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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by Enigma on September 26, 2006, at 13:57:15
What am I supposed to do now that everything I've tried for years has failed?
Nardil Pros:
About the only drug that has helped my depressionNardil Cons:
-Fatigued ALL day - useless around the house (out of work too)
-"Sleep waves" - Narcolepsy type fatigue that forces me to sleep, 1-2 times a day - restless sleep too
-Severe Insomnia - nothing I've taken besides Melatonin has helped it (but still need to nap twice a day, and still fatigued, even after 8 hours of sleep in a row)
-Severe sweating over the smallest exertion or heat
-Only brings me out of severe depression, about 5-6/10, 10 being happy, 1 being suicidal
-All the side effect cause their own depression!I've tried every major SSRI - all failed, 2 made me suicidal.
Parnate was intolerable - more side effects than Nardil for me
Emsam was working (partially), full dose, but caused severe application site reactions, had no choice but to discontinue - rashes were everywhere
ECT was only partially successful, but caused permanent memory loss - won't do it again.What the hell am I supposed to do now?
I've also tried a couple tricyclics (sp?) - no effect, and some anti-psychotics, with no real effect.
I'd be happier under a bus.
Posted by linkadge on September 26, 2006, at 16:27:02
In reply to Nardil - too many cons, everything else failed..., posted by Enigma on September 26, 2006, at 13:57:15
Have you tried selegiline in pill form ?
Linkadge
Posted by Declan on September 26, 2006, at 17:47:36
In reply to Re: Nardil - too many cons, everything else failed..., posted by linkadge on September 26, 2006, at 16:27:02
Any point in trying tianeptine?
Posted by Jost on September 26, 2006, at 19:32:51
In reply to Nardil - too many cons, everything else failed..., posted by Enigma on September 26, 2006, at 13:57:15
Are you sure you can't use Emsam?
the rashes, while obviously annoying, could be controllable with proper treatment. If OTC hydrocortisone isn't strong enough, you could try occasional application of prescriptions hydrocortisone, or other treatment.
Also the rash may be worse in hot weather, esp, if you kept them on during exercise or heated rooms, or with prolonged sunlight.
Not that you didn't do a lot to try to counteract the rash-- but are you sure there wasn't anything else, so as to use an AD that give you some relief?
Nardil doesn't sound like a great solution-- that much fatigue can be pretty discouraging over time, I've found.
Jost
Posted by gardenergirl on September 26, 2006, at 21:53:31
In reply to Re: Nardil - too many cons, everything else failed, posted by Jost on September 26, 2006, at 19:32:51
I used to take naps nearly every afternoon if I could. I almost never feel the need for one since I added Provigil. I haven't encountered any adverse side effects from it, either, although I had to cut back on caffeine. For many it also helps regulate sleep.
gg
Posted by Phillipa on September 26, 2006, at 22:39:49
In reply to Re: Nardil - too many cons, everything else failed, posted by Jost on September 26, 2006, at 19:32:51
Maybe see a dermatologist about the rash if you start again? Love Phillipa
Posted by willyee on September 26, 2006, at 22:47:10
In reply to Can you add Provigil?, posted by gardenergirl on September 26, 2006, at 21:53:31
> I used to take naps nearly every afternoon if I could. I almost never feel the need for one since I added Provigil. I haven't encountered any adverse side effects from it, either, although I had to cut back on caffeine. For many it also helps regulate sleep.
>
> ggDo you mind if i ask if you are being kept stable,or in remission on Nardil??
Posted by gardenergirl on September 27, 2006, at 1:08:46
In reply to Re: Can you add Provigil?, posted by willyee on September 26, 2006, at 22:47:10
I didn't find that Nardil alone was enough to tackle all the depression. There seemed to be some what my pdoc called "residual depression", so she added Lamictal, since it works on the depression side of Bipolar. Naril alone might have been the answer if I could take a high enough dose. At 75 mg, I developed akathisia and severe insomnia. Gabitril didn't help this, so it seems the highest dose I can tolerate is 67.5 mg. Even from 60-67.5 I'm not fond of the side effects, especially the urinary retention and peripheral edema. So for me, a "cocktail" seems to be the best.
Still, I have had depressive episodes over the last three years. They don't last very long, and they don't get very severe. And I can usually get back on track fairly easily. I view this type of "relapse" as inevitable for anyone with major recurrent depression, of which atypical depression is one type. The nature of the beast is that there will be relapses, but again, they are less intense, shorter duration, and less "entrenched", and more easily recovered from, in my experience, than un or undertreated depression. I view this as stable and relatively predictable.
gg
Posted by SLS on September 27, 2006, at 2:04:22
In reply to Re: Can you add Provigil?, posted by gardenergirl on September 27, 2006, at 1:08:46
> I view this as stable and relatively predictable.
