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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Mark Clement on January 31, 2000, at 15:25:59
I have been taking Nardil at a relatively high dose (90-105 mg/d)for several years. During most of my time on this med I have experienced moderate, though inconsistant, relief of depressive and anxious symptoms. Briefly, the most uncomfortable symptoms are squelched, yet others (anhedonism, apathy, concentration problems, et al) have persisted to varying degrees. At certain times I feel almost normal (although, I must admit, I'm not quite sure what constitutes "normal", since I have been depressed for some fifteen years now). This mood invariably passes within a day or so, and I end up having to wrestle with the return of the other symptoms .There seems to be no explicable reason for this change; even my psychiatrist says he doesn't know why I react to Nardil the way I do.
Now here's the crux of my posting: I am growing impatient with a partial response, and feel adverse to the idea (my psychiatrist's suggestion)that I try another med. I've been through more than a half dozen already, and nothing, save the Nardil, has given me the slightest relief from symptoms. Beyond this, I HATE the feeling of being off of this med. Since my Doc will not mix other antidepressants with MAOIs, it seems I may have to seek treatment elsewhere. If this comes to pass, I will need a referal. I can't say if my present psychiastrist will abide by such a request. Any suggestions regarding the referal or the med situation??
Posted by judy on January 31, 2000, at 16:57:11
In reply to Polypharmacy options with Nardil, posted by Mark Clement on January 31, 2000, at 15:25:59
Mark,
I have no experience with Nardil, since MAOI's are contraindicated with my dx. What I do have is experience with changing shrinks- I know how incredibly difficult it is once you've established a trusting relationship to end it. It's pretty obvious though that you are suffering and your present pdoc is either not knowledgeable enough about pharmacology or perhaps a little too egotistical to listen to your suggestions, (been there too). Anyway, I went through 6 pdocs in a period of 3 months. Initially, I looked at Dr. Ivan's site (if you are in a large city) he lists the leading pdocs. My best source was the University located in my city, they have many renowned and published psychs; if one wasn't taking a patient- I asked for a referral. Also you might want to ask the forum if someone can recommend a doc in your city. Just be really picky this time, ask if they are familiar with treatment- resistant depression and current trends in meds. I thought initially that a younger psychiatrist would be on top of things, but that wasn't always the case. If you don't have a local University, call a good psychiatric hospital and ask for a referral. And remember, you are the client and your opinion should be a valued part of your treatment. Best of luck.
Posted by Cam W. on January 31, 2000, at 18:47:10
In reply to Polypharmacy options with Nardil, posted by Mark Clement on January 31, 2000, at 15:25:59
> I have been taking Nardil at a relatively high dose (90-105 mg/d)for several years. During most of my time on this med I have experienced moderate, though inconsistant, relief of depressive and anxious symptoms. Briefly, the most uncomfortable symptoms are squelched, yet others (anhedonism, apathy, concentration problems, et al) have persisted to varying degrees. At certain times I feel almost normal (although, I must admit, I'm not quite sure what constitutes "normal", since I have been depressed for some fifteen years now). This mood invariably passes within a day or so, and I end up having to wrestle with the return of the other symptoms .There seems to be no explicable reason for this change; even my psychiatrist says he doesn't know why I react to Nardil the way I do.
> Now here's the crux of my posting: I am growing impatient with a partial response, and feel adverse to the idea (my psychiatrist's suggestion)that I try another med. I've been through more than a half dozen already, and nothing, save the Nardil, has given me the slightest relief from symptoms. Beyond this, I HATE the feeling of being off of this med. Since my Doc will not mix other antidepressants with MAOIs, it seems I may have to seek treatment elsewhere. If this comes to pass, I will need a referal. I can't say if my present psychiastrist will abide by such a request. Any suggestions regarding the referal or the med situation??Mark - Your doctor is correct not to mix your MAOI with other antidepressants. Mixed with TCAs, SSRIs or the newer agents can cause nasty side effects like hyperthermia (increased body temperature), rigidity, myoclonic movements (severe convulsions) and death. Sounds to me like your doc does care. The only other thing you might try if you are unwilling to try other antidepressant (possibly with augmenting agents) is electroconvusive therapy (ECT) or transcranial magnetic stimulation (TMS).
The TMS is probably not going to work, but I have seen wonders done with an ECT course. Don't have a knee-jerk reaction to ECT. It is not like in "one Flew Over The Cuckoo's Nest" or "The Snake Pit". Today's ECT is safe and effective in the old-old (>75yrs.) and in pregnancy. Maybe ask your doc about these. Sincerely Cam W.
