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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 jono_in_adelaide on February 10, 2013, at 19:54:53
See what he has to suggest.
I'm starting to think that Nardil might be my best option, probably combined with nortriptyline and alprazolam
My depression has been in more or less complete remission for good long time, I just need to knock this anxiety on the head
Posted by Phillipa on February 10, 2013, at 21:01:45
In reply to Doctor today, posted by jono_in_adelaide on February 10, 2013, at 19:54:53
Jono Monday already? What about weight gain with Nardil? Phillipa
Posted by jono_in_adelaide on February 10, 2013, at 21:18:47
In reply to Re: Doctor today » jono_in_adelaide, posted by Phillipa on February 10, 2013, at 21:01:45
I think I'll have to just deal with it.
I'mm be refered to a psychiatrist and i guess it will depend on what s/he thinks.
The anxiety and avoidant beheivior are starting to effect my work, and I cant afford to screw this job up.
Posted by jono_in_adelaide on February 10, 2013, at 23:01:12
In reply to Re: Doctor today, posted by jono_in_adelaide on February 10, 2013, at 21:18:47
Either that or increase the benzos - and i think thats a slipery slope to turning into Elvis
Posted by Phillipa on February 10, 2013, at 23:04:07
In reply to Re: Doctor today, posted by jono_in_adelaide on February 10, 2013, at 23:01:12
Switch Benzos? A Possibility? Phillipa
Posted by SLS on February 11, 2013, at 1:39:36
In reply to Re: Doctor today, posted by jono_in_adelaide on February 10, 2013, at 23:01:12
Have you tried Paxil or Effexor?
- Scott
Posted by jono_in_adelaide on February 11, 2013, at 3:58:39
In reply to Re: Doctor today » jono_in_adelaide, posted by SLS on February 11, 2013, at 1:39:36
"have you tried paxil and effexor"
Yep, and a no to both. ditto citralopram and fluoxetine, and many others.
Ended up with a referal to one of the few psychiatrists in this cow town, we'll see what she has to say.
Hopefully somthing unique - I'll let her make her suggestions before I make mine
Posted by brynb on February 11, 2013, at 5:35:20
In reply to Doctor today, posted by jono_in_adelaide on February 10, 2013, at 19:54:53
How about Lexapro? And perhaps switching your benzo would be good--maybe to Valium or Ativan? (I'm not a big fan of Klonopin.)
Fell better soon.
-b
Posted by jono_in_adelaide on February 11, 2013, at 5:38:26
In reply to Re: Doctor today » jono_in_adelaide, posted by brynb on February 11, 2013, at 5:35:20
Tried Lexapro as well haha - i think i have tried all of the SSRI drugs, and none of them have ever had any effect on me - i only take the Zoloft because it seems part of every doctors thinking that if you have an anxiety disorder you have to be on an SSRI, and its easier to adopt the path of lease resistance and take it.
Posted by SLS on February 11, 2013, at 8:21:18
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 5:38:26
If you decide to take Nardil, will you be discontinuing the nortriptyline first? Although there is a line of thought that suggests adding an MAOI to an ongoing treatment with a TCA is best, I never had a problem doing it in the reverse order.
For me, adding nortriptyline or desipramine to ongoing Nardil treatment produced hypotension and urinary retention of greater magnitude than with Nardil alone. What I don't know is whether or not adding Nardil to ongoing nortriptyline might mitigate these effects. I find Parnate to be much more forgiving when combining it with a TCA.
Gotta ask - have you ever tried adding Buspar to your treatment regime?
Good luck.
- Scott
Posted by jono_in_adelaide on February 11, 2013, at 16:46:58
In reply to Re: Doctor today » jono_in_adelaide, posted by SLS on February 11, 2013, at 8:21:18
I was thinking if i try Nardil + nortriptyline, I would take the nort back to 25mg a day and build it up over 2 weeks or so along with the Nardil. For me the hypotension probably wouldnt be an issue as i have high blood pressure, if need be I could reduce or stop the ACE inhibitor/HCTZ pill I take every day.
Yes, tried Buspar as well, it didnt work.
I'm ringing the shrink today to make an appointment (she got my referal yesterday by fax) so we'll see when i can see her and take it from there.
Posted by jono_in_adelaide on February 11, 2013, at 16:59:04
In reply to Re: Doctor today » jono_in_adelaide, posted by SLS on February 11, 2013, at 8:21:18
Bottom line is that my depression is in total remission on an NARI, maybe helped by the SSRI
The only things to help my anxiety have been benzos (which have been about equaly effective in equipotent doses) and risperidone (and once many years ago a short course of Melleril given to me by a benzophobe doctor) I'm taking Xanax 1mg tds - it might just be simpler to increase this than go down the Nardil path, according to the Xanax datat sheet, some panic disorder patients need upto 10mg/day.
Anyway, I'm paying this shrink good money, i guess I shouldnt try and pre guess her.
