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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by that_guy23 on November 1, 2008, at 18:31:13
I have ben on nardil for 8 weeks and 2 days. I think I thought because the euphoria was lessening, the drug was losing effect.
I think incresed dosage far too soon far too high! I started at 15 mgs 1 week, upped to 45 mgs for 2 weeks, then at 75 for weeks 4 and 5, I had that euphoria, mood change, attiutude change, and more motivation. Not extreme , but it was noticible, even to me.
Here is where me or my psychiatrist made a big mistake, I know I didn't ask for a dose this high considering i thought the highest wasat 90 mgs, she upped my dose for the 6th week to 105! I didn't know any difference! So I went on starting that dose, a day or 2 most I could feel major side effects. Orthostatic Hypotension, you can google it, it is a normal side efect of nardil,but I had it very bad. Along with the tiredness, all the time, and the other minor effects which I had already, don't know if they got worse.
It got so bad I couldn't walk around or sometimes even stand staight up with out, getting dizzy eyes gradually lossing sight, which if they did would last like 30 sec - 1 min, and my ears would ring, or things got so loud, I felt weak,This is Orthostatic Hypotension in a nutshell. And most time's could lie down and fall asleep, almost immediately. I stuck 105 out for a week, like to do doses weekly, bi-weekly, etc. This way I can keep track easier.
Then I called my psychiatrist to tell her I had to drop the dosage, to 90. I was supposed to see her in one week after this, my ride got cancelled and couldn't make it. I see her every 2 weeks as of now, and now at my time of need I had to wait 4 weeks.
I stuck at 90, which was just as bad, for 13 days, and dropped back to 75 mg's, that was where I had the best results in the beginning. This was thursday 2 days ago.
Since a few days of the big increase to 105 mgs,over 3 weeks now, I haven't been good. I'm really hoping that it's the way I was feeling, TERRIBLE, and not being able to do really anytihng, except minor excersice I started 8 weeks ago, that I never miss. I guess I'm coming around with the orthostatic hypotension, still there though, as wel as the minor side effects I had since almost starting.
So now at just over 8 weeks at 75, i'm feeling depressed again. So theres no possitive change now, but there was.
I would just like to know if I keep at this dose or even lower it, will this fix the problem eventually? If so will this mistake slow my recovery process?
I had originaally had chose the drug for my SA, which I suffer from pretty bad. I am going to try and get somthing to counteract with it when I see her next thursday.
Please anyone with any advice on this post, please tell me you've seen similar cases, or if not, just give me your input.
I had, and still have high hopes for this drug, any drug that can be safely monterd to counteract with narl?
Hope to hear from someone soon
later
Posted by azalea on November 1, 2008, at 19:06:50
In reply to Nardil - may of upped daose to fast!, posted by that_guy23 on November 1, 2008, at 18:31:13
There are options for augmenting Nardil; T3 and Lithium are 2 options.
In addition, there are several ways to counteract the orthostatic hypotension. Here's what an article says: (Current Psychiatry Vol.1, No.6, June 2002, p.45) "Clinical significant hypotension is best managed via dosage adjustment. If that fails, add NaCl, 1 to 2 grams BID with increased fluids. If that doesn't work, administer fludrocortisone, 0.1 to 0.4 mg/day. If that fails, administer d-amphetamine, starting with 2.5 to 5 mg/day, and observe carefully for hypertension."
> I have ben on nardil for 8 weeks and 2 days. I think I thought because the euphoria was lessening, the drug was losing effect.
>
> I think incresed dosage far too soon far too high! I started at 15 mgs 1 week, upped to 45 mgs for 2 weeks, then at 75 for weeks 4 and 5, I had that euphoria, mood change, attiutude change, and more motivation. Not extreme , but it was noticible, even to me.
