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Dr. Bob is Robert Hsiung, MD,
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Posted by jono_in_adelaide on April 18, 2013, at 17:45:09
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 6:47:08
> when i was in the Maudsley hospital, they told me it was better to stick to one medication if possible - and now Im already taking two, plus oxazepam for sleep.
----> Thats very true, but the key words are "where possible" - in your case, it isnt possible right now
I'd drop the Seroquel and substitute the nortriptyline taken in a single dose at bedtime
Have you had good experiences adding noritryptiline?
I looked it up and it is an ssri, so I would have thought it would be contraindicated for use with an maoi?
-----------> Nortriptyline is a tricyclic, not an SSRI, it has been commonly used *ss a booster with MAOI's and SSRI's for decades, it mainly works on noradrenalin, with minimul effects on seretonin reuptake
Posted by rose45 on April 18, 2013, at 18:04:38
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by jono_in_adelaide on April 18, 2013, at 17:45:09
is noritryptiline good for sleep ? Why would you stop the seroquel ? I just ask because my psychiatrist seems to be very keen on seroquel,and says he wants to keep me on it to stop me going manic on the parnate. I cant say ive felt much benefit from the seroquel, apart from helping with sleep, but in a strange kind of way.
Posted by jedi on April 18, 2013, at 23:11:59
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 18:04:38
Hi Rose, we are similar in a lot of ways. I have been on Nardil for most of 15 years. No combination of other meds (45+) has ever worked for me. I have stopped Nardil at least a half dozen times over the years, the major depression has always returned. I am lucky in that going back on Nardil has always stopped the major depression. I have had a level of dysthymia since my teenage years, and this has never gone away. But at least Nardil stops the major depression for me.
I was hypomanic, maybe manic, the first time I used Nardil in 1998. I made some very bad financial decisions at the time. Luckily, the mania went away, and has never returned; even after restarting Nardil after 9 months off.
I have some memory impairment also, I blame this mostly on the concurrent use of of clonazepam. I am currently in a very slow taper off the benzo, down to .5 mg per day.
I have been on every medication that you mention in your posts. I have taken Seroquel with Parnate. Unfortunately, for me, Parnate caused a rare spontaneous hypertensive reaction. So that trial ended. I have also used Nortriptyline in combination with Nardil. This can work well in some people, but for me, it did not really add very much.
Seroquel is an atypical antipsychotic, which in low doses, can work very well for sleep. Your Dr. is right in that it can help stop a med induced hypomania or mania. I believe that atypical depression does lie somewhere on the bipolar spectrum, and that is why we can be vulnerable to the med induced mania. Just my opinion. It is strange to me why the mania has never returned after it hit me when first starting Nardil. I'm wondering if the formula change in 2003? had something to do with it?
I am so sorry that the Nardil quit working for you. The MAOIs are a category of meds that can work for major depression when all others fail. Good luck with the Parnate. I know how painful major depression is. Worst pain I have ever had, including all physical pain!
Good luck and be well,
Jedi
Posted by rose45 on April 19, 2013, at 13:41:58
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 18, 2013, at 23:11:59
Thank you all, and especially Jedi for that long and detailed explanation. When I was on Nardil, I would take the dose up to 60 mg and stay on that for one month or so, and then go down to 45 mg, which was supposed to be my mainteance dose.But because of the side effects etc... I was always trying to reduce it slightly, and for the last 4 years, actually managed ok on 30mg per day... so there were minimal side effects, and i didnt need to take sleeping meds, as I managed to sleep ok. But the tendency to get manic, talk too much, get irritable etc, was always there.
The psychiatrist I am seeing on the NHS is being very flexible and agreed to put me on parnate, although he doesnt seem to know anything about maois. Is there anyone on these boards who knows a psychiatrist in London who does know about them ?I ve been told i can apply to the maudsley for a second opinion, but it would cost £600 for a 2 hr appt. and Im not sure they would have that much to add.The younger doctors seem to not know maois at all. Im on 30 mg parnate now..... they are stimulating and Im wondering if I could ever manage to sleep without sleeping pills, whilst on parnate. According to my psychiatrist, 30 mg is a therapeutic dose, though I notice that the americans on this board take much larger amounts. I still have no memory and my cognitive skills are zero, and I still couldnt work, but my mood has lifted, although Im still as spacy, and dont really feel myself. If this medication does work, how much longer should I give it ?I also take 100 mg seroquel at night and 50mg extended release, and am wondering if I should try to get off it, as maybe it is adding to the very spacy , passive, and unmotivated mood I am in. The one thing I remember about nardil is that once it worked, I became very motivated. The psychiatrist doesnt believe that its just the medication that stopped working, but it was also the kind of late mid life crisis I was going through. All I know is that when nardil worked at the beginning, I went through so many crises, but was able to see them through, thanks to the medication. Maybe sometimes its hard to know what is due to the illness, and what is due to the medication.
