# Nine years on Nardil



## spaceboy (Mar 5, 2006)

I take an MAOI (Nardil) that does a marvelous job of alleviating chronic mild depression (a.k.a dysthymia) and social anxiety. I've been on it for over 9 years so I have _a lot_ of experience with it.

I began taking it primarily to alleviate social anxiety. However, social anxiety and depression, in me, often seem to work in tandem, creating a vicious cycle which can make life very uncomfortable - and this dynamic duo had been putting me through the grinder for quite awhile.

When I first looked into medication treatments I began by trying a couple of the SSRIs. Unfortunately, they did little more than make me feel excessively wired, doing nothing for my SA whatsoever. After this, I became a bit more desperate and began digging deeper. In my research, I found material that spoke very positive things about the treatment of SA using MAOIs. I determined at that point, that if it was the last thing ever I did, I had to try it.

Unfortunately, the MAOIs are like the Desoxyn® (pharmaceutical methamphetamine occassionally used to treat ADHD) of anti-depressants. A "last line" treatment. So lemmee tell ya - getting doctors to prescribe it is like pulling teeth. And this is a damned shame. As one psychiatrist put it, "the MAOIs are _supremely effective_ anti-depressants". And when he says _supremely_, he's not being rhetorical.

So, I begged and pleaded - and pleaded and begged - with a couple of docs before landing a prescription. Once I got it, I had to wait a full six weeks (with fingers crossed) for it to work, but when it did - _holey moley_ - the effect it had was astonishing. It vaporized my depression/social anxiety combo like a scrap ship around the perimeter of a south pacific nuclear test site. Finding Nardil was like finding the freakin' Grail. I found myself thinking things like "Free at last! Free at last! Thank God Almighty, I'm free at last!"

Yessir, Nardil made a *HUGE* impression on me when I first took it. It energized me and allowed me to feel better than I'd ever felt as an adult. It's hard to describe in words what it was like to be able to go to parties and participate in things like play-acting games - to be able to let go, forget myself, act silly, and join in the fun. It was also awesome to have a group of friends throw me birthday parties for the first time in my life (because I actually had a group of friends to throw it.) And I could carry on conversations without feeling awkward, constantly thinking about myself, and wondering what to say. And it was great being able to go to job interviews without having my heart pound out of my chest, my palms sweat buckets, and my voice quaver.

As for me... I have an excellent tolerance of them - very minimal side effects. Less side-effects than I experienced with the SSRIs. At higher doses Nardil can even have a gentle soothing quality. (The increase in GABA?)

Another thing (and shhhh... don't tell anybody, especially my doctor) - but _I eat whatever I want with impunity_. Everything on the do not touch list - cheese, aged meats, chocolate, avacados, you name it. I discovered that I could do this by inadvertently eating a piece of cheese once. Realizing I had done this, I panicked a bit, then sat around waiting to die of a stroke. But, gee... no hypertensive reaction. Nothing. So I ate more cheese and still - nothing. After this experience, I gleefully put pizza back on the menu.

Over time, I've tried out all the other "off-limit" foods and noticed zero ill effects from any of them - _with a couple exceptions_: red wine gives me a very mild hypertensive reaction - and... at a fundraising event once, with *donated* beer, I drank half a glass from a keg that was flat and tasted slightly off. This, most definitely gave me a hypertensive reaction. (Tap beers apparently can be dangerous if there's a buildup of fermentation.)

While foods are one thing, over-the-counter drugs are entirely another. A thoughtless moment found me swallowing a small cup of Nyquil when I was sick. I didn't check the label. Oops. It contains a number of ingredients that don't mix with MAOIs. Headache, lotsa sweating, and a noticeably increased heartrate were the result. I made it through o.k. - but the worst part is the anxiety - wondering if you're going to, you know, die. Medical literature and doctors do their best to scare you - and this is doubtless for good reason. Not everyone is likely to tolerate them so well. (I read somewhere, that the actual number of people who have significant problems with food interactions are roughly 1 in 4. I also imagine that, if you are in poor health and at risk for stroke to begin with, an MAOI induced hypertensive reaction will break the camel's back.)

I've gone off my med a couple times in the past, feeling quite "cured". But, sure enough, give it a couple months and there I am - lethargic, low energy, of mood most foul... and highly self-conscious around people once again. Totally bogus. A couple months of this and, forget it... I'm back on the meds. Like an ever valiant warrior, the MAOI charges back on the scene to subdue the twin spectres of depressed mood and social inhibition. What a champ!

I will add, however, that Nardil is not perfect. In and of itself, it won't make your life a totally fabulous, all-the-time-happy bed of roses. Nor will it turn you into a "10" on the social scale. And life will still have its vicissitudes. But _it can very much assist you_ in finding a far more comfortable existence. It's a _boost_. And, hopefully, the boost it gives will find you flowing into a better scene. Cuz, believe me, there's nothing like a more extended social circuit to alleviate anxiety and quell depression. That's what you're ultimately seeking. Increase your social circle, solidify friendships, and establish a sense of belonging - and you'll have found the world's best anti-depressant. At least that's been my experience.

I've kept Nardil around for 9 years because it continues to serve as buffer, boost, and brake. On really low maintenance doses it provides a bit of a buffer (I'm on a very low maintence dose about 90 - 95% of the time). When I need a boost, I boost it. And it most definitely will put the brakes on a more precipitous decline. This last aspect is actually one of it's nicer anxiety reducing effects. Just knowing that it's available and that it works, helps keep a lid on anxiety.

Anyway, that's my word on Nardil after nine years. A++


----------



## spaceboy (Mar 5, 2006)

I'm new to this forum, having just discovered it a couple of days ago. I haven't dug around here too much, but I've been surprised to discover that there's not all that much posted about Nardil. In my experience it's been remarkably effective. 

Also - since I've been on it for a bit over nine years without much trouble, it's "scary" reputation (to me) has long seemed overblown. Which is not to say ignore the warnings. Definitely heed the warnings - but one may find, over time, that the dreaded hypertensive reaction from eating the wrong foods appears virtually non-existent. Though I don't doubt that, for some people, it can be a big problem.

If I had more problems with food interactions than I do, I don’t know if I’d still be using them. It can be really hard to monitor exactly what you eat, especially when eating at restaurants. (and having to avoid common things like cheese will make other people curious - and you might not want to explain the reason why, for example, you don’t eat pizza.) Also, you might be liable to do what I did and unthinkingly down something as seemingly benign as Nyquil. For me, this wasn’t that big of a deal - headache and a bit of discomfort - but someone else might end up kicking the bucket. In general, it seems that if someone is at risk for a stroke to begin with - stay away from the MAOIs.

Anyway - I just had to write a post giving a big thumbs up for Nardil.


----------



## Noca (Jun 24, 2005)

I wish I could get a script for nardil =p


----------



## spaceboy (Mar 5, 2006)

You have to work at it. You have to make the decision, and take full responsibilty for it. I had to switch doctors and find someone more specialized. Even then I had to virtually get on my knees and beg. (Most doctors know very little about it beyond the worst-case scenarios they've heard. But heck - even with my experience, if I was a doctor, I'd be nervous about prescribing it, cuz you never know how it might turn out in another person.)

At the time I was seeking a prescription, however, I couldn't have cared less if Nardil was pharmaceutical PCP - once I'd read of it's efficacy, I was absolutely determined to get it. My social anxiety/depression had made life way too painful for way too long. To be honest, I was isolated, desperate, and near suicidal. I couldn't seem to find a way out. Potentially deadly food interactions? What the hell... I needed some relief. Period. And I found it.


----------



## Flu102 (Jul 11, 2005)

I went through many of the SSRI's, a benzo and an anti-psychotic before I was precribed Nardil, and it is the first medication that has made any difference, and a large one at that.


I love you Nardil :blush


----------



## UltraShy (Nov 8, 2003)

spaceboy said:


> Unfortunately, the MAOIs are like the Desoxyn® (pharmaceutical methamphetamine occassionally used to treat ADHD) of anti-depressants. A "last line" treatment. So lemmee tell ya - getting doctors to prescribe it is like pulling teeth.


I had a GP who was absolutely thrilled with the idea of making me his first MAOI patient ever. I declined to try Nardil, despite his extreme enthusiasm for it. My psychiatrist doesn't think much of MAOIs as an anxiety treatment, though the most effective pill for depression he thinks. I'm not sure what to think of Nardil. It's hard enough to find anyone who's ever tried it to get any feedback on it. Finding someone with 9 years on it is a first for me.


----------



## spaceboy (Mar 5, 2006)

Hello UltraShy,

Well, I've been digging through some of the older posts on this site and there's a fellow on here named "workman" who's been on it 16 years and relates his good experience with it.

I have to admit - I'm really surprised at how few posts there are on this forum regarding Nardil. For social anxiety and depression - the MAOIs _rock_. The SSRIs that I tried seemed like toys in comparison. Maybe-sorta-kinda antidepressants. With an old MAOI like Nardil, lemmee tell you, there ain't no half-steppin' and no messin' around. You won't find yourself asking questions like "Gee... is it working yet?". Nosirree. When Nardil kicks in - _you know it_. Nardil is *p.o.t.e.n.t.* And the best part of it's potency is that - hot diggity dog! You can finally _be yourself_ around other people.

Look into the history of the MAOIs a bit and you'll have to wonder at the stats. Iproniazid (an MAOI, the very first drug marketed as an anti-depressant, and a chemical relative of Nardil) was first released in 1957. 
(below I'm quoting from _Listening to Prozac_ by Peter Kramer.)
"Approximately 400,000 depressed patients were treated with iproniazid in the first year. Unfortunately, 127 if these patients developed jaundice. Given the prevalence of viral hepatitis, this was probably a small number of cases for the population involved, but the manfacturer thought (wrongly) that it had a more potent antidepressant coming to market, so, rather than fight the bad publicity, it withdrew ipronizaid. Ipronizaids's reputation had been fatally tainted by the report of side effects, and it was never heard from again."

400,000 presciptions for an MAOI written in the first year. This was before doctors were even aware of the possibility of negative food interactions. In other words - no one was warned, and no one was being careful. And were people dying left and right from hypertensive crises? No. The drug was removed from the market because 127 patients developed jaundice and the manufacturer thought that there was a link.

There's no doubt that you can get a hypertensive reaction - but in my nine years, they've been very rare - and generally mild. You have to be either very susceptible to the "cheese reaction" - or already at high risk for a stroke.

I assume that doctors generally only hear "people have died from stroke!" having no idea what the actual numbers on it might be. So, whoooaaa! Scary, dangerous drug! Stay away! Let's try, um... prozac, or wellbutrin or something. It might not work for SA - but at least no one's died from eating cheese.

But dang. What a shame that its reputation is so bad. Because it works. _It works really well_. I've taken it for nine years, and paid for it out of pocket (I don't have insurance) for that reason, and that reason only.

<><><><><><>

Also, Nardil is a drug long off patent. There's very little economic incentive to promote it much or even study it. There's a little discussion of this at http://www.socialfear.com/ssri_failure_in_sp.html


----------



## No Limit (Dec 6, 2005)

Well I've been thinking long and hard about MAOIs trying to find every bit of information about it on the internet. I'm trying to schedule an appointment to see a psychiatrist because I was told to go through one of them to get an MAOI perscription. The only thing that sort of holds me back from taking MAOIs is the diet restrictions. I do drink protein shakes since I workout in a gym on a regular basis and I really do like cheese especially if it's melted on a pizza or sandwich.

To Spaceboy: Did you have to give up eating some foods in order to try this medicine? Is eating a little cheese even off limits?


----------



## spaceboy (Mar 5, 2006)

First, a correction to my earlier post. The *16 year* Nardil user I mentioned wasn't workman .... it's a forum member named *Captain Woodchuck*. Search for posts by him if you're curious.
<><><><><><><>

No Limit,
I mentioned my virtually non-existent problems with food interactions in my first post. Very, very few problems. Pizza, with extra cheese, please. Make it a large. I know what a hypertensive reaction is like, and I experience nothing of the sort when eating pretty much everything on the list.

I discovered my lack of food interactions during my first year and have been pretty non-chalant about it ever since. I don't know why I happen to be so lucky in this regard - I just am.

Like I said though, you'd be well advised to stick to the rules at first. Don't go flagrantly violating what your doctor tells because you read some guy on the internet saying he's had next to no problems with it. I suspect people are quite different in their tolerance levels.


----------



## spaceboy (Mar 5, 2006)

If you read some of the posts of Captain Woodchuck, you'll find him mentioning some of his experiences with food interactions and hypertension. He seems to have a bit less tolerance than I do. His posts might be better to pay attention to in this regard, cuz I don't know... maybe I just have an unusually good tolerance. 

When I started investigating my food reactions, tiny bits at a time - eventually getting to the point where I pretty much gobble down anything - I have to admit, I started wondering "What? Is this a joke?" regarding all the scary stories I'd heard. When I first went on Nardil, my doc tried to put the fear of god in me. (and my first doc wouldn't even prescribe it.)

But, hey, once again - everybody reacts differently to these things. I have no doubt that the scary stories I've heard have actually happened to some people. For example, I was told by my psychiatrist of one woman who had a stroke from eating a bar of chocolate. I don't doubt that the story was true - and my psychiatrist told it to me for a very good reason.

However, jeepers... I eat chocolate all the time now. Entire bars. Large bars. Entire, large bars of dark chocolate with nuts and dried blueberries. Mmmmm. No headache. No sweating. No increased heartrate. Nothing. 8 and half years of this and I'm still alive.


----------



## workman (Mar 5, 2004)

I didn't take nardil for 16 years. I did take it, but it caused all the nasty side effects all other AD's do for me. I didn't get any food interactions. I ate whatever, I did avoid really aged protiens. But beer from tap, cheese, stuff like that did bother me.


----------



## spaceboy (Mar 5, 2006)

Yeah, sorry. I confused you with *Captain Woodchuck*. My mistake. Ooops.


----------



## spaceboy (Mar 5, 2006)

Anyone interested in a more detailed description of side effects that I've experienced (those I had earlier on, but went away - and those I still experience)? Also - anyone interested in hearing about my "dosing strategy"?


----------



## No Limit (Dec 6, 2005)

Sure. It'll probably help in my decision on whether to try out MAOIs.


----------



## UltraShy (Nov 8, 2003)

spaceboy said:


> Also, Nardil is a drug long off patent. There's very little economic incentive to promote it much or even study it.


Nardil is about 45 years old, so the patent ran out decades ago, but there is still no generic version of it available. It's so rarely used that no generic drug company sees enough profit motive to try to make their own copy of it.


----------



## UltraShy (Nov 8, 2003)

spaceboy said:


> Anyone interested in a more detailed description of side effects that I've experienced (those I had earlier on, but went away - and those I still experience)? Also - anyone interested in hearing about my "dosing strategy"?


Yes, I'm very interested. Please do tell. It's not likely I'm going to find anyone else with as much Nardil experience as you.

Two issues I'd be most interested in are any sexual side effects (which seems very common with the vast majority of ADs) and weight gain.

Also, what is this "dosing strategy" you speak of?

Thanks for any information you can provide.


