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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by floatingbridge on June 27, 2011, at 20:17:02
Is there such a thing? If so, at what dose have you heard of it taking effect?
I am pretty med sensitive. Have never done well on top doses of anything.
Decisions :-/
fb
Posted by sigismund on June 27, 2011, at 21:08:24
In reply to nardil question re: low dose, posted by floatingbridge on June 27, 2011, at 20:17:02
People say not and there is that 1mg/kg body weight thing, but if it was me, for sure I would go up very slowly and stay on the minimum effective dose.
This is more important with Nardil than other meds because the side effects of Nardil are sufficient to deter some users.
I would be interested to hear from anyone who has tried this.
Perhaps in this sense it has been tried....those people on a normal kind of dose who say that it took 5 weeks to kick in.
Posted by jedi on June 28, 2011, at 1:29:06
In reply to nardil question re: low dose, posted by floatingbridge on June 27, 2011, at 20:17:02
> Is there such a thing? If so, at what dose have you heard of it taking effect?
>
> I am pretty med sensitive. Have never done well on top doses of anything.
>
> Decisions :-/
>
> fbHi fb,
When I lower my Nardil dosage from 60 to 45mg I lose the antidepressant effect. I also lose a lot of the side affects, but that doesn't really help if I lose efficacy. I'm a large man and body size does make a difference. I don't need the 1mg/kg dosage but 60mg is my minimum effective dose. Everybody is different. If you go on Nardil and can tough out a slow taper, I would also suggest finding the minimum dose for you personally. As dosage goes up, so do the side effects. I have been on dosages up to 120mg and have augmented with nortriptyline and bupropion.
Be well my friend,
Jedi
Posted by sigismund on June 28, 2011, at 2:23:26
In reply to Re: nardil question re: low dose » floatingbridge, posted by jedi on June 28, 2011, at 1:29:06
>When I lower my Nardil dosage from 60 to 45mg I lose the antidepressant effect.
How does that compare to the times when you have stopped Nardil?
Posted by SLS on June 28, 2011, at 5:31:17
In reply to nardil question re: low dose, posted by floatingbridge on June 27, 2011, at 20:17:02
In my experience, subtherapeutic dosages of Nardil are generally ineffective in treating acute depression or anxiety. There are undocumented suggestions that after treating the acute depression, one can then lower the dosage to 15-30mg. This has not been my experience with Nardil. To maintain remission, I must continue chronically the dosage that was effecive acutely.
Therapeutic range for Nardil = 60mg to 90mg.Top dosage = 1 mg/kg body weight.
45mg usually doesn't work.
- Scott
Posted by floatingbridge on June 28, 2011, at 9:11:52
In reply to Re: nardil question re: low dose, posted by SLS on June 28, 2011, at 5:31:17
Alright. Thanks everyone. I appreciate not having to search the archives.
Posted by Phillipa on June 28, 2011, at 10:38:18
In reply to Re: nardil question re: low dose, posted by floatingbridge on June 28, 2011, at 9:11:52
FB you going to? Love Phillipa
Posted by Roslynn on June 28, 2011, at 14:57:36
In reply to nardil question re: low dose, posted by floatingbridge on June 27, 2011, at 20:17:02
Hi FB,
I would probably need a small dose as well if I were to take nardil or parnate.
Can you tell me again, what happened with your EMSAM trial? Did you try 9mg?
I hope you are feeling okay. I am also going through a rough time--my meds seemed to have pooped out.
I will try to cheer you on if I can.
Roslynn
> Is there such a thing? If so, at what dose have you heard of it taking effect?
>
> I am pretty med sensitive. Have never done well on top doses of anything.
>
> Decisions :-/
>
> fb
>
>
>
>
Posted by zonked on June 28, 2011, at 15:15:13
In reply to Re: nardil question re: low dose, posted by SLS on June 28, 2011, at 5:31:17
>
There are undocumented suggestions that after treating the acute depression, one can then lower the dosage to 15-30mg. This has not been my experience with Nardil. To maintain remission, I must continue chronically the dosage that was effecive acutely.
>Yeah, it's in the PDR/PI as well: "Maintenance dosage: After maximum benefit is obtained, usually in 26 weeks, slowly reduce dosage over several weeks to a maintenance level.100 a Maintenance dosage may be as low as 15 mg daily or every other day."
Everyone I know of who's tried to do this has had their symptoms return or relapse.
I have a theory (albeit a complex one) as to why, perhaps, this is true.
Perhaps it's not MAO inhibition alone that's responsible for the therapeutic effects of Nardil - perhaps we also need the active metabolites: PEA (which only "works" because the parent compound, phenelzine, inhibits MAO-B which ordinarily breaks down PEA) and/or Phenylethylidenehydrazine (the GABA-T inhibitor active metabolite.)