Posted by baseball55 on April 19, 2013, at 19:23:36
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 19, 2013, at 13:41:58
I take 30mg parnate a day and that is enough for me. My doc won't prescribe high doses and I haven't felt I needed them. However, even after 3-1/2 years, insomnia is still an issue and I need sleep aids. I use xanax and trazadone and those seem to put me out most nights. When I've tried to go without, I don't sleep at all. Insomnia is the only lasting side effect I have from parnate. Others -- like postural hypotension -- went away after several months on the drug.
Posted by rose45 on April 20, 2013, at 18:51:01
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by baseball55 on April 19, 2013, at 19:23:36
I dont like the idea of having to depend on a benzo forever, which taking parnate implies.
Also, noone has mentioned severe cognitive difficulties, which I have had since the nardil stopped working. I literally have no memory, and cannot count the change in coins if I buy something, and havent been able to buy food, remember dishes I used to cook, buy clothes..... its as if im in a fog, and a totally different person really scary. Has anyone else experienced this to that degree?
Posted by rose45 on April 21, 2013, at 5:40:44
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 20, 2013, at 18:51:01
i also spoke to dr. ken gillman on skype last night. He said that the usual dose on parnate is 30-50 mg and he recommends trazodone for sleep. Is anyone using trazodone as a sleeping medication with maois?
Ive been useing a low dose of seroxat, and also seroquel, but am pretty sleepy and tired during the day.
Posted by jedi on April 21, 2013, at 12:59:46
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 5:40:44
> i also spoke to dr. ken gillman on skype last night. He said that the usual dose on parnate is 30-50 mg and he recommends trazodone for sleep. Is anyone using trazodone as a sleeping medication with maois?
> Ive been useing a low dose of seroxat, and also seroquel, but am pretty sleepy and tired during the day.I've used Traz in the past, but it gives me a very unpleasant drugged feeling. I'm lucky that I'm really sensitive to the histamine meds and 50mg of diphenhydramine hydrochloride(Benadryl) usually knocks me right out. I also usually use my .5mg of clonazepam at night.
The insomnia is one side effect of Nardil that has not gone away over the years. I have always had to treat it somehow. Parnate is a lot more stimulating than Nardil and the insomnia may have to be treated more aggressively.
Be Well,
Jedi
Posted by rose45 on April 21, 2013, at 17:05:46
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 21, 2013, at 12:59:46
thats interesting jedi, I thought benadryl was not allowed with maois. When I was on nardil, when it was working, I did manage to sleep ok without meds most of the time, but parnate feels much more stimulating... So far though, the insomnia seems to be the main side effect. I had loads of side effects with nardil and kept changing the dose and it often took quite a lot of time to get it back up and working after lowering the dose even slightly. I am praying that parnate will work, because I really dont know what I can do if it doesnt.
Does anyone know whether with parnate, you need to boost it to a higher dose, before lowering it to a maintenance dose as you do with nardil. When I was on nardil in hospital, the dose would go up to 60 mg. for a month or so, and would then be reduced to 45 mg maintenance dose. Is that how Parnate works too?
Posted by baseball55 on April 21, 2013, at 19:26:25
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 17:05:46
Raising then lowering the dose isn't how it worked for me. They just started me on 30mg and kept me there. Fortunately, 30mg has been enough most of the time and when it hasn't been, I have found that 200mg lamictal helps.
Posted by Phillipa on April 21, 2013, at 21:01:08
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by baseball55 on April 21, 2013, at 19:26:25
Isn't seroxat a combo of serquel & prozac? Or am I comfused? Phillipa
Posted by Phillipa on April 21, 2013, at 21:03:41
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 21, 2013, at 5:40:44
Google says seroxat is paxil? Are you taking an Maoi with an SSRI if so contraindicated. Phillipa
Posted by jedi on April 21, 2013, at 22:39:01
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Phillipa on April 21, 2013, at 21:03:41
> Google says seroxat is paxil? Are you taking an Maoi with an SSRI if so contraindicated. Phillipa
Rose, Phillipa is right on the paroxetine (which is a SSRI) with Parnate. Was this combination prescribed by a Dr. SSRIs with MAOIs are a strict contraindication. Serotonin syndrome and death can result.
I've never had any problems with Benadryl and MAOIs. I've also used nortriptyline and bupropion with Nardil, no problem.
But serotonin syndrome is nothing to mess with.
Jedi
PS Here is a post on serotonin syndrome from Elisabeth, an old poster on here who I consider the guru of treatment resistant depression.
http://www.dr-bob.org/babble/20020402/msgs/101847.html
Google some of her posts on MAOIs. A wealth of accurate information.
