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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by pedr on October 3, 2011, at 23:37:06
Hi PB-ers,
I am a long time Nardil-er but I want to reduce its side-effects so I have gradually weaned myself down from 90mg to 45mg.I have not heard anyone talking about "maintenance dose" Nardil. This is an old technique based on the "bath tub" model of certain AD's mechanics. Essentially the theory is that once sufficient levels of neurotransmitters have been stockpiled (maoi == bath plug, water level == amount of neurotransmitter), the tap (intake of AD) can be turned down to such a level as to compensate for the small amount of water leaking past the plug. Phew!
Generally these days it seems frowned upon for some reason. Has anyone tried decreasing their dose to say, 30 mg or 15 mg or even less? If so, what did they find?
Thanks,
Pedr
Posted by jono_in_adelaide on October 4, 2011, at 22:37:11
In reply to Nardil Maintenance Dose, posted by pedr on October 3, 2011, at 23:37:06
The daa sheet for nardil suggests reducing the dose for maintainance, down to as low as 15mg every other day, though that sounds very low. If you're feeling good on 45mg per day, you could either stay there, or drop to 30mg per day and see how you feel
Posted by creepy on October 4, 2011, at 23:38:09
In reply to Nardil Maintenance Dose, posted by pedr on October 3, 2011, at 23:37:06
Technically you should even be able to take an MAOI every couple days.. It takes awhile for MAO levels to replenish.
Posted by zonked on October 4, 2011, at 23:39:54
In reply to Nardil Maintenance Dose, posted by pedr on October 3, 2011, at 23:37:06
As my doctor said, the PDR is a legal document, not a medical one. :-)
I don't know if anyone's been able to get away with this. I've never tried myself. If you decide to try this, work carefully with your doctor and let us know how you do.
The weight gain on 90mg - well - since June I've put on 40-50lbs. :(
I told myself in the beginning though, if I have to be heavier to live a normal life, that's an acceptable trade-off. (I'd stopped Nardil while it was still working before with disastrous consequences because of the weight gain.)
-z
Posted by pedr on October 5, 2011, at 16:45:53
In reply to Nardil Maintenance Dose, posted by pedr on October 3, 2011, at 23:37:06
thanks for the replies all, I hadn't even thought to look at the PDR! Interestingly so far no-one has come forth with experience of trying going down to 15mg (daily or otherwise).
I quit Abilify over the weekend [and felt appropriately horrific] and it's been amazing feeling the changes to my outlook, mood and personality. Along with that has returned the somnolence [frequent bouts of incessant yawning, feeling dozy, nearly dropping off asleep at work etc.] which is a bummer. I was hoping that at 45mg this SE would be almost be gone. My appetite has increased too but not to the levels it was at when I was on 90mg. Since reducing from 90mg my weight has gone down 25lb. Going up&down in weight is very expensive clothes-wise. I gained new-found empathy with those who's weight fluctuates a lot, that's for sure.
Since Abilify "displays linear kinetics and has an elimination half-life of approximately 75 hours. Steady-state plasma concentrations are achieved in about 14 days." I am going to wait a good 2 weeks since quitting before adjusting the Nardil dose. Abilify + Nardil - a very serious and a unique med together - who knows what is going on inside my melon... :)
If/when I decrease dose I will report back with my findings.
Pedr
Posted by Chairman_MAO on October 5, 2011, at 22:48:55
In reply to Nardil Maintenance Dose, posted by pedr on October 3, 2011, at 23:37:06
I think it's frowned upon because it doesn't work. Also, phenelzine has a metabolite that is a GABA-T inhibitor; if you want a consistent effect in this regard, you have to take it in divided doses throughout the day.
When I was on Nardil, missing a few doses was enough to cause the "brain zaps". Yeah, I know, "it's irreversible". The real world is complex. ;-) YMMV.
Posted by pedr on October 6, 2011, at 21:44:15
In reply to Re: Nardil Maintenance Dose » pedr, posted by Chairman_MAO on October 5, 2011, at 22:48:55
Hi Chairman_MAO,
"I think it's frowned upon because it doesn't work."
- could you elaborate on this or better still provide links to evidence/studies to this effect?Thanks,
Pedr
Posted by Chairman_MAO on October 7, 2011, at 7:08:32
In reply to Re: Nardil Maintenance Dose » Chairman_MAO, posted by pedr on October 6, 2011, at 21:44:15
> Hi Chairman_MAO,
> "I think it's frowned upon because it doesn't work."
> - could you elaborate on this or better still provide links to evidence/studies to this effect?
http://archpsyc.ama-assn.org/cgi/content/abstract/35/5/629To sustain a robust response in the real world, ~1mg/kg is often needed. More to the point, I'd like to see some studies where they _did_ cut back to a maintenance dose, because I've only seen this in the monograph.
Phenelzine also has an active metabolite that inhibits GABA-T. You will not get this in sufficient quantities to do anything on a "maintenance dose".