Posted by Phillipa on February 11, 2013, at 19:11:52
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 16:59:04
Jono it's true many do take higher doses of xanax. Seems like you are devoping tolerance though? This is worrisome. Phillipa
Posted by jono_in_adelaide on February 11, 2013, at 19:38:09
In reply to Re: Doctor today » jono_in_adelaide, posted by Phillipa on February 11, 2013, at 19:11:52
I'm not sure if it is tollorence Phillipa, it might be, but my history is that I took 3mg/day for 18 months, then reduced to 2mg a day for 18 months, then in the space of 3 days had to go back to 3mg, and even that wasnt working - I'm more inclined to think that something else changed, though tolorence could be playing a part.
My goal is to tweak my treatment so I can get back down to 2mg per day and feel good on that.
Posted by jono_in_adelaide on February 11, 2013, at 20:04:54
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 19:38:09
She seems pretty good - Associate Professor of Psychiatry at two well respected Australian universities
Biography
Tricia Nagel is a consultant psychiatrist and NHMRC Research Fellow who has lived and worked in the Top End of the Northern Territory for 26 years. Tricia is an Associate Professor at both Flinders University and Menzies School of Health Research where she leads the Mental Health, Wellbeing and Chronic Disease research division
Posted by Phillipa on February 11, 2013, at 21:17:24
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 19:38:09
Jono I tend to agree with you. Something has you stirred up or else your metabolism at this point has changed. You aren't on a different generic are you? If so that could be the problem? Phillip
Posted by jono_in_adelaide on February 11, 2013, at 22:01:20
In reply to Re: Doctor today » jono_in_adelaide, posted by Phillipa on February 11, 2013, at 21:17:24
No, have been on the Sandoz generic for most of the last 3 years. I did try filling with genuian Xanax once to see if it made any difference, but it didnt.
Posted by SLS on February 11, 2013, at 22:03:00
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 16:46:58
> I was thinking if i try Nardil + nortriptyline, I would take the nort back to 25mg a day and build it up over 2 weeks or so along with the Nardil.
That sounds like a reasonable strategy to me. Just remember that there is a delay of 3 - 7 days between an increase in Nardil dosage and peak pharmacological effect; not to be confused with therapeutic effect. I suggest caution when assessing the magnitude of side effects after a dosage increase. You really need to wait. It has been my observation that most people need a minimum of 60 mg/day of Nardil to receive optimum therapeutic results. You might need as much as 90 mg/day. I would suggest waiting 3 weeks between dosage increases beginning at 60 mg/day to evaluate treatment effect; 1 week to establish peak MAO inhibition and 2 weeks to allow for the emergence of a therapeutic response.
I need 90 mg/day of Nardil and 150 mg/day of nortriptyline to receive an improvement of depression. For me, 90 mg represents 1 mg per Kg of body weight. I think most people end up at 75 mg/day when treating severe depression. I do not find that combining Nardil and nortriptyline allows me to take lower dosages of each drug when compared to monotherapy. If a dosage of 75 mg/day of nortriptyline is necessary to produce results in the absence of Nardil, you will most likely need 75 mg/day when combined with it.
If there is any residual anxiety after establishing optimal drug dosing, you might need to bring in a third drug. I would consider Zyprexa, Klonopin, Ativan, or Neurontin. Neurontin is a GABA releaser. If Nardil inhibits GABA deactivation, GABA stores should increase. When combined with increased release, you might glean a robust anxiolytic effect. At least, that's how I drew it up on my chalkboard.
How do you know that you are not bipolar? Does the word "agitation" ever apply? I have no reason to believe that you are overtly bipolar, but perhaps you lie along the bipolar spectrum. This might explain the residual anxiety you experience if you are in a mixed state. Alternatively, you can be suffering from comorbid depression and GAD, in which case your taking Nardil is an ideal choice.
As I have said before, I have little doubt that you will figure it out.
Good luck.
- Scott
Posted by jono_in_adelaide on February 11, 2013, at 22:17:39
In reply to Re: Doctor today » jono_in_adelaide, posted by SLS on February 11, 2013, at 22:03:00
I guess i could be bipolar, but i have never had anything resembling mania or hypomania, and my previous psychiatrist asked me a hell of a lot of screening questions about that sort of stuff. Also a very strong family history of depression, anxiety and panic.
His diagnosis was endrogenous depression, panic disorder and GAD.
We'll see what this new one says - if you dont hear from me, you'll know I've gone inside.
Posted by jono_in_adelaide on February 11, 2013, at 22:19:27
In reply to Re: Doctor today » jono_in_adelaide, posted by SLS on February 11, 2013, at 22:03:00
I'm not going to walk in and say I want Nardil on my first visit - she's a professor at two medical schools, I'll let her make some suggestions first, and see where they lead me, if we dont get anywhere after a couple of her treatment plans, I'll ask about Nardil with or without nortriptyline
Posted by Starsly on February 13, 2013, at 7:42:17
In reply to Re: Doctor today, posted by jono_in_adelaide on February 11, 2013, at 22:19:27
Good luck, I've tried Nardil & it was the best drug, I think I've ever been on. That said, you have to up the exercise, because you will gain weight overtime.
It pooped out, multiple times. So it's not an option for me, but I hope it works for you. Also, if your depression is gone I hope you will feel happy even with the anxiety. But hopefully you won't have that either,
This is the end of the thread.
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