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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by UGottaHaveHope on July 15, 2009, at 9:48:09
Any input would be greatly appreciated.
About two years ago, I was doing OK but not great on Emsam and I decided since I was in the MAOI family that I would go ahead and try Nardil (45mg, then 30, blood tests showed that it was circulating through my body well). It took nearly 12 full weeks to kick in, after a lot of nasty side effects that went away (light-headed, constipation, etc.) but I got a euphoric high for a few months. In other words, I finally felt like I had met the medicine of my dreams for a few months. After 10 long years, I thought had finally found the road to recovery from Generalized Anxiety Disorder and Atypical Depression. I started getting back confidence and everything.
Then slowly over time, I guess the same effect left. Since then, I have remained on Nardil but never been able to get back to that initial Nardil "high."
1) Has anyone else experience that?
Right now I take 45mg Nardil, 50-75 Seroquel, and 2-3mg Klonopin. I actually bumped up to 60mg Nardil since I weigh 250 pounds within the LAST WEEK, and it is destroying my sleep, which surprises me since I am taking Seroquel. I'm guessing the only way to solve this would be to go down in Nardil ... any input here, too?
THANKS
Posted by Phillipa on July 15, 2009, at 10:53:20
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
U gotta is it possible that you are not supposed to feel high or is that what normal is and that possibly the initial high was like a mild hypomania? I don't know just asking. Is the anxiety still gone? Love Phillipa
Posted by UGottaHaveHope on July 15, 2009, at 14:22:58
In reply to Re: Euphoric high on first trail w/NARDIL .. you too? » UGottaHaveHope, posted by Phillipa on July 15, 2009, at 10:53:20
nm
Posted by shasling on July 15, 2009, at 15:23:20
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
Google nardil anxiety community,there are hundreds of users who claim the nardil reformulation ruined the med,there are also people here who disagree,i personaly used it and went back to parnate quickly,i dont mind the people here who debunk the claim,however i find it odd that they put no credit to an entire site dedicated to this very issue,thats ignoring tons of users lot of veteran ones as well.
Here is the site link actualy
Posted by SLS on July 15, 2009, at 16:24:34
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
> Any input would be greatly appreciated.
You may not be able to reproduce the startup euphoria that Nardil can produce unless hypomania is part of a bipolar diathesis. I was able to produce a mania by going up and down in dosage every few days. I actually sustained a hypomania at 30mg for a number of months. This spiked into severe mania once I discontinued the drug altogether. With Nardil, I have had several drug discontinuation-induced rebound manias. Not fun.
If you are not euthymic, though, I would urge you to continue to 60mg, as this seems to be the dosage that most people settle on. When Nardil worked best for me, it produced insomnia. For me, insomnia is a good prognosis side effect. Perhaps you can try to continue at 60mg and attack the insomnia agressively. I needed a combination of Halcion plus Ativan. Perhaps the insomnia will dissipate over time with the sedating drugs you are currently taking. If you are prone to more severe mania, though, you would not want to allow total insomnia to go untreated.
- Scott
Posted by bleauberry on July 15, 2009, at 16:25:23
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
First thing I asked myself was, "was this a hypomanic episode?"
>It took nearly 12 full weeks to kick in, after a lot of nasty side effects that went away (light-headed, constipation, etc.) but I got a euphoric high for a few months.
That leads me to believe it was not a hypomania thing. Hypomania would likely have shown up much sooner. 12 weeks is right in line with expected therapeutic action.
>I started getting back confidence and everything.
Hypomania comes with something considerably more than "started" getting back confidence. It is more like invincible superman confidence beyond what would be considered normal confidence in a strong healthy human being.
>
> Then slowly over time, I guess the same effect left. Since then, I have remained on Nardil but never been able to get back to that initial Nardil "high."I wonder though, are you still well? I mean, I know the euphoric stuff is a whimper now, but is there depression? I'm trying to get a grasp on whether you are nondepressed but lacking the euphoric high, or whether some depression has returned. What do you think? If you had to choose to remain where you are now and be thankful for it, or to be the way you were before Nardil, which is better?
>
> 1) Has anyone else experience that?I don't know if it is a mild poopout, a tolerance to the dose level, or what.
>
> Right now I take 45mg Nardil, 50-75 Seroquel, and 2-3mg Klonopin. I actually bumped up to 60mg Nardil since I weigh 250 pounds within the LAST WEEK, and it is destroying my sleep, which surprises me since I am taking Seroquel. I'm guessing the only way to solve this would be to go down in Nardil ... any input here, too?
