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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by iforgotmypassword on May 27, 2008, at 7:06:53
wondering if a cholinergic med may be the right route.
nardil causes dry mouth by who knows what mechanism, and can cause "mental slowing". this may be an indication that somehow it throws off the cholinergic system.
cholinergic meds are supposed to be "pro-sexual", somehow...
cholinergic meds are: donepezil, rivastigmine (may be even more cholinergic in mechanism, needs multiple daily dosing, but so does nardil, the poster "utopizen" used a specific cholinergic drug (muscarinic receptor agonist) to counter desoxyn dry mouth. (he also took donepezil, with positive cognitive effects reported after 1 month, did not say anything about dry mouth relating to this drug, do not know if this was started before or after other drug)
my message is getting long again.
i may be being rx'd nardil or selegiline today. not that sexual related stuff ever really comes up in my life, it is still a concern for whatever wierd reason. and the other reported side effects of nardil make me paranoid. a huge part of my illness is cognitive dysfunction and periodic cognitive failure destroying vocational and social capacity. i do not want nardil to make days any more humiliating. (input?)
Posted by linkadge on May 27, 2008, at 11:52:27
In reply to cholinergic med counter to nardil sex. dysfunc.?, posted by iforgotmypassword on May 27, 2008, at 7:06:53
>nardil causes dry mouth by who knows what >mechanism, and can cause "mental slowing". this >may be an indication that somehow it throws off >the cholinergic system.The heavy rem supressing drugs can diminish cholinergic function over time. I think the MAOI's supress REM so much on account of their activity on multiple monoamines. This can diminish cholinergic induced growth hormone release which may impact sexual function and/or learning.
>i may be being rx'd nardil or selegiline today. >not that sexual related stuff ever really comes >up in my life, it is still a concern for >whatever wierd reason. and the other reported >side effects of nardil make me paranoid. a huge >part of my illness is cognitive dysfunction and >periodic cognitive failure destroying vocational >and social capacity. i do not want nardil to >make days any more humiliating. (input?)
You might keep the dose low if possible. Supplemental choline might help. Ginkgo has been shown to potentiate the AD efect of MAOI's. It is an acetylcholinsterase inhibitor. Other acetylcholinsterase inhibitors may help, but you run the risk of either reducing the AD activity or inducing a kind of irriable dysphoric state.
Selegeline is certainly more documented for its positive effects on cogntion, but may not be as strong an AD. If cognition and or energy are lacking it may help.
You may also try alpha lipoic acid. I have had cognative problems mainly since discontinuing SSRI's. It's problems with learning/memory and declaritive verbal function some of which has improved by ALA.
Linkadge
Posted by Phillipa on May 27, 2008, at 12:56:50
In reply to Re: cholinergic med counter to nardil sex. dysfunc.?, posted by linkadge on May 27, 2008, at 11:52:27
Link welcome back!!!! Phillipa
Posted by linkadge on May 27, 2008, at 14:53:23
In reply to Re: cholinergic med counter to nardil sex. dysfunc.? » linkadge, posted by Phillipa on May 27, 2008, at 12:56:50
I'm not really "back". Part of my recovery is to severly limit internet use. Since there is unfortunately no way to unregister from psychobabble, I may be tempted to post from time to time.
Linkadge
Posted by sdb on May 27, 2008, at 15:44:08
In reply to Re: cholinergic med counter to nardil sex. dysfunc.?, posted by linkadge on May 27, 2008, at 14:53:23
> I'm not really "back". Part of my recovery is to severly limit internet use. Since there is unfortunately no way to unregister from psychobabble, I may be tempted to post from time to time.
>
> Linkadgeyou're welcome here and elsewhere on the world without internet too!
Posted by SLS on May 27, 2008, at 17:01:19
In reply to cholinergic med counter to nardil sex. dysfunc.?, posted by iforgotmypassword on May 27, 2008, at 7:06:53
> wondering if a cholinergic med may be the right route.