>
> Here is where me or my psychiatrist made a big mistake, I know I didn't ask for a dose this high considering i thought the highest wasat 90 mgs, she upped my dose for the 6th week to 105! I didn't know any difference! So I went on starting that dose, a day or 2 most I could feel major side effects. Orthostatic Hypotension, you can google it, it is a normal side efect of nardil,but I had it very bad. Along with the tiredness, all the time, and the other minor effects which I had already, don't know if they got worse.
>
> It got so bad I couldn't walk around or sometimes even stand staight up with out, getting dizzy eyes gradually lossing sight, which if they did would last like 30 sec - 1 min, and my ears would ring, or things got so loud, I felt weak,This is Orthostatic Hypotension in a nutshell. And most time's could lie down and fall asleep, almost immediately. I stuck 105 out for a week, like to do doses weekly, bi-weekly, etc. This way I can keep track easier.
>
> Then I called my psychiatrist to tell her I had to drop the dosage, to 90. I was supposed to see her in one week after this, my ride got cancelled and couldn't make it. I see her every 2 weeks as of now, and now at my time of need I had to wait 4 weeks.
>
> I stuck at 90, which was just as bad, for 13 days, and dropped back to 75 mg's, that was where I had the best results in the beginning. This was thursday 2 days ago.
>
> Since a few days of the big increase to 105 mgs,over 3 weeks now, I haven't been good. I'm really hoping that it's the way I was feeling, TERRIBLE, and not being able to do really anytihng, except minor excersice I started 8 weeks ago, that I never miss. I guess I'm coming around with the orthostatic hypotension, still there though, as wel as the minor side effects I had since almost starting.
>
> So now at just over 8 weeks at 75, i'm feeling depressed again. So theres no possitive change now, but there was.
>
> I would just like to know if I keep at this dose or even lower it, will this fix the problem eventually? If so will this mistake slow my recovery process?
>
> I had originaally had chose the drug for my SA, which I suffer from pretty bad. I am going to try and get somthing to counteract with it when I see her next thursday.
>
> Please anyone with any advice on this post, please tell me you've seen similar cases, or if not, just give me your input.
>
> I had, and still have high hopes for this drug, any drug that can be safely monterd to counteract with narl?
>
> Hope to hear from someone soon
>
> later
Posted by JadeKelly on November 2, 2008, at 0:13:50
In reply to Re: Nardil - may of upped daose to fast! » that_guy23, posted by azalea on November 1, 2008, at 19:06:50
That guy,
Don't know how bad your hypotention is currently, but some quick easy remedies to add till you see doc: salt tablets, get them at the pharmacy counter, they're cheap, and gatorade, lots of it. You want to stay hydrated and keep your electrolites up. Ok it with Doc or Pharm 1st. I'm on parnate, my bp was pretty low, not as bad as yours! But hard to get out of bed at times. Also, don't think that chronic low BP gives you any pass on the restricts...I had low BP one night, woke up 6am with Hypertensive crisis. 190 and rising when called 911. Not fun. Don't know what caused it either.
Good luck!
Jade
Posted by Nadezda on November 2, 2008, at 0:27:01
In reply to Nardil - may of upped daose to fast!, posted by that_guy23 on November 1, 2008, at 18:31:13
Just give it time, thatguy.
You've only been taking nardil for 8 weeks and have been all over the map lately, with going from 75mg to 105 mg and then back down to 75. First of all it's going to take your body some time to readjust to the dosage, and to recover from the hypotension and other side-effects.
Just going through all that is demoralizing, especially since it's hard to be in a good mood when you're feeling like you can barely stand up and worrying that your pdoc has screwed up, and also that you might have to stop a drug that helped. Give your moods time to reestablish themselves.
Also, remember, these aren't miracle drugs. You can still have a bad day, or days, even on Nardil. So it's expectable that when you are stable again, you'll regain whatever long-lasting benefits you originally would have had. A slight glitch of this sort won't take away the effects of a drug that works for you. If you can remember this, while you're going through the dislocations, you;re much more likely to feel better sooner.
I hope your pdoc is able also to reassure you and to give you better information about what dose is best for you,, and how to counteract the hypotension, should you have a milder version.