Hmm.
Your position seems precarious, but you have a system that works. I would hate to be the agent to upset that balance, but I have to ask, have you ever thought to try Marplan? I guess you can keep that as an alternative should you need it. It has milder side effects. Some will characterize it as a weaker Nardil, but when it works, it will work every bit as good as Nardil. Terrence Ketter, MD will choose Marplan before Nardil when treating depression.
With MAOIs, don't let insomnia be a deal-breaker. Use benzodiazepines if you have to. To make the whole thing work, you treat the insomnia as aggressively as you treat the depression. Why hold back?
The akathisia is a new one on me. Can you describe what you experienced?
- Scott
Posted by willyee on September 27, 2006, at 7:27:09
In reply to Re: Can you add Provigil?, posted by gardenergirl on September 27, 2006, at 1:08:46
> I didn't find that Nardil alone was enough to tackle all the depression. There seemed to be some what my pdoc called "residual depression", so she added Lamictal, since it works on the depression side of Bipolar. Naril alone might have been the answer if I could take a high enough dose. At 75 mg, I developed akathisia and severe insomnia. Gabitril didn't help this, so it seems the highest dose I can tolerate is 67.5 mg. Even from 60-67.5 I'm not fond of the side effects, especially the urinary retention and peripheral edema. So for me, a "cocktail" seems to be the best.
>
> Still, I have had depressive episodes over the last three years. They don't last very long, and they don't get very severe. And I can usually get back on track fairly easily. I view this type of "relapse" as inevitable for anyone with major recurrent depression, of which atypical depression is one type. The nature of the beast is that there will be relapses, but again, they are less intense, shorter duration, and less "entrenched", and more easily recovered from, in my experience, than un or undertreated depression. I view this as stable and relatively predictable.
>
>
> gg
>
>Gabatril i found to be quite a drug,from seeming like a great wonder drug to worsening my depression,it seems there just isnt any consistency.
But when gabatril was first taken,it did poteinate my drug and i had a semi-remission for close to 3 days.
Posted by SLS on September 27, 2006, at 7:48:57
In reply to Re: Can you add Provigil? » gardenergirl, posted by willyee on September 27, 2006, at 7:27:09
> Gabatril i found to be quite a drug,from seeming like a great wonder drug to worsening my depression,it seems there just isnt any consistency.
>
> But when gabatril was first taken,it did poteinate my drug and i had a semi-remission for close to 3 days.My doctor finds Gabitril to be unpredictable. For some people, it works great as a sleep aid, anxiolytic, and mood-stabilizer. For others, it is de-stabilizing and agitating.
I did not like it.
- Scott
Posted by jaclinhyde on September 27, 2006, at 12:35:35
In reply to Nardil - too many cons, everything else failed..., posted by Enigma on September 26, 2006, at 13:57:15
Didn't read the other responses because I was anxious to jump right in so forive me if this was mentioned already but have you considered Marplan. Everyone seems to forget that there is a fourth MAOI option. For me Marplan was the best falling right in the middle of Nardil and Parnate. With less side effects to boot. And yes, it is still available (many people believe that it isn't.)
It might be the answer for you.
Terri
Posted by Enigma on September 27, 2006, at 16:08:32
In reply to Re: Nardil - too many cons, everything else failed..., posted by linkadge on September 26, 2006, at 16:27:02
> Have you tried selegiline in pill form ?
>
> LinkadgeNope, haven't tried that yet.
I heard it wasn't as effective as taking Seleg from the patch though.. untrue?
Posted by Enigma on September 27, 2006, at 16:09:24
In reply to Re: Nardil - too many cons, everything else failed, posted by Declan on September 26, 2006, at 17:47:36
> Any point in trying tianeptine?
Never heard of it, I'll have to look that one up. Thx.
Posted by Enigma on September 27, 2006, at 16:15:03
In reply to Re: Nardil - too many cons, everything else failed, posted by Jost on September 26, 2006, at 19:32:51
> Are you sure you can't use Emsam?
>
> the rashes, while obviously annoying, could be controllable with proper treatment. If OTC hydrocortisone isn't strong enough, you could try occasional application of prescriptions hydrocortisone, or other treatment.