Posted by jono_in_adelaide on April 22, 2013, at 0:17:18
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 18, 2013, at 18:04:38
I'd stop the Seroquel because it isnt working
Nortriptyline does help with sleep, yes
If you realy do need somthing to stop you going manic, then Tegratiol, Lamactil or Lithium would be better choices than low dose Seroquel
Posted by rose45 on April 22, 2013, at 4:27:34
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Phillipa on April 21, 2013, at 21:01:08
Sorry, I didnt mean seroxat... that is typical of what is happening to me, my memory and cognitive skills are zero.... I meant that im taking oxazepam for sleep... and i take it every 2nd day, but am getting worried because I dont want to get addicted to it, and I have never reacted well to tricyclics, so that is going to be a problem re. sleep if I stay on parnate long term.. I havent been able to work since the nardil pooped out on me, so Im praying that parnate will help.
Posted by rose45 on April 22, 2013, at 5:05:17
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by jedi on April 21, 2013, at 22:39:01
Thanks for the links, jedi. Does Elizabeth no longer post ? Sounds like she didnt stay on parnate for very long.... wish there were more long term parnate users - it would give me some encouragement.
Posted by jedi on April 22, 2013, at 9:51:15
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 22, 2013, at 5:05:17
> Thanks for the links, jedi. Does Elizabeth no longer post ? Sounds like she didnt stay on parnate for very long.... wish there were more long term parnate users - it would give me some encouragement.
Not sure what became of Elisabeth. If anyone knows, please post. She had severe treatment resistant depression and I believe was doing trials with buprenorphine when she last posted. Her posts were highly knowledgeable, on the SLS level or beyond. Even the MAOIs don't work for everyone. I still believe they are wonder drugs for atypical depression and social anxiety. I have heard of more long term success on Nardil than any other medication.
That being said, I often wonder where I would be if I could have gotten beyond my first major depression without having to use the MAOIs. I'm not sure I would have survived. I've had the dysthymia since my teenage years, but my major depressions have been life threatening. Still, I look at my level of success before the first major depression hit, and wonder if the medications caused some of the lost productivity since or if I just put it all on depression. Before the first "Big One" hit, when I was 40, I owned and managed a small computer & networking company, grossing over a half million per year. Also owned and managed 50 residential rentals. With major depression and the side effects of the medications, I know I could not do that now. I have missed what should have been the most productive years of my life.
I just have to play the hand I was dealt. So many people have it so much worse. Because I know what the pain is like, I feel deeply for people that can never control the major depression.
What is the highest dosage of Nardil that you have been on, Rose? I have always needed 60mg for maintenance. Sometimes, in low anxiety times, I can survive on 45mg. On the other hand, I have routinely used 90mg per day, and have been on doses as high as 120mg to kick back a major black hole. If the Parnate does not work, I would suggest high dosage Nardil. The medication worked well for you for many years.
Good Luck,
JediPS I am still thinking my long term use of clonazepam has really been the main factor in my cognitive decline. I sure hope it is not permanent! Sometimes feels like the early stages of dementia. I sure don't want to go there!
Posted by Phillipa on April 22, 2013, at 18:59:46
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 22, 2013, at 9:51:15
Jedi excellent post!!!! Phillipa
Posted by rose45 on April 23, 2013, at 13:44:59
In reply to Re: nardil tolerance and ensuing cognitive problems » rose45, posted by jedi on April 22, 2013, at 9:51:15
Very interesting post, jedi.
I also have had depression pretty much all my life. It was in my family, both my mother and her father suffered from it. I remember as a child of 6, hiding in the toilets at break time at school, because I was afraid of the other children. I always did well academically, but not socially.At the age of 36, I began to have insomnia. I would sleep for 3- 4 hrs and then wake up and not be able to sleep again. It was exhausting, but since I am into meditation and yoga etc. I never thought of taking medication, but tried homeopathy etc. which never really helped.
10 years later, I had a major 'breakdown'... didnt understand what was happening, but became very very anxious, depressed and unable to function at all. There were events in my life which contributed to this, but I often wonder whether it was aggravated by taking temazepam, which I had discovered just about 6 months before.... I took it every 3 days or so for 6 months in total, and it stopped working at the time I had the breakdown .
In my case, when I went on the nardil, I became manic, although I didnt realise it, and none of the doctors mentioned it as a side effect.This was in 1990. It seems that only recently have they started admitting that antidepressants can make you manic- because they can now give you an antipsychotic to balance it out !At least, thats what my psychologist told me when we were discussing it.Anyway, I became very motivated, started a massage business and did very well for 20 years.So in my case, the medication brought more productivity than before.However, when the nardil stopped working 6 months ago, I became a suicidal wreck. The most nardil I have ever taken is 60 mg, and I cant imagine taking more than that, because the side effects are horrendous for me. I would stay on 60 mg for one month or so, and then reduce to 45 mg, and I was able to sleep without meds most of the time on that dose - though in the past 4 years, I had reduced to 30 mg, and that was my ideal dose from the point of view of fewer side effects etc.
