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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by matt66 on August 21, 2003, at 9:18:56
During my first few months of tratment for a chronic depression I had endured for so long, without realizing how depresssed I really was. And then BOOM I try the Nardil and within 48 hours, it answered all my prayers and really showed me how easy life is for those not suffering from mental illnes. The nardil worked great for a month and then seemed to poop out. Subsequent nardil trials have given a brief sense of peace which didn't hold. That was four years ago. Now I've tried every mead out there (TCA, SSRI, MAOI, Lithium, ECT, all the alzhimers meds, and the anti-convulsants as well. I experience brief remission during some of these trials, but none lasting for over a few days, and none giving the underlying sense of peace the nardil gave me (I would classify some of the other meds trials as hypomanic). I recently read a post saying that a person on Manerix (MAOI) felt an initial high, and then had to wait a full 8 weeks for the medecine to start working again, slowly graduating until the full effect can be reached again. Is there any truth in this? So many times I've thought I was getting better, it always backfired. I would like to hear onther people's experience and advice. What I may have experienced on the Nardil was a brief remission period which may have developed into a full response had I stayed on it. My doses of NARDIL on subsequent trials were at 90mg for only a week which was above what the pdr recommends (you can't trust them anyways, they're constantly covering their asses should a person go too high on a med, with the slight possibility that an a potentially dangerous symptom to occur. I could give a shit about that right now. My first hope is that a med will work, and second that I die trying. Should I move on and forget about the nardil or try it one time at a gradully increaed dosage for a long period of time, or is it time to forget the past on Nardil, and just be more patient with other meds.
Much Love,
Matt
Posted by Ame Sans Vie on August 21, 2003, at 12:11:59
In reply to NARDIL- THE ONE THAT GOT AWAY, posted by matt66 on August 21, 2003, at 9:18:56
It's possible that a higher dose of Nardil will work for you, though I'd say unlikely, since I very rarely hear of a medication pooping-out on someone and then starting to work again, even at a raised dosage. I was on 120mg for six months (for social phobia, agoraphobia, panic disorder and depression, primarily) and it didn't work at all for me, unfortunately. But the point is, as long as your prescribing physician is comfortable with it, a higher dose is certainly an option. And if it ends up working, but only partially, you *can* augment with another medication (stimulants seem to work best, though the atypical antipsychotic Zyprexa also show great promise). I know stimulants are "contraindicated", but many people safely take stimulants with MAOIs. You just have to start at a very low dose and titrate upwards very gradually. And of course keep some Thorazine or nifedipine on hand in case of a hypertensive crisis.
And that leads to another possibility -- have you ever tried a stimulant to treat your depression? Or a narcotic pain-killer, for that matter? There are plenty of doctors that are willing to try these options out on you once all else has failed. I too have tried just about every med out there. The only ones I can think of offhand that I *haven't* tried are Parnate, several of the tricyclics, and about a dozen of the antipsychotics. Nothing has ever helped my depression, save a few tricyclics (but the side effects were just to awful to continue them). So I brought in some research to my doctor on the use of Ultram (tramadol, an opioid painkiller that also possesses serotonin/norepinephrine reuptake inhibition qualities) in treating depression and OCD (which I also have, to a moderate degree). To my complete and utter shock and disbelief, he immediately agreed to start me on a trial of it several months ago, and my depression and OCD symptoms haven't reared their ugly heads once since then. Another narcotic that has been studied for use in depression (with excellent results) is buprenorphine, brand name Subutex. Just fairly recently it was FDA-approved in a sublingual form (dissolves under the tongue) to treat opiate addiction, though people have been using the injectable form (Buprenex) either sublingually or intranasally for years before the new form was released. Often though, if a doctor is going to prescribe buprenorphine for depression (or probably just about anything else for that matter), they'll give you a form called Suboxone, which is also sublingual. Same active ingredient, but it also contains naloxone, an opioid-receptor antagonist, to prevent addicts from injecting the pills -- the naloxone prevents the buprenorphine from working and causes withdrawal symptoms when injected. Taken orally though, it doesn't have an effect.