>
> Also the rash may be worse in hot weather, esp, if you kept them on during exercise or heated rooms, or with prolonged sunlight.
>
> Not that you didn't do a lot to try to counteract the rash-- but are you sure there wasn't anything else, so as to use an AD that give you some relief?
>
> Nardil doesn't sound like a great solution-- that much fatigue can be pretty discouraging over time, I've found.
>
> JostThe Emsam reactions were horrible. Unbearably itchy. I was at the full dose/patch size, and the only place I could put those patches comfortably was on my legs. I'm a guy, so I had to shave my legs (quadracep area). I would get the reactions in just one day. The entire patch area was red, rash-like, itchy beyond belief.
I tried all over the counter meds to treat the rashes and nothing helped. I even took a dose of prescription drugs (forget the name).. it was a blister pack where you take X-many pills. That got rid of the patches, but you can't stay on that medicine, so, I had to say goodbye to Emsam.
I'd have to go back into to notes to see if I had fatigue with Emsam too.
The fatigue has caused its own share of depression, as I can't get anything useful done, at all. Usually my mood is too low, and I don't have the energy.
Posted by Enigma on September 27, 2006, at 16:17:31
In reply to Can you add Provigil?, posted by gardenergirl on September 26, 2006, at 21:53:31
> I used to take naps nearly every afternoon if I could. I almost never feel the need for one since I added Provigil. I haven't encountered any adverse side effects from it, either, although I had to cut back on caffeine. For many it also helps regulate sleep.
>
> ggI tried it a couple year back, and I recall that it had no effect on me. I tried to get a script for it again, and the insurance company actually denined me because I didn't have narcolepsy. I had to make this huge case out of it to get the drug, requiring letters from me, my doc, etc... I simply don't have the energy for that.
I'm gonna ask my doc for provigil again though on Friday (different doctor). Maybe he'll have samples.
Posted by Enigma on September 27, 2006, at 16:19:35
In reply to Re: Can you add Provigil?, posted by willyee on September 26, 2006, at 22:47:10
> > I used to take naps nearly every afternoon if I could. I almost never feel the need for one since I added Provigil. I haven't encountered any adverse side effects from it, either, although I had to cut back on caffeine. For many it also helps regulate sleep.
> >
> > gg
>
> Do you mind if i ask if you are being kept stable,or in remission on Nardil??Good question. I'm being kept stable. Only the severe depression is gone, but I'm still very unhappy and in a depressed mood a good deal of the time.
Posted by Enigma on September 27, 2006, at 16:27:56
In reply to Re: Can you add Provigil? » gardenergirl, posted by SLS on September 27, 2006, at 2:04:22
> > I view this as stable and relatively predictable.
>
> Hmm.
>
> Your position seems precarious, but you have a system that works. I would hate to be the agent to upset that balance, but I have to ask, have you ever thought to try Marplan? I guess you can keep that as an alternative should you need it. It has milder side effects. Some will characterize it as a weaker Nardil, but when it works, it will work every bit as good as Nardil. Terrence Ketter, MD will choose Marplan before Nardil when treating depression.
>
> With MAOIs, don't let insomnia be a deal-breaker. Use benzodiazepines if you have to. To make the whole thing work, you treat the insomnia as aggressively as you treat the depression. Why hold back?
>
> The akathisia is a new one on me. Can you describe what you experienced?
>
>
> - ScottI heard of Marplan, but an old doctor just mentioned it in passing. I'd definately give it a try.
I tried 2 prescription sleeping pills on the insomnia, and both failed. I maxed the dose on one, and it just stopped working, and the ambien gave me nightmares. 2-3mg of Melatonin actually does away with the insomnia, but I'm still just as fatigued and tired the next day, and still require naps.
What do you mean by the akathisia? I actually had to look that one up, but didn't see where I spoke about that topic in my orig message. It's a severe restless, panicy feeling right? I don't have those symptoms.
Posted by gardenergirl on September 28, 2006, at 12:07:42
In reply to Re: Can you add Provigil? » gardenergirl, posted by SLS on September 27, 2006, at 2:04:22
> I would hate to be the agent to upset that balance, but I have to ask, have you ever thought to try Marplan?
No upset here. :) Actually, I always forget about Marplan when I think of MAOI's. I have a pdoc appt. in about 10 days. I might ask her about it, although I need to devote most of the appt. time to re-establish expectations and the working relationship (long story). So I may have to keep that in the back of my head for now. Thanks for suggesting it, though.