----------



## Caedmon (Dec 14, 2003)

You are our current Nardil King. :yay Good to hear that it helps you.

I'm interested in what Ultrashy mentioned. Esp. dosing since you seem to be able to get away with a fairly low dose (I understand that many people have to go up to 90 mg.) I'd also be interested if you +/- experienced side effects of sedation, hypomania, increased sweating, or dry mouth.

Drug-drug interactions worry me far more than the food restrictions. I am pretty much a walking pill, so anything as extreme as a monoamine oxidase inhibitor is going to be a massive lifestyle change. If I did go on an MAOI my first choice would actually be Parnate.


----------



## streetsk8er794 (Mar 5, 2006)

i did some research on many different sites and it seems that Nardil is even more effective than Klonopin, without the addictiveness!!! I am very curious as to how much you take and how many pills a day you have to take? Also, is it expensive?


----------



## spaceboy (Mar 5, 2006)

O.k. Here's a brief run down of side-effects.

To start with: They come in 15mg pills. The highest recommended dose is 6 pills daily, or 90mg. When I say "higher dose" in describing side effects, I'm referring to 4 - 6 pills a day, or 60mg to 90mg.

Push the dose up to 90mgs daily and, believe me, you can zap your social anxiety very effectively. Run of the mill chit-chat in social situations is effortless. Thoughts are freely available, and - whadda ya know - you can just say them as they pop into your head. (Hey, what a novelty!) Even with complete strangers, people I've just met at a party for example, I can be quite chatty and outgoing - joking and laughing.

I don't, however, particularly care to be on a high dose for too long because that's obviously when I experience side effects the most. The worst of the side effects (for me) is *insomnia*. Get my dose up to 90mgs and sleeping can become a real problem. Not being able to sleep after you've been awake for a long time (or only being able to sleep for a couple hours) is uncomfortable. You might feel worn out - but you can still lie in bed wide awake. Insomnia is a definite problem on higher doses.

Other side effects.

*Weight gain* - yes. I'm fortunate in that I'm naturally thin, so adding a bit of weight is not an issue. It almost makes me seem more appropriately "filled out". I'm going to roughly guage my weight gain at about 10 pounds - from roughly 160 to 170lbs. When I first noticed the increase in weight, I wondered if it was going to stop, or if I'd just keep adding the pounds. It leveled off after about 10 pounds, and over numerous years, my weight has been very stable. When I've gone off Nardil, sure enough, I've started shedding those extra pounds.

(Side effect that's gone away) *Sexual dysfunction*. (male) This took somewhere in the neighborhood of 2 to 3 years to become less of a problem. It's also a side effect that is way more noticeable on higher doses. Back in the day, on a higher dose, I could get an erection without problems, but orgasm was pretty, um... hard to come by. You might surprise a lady with your stamina... however, she'll also wonder what's going on. I haven't had nearly the problem with this in recent years than I did initially.

(Side effect that's gone away) *Standing up quickly and getting light-headed*. (again, a higher dose issue) This was a side effect that was never entirely predictable - and something I haven't experienced in a long time - but I can recall experiencing it well into my 2nd year. Basically, it's like - if you're sitting down and you suddenly get up... woooo... be careful. You can get seriously light-headed and dizzy. You'll need to quickly sit back down again or you can keel over. I learned to be careful when standing up - doing it slowly, or in "stages". For whatever reason, this side effect has entirely gone away. (I play softball in the summer, and have done so for 7 or 8 years, and I've never had a problem with dizzyness being caused by sudden movement while playing.)

Because of the increase of side effects (particularly insomnia), I reserve higher doses for special situations like parties or job interviews, or moving into a new job. Remember, for anti-depressants, it takes a little while for increased dosage to be felt, so you have to plan ahead. For example, if there's a party I'm going to on Friday, I'll start working my dose up a couple days in advance so that it "peaks" on the day of the party. (This is my "dosing strategy" in a nutshell. Maintenance dose... boost when needed. But I have more to say about it, which I'll post soon.)

Also, I'll add that after being on them for so long, their effect on me is well known and predictable. In other words, the gigantic, huge, glorious excitement I experienced when I first took them (from being able to socialize far more smoothly) is now a routine phenomena. And frankly, I get tired of taking the stuff. Hell, I got tired of taking the stuff after a few months. But I still do.

In taking any of these medications, you have to do a cost/benefit analysis. To me the benefits of greatly increased social comfort and better overall mood _far outweighs_ the cost in terms of both money and side effects.


----------



## streetsk8er794 (Mar 5, 2006)

jesus man, six friggin pills a day!!?? that seems like a lot for a single medication. what do you get like 180 pills at a time?


----------



## No Limit (Dec 6, 2005)

spaceboy said:


> To me the benefits of greatly increased social comfort and better overall mood _far outweighs_ the cost in terms of both money and side effects.


Thanks for sharing your experience. I think your last sentence summed up why I'm considering taking Nardil. I mean the Celexa is making me open up a little more, but I just need the extra push. I think Nardil is it.


----------



## Noca (Jun 24, 2005)

streetsk8er794 said:


> jesus man, six friggin pills a day!!?? that seems like a lot for a single medication. what do you get like 180 pills at a time?


6 pills isnt much I take 14 pills average a day


----------



## Caedmon (Dec 14, 2003)

Seems like the people who don't need to gain weight, gain the most; those who could use some extra pounds gain the least. The universe is cruel that way.



Noca said:


> streetsk8er794 said:
> 
> 
> > jesus man, six friggin pills a day!!?? that seems like a lot for a single medication. what do you get like 180 pills at a time?
> ...


 :agree I have a pill caddy, one space for each day of the week. Each day has about one cubic inch of space. When I lay out the pills for the week it's usually filled up to the brim with various psych meds, acne stuff, a big famotidine tablet, vitamins, etc.

I don't know what the average # of pills per day is that I take but if I discount fish oil pills (which is 10 per day right there, although I take it in three doses w/ meals) it's probably around... 10 a day?

Edit: crap, I underestimated, it's about 20 pills a day. :hide


----------



## spaceboy (Mar 5, 2006)

_A bunch of new posts here. I wrote a new post and I'm responding to a few that were earlier.

Important to note, of course, that what I'm writing relates my experiences only. I've never once come across another individual who takes Nardil, and everyone has a different reaction to these things. I've felt very lucky with Nardil._

I've never experienced dry mouth at all.

Sedation... no. Not that. I've generally found it energizing and - ug - the insomnia thing is a drag.

It's definitely not addictive. I can reduce my dose or go off it altogether quite easily, with no discomfort. (I wish I could say the same about cigarettes.)

About the lower maintenance dose... just to fill in some background: Back when I was struggling monstrously with social anxiety and depression... ug. Ug. Ug. Ug. Social anxiety led me into isolation... and isolation is a fabulous environment for the cultivation of depressed moods. With depression, lo and behold - my anxiety increased. Depression, of course, is also very effective in reducing one's motivation to socialize in the first place. So there I was - frequently stuck. Sliding down the sides of a sand-pit trap with big pincers and poisonous things awaiting my arrival at bottom.

And the way out? End the isolation. Unfortunately, because my need and desire to get out of isolation was so strong, it placed a tremendous amount of pressure on my social interactions - making me, at times, extremely self-conscious. I went through several rounds of this vicious cycle back in the day.

I tried to fight it for a long time (would force myself into situations that made me uncomfortable, because, dammit, I knew that rationally there was nothing to fear in interacting with people) - but the social anxiety/depression combo kept restricting my life in the most miserable ways. It kept killing me. So I wanted to kill it. Wipe it of the map. Blow it out of the water. Bomb it with the Mother of All Bombs. Whatever it took. *I did not care anymore.* And while I didn't find an MOAB, I found the MAOIs - a.k.a. the Mother of All Antidepressants (both literally and figuratively). And the result was ... Kaaaabooooooom!!!!! A direct hit.

(You should see my journal entry from back when it fully kicked in for the first time. Glorious! It's so full of expletives I can't really post it here, but it's stuff like - "this SH*T F#@**ING ROCKS!!! Oh my god!!! M*TH*RF#@**ING MAGIC PILLS!!! The GRAIL!!! FOUND!!! AT LAST!!!" etc. etc. etc.)

Anyway... where was I? Oh, yeah. I was going to say something about the low maintenance dose. See... the grand result of having landed a direct and massive hit on my SA/Depression combo was that I found myself having a vastly improved social life. (I'm not b.s.ing - it was hugely improved.) And having a decent social life definitely helps to keep depression and anxiety at bay. The root of the problems I'd been having earlier seemed a result of my social anxiety leading to very little social activity - feelings of isolation would then precipitate an emotional decline summed up in three words - loneliness, sadness, and hopelessness.

So... fix the isolation problem. Become familiar with yourself actually being a bit outgoing and having fun with other people. Start cracking jokes with strangers you meet at a party. Get to know people better and grow into new friendships. If you can do that, then a higher dose is no longer quite so necessary because life is more stable and a lot more comfortable.

And this is why I've actually gone off it twice in the past. "Look! I'm cured!" ... well, not quite. I very slowly, imperceptibly start to sink again. The lady behind the counter makes a small joke as I purchase my groceries, and I cannot muster even a lame response. Ooop. Um... let's go back on the Nardil.

I have more to post about my "dosing strategy", because there's another reason why I'm on a low maintenance dose. It has to do with tolerance when I increase the dosage - the brain's natural inhibitory feedback-mechanism - the re-regulation of neurochemicals designed to keep things on the level.


----------



## Caedmon (Dec 14, 2003)

I'm a lazy, lazy man. But for what it's worth, here's what I dug up on PubMed, an abstract on side effects from MAOIs. You do the math.

~~~~~~~~~~~~~~~

Prog Neuropsychopharmacol Biol Psychiatry. 1989;13(3-4):497-504. Related Articles, Links

*Common side effects associated with monoamine oxidase inhibitors.
*
Remick RA, Froese C, Keller FD.

Department of Psychiatry, University Hospital - U.B.C. Site, Vancouver, Canada.

There is relatively little documentation on the common side effects associated with monoamine oxidase inhibitors (MAOI) and their frequency of occurrence. A retrospective chart review of patient records in a Mood Disorders Service was completed. Side effects of patients receiving phenelzine (N = 42) and tranylcypromine (N = 19) were rated as mild (resulting in no change in treatment), moderate (some modification in treatment plan necessary), and severe (definite change in treatment plan or drug discontinuation due to MAOI side effect). A total of 35 reports of side effects were noted in 15 of 19 tranylcypromine patients (1.84 per patients) and a total of 125 side effect reports were noted in 39 of 42 phenelzine patients (2.98 per patient). Only two severe tranylcypromine side effects occurred (resulting in drug cessation for one of these patients - hypotension), while 9 severe reactions occurred with phenelzine, resulting in drug discontinuation in 6 of these patients. The side effects for tranylcypromine and the number of reports were insomnia (N = 10), sedation (N = 8 ), hypotension (N = 5), sexual dysfunction (N = 3), hypomania (N = 3), weight gain/edema (N = 2), hypertensive episode (N = 2), and myoclonic jerking (N = 2). The number of reports of phenelzine side effects were insomnia (N = 26), hypomania/mania (N = 27; most common reason for drug cessation - 4), hypotension (N = 16; three cases considered severe), weight gain/edema (N = 15), sedation (N = 15), sexual dysfunction (N = 13), hypertensive episode (N = 6), and myoclonic jerking (N = 7).