Good luck.
Nadezda
Posted by that_guy23 on November 2, 2008, at 13:52:11
In reply to Re: Nardil - may of upped daose to fast! » that_guy23, posted by Nadezda on November 2, 2008, at 0:27:01
Yes I have heard, of taking 1-2 g of salt. have been doing this. My hypotension, I think should imprive, which it has alot, within a week or 2, I think I'll just try, and do the salt, and someone told, to sleep, or just relax, with my feet elavated, and and my head loewered. But I was wonding About provigal or something that can hust get me going. You think dexedrine or, a mood stabalizer would be better?
Thanks for you input, it realy helped.
Hope to hear back.
later
Posted by that_guy23 on November 2, 2008, at 14:03:54
In reply to Nardil - may of upped daose to fast!, posted by that_guy23 on November 1, 2008, at 18:31:13
I had heard of the 1-2 grams of salt aday, plus, sleeping or relaxing, with my legs elavated and my head as low as possible. iwas just gonna try this for the OH. I was gonna try to get provigal, to give me a boost. Do you think that D-amphetemin, or mood stabilizer would be better, for this? I've heard stories of it being safer. What about ritalin, or adderall xr?
Thanks by the way your answers are very helpful.
hope to hear back soon.
later
Posted by that_guy23 on November 2, 2008, at 14:18:12
In reply to Re: Nardil - may of upped daose to fast!, posted by that_guy23 on November 2, 2008, at 14:03:54
provigal safer I meant
Posted by JadeKelly on November 2, 2008, at 14:43:56
In reply to Re: Nardil - may of upped daose to fast!, posted by that_guy23 on November 2, 2008, at 13:52:11
> Yes I have heard, of taking 1-2 g of salt. have been doing this. My hypotension, I think should imprive, which it has alot, within a week or 2, I think I'll just try, and do the salt, and someone told, to sleep, or just relax, with my feet elavated, and and my head loewered.
I forgot, I did have one close call in my kitchen, early on with Parnate. Lost vision and felt faint. Quick layed on the couch and was gone in 2 minutes. It gets a lot better, just do all the safe things that help. Yes, lay with feet/legs elevated (pillow underneath?) If you ever feel dizzy, etc. Just sit or lie down asap. Get some of that gatorade and sip it all day too.
But I was wonding About provigal or something that can hust get me going. You think dexedrine or, a mood stabalizer would be better?
OK, now you're scaring me. Thats a recipe for a hypertensive crisis. Please go over drug interactions with someone (Your Doc). Don't make the mistake of thinking you couldn't go straight from hypotention, to a serious hypertensive crisis. I happened to me. You DON'T want to mess with the restricts...meds or foods!!!
>
> Thanks for you input, it realy helped.
Just hoping you stay safe on Nardil!
Jade
>
> Hope to hear back.
>
> later
>
Posted by JadeKelly on November 2, 2008, at 14:50:47
In reply to Re: Nardil - may of upped daose to fast!, posted by that_guy23 on November 2, 2008, at 14:18:12
> provigal safer I meant
Not sure where you heard this, stims are def out, and I'm not a dr., but I would think a mood stablizer would not only make your hypotension worse but is probably also on the drugs not allowed list. I think you really need to talk to your Doc about your ideas and have him go over the drug and food list. I STRONGLY advise against taking anything without your docs approval. Just not worth it!
Jade
Posted by that_guy23 on November 2, 2008, at 17:18:58
In reply to Re: Nardil - may of upped daose to fast!, posted by JadeKelly on November 2, 2008, at 14:50:47
I appretiate it your input, but have heard of a few people doing well on small doses of ritalin even, not sasying I'm gonna do this, and I know of someone who completely recovered, he was also on provigal.
I do know very well the contradictions of drugs,I have done alot of reserach, And I follow everything on the food list perfectly, I don't even drink anymore, and I was on my way to becoming an alcoholic. Mood stabalizers aren't contradicted, actually lithium is supposed to be a good augmentor, that is at a later time, 3to 4 months. I'm just kind of looking for a little pickup, and I would watch it carefully, I am really not careless with this drug.