>
> nardil causes dry mouth by who knows what mechanism, and can cause "mental slowing". this may be an indication that somehow it throws off the cholinergic system.
>
> cholinergic meds are supposed to be "pro-sexual", somehow...
>
> cholinergic meds are: donepezil, rivastigmine (may be even more cholinergic in mechanism, needs multiple daily dosing, but so does nardil, the poster "utopizen" used a specific cholinergic drug (muscarinic receptor agonist) to counter desoxyn dry mouth. (he also took donepezil, with positive cognitive effects reported after 1 month, did not say anything about dry mouth relating to this drug, do not know if this was started before or after other drug)
>
> my message is getting long again.
>
> i may be being rx'd nardil or selegiline today. not that sexual related stuff ever really comes up in my life, it is still a concern for whatever wierd reason. and the other reported side effects of nardil make me paranoid. a huge part of my illness is cognitive dysfunction and periodic cognitive failure destroying vocational and social capacity. i do not want nardil to make days any more humiliating. (input?)
Feeling whacked-out on Nardil at the beginning of treatment is normal and may even be a sign of good things happening. My advice is to try Nardil, starting at 1/2 pill per day and move up to 1 pill after a week. You can then move up by 15mg every week until you get to 60mg. Go slower if necessary. Once you establish 60mg as your target, remain there for at least 3 weeks and assess clinical benefit and side effects. Go to 75mg if necessary and remain there for 6 weeks. If necessary, and if you are tolerating the drug, you might find that you don't hit pay dirt until you reach 90mg.Once the true antidepressant effect emerges, you will probably find that your cognitive function will improve far beyond where it is now.
- Scott
Posted by linkadge on May 27, 2008, at 20:16:10
In reply to Re: cholinergic med counter to nardil sex. dysfunc » iforgotmypassword, posted by SLS on May 27, 2008, at 17:01:19
From my experience, the MAOI's seem to always be associated with cognitive impairment even when an AD effect kicks in. Mind you, I am only basing this on reports from 4 individuals plus myself.
Cognitive dysfunction can be a symptom of depression and resolution of depression usually improves this. I reached a theraputic dose of nardil/parnate for a theraputic length of time. The main things I noticed were:
Slighly increased associative learning (ie making connections between previosly established ideas).
Decreased procedural learning and learning for brand new tasks.The MAOI's made it very difficult to retain novel material from one day to the next. I could generally learn a new process one day, but as soon as it left short term memory it was almost gone. The quality of sleep I got on MAOI's was terrable. If I got 4 hours a day I was lucky, and it was a very very shallow sleep. The loosening of contrast between the dream world and the real world can make MAOI's an anhednoia killer for some and psychosis inducing for others.
I had to drop the semesters I spent on MAOI's because I just couldn't keep up. The euphoria quickly changed to psyhosis when I realized that I was only realy developing a very shallow surface memorization of the material. Missing even one day of parnate sent me into a hellish REM rebound where it was like I finally started to process the last 2 months of my life.
In one study MAOI administration resulted in an almost complete elimiation of REM sleep even after 8 months of administration.
I could go on. The friends I had on nardil generally became very spaced out.
Posted by SLS on May 28, 2008, at 5:38:51
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by linkadge on May 27, 2008, at 20:16:10
In my experience, the longer one is on Nardil, the less of these cognitive effects remain. They may take several months to mitigate.
- Scott
Posted by SLS on May 28, 2008, at 5:52:40
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by SLS on May 28, 2008, at 5:38:51
> In my experience, the longer one is on Nardil, the less of these cognitive effects remain. They may take several months to mitigate.
>
>
> - ScottWhat is interesting is that I suffered no recognizable cognitive side effects the first few times I took Nardil. The resultant antidepressant effect was extraordinarily clean. Perhaps the "zombie" effect is more prevalent among people having taken many antidepressants previously.
Just a thought.
