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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by Four Feathers on June 16, 2008, at 22:15:30
I am nearing the end of my patience with this med go around which I have been on for the last 10+ years. I have tried a large number of meds singularly as well as certain combos. My current pdoc has recommended Nardil from the first meeting(last December) that I had with him. Honestly, I have been hesitant due to the concerns of food reactions and hypertensive crisis. While I understand that unfortunate experiences like what 4WD and Phoenix have had are rare, I am still a bit reluctant. I am well aware that negative experiences can occur with any medication, regardless of the type.
My questions are these:
1) are male sexual side effects a given on this medication, or is it something that is often transient? I would like to have a family and anorgasma creates a bit of a problem with that. :)
2) What are typical impacts on energy from this med? I am diagnosed GAD/depression with a definite hint of SP in there as well.
3) I have always been athletic, at least up until this last round of depression where keeping up with work and every day living activities saps all of my energy. Are there any restrictions or things to be concerned about with exercise when on Nardil, besides the obvious concerns with low blood pressure in the early phases of the med or dosage increase?
4) Is weight gain a given with this med?
5) What are your experiences with concentration on this med? One of my symptoms is definite cognitive impairment with a decrease in short-term memory when not on any meds. Clonazepam actually increases my ability to concentrate...hopefully the gabaergic effects of Nardil could do the same.Sorry for the long post. Thank you in advance to anyone willing to share information.
4F
Posted by blueboy on June 17, 2008, at 10:48:48
In reply to Nardil users/experts information needed, posted by Four Feathers on June 16, 2008, at 22:15:30
> I am nearing the end of my patience with this med go around which I have been on for the last 10+ years. I have tried a large number of meds singularly as well as certain combos. My current pdoc has recommended Nardil from the first meeting(last December) that I had with him. Honestly, I have been hesitant due to the concerns of food reactions and hypertensive crisis. While I understand that unfortunate experiences like what 4WD and Phoenix have had are rare, I am still a bit reluctant. I am well aware that negative experiences can occur with any medication, regardless of the type.
>I took Nardil for two years, 60mg/day. Like you, I took countless other drugs that didn't help or had intolerable side effects.
Nardil was a very dirty drug for me. I got almost all of the common side effects, but still, it was the only drug that helped me that I could tolerate. So my advice would be, give it a try.
Also, after I went off the Nardil, I got a diagnosis of Bipolar II. If you have had a lot of lack of success with AD's, you might want to double check with a really good diagnostician -- one that will listen more than three minutes before making a diagnosis. I would also suggest writing out two lists, one a historical list, one grouped by symptom type.
> My questions are these:
> 1) are male sexual side effects a given on this medication, or is it something that is often transient? I would like to have a family and anorgasma creates a bit of a problem with that. :)I had major problems with both erectile dysfunction and anorgasmia. It was not, however, completely impossible for me. Both went away immediately when I discontinued usage.
If I had wanted to have children during that period, I might have been able to do it. I'm sure a fertility doctor could manage it. It's a matter of how bad the underlying condition is.
Neither the sexual problems nor any other side effect improved over time. However, they would improve periodically. Like, say, for three days I might be totally impotent, then a couple of days of barely manage, then some days of impotence, then a day of almost normal function, and so on.
> 2) What are typical impacts on energy from this med? I am diagnosed GAD/depression with a definite hint of SP in there as well.
I think it is known as an "activating" drug. It definitely put my energy level WAY up. My problem was getting enough sleep to stay healthy.
> 3) I have always been athletic, at least up until this last round of depression where keeping up with work and every day living activities saps all of my energy. Are there any restrictions or things to be concerned about with exercise when on Nardil, besides the obvious concerns with low blood pressure in the early phases of the med or dosage increase?
In my experience, the low blood pressure subsided during exercise. I would get out of breath from bending over to pull a couple of weeds. Once I started exercising and got warmed up, however, I was pretty normal.
> 4) Is weight gain a given with this med?
Don't know. If you can exercise a lot, maybe you can control it. I did put on considerable weight.
> 5) What are your experiences with concentration on this med? One of my symptoms is definite cognitive impairment with a decrease in short-term memory when not on any meds. Clonazepam actually increases my ability to concentrate...hopefully the gabaergic effects of Nardil could do the same.
>My concentration and cognitive function was very good while I was taking Nardil. YMMV. Unfortunately, it tended to make my hypomanic.
This isn't a drug anyone WANTS to take. You sound like a younger man and I'm sure the prospect of weight gain and sexual problems is extremely worrisome. My guess is that you will have less of a problem actually conceiving children than with things like 1) attracting or keeping a woman happy when you are fatter and less sexually able, 2) embarrassment over perceived failure as a man, i.e. self-image, 3) sexual frustration, 4) social embarrassment over higher weight.
It's bad but perhaps not as bad as you think. I managed to stay married while taking it. (In fact, I would say overall the marriage was better off.) You just have to do the potential cost/reward ratio. I think, in most cases, the inability to hold onto a job, engage in social activities, hold a conversation, etc., would be more disabling to a male/female relationship than additional fat or sexual dysfunction.