Similarly, perhaps the therapeutic effects of Parnate depend on its unique properties as well: In addition to MAO inhibition, it also acts as a dopamine releasing agent. Perhaps, in some folks, both actions are required for antidepressant effect.
Remember last year how we both failed on
Marplan (around the same time)? Marplan, to my knowledge, does not have any properties other than nonselective, irreversible inhibition of both MAO isoforms.Just a theory, one I will probably never be able to prove.
Glad we're both doing well this time around. Very glad. :-)
-z
Posted by floatingbridge on June 28, 2011, at 16:28:15
In reply to Re: nardil question re: low dose » SLS, posted by zonked on June 28, 2011, at 15:15:13
zonked, I barely follow the science here, but as a consumer :-/ my brief emsam experience was that it was a very different animal than my (umpteen) ssnri/ssri experiences.
The only thing that really broke the wall of what had become major, unrelenting depression in all these years was dexedrine. That was a big switch. But that was not sustainable for me. The emsam felt very good in a similar way without being a rocketship--. And other than the sleep issue, it felt good enough.
Posted by floatingbridge on June 28, 2011, at 17:17:24
In reply to Re: nardil question re: low dose, posted by Roslynn on June 28, 2011, at 14:57:36
Hi Roslynn,
>
> Can you tell me again, what happened with your EMSAM trial? Did you try 9mg?I didn't go to 9mg. I haven't able to give the emsam a full trial yet. I would need more sleep support. That was the only sx I can report. Other than that, it was
pretty transparent for me. I didn't have a rash or undue anxiety. The insomnia (which has always been an issue) became very different and difficult (not impossible) to treat. It could still work. I don't know. I felt a quiet lift, other than a few start up things around days 3, day
5 . Those were a transitory sense of over stimulation. Once I realized this was a start-up issue, I could relax more with it.>
> I hope you are feeling okay. I am also going through a rough time--my meds
seemed to have pooped out.
Well this stinks. What are you working with?
Thanks for the cheer, and I'm doing the same for you.Hang in there, yeah?
fb
>
> I will try to cheer you on if I can.
>
> Roslynn
>
>
> > Is there such a thing? If so, at what dose have you heard of it taking effect?
> >
> > I am pretty med sensitive. Have never done well on top doses of anything.
> >
> > Decisions :-/
> >
> > fb
> >
> >
> >
> >
>
>
Posted by jedi on June 28, 2011, at 21:45:55
In reply to Re: nardil question re: low dose » jedi, posted by sigismund on June 28, 2011, at 2:23:26
> >When I lower my Nardil dosage from 60 to 45mg I lose the antidepressant effect.
>
> How does that compare to the times when you have stopped Nardil?In the past, when I have lowered to 45mg to try and reduce side effects; I have felt my depression start to worsen after a few weeks. When this happens I will immediately jump back up to 60mg to stop the downward spiral. By comparison, when I have stopped Nardil completely, it has usually taken several months before a full blown major depression hits. I have generally only stopped Nardil completely when I have been feeling very good or for trials of other medications. I always taper slowly, but the depression always returns. I have probably been very lucky that I have always been able to regain the antidepressant effect of the drug upon restarting. At least I have one medication that works for me, it is not perfect, but I have to have it. I have been on 45+ different combinations of antidepressants and augmenters. This is the only one that has ever worked for me long term.
Be well,
Jedi
Posted by Roslynn on June 30, 2011, at 15:39:07
In reply to Re: nardil question re: low dose » Roslynn, posted by floatingbridge on June 28, 2011, at 17:17:24
Hi FB,
Sorry you were unable to get a full trial of EMSAM. Your experience with the med sounds a lot like mine, except for me the insomnia went away. But I felt very similar on it to what you describe. Unfortunately I was allergic.
My meds currently are Prozac 60mg, Anafranil 50mg, Ativan prn, Seroquel 100mg and lithium 300. The combo of Prozac/Anafranil is no longer working very well.
I hope you are okay. When do you go to the clinic?
Best,
Roslynn>
> I didn't go to 9mg. I haven't able to give the emsam a full trial yet. I would need more sleep support. That was the only sx I can report. Other than that, it was
> pretty transparent for me. I didn't have a rash or undue anxiety. The insomnia (which has always been an issue) became very different and difficult (not impossible) to treat. It could still work. I don't know. I felt a quiet lift, other than a few start up things around days 3, day
> 5 . Those were a transitory sense of over stimulation. Once I realized this was a start-up issue, I could relax more with it.
>
> >
> > I hope you are feeling okay. I am also going through a rough time--my meds
> seemed to have pooped out.
>
>
> Well this stinks. What are you working with?
>
>
> Thanks for the cheer, and I'm doing the same for you.
>
> Hang in there, yeah?
>
> fb
>
> >
> > I will try to cheer you on if I can.
