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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 97. This is the beginning of the thread.
Posted by PeterMartin on February 16, 2018, at 7:54:22
Im in the process of transitioning from Marplan to Nardil. Couple days washout (per doc) then right in to 60 Nardil where my doc wants me to stay for a while.
Up until last week I felt pretty good. More talkative than normal, lower social anxiety, mood pretty positive. However the past 6 or so days I've lost that and have been pretty depressed and uninterested in anything.
I had some side effects while I was feeling well (mostly bad urinary retention) but that became much less. I know Im dreaming. I wake early which is a good sign but I've been a bit grumot about doing anything or the prospect this is going to kick in at this dose of 60. I just saw my doc two days ago and was hoping to go to 75mg. Probably next month if I am still depressed.
Maybe I just need someone to tell me its very easy on and Nardil will still help at this point? I guess I figured since marplan should have inhibited lots of MAO that Nardil would be effective quicker.
Posted by SLS on February 16, 2018, at 16:00:46
In reply to Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 16, 2018, at 7:54:22
> Im in the process of transitioning from Marplan to Nardil. Couple days washout (per doc) then right in to 60 Nardil where my doc wants me to stay for a while.
>
> Up until last week I felt pretty good. More talkative than normal, lower social anxiety, mood pretty positive. However the past 6 or so days I've lost that and have been pretty depressed and uninterested in anything.
>
> I had some side effects while I was feeling well (mostly bad urinary retention) but that became much less. I know Im dreaming. I wake early which is a good sign but I've been a bit grumot about doing anything or the prospect this is going to kick in at this dose of 60. I just saw my doc two days ago and was hoping to go to 75mg. Probably next month if I am still depressed.
>
> Maybe I just need someone to tell me its very easy on and Nardil will still help at this point? I guess I figured since marplan should have inhibited lots of MAO that Nardil would be effective quicker.I have lots of things to say about all of this, but not the mental energy to type it out.
I will say this, though. Sometimes, MAO inhibition is not sufficient to produce an antidepressant effect. Selegiline, even at high dosages that become non-selective, is not much of an antidepressant. If MAO inhibition were sufficient, then why do some people respond to Nardil but not Parnate or Marplan? I don't know if Marplan pre-treatment will make Nardil work faster. It obviously does things that Marplan does not. It might be those things that need additional time to elicit a therapeutic response. I don't like that your doctor began treatment at 60 mg/day for reasons related to side effects. Anyway, it is probably time to see if you can tolerate 75 mg/day and then hang out there for another 3-4 weeks before making any decisions. I have seen some people fail to respond to Nardil until they took it for a minimum of 2-3 months. I regard 75 mg/day as being the sweet spot. The blood levels of Nardil verus dosage is exponential and not linear. Nardil interferes with its own metabolism. Therefore, an increase from 60 to 75 is substantially greater than going from 45 to 60. Don't underestimate this drug. The initial "buzz" that you get from it disappears. It is a mistake to chase this feeling for instant relief by over-medicating. If you are patient, you might end up feeling much better - better than the initial buzz.
I question your doctor's decision for you to crossover from Marplan to Nardil without a washout. All that I will say is that serotonin syndrome might occur more readily going from Nardil to Parnate than from Parnate to Nardil - so be careful.
I typed out more than I thought I would.
- Scott
Posted by PeterMartin on February 16, 2018, at 18:28:02
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by SLS on February 16, 2018, at 16:00:46
Thanks for the reply. Im at the eye doc so I may post more after thinking but have you seen this about MAOI washout/crossover?
It's a 2018 study but unfortunately I don't think it's available free:
Monoamine Oxidase Inhibitor Switching Strategies: No Adverse Events Associated With Outpatient Cross-taper or Inpatient Rapid Switch
I didn't mention anything to him but when he said it would be ok I google scholar searched and saw that.
Sorry you aren't feeling great.
Posted by PeterMartin on February 16, 2018, at 22:13:04
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by SLS on February 16, 2018, at 16:00:46
Good to know about Nardil interfering with its own metabolism. That might be reason enough for me to try to stick at 60 and just hope it kicks in. Its odd but today I felt almost like I wanted to feel better but my internal dialogue was saying I feel like crap, I don't want to do this, etc. I'm really hoping I just need a few more days. Not enjoying things is the worst.
I don't foresee calling my doctor before our next apt (month) to go to 75 unless things really dip. I'd hate to go too quick and end up manic... especially if it was me not being patient. Just tough days.
I'm over the washout window now and have moniored my boss throughout (home cuff/no high reading). The dip certainly could have been to the 36hr half life marplan finally running it's course + MAO coming back.