Ive been on 30 mg parnate for 3 weeks or so and tomorrow I will suggest to the psychiatrist that we up it to 40 mg. I do feel better on it, and my psychiatrist has never given it to anyone, so he really doesnt have a clue about it. I will show him the documents which dr.ken gillman sent me re. taking your blood pressure etc.
I will keep you updated. Really hoping that parnate will work, but Im still not sure what to do about the sleeping problem, because i dont want to get addicted to benzos. Nothing is simple with this illness, is it ?
Posted by rose45 on April 25, 2013, at 7:01:22
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 23, 2013, at 13:44:59
Well I saw the psychiatrist yesterday, and he refused to increase the dose of parnate to 40 mg, and he also refused to order trazodone, because acc. to his books its dangerous to combine tca with maoi. I have phoned dr. gillman and he told me it is possible to order trazodone on the net, if I want to. Has anyone ordered medications over the net ? Do you know whether desyrel is the same as trazodone ? It cost half of what trazodone does, and as far as I know is the same product. It seems that a lot of people dont like trazodone, but I cant stay on benzos for the rest of my life.
Any feedback would be really helplful.
Posted by rose45 on April 25, 2013, at 7:22:52
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 25, 2013, at 7:01:22
Have just read that if you are bipolar (which my psychiatrist thinks I am) then trazodone will not work for you. Any thoughts on this from anyone?
Posted by Englishman006! on May 12, 2013, at 1:34:07
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on April 25, 2013, at 7:22:52
> Have just read that if you are bipolar (which my psychiatrist thinks I am) then trazodone will not work for you. Any thoughts on this from anyone?
Hi Rose, I don't for a minute believe you have manic depression or bipolar as its now referred to. I'm surprised that dr's still diagnose people as bipolar, after a 'medication induced' hypomanic episode. My theory is that when you get depressed on an ongoing basis the receptors in the brain are starved of dopamine. In an effort to compensate (and this is purely my belief) the receptors become super sensitive allowing them to mop up any dopamine that is available. Then Nardil is introduced and for the first time in a long time dopamine becomes abundant. But the receptors super sensitive response results in mania. In effect too much dopamine transmission is now at work, until they desensitise gradually (adapt to the drug).
Unless you have experienced mania which was not drug induced, my guess is they have mis-diagnosed you. I would try stabilising the dose of parnate at it's minimal effective dose and VERY SLOWLY introduce Lamotrigine beginning at 25mg (any sign of rash discontinue immediately) for first week or so then slowly taper up over six weeks - under medical guidance, to 200mg. Provided lamotrigine doesn't interact with maois this should provide an antidepressant effect, it even acts as a mood stabiliser for resistant bipolar. The side effects are pretty benign. If all goes well perhaps you could reduce or wean off the the other meds..?
Posted by rose45 on May 20, 2013, at 16:56:36
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Englishman006! on May 12, 2013, at 1:34:07
hi Englishman,
I agree with you - I dont think I am bipolar either. In fact I am weaning off the quetiapine, and at the moment just on 25 mg for sleep. The parnate has been amazing, completely got rid of my depression. Im taking 40 mg and might reduce to 30 mg, and really dont feel the need to take anything else, except to sleep, and hopefully will wean off sleeping tablets also. I was so surprised that parnate had no other side effects, as nardil was a far more complex drug with loads of side effects for me.
Posted by Venielle on May 27, 2013, at 5:47:43
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by rose45 on May 20, 2013, at 16:56:36
Hi Rose. My husband takes trazodone for insomnia and it works well for him. He can't take benzos as he gets disinhibited on them. He does not, however, take MAOIs. I found this info on trazodone that might help.
Trazodone (also sold under the brand names Desyrel, Oleptro, Beneficat, Deprax, Desirel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, and Mesyrel) is an antidepressant of the serotonin antagonist and reuptake inhibitor (SARI) class.
Because it is not known whether an interaction will occur between trazodone and monoamine oxidase inhibitors (MAOI's), administration of trazodone should be initiated very cautiously with gradual increase in dosage as required, if an MAOI is given concomitantly or has been discontinued shortly before medication with trazodone is instituted.
Posted by Linderthered on May 28, 2013, at 11:06:00
In reply to Re: nardil tolerance and ensuing cognitive problems, posted by Venielle on May 27, 2013, at 5:47:43
I've been on MAOIs since the early 1990s (with two breaks of 1-2 years). Something I just noticed is that nobody has suggested replacing Nardil with Marplan (isocarboxazid).
I was initially treated for severe agoraphobia with Marplan, which worked amazingly well. In less than a week my agoraphobia was 90% gone. The only reason I was moved to Nardil is that Marplan was discontinued by its then-manufacturer (Roche). I understand it is available again.
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