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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by ed_uk on December 5, 2004, at 4:43:11
Hi,
I've been considering trying Nardil or Parnate for my anxiety instead of taking citalopram. MAOIs can sometimes cause severe withdrawal symptoms. I'd like to hear from people who have taken Nardil, Marplan or Parnate. How bad was your withdrawal? How did it compare with withdrawal from other drugs such as Effexor?
I decided to compile a list of MAOI withdrawal symptoms using a variety of sources. Here it is..... they are not in any particular order. Some symptoms may have been listed twice by mistake.
acute psychosis (visual, auditory, and tactile hallucinations), severe depression, impairment of cognition, mania or hypomania, vivid nightmares, severe anxiety, agitation, delirium, convulsions, confusion, headache, weakness, diarrhea, nausea, vomiting, malaise, anorexia, giddiness, chills, panic attacks, extreme motor restlessness, irritability, anger, rage, stiff neck, rigid muscles, fever, fatigue, hypersomnia, sensitivity to sound and light, lack of energy, extreme mood swings, abnormal movements in sleep eg. of legs, lethargy, spontaneous crying spells, sweating, influenza-like symptoms.
Posted by cybercafe on December 5, 2004, at 5:58:09
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
> Hi,
>
> I've been considering trying Nardil or Parnate for my anxiety instead of taking citalopram. MAOIs can sometimes cause severe withdrawal symptoms. I'd like to hear from people who have taken Nardil, Marplan or Parnate. How bad was your withdrawal? How did it compare with withdrawal from other drugs such as Effexor?
>
> I decided to compile a list of MAOI withdrawal symptoms using a variety of sources. Here it is..... they are not in any particular order. Some symptoms may have been listed twice by mistake.
>
> acute psychosis (visual, auditory, and tactile hallucinations), severe depression, impairment of cognition, mania or hypomania, vivid nightmares, severe anxiety, agitation, delirium, convulsions, confusion, headache, weakness, diarrhea, nausea, vomiting, malaise, anorexia, giddiness, chills, panic attacks, extreme motor restlessness, irritability, anger, rage, stiff neck, rigid muscles, fever, fatigue, hypersomnia, sensitivity to sound and light, lack of energy, extreme mood swings, abnormal movements in sleep eg. of legs, lethargy, spontaneous crying spells, sweating, influenza-like symptoms.
>
no withdrawal symptoms from 30 mg parnate... except that depression eventually returned :( :(
Posted by ed_uk on December 5, 2004, at 7:42:59
In reply to Re: MAOI withdrawal, posted by cybercafe on December 5, 2004, at 5:58:09
Hi!
Thank you! Maybe I'll ask for Parnate!
Regards,
Ed.
Posted by jclint on December 5, 2004, at 9:47:46
In reply to Re: MAOI withdrawal » cybercafe, posted by ed_uk on December 5, 2004, at 7:42:59
Didn't know you were interested in MAOIs as well, Ed. Have you had any experience in trying to get Parnate before in the UK?
Posted by SDW on December 5, 2004, at 9:52:03
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
I have withdrawn from Parnate several times at doses at as high as 60 mg/day. The only effects I remember were a "rebound" depression (which cleared up within a week of restarting Parnate), and in one case, where I withdrew the med *very* fast, I had several days of transient anxiety.
Like any AD, if MAOI' are withdrawn at a reasonable rate, the primary concern is a return of symptoms for most people IMO. Obviously some will have other experiences, but I don't think the MAOIs are any worse in terms of withdrawal than any other psychoactive drug.
Posted by jclint on December 5, 2004, at 9:55:00
In reply to Re: MAOI withdrawal, posted by SDW on December 5, 2004, at 9:52:03
I agree. I am off Effexor as of 3 days ago now, and can say that the rebound depression is much more troublesome than any of the physical withdrawal symptoms.
Posted by ed_uk on December 5, 2004, at 10:04:04
In reply to Re: MAOI withdrawal, posted by jclint on December 5, 2004, at 9:47:46
Hi,
I'm quite interested in MAOIs because SSRIs make me too lazy and I never seem to get anything done. Paroxetine (Paxil/Seroxat) seemed to be the worst in that regard, getting out of bed was a major achievement. I think an MAOI could be effective for many aspects of my anxiety but I'm concerned that an MAOI might not keep my OCD at bay. I don't have OCD at the moment but I do tend to develop it periodically so it's still a concern. There is *no* possibility of my current psychiatrist prescribing Parnate but I could transfer to a new psychiatrist in Manchester (so I suppose there might be a very small chance that s/he might be willing to prescribe it).