~~~~~~~~~~~~~~

Here's one that I just thought was really interesting. Part of the reason why I asked about the hypomania. I mean _holy crap_, more than half the people in the study above got hypomanic or manic on phenelzine (Nardil) (27/42 = 64%).

~~~~~~~~~~~~~~

J Affect Disord. 1998 Sep;50(2-3):203-13. Related Articles, Links

* Social anxiety, hypomania and the bipolar spectrum: data, theory and clinical issues.
*
Himmelhoch JM.

Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA.

Reports in the literature indicate a subtle but consistent relationship between panic and bipolar II disorder. The possible connection between social phobia and bipolarity is less investigated. When we studied the treatment outcome of 32 social phobic patients administered either the reversible monoamine oxidase inhibitor (RIMA) meclobomide or the irreversible inhibitor MAOI phenelzine, we found that eighteen had remission > 50% of their socially anxious symptoms. Moreover, 14/18 of those improved became hypomanic, according to the Raskin Mania Scale (RMS) and the Young Mania Scale (YMS) coupled with expert clinical diagnosis. These findings possibly allude to a relationship of social phobia to bipolarity. Treatment with RIMA or MAOI exposed these subjects as having an atypical bipolar syndrome which is part of the bipolar spectrum. We then compared this special subset of subjects to the 18 socially phobic patients who failed to respond to RIMA's or MAOI's and to 26 patients with generalized anxiety disorder (GAD). Eleven of the 14 hypomanic responders gave histories of serious developmental deprivation (anaclisis); only 5/18 social phobics and 3/26 GADs without hypomanic responses had anaclitic histories. The author raises the possibility that anaclisis may have interacted with the impediment of volition of uncomplicated bipolar depression to produce social inhibition and anxiety. Finally, the author upholds the central role of depressive inhibition in bipolar disorder, which during antidepressant therapy often overshoots in a hypomanic direction; even in the absence of prior spontaneous hypomania, such disinhibition should classify this special subset of social phobic patients within the bipolar spectrum.


----------



## spaceboy (Mar 5, 2006)

Thanks for digging up the info on the MAOIs. Anything on the MAOIs is interesting to me.

Re hypomanic: (I just went and looked the word up) Back during my first six months on Nardil, I decided to "experiment" with my dose somewhat. It worked really well at 90mgs - but give it a bit of time and I'd notice it's usefulness beginning to wane. Some kind of re-regulation of neurochemicals was going on in an effort to level things out, and as it did, it seemed to reduce the effectiveness of the medication. In short, the longer I cranked the dosage knob to high, the less bang I got for my buck.

Since I really enjoyed the efficacy of 90mgs (especially at the time, since it was such a novelty to find myself far more outgoing) I thought, heck, I'm just going to keep increasing the dose. I eventually got it up to about 150mgs for maybe a week. And it was here that I started verging on becoming manic. I was overdoing it, for sure, but to be honest, I actually enjoyed it because it was the polar opposite of how I'd previously felt. Talking too much was certainly a part of that high-dose experience - and excess talking is a sign of hypomania. (Note: it's also pretty easy to make a fool of yourself if you're highly energized and excessively disinhibited.)

That's the only "manic" experience I can relate, but I was getting close to twice the recommended maximum dose at the time.

I've always been in the dysthymic range - chronically mildly depressed. No swings in mood from down to up - more of a consistent low level down... with episodes of more serious depression when things seemed to get out of control. I can never recall a time when I was ever even close to manic - which is probably why I enjoyed the time I went over limit on Nardil. "Wow! This is great! Wooooooo! I've never felt like this before in my life!!!"

In my writing (just to note) I'm trying to convey what it felt like when I first started taking it. The improvement in mood, my ability to feel at ease in social situations, and my integration into a comfortable social group for the first time in my life - man, it's hard to put in words how exciting it was. In trying to do so, it might come off sounding as if I'd been taking large amounts of cocaine or something - but no... since my situation had not been pleasant prior to discovering Nardil, back then the improvements it made were BIG NEWS. Big, fabulous news.

It ain't exciting like that anymore. That excitement is long gong. Now it's just, you know, life. And taking psyche meds sucks. Period. Don't anyone get me wrong on that account. I keep it as low as I can 90-95% of the time - using it as a boost or an anxiolytic when needed.

<><><><>

Hmmm. Thinking about it - maybe along with the insomnia, I don't enjoy staying in the higher dose range for long because it starts to approach something like hypomania. Just a bit too much ooomph. Good for a short time, perhaps, but, well... it's too much.

Hmmmmm. Never thought of it as having a name (hypomania). As soon as I reduce the dose, however, along goes the extra charge. In other words, it's never precipitated anything in me that took on a life of it's own, as it might in someone who's bi-polar.


----------



## spaceboy (Mar 5, 2006)

You know what, just for the heck of it, I'm going to go into more detail about my early experience on Nardil. A bit like a very abreviated journal.

First, however: Is my life a bed of roses? No.
Does social anxiety still trouble me? Yes, it sure does. It's a pain in the pattootie, and I've had to deal with it all my life - much to my chagrin. But life has been way better with it than without.

My first three years on it were the best. This has more to do with my social life during those first three years than it does with whether or not Nardil worked better at the time than it does now. Circumstances just seemed to come together very nicely in a lot of ways, and shortly after Nardil started working for me, I found myself rather quickly integrate into a very enjoyable social circle. And this was the first time in my life that I'd ever had an extended social circle - so it was a really big deal.

I had known a group of people (a fairly tight knit group of friends around whom there revolved a broader social circle) for about a year before I began taking Nardil, but I knew them only from a distance. Initially I'd been very hopeful that I would integrate more fully into the social life of these folks. I'd been invited over for some of their parties before, but I could never break through my shell at these events, so I remained pretty much a wall flower. The result was that - while they initially had an interest in getting to know me, I seemed unable to reciprocate. I remained quiet, distant, and disengaged. And I had been hearing from them less frequently as time had gone on.

This actually bothered me quite a bit, because they were definitely my kind of people. We shared a lot of the same interests. But I found myself unable to "let go" around them, and I also began noticing myself becoming highly anxious and depressed again. In part this depression was precipitated by what appeared to be yet another opportunity for friendships gone down the tubes. These people seemed to like me, but I could not relax and open up even after repeated efforts had been made as if to say "hey, c'mon, come hang out with us." My sense of isolation was growing along with my depression. And it was fall, going into winter, and it's always worse for me at this time.

It was during this period that my research into medications for social anxiety kicked into very high gear - driven by despair. I came across Nardil mentioned in a book called "The Hidden Face of Shyness" and tried to find anything else I could read about it. I decided that I had to try it, and it felt like a last resort. I got a prescription and started taking it. Week after week went by while I prayed for it to work.

Six weeks, almost to the day, it began to take effect. At first, I didn't even realize that it had started working. I was at a New Year's party thrown by the above mentioned group of people. The party went fine - no problem. The the next day, I thought about this. The party went fine - no problem. Hmmmm. Wow. Gee... you know what? I had a really good time. Dang! I was talking quite a bit... people were laughing at my jokes! Good lord! Could it be the Nardil???

This was Jan 1st, 1997. I found my answer to that question on Jan 2nd. On Jan 2nd 1997, Nardil broke down the doors like a shotgun. And man it felt gooood. It's hard to describe. It was like my brain was soaking in a warm, luxurious bath of golden neurotransmitter fluid. It was energizing - but very soothing at the same time. On January 2nd I was at work and I found myself engaging my co-workers in conversation far more than I ever had before. And it felt so utterly natural. Noticing this, and feeling what felt like a flood of warmth in my brain - oh my goodness, I was beside myself with glee. It was working like freakin' crazy! It was soooo much better than anything I'd experienced on an SSRI. Absolutely no comparison. I could hardly, barely wait until I had a chance test it out once again in a recreational social environment - a.k.a. a party.

I had my chance soon enough, and again, it was with the same group of folks. Another party over at their house. (My good performance at the New Years party probably helped with this invite). I very vividly recall the play-acting game that went on during this party. One person went into another room so as not to hear what was being discussed. The rest of the group picked a character, and someone was selected to act this character out when the person was called back from the room. The person who'd been in the room had to guess what the actor was trying to portray. I eventually got my chance to act and I played a door to door sales person. It was... well, it was soooo good. I'm not a great actor or anything - but I was silly and spontaneous, and people were digging it. People were laughing and digging it and ... god, it was just so much fun.

I could _never_ have done that before. It was like I came out of my shell overnight. It was weird... and it was utterly fascinating. I couldn't understand how this drug could do such a thing. It seemed like a miracle.

After that party I was invited over with increasing frequency. I started going out with them to restaurants and rock shows, on day trips and camping trips, and eventually, at a house where a number of them lived, a room opened up and I moved in. I was absolutely beside myself with silly, crazy happiness. My social life had been so minimal, virtually non-existent, prior to this that I was unbelievably relieved and overjoyed. A surprise party was thrown for me on my birthday and that was, like, the absolute cherry on the cake. No one outside of my family had ever thrown a birthday party for me before.

That period of my life was wonderful nourishment. Soul food. Ahhh, but life has it's vicissitudes. People moved to other parts of the country, some people had a falling out, others just drifted away. So what was once a nice nucleus to a broader network just sorta melted in the sands of time. And I've never quite found that same richness of social activity since.

I still keep in touch with most of the people from the time I just described - and I hear others express a sense that that time was something of a golden period. Glory days, if you will. I can absolutely 100% guarantee you that it never would have happened for me if I hadn't come across Nardil. I'd absolutely swear by the stuff if just for that time of my life alone.

I'm not a high power socializer. Nardil didn't turn me into that. But I'm waaay better than I was. And life goes on with it's ups and downs. And, as a matter of fact, I've even seen myself nose dive into depression since that time (triggered by an unfortunate event and some difficult circumstances). Nardil puts the brakes on a more significant decline, however, and my depressive episodes since I began taking it have been far easier to handle than they used to be.

And blah, blah, blah, blah...


----------



## Caedmon (Dec 14, 2003)

Okay, thanks for sharing that. I am bipolar so that is, of course, a concern for me. I tend not to get the good kind of mania btw, it turns into the "insomnia, irritable, agitated, arsehole, talkative with nothing to say, mood swings" type of mania. 

But I tend to do okay with antidepressants if I'm on a mood stabilizer too. We'll just have to see.


----------



## apprentice1 (Feb 9, 2005)

Well, I don't want to say that you can be "long-winded" or anything, but whoa! (I am just kidding, look at the size of some of my posts, especially in the beginning...).
I'm impressed! I live in Germany and this drug is the first thing my psych offered up. He said it is kind of like cocaine...then told me of the diet restrictions...iI cowered. I live here where old cheeses from Holland like alt Amsterdamer and good dark red wines from Italy cost like a dollar, okay, three, sometimes four Euro...I wasn't ready to give them up. I have since then, however found that psych meds and alcohol don't work together at all...and realized I had built up a nice alcohol problem to handle my SA, I am at least down to no alcohol at home alone and when I do go out for dinner, a glass or two of white wine will do quite nicely. (Anything more is just a waste of money and other peoples nerves having to put up with an aggressive drunk letting out a lifetime of held in resentment...) It is a shame that we get almost driven to alcoholism because they won't prescribe the "good" drugs. If I had always been able to get Benzos, I would have never gone so far with alcohol as a "medication"... I am getting off topic here. Are you sure you are not a new salesperson for Nardil, I think you have half of us ready to run to our docs and snatch Nardil off the shelves! How do you take it, I mean dedicatedly at the same time every day rain or shine or irregularly? Any experience with taking Benzos at the same time?

I have read that a good combo for SA is

1. an antidepressant. like an SSRI ie; Effexor, moclobomide OR a MAOI like Nardil and

2. a Benzo like Klonopin or xanax or valium and

3. an optional augmentation like: Ritalin, Wellbutrin, Lamictal, Depakene, Neurontin, Keppra or Provigil

http://www.socialfear.com/ If that doesn't work, try [email protected] Thanks for a new voice for Nardil.


----------



## streetsk8er794 (Mar 5, 2006)

hes not a salesperson man. ive heard his story over and over from different anxiety forums, but ive just never tried it because of the amount of pills i have to take. but, as soon as i figure out if my strettara is going to work on my ADHD/SA i can make the decision as to whether or not i will take Nardil or not.


----------



## UltraShy (Nov 8, 2003)

streetsk8er794 said:


> i did some research on many different sites and it seems that Nardil is even more effective than Klonopin, without the addictiveness!!!


Benzo "addiction" or dependency is a vastly overblown issue IMO.



streetsk8er794 said:


> Also, is it expensive?


I just looked and it's hard to find many price quotes for this drug online as a lot of pharmacies don't even bother to list it, presumably becuase it's so very rarely used.

Costco quotes a price of $54 for 100 pills, so about $3.25 a day at the max dose of 90 mg. Pretty much on par with modern brand name ADs. As for having to take a lot of pills, I already take Xanax which requires 5 pills a day to reach the 10 mg that I'm prescribed and it's a short-acting benzo, so I'm used to frequent pill popping. For comparison, generic Xanax, even at that max dose, can be had for $1 a day.

I'm disappointed to hear about spaceboy's anorgasmia problem with Nardil (at least at high doses). That's a standard SSRI problem and it drove me nuts, though I stopped SSRIs because they didn't work at any dose, though not being able to orgasm is a side effect that I don't think I could tolerate long term. What's the point of taking Nardil so that I'm able to talk to girls -- I wouldn't have much use for them if I had this side effect!

I also greatly fear weight gain. I'm 6' and currently weigh just under 260. More weight is the last thing I need. Controlling my weight has been a life-long (and generally losing) battle.


----------



## UltraShy (Nov 8, 2003)

Caedmon said:


> I mean _holy crap_, more than half the people in the study above got hypomanic or manic on phenelzine (Nardil) (27/42 = 64%).


That's probably the only thing that doesn't scare me about Nardil. I'm about as far from manic as possible. I'm the polar opposite of energetic, impulsive & reckless, so I probably don't need to worry about that issue.


----------



## spaceboy (Mar 5, 2006)

Yeah, I'm long winded ... no doubt about it. I do like to write. And look, here I go again. But, as I've said - I've never met anyone remotely interested in this topic before - and expressing my experience with Nardil is kind of an itch I've _long_ wanted to scratch.



UltraShy said:


> I'm about as far from manic as possible. I'm the polar opposite of energetic, impulsive & reckless


UltraShy sounds like me - about as far from manic as you can get. I've always been low energy and a bit... uh, gloomy - with a tendency to more serious depression on occassion. When I read about Nardil, these are precisely the kind of symptoms I most often see associated with the best results. People who seem to respond best are people with atypical depression and dysthymia - and these kinds of depression are frequently comordant with anxiety and phobias (like social anxiety). Nardil seems almost tailor made for these conditions. Something to keep in mind.

The remarkable effect it has on social anxiety is the primary reason I take it - but there's no question that, for me, it's antidepressant action is very valuable. And that's one reason I never leaned towards the benzos. I've read that one of their possible side effects can be the aggravation of depression.



apprentice 1 said:


> I live in Germany and this drug is the first thing my psych offered up. He said it is kind of like cocaine...


Interesting... interesting. Cuz I've thought that to myself before. When I was "experimenting" back during my first year - pushing the dose well over the recommended maximum - the only way I could describe _one_ aspect of it was - "jeez... it feels a bit like a very mild cocaine high with an incredibly long half-life." (yes, I had tried cocaine in the past and knew what it felt like). Cocaine raises dopamine levels significantly. And Nardil would be raising dopamine levels as well. At a high dose, it's no wonder that a "cocaine like" feeling would result.

