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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by frank_23423 on January 21, 2019, at 20:07:12
Long story short - I have varied between Nardil and Parnate for almost 20 years. Neither has been perfect, but they've given me my life back when all else had failed.
Have been on Nardil at about 60-90 mg for some 5 years straight, which is probably the longest stretch on either med for me.
Over the years, I've hated the weight gain, sexual problems, etc of Nardil and have tried to come off it several times, usually going back on it after hitting rock bottom a few months later. Note that I've never had a problem with restarting either Nardil or Parnate after waiting two weeks or so, and usually I'd ramp up to my effective dosage pretty quickly after a few days of low doses.
About 3 months ago, I decided to taper off Nardil slowly in order to try Cymbalta as it wasn't one of the ones I tried many years ago. I took my last 15 mg mid November, and by that time I was in pretty bad shape - heavy depression, lying in bed all day, ignoring all contact with the outside world, sporadic hours of sleep here and there, isolated, etc. But I wasn't concerned because I knew I could always just go back to Nardil and get better in a few weeks.
Washed out two weeks and took my first 60 mg of Cymbalta. 2 hours later I woke up to the worst panic attack I've had in about 20 years.
Over the next two weeks I tried to take very small amounts of duloxetine, and anytime I'd get up to about 20 mg which is the minimum starting dose, I'd wake up to terrifying delrealization / panic. By this time, I was obviously not only depressed but severely anxious.
Threw in the towel on Cymbalta and decided it was time to go back to Nardil and throw Cymbalta into the ever-growing pile of failed AD drugs.
Waited a week for the last of the Cymbalta to wash out and began Nardil with the plan to work my way up to 75 mg or so over the next two weeks.
About three days at 15 MG, three more days at 30 MG, and then, on the 7th evening, finally worked my way up to 45MG.
Woke up a few hours later with yet another massive panic attack that seemed to drain whatever remaining amount of 'happy chemicals' were left in my brain.
Though I'd been in bed for the past three months nearly 24/7, I now couldn't sit still. I was pacing back and forth, waiting for more panic attacks, couldn't concentrate, watch tv, read a book, racing thoughts, terrified. It is very traumatic even thinking about it over two weeks later.
Went to urgent care and got 3 days of Xanax to get me through till an appointment with my GP who told me to again start taking 30 MG Nardil and 0.5 mg Klonopin "as needed".
I tried to only use the klonopin at night, but every time I went up to 30MG of nardil, I'd get more panic attacks now even during the day, more racing thoughts, awful suicidal thoughts.
Finally got an appointment with a PDOC who I've only met once for an initial consult, and he told me to go back to 15MG of Nardil, take 1.0-1.5 of klonopin as needed to 'get some breathing room' from the panic attacks.
5 Days of 15MG of Nardil and 1.5 MG Klonopin have kept the panic attacks and racing thoughts at bay for now, but the depression is now pretty bad as I feel hopeless. The drug I need the most right now has turned against me, and I'm deathly afraid of now adding a Klonopin addiction to my list of problems by the time I ever get up to the 45-60 MG at a few weeks I'll likely need to (hopefully) no longer need benzos for anxiety. The depression may take longer, but who knows as I was only off of Nardil for a few months and may respond far more quickly than someone who has never used it.
Today I've moved up to 22.5 MG of Nardil along with the 1.5 MG of Klonopin, and we'll go from there in a few days.
I feel I'm at the lowest I've been in 20 years, if not ever.
Any advice would be appreciated. Especially with regard to how much Klonopin is too much, how aggressive I should be in moving up dosages, etc. I feel like my life has literally unraveled in the past three weeks.
Posted by frank_23423 on January 29, 2019, at 18:11:11
In reply to Restarting Nardil causing major panic attacks, posted by frank_23423 on January 21, 2019, at 20:07:12
Just an update for anyone who is later browsing for 'nardil' or 'phenelzine' experiences.
One week later (though it seems like an eternity):
Worked my way up to 30 MG of Nardil for the last week and 1MG of Klonopin. I've also added hydroxine for the anxiety - seems to kind of work by just slowing me down (including my racing thoughts, which is what I need).
Just took my final 15MG today making this the first day back on 45 MG which is where everything started to go wrong.
Have been exercising and getting sunshine and spending time with my family while taking work leave, so if this causes another major anxiety event like it did last time, I'm throwing in the towel on the Nardil and will be looking for ECT as I have few options left and don't have it in me to go through the months of trying the tricyclics and the few SSRIS and other drugs I didn't try years ago.
One thing a psychiatrist at an outpatient group I'm attending mentioned was that maybe it wasn't the Nardil that was causing the problem in the first place. I was already having panic attacks on the Cymbalta and maybe I had just associated the fateful few days of ramping up the nardil to the meltdown.
We'll see in a day or two, I suppose...
I have a theory that my GABA system is just really f*ck*d up. I was drinking pretty regularly for the last 10 years which I abruptly stopped when I tapered down the Nardil (when I'm depressed, I don't even have the energy to go to the local bar or drink at home as I have always done). There are reports of long term drinkers suddenly developing panic disorder after going sober. Who knows.
Posted by SLS on January 29, 2019, at 20:35:33
In reply to Re: Restarting Nardil causing major panic attacks, posted by frank_23423 on January 29, 2019, at 18:11:11
Hi.
I have no advice for you at the moment, but I just wanted to wish you luck. I hope things work out with Nardil.