Also wouldnt it be hader to reach hypertension if your in hypotension.
I am planning on getting aregular weekly check-up.
So do you still think provigal, or small doses of ritalin would be bad, I think I may take the risk with more reserach.
Do you know anybody with nardil expertice on here?
thanks aagaig for your cocern
Posted by Questionmark on November 2, 2008, at 23:24:53
In reply to Nardil - may of upped daose to fast!, posted by that_guy23 on November 1, 2008, at 18:31:13
Yeah, your dose was raised way too fast.
I was a little confused about exactly what you're asking in some respects, but I can try to offer some advice.
First, you definitely should still have high hopes for Nardil. It is an amazing drug, especially for SA and depression, as well as other conditions i'm sure. Try to give it some time. It's possible your receptors are "out of whack" a bit now from all that dosage alteration and as a result may take a bit longer to even out, so to speak. And even 75mg is on the higher end (at least for a lot of/ some people), so if your depression does start to get kicked in the proverbial groin, you should consider lowering the dose to lessen the side effects.
If you decide not to lower the dose or some of your side effects are still too bothersome, Ritalin (methylphenidate) can certainly be employed, (preferably under a doctor's cautious supervision, of course). I have taken Ritalin while on Nardil with no adverse effects at all. Definitely stay away from Adderall-- i had unpleasant effects even at very low doses (like 2 or 3 mg), and it's too risky and too many different amphetamines anyway. As azalea i think mentioned dextroamphetamine-- low dose probably-- can potentially be utilized, however. I would think that Provigil should be fine, too, but i'm not sure-- though i doubt that would be as helpful for hypotension, if that's for what you were considering it.
As far as the daytime drowsiness i can't really think of anything else to suggest though except for, well obviously, try to get enough sleep, make sure you spread your doses out throughout the day (like 3x/day), and staying hydrated might help some (as well as with the hypotension a bit too actually). The only thing that really helped me with that significantly was lowering my dose.
Good luck to you, and may Nardil be the blessing (albeit imperfect) for you that it has been for me and so many others.
> I have ben on nardil for 8 weeks and 2 days. I think I thought because the euphoria was lessening, the drug was losing effect.
>
> I think incresed dosage far too soon far too high! I started at 15 mgs 1 week, upped to 45 mgs for 2 weeks, then at 75 for weeks 4 and 5, I had that euphoria, mood change, attiutude change, and more motivation. Not extreme , but it was noticible, even to me.
>
> Here is where me or my psychiatrist made a big mistake, I know I didn't ask for a dose this high considering i thought the highest wasat 90 mgs, she upped my dose for the 6th week to 105! I didn't know any difference! So I went on starting that dose, a day or 2 most I could feel major side effects. Orthostatic Hypotension, you can google it, it is a normal side efect of nardil,but I had it very bad. Along with the tiredness, all the time, and the other minor effects which I had already, don't know if they got worse.
>
> It got so bad I couldn't walk around or sometimes even stand staight up with out, getting dizzy eyes gradually lossing sight, which if they did would last like 30 sec - 1 min, and my ears would ring, or things got so loud, I felt weak,This is Orthostatic Hypotension in a nutshell. And most time's could lie down and fall asleep, almost immediately. I stuck 105 out for a week, like to do doses weekly, bi-weekly, etc. This way I can keep track easier.
>
> Then I called my psychiatrist to tell her I had to drop the dosage, to 90. I was supposed to see her in one week after this, my ride got cancelled and couldn't make it. I see her every 2 weeks as of now, and now at my time of need I had to wait 4 weeks.
>
> I stuck at 90, which was just as bad, for 13 days, and dropped back to 75 mg's, that was where I had the best results in the beginning. This was thursday 2 days ago.
