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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by gardenergirl on December 1, 2004, at 22:46:27
Hi all,
I've been on 60 mg of Nardil for several months now, and on Nardil in general for over a year. The most annoying side effects I've had have been peripheral edema (especially when also taking an NSAID), insomnia, myoclonic jerks, and urinary retention. Oh, and weight gain, of course.These have mostly been gone for awhile now, but for some reason they are BAAAAACK. I've got more UR, a greater tendency for edema, and have been getting myoclonic jerks. The latter often are a withdrawal symptom, and when I backed down to 45 mg last week, they indeed increased for a few days.
In addition, ever since I've been on Nardil, I've had only one or two migraines in over a year. I used to get more than two a month. I don't know why Nardil made them go away, but I was grateful for it. Now migraines are back!
What's going on? Is this poop out? A bad batch? I see my pdoc on Friday, and I am tempted to talk to her about going on a maintenance dose or even going off of it. I'm at the point in my therapy and meds treatment where I think it's mostly up to me doing the work now, anyway. (Of course I could be fooling myself).
Any suggestions?
gg
Posted by Pfinstegg on December 2, 2004, at 21:54:13
In reply to Nardil Side Effects: The Sequel, posted by gardenergirl on December 1, 2004, at 22:46:27
I'd suggest, that, if you want to try a drug-free interval, go VERY slowly downwards- over months, and maybe taking a tiny bit for quite a long time.
It's such a great thing if we don't have to take these drugs, but it's not so easy once we've started on them. My own experience has been taking SSRI's SNRI's, Zyprexa and Wellbutrin in various combinations over 8 years. Once I had gotten well into analysis and was trying to learn to deal better with the depression and affect dysregulation, I slowly went off everything- except that i still take a very small dose of Wellbutrin (37.5mg). The reason for that is because of the lowered dopamine which my pdoc and I thought I would probably have after all those years of SSRI's.
I can't say I'm completely depression free, but I'm a lot better. I try to exercise and meditate every day. Being off all those meds gives me a chance to really deal with my real feelings- they are a lot more painful without any drugs to dull them down, but with as much help as I'm getting, it's OK.
I do think, though, that we all have to respect the brain changes that occur with major depression- the HPA axis over-activity, the absence of neuronal new growth and the shrinkage in the hippocampus,the changes in neurotransmitters, the underactive blood flow to the frontal lobes- these are such big things, and the Ads we have do help these things to an extent. So going off the meds is a big deal, and if it fails, no-one should feel like they have somehow failed.
Wish you luck!
Posted by KaraS on December 3, 2004, at 5:20:00
In reply to Nardil Side Effects: The Sequel, posted by gardenergirl on December 1, 2004, at 22:46:27
> Hi all,
> I've been on 60 mg of Nardil for several months now, and on Nardil in general for over a year. The most annoying side effects I've had have been peripheral edema (especially when also taking an NSAID), insomnia, myoclonic jerks, and urinary retention. Oh, and weight gain, of course.
>
> These have mostly been gone for awhile now, but for some reason they are BAAAAACK. I've got more UR, a greater tendency for edema, and have been getting myoclonic jerks. The latter often are a withdrawal symptom, and when I backed down to 45 mg last week, they indeed increased for a few days.
>
> In addition, ever since I've been on Nardil, I've had only one or two migraines in over a year. I used to get more than two a month. I don't know why Nardil made them go away, but I was grateful for it. Now migraines are back!
>
> What's going on? Is this poop out? A bad batch? I see my pdoc on Friday, and I am tempted to talk to her about going on a maintenance dose or even going off of it. I'm at the point in my therapy and meds treatment where I think it's mostly up to me doing the work now, anyway. (Of course I could be fooling myself).
>
> Any suggestions?
>
> gg
I'm so sorry you're having a rough time now, gg. You've always been so helpful to me and I'd like to return the favor - even though I probably don't have that much I can add here. Did you read Ace's recent post? He thought the Nardil might be pooping out but it later turned out that he was just having a bad week. Maybe that could be your problem and things will stabilize soon.The first AD alternative that comes to my mind is Parnate. You've probably already considered it and maybe you have reasons (insomnia?) for not going with it. But, it is a very effective AD that doesn't have as much of the weight gain issue or the edema problem as Nardil. I don't know if it would also help with migraines.
If you do think that you may not need an AD anymore and you go off of the Nardil, you'll find out soon enough if that's correct.
You could always combine other ADs so as to hit the big 3 neurotransmitters. They may not be as effective as what you're used to though.