Posted by Mark C. on January 31, 2000, at 21:50:38
In reply to Re: Polypharmacy options with Nardil, posted by Cam W. on January 31, 2000, at 18:47:10
Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
Posted by Cam W. on January 31, 2000, at 22:08:33
In reply to MAOIs c/ other antidepressants, posted by Mark C. on January 31, 2000, at 21:50:38
> Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
Mark - Thanks for the info. Work closely with your doctor and share your research with him/her. If you are willing (and it sounds like you are) your doctor should be open to trying a polypharm approach. Sorry to hear about your ECT experience. Good luck and keep us posted on your progress, we would all be interested. - Cam W.
Posted by Cam W. on January 31, 2000, at 22:12:19
In reply to Re: MAOIs c/ other antidepressants, posted by Cam W. on January 31, 2000, at 22:08:33
> > Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
>
> Mark - Thanks for the info. Work closely with your doctor and share your research with him/her. If you are willing (and it sounds like you are) your doctor should be open to trying a polypharm approach. Sorry to hear about your ECT experience. Good luck and keep us posted on your progress, we would all be interested. - Cam W.
Mark - One more thing, if your doctor still refuses to do the polypharm after you show him the research, ask him why he/she is reluctant and tell him you will sign a waiver absolving him in case of any serious event. If you and your doc work together there should be little chance of a problem. - Cam W.
Posted by jd on February 1, 2000, at 0:38:27
In reply to Re: MAOIs c/ other antidepressants, posted by Cam W. on January 31, 2000, at 22:12:19
Mark,
I can understand your frustration--it seems like some people ONLY respond to an MAOI, and if the response is partial, it's natural to want to augment it in some way.You're also absolutely right that, under proper supervision, certain meds can be mixed with MAOIs--it must be doubly frustrating to have a doctor who refuses to acknowledge this. Especially with TCAs, however, I do believe it's easier and safer to add an MAOI to an existing regimen than the other way around.... Provided you can find a doctor who's willing to actually work with you, you might also want to look into augmentation strategies that are a little less orthodox. (This is also suggested by the fact that most other ADs you've tried haven't helped, though I'm unsure if you've tried mood-stabilizers too.) For example, I've seen one person on this board mention successfully augmenting an MAOI with the beta-blocker pindolol. Going yet farther afield, on the "tips" part of this site, Dr. Lee Dante mentions that he has at least once tried the opioid-blocker naltrexone as an augmentation strategy with Nardil. While he says the results were rather mixed for this particular person, naltrexone seems to have a good track record as an augmentation strategy in refractory, chronic depression, especially when presenting with apahthy and anhedonia. (The best results seem to be as an add-on to SSRIs.) So this is something you might look into as well, though I suppose one might want a little more assurance that naltrexone is safe with MAOIs in the first place.
Good luck to you, whatever your decisions. May you find a doctor who's keeping up with the literature!
best,
jd> > > Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
> >
> > Mark - Thanks for the info. Work closely with your doctor and share your research with him/her. If you are willing (and it sounds like you are) your doctor should be open to trying a polypharm approach. Sorry to hear about your ECT experience. Good luck and keep us posted on your progress, we would all be interested. - Cam W.
> Mark - One more thing, if your doctor still refuses to do the polypharm after you show him the research, ask him why he/she is reluctant and tell him you will sign a waiver absolving him in case of any serious event. If you and your doc work together there should be little chance of a problem. - Cam W.
Posted by Stephanie L. on February 1, 2000, at 12:49:26
In reply to Re: MAOIs c/ other antidepressants, posted by jd on February 1, 2000, at 0:38:27
> Mark,
> I can understand your frustration--it seems like some people ONLY respond to an MAOI, and if the response is partial, it's natural to want to augment it in some way.
>
> You're also absolutely right that, under proper supervision, certain meds can be mixed with MAOIs--it must be doubly frustrating to have a doctor who refuses to acknowledge this. Especially with TCAs, however, I do believe it's easier and safer to add an MAOI to an existing regimen than the other way around.... Provided you can find a doctor who's willing to actually work with you, you might also want to look into augmentation strategies that are a little less orthodox. (This is also suggested by the fact that most other ADs you've tried haven't helped, though I'm unsure if you've tried mood-stabilizers too.) For example, I've seen one person on this board mention successfully augmenting an MAOI with the beta-blocker pindolol. Going yet farther afield, on the "tips" part of this site, Dr. Lee Dante mentions that he has at least once tried the opioid-blocker naltrexone as an augmentation strategy with Nardil. While he says the results were rather mixed for this particular person, naltrexone seems to have a good track record as an augmentation strategy in refractory, chronic depression, especially when presenting with apahthy and anhedonia. (The best results seem to be as an add-on to SSRIs.) So this is something you might look into as well, though I suppose one might want a little more assurance that naltrexone is safe with MAOIs in the first place.
>
> Good luck to you, whatever your decisions. May you find a doctor who's keeping up with the literature!