Thanks a lot for your post - always nice to know I'm not the only one deal w all of this.
Posted by PeterMartin on February 18, 2018, at 13:23:42
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 16, 2018, at 22:13:04
It seems to be helping much more today.
Posted by PeterMartin on February 21, 2018, at 9:13:09
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by SLS on February 16, 2018, at 16:00:46
Had a few really good days but seem to have dipped today. Woke up late and finding it hard to motivate. Perhaps that was the initial "buzz". Need to stick w it for a bit to see if it settles in (just under a month)
Posted by SLS on February 21, 2018, at 9:59:50
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 21, 2018, at 9:13:09
Hi.
> Had a few really good days but seem to have dipped today. Woke up late and finding it hard to motivate. Perhaps that was the initial "buzz". Need to stick w it for a bit to see if it settles in (just under a month)
Thanks for the update. I hope you feel better sooner rather than later.
Do you get dizzy? Do you still experience urinary retention? Other side effects?
- Scott
Posted by SLS on February 21, 2018, at 10:04:56
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 21, 2018, at 9:13:09
> Had a few really good days but seem to have dipped today. Woke up late and finding it hard to motivate. Perhaps that was the initial "buzz". Need to stick w it for a bit to see if it settles in (just under a month)
One more thing that is often true. The therapeutic response to antidepressants do not follow a straight line, especially for difficult TRD cases. It can be a bumpy ride. Two steps up and one step back. However, you should see a long-term trend towards continued improvement until you reach a maximum effect.
Good luck.
- Scott
Posted by PeterMartin on February 21, 2018, at 22:22:05
In reply to Re: Hoping Nardil kicks in at 60 (wk3) » PeterMartin, posted by SLS on February 21, 2018, at 10:04:56
> One more thing that is often true. The therapeutic response to antidepressants do not follow a straight line, especially for difficult TRD cases. It can be a bumpy ride. Two steps up and one step back. However, you should see a long-term trend towards continued improvement until you reach a maximum effect.
>This is a good reminder - thanks a lot. I had bad urinary retention early on (about 10days in) along w anorgasmia and increased sweet cravings. All are much less now. I never got the sitting/standing bp drops and my BP is just under normal (110/75 usually). On marplan it used to be real low.
I don't feel "bad" but somewhat deflated and tired today (slept a lot) where I had been happy and motivated.
I'm not sure I mentioned but I did also just start Metformin ER (same time as Nardil) which I suppose could cause some fluctuations.
It's nice to hear the two steps forward / 1 back thing though. Hopefully I tend back the other way. Today was definitely a step back.
Posted by PeterMartin on February 21, 2018, at 22:24:53
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 21, 2018, at 22:22:05
Btw I'm taking it 4 times a day; 6am 8am, 5pm, 8pm. Could there be benefit to take all at once? Doesn't take out the same amount of MAO regardless of peak levels? (I'd assume they'd be higher if I took them all at once)
Posted by SLS on February 22, 2018, at 2:54:26
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 21, 2018, at 22:24:53
> Btw I'm taking it 4 times a day; 6am 8am, 5pm, 8pm. Could there be benefit to take all at once? Doesn't take out the same amount of MAO regardless of peak levels? (I'd assume they'd be higher if I took them all at once)
Is your sleep disturbed? I would consider taking Nardil 3 times a day if it is. 2 @ 6 am / 1 @ 12 pm / 1 @ 3 pm. I don't know any advantage to taking Nardil all at once. In my experience, Nardil acts differently than Parnate. Large doses make me feel weird. I suspect that it upsets the autonomic nervous system. Regardless, it is my suggestion to take Nardil in divided doses.
From the Nardil (phenelzine) monograph:
"
Initial dose: The usual starting dose of NARDIL is one tablet (15 mg) three times a day.
Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly
rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to
90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical
response until treatment at 60 mg has been continued for at least 4 weeks.
"
- Scott
Posted by PeterMartin on February 26, 2018, at 8:43:15
In reply to Re: Hoping Nardil kicks in at 60 (wk3) » PeterMartin, posted by SLS on February 22, 2018, at 2:54:26
Most of the sides seemed worse earlier on but that may have been to no washout from Marplan.
I had three of the worst days of depression I've had in a long time this weekend. Then midday yesterday it seemed to break. I got in to working on an artistic project for a few hours (hadn't been motivated prior) and feel A ton better this morning.
Today is a month and a day on Gavis(Lupin) Nardil 60mg so hopefully this is the true AD effect. It's been Avery bumpy ride. Adjusting to metformin ER might have something to do with it(?) but hopefully I just needed a few more days to get to consistency.