Regards,
Ed.
Posted by SLS on December 5, 2004, at 11:04:55
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
In my experience, I find withdrawing from MAOIs uneventful if I taper gradually. Some REM rebound.
- Scott
Posted by SLS on December 5, 2004, at 11:25:07
In reply to Re: MAOI withdrawal- to jclint, posted by ed_uk on December 5, 2004, at 10:04:04
> Hi,
>
> I'm quite interested in MAOIs because SSRIs make me too lazy and I never seem to get anything done. Paroxetine (Paxil/Seroxat) seemed to be the worst in that regard, getting out of bed was a major achievement. I think an MAOI could be effective for many aspects of my anxiety but I'm concerned that an MAOI might not keep my OCD at bay. I don't have OCD at the moment but I do tend to develop it periodically so it's still a concern. There is *no* possibility of my current psychiatrist prescribing Parnate but I could transfer to a new psychiatrist in Manchester (so I suppose there might be a very small chance that s/he might be willing to prescribe it).
>
> Regards,
> Ed.
You might want to consider trying Nardil first. I believe it is considered to be more effective for OCD than is Parnate. It is probably more serotonergic. If you are taking Nardil for the first time, you might find it mildly sedating for the first few weeks. This should dissipate, and leave you energized if it is the right drug for you.Good luck.
- Scott
Posted by sfy on December 5, 2004, at 15:12:28
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
I don't recall having any problems withdrawing from Nardil in a systematic, tapered manner.
Posted by gardenergirl on December 5, 2004, at 22:09:07
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
Hi Ed,
Thanks for posting this. I recently went down from 60 mg to 45 mg of Nardil due to peripheral edema. I experienced the following from your list that might be considered withdrawal: > headache, irritability, anger, stiff neck (at least according to the massage therapist), hypersomnia, sensitivity to sound and light, lack of energy, abnormal movements in sleep eg. of legs.I never considered these (except for the myoclonic jerks) to be related to decreasing the dose. Thanks again for posting this.
gg
Posted by ace on December 5, 2004, at 23:44:42
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
Personally, for me, Ace, the Nardil Champ!, Nardil withdrawal has been very benign in the past.
Vivid dreams and a bit of insomnia is all that it really has caused.
Just another great aspect to a great drug!
Ace
Nardil- 60mg
Zyprexa- 2.5mg
Xanax- 2-4mg
Lamictal- 50mg
Posted by SLS on December 6, 2004, at 0:36:16
In reply to Re: MAOI withdrawal » ed_uk, posted by gardenergirl on December 5, 2004, at 22:09:07
> Hi Ed,
> Thanks for posting this. I recently went down from 60 mg to 45 mg of Nardil due to peripheral edema. I experienced the following from your list that might be considered withdrawal: > headache, irritability, anger, stiff neck (at least according to the massage therapist), hypersomnia, sensitivity to sound and light, lack of energy, abnormal movements in sleep eg. of legs.
>
> I never considered these (except for the myoclonic jerks) to be related to decreasing the dose. Thanks again for posting this.
Some of these symptoms could also represent a return of depression. I would say that most people with severe depression don't do well at dosages below 60mg.
- Scott
Posted by gardenergirl on December 6, 2004, at 10:11:42
In reply to Re: MAOI withdrawal, posted by SLS on December 6, 2004, at 0:36:16
Very good point, Scott. I am trying to monitor this. It's so hard to piece out what's situational (like the inlaws and their incessant need for heat) and what's a return of depression. Ugh. But hopefully 45 mg will be okay, will help me with the weight, and will not cause edema.
Oh, and if it could wash my car on occasion, that would be cool, too! ;)
Thanks for you input.
gg
Posted by kellym on December 6, 2004, at 17:34:15
In reply to MAOI withdrawal, posted by ed_uk on December 5, 2004, at 4:43:11
When I first tried to get off Nardil, I went too fast. It was not pretty-I was up to 105 or 120mg (I only started to feel the positive effects at 90mg). I think I tried dropping a couple of tablets at first and I started crying like a baby a day or two later. When I went more slowly it was much better, although I still suffered some effects- "electrical zaps" and nightmares.
I understand the apathy with some drugs. Wellbutrin doesn't cause me any problems in that regard and neither did Nardil; it unfortunately stopped working. At that point there wasn't much point in continuing with the dietary restrictions and the insomnia it caused. However, I understand it works for some people- good for them.