- Scott
Posted by linkadge on May 28, 2008, at 7:26:39
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by SLS on May 28, 2008, at 5:52:40
Not everybody gets all the side effects, it may of course depend on your initial state.
For instance, if you were experiencing a profound increase in REM sleep as a result of depression then Nardil may work more to normalize REM sleep as opposed to abolishing it.
Personally SLS, I don't know how you get any REM sleep at all. An MAOI plus a NET inhibitor, these are two of the strongest REM supressing drugs available.
Linkadge
Posted by SLS on May 28, 2008, at 7:51:06
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by linkadge on May 28, 2008, at 7:26:39
> Not everybody gets all the side effects, it may of course depend on your initial state.
>
> For instance, if you were experiencing a profound increase in REM sleep as a result of depression then Nardil may work more to normalize REM sleep as opposed to abolishing it.
>
> Personally SLS, I don't know how you get any REM sleep at all. An MAOI plus a NET inhibitor, these are two of the strongest REM supressing drugs available.
>
> Linkadge
Unfortunately, this is not the case. My stupid brain is no longer responsive to the REM suppressive properties of these drugs. Both Nardil and Parnate completely abolished REM early in my treatment history. I never dreamed. Now, I do. Adding Deplin has increased my REM, if vivid dreaming is an index of this. I really don't know for sure. Dreaming can occur in other stages of sleep.My brain is no longer drug-naive. That sucks. I believe I am less responsive to medication because of the constant exposure to antidepressants throughout the years.
- Scott
Posted by linkadge on May 28, 2008, at 9:43:48
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by SLS on May 28, 2008, at 7:51:06
For myself I don't know if my REM sleep was messed up or not. I respoded well to trimipramine which supposedly enhances REM sleep. I have never tried wellbutrin.
Some of the REM supressors I took led to a rather quick mood brightening AD effect (similar to sleep deprivation), but usually lead to apathy long term.
I felt great on clomipramine for the first month or so, but slowly grew more apathetic on it.
I get the same thing with lithium (a REM supressor) feel great for the first 3 weeks then just apathy, at which point I felt better when I discontinued (nocturnal growth hormone rebound surge?)
Linkadge
Posted by SLS on May 28, 2008, at 12:41:58
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by linkadge on May 28, 2008, at 9:43:48
> For myself I don't know if my REM sleep was messed up or not. I respoded well to trimipramine which supposedly enhances REM sleep.
That is interesting. Unfortunately, I did not respond to trimipramine. If I had, it would have increased the (seeming) paradox this drug represents. I might have stayed with it longer had the drug been covered by my prescription plan. I don't remember having any intense side effects with trimipramine.
> I have never tried wellbutrin.
Have you been purposely avoiding it?
- Scott
Posted by iforgotmypassword on May 28, 2008, at 18:51:50
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by SLS on May 28, 2008, at 12:41:58
in case anyone will still be around. as usual having a lot of trouble generating coherent thought and communicating meaningfully and productively. nerves feeling wierd as usual and i am going to take a shower.
Posted by linkadge on May 28, 2008, at 20:47:33
In reply to Re: cholinergic med counter to nardil sex. dysfunc, posted by SLS on May 28, 2008, at 12:41:58
I don't really think that the REM supression theory is a good model for all affective disorders.
It is clear that certain forms of depression are associated with enhanced REM, but I don't think that a potent REM supressor is necessarily needed to correct that.
I think one study showed that after a month or so on trimipramine, the depressed sleep profile improved to resemble a more healthy state. But, trimipramine doesn't necessarily need to be a potent, fast acting REM supressor to accomplish this.
Linkadge
Posted by cumulative on May 28, 2008, at 20:49:08
In reply to cholinergic med counter to nardil sex. dysfunc.?, posted by iforgotmypassword on May 27, 2008, at 7:06:53
Very effective. I'm not surprised given the mechanisms probably in play. Might be worth a shot! Care should be taken with dosing. Other options include the highly neuroprotective and also dopaminergic CDP-choline, etc.
This is the end of the thread.
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