Btw I've become insistant on the brand of generics I've been using of late. I know the common response that the FDA requires them all to be the same etc. I don't find they work the same for me. From trying to find info on Nardil it seems Gavis(Lupin owns) might be slightly more potent. Very few people ever note the brands of meds they try (and either succeeded on or fail on). I think it'd be helpful if more did this. I call pharmacies first to make sure they have or can get particular brands that I find work for me. Anyway my experience noted here is per:
Nardil 60mg (Gavis/Lupin)
Lamictal 150mg (Teva - used for years)
Seroquel 25mg - Sleep only - (Lupin - was on brand pre-generic - Lupin seemed stronger when I switched)
Metformin ER 1500 - Sun Pharma - To try to stave off Nardil Wt Gain. Was on MyLan IR 500x2 for a month - didn't notice much bad or good (wt stable). 2wks on ER by Sun since that's the only brand the pharmacy had / couldn't find a consensus. Would consider trying another generic if I gain a lot of weight over time just to make sure)
Posted by PeterMartin on February 26, 2018, at 13:13:48
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 26, 2018, at 8:43:15
Oh I forgot Nuvigil (Teva) but it I think I'm a nonresponder to it. It gives me a slight boost but I can easily take a nap right after taking it. I've tried a few different generics and also provigil but none seem to help as they seem to people on Reddit (www.reddit.com/r/afinil is a whole group dedicated to those meds).
It actually seems to make me less productive at certain tasks I do for work (slower/less able to just make a decision and move on).
Hoping to get off it at some point but I expect there to be some withdrawal after almost a year. Now probably isn't a good time.
Posted by SLS on February 26, 2018, at 20:38:14
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on February 26, 2018, at 13:13:48
I'm grateful that you are documenting your treatment experiences.
I'm going to ask my doctor about metformin.
- Scott
Posted by Lamdage22 on March 1, 2018, at 7:38:21
In reply to Re: Hoping Nardil kicks in at 60 (wk3) » PeterMartin, posted by SLS on February 26, 2018, at 20:38:14
> I'm going to ask my doctor about metformin
Let us know how it goes
Posted by PeterMartin on March 1, 2018, at 11:50:05
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by Lamdage22 on March 1, 2018, at 7:38:21
It's definitely kicked in the past few days. I feel a lot like I did on Marplan when I responded well to it. I think I'll do better off Nuvigil which seems to just space me out so I'm going to try to wean myself off of that.
My big concern is weight. I started Nardil & metformin in late Jan and weighted 216.9. So far I'm only up to 218.2 but I've hit the gym for at least 20min of bike riding every morning (haven't done that in months). Was hoping to see a drop.
Lamdage can you share which brand (generic manufacturer) or Metformin you take? I've found many comments online saying some brands work and others less so. I was taking MyLan IR but for the past 2 weeks have been taking Sun Pharma ER (1500). I don't really notice it so I hope it's effective.
Posted by Lamdage22 on March 1, 2018, at 12:02:42
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on March 1, 2018, at 11:50:05
> Lamdage can you share which brand (generic manufacturer) or Metformin you take? I've found many comments online saying some brands work and others less so. I was taking MyLan IR but for the past 2 weeks have been taking Sun Pharma ER (1500). I don't really notice it so I hope it's effective.
its a german brand. There are high requirements for generics over here. I dont know about the US. Sun pharma is not bad. Could it be that you got fake medication? i hear Metformin does not work for everyone. I think Metformin is a good example for a really good med. Good luck
Posted by PeterMartin on March 2, 2018, at 0:11:15
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by Lamdage22 on March 1, 2018, at 12:02:42
> > Lamdage can you share which brand (generic manufacturer) or Metformin you take? I've found many comments online saying some brands work and others less so. I was taking MyLan IR but for the past 2 weeks have been taking Sun Pharma ER (1500). I don't really notice it so I hope it's effective.
>
> its a german brand. There are high requirements for generics over here. I dont know about the US. Sun pharma is not bad. Could it be that you got fake medication? i hear Metformin does not work for everyone. I think Metformin is a good example for a really good med. Good luck
>
>Thanks for the reply! I've only been on Sun 1500 ER for 15 days (a month of 1000 IR Mylan prior) Perhaps it's just too early for any potential weight loss. If it keeps my weight neutral I'd be happy. I've only gained a pound and I did cave in to some sugar craving early on. Don't have them at the moment.
Appreciate the reassurance on Sun. I know they make a good generic Provigil.