>
> THANKSIt could be one of several things that crossed my mind:
1. According to veterans of Nardil, the suppliers and batches of Nardil now are not consistent. Maybe the batch you had in the euphoric days was a good one, and the batch you have now is slightly flawed? Though I don't understand it all, I do get the message that Nardil is very tricky to manufacture and can have variable quality from minor quirks in the manufacturing process.
2. I understand sleep is an issue, and probably anxiety? Set that aside for a moment. Seroquel in my opinion is doing you no favors and probably cutting quite an edge off the goodness of Nardil. The same goes for those doses of Klonopin. If the dose was in the .5mg to 1mg range I don't think it would such an issue. Maybe Lorazepam or xanax would be options to try? Klonopin is just basically a rather depressing med for most people and though Nardil is more powerful, Klono can cut the good edge off Nardil.
3. The dose might have to go higher. But as you pointed out, sleep needs to be addressed seriously. I do not like the choice of seroquel to do that. I think it hurts people than helps and they don't realize it. Just my own observation.
4. Maybe the euphoric effect is gone forever, a nice memory, but the rest of life will have to be viewed as a blessing to at least be free of the dark place you came from?
I don't know if low doses of Amitriptyline can be taken with Nardil. I wonder if anyone knows? I know Nortriptyline is fairly safe, but I don't know about Amitriptyline. I am tempted to think 25mg is safe enough. That in my opinion is a much better sleep option. I kind of wonder if Lunesta would have the power to overcome Nardil insomnia but I think it is definitely worth a try. Go for 100% to 200% of the max dose. I think some magnesium, as much as you can tolerate, would be good as a base to help sleep mechanisms function better.
Melatonin. I think one of the reasons insomnia happens frequently with ssris and maois is because melatonin comes from serotonin...when serotonin is prevented from going its natural course, melatonin suffers.
So what I guess I am saying is:
1. Slowly get rid of the seroquel (squashing down Nardil). Option is Zyprexa, a much better med, but lacks the knockout power of seroquel.
2. Slowly decrease the klonopin (squashing down Nardil). Options are xanax or lorazepam.
3. A base of magnesium and melatonin for sleep circuitry, even if they do not at first seem to put a dent in it.
4. Explore other sleep options, which might include Amitriptyline, Lunesta, Doxepin? I'm really not sure on the TCAs safety with MAOIs so you will have to ask SLS about that. I know for sure Clomipramine is a big no-no.
5. Try to think back on what else has changed. For example, did you drink more coffee back then? Has it been an unusually long dreary season such as in New England this year? Might it be associated with a seasonal change or daylength? Are you getting as much sunshine as you did then? Are you doing the same activities you did then? Have you been eating a lot sugar foods that would be increasing yeast in the gut? (feeding your brain their toxins that are absorbed into nerve endings along with neurotransmitters, corrupting the whole mood process) Going forward, make a dedicated goal of very little sugar of any kind, heavy on veggies, good proteins, go very light on the breads, pastas, and such. Should be mostly veggies and fruits. It is a hard change but honestly makes everything work so much better. Frustrating though because it takes several months to see the difference, and a month or so of maybe feeling a little worse (like breaking a mild addiction to something that makes you feel good but is actually harming you).
6. Thank God these days are not the bad ones you came from.
Posted by SLS on July 16, 2009, at 7:15:43
In reply to Re: Euphoric high on first trail w/NARDIL .. you too?, posted by bleauberry on July 15, 2009, at 16:25:23
My manias didn't evolve for months after beginning either Parnate and Nardil. As you say, though, perhaps there is no bipolarity involved here, but rather, the reaching of full euthymia which has now pooped-out somewhat. When I went from Parnate to Nardil quite a few years ago, I felt the best I ever did. This remission lasted a month or two. I am sure that it was euthymia rather than hypomania. I can compare this period with the subsequent hypomania I experienced.
In the case of Nardil, I am not ruling out the possibility of the occurrence of a mild hypomania early in treatment. It has been reported by very many people. Perhaps the term "hyperthymia" would better fit this phenomenon.
- Scott
Posted by atypical on July 17, 2009, at 0:06:51
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
I recently started Nardil (July 1) and am up to 45mg. I too felt a bit of a euphoric high at first. I was confident, getting a LOT work done, even giddy. Granted some of it may be because I had a woman or two in my life which I usually don't, so maybe that's why I was so giddy and happy. But, still, I was taking the Nardil. I then hit a wall and for the past week and climbing out of the trough. Let's see how I feel afterwards. I too have an atypical depression.