Hopefully the selegiline patch will be out early next year. Maybe you can hold on until then.
Kara
Posted by gardenergirl on December 5, 2004, at 0:10:03
In reply to Re: Nardil Side Effects: The Sequel » gardenergirl, posted by Pfinstegg on December 2, 2004, at 21:54:13
Thanks for your insights. I do think I might have jumped the gun on blaming recent side effects/symptoms on Nardil. It may have been the plane ride and/or stress. But yes, especially with Nardil and since I have been on it so long, I would not want to get off it quickly. Unless I found myself pregnant. Then it would be tricky, but important.
I talked with my pdoc about what might be an acceptable maintenance dose on Friday. She thinks 45 mg may be it. She is very hesitant to go lower. So I'll see how I do at 45 mg. Today I slept ALL DAY! I don't know if that is a rebound effect, a sign of returning depression (I have atypical, and sleep alot when I am depressed), or just stress. I'm trying to avoid reacting to it until I see more of a pattern. I get a little impatient/impulsive at times, so I need to just chill.
I think I also was thinking maybe I could do without meds because I'm feeling so empowered in therapy lately. Funny feeling given that therapy has been really intense and painful. How is that empowering? :)
But she pointed out that for someone with MDD recurrent, I'll probalby always be on meds of some kind. That's okay with me in principle. Maybe I was going into a flight into health?
Finally, I really do need to exercise and meditate more. I know it helps me. Maybe that would be a true sign it's time to try lower meds...when I can take care of my body and soul consistently.
Thanks for you input.
gg
Posted by gardenergirl on December 5, 2004, at 0:12:18
In reply to Re: Nardil Side Effects: The Sequel » gardenergirl, posted by KaraS on December 3, 2004, at 5:20:00
Kara,
I think maybe it was a bad week. I can't really pinpoint much in the way of specific stressors, but there was a lot of low level stuff that could have accumulated. So things are looking up.Thanks for your help and rational response. Sometimes I jump the gun on my conclusions. I tend to be an impatient person.
Take care,
gg
Posted by Questionmark on December 5, 2004, at 2:43:23
In reply to Re: Nardil Side Effects: The Sequel » KaraS, posted by gardenergirl on December 5, 2004, at 0:12:18
gardenergirl,
you may very well *not* be overreacting. Doctors probably don't tell you/us this s*** most of the time, since they don't know, but i know with myself that every time i miss one or two (or more) doses of Nardil for a couple days or so, i start to feel partial but noticeable withdrawal-type effects. i am also on 60mg. i have become very adept at noticing the effects and subtleties of Nardil dose variations. It's natural if you're on it for long enough and are careful to observe differences in effects, feelings, etc. of variations in Nardil dose, timing, etc.
You will probably adjust to the 45mg dosage after not too long. Of course, if you're finding that it's significantly difficult, you might want to alter between taking 60mg one day and 45mg the next. Or, possibly better, you could cut the pills in half for awhile and just take ~52.5mg/day and then eventually go to 45mg/day.
Posted by Pfinstegg on December 5, 2004, at 12:45:03
In reply to Re: Nardil Side Effects: The Sequel » Pfinstegg, posted by gardenergirl on December 5, 2004, at 0:10:03
I wonder if anyone can ever really know whether they'll be better off with or without AD's until they try. You've been given the diagnosis of MDD, atypical, but, still, who knows whether or not you'll have a prolonged or even permanent remission without meds, but with therapy? (Sounds like that it going really well!) The most your pdoc can do is make a good educated guess. Even though I am doing a lot better now, I could very well be back on them the next time we speak! But, even if I have to, I have had the encouraging experience of being off of them after so many years on (8 years). I tried several times to go down, but only succeeded when I went MUCH more slowly than anyone thought I needed to- there was a lot of intricate pill-cutting, grinding and liquid-solution making in the process!
Posted by KaraS on December 5, 2004, at 20:08:56
In reply to Re: Nardil Side Effects: The Sequel » KaraS, posted by gardenergirl on December 5, 2004, at 0:12:18
> Kara,
> I think maybe it was a bad week. I can't really pinpoint much in the way of specific stressors, but there was a lot of low level stuff that could have accumulated. So things are looking up.
>
> Thanks for your help and rational response. Sometimes I jump the gun on my conclusions. I tend to be an impatient person.
>
> Take care,
> gg
gg,
I'm so glad you're doing better! It helps to keep in mind that nondepressed people have bad weeks too (or so I hear).Exercise and meditation are good additions to your routine anyway, if you can find the time to fit them in.
Stay well,
Kara
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