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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Mike_H on July 16, 2011, at 10:43:10
I've been taking Nardil since 6/11, and I've been on 45 mg since 7/4. I'm only noticing a subtle difference. I know I need to increase, but I'm a little scared ..
1) It seems like everyone experiences insomnia at 60 mg. Has anyone not experienced this?
2) How long do you think I should wait until increasing to 45 mg? I'm not experiencing really any major side effects, except for a complete loss of libido and slightly restless sleep. I'm running a marathon on 7/31 so ideally I'd like to wait until like 8/2 or so to increase in case insomnia does hit.
Any feedback would be appreciated. Thanks!
Posted by SLS on July 16, 2011, at 11:48:21
In reply to two nardil questions, posted by Mike_H on July 16, 2011, at 10:43:10
Hi.
It is my observation that most people need a minimum of 60 mg/day of Nardil.
Good luck with your marathon.
- Scott
Posted by jedi on July 16, 2011, at 17:30:21
In reply to two nardil questions, posted by Mike_H on July 16, 2011, at 10:43:10
I'm with Scott on this one. I have never responded to a dosage less than 60mg. For efficacy I have to be between 60mg and 90mg. 60mg usually works for me now. But I will raise to 75mg during bad, anxious or trying times. I commend you to be able to keep exercising at your level with major depression. When mine hit, I just hit a wall on exercise until the depression was under control. You probably will have to treat insomnia when you hit an efficacious dose of Nardil. Almost everyone does. Keep up the exercise. It will obviously help with the weight gain side effects of Nardil.
Be Well,
Jedi
PS Once you hit that efficacious dosage, it usually takes several weeks or longer for the Nardil to kick in. Oh, if you are not in major, treatment resistant depression, or social anxiety(running marathons?); you are probably on the wrong medication. Nardil is the bomb, when the others fail. Just an observation, knowing none of your history.
> I've been taking Nardil since 6/11, and I've been on 45 mg since 7/4. I'm only noticing a subtle difference. I know I need to increase, but I'm a little scared ..
>
> 1) It seems like everyone experiences insomnia at 60 mg. Has anyone not experienced this?
>
> 2) How long do you think I should wait until increasing to 45 mg? I'm not experiencing really any major side effects, except for a complete loss of libido and slightly restless sleep. I'm running a marathon on 7/31 so ideally I'd like to wait until like 8/2 or so to increase in case insomnia does hit.
>
> Any feedback would be appreciated. Thanks!
Posted by Mike_H on July 16, 2011, at 20:44:21
In reply to Re: two nardil questions » Mike_H, posted by jedi on July 16, 2011, at 17:30:21
> I'm with Scott on this one. I have never responded to a dosage less than 60mg. For efficacy I have to be between 60mg and 90mg. 60mg usually works for me now. But I will raise to 75mg during bad, anxious or trying times. I commend you to be able to keep exercising at your level with major depression. When mine hit, I just hit a wall on exercise until the depression was under control. You probably will have to treat insomnia when you hit an efficacious dose of Nardil. Almost everyone does. Keep up the exercise. It will obviously help with the weight gain side effects of Nardil.
> Be Well,
> Jedi
> PS Once you hit that efficacious dosage, it usually takes several weeks or longer for the Nardil to kick in. Oh, if you are not in major, treatment resistant depression, or social anxiety(running marathons?); you are probably on the wrong medication. Nardil is the bomb, when the others fail. Just an observation, knowing none of your history.
>Well, just to give you some brief history. I have been suffering from social anxiety for about 15 years, and along with it, is depression. I have been able to handle the depression pretty well until last January when I hit a wall. I stopped everything in my life and eventually tried to commit suicide a few times. I've obviously stabilized, mostly through my own volition and just the organic decrease in depression through the passage of time, I guess.
I do believe that my depression manifests mostly from the social anxiety. I've tried quite a few SSRIs with no luck. Benzos give me a little relief. But I need something more. I need something to work. So, I'm trying Nardil.
Anyway, I am scared about increasing my dose, but my hope is that the ends will justify the means. If along with it comes insomnia so be it. I'll get through it somehow.
Thanks!
Posted by jedi on July 16, 2011, at 22:36:16
In reply to Re: two nardil questions, posted by Mike_H on July 16, 2011, at 20:44:21
Mike,
I really think most people and MDs underestimate how devastating social anxiety can be. I was afflicted with social anxiety and comorbid dysthymia since my teenage years. I was so socially anxious, with fear of rejection, that I never could even ask a girl out in high school. The disease changes your entire life. This was back in the 70s, and they called it being shy, I guess. I succeeded at everything I did, but that fear really limited my life choices. Following high school, came the alcohol and pot in college as an attempt to self medicate. Never was an alcoholic, but a problem, binge drinker, YES. Of course this strategy worked very well! Right. Looking back, if I could have been successfully treated for the social anxiety, at that young age; my life would have been totally different. And probably no major atypical depression.
Good luck on Nardil,
Jedi
> I do believe that my depression manifests mostly from the social anxiety. I've tried quite a few SSRIs with no luck. Benzos give me a little relief. But I need something more. I need something to work. So, I'm trying Nardil.
Posted by europerep on July 17, 2011, at 5:47:24
In reply to Re: two nardil questions » Mike_H, posted by jedi on July 16, 2011, at 17:30:21
> Once you hit that efficacious dosage, it usually takes several weeks or longer for the Nardil to kick in.
If I may jump in here... how does one know at which dosage to stop, and not go further up? I went on 60mg today, and I'm not really sure what to do now.. stay on it for a week and then go to 75mg, or stay on it for longer to see what happens?