As for Nardil being the "first thing offered up" by your German doctor - Peter Kramer has some interesting comments in _Listening to Prozac_ about the apparently far more prevalent use of the MAOIs in England relative to the U.S. (Kramer's comments are from 1993.) The rest of Europe might be like England in this regard. Here in the U.S., the "first line" suggestion of an MAOI is something that would seem to almost never happen. I could quote Peter Kramer's remarks on this if anyone is interested.

[Oh yeah, those "good, dark red wines" that apprentice 1 mentions - those are about the only food or beverage I've experienced hypertension with - though it's been mild. Cheap red wines haven't been a problem - it's the meaty, flavorful one's that have done it.]

<><><><><>

Further background on my life (if you're interested) so that you can contrast where I was coming from with what I've just described about the positive effects of Nardil.

My college experience was truely miserable because of social anxiety and very significant depression. I went through my four years of college literally without a close friend. I would sleep in the library between classes, and as soon as my last class was over - I'd head back to my apartment. I never went to parties, didn't hang out with a group, and didn't date. Speaking in class could produce enormous stress. Even going into an administration office to fill out some forms might have me walking for blocks in an effort to calm myself down before entering. (crazy! jeez... all I needed to do was go fill out some damned forms!) Interestingly, while I could never "let go", be spontaneous, play, or joke around - I could always converse about things on an intellectual level, particularly if it was one on one. I must have come across as this extremely quiet loner guy who was way too serious.

After college, I moved back to my city of origin where I had family and some old friends from highschool. When I did this, my life improved in small increments because I had more emotional support. But I was always subject to backsliding into fairly heavy depression - something which freaked me out because I had little sense of being able to put the brakes on it.

My social anxiety fluctuated between moderate and severe. Contrast that to what I've described about integrating into a social group for the first time. That's why I describe my experience with so much passion.


----------



## workman (Mar 5, 2004)

I've read that when you first take an MAOI it can cause a high, everything is awsome, feeling. But it wears off after a few weeks or so. That might be the hypomania the experiments found. If they went longer, they might find it wore off.


----------



## spaceboy (Mar 5, 2006)

Yes indeed. Boost the dose, and it not only feels quite good, but it can clobber SA in an amazingly effective way.

Within a few days of being in a higher dose range (90mgs), however, you will notice that the effectiveness of the medication begins to wane a bit. Some kind of re-regulation of neurotransmitters is clearly taking place - the brain's managment system is saying - whooooa! Chill out! Stay in the same higher dose range, and within one or two weeks you'll feel pretty close to baseline levels again while still taking the same amount of the drug.

I figured this out pretty quickly and devised a bit of a workaround, because one obviously can't keep increasing the dose infinitely in an effort to sustain efficacy. My workaround involves keeping a low-level maintenance dose in my system (and you do need to keep an antidepressant in your system), boosting it only when I feel a particular need for it - at social events, moving into a new job, etc. Once past the situation for which I need greater control of my anxiety, I'll lower the dose again. The brain, once again readjusts, and in doing so it's "primed" for the next time I feel the need for the anxiolytic effects of a higher dose.

I've been using it in this way since my first few months on it, and it's seemed to work. I started using this "low dose - boost when needed" method while trying to see what would work. But I recently found a similar dosage description on the web. It doesn't say anything about increasing the dosage on an as needed basis - but it does describe using a maintenance dose.

"Maintenance dose: After maximum benefit from Nardil is achieved, usually within two to six weeks, the dosage should be reduced slowly over several weeks. Maintenance doses may be as low as one tablet (usual dose) a day or every other day, and should be continued for as long as is required."
http://www.psyweb.com/Drughtm/phenel.html

One tablet every other day - that's about my standard dose. This is very low. Nardil's often amazing anxiolytic effects are available at anytime simply by increasing the dose. (given about a two day head start).


----------



## UltraShy (Nov 8, 2003)

spaceboy said:


> And that's one reason I never leaned towards the benzos. I've read that one of their possible side effects can be the aggravation of depression.


Klonopin is the benzo that is most commonly linked to depression. Even trials by Roche (the company that created it) found that their Klonopin causes depression in a small percentage of patients. I take Xanax, which has never been linked to depression and may, according to some, even have a slight antidepressant effect.


----------



## spaceboy (Mar 5, 2006)

I've never investigated the benzos much because of the antidepressant, energizing aspect of Nardil. Once I found Nardil to work - that was it, and for nine years I've pretty much left the topic alone. So I don't really know too much about the benzos. 

Being typically somewhat sluggish (dysthymic) - it's also seemed to me that my thoughts are also, somehow, a bit slow. Which is not to say I'm unintelligent, just that my thought process is not the quickest. When I am more seriously depressed, it seems to slow down even further. Also, the tone of my voice starts going flat, becomes less expressive and more monotone.

With Nardil, I have the sense of an increase in "thought speed". Like the neurons are firing faster, and so my thoughts flow faster. I'm not totally 100% sure about this - but it seems to me that one aspect of Nardil that helps with social interaction is that one is, quite literally, more quick witted. Much quicker to process and respond in conversation, for example. 

Nardil's energizing effect also gives the tone of my voice a more dynamic expressive range. It's not artificial or manic, it's simply more expressive - which is actually more natural in appearance.

So... the energizing aspect of Nardil appears to create a zippier thought process along with more dynamic expression. There's a definite advantage to this in social interaction if one is ordinarily more sluggish with a tendency to lower moods.

I don't know much about the benzos, so I don't know if they produce a similar energizing effect.


----------



## No Limit (Dec 6, 2005)

I've taken .5mg of Xanax during high-anxiety situations and it definitely doesn't energize me. It does, however, keep me calm under high-anxiety situations like a class presentation.


----------



## AdamCanada (Dec 6, 2003)

I think im gunna look into somthing like this in the summer, when i have some $$, seems like its got some pretty good potential, i hope its okay to drink a bit though, i sure can't miss out of drinkin' some beers!!


----------



## spaceboy (Mar 5, 2006)

No Limit said:


> (Xanax) does, however, keep me calm under high-anxiety situations like a class presentation.


I'm no scientist, but from what I've gleaned through a bit of reading the anxiolytic effects of the benzos is produced by increasing the action of a substance called gamma-aminobutyric acid (GABA)

Nardil (because it's action is so _non_-selective), also has an effect on GABA, which likely accounts for some of it's efficacy.

Quoting from the website socialfear.com:


> Phenelzine (PLZ) is a non-selective monoamine oxidase inhibitor (MAOI) commonly used to treat depression and panic disorder. As expected, PLZ increases brain levels of dopamine, norepinephrine, and serotonin. Interestingly, PLZ also elevates brain levels of gamma-aminobutyric acid (GABA), and previous studies have suggested that these increases may also contribute to the anxiolytic effects of PLZ.


Nardil's non-selctive action also affects other neurotransmitter theorized as underlying social anxiety.

From socialfear.com:


> *Neurobiology of Social Anxiety Disorder:*
> Dysregulation of neurotransmitter function in the brain is thought to play a key role in Social Phobia (SP). Specifically, dopamine (DA), serotonin (SE), and GABA dysfunction are hypothosized in most cases of moderate to severe SP, in varying degrees depending on the individual. My experience has been completely consistent with this hypothesis. I have responded very well to certain drugs boosting levels of these specific neurotransmitters. The MAOI antidepressant "phenelzine" (Nardil) uniquely boosts levels of all three - and is probably the single most effective (single drug) treatment for Social Phobia.


Nardil's non-selective action definitely gives it an advantage over the SSRIs. (In my experience, the difference between the two is like night and day - Nardil being waaaay more effective for social anxiety.)

Nardil's non-selectivity, of course, is also the reason why it's _potential_ side-effect list is rather lengthy, and - in absolute worst case scenarios - even lethal if combined with the wrong foods or medications.

It sounds as if a drug that selectively increased levels of dopamine, seratonin, and GABA would be the just the thing for social anxiety.


----------



## spaceboy (Mar 5, 2006)

Having crowed quite a bit about Nardil and the positive effects I've experienced from it's use, I also want to make another observation (one that would seem to apply to the use of psych meds in general.) And my comments may seem obvious and a bit banal, but, what the heck...

While Nardil has been very beneficial for me in regards to depression and the alleviation of social anxiety - I've definitely had the sense that, in using it, I'm essentially attempting to jerry-rig the neurochemicals in my brain. And there's definitely something "rinky dink" and imprecise about doing this. It's certainly not perfect. There are side effects, and it lasts only as long as the drug is in your system - so you have to keep tending to it. I see people who are naturally outgoing and socially fluid, and, man... I wish that I was more like that from the start - not having to rely on something like Nardil.

But I'd rather have access to Nardil than go through what I used to go through. For me, the best thing it ever did was break the isolation/depression/social anxiety cycle I was mired in. The relief it provided was _enormous_. It enabled me to expand my social life substantially, and I've been able to experience myself as a far more outgoing person - and that's something that does stick with me. If you experience yourself in different ways, you start to think of yourself in different ways. And, without question, having a more stable and comfortable social life (or the ability to speak up in class, or go to job interviews without over-the-top stress, or date, etc.) has huge benefits in terms of one's overall sense of well-being - a natural anxiety and depression reducer.


----------



## spaceboy (Mar 5, 2006)

AdamCanada said:


> i hope its okay to drink a bit though, i sure can't miss out of drinkin' some beers!!


I drink while on it without problems... but watch out - it has the effect of amplifying your level of intoxication.


----------



## UltraShy (Nov 8, 2003)

spaceboy said:


> I'm no scientist, but from what I've gleaned through a bit of reading the anxiolytic effects of the benzos is produced by increasing the action of a substance called gamma-aminobutyric acid (GABA)
> 
> Nardil (because it's action is so _non_-selective), also has an effect on GABA, which likely accounts for some of it's efficacy.


Yes, benzos work by enhancing the effect of GABA (but doesn't increase the level of it), while Nardil actually bossts GABA levels.

I don't know if serotonin plays any role at all in my SA, since no SSRI has had any effect on my SA at all, even at high doses. Either SSRIs have failed to work in raising my serotonin level or they did their job and serotonin simply isn't my problem.

From what I've read I've gathered that Nardil is sort of like a sawed-off shotgun -- it hits everything in sight.


----------



## spaceboy (Mar 5, 2006)

UltraShy said:


> From what I've read I've gathered that Nardil is sort of like a sawed-off shotgun -- it hits everything in sight.


Posting this for those who aren't familiar - MAOI stands for *M*ono*A*mine *O*xidase *I*nhibitor. A monoamine is molecule containing one amine group. The "biogenic monoamines" are natural, biologically active compounds that often function as neurotransmitters, including dopamine, serotonin, noradrenaline, and epinephrine.

Monoamine oxidase (MAO) is a "janitorial" enzyme found throughout the body, including the brain, liver, and intestines, and it oxidizes or "burns-off" excess monoamines. An MAOI like Nardil neutralizes the action of monoamine oxidase. In doing so, greater levels of *all* the neurotransmitters are available - including dopamine, norapinephrine, seratonin, epinephrine, etc. Whatever deficiency of neurochemicals there is that might be responsible for social anxiety, they will be increased by an MAOI - resulting in relief from symptoms. As I've posted, the relief I've experienced from social anxiety while on Nardil is striking.

Just so folks know - monoamine oxidase also breaks down a chemical called "tyramine" in the intestines. Tyramine is a monoamine that's involved in the regulation of blood pressure, and it's naturally found in certain foods - particularly foods that are aged, like cheese. Inhibiting the oxidizing action of MAO allows a substantial amount of non-neutralized tyramine (from tyramine-rich foods) to pass through the intestine walls, and this can cause blood pressure levels to elevate substantially. Headache is often the result, along with excess sweating, and increased heartrate. Worst-case scenarios are stroke.

It's interesting to note that some people experience migraines from eating tyramine rich foods (like aged cheese and meats, red wines, etc.) even though they're _not_ on an MAOI. In my case, even while using an MAOI I've experienced virtually no adverse food reactions.


----------



## spaceboy (Mar 5, 2006)

Here's another Nardil success story I found on the web at a site called "sp newsletter":

http://www.spnewsletter.com/selections/ ... Chris.html

For this person, social anxiety was apparently quite debilitating. He writes "I was really bad too. I basically stayed in my room for 6 or 7 years." He was prescribed Nardil by a doctor and writes "Nardil turned out to be amazing for me! It has completely cured me." He mentions getting a job for the first time and uses a ton of exclamation marks - you can tell he was pretty happy about his new lease on life.


----------



## living in darkness (Apr 17, 2005)

What up spaceboy? I'm on Nardil as well and the effect is truly amazing. I can really relate to everything you said. I also suffer from chronic depression and dysthmyia, and tried many different medications over the years. I've been on a ton of SSRI's as well as TCA's, antispychotic medication, anticonvulsants, benzo's, drugs like Buspar...the list goes on and on.

Nardil not only eliminated my social anxiety, it was also the only medication that ever gave me relief from dysthmyia. Our symptoms seem to be really similiar. I've never had a manic phase, just always down. The clinical depression would come in cycles, but even when I was doing well I always had a low-grade depression that left me feeling tired and exhausted all the time and took away all of my enthusiasm. 

The effect for me was exactly as you described. All of a sudden, it became very easy to talk to people. Effortless. I could make eye contact and spontaneously join in conversations with coworkers or make small talk with cashiers without even thinking about it. When the fear is removed, this kind of thing became enjoyable. I began to look forward to talking to people and participating in social settings.

Anyway, I'm at work right now and it looks like call volume is picking up so I need to run, but I'll write more later. I also put myself back on a really low dose because I started experiencing sexual side effects. The side effects are gone, but I think I need to increase the dose because some sa symptoms are starting to return. I wanted to talk about that and some other things. Really glad you're here. You have an awful lot of experience and I think we can all learn a lot from you.


----------



## spaceboy (Mar 5, 2006)

living in darkness said:


> The effect for me was exactly as you described. All of a sudden, it became very easy to talk to people. Effortless.


Yeah, Nardil pretty much blew my mind in that regard. I found it totally fascinating. I couldn't believe that a drug - an ancient, seldom used anti-depressant of all things - could do that.

I'd experienced some pretty heavy-duty SA in previous years and absolutely hated it. I would try to force myself into anxiety provoking situations in order to desensitize myself and overcome it, but I found it very difficult to ease the self-consciousness no matter what I did. It frustrated the hell out of me. I felt isolated, and I'd get very depressed. And when I got depressed, my SA would get worse.



living in darkness said:


> Nardil not only eliminated my social anxiety, it was also the only medication that ever gave me relief from dysthmyia. Our symptoms seem to be really similiar. I've never had a manic phase, just always down. The clinical depression would come in cycles, but even when I was doing well I always had a low-grade depression that left me feeling tired and exhausted all the time and took away all of my enthusiasm.


That's me, for sure. Nardil seemed to work so well, with relatively few side effects, that I've kind of wondered if levels of MAO aren't maybe a bit high in me when I'm not on the drug. Who knows? All I know is that it got me out of a seriously ugly situation, and I'm forever grateful for that.

In the past 9 years, I haven't spent too much time focusing on social anxiety because it's not been a problem like it was. I've occassionally looked on the web to see if new research has turned things up - and that's how I came across this site. Finding this forum, I just had to jump on and start yodelling as loud as I could "Hey you guys! Here's a _Public Service Announcement!_ *Nardil is amazing!!!* If social anxiety is making your life miserable - try it!" (especially if you seem to have chronic low-level depression, with periods of deeper "atypical" depression - characterized [among other things] by wanting to sleep a lot.)

