain amount of MAOI inhibition in order for the drug to have affect. I feel 30mg won't do this in the vast majority of cases!!
Also, certain metabolites of Nardil increase GABA levels, which, I feel plays a definite role in Nardil's effect.
All I am saying here is it takes time and the correct dose. I think your MD is correct about the time part, but he is way off about the dose.
MAOI's and, especially, TCA's are usually prescribed at TOO LOWER DOSES!!! And SSRI's far too high!
I have seen 1000's of anectodes on Nardil and read literally any and all clinical trials on it I could find.
I really feel your MD has not got the correct information on MAOI's. Is he/she a younger doctor?
I feel you should start of with 15mg bid, and increase by 15mg, every 3/5'th day until one reaches a maximum of 60mg (I recommend divided doses) This assumes one can tolerate any s/effects.
Once at 60mg, stay at this dose for a minimum of 6 weeks. If no response, increase to 90mg for a further 6 weeks. However, I feel that 60mg is the optimum dose where Nardil kicks in for most- 90mg has the potential to augment a wonderful AD/anti social phobic etc etc etc effectso it's gonna be a long time to get to 60...
I would politely talk to your doctor about this issue. I personally would ignore him/her, but that's just me, ha ha!
and god forbid i don't know what i would do if this drug doesn't work for meI would try to curtail those thoughts. For some reason I knew Nardil was going to work for me....I justknew it. Even when their was great doubt....I kept hope. Please do the same!!!!
Look at the psycho Babble history of Nardil responders and this will help!!! Their used to actually be some Nardil group ages ago, where these people who were in love with Nardil used to just post!
:(.. anyways.. do u think this is titrating up a bit too slowly?I think you know my answer=- WAY too slow!!!
i'm not sure whether to trust him or put my foot down and say i'm only waiting a month for each 15mg until i get to 60Even this is too slow!!!
Be polite to him. I can dig out some old studies that you can refer him too if you want??
Just remember that you are paying him for a service!
if i'm not hving any problems with side effects.
> Anyways sorry to hijack your thread with my problems :)Hey- no probs at all! Your 'hijack' is a welcome one! Sometimes I just have time factor problems....We are all so buzy in this world!!!
Your story was hugely inspirational for me and I'm sure many other people who are suffering.Thank you so much for this....this is my main purpose, and to feel I have achieved it, is such a great feeling. Please keep me up to date...!
Good luck with your studies i'm sure you will pass with flying colours!
Cheers!!!
God Bless!
Andrew
>
Posted by ace on May 8, 2008, at 0:03:55
In reply to Re: Nardil- The best AD ever....... » simon79, posted by ace on May 8, 2008, at 0:02:09
Thanks to all you who responded....gotta run, but be back shortly!
Ace:)
Posted by ace on May 8, 2008, at 0:09:49
In reply to Re: Nardil- The best AD ever.......Ace, posted by Justherself54 on May 7, 2008, at 0:41:47
> Nardil is a great medication but it was a failed med trial for me. I developed bad urinary issues and a lovely side effect of spontaneously vomiting in my sleep. The danger of that side effect was the reason I went off it. On the other hand Parnate only had two side effects, hypotension and anorexia. What are your views on Parnate?
Cheers for post- definately have some opinions and qstns on this.....will be back soon!
>
Posted by ace on May 8, 2008, at 1:26:31
In reply to Re: Nardil- The best AD ever.......Ace, posted by Justherself54 on May 7, 2008, at 0:41:47
> Nardil is a great medication but it was a failed med trial for me. I developed bad urinary issues and a lovely side effect of spontaneously vomiting in my sleep. The danger of that side effect was the reason I went off it. On the other hand Parnate only had two side effects, hypotension and anorexia. What are your views on Parnate?
The vomiting is strange.....Although people do experience this on Remeron....
Were you taking any other medicines at the time of your Nardil trial?
Parnate can be a real Godsend too.....it has been shown, like Nardil, to be extremely effective.
Differences about Parnate, in contrast to Nardil, , are its s/effect profile...obviously it has a different pharmacology-
In my opinion Parnate has unequivocal psycho-stimulant properties that can lead to a great response (and some insomnia). other s/effects are lack of appetite (which you know) and minor psychomotor problems. There's is a full list, but these are what I have noticed most....For some it's NE profile, I feel, can cause a paradoxical depression.
I think this is mainly the exception, not the rule but.
I have seen phenomenal responses to Parnate- not as manu as Nardil, but still a lot.
I definately would give it a go.....how long was your last trial?
And in one study I have, it was the leading medicine that psychiatrists would treat themselves with!