> >
Posted by floatingbridge on June 30, 2011, at 18:58:29
In reply to Re: nardil question re: low dose » floatingbridge, posted by Roslynn on June 30, 2011, at 15:39:07
Hi Rosalynn,
Do you think it was enough for you to have continued except for your reaction? That would be very disappointing. I am curious if your response to your trial suggests anything to you about considering anothet maoi treatment. I think the washout between prozac and an maoi seems like a very long time for some people to endure, but it's been managed.
That insomnia remitted for you is really good to hear because it can be a big side effect for some (me).
I looked up anafranil after your post. I saw that is a standard add-on treatment with prozac. But it pooped on you :-/ What would you rate your best response level to that combo?
I would be curious to know if you have ideas about your next step. I am sorry you are being faced with these decisions. There seem to be many tca's. From reading, it seems like it can take a few years for someone to find their best treatment going forward on a tca.
I am wishing you good luck and more.
fb
I go next week. Thanks for asking :-) Hopefully they will be very kind and helpful. I saw a very helpful cbt/anxiety/phobia person for awhile, and he understood how difficult it was for someone to show up anywhere to be treated for anxiety and/or depression.
> Hi FB,
>
> Sorry you were unable to get a full trial of EMSAM. Your experience with the med sounds a lot like mine, except for me the insomnia went away. But I felt very similar on it to what you describe. Unfortunately I was allergic.
>
> My meds currently are Prozac 60mg, Anafranil 50mg, Ativan prn, Seroquel 100mg and lithium 300. The combo of Prozac/Anafranil is no longer working very well.
>
> I hope you are okay. When do you go to the clinic?
>
> Best,
> Roslynn
>
> >
> > I didn't go to 9mg. I haven't able to give the emsam a full trial yet. I would need more sleep support. That was the only sx I can report. Other than that, it was
> > pretty transparent for me. I didn't have a rash or undue anxiety. The insomnia (which has always been an issue) became very different and difficult (not impossible) to treat. It could still work. I don't know. I felt a quiet lift, other than a few start up things around days 3, day
> > 5 . Those were a transitory sense of over stimulation. Once I realized this was a start-up issue, I could relax more with it.
> >
> > >
> > > I hope you are feeling okay. I am also going through a rough time--my meds
> > seemed to have pooped out.
> >
> >
> > Well this stinks. What are you working with?
> >
> >
> > Thanks for the cheer, and I'm doing the same for you.
> >
> > Hang in there, yeah?
> >
> > fb
> >
> > >
> > > I will try to cheer you on if I can.
> > >
>
Posted by Roslynn on July 1, 2011, at 15:03:16
In reply to Re: nardil question re: low dose » Roslynn, posted by floatingbridge on June 30, 2011, at 18:58:29
Hi fb,
No, I don't think there was a strong enough response for me to continue EMSAM. If there were, I would have tolerated the rash somehow. I wonder if maybe the 9mg would work for me?
I am scared of doing another Prozac washout..every time I try seems I end up needing to restart Prozac again.
My Prozac/Anafranil combo got me feeling quite a bit better but I think I was still lacking motivation.
I think I will post here and see if anyone has ideas for my next step.
Thanks for your message!
Roslynn
> Hi Rosalynn,
>
> Do you think it was enough for you to have continued except for your reaction? That would be very disappointing. I am curious if your response to your trial suggests anything to you about considering anothet maoi treatment. I think the washout between prozac and an maoi seems like a very long time for some people to endure, but it's been managed.
>
> That insomnia remitted for you is really good to hear because it can be a big side effect for some (me).
>
> I looked up anafranil after your post. I saw that is a standard add-on treatment with prozac. But it pooped on you :-/ What would you rate your best response level to that combo?
>
> I would be curious to know if you have ideas about your next step. I am sorry you are being faced with these decisions. There seem to be many tca's. From reading, it seems like it can take a few years for someone to find their best treatment going forward on a tca.
>
> I am wishing you good luck and more.
>
>
> fb
>
>
> I go next week. Thanks for asking :-) Hopefully they will be very kind and helpful. I saw a very helpful cbt/anxiety/phobia person for awhile, and he understood how difficult it was for someone to show up anywhere to be treated for anxiety and/or depression.
>
>
>
>
> > Hi FB,
> >
> > Sorry you were unable to get a full trial of EMSAM. Your experience with the med sounds a lot like mine, except for me the insomnia went away. But I felt very similar on it to what you describe. Unfortunately I was allergic.
> >
> > My meds currently are Prozac 60mg, Anafranil 50mg, Ativan prn, Seroquel 100mg and lithium 300. The combo of Prozac/Anafranil is no longer working very well.
> >
> > I hope you are okay. When do you go to the clinic?