Posted by Lamdage22 on March 7, 2018, at 1:32:43
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on March 2, 2018, at 0:11:15
It might not work for you the way it does for me. You will have to try.
> Thanks for the reply! I've only been on Sun 1500 ER for 15 days (a month of 1000 IR Mylan prior) Perhaps it's just too early for any potential weight loss. If it keeps my weight neutral I'd be happy. I've only gained a pound and I did cave in to some sugar craving early on. Don't have them at the moment.
>
> Appreciate the reassurance on Sun. I know they make a good generic Provigil.
Posted by PeterMartin on March 10, 2018, at 2:30:01
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by Lamdage22 on March 1, 2018, at 7:38:21
I think the metformin is doing the job of at least keeping my weight stable for now. Haven't gained anything since I started Nardil 7 weeks ago (60mg for 6 & now 75 for a few days). Tmi but I'm going a lot which is really refreshing after years of constipation with Marplan+Lamictal/Etc.
But wow has this been a very bumpy ride. One day I'm great waking up early ready to go to the gym, get breakfast, get to work on the computer then the next (like today) I'm dragging and wanting to head to bed very early to just end the day.
My doctor oked me to go up to 75 3days ago prior to our meeting middle of next week (5days). So far it either hasn't helped or has led to a downturn. I doubt it's hurt per say but my mood has dipped again and I'm back to wondering when it'll "kick in". It's so odd to be great one day and down the next (or a few hrs later). I know it takes time at each dose to get the effects I'm just hoping it starts to be more consistent soon.
Mid-day fatigue seems to be the biggest side effect affecting me. Today it was enough to force me to go take nap. I know that'll prob stick around for a bit but I wasn't really in to anything before the fatigue set in so maybe its partially a result of being down.
I'm pretty sure anorgasmia is in full effect. Haven't even bothered to confirm but that started a day or twl before I went up to 75 (6 weeks or so at 60). Carb cravings/sweets are pretty much gone but that could definitely be metformins magic. I suppose that coidk be messing w my moods too - hard to say since so few people here seem to have trialed it.
I expect to feel better in a day or two but hopefully the next time it'll be because 75 is taking hold. Hopefully it'll be the "sweet spot" that Has been suggested...
Posted by Lamdage22 on March 11, 2018, at 4:49:13
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on March 10, 2018, at 2:30:01
I think i would try to leave the Metformin away for a few days and see if you are more hungry when you dont take it. Otherwise you wont know.
Posted by Lamdage22 on March 11, 2018, at 5:09:39
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on March 10, 2018, at 2:30:01
I often go to bed early to end the day. It comes with depression i guess.
Posted by Lamdage22 on March 11, 2018, at 6:28:15
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by Lamdage22 on March 11, 2018, at 4:49:13
For me the difference was profound.
Posted by PeterMartin on March 13, 2018, at 12:54:57
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by Lamdage22 on March 11, 2018, at 6:28:15
The last few days have bsen really good. I seem to dip a little after my morning dose and gym but I keep reminding myself it's going to be a long process.
I also think the metformin ER (Sun Pharma at 1500) is helping. I has a couple weeks of sweets cravings but that's gone. My appetite the last few days has probably been less than the last few years. I kept myself busy and made it through the day with limited amount. Also using the bathroom a lot daily. On Maprlan (w/o metformin) I would go days w.o. due to severe constipation.
Weight at start of Nardil was 216.9. After 6wks of Nardil(Gavis) at 60 + a few days of 70 my wt this morning was 215.8. it's been as high as 218.7 but so far weight gain (probably thanks to Metformin) hasn't been a problem.
Posted by PeterMartin on March 15, 2018, at 0:52:52
In reply to Re: Hoping Nardil kicks in at 60 (wk3), posted by PeterMartin on March 13, 2018, at 12:54:57
After another down day I tried taking a tiny piece of B6 (~10mg) last night. This morning was difficult. I have poor reaction to vitamins & supplements so I'm not surprised my reaction was negative.
I saw my doctor today (regularly scheduled monthly apt) and I suggested I try ceasing the Nuvigil. It's never provided the awakeness it's supposed to for me. I can sleep right after taking it.
There is a curiously addictive part of Nuvigil that has kept me from dropping it on my own. I've been on it a year and it makes me kinda zone out but I don't get things done. I do think about it in the morning if I try to take a day off though.
Telling my doctor I want off and giving my remainder to my GF to put away should force me to finally give it up. There's a good chance it was holding me back from remission.
I just need to keep waiting and hope that there's more to come from Nardil. Today I was pretty melancholy, unmotivated to do anything, and fatigued.
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