>
> Since a few days of the big increase to 105 mgs,over 3 weeks now, I haven't been good. I'm really hoping that it's the way I was feeling, TERRIBLE, and not being able to do really anytihng, except minor excersice I started 8 weeks ago, that I never miss. I guess I'm coming around with the orthostatic hypotension, still there though, as wel as the minor side effects I had since almost starting.
>
> So now at just over 8 weeks at 75, i'm feeling depressed again. So theres no possitive change now, but there was.
>
> I would just like to know if I keep at this dose or even lower it, will this fix the problem eventually? If so will this mistake slow my recovery process?
>
> I had originaally had chose the drug for my SA, which I suffer from pretty bad. I am going to try and get somthing to counteract with it when I see her next thursday.
>
> Please anyone with any advice on this post, please tell me you've seen similar cases, or if not, just give me your input.
>
> I had, and still have high hopes for this drug, any drug that can be safely monterd to counteract with narl?
>
> Hope to hear from someone soon
>
> later
Posted by that_guy23 on November 3, 2008, at 6:28:51
In reply to Re: Nardil - may of upped daose to fast! » that_guy23, posted by Questionmark on November 2, 2008, at 23:24:53
Yes, the ritalin has been something I have heard of before as being helpful if safly monitored. I see my pdoc. on thursday, and I think I will try and get this. Thanks quistionmark, I was hoping to hear of someone else who used these 2 safely.
And thanks to everyone else, you've been helpful.
Wish me luck.
Posted by JadeKelly on November 3, 2008, at 12:50:42
In reply to Re: Nardil - may of upped daose to fast!, posted by that_guy23 on November 3, 2008, at 6:28:51
Hi that guy, sounds like your going to do it so be careful!! It sounded like you had little experience with Nardil, (105mg dose, etc.). Just be careful with those stims please!
Also, one thing I can answer with certainty: You CAN go fron hypotention to hypertention in a fairly short amount of time. I had been treating hypotention with hydration, salt tabs, Gatorade for elecrolites. Had low BP late one night, as usual, woke to hypertensive crisis, last I remember, systolic 190 and rising. 911,hospital, the whole bit. No fun. Won't even try to describe the headache.
I'm not trying to scare you, I'm still on Parnate!!! Just trying to scare you enough to be really careful!! I suggest again being prepared with a BPcuff, Antidote like Nifedipine, and you'll know hypertentsive crisis by headache: all over with more pain in back of neck and unrelenting pounding. I think its similar for most people. Don't wait to pop antidote if you think thats whats happening. I wish my Pdoc had been more informitive about possibilities. Like you, almost fainted on more than one occasion from low BP. Its a srange mixed bag, but boy they work, huh?
Good luck, and pass on your experience, will you?
Cheers! Jade
Posted by JadeKelly on November 3, 2008, at 13:14:36
In reply to Re: Nardil - may of upped daose to fast! » that_guy23, posted by Questionmark on November 2, 2008, at 23:24:53
Hi Questionmark,
You really think ritalin ok for short time user of Nardil is ok, especially with dosage complications? I'm no expert for sure, probably a little anal on the "rules" side after my experience, but I'm really asking. Because if my Parnate poops out, does small amount ritalin(dose?) kick in the effects again, or just address fatigue?
I took ritalin for long time with Klonopin, and they got me through an insanely busy time, as in years! I think they were just bandaid, but hey, when nothing else works and things gotta get done...do what ya gotta do.
Would be afraid to take ritalin, even small dose, with Parnate after having hypertensive, crisis. I must be sensistive? Would that make me NOT a good candidate for stim augmentation later? Sounds like you know a lot, hope to hear back from you.
Sorry to hi-jack your post That Guy!