Please feel free to ask any more, and I hope all is well:)
Ace
>
Posted by simon79 on May 8, 2008, at 3:50:43
In reply to Nardil- The best AD ever......., posted by ace on May 5, 2008, at 23:36:34
Dear Ace
1>> I myself have suffered from social anxiety (currently severe) and depression (currently moderate) for 14 years.
>When you say "severe" are you home-bound? What sort of symptoms do you get?
Home bound. Unemployed on sickness benefit. No social life since I stopped being an alcoholic. Symptoms: anxiety attacks ranging from mild-severe (half my shirt drenched in sweat, sweat pouring off my forehead, blushing, violently shaking, shaky voice, my memory and ability to use my brain turns to jelly) , blushing, sweating, shaking, shaky voice, feels like knives inside my stomach, intense anticipatory anxiety etc..
2>I really feel your MD has not got the correct information on MAOI's. Is he/she a younger doctor?
I think he is in his 30s
3>Look at the psycho Babble history of Nardil responders and this will help!!! Their used to actually be some Nardil group ages ago, where these people who were in love with Nardil used to just post!
I have spent days going through nardil forums on phsycho babble and other websites :)
4>Be polite to him. I can dig out some old studies that you can refer him too if you want??
Please, that would be invaluable if you could. I meet with him in a couple of days, and without any solid evidence I think the compromise will be go to 45mg for 6 weeks. Im sitting at home with depression and anxiety popping out my eye balls since coming off the effexor which help a tiny bit, I need to get better in 3-4 months.. not a whole year or the depression is going to kill me  some rock hard evidence to show him would mean more to mean than anything in the world right now Ill even pay u if u can get it hah! :)Im really really suffering and the last thing I need is a doctor who is stingy about the meds Thanks for your help, it means more to mean that I could put in to words, people like you are invaluable and the advice you are willing to share helps the suffering of many, of whom I am one.
Best wishes
Simon
Posted by Justherself54 on May 8, 2008, at 9:41:51
In reply to Re: Nardil- The best AD ever.......Ace » Justherself54, posted by ace on May 8, 2008, at 1:26:31
>
> The vomiting is strange.....Although people do experience this on Remeron....Yes, it was strange...and scary...
>
> Were you taking any other medicines at the time of your Nardil trial?
50 mg. seroquel up from my usual 25 mg, .05 clonazapam and 7.5 zopiclone (which I had to increase also to combat insomnia.
>
> Parnate can be a real Godsend too.....it has been shown, like Nardil, to be extremely effective.It was an effective med for me also
>
> Differences about Parnate, in contrast to Nardil, , are its s/effect profile...obviously it has a different pharmacology-
> In my opinion Parnate has unequivocal psycho-stimulant properties that can lead to a great response (and some insomnia). other s/effects are lack of appetite (which you know) and minor psychomotor problems. There's is a full list, but these are what I have noticed most....I had pyschomotor problems on Nardil...the drunken sailer walk...I also had a terrible time with transposing letters and leaving off the ends of words when I typed...
>
> For some it's NE profile, I feel, can cause a paradoxical depression.
>
> I think this is mainly the exception, not the rule but.
>
> I have seen phenomenal responses to Parnate- not as manu as Nardil, but still a lot...Yeah...Nardil has that great euphoria at the beginning...had to keep an eye on it so I didn't overshoot from a hypomania to nastier one...initially it was like WOW...I can't believe the energy I have, but then the side effects popped up...Parnate didn't have that...but it made me stay on task and my focus was incredible...not very social but felt smarter than usual (if that makes any sense)
>
> I definately would give it a go.....how long was your last trial?Was only up to 20 mg for a couple of months and went off due to major surgery, then restarted but ended up with severe chilling...found out later it was from surgery but at that time I was already on Nardil...
>
> And in one study I have, it was the leading medicine that psychiatrists would treat themselves with!I wonder if that's why my pdoc has many patients on Parnate...I was his only one on Nardil...must ask him...
>
> Please feel free to ask any more, and I hope all is well:)So far I have been able to go without an AD for the first time in years...I have a prescription for Parnate sitting...but right now it's nice to be side effect free...how long it will last I don't know...if I do restart it I'm going to have to force myself to eat, as I think that excaberated the hypotension...low blood sugar on top of hypotension...
As I have fibromyalgia my pdoc has mentioned Cymbalta ,as it's just been released in the land of hockey and beer, but I'm still leaning towards the MAOI's and I think he is too, at least in my case. I've had the best responses ever from them. They have more "physical" side effects which I can tolerate more than the "inside the head" side effects of SSRI's. (I don't know if I'm making much sense...I have a major case of fibro fog going on right now.