Have you ever tried Marplan? Its side effects milder than Nardil.
How would you describe the differences in what you experience between Parnate and Nardil?
- Scott
Posted by PeterMartin on February 6, 2019, at 2:16:06
In reply to Re: Restarting Nardil causing major panic attacks » frank_23423, posted by SLS on January 29, 2019, at 20:35:33
> Have you ever tried Marplan? Its side effects milder than Nardil.
>Unfortunately, Marplan is STILL not available in the United States at this time. The only place it is available is in Denmark. Hopefully anytime now but we're coming up on a year. The delay is really taking a toll on me as Nardil has worked nearly as well for me (but I do not want to hijack this thread). Just saying it's not an option at the moment.
Posted by frank_23423 on April 30, 2019, at 15:58:05
In reply to Re: Restarting Nardil causing major panic attacks » frank_23423, posted by SLS on January 29, 2019, at 20:35:33
> How would you describe the differences in what you experience between Parnate and Nardil?
They both work similarly for depression - keep me out of pits of despair and suicidal, and just kind of turn off all my emotions, allow me to get some enjoyment out of work and hobbies, socializing, etc. Neither of them really make me 'happy' but I don't think any drug (except for cocaine, amphetamines, etc in the short term) is possible of doing that.
Parnate has less side effects, especially with regard to weight gain. It is a bit more activating.
Nardil is much worse for carb cravings and weight gain, but much more calming. If you have general anxiety, social anxiety, panic attacks, etc then Nardil is what you want.
Posted by frank_23423 on April 30, 2019, at 16:31:58
In reply to Re: Restarting Nardil causing major panic attacks, posted by PeterMartin on February 6, 2019, at 2:16:06
Just a three month followup:
Wow what a ride.
In late January, after taking a leave from work, moving out of my apartment and moving in with family, I had worked my way up to 60 mg of Nardil in a partial hospitalization program.
After a few nights of terrible insomnia, I decided (regretfully looking back :/) to stop the Nardil and try something else. Because I was on 1mg of Klonopin, I didn't realize how much the Nardil actually did help my anxiety which has evidently gotten worse over the years, but was masked by the meds. Very bad idea.
At the urging of family, I voluntarily went into a psych ward at a local hospital via the ER with suicidal ideations. After two days in the psych ward, I voluntarily checked myself out as it really wasn't helpful.
At this point I was on only 1mg of Klonopin and was started on 1000 mg of Depakote with a shiny new diagnosis of BP2. Now I remember why I gave up on psychiatrists many years ago and just tolerated MAOIs from my GP. Not a big fan of all the diagnoses and cocktails that psychiatrists tend to use.
I eventually decided to go through ECT at a good hospital in my area as it was covered by insurance. After 11 bilateral sessions, I threw in the towel due to the severe memory loss and other cognitive issues. As expected, the last six months is now a haze.
The ECT probably did pull me out of the dark depressive pit I was in, but along with the cognitive issues, jacked up my anxiety to levels I've never before experienced.
Though a little less depressed, I was now having daily panic attacks, constant racing thoughts, and starting to become agoraphobic which was a first for me. Awful experience.
Once again, I returned to Nardil.
In the last month, I've titrated up to 90mg. Once I got up to 75mg, the panic attacks, racing thoughts, and most of the anxiety were gone.
I'm now able to get out of bed for most of the day, and asked my employer if I could return to work in a few weeks. I'm slowly returning to my old self; while not ideal, it is 100X better than the hell I experienced the past few months. I'm seriously thinking of tattooing the Nardil molecule on my arm to remind me to NEVER again decide to come off the MAOIs. Every time, it has ended in disaster. I only pray they don't poop out in the next 40 years, or cause some sort of serious side effects (like Liver damage or hypotension) where I'm forced to switch.
I now have a psychiatrist for the first time in many years who will pretty much go along with whatever I suggest as he has no experience with MAOIs, but apparently trusts me.
I'm thinking of trying an additions such as low dose amphetamine or Seroquel or Lamictal or maybe Nortryptaline to work on the numbing anhedonia / depression, but we'll see. I'm off the Depakote - the last thing I need is more weight gain, and I don't believe I'm actually bipolar as I've never had 'hypomania' other than racing thoughts and agitation. I believe this is more anxiety related.
I don't touch the benzos anymore as I've read enough addiction and withdrawal horror studies over at benzobuddies and Reddit to convince me they're a bad idea long term. I limit myself to Ambien once a week, and might use low dose Seroquel once a week if the insomnia gets worse.
My memory has improved over the last month, but I still feel the ECT left me with some cognitive issues. Hopefully, they'll get better in the next few months.
Although some people swear that ECT is the only thing that works for them, I do not feel it was very helpful. Nor was it the nightmare others claim - I did not lose the last 30 years of memories. Like meds, YMMV.
I'm in the US and my insurance has been pretty good about covering most of the bills without issue. After it's all said and done - PHP program for a week, 48 hours in the psych ward and ER visit, sleep study, half a dozen worthless counseling sessions with various crisis teams, a few meetings with psychiatrists, and 11 ECT sessions with anesthesia, and a lot of meds, I'm out of pocket about $10K with the next 6 months mostly covered 100% as I've met my deductibles. I will be stocking up on Nardil and trying to take care of all other less serious medical issues I've put off over the years.
This is the end of the thread.
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