In other words, what happens if you go *above* the dose that's right for you? Does it have actual negative effects, or does it just mean an increase in side effects? If only the latter, one could go up to a fairly high dose and then wait. If and when it kicks in, one can still gradually reduce and see whether the positive effects remain. Still though, the idea of taking more than necessary scares me, just as the idea of taking too little. :(
Posted by SLS on July 17, 2011, at 6:21:46
In reply to Re: two nardil questions » jedi, posted by europerep on July 17, 2011, at 5:47:24
> > Once you hit that efficacious dosage, it usually takes several weeks or longer for the Nardil to kick in.
>
> If I may jump in here... how does one know at which dosage to stop,You might want to give each dosage beginning at 60mg at least three weeks. If you go up too fast, you risk side effects that, once triggered, might linger. Hypotension and urinary retention can become persistent problems.
> In other words, what happens if you go *above* the dose that's right for you?
You might experience increased side effects, but no dimunition in therapeutic efficacy. You can go as high as you can tolerate. Generally, the maximum dosage is 90mg or 1 mg/kg body weight. I am not going to recommend that you remain on Nardil for four months, but there are a few people who are rewarded for waiting that long. If you get a brief antidepressant response during the first 1-2 weeks, this could be a prognosticator of successful long-term treatment. However, you might need to reach a dosage of 60mg before this happens.
- Scott
Posted by jedi on July 17, 2011, at 9:10:47
In reply to Re: two nardil questions » jedi, posted by europerep on July 17, 2011, at 5:47:24
Posted by zonked on July 17, 2011, at 10:26:16
In reply to Re: two nardil questions, posted by SLS on July 17, 2011, at 6:21:46
> If you get a brief antidepressant response during the first 1-2 weeks, this could be a prognosticator of successful long-term treatment. However, you might need to reach a dosage of 60mg before this happens.
>
>
> - ScottScott, I hope you see this. I seem to have backslid a little since I first reported a response several weeks into treatment. At first, I attributed this to switching to the Greenstone/Pfizer Nardil (not my choice, my pharmacy did this despite me asking for "the same generic" and being assured I would get it, my refill was a mix of Gavis (on top) and Greenstone (below)) but am wondering if I am experiencing what you're describing.
Not backslid enough to pretreatment state, but the motivation, energy and sense of relief isn't quite what it was.
I'll be continuing at 75mg until later this month - shrink visit and refill are about the same day, and just as a rule-out will be making sure I get refill with the Gavis generic.
A little scared, but at the same time, encouraged by your experience (it took longer for you.) You have any thoughts or comments?
-z
Posted by Phillipa on July 17, 2011, at 10:47:21
In reply to Re: two nardil questions, posted by Mike_H on July 16, 2011, at 20:44:21
Not being critical to run a marathon is the ultimate of feeling good to me. Was my goal but body wouldn't physically allow me. Was a runner though. Phillipa
Posted by Mike_H on July 17, 2011, at 12:56:05
In reply to Re: two nardil questions » Mike_H, posted by Phillipa on July 17, 2011, at 10:47:21
> Not being critical to run a marathon is the ultimate of feeling good to me. Was my goal but body wouldn't physically allow me. Was a runner though. Phillipa
So, I should be "fine" then--Is that what you're saying? Based on that logic, maybe I should just look at my behaviors rather than my inner experience. I have a job. I'm in graduate school. I have a girlfriend. I have some friends. And yes, I exercise. Sounds like I should be fine right?
I'm great at putting up facades. Inside, I'm not okay. I may not be as debilitated with depression as I once was and my social anxiety is not as bad as some other peoples', but that doesn't mean I am fine. You are just looking at behavior, which is what people judge of course, but it tells a very small picture of what's really going on.
You cannot objectify experience. Saying that running a marathon is the ultimate good feeling and implying (or perhaps I'm inferring) that means I shouldn't be on Nardil, is simply wrong. Everybody has different definitions of what they believe is the ultimate good feeling.
I judge people too, don't get me wrong. I've seen people who seem very successful, but who also have a dark side and who are very, very depressed. You cannot judge how you feel on the inside with what you see others doing. It's unfair not only to them but mostly to you.
Anyway, I am offended by your comment, and I may be totally off base--if I am, I am sorry.
Posted by Phillipa on July 17, 2011, at 21:16:16
In reply to Re: two nardil questions, posted by Mike_H on July 17, 2011, at 12:56:05
Sorry didn't mean to offend you at all. Was quite envious truthfully. I don't feel the med you take is a reflection on your illness. You take whatever works or try to find a med that works. You are the right road if you are accomplishing all this. Oh I know about facades I live that way. It's learned behavior I feel to allow functioning. Well in my case it is. Phillipa
Posted by Mike_H on July 17, 2011, at 23:05:33
In reply to Re: two nardil questions » Mike_H, posted by Phillipa on July 17, 2011, at 21:16:16
> Sorry didn't mean to offend you at all. Was quite envious truthfully. I don't feel the med you take is a reflection on your illness. You take whatever works or try to find a med that works. You are the right road if you are accomplishing all this. Oh I know about facades I live that way. It's learned behavior I feel to allow functioning. Well in my case it is. Phillipa
No worries. I definitely overreacted. I get very triggered by that subject. It's good that people are reminding me that I'm probably not as bad as I think I am, but I'm still in need of some help. I just got through a very difficult, debilitating episode of major depression, and I don't want to go through it again.
Anyhow, I hope that you find peace and that you are able to run again.
This is the end of the thread.
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