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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 stargazer2 on June 3, 2010, at 17:51:47
Hi, I started back on Nardil a few weeks ago and my doc also ordered Lithium 600 mg, which I have been on for a week now.
I have noticed that I have absolutely no interest in anything nor do I have any motivation at all. I am spending large numbers of hours doing nothing which I find extremely depressing.
I am unemployed right now and mentally I am not in a good position to work right now but after working like a machine for 2 years straight, I am amazed how poorly I tolerate having idle time and how I am unable to structure my day and find any purpose in life right now.
NOt sure if the Lithium is making me more lethargic and numb, which might be better than the extreme depression I was just coming out of.
For those who are on this combination, any insight you can provided would be apprciated.
Star
Posted by Phillipa on June 3, 2010, at 18:00:18
In reply to Anyone on Lithium and Nardil???, posted by stargazer2 on June 3, 2010, at 17:51:47
Stargazer had to say I'm sincerly glad the depression is lifting. Not a long time on the lithium. Love Phillipa
Posted by atypical on June 3, 2010, at 22:20:18
In reply to Anyone on Lithium and Nardil???, posted by stargazer2 on June 3, 2010, at 17:51:47
Stargazer,
I take Nardil 60mg and Lithium ER 900mg. I took Lithium before Nardil. I found it helped take the edge off the anxiety and reduced depression a bit in combination with another med. I don't think I ever felt dull on Lithium. At higher doses I felt tremors, so the dose was reduced. My level of interest in things is fine. Granted, I'm still not happy, but I'm almost free from depression and anxiety. Happiness will come not through medication but through making the right changes in my life.
Atypical
Posted by SLS on June 4, 2010, at 7:16:26
In reply to Re: Anyone on Lithium and Nardil???, posted by atypical on June 3, 2010, at 22:20:18
> Granted, I'm still not happy, but I'm almost free from depression and anxiety. Happiness will come not through medication but through making the right changes in my life.
I wish more people had your insight.
Happiness is not the opposite of depression or the lack thereof. Many people expect a pill to make them happy when the best that can be expected is that it resolve the affective disorder (depression). Some people then blame the pills for not making them happy and come to the erroneous conclusion that they don't work at all.
- Scott
Posted by stargazer2 on June 4, 2010, at 8:25:22
In reply to Re: Anyone on Lithium and Nardil???, posted by atypical on June 3, 2010, at 22:20:18
Thanks, you're right about happiness. That is a moving target, as I'm not sure I have ever been really happy.
I told my pdoc I remembered being unhappy as a child and this has continued for most of my life. I just accept it when the depression is under control. That was why I chose not to have kids, I could not see putting someone that could potentially have my genetic disposition through what I had gone through in my first 20-30 years of life. The second 20-30 have not improved despite medication, therapy and whatever else I thought might make a difference.
Getting through the next 20-30 is the place I'm at now and is proving to be the most difficult of all. People used to say you're attractive, educated and whatever else, and that was supposed to give me hope and optimism.
Nothing has changed for me and I do not see the purpose of life and never have.
Does anyone else see what I'm saying? Is it all about working, having sex, raising offspring and eating? It seems those are the reasons people fight to live? What else gives people a reason to live or do most people not question this at all?
Posted by Phillipa on June 4, 2010, at 19:54:41
In reply to Re: Anyone on Lithium and Nardil???, posted by stargazer2 on June 4, 2010, at 8:25:22
Seriously I live as I love life although not feeling the best. My hope is that I now find a place for myself in this world. As seriously I absolutely Loved nursing. Very rewarding and I was very good at it and my patients loved me. I used to Dance to get them to laugh in psych. I ran groups that I designed based on the patient population. On other floors as I floated where they needed an RN I could sit on a patient bed and put their arm on a towl on my leg to relax them while starting an IV. Sometimes if on ob-gyn I was allowed to attend Births Even C-sections with approval of parents. I loved to run and excercise, be out doors. Can't do that anymore so searching. Love Phillipa
Posted by stargazer2 on June 10, 2010, at 22:12:43
In reply to Re: Anyone on Lithium and Nardil??? » stargazer2, posted by Phillipa on June 4, 2010, at 19:54:41
YOu have no idea how lucky you are to not experience utter despair and suicidal thoughts on a recurrent basis. I would take anxiety over TRD any day, of course I do not live your life so it's easy for me to say that.
I would go right back to work if I got that much joy out of it, it wouldn't even be a question.
I have always longed for something that could be that fulfilling, and the depression has never, ever allowed me to get to a point in any career where I could enjoy anything for more than a few months before the beast came back and took me down...that is sad...so much time lost to this disease...it sucks that science is so limited in finding real cures or good treatments for so many of us. Suicide becomes an option because the treatment is so poor in targeting each condition.
I saw the ineptitude with the treatment of psych patients where I worked and I have had a very jaded opinion of what the true experts really can do for so many of us. I sought out one of the leading experts at Yale for a second opinion and got a very lukewarm attitude and no confidence that this person had any idea how to manage my depression. IT was so bizarre to feel that if that was the best person to help me figure this out, he was not prepared in approaching my disease and giving me any confidence that he could help me. Literally he come across as more depressed than I did and that really surprised me.
Oh well, life goes on, some days...as long as the depression stays contained...Lithium has helped to squelch the severe suicidal thoughts...just increased to 900 along with 45 mg Nardil...say a prayer or me, I can always use good old fashion faith...it can be better than the latest and greatest meds.
Star
Posted by SLS on June 11, 2010, at 7:43:41
In reply to Re: Anyone on Lithium and Nardil??Phillipa, others, posted by stargazer2 on June 10, 2010, at 22:12:43
> 45 mg Nardil...