Thanks Ace...it was nice to see some feedback on Parnate...it could be helpful to those who had failed trials with Nardil to know that Parnate is out there and may be suitable for them...MAOI's rock...to bad they couldn't work out the nastier side effects without compromising the effectiveness of the drug..
Justy
Posted by ace on May 8, 2008, at 23:51:19
In reply to Re: Nardil- The best AD ever......., posted by clipper40 on May 7, 2008, at 0:02:34
> Ace,
>
> Your argument adds weight to why you should STAY on your medications once you become a pdoc. It doesn't explain why you're planning to stop them once you're a doctor who is treating patients. Could it be that you just typed that sentence wrong and you meant that you are NOT planning to stop your medications?
I may have been thinking in reverse or something here! Your basically saying I provide more reason to stay on the meds when a shrink? That seems like a dumb question!I got to bed 6am this morning, so my brain is functioning somewhat weird!
My main concern, I feel, is that I wouldn't want my illness to in anyway be a detriment to my ability to empathize and try to ameliorate another persons illness.
I think your saying- If i stay on the meds, my illness would at bay, and allow me to conduct myself in such a way?
A part of it is ethics too...I just feel a little 'wrong' being on treatments that I would dispense...I am old fashioned I feel in some respects....Certainly as a Doctor I wouldn't use swear words in a clinical setting, in a sense, I would also have to suppress my eccentric side....not totally!
Does any of this make sense??!!
> I also wanted to say that I have enjoyed your posts over the years and I'm glad that you have a medication that works so well for you.Thankyou very much- I really do feel happy that you feel this way. I ruly hope things are going great for you....if not, hang in there!!
Peace to you,
Ace:)
Posted by ace on May 8, 2008, at 23:58:20
In reply to Re: Nardil- The best AD ever/Ace, posted by Justherself54 on May 8, 2008, at 9:41:51
I have to run now, but will answer all....in addition I will get those studies for Simon no probs at all....
Once again I hope this doesn't make me sound like a self-important snob!
Posted by ace on May 9, 2008, at 0:00:43
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 8, 2008, at 3:50:43
Simon- will dig out studies tonight, not a problem....also will answer your message in full..
Just overwhelmed on this day!What day do you see him?
It's Friday in Australia at the moment.
I'd obviously like to get them to you ASAP.....
Peace to you,
Andrew
Posted by simon79 on May 9, 2008, at 0:49:05
In reply to Re: Nardil- The best AD ever....... » simon79, posted by ace on May 9, 2008, at 0:00:43
Dear Ace/Nardil champ
>What day do you see him?
I leave in New Zealand and i see him on mondayIt's Friday in Australia at the moment.
It's friday in new zealand at the moment too :)I'd obviously like to get them to you ASAP.....
Thanks you i'm sure just one or two would be enoughThanks again for sharing your knowledge on nardil
Simon
Posted by mav27 on May 9, 2008, at 3:09:29
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 7, 2008, at 3:17:16
> Dear Ace
> I find your story so inspiring it almost brings tears to my eyes. I wish you all the very best in becoming a psychiatrist.
> I myself have suffered from social anxiety (currently severe) and depression (currently moderate) for 14 years.
> After trying nurmerous drugs, a few emotional breakdowns, and abusing recreational drugs to escape my pain I have been given clonazepam and nardil. My only query is my doc is titrating me up very slowly on the nardil, i'm currently on 30 and don't feel anything much from it or much in the way of side effects and he says "2 months and u will get full effect at that dose and then we can think about adding another 15mg"... so it's gonna be a long time to get to 60... and god forbid i don't know what i would do if this drug doesn't work for me :(.. anyways.. do u think this is titrating up a bit too slowly? i'm not sure whether to trust him or put my foot down and say i'm only waiting a month for each 15mg until i get to 60 if i'm not hving any problems with side effects.
>
>My doc started me the same way.. but i figured stuff it the info that came with nardil said increase to 60 as fast as you could so thats what i did. All was good for 4 weeks and then bang.. the side effects were so bad i ended up in hospital. Had to then start all over again so that was about 6 weeks down the drain. This time i stuck to the 30 mg for two months then went to 45 and it kicked in in 2 days and i was actually able to remain conceous for more than 5 seconds this time to enjoy it!
Posted by cumulative on May 9, 2008, at 6:46:48
In reply to Nardil- The best AD ever......., posted by ace on May 5, 2008, at 23:36:34
I agree with ace's sentiments here.
Many of the people on this forum have had similar experiences -- lowering the dose (CONTRARY to the theory that the antidepressant effect from MAO inhbibition can be maintained at a lower dose which continues to get rid of MAO) has caused a loss of effect and relapse.