> >
> > Best,
> > Roslynn
> >
> > >
> > > I didn't go to 9mg. I haven't able to give the emsam a full trial yet. I would need more sleep support. That was the only sx I can report. Other than that, it was
> > > pretty transparent for me. I didn't have a rash or undue anxiety. The insomnia (which has always been an issue) became very different and difficult (not impossible) to treat. It could still work. I don't know. I felt a quiet lift, other than a few start up things around days 3, day
> > > 5 . Those were a transitory sense of over stimulation. Once I realized this was a start-up issue, I could relax more with it.
> > >
> > > >
> > > > I hope you are feeling okay. I am also going through a rough time--my meds
> > > seemed to have pooped out.
> > >
> > >
> > > Well this stinks. What are you working with?
> > >
> > >
> > > Thanks for the cheer, and I'm doing the same for you.
> > >
> > > Hang in there, yeah?
> > >
> > > fb
> > >
> > > >
> > > > I will try to cheer you on if I can.
> > > >
> >
>
>
Posted by floatingbridge on July 1, 2011, at 16:09:41
In reply to Re: nardil question re: low dose » floatingbridge, posted by Roslynn on July 1, 2011, at 15:03:16
Rosalynn,
I'll look for your posts. Just what came to mind is another poster mentioned oral segeline. I don't really know about these things :-/ I'm just passing it on as possibly useful info for thinking. But you might be needing different AD effect.
Still cheering for you, however quietly.
Posted by Roslynn on July 1, 2011, at 16:23:14
In reply to Re: nardil question re: low dose » Roslynn, posted by floatingbridge on July 1, 2011, at 16:09:41
Hi FB,
Selegiline is a great suggestion given that it's the same med as the patch. Right?
Hope you have a nice weekend.
Roslynn
> Rosalynn,
>
> I'll look for your posts. Just what came to mind is another poster mentioned oral segeline. I don't really know about these things :-/ I'm just passing it on as possibly useful info for thinking. But you might be needing different AD effect.
>
> Still cheering for you, however quietly.
>
>
Posted by floatingbridge on July 1, 2011, at 16:35:43
In reply to Re: nardil question re: low dose, posted by Roslynn on July 1, 2011, at 16:23:14
Yes. There is something about the effect being different when administered orally. I don't recall the thread, oh yeah, it is in 'restart emsam' and the poster is poser. It may not apply to you, but I figure info is good.
I understand the hesitation to wash from prozac. A supported wash is very wise in my opinion if you that is what you decide to do.
I don't think the anafranil washout will near as long. I hope you get all the information and guidance you need with this decision making. I am wishing you as swift relief as possible.
Posted by Lamdage on July 4, 2011, at 10:12:01
In reply to Re: nardil question re: low dose » SLS, posted by zonked on June 28, 2011, at 15:15:13
I might be a candidate for this very low dosage. I can say that last time i weined off i still had a decent effect at even 30mg (for 2 weeks at least).
Theres a theory about phenelzine that 30-40% are very slow metabolizers of phenelzine. (lack en enzyme or sth? cant remember, maybe someone can enlighten us) I think part of the reason my last trial got a bit out of hand was that im a slow metabolizer. Also this non-enteric coated --> too much PEA sounds plausible to me, as it was a buildup of more and more dopaminergic effect and obviously this contributes to paranoid/psychotic thoughts.
As for this time i am confident i will make nardil work. Adding higher dose lithium orotate in the mix, being able to adjust the dosage in 3,25 mg steps to the minimal effective dosage and i am better prepared for insomnia. I will not go a single night with less than 5 hours of sleep (enforce it if necessary) and will aim at 6 1/2 hours. I think this is the ideal amount of sleep for me.. too much and my atypical depression is building up.
Ill try to steer within the euthymic-hypertymic range with a very rigid sleep regimen, going to bed and waking at the exact same time every day including weekends.
Posted by floatingbridge on July 4, 2011, at 11:32:15
In reply to Re: nardil question re: low dose, posted by Lamdage on July 4, 2011, at 10:12:01
Lamdage, this sounds very reasonable. I am glad to hear you are titrating up slowly.
For some people the sleep piece is very big. If you are in that category, figuring that out and working with it is going to be very helpful in maintaining recovery and gently pushing it forward.
Always wishing you luck and everything good,
fb
Posted by Lamdage on July 5, 2011, at 4:54:20
In reply to Re: nardil question re: low dose » Lamdage, posted by floatingbridge on July 4, 2011, at 11:32:15
> Lamdage, this sounds very reasonable. I am glad to hear you are titrating up slowly.
>
> For some people the sleep piece is very big. If you are in that category, figuring that out and working with it is going to be very helpful in maintaining recovery and gently pushing it forward.Smoothness is key;) Long term goal: stable hyperthymic mood. Yeah i know normal is euthymic but lets be classy!
>
> Always wishing you luck and everything good,
>
> fbThanks!
This is the end of the thread.
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