I would say that the therapeutic range for severe depression is 60-90mg.
There is a formula that is sometimes used to establish a target dose:
1 mg per kg of body weight
"DOSAGE AND ADMINISTRATION
Initial dose: The usual starting dose of NARDIL is one tablet (15 mg) three times a day.
Early phase treatment: Dosage should be increased to at least 60 mg per day at a fairly
rapid pace consistent with patient tolerance. It may be necessary to increase dosage up to
90 mg per day to obtain sufficient MAO inhibition. Many patients do not show a clinical
response until treatment at 60 mg has been continued for at least 4 weeks."http://www.pfizer.com/files/products/uspi_nardil.pdf
- Scott
Posted by stargazer2 on June 13, 2010, at 20:07:32
In reply to Re: Anyone on Lithium and Nardil??Phillipa, others » stargazer2, posted by SLS on June 11, 2010, at 7:43:41
I will always elect to take the smallest possible dosage of any med, as I have always had extreme sensitivity to meds and I believe many of my failures with drug trials (1989-2007) were due to being given standard manufacturer doses, which caused severe side effects.
I used to take NArdil 15 mg BID in 1987 before it was reformulated by Pfizer and I belive they probably made a change in the absorption rate causing a higher amount of NArdil to give the same effect of the longer lasting "Hard shell" version I took in 1986. Perhaps Pfizer's way to increase revenue by making the drug weaker, thus requiring more pills.
At higher doses Of Nardil I have had peripheral edema and GI severe cramping and constipation. This weekend I'm having a new side effect, hypertension, which I've never had in my life, wondering if it might be related to Nardil and Lithium combo. Do you know anything about that????
It kind of scares me, as for my entire life, I have had to add salt to food to maintain my pressure and push fluids as I can become so lightheaded with medication increases. I was 60/40 2 years ago with trials of NArdil and something else, can remember the combination right now.
Thanks SLS.
Star
Posted by SLS on June 14, 2010, at 4:14:48
In reply to Re: Anyone on Lithium and Nardil??SLS, posted by stargazer2 on June 13, 2010, at 20:07:32
> I will always elect to take the smallest possible dosage of any med, as I have always had extreme sensitivity to meds and I believe many of my failures with drug trials (1989-2007) were due to being given standard manufacturer doses, which caused severe side effects.
Go with what works.
> At higher doses Of Nardil I have had peripheral edema
Not uncommon, unfortunately.
> This weekend I'm having a new side effect, hypertension, which I've never had in my life, wondering if it might be related to Nardil and Lithium combo. Do you know anything about that????
I have not heard of a hypertensive reaction to the combination of Nardil and lithium. No citations appeared on PubMed (Medline) when I performed searches.
What is your BP? What other side effects are you experiencing?
- Scott
Posted by stargazer2 on June 14, 2010, at 16:50:04
In reply to Re: Anyone on Lithium and Nardil??SLS » stargazer2, posted by SLS on June 14, 2010, at 4:14:48
Thanks for doing the Medline search on that combo. My BP was 130/98 and a had a sever headache. The only reason I checked my BP was that I was checking my husbands who has HTN and I though what the heck, I'll check mine too.
The other thought was that I perhaps ate something that triggered a tyramine reaction but not sure if that was the case but I suppose it could have been. The only change in my situation was I had increased the Lithium from 300 hs to 600 hs, so that is why I figured that was the cause and it was a one time dose of 600.
My mother told me today she thinks my mouth was drooping at the time but didn't mention it to me as she did not want to worry me...she revealed this tidbit of info today, 2 days later. I saw my doc today and mentioned this to him and he was a bit concerned.
Now my doc says I'm a tad hypomanic and put me back on the higher dose of Li. I told him I was too nervous to take 600 all at once so we agreed I would increase my hs dose to 450 and keep my am dose at 300 for 2 days and then go to 450/450. He's really concerned about this mania and said if is is not controlled I could crasah an dburn again...I am so scared. It never stops, one thing after another, just when I was feeling better on the combo too. Slight hypomania is fine with me as I've been really depressed for a few months with no relief.
Life sucks doesn't it.
And I've never been labeled bipolar, so don't even go there as I will just give up if that comes up after 26 years without that diagnosis.
**Star
Posted by Phillipa on June 14, 2010, at 19:37:44
In reply to Re: Anyone on Lithium and Nardil??SLS, posted by stargazer2 on June 14, 2010, at 16:50:04
Stargazer that Bp isn't that high. Not to demean your concerns. But what symptoms led the doc to diagnose the forbidden word? Phillipa
Posted by stargazer2 on June 15, 2010, at 6:49:58
In reply to Re: Anyone on Lithium and Nardil??SLS » stargazer2, posted by Phillipa on June 14, 2010, at 19:37:44
Nothing was diagnosed, so not sure what you are talking about?
My BP is typically 100/600, so this was significant as I had a whopper of a headache and some possible mouth drooping, as per my mother's observation of me.
I know it's not what one would call excessively high but 98 as a diastolic is certainly a concern with the other symptoms. The only other time I had a real BP concern was with a tyramine reaction and I was 210/110, on the bathroom floor taking Nifedipine sublingually, small squirts at a time and rechecking BP until it stabalized.
You know I hate doctors/hospitals and did not want to go to that big useless hospital near me, despite it's claim of being one of the best...I don't think so, Having worked there, so I self treated and avoided that whole scene. It was the right thing to do as they do not know how to treat a MAO/tyramine reaction and you can end up with worse troubles, besides their specialty in the ER is GSW's.
This is the end of the thread.
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