>
> best,
> jd
>
>
>
> > > > Thanks for the responses. First off, I am aware of the potential risks of mixing MAOI's c/ other meds. However, there are two important points I failed to mention in my initial posting; MAOIs have been safely and effectively taken concurrently with drugs such as Lithium, Wellbutrin, some TCAs, and others as well (see Ask an Expert-Mental Health, or Dr. Goldberg's site for relevant info). As far as ECT is concerned, I did have a brief trial four years ago. The results were, to say the least, undesireable-I experienced visual hallucinations without the benefits of symptom relief. Furthermore, I think I have gotten all I'm going to get out of taking Nardil straight up. Consequently, I am opting to proceed with the polypharmacy approach.
> > >
> > > Mark - Thanks for the info. Work closely with your doctor and share your research with him/her. If you are willing (and it sounds like you are) your doctor should be open to trying a polypharm approach. Sorry to hear about your ECT experience. Good luck and keep us posted on your progress, we would all be interested. - Cam W.
> > Mark - One more thing, if your doctor still refuses to do the polypharm after you show him the research, ask him why he/she is reluctant and tell him you will sign a waiver absolving him in case of any serious event. If you and your doc work together there should be little chance of a problem. - Cam W.Mark:
I've been on MAOIs for 17 years -- they weren't perfect, but they helped a lot. Five years ago, I sunk into a deep depression and tried many medications and medication mixes. What finally worked? Nardil, protryptaline (a TCA), Wellbutrin, dexedrine, and resperdal -- all together.I was able to do this because I was with the only good psychopharmacologist in town. By the time I got to him, I had already tried 7 other psychiatrists, whose knowledge and experience seemed limited to SSRIs.)
I also did a lot of reseach on mixing MAOIs with TCAs. I found a book on medications at the med school library here, and I came across a book which had a lot about mixing these drugs.
(The author was very experienced in doing it.)My doctor and I did a phone consultation with him, in which he talked favorably about mixing TCAs and MAOIs, and about all the evidence that said it was okay.I have had no side effects at all from the mixture I am currently on. Also important is the fact that protryptaline was the only TCA that worked for me --- I tried several others, but they really sedated me ( a side effect that never went away.) I head read somewhere that protryptaline was, unlike the other TCAs, an energizing drug. And for me, it was.
Stephanie L.
Posted by Kim on February 6, 2000, at 3:04:20
In reply to Re: MAOIs c/ other antidepressants, posted by Stephanie L. on February 1, 2000, at 12:49:26
Mark--
I'm currently taking Parnate (MAOI) in combination with dexedrine, Visken (pindolol), and temazepam. We've tried adding in lithium, risperdone, ambien, and ritalin but they didn't help. I haven't had any side effects with the combination I'm currently on. Unfortunately, I've moved to a new state and my new doctor doesn't approve of my current combination (which I've been on for about 2 years) and so he's making me discontinue them, inspite of everything I've copied from this site and other sites.
Kim
Posted by Noa on February 6, 2000, at 11:25:45
In reply to Re: MAOIs c/ other antidepressants, posted by Kim on February 6, 2000, at 3:04:20
Did your new doctor make an effort to contact your previous doctor before deciding to take you off a combo that worked for two years?
Posted by michael on February 6, 2000, at 14:26:11
In reply to Re: MAOIs c/ other antidepressants, posted by Noa on February 6, 2000, at 11:25:45
> Did your new doctor make an effort to contact your previous doctor before deciding to take you off a combo that worked for two years?
Or might your previous doctor be able to refer you to someone, who might be more in tune with his line of thinking? Good luck.
michael
Posted by Kim on February 7, 2000, at 0:30:54
In reply to Re: MAOIs c/ other antidepressants, posted by michael on February 6, 2000, at 14:26:11
> > Did your new doctor make an effort to contact your previous doctor before deciding to take you off a combo that worked for two years?
>
>
>
> Or might your previous doctor be able to refer you to someone, who might be more in tune with his line of thinking? Good luck.
> michaelThe new doc did talk to the old one (otherwise I think he would have just taken me off them cold turkey instead of adjusting them gradually). I think the new doc is more concerned about his reputation--doesn't want to do anything "unconventional." Even the pharmacy here refused to dispense the combination until they had talked to doctor--even after I assured them that I was well aware of the theoretical risks and knew how and what to monitor for.
As for another doc, it all comes down to insurance. They tell me who I can go to and how often and for how long. (Don't even get me started on insurance coverage for "mental" illness!)
I do have a very good therapist though, and know he will be willing to intervene with the doc if I get too bad--he has called him before when I've had medication problems.
Kim
Posted by Noa on February 7, 2000, at 5:29:24
In reply to Re: MAOIs c/ other antidepressants, posted by Kim on February 7, 2000, at 0:30:54
I don't take an MAOI, but out of curiosity, I asked my pdoc at my last appointment if he ever combines them with anything else, and he said yes.
This is the end of the thread.
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