Posted by cubbybear on December 7, 2004, at 0:45:40
In reply to Re: MAOI withdrawal, posted by kellym on December 6, 2004, at 17:34:15
In the old days when I used to try a "holiday" and survive without Parnate (before I discovered I need it daily and probably for the rest of my life), I followed the withdrawal schedule my pdoc gave me:
Going down from 40 mg maintenance dose:
30 mg. for one week,
20 mg. for one week,
10 mg. for one week,
then zero.NEVER had a problem. My only noticeable changes were an increase in the need to sleep (conversely, Parnate reduces my need for sleep) plus a change my dreams--seemingly, they became more vivid. But, as one poster said, withdrawing from Parnate has always been uneventful.
Posted by Dan Perkins on December 7, 2004, at 20:01:34
In reply to Re: MAOI withdrawal, posted by cubbybear on December 7, 2004, at 0:45:40
I had a very bad experience coming off of Parnate. I came off of it too quickly (from 70mg to zero in about two weeks) and it really screwed me up. I just remember walking down the street in absolute misery and having to stop at one point and just stand there paralyzed like a heroine addict. And when I went back on it I found that it was never again as effective as before I stopped taking it.
MAOIs are very good (at least Parnate was for me), but my advice would be to taper off of them as slowly as possible if you do have to stop.
Posted by cubbybear on December 8, 2004, at 5:54:12
In reply to Re: MAOI withdrawal, posted by Dan Perkins on December 7, 2004, at 20:01:34
> I had a very bad experience coming off of Parnate. I came off of it too quickly (from 70mg to zero in about two weeks) and it really screwed me up. I just remember walking down the street in absolute misery and having to stop at one point and just stand there paralyzed like a heroine addict. And when I went back on it I found that it was never again as effective as before I stopped taking it.
>
This is an unusual thread--we don't often see posts here about MAOI withdrawal. Just curious--why did you try coming off the med. so fast? Was it your decision or your doctor's?
Posted by Dan Perkins on December 8, 2004, at 13:05:42
In reply to Re: MAOI withdrawal » Dan Perkins, posted by cubbybear on December 8, 2004, at 5:54:12
> This is an unusual thread--we don't often see posts here about MAOI withdrawal. Just curious--why did you try coming off the med. so fast? Was it your decision or your doctor's?
I came off of Parnate b/c I was planning to have an elective surgery and Parnate and general anesthesia don't mix. I didn't tell my doctor that I was going to stop taking Parnate, so the decisions to stop and to stop so quickly were mine. I knew that the sensible thing would have been to taper more slowly, but I was feeling a bit reckless. So, in other words, there was no good reason to stop so quickly.
Posted by cubbybear on December 10, 2004, at 3:31:52
In reply to Re: MAOI withdrawal » Dan Perkins, posted by Dan Perkins on December 8, 2004, at 13:05:42
>
> I came off of Parnate b/c I was planning to have an elective surgery and Parnate and general anesthesia don't mix. I didn't tell my doctor that I was going to stop taking Parnate, so the decisions to stop and to stop so quickly were mine. I knew that the sensible thing would have been to taper more slowly, but I was feeling a bit reckless. So, in other words, there was no good reason to stop so quickly.Your problem is of much interest to me because I've been putting off an elective procedure (colonoscopy) myself since,among other things, I dread the whole issue of anaesthesia. I made a decision not to come off the Parnate for this procedure but rather to go through with it. If I can get up the guts to make an appointment with the gastroenterologist, I will discuss with her ahead of time, the various analgesics/sedatives that could be used safely. I'm pretty sure that in this case, general anaesthesia would be unnecessary.
Posted by Dan Perkins on December 10, 2004, at 13:55:53
In reply to Re: MAOI withdrawal » Dan Perkins, posted by cubbybear on December 10, 2004, at 3:31:52
If you don't absolutely have to come off of Parnate, then my advice would be to not come off of it. Aside from having a horrible time coming off of the drug, the Parnate never worked as well for me again after I stopped it that first time.
It seems to me that just about every warning that goes along with taking an MAOI is either exagerated or entirely unnecesary. I'm not sure if this is the case w/anesthesia, but I would try everything possible to avoid coming off of Parnate for your colonoscopy.
Your gastroenterologist may tell you that you have to stop the Parnate simply b/c he/she might not have any experience with MAOIs and might be being overly cautious. I think the best way to find out which anesthesia is OK to take w/Parnate would be by posting the question directly on this message board in a seperate topic and maybe in an MAOI discussion forum (I know that Yahoo has an active one) to hear from people who have direct experience with this topic.