Posted by UGottaHaveHope on July 17, 2009, at 0:44:33
In reply to Re: Euphoric high on first trail w/NARDIL .. you too?, posted by bleauberry on July 15, 2009, at 16:25:23
I wonder though, are you still well? I mean, I know the euphoric stuff is a whimper now, but is there depression? I'm trying to get a grasp on whether you are nondepressed but lacking the euphoric high, or whether some depression has returned. What do you think? If you had to choose to remain where you are now and be thankful for it, or to be the way you were before Nardil, which is better?
I'VE BEEN STRUGGLING LATELY. HAD SOME JOB CHANGES WHICH TRIGGERED ANXIETY, WHICH TRIGGERED DEPRESSION. NOW I FEEL NO ANXIETY JUST DEPRESSION. I CAN'T REMEMBER WHAT IT WAS LIKE BEFORE TAKING NARDIL. I'VE BEEN TAKING NARDIL FOR TWO YEARS.
.
3. The dose might have to go higher. I'VE BEEN TAKING BETWEEN 30-45 MG FOR TWO YEARS. I'VE BEEN AT 45MG FOR EIGHT WEEKS, AND NOW HAVE GONE UP TO 75MG THIS WEEK TO SEE WHAT WILL HAPPEN THE FINAL MONTH.4. Maybe the euphoric effect is gone forever, a nice memory, but the rest of life will have to be viewed as a blessing to at least be free of the dark place you came from?
I'VE GOT TO CHANGE MY THOUGHT PATTERNS FOR THAT TO HAPPEN.
THANKS FOR YOUR WONDERFUL HELP!
Posted by bulldog2 on July 17, 2009, at 18:42:44
In reply to Re: Euphoric high on first trail w/NARDIL .. you t » bleauberry, posted by UGottaHaveHope on July 17, 2009, at 0:44:33
> I wonder though, are you still well? I mean, I know the euphoric stuff is a whimper now, but is there depression? I'm trying to get a grasp on whether you are nondepressed but lacking the euphoric high, or whether some depression has returned. What do you think? If you had to choose to remain where you are now and be thankful for it, or to be the way you were before Nardil, which is better?
>
> I'VE BEEN STRUGGLING LATELY. HAD SOME JOB CHANGES WHICH TRIGGERED ANXIETY, WHICH TRIGGERED DEPRESSION. NOW I FEEL NO ANXIETY JUST DEPRESSION. I CAN'T REMEMBER WHAT IT WAS LIKE BEFORE TAKING NARDIL. I'VE BEEN TAKING NARDIL FOR TWO YEARS.
> .
> 3. The dose might have to go higher. I'VE BEEN TAKING BETWEEN 30-45 MG FOR TWO YEARS. I'VE BEEN AT 45MG FOR EIGHT WEEKS, AND NOW HAVE GONE UP TO 75MG THIS WEEK TO SEE WHAT WILL HAPPEN THE FINAL MONTH.
>
> 4. Maybe the euphoric effect is gone forever, a nice memory, but the rest of life will have to be viewed as a blessing to at least be free of the dark place you came from?
>
> I'VE GOT TO CHANGE MY THOUGHT PATTERNS FOR THAT TO HAPPEN.
>
> THANKS FOR YOUR WONDERFUL HELP!I'm beginning to think my depression is reactive. You mention thought patterns. Just something that gives me a hint of what my mind sees as a positive development sends me into euphoria. On the other hand any thing that I see as negative sends me into a downward spiral. So one would think I have the necessary neurotransmitters to feel well.
On the other hand certain chemicals keep me on a more positive keel so that I am more likely to interpret events in a more positive light. So try and figure out this situation.
So I have the necessary neurotransmitters to feel good but I need certain chemicals to have access to the positive reward thought patterns???
Posted by atypical on July 17, 2009, at 20:48:12
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
Here's a previous thread on the same subject, from 2006. It is a very insightful series of exchanges that has given me some good understanding and "closure" about this euphoria issue with the Nardil.
Posted by atypical on July 17, 2009, at 22:36:56
In reply to Euphoric high on first trail w/NARDIL .. you too?, posted by UGottaHaveHope on July 15, 2009, at 9:48:09
And another good posting/thread on the euphoria/nardil issue:
This is the end of the thread.
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