I think that the reason for this is that much of Nardil's antidepressant effect might stem from additional properties beyond MAOI:
a) the gabaergic activity of Nardil and its metabolites, which is dose-dependent
b) another Nardil metabolite is phenethylamine (PEA), an endogenous stimulant-type substance with effects comparable in many ways to amphetamine*. Typoically PEA is rapidly destroyed by the monoamine oxidase enzymes before it can reach blood levels of any significance -- Nardil's MAOI stops this from happening, but the metabolism to phenethylamine is still dose-dependent.I think this theory accounts for Nardil's stimulating, prosocial, and (great stuff!)euthymic/hyperthymic (bordering on hypomanic) effects. The GABAergic properties might optimally be offseting nervousness from PEA, and also improving e.g. social phobia on their own.
(*alpha-methyl-phenethylamine)
What's particularly interesting to me about Nardil is the very long-lasting efficacy -- it seems to me, from reading these anecdotal reports, that many of those (though not all) who do well on it can continue to do so for many years, even decades! The early hypomania seems to usually fade, but a VERY considerbale mood improvement remains. This to my mind is unusual among most of the antidepressant substances, especially those that seem to provide some dopaminergic effect, as Nardil to my mind does.
I wonder ... just found this. Very,very interesting in the context of memantine (a partial NMDA glutamate subtype antagonist) that some of us here have been examining both as a standalone antidepressant, and for halting the development of tolerance to psychostimulants, particularly the antidepressant, antianhedonic effects of these stimulants ...
One more thing. A few people have complained of cognitive issues with Nardil, especially early in treatment. I'm not sure if anticholinergic properties have been identified for this drug, but some of the possible side effects would seem to suggest possible anticholinergic activity very well. It's not hard to imagine that something like that could be occurring downstream. In this case, it may be interesting to look at the cholinergic precursor supplements Alpha-GPC and citicoline, both of which have benefits beyond cholingeric enhancement. iirc the old great poster here Chairman MAO found galantamine (the combined acetylcholinesterase inhibitor/nicotinic agonist) to completely eliminate any cognitive issues from Nardil, and even help with Nardil anorgasmia ... which can also be an effect of excessive anticholinergic activity, among other things.
Last time I talked to Chairman some months ago he was taking 60mg dextroamphetamine (VERY cautiously titrated upwards by 2.6 mg at a time!) + 105 mg Nardil daily, and this had been successful for him for around 2 and a half years and continuing.
Posted by octothorpe on May 9, 2008, at 7:49:20
In reply to Nardil- The best AD ever......., posted by ace on May 5, 2008, at 23:36:34
Ace - you are a legend in my eyes! Much of what helped me decide to take Nardil was your great info and extremely positive attitude on the med.
Just wanted to take the opportunity thank you my man. Best of luck to you...
Tom
Posted by ace on May 10, 2008, at 0:20:30
In reply to Re: Nardil- The best AD ever......., posted by simon79 on May 9, 2008, at 0:49:05
> Dear Ace/Nardil champ
>
> >What day do you see him?
> I leave in New Zealand and i see him on monday
>
> It's Friday in Australia at the moment.
> It's friday in new zealand at the moment too :)
>
> I'd obviously like to get them to you ASAP.....
> Thanks you i'm sure just one or two would be enough
>
> Thanks again for sharing your knowledge on nardil
> Simon
Not a problem mate!...I have located the papers, will get them to you by Monday- I am just away from home at the moment....would I be able to grab your email?Ace:)
Posted by ace on May 10, 2008, at 0:27:41
In reply to Re: Nardil- The best AD ever....... » simon79, posted by ace on May 10, 2008, at 0:20:30
> > Dear Ace/Nardil champ
> >
> > >What day do you see him?
> > I leave in New Zealand and i see him on monday
> >
> > It's Friday in Australia at the moment.
> > It's friday in new zealand at the moment too :)
> >
> > I'd obviously like to get them to you ASAP.....
> > Thanks you i'm sure just one or two would be enough
> >
> > Thanks again for sharing your knowledge on nardil
> > Simon
>
>
> Not a problem mate!...I have located the papers, will get them to you by Monday- I am just away from home at the moment....would I be able to grab your email?
>
> Ace:)
I just read Cumulative's post- I would recomend taking this to your MD too- I agree with everything he stated- and he elaborated his sentiments with pertinent pharmacological evidence.I have seen many posters on this very site who know exponentially more than your average psych, on the ins and outs of MAOI's.....
Cheers!