As for the stimulants, many people with treatment-refractory depression respond amazingly well to treatment with methylphenidate (Ritalin, Metadate, Methylin, Concerta) or an amphetamine (e.g. Adderall [dextro- + levo-amphetamine], Dexedrine [dextro-amphetamine], Desoxyn [dextro-methamphetamine]). I take Dexedrine Spansules (the extended-release form of the drug) for my ADHD. I find that occasionally when I miss a dose of my Ultram, the Dexedrine keeps the depression at bay.
Also, you didn't mention benzodiazepines in your post... have you tried them? I know, I know -- they're anti-anxiety drugs, and you didn't mention in your post that you have any issues with anxiety. But several of the benzos are also quite useful in depression -- Xanax, Ativan and Serax in particular. And now that a long-acting version of Xanax has been released to market (Xanax XR), it makes it a lot more practical since it requires only once- to twice-daily dosing. These seem to be the most reliable benzos for treating depression, though some find that Klonopin works better for them. Oh, and a benzodiazepine with antidepressant activity is another option for augmenting an MAOI.
Hmm... what about things that are even a bit *more* off the beaten path? In other words, anti-Parkinsonism drugs -- dopamine agonists. Many people find great relief from depression, increase in libido, and increased motivation and cofidence taking one of these medications. The two that are most likely to help are Mirapex (pramipexole) and Requip (ropinirole). I took Mirapex myself for several months and was thrilled with the results. Unfortunately it began to make me very sleepy at times, so I discontinued it. But if you decide to try one of these meds and that ends up being a problem, Provigil or another stimulant medication could take care of that side effect. Keep in mind that not everyone experiences that side effect, either. Another Parkinson's drug, though you may have already tried it since it's an MAOI, is Eldepryl (selegiline). At lower doses though, it only effects MAO-B, not MAO-A. The result is an increase in available dopamine, and no need to strictly adhere to dietary restrictions. At higher doses however, it inhibits both MAO-A and -B and is said to act similarly to Parnate.
Other than that, all I can think of at the moment is the drug Rilutek (riluzole), the only FDA-approved medication for amyotrophic lateral sclerosis (Lou Gehrig's disease). There are currently studies underway that are testing its efficacy in treating depression and anxiety, and judging solely from its mechanism of action, it looks pretty promising. You may want to research it a bit.
Finally, I really hope you're in therapy -- in the opinions of most medical professionals and patients, medication plus therapy is the only way to go.
~~Michael
P.S. Just thought I'd let you know (I think you're new here -- correct me if I'm wrong) that you're probably going to receive a PBC from Dr. Bob for using certain language in your post. There are some pretty straightforward civility guidelines that help keep this board as relatively safe as it is. You can access those guidelines here:
http://www.dr-bob.org/babble/faq.html#civil
Posted by Caleb462 on August 21, 2003, at 15:48:20
In reply to Re: NARDIL- THE ONE THAT GOT AWAY, posted by Ame Sans Vie on August 21, 2003, at 12:11:59
> So I brought in some research to my doctor on the use of Ultram (tramadol, an opioid painkiller that also possesses serotonin/norepinephrine reuptake inhibition qualities) in treating depression and OCD (which I also have, to a moderate degree). To my complete and utter shock and disbelief, he immediately agreed to start me on a trial of it several months ago, and my depression and OCD symptoms haven't reared their ugly heads once since then.
You are very lucky. I am quite certain my doc would refuse a trial of Ultram. I'm also quite certain every doc in my area would refuse it. Opiods, for me, are the "wonder" drugs everyone is always looking for. Unfortunately, I don't indulge merely for the sake of reducing my psychiatric symptoms (though that is the main reason), I also like to get stoned out of my freaking mind - and I've been flirting with addiction the past couple months, which is scary. Right now I'm trying to stay sober and hope the Nardil will be the psych. drug that will finally work. But fighting the cravings isn't easy, especially when I can get hydrocodone right now... very, very easily and very very free.