Posted by pedr on October 7, 2011, at 8:25:37
In reply to Re: Nardil Maintenance Dose » pedr, posted by Chairman_MAO on October 7, 2011, at 7:08:32
Hi,
>
> http://archpsyc.ama-assn.org/cgi/content/abstract/35/5/629
>
> To sustain a robust response in the real world, ~1mg/kg is often needed.yes but this is just an abstract for a 6-week study, it doesn't mention maintenance dose at all.
> More to the point, I'd like to see some studies where they _did_ cut back to a maintenance dose, because I've only seen this in the monograph.
right. I've never seen such an article either during my wanderings through PubMed and so on. Some kind of data would be nice!
> Phenelzine also has an active metabolite that inhibits GABA-T. You will not get this in sufficient quantities to do anything on a "maintenance dose".
I'm unfamiliar with GABA-T but I figure that the logic you're referring to is something like :
a) GABA == anti-anxiety; relaxing agent [good]
b) GABA-T is GABA transaminase, an enzyme which catalyses GABA's breakdown [bad]
c) phenelzine is a GABA-transaminase inhibitor
d) transitioning to maintenance dose lowers Phenelzine's GABA-T inhibition
e) GABA-T subsequently increases and breaks down more GABA
f) less GABA == smaller calming effect == baddo you perchance have any good resources on this metabolite and its Pharmacokinetics etc. ?
Thanks,
Pedr
Posted by Chairman_MAO on October 7, 2011, at 16:56:24
In reply to Re: Nardil Maintenance Dose » Chairman_MAO, posted by pedr on October 7, 2011, at 8:25:37
Inhibition of GABA-T is not necessarily anxiolytic. It probably is for some people, but it is far more broad-spectrum than "calming"; it's _way_ more complex than that.
Here is the reference:
GABA-elevating effects of the antidepressant/antipanic drug phenelzine in brain: effects of pretreatment with tranylcypromine, (-)-deprenyl and clorgyline
by
Todd KG, Baker GB
Department of Psychiatry,
University of Alberta,
Mackenzie Health Sciences Centre,
Edmonton, Canada.
J Affect Disord 1995 Dec 13; 35(3):125-9ABSTRACT
The antidepressant/antipanic drug phenelzine (PLZ) is both an inhibitor of, and a substrate for, monoamine oxidase (MAO). PLZ also causes an elevation of brain levels of the amino acid neurotransmitter gamma-aminobutyric acid (GABA); this action can be reversed by pretreatment with the MAO inhibitor tranylcypromine (TCP), suggesting that the GABA-elevating effect is largely the result of a metabolite of PLZ formed by MAO. In the present report, rats were pretreated with the nonselective MAO inhibitor TCP, the MAO-A inhibitor clorgyline and the MAO-B inhibitor (-)-deprenyl: at the doses used, clorgyline and (-)-deprenyl caused selective inhibition of MAO-A and MAO-B, respectively. Both TCP and (-)-deprenyl caused a greater reduction in the GABA-elevating action of PLZ than did clorgyline, suggesting that MAO-B is more important than MAO-A in the formation of the active metabolite of PLZ. The results also suggest that an effect other than, or in addition to, inhibition of GABA transaminase by the metabolite may be important in the GABA-elevating action.
1. Biochem Pharmacol. 2002 Jan 1;63(1):57-64.
Effects of the antidepressant/antipanic drug phenelzine and its putative
metabolite phenylethylidenehydrazine on extracellular gamma-aminobutyric acid
levels in the striatum.Parent MB, Master S, Kashlub S, Baker GB.
Department of Psychology, University of Alberta, Edmonton, Canada.
psymbp@langate.gsu.eduPhenelzine (PLZ) is a non-selective monoamine oxidase inhibitor (MAOI) commonly
used to treat depression and panic disorder. As expected, PLZ increases brain
levels of dopamine, norepinephrine, and serotonin. Interestingly, PLZ also
elevates brain levels of gamma-aminobutyric acid (GABA), and previous studies
have suggested that these increases may also contribute to the anxiolytic effects
of PLZ. Using in vivo microdialysis in conscious, freely moving rats, combined
with high performance liquid chromatography, the present experiments determined
that PLZ (15 or 30 mg/kg, free base weight) increases extracellular levels of
GABA in the caudate-putamen and nucleus accumbens. The results also indicated
that phenylethylidenehydrazine (PEH; 29.6 mg/kg, free base weight), a putative
intermediate metabolite of PLZ that is not an MAOI, also significantly increases
extracellular GABA levels in the caudate-putamen. These findings provide further
evidence that GABA may play an important role in the actions of PLZ and suggest
that PEH should be pursued further as a GABAergic drug in its own right.
so, re: your post (a) is an oversimplification or false, (b) that is what GABA-T does, but whether it is bad or good depends upon the patient's needs, (c) It is a metabolite that is a GABA-T inhbiitor (d) yes (e) yes (f) see my answer to (b)
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