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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by KellyM on December 28, 2002, at 9:01:42
Just wondering if anyone has had any experience with dosages of Nardil beyond 90mg. My best response has been at this level. My doctor seems to believe that after a certain time, you should be able to lower the dose as your body reaches a certain level of mao inhibition(?) Well, after going from 90mg to 75mg I sure can tell the difference-depression is slowly creeping back. I'm through "playing with" 5 pills and going back to 6. This led me to wonder about the higher dose-say 105 mg, if that might be even better (of course with possible increased side effects).
Posted by chad_3 on December 28, 2002, at 12:14:48
In reply to High doses of Nardil?, posted by KellyM on December 28, 2002, at 9:01:42
Hi -
Was curious what is dx? Sounds like at least depression (atypical? endogenous?) - anything else? If you have little anxiety - have you ever tried parnate? Lower doses might work...
Also - as far as higher than 90 I've heard of some going higher than 90 to 105. I have in past gone to 90 nardil for SP - I bet I would have had better results (complete?) at 105 but 90 worked very good anyway.
Chad
> Just wondering if anyone has had any experience with dosages of Nardil beyond 90mg. My best response has been at this level. My doctor seems to believe that after a certain time, you should be able to lower the dose as your body reaches a certain level of mao inhibition(?) Well, after going from 90mg to 75mg I sure can tell the difference-depression is slowly creeping back. I'm through "playing with" 5 pills and going back to 6. This led me to wonder about the higher dose-say 105 mg, if that might be even better (of course with possible increased side effects).
Posted by KellyM on December 28, 2002, at 19:53:59
In reply to Re: High doses of Nardil? What is DX?, posted by chad_3 on December 28, 2002, at 12:14:48
Technically SP with atypical depression, although anxiety really hasn't been a problem. Other meds helped, at least for a time, to lessen depression but Nardil is the only one that really has made me feel "alive". I remember when it started to kick in at 90mg I felt like a new person. The side effects at first were tough but they have gradually lessended to where they're tolerable.
I wondered about the increased dose because it was only at 90mg that I really saw a big difference. I don't know if body weight makes a difference, but I'm over 200 pounds (although I've dieted and lost about 12, knock on wood) and thought that might make a difference. In any event, the conventional wisdom that you can lessen your dosage after a while doesn't seem to work for me. I think it may have been Elizabeth who has stated that this old idea is really not true. I haven't researched it yet, but personally I have to agree.
Posted by djmmm on December 29, 2002, at 11:38:28
In reply to Re: High doses of Nardil? What is DX?, posted by KellyM on December 28, 2002, at 19:53:59
The theory behind lowering your dose after a certain period of time is based on the amount of time it takes for your body to resynthesize MAO.
Irreversible MAOIs form a permanent covalent bond with the MAO enzyme..full recovery from this only occurs when new MAO is synthesized. So, theoretically, after you have achieved significant and effective MAO inhibition, only a "maintenance" dose of a MAOI would be needed.
The problem lies in that MAOIs seem to have immediate effects on neurons, like, in the case of Parnate a driect stimulation of catecholamine release, or, in Nardil's case, direct effecs on the GABA system...so, even though you can keep MAO activity low with a maintenance dose, and get an antidepressant response, If you don't take the MAOI regularly, or the same dose regularly, you lose the immediate effects.
Posted by chad_3 on December 29, 2002, at 15:48:22
In reply to Re: High doses of Nardil? What is DX?, posted by KellyM on December 28, 2002, at 19:53:59
If there isn't much social anxiety compared to atypical depression maybe Parnate would work at lower doses. It is relatively more dopaminergic and noradrenergic vs. serotonergic - compared to Nardil. So lower doses give good DA and NE boost.
Atypical depression (with prominent rejection sensitivity) can be treated with Prozac - but I assume you tried that and I think Parnate is good to try if you have not tried it yet - the MAOI's are probably best for atypical depression overalll - they boost dopamine which reduces interpersonal senstivity, passivity, and fear.
chad
http://www.socialfear.com/
> Technically SP with atypical depression, although anxiety really hasn't been a problem. Other meds helped, at least for a time, to lessen depression but Nardil is the only one that really has made me feel "alive". I remember when it started to kick in at 90mg I felt like a new person. The side effects at first were tough but they have gradually lessended to where they're tolerable.
>
> I wondered about the increased dose because it was only at 90mg that I really saw a big difference. I don't know if body weight makes a difference, but I'm over 200 pounds (although I've dieted and lost about 12, knock on wood) and thought that might make a difference. In any event, the conventional wisdom that you can lessen your dosage after a while doesn't seem to work for me. I think it may have been Elizabeth who has stated that this old idea is really not true. I haven't researched it yet, but personally I have to agree.
Posted by KellyM on December 29, 2002, at 19:52:24
In reply to Re: High doses of Nardil? What is DX?, posted by djmmm on December 29, 2002, at 11:38:28
> The theory behind lowering your dose after a certain period of time is based on the amount of time it takes for your body to resynthesize MAO.
>
> Irreversible MAOIs form a permanent covalent bond with the MAO enzyme..full recovery from this only occurs when new MAO is synthesized. So, theoretically, after you have achieved significant and effective MAO inhibition, only a "maintenance" dose of a MAOI would be needed.
>
> The problem lies in that MAOIs seem to have immediate effects on neurons, like, in the case of Parnate a driect stimulation of catecholamine release, or, in Nardil's case, direct effecs on the GABA system...so, even though you can keep MAO activity low with a maintenance dose, and get an antidepressant response, If you don't take the MAOI regularly, or the same dose regularly, you lose the immediate effects.Thanks djmmm for the explanation. Not to be lazy, but if you happen to know any links or sites which might have more info I'd appreciate it. If not, no problem...you gave be a good start :)
Posted by KellyM on December 29, 2002, at 20:04:15
In reply to Re: High doses of Nardil? What is DX?, posted by chad_3 on December 29, 2002, at 15:48:22
I've tried all the SSRI's and Effexor...nothing special compared to Nardil. I'm holding out on Parnate should Nardil ever stop working. Like you, at 90mg it works pretty well so if I never try a higher dose I'm still pretty happy with the results all told. Nice web site by the way.
Posted by Jumpy on December 29, 2002, at 20:19:09
In reply to High doses of Nardil?, posted by KellyM on December 28, 2002, at 9:01:42
Hey Kelly,
In the medical literature you will consistantly see the figure "1mg per kilogram per day" as approximately dose for nardil. I think what matters most is that you inhibit 80% of the MAOI enzymes ... I think studies have shown this is usually when nardil take effect. I have heard of one patient recieving 120mg per day in the literature. So I would not be concerned with your current dose or even going higher if need be.
Jumpy
Posted by chad_3 on December 31, 2002, at 17:32:23
In reply to Re: High doses of Nardil? What is DX? » chad_3, posted by KellyM on December 29, 2002, at 20:04:15
Kelly -
Glad to hear you like the results. And thank you on your last comment.
I hear a lot of people who like you get very good results with Nardil for SP (also Klonopin). The SSRI's and gabapentin are used far more often and despite their heavy use most all the postive stories to my website are unrelated to SSRI or gabapentin as main treatment. Only Paxil (twice) both time stopped working within 1 year for those reporting good results.
Chad
> I've tried all the SSRI's and Effexor...nothing special compared to Nardil. I'm holding out on Parnate should Nardil ever stop working. Like you, at 90mg it works pretty well so if I never try a higher dose I'm still pretty happy with the results all told. Nice web site by the way.
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