Stims are depression lifters as well, yeah... but nothing like the opiods for me. I've never used stims in any kind of controlled manner, but "recreational" use always leaves me feeling bad in the end.>
> Hmm... what about things that are even a bit *more* off the beaten path? In other words, anti-Parkinsonism drugs -- dopamine agonists. Many people find great relief from depression, increase in libido, and increased motivation and cofidence taking one of these medications. The two that are most likely to help are Mirapex (pramipexole) and Requip (ropinirole). I took Mirapex myself for several months and was thrilled with the results. Unfortunately it began to make me very sleepy at times, so I discontinued it.Do you perhaps know why dopamine agonists can cause sleepiness? Pharmacologically speaking...
>
> Other than that, all I can think of at the moment is the drug Rilutek (riluzole), the only FDA-approved medication for amyotrophic lateral sclerosis (Lou Gehrig's disease). There are currently studies underway that are testing its efficacy in treating depression and anxiety, and judging solely from its mechanism of action, it looks pretty promising. You may want to research it a bit.
>Hmm... haven't heard of this I don't think. Care to fill me in?
Posted by MelD on August 21, 2003, at 17:20:06
In reply to NARDIL- THE ONE THAT GOT AWAY, posted by matt66 on August 21, 2003, at 9:18:56
Matt, first - my heart goes out to you. Getting true relief from depression and then losing it is nearly unbearable. Now that you know how you can feel, i know you wont give up trying.
In my opinion, based on my own experience and others who have posted here, i would give the nardil another chance and stick with it. One of our most "famous" posters (who got banned, btw, for language) had the same experience as you and ended up taking Nardil at a lower dose. So you may have to work with it and try augmentations, but it sounds like the one for you. Good luck, Mel
Posted by lawrence S. on August 21, 2003, at 19:46:28
In reply to NARDIL- THE ONE THAT GOT AWAY, posted by matt66 on August 21, 2003, at 9:18:56
Matt, Ive been on Nardil and it is just staring to work after 4 months. Yes I have had fleeting moments of relief before now. Now I am absolutely certain that I am responding.
Another thing: Nardil has an extremely sharp doseage curve threshhold. If I take 90mg a day I get a 90% improvement. If I take one less pill and drop it down to 75mg. a day I get maybe a 30% improvement in symptoms. You HAVE to be very consistent with this stuff. You have to take it for a long time.
Hope you can give it another try. Get well
Lawrence S.
Posted by matthhhh on August 21, 2003, at 20:00:11
In reply to Re: NARDIL- THE ONE THAT GOT AWAY, posted by lawrence S. on August 21, 2003, at 19:46:28
Ive tried all of the ssris - all made me soooo tired. couldnt stand the sedation.
Ive heard a lot of talk about maois like nardil and parnate being effective for people. Are they much different from ssris, i mean, if your tired on the ssri's do maois have any potential?
Posted by Caleb462 on August 21, 2003, at 21:10:31
In reply to Re: NARDIL- THE ONE THAT GOT AWAY, posted by matthhhh on August 21, 2003, at 20:00:11
> Ive tried all of the ssris - all made me soooo tired. couldnt stand the sedation.
> Ive heard a lot of talk about maois like nardil and parnate being effective for people. Are they much different from ssris, i mean, if your tired on the ssri's do maois have any potential?Yup. MAOIs are much, much different than SSRIs. SSRIs have a direct effect only on serotonin, where as the MAOIs effect serotonin, norepinephrine, dopamine, and phenethylamine. As a class, they aren't generally considering sedating, though Nardil can be for some (it has additional effects on GABA). Parnate, due to its combined MAOI + amphetamine-like properties, is quite likely to cause the opposite effect, insomnia.
Posted by Dr. Bob on August 22, 2003, at 0:22:05
In reply to NARDIL- THE ONE THAT GOT AWAY, posted by matt66 on August 21, 2003, at 9:18:56
> they're constantly covering their *sses should a person go too high on a med, with the slight possibility that an a potentially dangerous symptom to occur. I could give a sh*t about that right now.
As predicted, I need to ask you please not to use language that could offend others. Here, that includes words and phrases considered often or usually disparaging, obscene, offensive, or vulgar by Merriam-Webster, which you can now check from the posting page. Thanks,
Bob
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