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Re: Hoping Nardil kicks in at 60 (wk3)

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

Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw




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