Best of luck,
>
> Your problem is of much interest to me because I've been putting off an elective procedure (colonoscopy) myself since,among other things, I dread the whole issue of anaesthesia. I made a decision not to come off the Parnate for this procedure but rather to go through with it. If I can get up the guts to make an appointment with the gastroenterologist, I will discuss with her ahead of time, the various analgesics/sedatives that could be used safely. I'm pretty sure that in this case, general anaesthesia would be unnecessary.
Posted by cubbybear on December 11, 2004, at 6:14:38
In reply to Re: MAOI withdrawal » Dan Perkins, posted by Dan Perkins on December 10, 2004, at 13:55:53
. I think the best way to find out which anesthesia is OK to take w/Parnate would be by posting the question directly on this message board in a seperate topic and maybe in an MAOI discussion forum (I know that Yahoo has an active one) to hear from people who have direct experience with this topic.
>
> You're really on my wavelength, although I haven't experienced any loss of effectiveness in the (distant) past when I stopped the Parnate for a while and then went back on it.
More to the point, I've found that there's a lot of contradiction in warnings regarding what anaesthesia is safe with an MAOI and which isn't. I've already done a lot of research on this topic and think I know the way to go, especially which anaesthesia would NOT be safe.Just to illustrate what we're up against when we try to pose the MAOI vs. anaesthesia question to the doctors themselves, I sent an E-mail to this guy who actually performed the surgery on a Psychobabble poster who was taking an MAOI. The doctor never responded. I myself went to a local hospital to pose the question. The gastroenterologist told me that I should start with the anaesthesiologist. So I went to consult with him, and his department told me to start with the surgeon. Nobody in this rotten profession wants to take responsibility for a difficult decision and we all know why. Hence, we have to do our own homework and our own research and rely on message boards like Psychobabble
Posted by Dan Perkins on December 11, 2004, at 7:44:02
In reply to Re: MAOI and anaesthesia » Dan Perkins, posted by cubbybear on December 11, 2004, at 6:14:38
>Nobody in this rotten profession wants to take responsibility for a difficult decision and we all know why. Hence, we have to do our own homework and our own research and rely on message boards like Psychobabble
Totaly agree with you. I'm always a bit embarassed to tell people that I get medical information from the internet (or worse yet, internet message boards), but I tell you that there is no more reliable source for information than places like these. After a lifetime of dealing with ignorant doctors, I have come to realize that the combination of anecdotal experience (from websites like this one) and first hand research (actually going back and sorting through the studies to figure out which make sense (not many of them) is the only way to find reliable healthcare information. It certainly beats how the doctors themselves get their information, from the always attractive pharmaceutical sales reps who dish out free meds and biased advice.
Posted by KaraS on December 11, 2004, at 16:15:37
In reply to Re: MAOI withdrawal » Dan Perkins, posted by Dan Perkins on December 10, 2004, at 13:55:53
> If you don't absolutely have to come off of Parnate, then my advice would be to not come off of it. Aside from having a horrible time coming off of the drug, the Parnate never worked as well for me again after I stopped it that first time.
>
> It seems to me that just about every warning that goes along with taking an MAOI is either exagerated or entirely unnecesary. I'm not sure if this is the case w/anesthesia, but I would try everything possible to avoid coming off of Parnate for your colonoscopy.
>
> Your gastroenterologist may tell you that you have to stop the Parnate simply b/c he/she might not have any experience with MAOIs and might be being overly cautious. I think the best way to find out which anesthesia is OK to take w/Parnate would be by posting the question directly on this message board in a seperate topic and maybe in an MAOI discussion forum (I know that Yahoo has an active one) to hear from people who have direct experience with this topic.
>
> Best of luck,
>
>
> >
> > Your problem is of much interest to me because I've been putting off an elective procedure (colonoscopy) myself since,among other things, I dread the whole issue of anaesthesia. I made a decision not to come off the Parnate for this procedure but rather to go through with it. If I can get up the guts to make an appointment with the gastroenterologist, I will discuss with her ahead of time, the various analgesics/sedatives that could be used safely. I'm pretty sure that in this case, general anaesthesia would be unnecessary.
>
>Would you mind posting more information on how to get to that Yahoo chat group. I just went to check it out. I found live chat groups on depression but most of the talk was silliness - not about anything medical or even depression related. It was probably a group of teenagers. I must have gone to the wrong place.
Posted by Dan Perkins on December 12, 2004, at 2:40:12
In reply to Re: MAOI withdrawal » Dan Perkins, posted by KaraS on December 11, 2004, at 16:15:37
Here is the link to the an MAOI chat group on Yahoo. I used to post on here a lot and found the other posters to be extremely well informed about all aspects of Nardil/Parnate.
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