I was a bit dismayed when I got here to see all the posts about the SSRIs and so little about Nardil. (For SA - compared to Nardil, the SSRIs _blow_.) No doubt it's mostly because doctors know very little about it, are freaked out by a few worst-case stories they've heard, and so getting a presciption can be very difficult.

But it could also be because, hey, if Nardil works for you - you know what? You won't need to spend much time on a social anxiety support forum. My social anxiety books got put away in a box and I haven't cracked them in years.

Looking through past posts, I found a member here named ck1 who tried Nardil. After a week on it, that was the last he ever posted. Maybe he *gasp* died of a hypertensive reaction after eating some cheese. Or maybe he could no longer relate so well and found other things he'd rather do.


----------



## apprentice1 (Feb 9, 2005)

I have had bad luck with almost everything except valium and xanax and Prozac...Prozac was wonderful, but my libido simply disappeared...I was so impressed about how well it helped my depression though, I didn't care, (wasn't having a sex-life, anyway...) But after a while, you aren't depressed anymore and you WOULD like to think about a sex-life again, so I quit. (I had worked my way up to 60mg. a day of Prozac). Since then, the latest thing I was on was Trazodon. It gave me severe headaches in the late afternoon everyday so I gave it up and went to the psych today and went for the Parnate....I have to wait another week before I can start taking it he said, to let the Trazodon wash out...so I will be letting all know how it is for me. my dx is generalized anxiety, dysthymia (sp?) social anxiety and depression. Sounds like the way to go. I only worry that I will forget and drink...white wine only these days, even though I told myself I have to totally give up alcohol and move on to the drugs. It is amazing how many people "treat" themselves with alcohol, become alcoholics, deny it, etc. when alternatives can help. I developed a pretty good wine habit, saw it, stopped it, but still enjoy a glass or two when I go out to eat with a close friend or am at a close friends house and they offer up a glass of Veuve Cliquot champagne or an extrordinarily good white wine. I have found though, that one or two glasses is nice, but anything after that is basically overkill. I hope I can stick to the no drinking thing, even if, I noticed white wine was not on the list..they mention red wine and Alcohol in general,...oh well, what is it they say"if you gotta go, it's best to go with a chocolate bar in one hand and a glass of chardonnay in the other"...and if you can manage to be having a good time in the company of others, what a way to go...I don't find many of the other food restrictions to tough to leave alone...banana peels? duh. By the way, here it is called Jatrosom N Capsules...


----------



## Caedmon (Dec 14, 2003)

apprentice1 said:


> so I gave it up and went to the psych today and went for the Parnate....


Let us know how it goes. I'm interested in taking Parnate (among many other options).


----------



## streetsk8er794 (Mar 5, 2006)

Spaceboy..... Before taking nardil. were you constantly worrying about your social anxiety to the point that even when you were by yourself, you cant enjoy anytyhing, or focus on anything, and have this chest tightening in your gut all the time? Because thats how I feel.


----------



## spaceboy (Mar 5, 2006)

streetsk8er794 said:


> even when you were by yourself, you cant enjoy anytyhing, or focus on anything, and have this chest tightening in your gut all the time?


Most of the time, my anxiety was pretty specific to social interaction. When I was by myself, I would feel "normal" and wished that I could be "normal" like that when I was around other people.

However, when I would get more seriously depressed, my anxiety would seem to become more generalized and take on a life of it's own. I can recall waking up in the morning and immediately feeling knots of anxiety. I'd dread getting out of bed, not wanting to face my life. All I wanted to do was sleep, because sleep was a way to escape.

Alot of that anxiety seemed to revolve around feeling like my life was going down the tubes - that I couldn't control the direction of my life - or that I was weird, a freak, lost, and hopeless. I was afraid I'd be a total failure, never have friends, and, because I was isolated, would eventually go nuts. Being very depressed and becoming isolated will put you under tremendous amounts of stress, and stress will jack up your anxiety levels. It'll also make your social anxiety much worse.

In the midst of my deepest depression during college (the ultimate, ugliest, blackest, and most god-forsaken low I have ever experienced) I became _unbelievably_ self-conscious around people. I could barely speak a word to anyone. Things very slowly got better after that, but I was still prone to sliding back down. And anytime I started slipping into depression, I'd get freaked out because I was afraid I'd slide all the way back down to that ultimate low I experienced in college.

When I discovered Nardil, I was sinking into a "near meltdown" once again, and I was horribly anxious all the time. I couldn't control my thoughts - they spun around and around - almost constant thoughts of ugly, anxious, worst-case endings. "I'm f*#%ked! I'm f*#%ked! I'm totally lost! Hopeless! I'll never get out of this!!!" I was trippin' big time. And yeah, that'll make it hard to concentrate on anything. Nardil seemed like a last chance for me. And it _rocked_. It broke the chains.

I don't know if you can relate to what I've just written about my experience, but if your gut's twisting, your thoughts are likely to be twisting too.


----------



## streetsk8er794 (Mar 5, 2006)

my guts and thoughts are always sicky. and yeh i guess im very depressed too but didnt realise it. i quit drinking and smoking about 2 months ago, but i started smoking pot again, which helps for my anxiety, but makes my depression worse. Can someone please give me some testimonials and positive information on nardil to help me persuade my doctor to get me some?


----------



## streetsk8er794 (Mar 5, 2006)

my doc wont give nardil to me.

EDIT:
12. Posts that discuss obtaining medication online legally or otherwise are not allowed and will be removed.


----------



## No Limit (Dec 6, 2005)

streetsk8er794 said:


> my doc wont give nardil to me.


Is he a psychiatrist and did he mention the reason why he wouldn't prescribe it to you?


----------



## spaceboy (Mar 5, 2006)

streetsk8er794 said:


> Can someone please give me some testimonials and positive information on nardil to help me persuade my doctor to get me some?


You likely won't be able to change your doctor's mind based upon what you find on the internet. If you have a GP, I think you can pretty much forget about getting a prescription for it. The MAOIs are very seldom prescribed medications, and GPs aren't likely to know much about them beyond the worst-case scenarios they've heard. In my case, I had to go to see a psychiatrist who was more specialized in order to get a prescription. Once I'd done this, I went back to my GP, described to her the substantial benefits I'd experienced, and she's been writing my prescriptions ever since.

It's a very good idea to educate yourself as much as possible about these medications. Be aware of possible side-effects, and learn the do's and don'ts of taking them. (This is especially true of the MAOIs!) Being educated on the topic will also help you quite a bit when seeking a prescription from a doctor, because you'll be able to speak intelligently on the topic.

My posts about Nardil, in case you hadn't noticed, are highly slanted in a postive way because I've had a good experience with them. Not everyone responds so well. A good number of people run into problems with side effects. I've recently found a website that has a ton of postings about the MAOIs like Nardil and Parnate. http://www.dr-bob.org/babble/ Do a search on this website, and you'll find a wide range of posting about the MAOIs - from very good, to o.k., to bad. Reading these will give you a broader perspective.


----------



## spaceboy (Mar 5, 2006)

I've mentioned atypical depression a number of times in my posts, as it's something I have been affected by. It's frequently comordant with SA, and it's a kind of depression that appears to respond very well to the MAOIs - so I thought I'd post a bit more information about it.

The diagnosis of atypical depression "depends on the presence of 'mood reactivity'-depressed mood that can brighten readily at a positive turn of events-in conjunction with any two of the following: hypersomnia (wanting to sleep a lot), hyperphagia (wanting to eat more), leaden paralysis, and interpersonal rejection sensitivity (sensitivity to social rejection)."

<><><><><>
"Almost 50 years ago the English psychiatrists West and Dally first described a subset of patients who were depressed but whose clinical symptoms differed from those of classic melancholic depression. Moreover, while this group did not respond to tricyclic antidepressants, it did respond to monoamine oxidase inhibitors (MAOIs).

Stewart said the Columbia research in the 1980s confirmed the latter, identifying a group of depressed patients who preferentially responded to the MAOI phenelzine sulfate (Nardil). The treatment studies also validated criteria for atypical depression that originated with published observations by the English group and by the American Donald F. Klein, M.D., with reactivity of mood as the basic distinguishing characteristic.

'If you are depressed and something nice happens, you feel better for a while,' Stewart explained. 'In contrast, the quintessential melancholic is an emotional rock. The melancholic is not going to have any reaction at all.'

Stewart and colleagues also found the opposite to be true of the patients with atypical depression-that they had an extreme reaction to negative events, particularly interpersonal rejection that others might just brush off. In contrast to the insomnia and loss of appetite usually seen in patients with melancholic depression, the patients with atypical depression were prone to overeating and oversleeping."
<><><><><>

My depression was almost always a consequence of "interpersonal rejection sensitivity" - either a loss of friendship, or simply feeling left-out and isolated because of my social anxiety. Also, as the definition of "mood reactivity" suggests - once I was able to establish a broader social network, my mood lifted considerably. One result of this: My need for medication was substantially reduced. For the most part, a low maintenance dose works just fine for me - it seems to keep me stable. I experience symptoms of SA on this low dose, but it's not enough to bother me.

<><><><><>
_Also, here's a curious thing I found on the web:_
I had wondered in an earlier post if my levels of monoamine oxidase might be higher than normal (or it's activity higher than normal) when I'm not on the drug. Interestingly, I found a study conducted in 1980 that was related to this. It would seem to suggest why a chemical that inhibits the activity of MAO might be particularly effective for certain kinds of depression.

"*Increased platelet monoamine oxidase activity in affective disorders.*
Platelet monoamine oxidase activity was determined in 52 unipolar depressive patients, 26 patients with bipolar affective disorder and 48 controls using phenylethylamine as substrate. Unipolar depressive patients of either sex and bipolar depressive women _showed significantly higher platelet MAO activity than controls_."

If MAO activity is higher than normal, it stands to reason that there would be lower levels of all the neurotransmitters, since MAO oxidizes them. Inhibiting the action of MAO with a drug like Nardil would assist in normalizing neurotransmitter levels. This may explain why raising the level of only one neurotransmitter (seratonin) with an SSRI didn't seem to do much for me beyond making me feel uncomfortably buzzed.


----------



## workman (Mar 5, 2004)

Well, since I'm now certain I'm allergic to wellbutrin, I'm going to go back to an MAOI. I'm going to try for parnate because I want something that is more motivating and it seems to have less side effects. If the doc don't go for that I'll see about going back on nardil. I don't know why I got off of it in the first place, but I'll try harder to manage the negative effects. 

Just as a side note, I don't think nardil itself effects gaba through mao inhibition, but a metabolite of it inhibits an enzyme that breaks down gaba. So that makes Nardil slightly different from other maoi's.


----------



## SomethingNew (Mar 23, 2006)

Thanks for posting your story SpaceBoy. Very insightful! Your description of atypical depression sounds a lot like me.

I was wondering, prior to going on Nardil, did you have trouble with making eye contact and engaging in small talk? I have a lot of trouble with these things (makes day-to-day on-the-job interactions a nightmare). Even if a drug were to help me feel happier and more talkative, I can't imagine it will help me know what to say/do in social settings.

The other thing that you wrote which was really fascinating was about Nardil seeming to "increase your thought speed". I've always felt like my brain seemed to process information at somewhat of a slower rate than others. Also, I seem to have great difficulty concentrating on things, so that's part of what slows me down. Do you feel Nardil helps with "increasing thought speed" even at a your lower maintenace dose, or is this something that comes about only when you are taking higher doses? And did you have any trouble w/focusing prior to Nardil? If so, did the drug help with that?

I really wish I knew how to get a prescription for this drug. I went to a psychiatrist for the first time a few weeks ago and he flat out refused to prescribe an MAOI, thinks they are dangerous. How did you go about finding a psychiatrist who specialized in SA and was willing to prescribe Nardil? Did you just go to Dr after Dr until you found the right one? I've tried searching for anyone who specializes in SA but there don't appear to be any in my state (NJ).

Oh well, guess I'll have to keep trying...if a drug could actually help me be able to socialize, help with chronic low-grade depression, _and_ help me think more clearly... sounds like a dream come true.


----------



## UltraShy (Nov 8, 2003)

SomethingNew said:


> I really wish I knew how to get a prescription for this drug. I went to a psychiatrist for the first time a few weeks ago and he flat out refused to prescribe an MAOI, thinks they are dangerous.


Call around and ask is the best IMO. When you buy medical service you should know what you're getting. People ask more questions before selecting a phone service than they do a doc it seems. Talk to the receptionist and briefly explain that you're looking for a doc who's willing to use MAOIs when needed and ask for the doc to call you back. It's a waste or your time & the doc's if you go in and they can't give you what you require.


----------



## PBNC (Mar 4, 2006)

Gosh, spaceboy........it's as if you're describing me. Wallflower.....comes across as a serious, quiet loner....simply unable to let go and be myself, even around people I've been friendly with for years. 

I really want to try Nardil, but I think my doc is going to want me to try me on one more SSRI (actually, SSNRI - Effexor) before she'd consider Nardil. I did bring it up in our last appointment, and she didn't act horrified or like it was out of the question - just said it's usually a last resort, and that many people end up growing very sick of the dietary restrictions. 

I don't drink wine or beer, don't eat any aged meats.....cheese would be the toughest thing for me. 

Ever since I read your line about Nardil letting you finally BE YOURSELF around people, I've been really wanting to try it. I can't imagine how that would feel.....to speak spontaneously, without mentally rehearsing my words or taking a long time to get up the courage to talk. To not be depressed.....to feel a "brain boost" and feel like my brain was awake.....amazing. I wish I could try it. 

One question - do you know anything about the occasional use of marijuana with Nardil?


----------



## apprentice1 (Feb 9, 2005)

This is an exciting thread for me and it seems many others...I have been taking Jatrosom N 10mg. for about a week now. I am still going through a phase...I have been through two years of psychotherapy while taking prozac, which totally destroyed my already non existent extroverted libido as well as my introverted one, (except when alone)...Alone the libido was very overactive... I have tried everything for depression, mostly thinking I didn't have depression...I thought I had more social anxiety than depression...after years go by, you just don't know anymore where to turn...you just accept what you are...I was one who in college volunteerd (sp?) at the neighboring then, "retarded" clinic. I just went and helped at feeding time when the staff was overworked and under stress, and I asked to be put with the worst cases...physical dysformities, handicaps, etc. and I enjoyed the..I can't call it work. They were the only people at the time that I thought were worse off than me. I have lived my life with S/A and accepted it and forced myself to accept more than I could endure. It is how I was brought up. Don't complain. There is always someone else who is worse off than me...that is true enough...but. I never had a love life, or a love life with sex. I am now 56 years old, not in bad shape physically, but with the mental/social developement of a 20 year old. I see how young you guys are here and can relate...wierd. Fifty percent of the time I think I should just go on and be the grandmotherly friend of the people I know and fifty percent of the time I think, I deserve to have a love life, like other "normal" people...I really don't know if messing with my personality at my age is.."worth it" or not. I am finding out though, that people my age are not only sometimes valued by some younger people as well as people my own age, that I think, before I go, let me have a little fun... I expect rejection and can handle that with no problem...so, what do I have to lose? I shall keep trying to develope a more "adult" relationship with the people I deal with, (here comes the important part, if you have read this far)...Jatrosom N filmtabletten...(Parnate) is responsible for giving me the whatever it takes to do something, anything, except hide under the covers and sleep...I will only make statements contradictory to the diet restrictions privately. I would do the necessary things like get out and go to work, but then I always just headed back to the barn afterwards and lived with the tv as my best friend. I even started to watch Dr. Quinn!!!!!! The restrictions must be there for good reason I am sure, and I don't think it our place here to say otherwise. However... ask. Thank you spaceboy, for coming onto the forum and giving us your experiences.