>
> With MAOIs, don't let insomnia be a deal-breaker. Use benzodiazepines if you have to. To make the whole thing work, you treat the insomnia as aggressively as you treat the depression. Why hold back?I agree. Usually ambien works well for me. I went through a phase when I was waking up and getting up. I didn't do anything dangerous, although yoga in the dark without my contacts in while in the ambien "stagger" mode might be on the edge...:) Also, when it's not working well in letting me get to sleep, it seems to be correlated with eating something before I went to bed.
>
> The akathisia is a new one on me. Can you describe what you experienced?I had extreme restlessness. I couldn't get into a comfortable position and felt like I was "jumping out of my skin." It was awful! I think the insomnia was actually more related to the restlessness versus a separate effect since I couldn't lie still. The Gabitril didn't help at all, but it went away as soon as I lowered the Nardil back to 60 mg. I can tolerate 67.5 mg, although at that dose I often get peripheral edema and urinary retention, so I try to stay lower.
Now, if only there were a good way to deal with the effect of hormones on my mood. During PMS I get way more sensitive and emotional. That doesn't help one feel stable with depression. Bah.
Thanks for sharing your thoughts.gg
Posted by gardenergirl on September 28, 2006, at 12:11:14
In reply to Re: Can you add Provigil? » gardenergirl, posted by willyee on September 27, 2006, at 7:27:09
> Gabatril i found to be quite a drug,from seeming like a great wonder drug to worsening my depression,it seems there just isnt any consistency.
>
> But when gabatril was first taken,it did poteinate my drug and i had a semi-remission for close to 3 days.Hi willyee,
Sorry I didn't reply to this earlier. About the only thing gabitril did for me was give me heartburn. Although I never took more than 4 mg, I think. I'm sorry your first response to it didn't last.gg
Posted by gardenergirl on September 28, 2006, at 12:25:06
In reply to Re: Can you add Provigil? » gardenergirl, posted by SLS on September 27, 2006, at 2:04:22
I just checked my insurance formulary, and it seems to be in there. :) I'm sure that it would have to be ordered special, though.
gg
Posted by gardenergirl on September 28, 2006, at 12:29:45
In reply to Re: Can you add Provigil?, posted by Enigma on September 27, 2006, at 16:27:56
>
> What do you mean by the akathisia? I actually had to look that one up, but didn't see where I spoke about that topic in my orig message. It's a severe restless, panicy feeling right? I don't have those symptoms.Scott's question about akathisia was actually for me. If you look at the subject lines of posts, if there is a ">>" and a poster's name, it's usually a post directed to that person. You can use this feature by checking the box that says "add name of previous poster", which is just below the subject line field in the posting window.
Regards,
gg
Posted by gardenergirl on September 28, 2006, at 12:33:34
In reply to Re: Can you add Provigil?, posted by Enigma on September 27, 2006, at 16:17:31
> I tried it a couple year back, and I recall that it had no effect on me. I tried to get a script for it again, and the insurance company actually denined me because I didn't have narcolepsy.I've heard that can happen. My pdoc was sure that my insurance would deny it for me, too, but my plan seems pretty lenient about off-label uses.
Your doc is unlikely to have samples of Provigil due to the type of med (schedule?). You might be able to get a certificate for a week's worth free which you would take to your pharmacy to fill. That's how I got my "sample".
Good luck,
gg
Posted by Enigma on September 28, 2006, at 14:03:56
In reply to Re: Can you add Provigil? » Enigma, posted by gardenergirl on September 28, 2006, at 12:29:45
Yeah, I realized that when I read a few more messages. Been on messages boards since way before the internet began. :) I was just really tired (so what else is new) that day.
Also was very upset about my parents, but that's a story for the social board if I ever have the strength to write about it. Man, it's so true what they say, You can't pick your parents... I still think there should be some kind of exchange policy.
> >
> > What do you mean by the akathisia? I actually had to look that one up, but didn't see where I spoke about that topic in my orig message. It's a severe restless, panicy feeling right? I don't have those symptoms.
>
> Scott's question about akathisia was actually for me. If you look at the subject lines of posts, if there is a ">>" and a poster's name, it's usually a post directed to that person. You can use this feature by checking the box that says "add name of previous poster", which is just below the subject line field in the posting window.
>
> Regards,
>
> gg
Posted by Michael D on September 28, 2006, at 16:11:13
In reply to Nardil - too many cons, everything else failed..., posted by Enigma on September 26, 2006, at 13:57:15
Try Nefazodone.
and then Trazadone.
Michael D
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