Ace:)
Posted by ace on May 10, 2008, at 0:57:42
In reply to nardil thoughts. why not to lower for maintenance, posted by cumulative on May 9, 2008, at 6:46:48
> I agree with ace's sentiments here.
>
> Many of the people on this forum have had similar experiences -- lowering the dose (CONTRARY to the theory that the antidepressant effect from MAO inhbibition can be maintained at a lower dose which continues to get rid of MAO) has caused a loss of effect and relapse.
100% agreed upon. I think the monograph has to be amended: not just in the respect either....
I have not seen any clinical trials that support sustained therapeutic action, with subsequent lowering of dose. I actually feel this sentiment is an affront to medical logic...
> I think that the reason for this is that much of Nardil's antidepressant effect might stem from additional properties beyond MAOI:
>
> a) the gabaergic activity of Nardil and its metabolites, which is dose-dependentWhich I think accounts for accounts for not only Nardil's anxiolytic properties, but also it's AD effects. This aspect, I also feel, is very very much dose dependant....
> b) another Nardil metabolite is phenethylamine (PEA), an endogenous stimulant-type substance with effects comparable in many ways to amphetamine*. Typoically PEA is rapidly destroyed by the monoamine oxidase enzymes before it can reach blood levels of any significance -- Nardil's MAOI stops this from happening, but the metabolism to phenethylamine is still dose-dependent.> I think this theory accounts for Nardil's stimulating, prosocial, and (great stuff!)euthymic/hyperthymic (bordering on hypomanic) effects. The GABAergic properties might optimally be offseting nervousness from PEA, and also improving e.g. social phobia on their own.
>
> (*alpha-methyl-phenethylamine)
>
> What's particularly interesting to me about Nardil is the very long-lasting efficacy -- it seems to me, from reading these anecdotal reports, that many of those (though not all) who do well on it can continue to do so for many years, even decades! The early hypomania seems to usually fade, but a VERY considerbale mood improvement remains.
I know what you mean. However, I notice that many patients, in addition to retaining a formidable therapetic response, also tend to cycle in and out of their initial hypomaniac-like state. Some have stated that Nardil (and Parnate) suffer from the 'poop-out' syndrome to a great degree. I disagree with this, not only on anectodal reports, but clinical evidence. When I have seen/heard of Nardil loosing efficacy over a period of time, the genesis of this seems to be in the fact that the patient becomes remiss to certain fundamental issues as taking the drug every day (as opposed to skipping doses), taking the drug at totally unregular time intervals.....tampering with the (effective) dosage etc etc etc
This to my mind is unusual among most of the antidepressant substances, especially those that seem to provide some dopaminergic effect, as Nardil to my mind does.I think, along with Nardil, Clomipramine, in particular, seems to share this trait. SSRI's, in my view, not only provide (for the most part) little efficacy, but seem to poop-out a lot, and, only have 'one-shot' efficay....
>
> I wonder ... just found this. Very,very interesting in the context of memantine (a partial NMDA glutamate subtype antagonist) that some of us here have been examining both as a standalone antidepressant, and for halting the development of tolerance to psychostimulants, particularly the antidepressant, antianhedonic effects of these stimulants ...
>
> http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T0F-41KP985-2&_user=1537448&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000053621&_version=1&_urlVersion=0&_userid=1537448&md5=27e5d89f3df6c1d9491bb0b5e3951d21
>
> One more thing. A few people have complained of cognitive issues with Nardil, especially early in treatment. I'm not sure if anticholinergic properties have been identified for this drug,This is true, and I do have papers at home that do strongly point to anticholinergic properties which account for this. Cognitive problems, usually are usually only early in treatment as you stated....I think they usually appear as the first s/effects (apart from somnolence in some) and are the first to dissipate....
but some of the possible side effects would seem to suggest possible anticholinergic activity very well. It's not hard to imagine that something like that could be occurring downstream. In this case, it may be interesting to look at the cholinergic precursor supplements Alpha-GPC and citicoline, both of which have benefits beyond cholingeric enhancement. iirc the old great poster here Chairman MAOWhere has Chairman gone!!?? He certainly knew his MAOI's!!!!
found galantamine (the combined acetylcholinesterase inhibitor/nicotinic agonist) to completely eliminate any cognitive issues from Nardil, and even help with Nardil anorgasmia ... which can also be an effect of excessive anticholinergic activity, among other things.
>
> Last time I talked to Chairman some months ago he was taking 60mg dextroamphetamine (VERY cautiously titrated upwards by 2.6 mg at a time!) + 105 mg Nardil daily, and this had been successful for him for around 2 and a half years and continuing.
A very good, accurate post......Ace:)
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