----------



## apprentice1 (Feb 9, 2005)

Ultra Shy wrote: " Call around and ask is the best IMO. When you buy medical service you should know what you're getting. People ask more questions before selecting a phone service than they do a doc it seems. Talk to the receptionist and briefly explain that you're looking for a doc who's willing to use MAOIs when needed and ask for the doc to call you back. It's a waste or your time & the doc's if you go in and they can't give you what you require."

Right on. and if you have problems talking to a doc like I did, write down what you want and let him read it and sign your name to it...again, he doesn't want to get sued for you writing bad checks...


----------



## Chet (Feb 12, 2005)

*Nardil*

I would like to say thankyou spaceboy, just like many other members for your post. Nardil has made a drastic change in my life also!!


----------



## spaceboy (Mar 5, 2006)

SomethingNew said:


> ...Did you just go to Dr after Dr until you found one (willing to prescribe Nardil)?


Some good general advice has already been posted by UltraShy about calling around to see which way a doc's wind is blowing. Can it be directed favorably towards the MAOIs, or no? If you're an adult and you want to try it, then try it. For goodness sake, people have been using them for years - have been _on them_ for years. It's not illegal. I've read of docs having patients sign waivers. If I had to sign a waiver - hand me a pen, no problem.

Doc's are freaked out by this med - understandably so. If I didn't have the personal experience with it that I do, gee... what else could I be expected to think when confronted with a ten mile long list of potential side effects and possible death by eating yummy, everyday foods like chocolate and pizza? You can't read the acronym "MAOI" without "hypertensive crisis" firmly attached. Do an internet search for the MAOIs and you'll find plenty - plen-tee - of warnings about hypertension and "don't eat this" and "don't eat that" near the beginning of any description.

I read a post on dr-bob from a medical student who discusses his very brief introduction to the MAOIs in med school. He learned the standard line - drug and food interactions can kill patients, etc. before his studies quickly moved on to a thorough examination of newer meds like the SSRIs. Docs have to know a lot about a lot of things. It seems unlikely that they'd have much time for delving into "outdated" meds like the MAOIs. The brief introduction they're likely to get is going be more of a warning than anything else.

And, hey, if you read a comprehensive list of possible side-effects, you'd think that Nardil was arsenic. The list of potential side-effects is a reader's endurance test. For example: http://www.psyweb.com/Drughtm/phenel.html

Many of these side effects are likely quite rare. But it's not a bad thing to be aware of any possible side effect from these drugs.

(Do a search for Nardil on this website and read what comes up. 
Also, head on over to dr-bob.org and search the "babble" dept. for whatever you can find on Nardil, Parnate, the MAOIs, and social phobia. It's the only place so far I've found where there are lots 'n' lots of posts about the MAOIs and reading through them can't hurt. Knowledge is good.)

*For me:* As long as I'm not drinking a bottle of Nyquil, the stuff seems quite benign. My earlier posts talk about other side effects I've had. And, of course, staying in the low dose range most of the time helps minimize side effects. (My insomnia is ugly-bugly on higher doses.)

<><><><>



SomethingNew said:


> The other thing that you wrote which was really fascinating was about Nardil seeming to "increase your thought speed". I've always felt like my brain seemed to process information at somewhat of a slower rate than others.


Increased thought speed. Yeah, there's definitely something to that - if you ask me. I mean, back in the day, when I pushed the dose beyond recommended levels the result was - as mentioned - "Woooooo! This is rad! Look at me! I'm talky, talky, talky, talky, talk-eeee! Yee Haw!" In short, I was mildly manic (a.k.a. hypomanic). To be mildly manic is to be speedy. Far, far speedier than I normally am. Reduce the dose to more moderate levels and Nardil still makes me a bit speedier than usual. And it's helpful, because...

...hey, you ever listen to people who are naturally chatty and outgoing? There are a couple people like this in my office - and my roommate is very outgoing - and dang! To me these people seem to talk _a mile a freakin' minute_. They love to talk! Yakkity-yak! Yakkity-yak! Yak, yak, yak, yak, yak! And they're very expressive while doing so.

<><><><><>



SomethingNew said:


> I was wondering, prior to going on Nardil, did you have trouble with making eye contact and engaging in small talk? I have a lot of trouble with these things (makes day-to-day on-the-job interactions a nightmare). Even if a drug were to help me feel happier and more talkative, I can't imagine it will help me know what to say/do in social settings.


Eye contact? Hmmmm. Eye contact isn't something I recall having problems with. I mean, I could do it, and would even make a point of doing it. But I've definitely become self-conscious while making eye contact before - like, uh... am I making too much? Am I looking too intently? What did that subtle movement in their eyes mean? Should I look away now? And guess what? While I've been busy analyzing the theoretical nature of eye contact and the social protocol involved in it's use, um... the conversation has passed me by. Doh! Now how do I respond? "Uh, nice eyes you got there. I see you have two of them."?

Small talk a problem? Yep. Making small talk has always been a thorn in my side. Or a spear. It's relative ease while judiciously medicated has to be Nardil's single most curious - most fascinating - effect. Veeerrrry interesting, indeed.

It's the reason I coined Nardil "The Grail". For it does this without the presence of intoxication. You can get loaded on booze and lose your inhibitions, or do up a bunch of blow and lose your inhibitions, or take a psychedelic compound and find yourself suddenly chatty and out of your shell (really) - but the level of intoxication with these things is so overwhelming that they're useless for daily life. With Nardil this is not so.

As I'm sure you know, anxiety binds the natural responses to conversation. Thoughts that might otherwise flow freely (as they do when you're reading a book or talking to your mom) get stuck in the nozzle. Unable to respond naturally, you feel awkward. Awkwardness - self-consciousness - increases the pressure behind the block, binding it further. And there you are - mute and disconnected. Groovy! "I'm smart, I'm funny, I have good ideas! Where have they gone?" So you go home alone. Again. Boo hoo!

Cut the anxiety, and hey - thoughts appear. Naturally. Amazing. And you can even say them when appropriate.

<><><><><>

I have more to say in response to some of the above comments, but I'm out of steam for now.


----------



## spaceboy (Mar 5, 2006)

I've been rooting through posts about Nardil on this forum and on dr-bob.org - and something I've come across a number of times is "Nardil poop out". The drug seems to work very well for awhile then its effects wane and eventually disappear.

There's a post on this forum by a member named StarGazingLilyGirl that seems to describe this: "I was on Nardil and I didnt experience any kind of withdrawal what so ever. It worked amazingly until i stopped responding to it all together and had to discontinue usage."

The Nardil "poop-out" I've read about seems similar to what I experienced. (I've mentioned this before in my posts - but since I've been reading about it, I thought I'd repeat it.) If you stay at a higher dose for long, you develop a tolerance to it. Neurochemical levels naturally re-regulate after being on consistent dose, and the theraputic benefits diminish in the process. When I first noticed this happening in me, I was concerned because the effects of the drug had been _incredibly helpful_.

I could maintain the theraputic effect by continuing to raise the dose, but tolerance once again develops, and you can't keep increasing the dose indefinitely. So I lowered the dose (I did _not_ go all the way off it). After a short while on a lower dose I tried raising it once more to see what would happened. Lo and behold, I was once again able to get the desired theraputic effect.*

I realized at this point that the most I could get from Nardil was part-time efficacy - keeping it low and raising it when needed. (You have to maintain a small amount in your system for this to work.) Part-time efficacy is not a perfect solution, but it's far better than no efficacy at all.

Here's a recent example: At times during my workday there's a lot of banter going on among my coworkers. (I happen to sit next to a couple of people who love to chatter.) If I'm on a lower dose, I can sometimes find myself unable to participate so easily and occasionally I'll hear things like "Yoo hoo! You're being awfully quiet today!"

I might respond with something like "Yeah, yeah. I don't have a lot to say." But, for the heck of it, I figure I'll raise my dose of Nardil. So when I get home in the evening, I take two. The next morning I take 3. The next day 3. And on the day after that, I'll take four. I grow chattier each day - it has yet to fail. (Something I find kind of amazing.)

No one notices my increase chattiness and social participation, because it's not unusual or out of the blue. I'm definitely being myself - it's not like being cranked up, manic, or out of control.

This on-again off-again approach may seem goofy, but it's the only way I've been able to make Nardil work over the long haul. I think of it as "skillful manipulation of dosage levels". I adjust it up or down based upon how I feel and the degree of social interaction required by circumstances (a party, new job, etc.)

Over 9 years I've tried to squeeze the most I can get out of Nardil using this technique, and my life has been far more workable as a result. There's no question that it's far from ideal (certainly far less optimal than being naturally outgoing). However - prior to Nardil, I'd had jobs where I felt so uncomfortable and self-conscious from not being able to participate in casual banter that I'd eventually quit. In previous years, I'd go to parties and not say a word to anyone. In previous years, I had a very difficult time getting to know anyone. Now I can go to a party and really enjoy myself. Now I can fit more easily into workplace social activity. Now I'm able to get to know people more easily.

A key aspect of this: Once you've developed a bond with someone - or with a group of people - or integrated into a work environment - you feel comfortable and anxiety no longer plays the role it did when you were dealing with strangers.

<><><><><>

*I've found the long half-life of Nardil (true for all the antidepressants) to be _very_ helpful. It takes several days to reach the peak, you can stay there for quite awhile if you want, and it's a long slow decent when you decide to reduce the dose. It's not a bumpy "up-down" experience. Coming down, I've never noticed any kind of "rebound" where my anxiety or depression has increased. Nor have I ever felt the slightest craving for it. As StarGazingLilyGirl posted about Nardil "I didnt experience any kind of withdrawal what so ever."


----------



## Lupus (Oct 29, 2005)

From what i understand some of the better p-docs out there often cycle drugs to avoid this sort of neurochemical acceptance of the drug as a normal part of the brain chemistry. This of course also depends on if you can find multiple drugs that work for you.


----------



## apprentice1 (Feb 9, 2005)

I read where Parnate can be addictive in a couple of places. I take this, as with the benzo scare, minimally to my attention. If I remember correctly (and be lazy and not take the time to look back through the postings), Space boy said something about it taking six weeks before he noticed the effects. I haven't even been taking it for more than a week and already notice a lot. I am older, I also keep seeing that "older people can usually get by on a lower dose" of this or that, so maybe that's the reason. I think the way space boy ups and downs the dose is ...basically...correct. I do the same with the benzos. I try to keep dosages as low as possible. I am grateful that I am even getting the stuff!


----------



## apprentice1 (Feb 9, 2005)

I see that Nardil is no longer prescribable in Germany, only Parnate. What is the difference?


----------



## Britney (Mar 22, 2006)

NARDIL SOUNDS AWSOME!!!! Few itchin questions though. 
alcohol is a 'no-no'? But if ur brave enough to see if you will survive gettin drunk, is there a limit or anything, b/c i'd hate to give up weekend drinkin. 
does it cause sexual failure for girls too? 
why again is it so hard to get a perscription? Even if ur sa is sever? 
does it make u more depressed in those 6weeks waiting for the rusults, like some drugs do?
Do u sleep at all while on this drug?
spaceboy mentioned that it gives you energy. really noticable increased energy?


----------



## streetsk8er794 (Mar 5, 2006)

in 2003 Nardil was given to another company and the chemical composition changed. Spaceboy, did you notice a decrease in the positive effects after Nardil changed?


----------



## celtic1973 (Mar 8, 2006)

*new nardil*

i asked this very same question to spaceboy as ive now just started using nardil this was hes reply to private mess . Oh yeah,

About the "new Nardil". I've been reading posts about this recently. I remember when it changed a few years back and had no idea why the manufacturer did this. I haven't had a problem with it though - it still seems to work pretty much like it had in the past.

Some people seem to think that it doesn't work as well for them because it's being absorbed differently by their body. The active ingredient (phenelzine sulfate) is still the same, but it's now mixed with inactive ingredients that dissolve more easily, allowing for more rapid absorption.

In my case, I didn't notice a difference.


----------



## spaceboy (Mar 5, 2006)

If you go to dr-bob.org and do a search for "new Nardil", you'll see quite a number of posts. More than a few people felt that the new formulation wasn't as effective as the old, and there's been an ongoing debate about this among the "Nardil cognoscenti".

When it changed back in 2003, I wondered what was up, but never did any internet research on it, just kept taking them. Seemed o.k. to me.

Part of the fuss could have been caused by a "placebo effect" - I mean, some people have been taking this stuff for ages and when you start tampering with an old familiar - sorta like they did with Coca Cola - people will raise a stink. (It'd be funny if they brought back the old formulation and called it "Nardil Classic".)

Interestingly, I came across a notice from October 2002 about a manufacturer recall of Nardil tablets due to subpotence. http://www.copd-international.com/Libra ... recall.htm
This was right around the time they changed the formulation of inert ingredients. Perhaps some of the problems people were having were related to this recall.

Who knows?


----------



## spaceboy (Mar 5, 2006)

As for "awesome"...

That, as we know, is a relative term. Considering where I was at the time I first started taking Nardil - it was indeed awesome. Magnificent. A life saver, to be honest.

And over time Nardil has proven to be a useful tool. I keep it around for a very good reason.

I don't want to be a wet blanket, but I can't emphasize enough that Nardil is not a panacea. In and of itself, it won't make things perfect, it won't make your life rich and full, it won't correct years of frustration and sadness, it won't find you great friends, it won't land you a great job - etc. etc.

My initial experience on it was particularly good because it enabled me to integrate into a social group for the first time. And it was very fortunate that that particular group of people was available to me at the time - something that, unfortunately, doesn't come with a prescription.

Becoming a completely comfortable member of this social circle was the *best therapy* I could possibly find. (I could sit in an office and talk about my problems interacting with people - or, hey, I could go run and play.) Having struggled quite a bit with social isolation and depression, it was a very healing experience. Nardil wasn't responsible for that healing - Nardil was the assist that enabled me to get there.


----------



## No Limit (Dec 6, 2005)

To Spaceboy - Do you feel that you could eventually taper off of Nardil without relapsing?


----------



## spaceboy (Mar 5, 2006)

Britney said:


> why again is it so hard to get a perscription?


Well, for one, it's _possible_ to croak - bite the dust - give up the ghost - if you eat certain foods or mix it with some pretty common over-the-counter meds.

And, here, just to give a more "full bodied" impression of Nardil - check out this less than enthusiastic thread on SAS. 
http://www.socialanxietysupport.com/vie ... hp?t=37307

I haven't had much problem with side effects. Nardil has actually seemed smoother and more agreeable than the couple of SSRIs I took. And I've been using it for so long I've become pretty non-chalant about it. The few hypertensive experiences I've had have tended to be mild and they're very easy for me to avoid.

My experience, however, is not going to be the same for everyone. I read a post on dr-bob where a woman described experiencing significant relief from depression - but suffered the unfortunate side effect of edema (swelling of arms legs and other body parts caused by excessive buildup of fluid in the tissues) and had to go off it. If you read through the considerable list of Nardil's potential side effects, edema is one of them.

<><><><>

On the other hand... (and this is why I posted to begin with)

I have no doubt that there are many people out there, like myself, for whom Nardil might prove very beneficial. People who would not have too many problems with side effects, and who would use it responsibly, etc.

Unfortunately, many of these people may never hear of Nardil or have it prescribed because of it's reputation for being dangerous - coupled with a general lack of knowledge among doctors in regards to using MAOIs.

[To give you some idea of how seldom used Nardil is... In 2001, approximately 1.8 million prescriptions were written for Prozac in the United States alone. In contrast, there are roughly 10,000 to 15,000 people currently using Nardil _worldwide_ - according to Wikipedia, anyway.]


----------



## spaceboy (Mar 5, 2006)

No Limit said:


> Do you feel that you could eventually taper off of Nardil without relapsing?


Good question. (and another great excuse to cook up a lengthy post) I've tried going off it twice before, because, dang - I felt fine. Things were groovy. My social life was stable, my economic situation was o.k. (not great, but o.k.), etc.

Unfortunately, each time I did this, it seemed to take about two months before I realized that I'd become quite sluggish and somewhat withdrawn. Interactions with strangers, for example, were more awkward than I cared for. "Crap. You know what? Screw it. Time to refill the script." And Nardil would kick in again and I'd be like, "Jeez - this is more like it." I'd forgotten how much better I function on it.

Last time I went off it (and shortly jumped back on) I figured, oh well... *sigh* I guess I'm in it for the long haul. I just hope it keeps working.

Whatever the root of the problem - it definitely seems to be a physical one and not caused because my parents didn't hug me enough or _something_. I mean, elevate levels of certain brain chemicals and, wow - you become way more outgoing overnight? It's so dramatic and strange that I can't help but conclude that whatever neurochemicals are responsible for SA - their default brain levels are set too low in me.

<><><><>Now that I'm started...<><><><>might as well finish<><><><>

Before I began taking Nardil, I'd seen a couple of "talk therapists" on and off for 8 years, and they were _totally_ anti-medication. "Drugs are bad. You have to do this on your own. Drugs will just temporarily mask your problems. You have to deal with the real issues - the psychological and emotional roots of the problem - in a way that'll stick with you." I bought this talk therapy approach quite firmly.

So, yeah, o.k., jeez, I talked about my upbringing, recalled ancient events from my past, developed this theory, and analysized that possibility. All very interesting, I suppose... but, like, _whatever_. I had done this for years and was still chronically uptight around people. I still slid into murky, morose moods. I was still panicked by my life's narrowed prospects. I was still lonely and anxious. (And, dang, all that talk therapy costs money.)

I finally investigated medication because, frankly, I had become really desperate. Life was too painful and I could only seem to envision it getting worse. I came across _Listening to Prozac_ by Peter Kramer, and, as a result of reading it I tried a couple of the SSRIs with great anticipation.

Unfortunately... pffft. Not much help there. Peter Kramer's words had inspired hope that didn't transpire. Uh oh. What next? Then I read about Nardil in a book called "The Hidden Face of Shyness". I tried it, and holy sh*t! It didn't just work - it kicked a_ss.

After that I revised (massively) my map in regards to the underlying cause of things like depression and social anxiety. And I was kind of pissed for having listened to the ol' "you gotta do it without meds" approach. While I was sitting in an office talking about my problems, steeping in my angst like an old teabag, I could have been out meeting people, enjoying relationships, hangin out, having fun, and learning to think of myself in different ways. (My college years had been hopelessly blown - even as I went regularly to a therapist to recap the highlights of my misery like a sports announcer.)

<><><><>

Even still, I'm not especially enthusiastic about taking psyche meds. I try to keep it as limited as possible. I've never asked for some kind of sleeping aid to help with Nardil's insomnia problem (on higher doses) because I don't want to go chasing side effects with some other drug. The less chemical substances I'm on, the better - one reason why I like Nardil's antidepressant/anxiolytic relief in a single substance.

There have been many times that I either forget to take a dose, or simply let it slide. As in "Jeez, I don't feel like taking these damned pills - forget it." So I'll let it go for a week or so - then I take a bit just to keep it in my system. This keeps it there so when I want to increase it for a better therapeutic effect at some later time, it's only a hop skip and a jump away.

And - to tell you the truth - I don't know if Nardil is causing my brain to slowly turn to mush or not. I mean, some of the things I've read posted by long time (or even not so long time) Adderall (amphetamine) or benzodiazepine users certainly makes me wonder. You hear grisly stories of imparied cognitive functioning followed by anguished and unpleasant periods of withdrawal - and you cringe.

I take heart whenever I read of some person who's been on it longer than I. (I read of a patient of Leibowitz - the doc who first investigated Nardil for SA - who was on it for twenty years. Unfortunately, I haven't been able to locate this on the internet lately.) Even still, maybe my brain is turning to mush. Oh well! I was contemplating far quicker ways to turn it to mush back when I was spiralling into isolated pits of black tar depression.


----------



## No Limit (Dec 6, 2005)

Did you stop talk therapy after finding Nardil? Or are you still seeing someone like a psychiatrist once a month? I'm starting to think talk therapy is useless myself although the doctors I've encountered encouraged me to take psych meds as an aid to therapy.


----------



## streetsk8er794 (Mar 5, 2006)

I finally got my doc to prescribe it to me, and I have some questions. First off, spaceboy, what dose are you on now of nardil, and do you take it all at once or space it throughout the day? And second, can I take Stattera with it?


----------



## spaceboy (Mar 5, 2006)

No Limit said:


> Did you stop talk therapy after finding Nardil? Or are you still seeing someone like a psychiatrist once a month? I'm starting to think talk therapy is useless myself although the doctors I've encountered encouraged me to take psych meds as an aid to therapy.


I haven't seen a therapist since I started on Nardil - for better or for worse. There are issues in my life for which therapy would be good, unfortunately, I can't really afford it, and I don't have insurance.

I don't discount therapy altogether - a lot of people see therapists to work through a variety of issues and it can be very helpful. I think for SA, however, it's relatively useless. The whole point of treatment for SA is to get you out in the world interacting more comfortably with people. Actually doing it is way better therapy than talking about doing it, and the quickest, most efficient means to getting out there is medication (if you're someone for whom it's effective).

Was it better for me to go through college without a close friend, while seeing a therapist once a week, talking about what a struggle life was, and trying to work things out in their office? Or would it have been better to simply take a med like Nardil and actually develop a network of friends, go to parties, and date? I'll take the later option anyday.

It's cool that your therapists aren't threatened by the use of psyche meds and encourage you to take them if they can help you. The fact that my therapists were so anti-medication (in a dogmatic kind of way) was a factor in my not seeking the kind of pharmacological treatment that, a number of years after graduating, proved highly effective. If I'd found Nardil earlier, that time of my life would have been a way more positive experience.

Also - a side effect of my SA was that it was painful, lonely, and frustrating. Social interaction is like food for the psyche - go without it and you emotionally starve. That's something you're not really going to heal in a therapist's office. Real healing occurs when you find yourself forming bonds with people - and you won't form too many bonds with people if you can't relax around them. That's been Nardil's biggest blessing for me.


----------



## spaceboy (Mar 5, 2006)

streetsk8er794 said:


> I finally got my doc to prescribe it to me, and I have some questions. First off, spaceboy, what dose are you on now of nardil, and do you take it all at once or space it throughout the day? And second, can I take Stattera with it?


I'm not a psychiatrist, and I don't play one on the net - but I can assure you that mixing the wrong meds (and this means over the counter meds as well as prescription meds) on an MAOI are a _major_ recipe for disaster. If you're currently taking Strattera - you should *ABSOLUTELY NOT* be taking an MAOI. If you're thinking about taking Strattera while on an MAOI - *DON'T*.

Your psychiatrist would know this - and so would your pharmacist.

Here's a warning I pulled off the web by typing - Strattera MAOI - into google.



www.strattera.com said:


> You should NOT take Strattera with an MAOI or within 14 days of stopping an MAOI. The names of some common MAOIs are Nardil® (phenelzine sulfate) and Parnate® (tranylcypromine sulfate). Taking Strattera and an MAOI together or within two weeks of each other can cause serious side effects or be life-threatening.


When you see warnings posted about MAOI medication interactions - *I guarantee you they aren't playing around*. It can screw you big time.

<><><>

I usually take my dose once in the morning. Others like to divide it into morning and afternoon - you'll get a more even effect this way. Taking it all at once - especially if you're taking 4 to 6 pills - can cause a noticeable "peak" about an hour after taking it that some people find uncomfortable. I take it once in the morning because I'm lazy and don't want to hassle with it.

I change my dose somewhat frequently. I've described it in other posts. Right now I'm taking 3 pills a day - but I'll only be doing this for a few days then drop back down. I might occassionally build up to 4 a day - but I almost never go as high as 6 any more.

Good luck with it!


----------



## spaceboy (Mar 5, 2006)

Here's a description of some med interactions posted by Captain Woodchuck - a 16 year Nardil veteran.



Captain Woodchuck said:


> A dentist once gave me Demerol for pain, which doesn't go with Nardil. For three days I felt like my head was going to explode.
> 
> The other time was when my family doctor gave me Methadone for Kidney Stone pain. I ended up in ER. No, not from the Kidney Stones, as painful as they were, but from a bad drug reaction between Nardil and Methadone. ... I was shaking uncontrollably, vomiting my guts out, and close to passing out from nausea.


Here's the entire thread: 
http://www.socialanxietysupport.com/vie ... hp?t=33753

If you read the thread, you'll notice that Captain Woodchuck has less tolerance with food interactions than I do - and his experience might be more typical than mine. Researching these meds and reading first person accounts of their use is very beneficial - an excellent aspect of forums like this.


----------



## Caedmon (Dec 14, 2003)

spaceboy,

I'm joining the ranks of MAOI-takers in a couple of weeks. I'll be evaluating Parnate (tranylcypromine). It's the biggest med decision I've ever had to make. I've been doing almost daily PubMed searches on information as well as reading everything I can anecdotally on MAOIs.

I'm very anergic (lacking energy) and have concentration problems. The stimulant properties of Parnate should help that. I also was concerned with weight gain and hypotension on Nardil. However I think they can both be very effective, and it just depends on the needs of the person taking the medication (Nardil is likely to be better for people with more severe anxiety, I should think). Stephen Stahl's "Essential Pharmacology" lists Parnate as effective for treatment-resistant social anxiety disorder, along with Nardil (which has more studies behind it, but essentially Parnate can also be helpful, and there is literature behind this). Parnate is associated more with weight _loss_ than weight gain, and I think it has a lower incidence of sexual side effects too. However, it does cause more insomnia I think. Anyway these factors made Parnate a better choice for me and for my situation. I'll be given Thorazine to take in unlikely the event of a hypertensive crisis.

Re: Nardil, I'm not sure that the metabolite which increases GABA in parts of the brain is solely responsible for its anxiolytic properties. MAOIs do work on the same neurotransmitters as reuptake inhibitors, i.e. serotonin, dopamine, norepinephrine. But in a very different way. RI's increase serotonin in the synaptic gap (by blocking... reuptake). MAOIs, destroying the enzyme (MAO) which breaks down these neurotransmitters, increases them globally. Inside neurons, outside them, and all that.

The food restrictions are often outdated. The diets listed in the PDR and many other sources are not evidence-based. A number of Canadian researchers published an updated MAOI diet in 1996 which is less restrictive, based on actual measurements of tyramine content in foods. Basically anything published before 1996 is likely to be outdated information, often based on anecdotes:

_ J Clin Psychiatry. 1996 Mar;57(3):99-104. _

* The making of a user friendly MAOI diet.*

Gardner DM, Shulman KI, Walker SE, Tailor SA.

Department of Pharmacy, Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

BACKGROUND: Many monoamine oxidase inhibitor (MAOI) diets are considered to be excessively restrictive and founded on poor scientific evidence. We present a safe and practical MAOI diet based on the related clinical and analytic data. METHOD: We used a critical review of the literature and our own tyramine assay results to categorize foods to be restricted absolutely, taken in moderation only, or unrestricted. RESULTS: We recommend that users avoid aged cheese; aged or cured meats (e.g., air-dried sausage); any potentially spoiled meat, poultry, or fish; broad (fava) bean pods; Marmite concentrated yeast extract; sauerkraut; soy sauce and soy bean condiments; and tap beer. Wine and domestic bottled or canned beer are considered safe when consumed in moderation. Other foods not mentioned are considered unrestricted. CONCLUSION: The concerns about perpetuating an overly restrictive MAOI diet include the avoidance by prescribers of a potentially useful treatment option, excessive limitations on lifestyle for patients, and increased risk to patients secondary to noncompliance with the diet. We propose an MAOI diet that has a solid scientific and clinical basis and that is, above all, practical.

_____________

IOW, pizza is okay, just watch the toppings. Red wine is okay, much to my relief. All things in moderation however. Chocolate is okay, in moderation. So is caffeine. Basically the things on the "Do Not Eat List" that I will have to give up is cheddar cheese and soy-containing whey supplements (I'll just need to find one without soy), and I'll need to be vigilant about food ingredients and eating certain foods in moderation. I'll live. 

More detailed information can be found on this thread from dr-bob.org:
http://www.dr-bob.org/babble/20010814/msgs/75408.html

My asthma medications are not contraindicated, although I thought they would be. Specifically I thought albuterol might be. It's not, there is no evidence of an interaction. There _is _an interaction with orally administered antiasthmatics such as ephedrine, or inhaled epinephrine. (Also some forms of decongestants, and dextromethorphan, and some other things.) It's good to know that I could still breathe! :lol

My pdoc is (IMHO) fairly brilliant, is on the American Board of Psychiatry and Neurology, teaches part-time at the University of Utah. If anyone in the Salt Lake City area wants to see an excellent psychiatrist, I can't recommend him enough. Anyway, he believes I would be an excellent candidate for Parnate (or Nardil, if the former should fail) and believes MAOIs are underprescribed as well.

He trains psychiatry residents at the hospital and of coures, none of them have used an MAOI and almost never get to see them work for treatment-resistant patients. Since he's been in the field for over 2 decades he's had the chance to utilize them. MAOIs are sadly something that most residents are taught about, sort of 'briefly', and then shuffled away because of outdated concerns wrt food restrictions and hypertensive crisis.

I wouldn't recommend MAOIs for people who are not prepared to be very self-educated, who have not tried multiple medications in the past (including sufficient benzodiazepines), and so on. I think many people should give Remeron a shot before trying Nardil, as it's also a unique mechanism of action and is probably the most effective "new" antidepressant out there. Unless of coures the weight gain is a concern, in which case one may want to just try out Parnate instead of Remeron or Nardil. But MAOIs should be used more than they have been.

There was an article about a case series of 7 Tx-resistant patients (click here) and the author states that "No patient should be considered treatment resistant without being offered a trial of phenelzine [Nardil]."

This is all IMHO, your mileage may vary, please correct me if I'm wrong on anything, etc.

Edit: paranoid about giving out my doc's name for some reason. If you are in the SLC area and want to know who I see, PM me.


----------



## PBNC (Mar 4, 2006)

Caedmon, I'll be following your experience with much interest. I'm interested in an MAOI, and I experience a lot of what you do (low energy, poor concentration.) I've been mostly researching Nardil but will look into Parnate as well. Any good resources you've found?


----------



## apprentice1 (Feb 9, 2005)

Thorazine seems pretty severe to me for an antidote to hypertension...it could put you out for a day or two...boom! Ever hear of the thorazine shuffle? Thorazine is nasty stuff. My doc didn't give me anything, seemingly convinced that I would be safe without, I will ask though next week. it makes sense to carry a "rescue med".


----------



## Caedmon (Dec 14, 2003)

Absolutely, I'll let you know. To my knowledge I will be fairly unique on SAS as trying out Parnate for social anxiety disorder, rather than the more well-known Nardil. I have to discontinue some of my meds first and then later on (in about two and a half weeks) I'll start a separate thread detailing my Parnate experience.

Good resources... PubMed (an article database) is always good. I highly recommend http://www.dr-bob.org, like spaceboy, I have found it to be the best source of information on MAOIs especially in conjunction with depression or social phobia. Both Dr bob's "babble" section, and the searchable "Tips" section which details conversations among psychiatrists.

Anyone who is interested in the medications they are taking should try to get their hands on a copy of Essential Pharmacology of Depression and Bipolar Disorder by Stephen M. Stahl. Or, anything by Dr. Stahl. This book is like a "Psych meds for Dummies" type book, very user-friendly but also thorough and up-to-date. He also has a book on mood stabilizers and antipsychotics, which I want to get someday, but I haven't read that one.