Jade
Posted by tepi on November 8, 2008, at 0:03:53
In reply to Re: Nardil - may of upped daose to fast! » that_guy23, posted by Questionmark on November 2, 2008, at 23:24:53
> Ritalin (methylphenidate) can certainly be employed, (preferably under a doctor's cautious supervision, of course). I have taken Ritalin while on Nardil with no adverse effects at all. Definitely stay away from Adderall-- i had unpleasant effects even at very low doses (like 2 or 3 mg), and it's too risky and too many different amphetamines anyway. As azalea i think mentioned dextroamphetamine-- low dose probably-- can potentially be utilized, however. I would think that Provigil should be fine, too, but i'm not sure-- though i doubt that would be as helpful for hypotension, if that's for what you were considering it.
>>Hi QuestionMark
thinking many time ago of adding an stimulant to Nardil. I see you have already done it.
Are you still on it ?
did you have to increase the stimulant dose with time?
What is the different between Ritalin and Aderall
Why is more dangerous the last one? I though Ritalin was stronger and more dangerous
Posted by Questionmark on November 9, 2008, at 19:23:06
In reply to Re: Nardil - may of upped daose to fast! » Questionmark, posted by tepi on November 8, 2008, at 0:03:53
Sorry i should have made that more clear. I was never on Ritalin consistently while I was on Nardil, i just have taken it on occasion. But each time i did i was fine, it worked as it normally did relatively, and no hypertensive reaction in the least.
Ritalin and Adderall are both similar in "strength" at comparable doses (i guess that's kind of an obvious statement though). But while on an MAOI, Adderall is definitely the more dangerous of the two, judging from my experience. Why I am not certain, but I would guess it is because Adderall is more adrenergic and/or noradrenergic than is Ritalin. But that's just my guess. However, it is possible that Ritalin has enough noradrenergic activity (as it is believed to have some for sure) to be dangerous at higher doses while on an MAOI, so caution is still advised of course. Just start low.
> > Ritalin (methylphenidate) can certainly be employed, (preferably under a doctor's cautious supervision, of course). I have taken Ritalin while on Nardil with no adverse effects at all. Definitely stay away from Adderall-- i had unpleasant effects even at very low doses (like 2 or 3 mg), and it's too risky and too many different amphetamines anyway. As azalea i think mentioned dextroamphetamine-- low dose probably-- can potentially be utilized, however. I would think that Provigil should be fine, too, but i'm not sure-- though i doubt that would be as helpful for hypotension, if that's for what you were considering it.
> >>
>
> Hi QuestionMark
> thinking many time ago of adding an stimulant to Nardil. I see you have already done it.
> Are you still on it ?
> did you have to increase the stimulant dose with time?
> What is the different between Ritalin and Aderall
> Why is more dangerous the last one? I though Ritalin was stronger and more dangerous
Posted by Questionmark on November 9, 2008, at 20:23:56
In reply to Re: More questions re: Nardil/Parnate/Ritalin » Questionmark, posted by JadeKelly on November 3, 2008, at 13:14:36
I can't comment on kicking in the effects of anything-- i have no idea. And i'm not sure about the amount of risk for you in taking Ritalin with Parnate. I would say if you have had a spontaneous hypertensive crisis on Parnate (i.e. without eating or taking anything to cause it), then you definitely might be a little sensitive or might not be a good candidate for a stimulant. I'd still assume that a small amount of Ritalin would be okay, but you should ask your dr his/her opinion and go with that.
> Hi Questionmark,
>
> You really think ritalin ok for short time user of Nardil is ok, especially with dosage complications? I'm no expert for sure, probably a little anal on the "rules" side after my experience, but I'm really asking. Because if my Parnate poops out, does small amount ritalin(dose?) kick in the effects again, or just address fatigue?
>
> I took ritalin for long time with Klonopin, and they got me through an insanely busy time, as in years! I think they were just bandaid, but hey, when nothing else works and things gotta get done...do what ya gotta do.
>
> Would be afraid to take ritalin, even small dose, with Parnate after having hypertensive, crisis. I must be sensistive? Would that make me NOT a good candidate for stim augmentation later? Sounds like you know a lot, hope to hear back from you.
>
> Sorry to hi-jack your post That Guy!
>
> Jade
This is the end of the thread.
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