I'd imagine that among women who want children -- and for sure among women who HAVE children -- they'd take a happy chubby guy with a job who can't have much sex over a depressed unemployed skinny sexual guy, any day of the week. I have talked to a number of young people who are amazed and distressed about "never" having sex after the baby comes.
I'm not saying that applies to everyone, but if you got married and had a baby or two, and gave your wife a choice between
A) unemployment-underemployement/depression and
B) fatter/less sexual,
I'm guessing she (and you) would choose option 2.Also, your dependence on sex for self-image is very likely distorted a bit by modern US culture. I found that life after gaining 20 pounds and losing 90% of my sex life was bad, but not as bad as I would have imagined. If the proof is in the pudding, I stayed on the drug as long as I could.
I would say that in my case I would once have put the importance of sexuality at a 10 out of 10 -- totally inconceivable that I could live without being sexual and sexually attractive -- whereas, in practice, once I started taking the Nardil, the sexual and weight problems were less distressing than the insomnia. Maybe a 5 or 6 out of 10.
Posted by Four Feathers on June 17, 2008, at 17:58:33
In reply to Re: Nardil users/experts information needed, posted by blueboy on June 17, 2008, at 10:48:48
Blueboy,
Thank you for taking the time to provide such thorough information, it is much appreciated.
> Also, after I went off the Nardil, I got a diagnosis of Bipolar II. If you have had a lot of lack of success with AD's, you might want to double check with a really good diagnostician -- one that will listen more than three minutes before making a diagnosis. I would also suggest writing out two lists, one a historical list, one grouped by symptom type.The current Pdoc that I am now working with is anti "15 minute appts". He takes as much time as necessary and I have never once been pressured to hurry up and get out. This is likely b/c he does not participate with many insurance carriers here in the US so he sets his own rules, which in my opinion works well if one can afford to pay his rates.
I have asked about the possibility of BP spectrum and have had multiple pdocs tell me that they don't see any signs of hypomania or mania in my past. While I have had different dx around anxiety and dep, the one from my current doc, atypical depression, I feel is the best based on documented symptomology.
> This isn't a drug anyone WANTS to take. You sound like a younger man and I'm sure the prospect of weight gain and sexual problems is extremely worrisome. My guess is that you will have less of a problem actually conceiving children than with things like 1) attracting or keeping a woman happy when you are fatter and less sexually able, 2) embarrassment over perceived failure as a man, i.e. self-image, 3) sexual frustration, 4) social embarrassment over higher weight.I am 35 and currently in a very good relationship. I have been successul in my life both professionally and personally, but I have had to hide many of my depressive feelings and work much harder to comprehend and learn things over the years than others. I have a girlfriend and things are great in that area. Unfortunately, she does not suffer from depression or anxiety so finds it difficult at times to understand what I go through. She is very supportive though. I actually believe that getting some of my good mood back and ability to feel pleasure from things again will help our relationship further. How I long for the way I remember actually being able to get excited about things! :)
> I'd imagine that among women who want children -- and for sure among women who HAVE children -- they'd take a happy chubby guy with a job who can't have much sex over a depressed unemployed skinny sexual guy, any day of the week. I have talked to a number of young people who are amazed and distressed about "never" having sex after the baby comes.I have plenty of friends who would echo that statement!
> I would say that in my case I would once have put the importance of sexuality at a 10 out of 10 -- totally inconceivable that I could live without being sexual and sexually attractive -- whereas, in practice, once I started taking the Nardil, the sexual and weight problems were less distressing than the insomnia. Maybe a 5 or 6 out of 10.
>I met with my Pdoc today and he gave me a script for Nardil, along with Procardia should I ever have a hypertensive reacation. I am usually med sensitive so he is hoping that I may respond well to a low dose. In our discussion today I found that he has actually been on this med for 20+ years himself and speaks with great candidness regarding its effects and side effects. He is by far the best Pdoc that I have ever seen and I truly trust his judgement and opinions on my condition. Of course, I realize that YMMV with any of these meds!
You sound as though you had very positive effects while you were on Nardil...why did you stop? What led to the subsequent BPII dx and what are you currently taking to control your symptoms? Just curious....
Did you ever experience a hypertensive crisis while on Nardil?
Thanks again Blueboy!
Posted by blueboy on June 18, 2008, at 14:19:02
In reply to Re: Nardil users/experts information needed » blueboy, posted by Four Feathers on June 17, 2008, at 17:58:33
> You sound as though you had very positive effects while you were on Nardil...why did you stop?
I developed a bad and unusual body rash while on vacation. My pdoc ordered me to stop taking it.
When I tried to take it again, the rash returned. Rashes are a big freak-out for psychiatrists.
> What led to the subsequent BPII dx and what are you currently taking to control your symptoms? Just curious....
>Frustrated by lack of success, my pdoc referred me to a diagnostic specialist, a guy who mainly does research but sees one patient a day, for two + hours, for diagnosis only.
His opinion was that I was definitely BP II.
> Did you ever experience a hypertensive crisis while on Nardil?
>Not that I am certain of. I did get sick on several occasions prior to getting a home blood pressure cuff, once after unwittingly eating a dish with parmesan cheese.
I think I may have had some mild episodes of serotonin syndrome. If not, then plain old hypomania.
This is the end of the thread.
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