Frank, the Thorazine I will probably only take a few times in my entire life, if ever. I have been told by my psychiatrist that there is basically no such thing as a 'mild hypertensive crisis' (though many people experience headaches from antihistamine action). When you have one, you KNOW you have one. It is like the most intense, horrific migraine imaginable. The two meds most often used are a blood pressure medication called nifedipine (taken by mouth or under the tongue), or else thorazine (chlopromazine). They both work very fast to reduce blood pressure. I don't know if one is necessarily better than the other, but my psych is more familiar with chlopromazine as the antihypertensive. It's not something you take and then wait it out. You take it and go straight to an emergency room, hospital, or anyplace with doctors. It's true, I will be tired and groggy for a day or two if I have to take Thorazine, but that is a better outcome than a two-day migraine or (worst-case scenario) a stroke, heart attack, or dying.

IMO if I am going to be on an MAOI it is in my best interests to have an emergency plan. Much like the safety instructions on an airplane flight, I will probably never need to use it, but it is wise to have on hand.


----------



## Britney (Mar 22, 2006)

so nardil is better for sever sa, and parnate is a little less? and parnate cause you to lose weight?????


----------



## Caedmon (Dec 14, 2003)

Britney said:


> so nardil is better for sever sa, and parnate is a little less? and parnate cause you to lose weight?????


There is no evidence that Nardil is more effective than Parnate for SA. No study has compared them head to head. That is just my _intuition_, based on the fact that Nardil has been studied more and has a reputation among experienced clinicians for Nardil being really good at treating anxiety and phobias. However, there is very little in the way of (what I would consider to be) reliable scientific data on the treatment of social anxiety disorder/ social phobia. There isn't data on it, but my guess is that many people with severe chronic social phobia could also respond to Parnate (or Marplan, a lesser-known MAOI), especially if augmented with a benzodiazepine.

It's sort of like benzos. In a similar vein, Klonopin has data backing it for SA, and to a lesser extent Xanax, but other benzodiazepines do not. I don't think. Yet I imagine that other benzodiazepines _are _often just as effective, they just haven't been studied, for whatever reasons.

My problem is not so much social _anxiety _as it is depression and entrenched avoidant behaviors. I also want less side effects, and Parnate is a little more innocuous in this regard. Which is not to say that Nardil will give people horrible side effects, I'm sure there are many people such as spaceboy who tolerate it quite well, but for me I would rather not have as much of a risk gaining weight or experiencing sudden fainting or narcolepsy. So that's why I'm evaluating Parnate first.

Parnate doesn't cause weight loss per se. It's not reliable. Some people will gain weight on it. It's just that, if you look at patients who are on it and look at weight changes, losing weight is a little more likely than gaining weight.


----------



## spaceboy (Mar 5, 2006)

Good luck with the Parnate. If the MAOIs work, they can work amazingly well.

Here are a couple of positive accounts of using Parnate to treat social anxiety:

http://www.spnewsletter.com/selections/ ... MikeO.html

http://www.spnewsletter.com/selections/ ... chael.html

<><><><>

I imagine that the food restrictions can vary quite a bit from person to person. Here's Captain Woodchuck again, describing reactions from food.



Captain Woodchuck said:


> I've only experienced two minor food related hypertensive reactions with Nardil in the 16 years that I've taken it.
> 
> One of those times, I didn't read the label on a can of soup closely enough. The soup contained a small amount of cheese which caused a mild headache for two days.
> 
> The other time, I drank too much Orange Juice, which isn't on the list of restricted foods that comes with my prescriptions, but probably should be. Orange Juice contains Tyramine. If I'd only drunk a moderate amount of Orange Juice it wouldn't have caused me a problem. I was drinking more than a quart a day. I had a fairly painful pressure headache, which went away about 2 days after I stopped drinking Orange Juice.


I'm using Captain Woodchuck's experience here because I've had very very few hypertensive food interactions to report after nine years - and this is not from dietary diligence. (When I first started on Nardil, however, I was scrupulous about what foods I avoided.) In my experience with hypertension reactions - they do vary by degree. My experience with Nyquil was the most significant - even then, it lasted maybe six hours. (elevated heartrate, sweating, headache)

As I posted before, I found on the internet reports of people experiencings headaches from tyramine rich foods without even being on an MAOI. (just google tyramine) So it appears that some people are going to be far more susceptible to it than others. I'm sure it varies across a spectrum.



Caedmon said:


> I wouldn't recommend MAOIs for people who are not prepared to be very self-educated.


I totally agree with that. As one poster on dr-bob said "The MAOIs are the big guns." When you're using the big guns, you need to know what you're involving yourself with.


----------



## UltraShy (Nov 8, 2003)

Caedmon said:


> There is no evidence that Nardil is more effective than Parnate for SA.


The story I've heard from two psychiatrists and what I've also read, goes like this: Parnate is more stimulating and thus not best suited for anxiety.

Given that finding people who've used both Nardil & Parnate to give us a comparison is next to impossible, we don't have much to go on. And Marplan patients, well, it would be easier to find a needle in a haystack then one of them.


----------



## streetsk8er794 (Mar 5, 2006)

does anyone have experience smoking marijuana on nardil?


----------



## Caedmon (Dec 14, 2003)

spaceboy, I'm still in the process of learning. To me, it makes sense that a person can have hypertension-related headaches when consuming a small(ish) amount of tyramine. I wonder if this is a little different from a true hypertensive _crisis_? I don't know. I may have also misunderstood what my psych said, or perhaps he doesn't know as much as experienced patients in this regard.

As you mentioned, some people are sensitive to tyramine regardless of MAO. Also, tyramine can cause hypertensive crisis in *anybody*, the thing with MAOIs is that your sensitivity to tyramine increases something like 50-fold.

Karl, you know that sedation and activation aren't the only things involved with anxiety efficacy. TCAs are often sedating, but are not effective for SA for example. Dr. Stahl lists treatment-resistant social phobia as one of the non-FDA indications for Parnate. (Tx-resistant depression is another one. It's only approved for major depressive disorder without melancholia.) I'm at work and can't look it up, but I'll try to dig up the study that they did on Parnate and social phobia. It was an open-label study so it will be overly-positive, but it's still suggestive. By Versiani or somebody like that, around 1991? Or someone could beat me to it.


----------



## PBNC (Mar 4, 2006)

Well, I'll confess - I'm also curious about using marijuana with an MAOI, so I've been doing my best to google up any possible information on it. To be honest, I haven't found a single negative thing, and trust me, I've looked. So I'm guessing it's definitely something to be handled cautiously, which is how you should behave when using ANY drug - but that individuals may be able to tolerate it just fine. 

Here's another question I have: I understand how MAOIs work differently than reuptake inhibitors. My question is, does everyone's brain make enough neurotransmitters naturally, and it's just a matter of finding the best way for your brain to access them (either through limiting their reuptake, or getting rid of the MAOs that otherwise vacuum them up)? Or is it possible that some people just don't make enough of certain neurotransmitters, and so even if you're taking an MAOI or SSRI, your brain just doesn't have enough naturally to make a positive difference? Am I making any sense? 

I keep telling myself I need to give Effexor a good college try, even though, truthfully, I'm dying to just try an MAOI. I feel like I have pretty severe social anxiety sometimes - I'm not afraid to go out in public or anything, but talking to people is terrifying and draining for me, and I avoid it as much as I can. And I mean, talking to nearly everyone - even coworkers I've known for a while or family members that I don't see often but have known all my life. I just freeze in conversations, and definitely feel a fight-or-flight thing kick in.....tensed muscles, increased heart rate, etc...which means that by the end of the encounter, I'm usually tired from all that arousal. 

I hate SA. :afr


----------



## apprentice1 (Feb 9, 2005)

_A quick update from my experience with 10 days of Parnate. This is day 10 or 11...I am beginning to notice a slack in the energy effects... this waning in the energy area disappoints me. I am beginning to worry that I am losing the effects of my Parnate...granted, the weather here is miserable and any normal person would have the right to be depressed today, so...but I have another good week to go before I go to the doc again for a review of the first 20 days of Parnate...I have hurried before to up the dose on medicines before and had bad luck, so I want to take this slower and at least wait until my appt. to ask to up the dose...Maybe tomorrow will be better. I can imagine that after a while I will also do the up and downing the dose like spaceboy, I just want to go slow. I want this to work!
As far as helping concentration which is a way major big problem with me...I didn't notice any help from Parnate so far. 
Caedmon wrote, "I'm very anergic (lacking energy) and have concentration problems. The stimulant properties of Parnate should help that". 
I have the same problem, way bad. . I can't read books unless they are super good, I find myself daydreaming and reading the same page over and over. People tell me things and I forget what they said right away. In fact since starting the Parnate, I have had no trouble getting out of bed and getting going, but I have ridden the subway past my stop, gotten in the wrong subway and rode a good long way before I noticed I was on the wrong train...I am very forgetful, it runs in the family, especially the males so I can slump it off onto that. I think somewhere in this thread spaceboy said something similar... Anyway, I am curious how you youngin's do at a low dose and if you go up on your dosage...let me know, as I will. 
Caedmon, about Thorazine as an anti-dote for hyper-tension. I am sorry, I posted a stupid post, what can I say? I will edit it to at least take out my "doctor myself" remedy. It is just that I was "treated" with thorazine when I was 22. What size tablet did he give you if I can ask? What you said made sense.


----------



## Caedmon (Dec 14, 2003)

Hi apprentice1, I am moving a response to your comments on a new thread, so that this thread can be mostly about Nardil.


----------



## spaceboy (Mar 5, 2006)

It would be nice if the medication section of this forum was subdivided into catagories. Under the heading "Medication", there could be a "general medication discussion" section, followed by, for example - "benzodiazepines" - "SSRIs" - "MAOIs", etc. It would make it easier to find posts specifically related to certain medications.

(I don't mind the discussion of Parnate here - I see this as sort of an "MAOI" thread.)

I don't know what to tell you in regards to my lack of hypertension from off-limit foods. Only two food items have caused it, both liquids - a stale, slightly off-tasting tap beer I drank once, and the more expensive, robust red wines. Of solid foods - I've never once encountered a problem. As a result of that, I eat exactly as I always have - I don't scrutinize restaurant menus or carefully read processed food labels. I eat aged and dried foods like pepperoni, salami, blue cheese, parmesan, romano, etc. I have no idea why I haven't had a problem where others very obviously do. I posted the quote from Captain Woodchuck because his experience is probably more the norm.

<><><><>

Comments on "difficulty concentrating" - I've seen a couple of people mention this in posts. It's a trait most commonly associated with attention deficit disorder.



apprentice1 said:


> As far as helping concentration which is a way major big problem with me...I didn't notice any help from Parnate so far.
> Caedmon wrote, "I'm very anergic (lacking energy) and have concentration problems. The stimulant properties of Parnate should help that".
> I have the same problem, way bad. I can't read books unless they are super good, I find myself daydreaming and reading the same page over and over.


This next quote is from the link I recently posted describing a user's positive experience (for SA) with Parnate, however, make note of this comment: "...one of the side effects of parnate for me is that I simply am not as 'sharp' as I was pre-parnate."

I also have difficulty with focus and concentration - difficulty staying organized, completing tasks, forgetfulness, etc. I also have a distinct tendency to hyperfocus when something interests me. My symptoms are the very definition of Inattentive ADD. Nardil seems to do _nothing_ for this beyond a general increase in motivation. What it seems to do, is move me from being a languid, inattentive ADDer towards a more outgoing and active ADDer - but I remain an ADDer nonetheless.

It could be that, as the MAOIs increase neurotransmitter levels globally, some kind of "interference" still persists along the dopamine pathway (or whatever part of the brain that is responsible for "executive functions".)

The MAOIs are definitely _not_ an ADD medication. I've even wondered if an increased dose of Nardil might actually make me a bit more spacey, a bit more scattered - or as the Parnate user described above, not as "sharp".

Socialfear.com notes:


> There is strong evidence for dopamine dysfunction in SP. Comorbidies with other DA hypofunction disorders such as atypical depression, dysthymia, and attention deficit disorder (ADD)... are common.


Of these, attention deficit disorder seems the least directly related - and not just judging from my response to Nardil (which is great for SA, atypical depression, and dysthymia, while doing nothing for ADD.) Many, many people with ADD (most, I suspect) are quite outgoing and gregarious. Conversely, I personally know at least one person with very clear SA who is highly organized, focused, and productive. (Also, if you're familiar with the cartoonist Robert Crumb - he's definitely a social phobic, [just watch the movie about his life] while also being tremendously focused and productive with his artwork.)

What this suggest to me is that ADD symptoms are not that closely related to SA. (whereas, at least for me, depression and anxiety seem to intertwine quite a bit.)


----------



## Caedmon (Dec 14, 2003)

Wow, you can eat salami? The parmesan doesn't surprise me a whole lot, I read somewhere that it actually doesn't have a lot of tyramine in it although my guess is this can vary widely depending on brand and length of storage.



spaceboy said:


> The MAOIs are definitely _not_ an ADD medication.


:agree ADD responds best to stimulants. I know they've done some studies on Parnate and selegiline for ADD but I am not aware of a body of evidence anywhere near approaching that of amphetamine/ methylphenidate. It will be interesting to see what happens with the new EMSAM (selegiline) MAOI patch, which has been approved for depression by the FDA. There is no official release date on it yet but I've heard speculation that samples could arrive in doctor's offices as early as next month.


----------



## spaceboy (Mar 5, 2006)

streetsk8er794 said:


> does anyone have experience smoking marijuana on nardil?


I sorta have the impression that talking about "illicit" drugs here in the forums is generally frowned upon - but I'll venture into this one. A couple people have asked about it.

First: Marijuana and myself have never been a great combo. It has always had a tendency to amplify my SA in a significant way, making me very self-aware and uncomfortable. If I smoked pot in a social setting, I could pretty much count on leaving shortly because of the discomfort. Even if I'm by myself, smoking pot can produce anxious, uncomfortable thoughts. For this reason, I rarely smoke it.

Nardil, however, does indeed manage to block the appearance of anxiety when I'm stoned (with no adverse drug interaction in me whatsoever) In a way, smoking pot in a social setting was Nardil's "acid test", because smoking pot in a social setting triggers the very worst SA in me. On Nardil, if I smoke pot, I don't become anxious and uptight, I tend to become goofy - dumb little jokes seem outrageously funny, and my free-associative powers increase, etc.

Even still, if I'm at a social event and a pipe is making the rounds, I'll almost always pass - I just don't like it that much. The last time I smoked pot was a little over a year ago at my roommates birthday party.


----------



## spaceboy (Mar 5, 2006)

Caedmon said:


> Wow, you can eat salami?


No problems so far. I like to buy packs of good pre-sliced salami and I'll wolf down quite a bit of it as a snack. The only problem with this is the expense of the salami.

I cannot explain my lack of hypertensive reaction, and I know what one feels like - my heartrate increases and feels "pressured" - I sweat a lot - and of course, get a headache.

When I first started on Nardil - I avoided all the off-limit stuff scrupulously. Over time, I experimented with little bits of off-limit food. No reaction. So I'd eat more. No reaction. O.k., the coast seemed to be clear - so... I just started eating as I always have.

I *absolutely do not* recommend this non-chalant approach for anyone starting on an MAOI - because my guess is that you're more liable to be like Captain Woodchuck than myself.

OTC meds are different for me. My experience with Nyquil taught me to be very careful - *always* read the warning label.


----------



## spaceboy (Mar 5, 2006)

My seemingly very high tolerance of tyramine rich foods is what caused me to wonder if MAO wasn't naturally a bit overactive in me to begin with. As I posted earlier in this thread, I came across a study that investigated exactly this:



> *Increased platelet monoamine oxidase activity in affective disorders.*
> Platelet monoamine oxidase activity was determined in 52 unipolar depressive patients, 26 patients with bipolar affective disorder and 48 controls using phenylethylamine as substrate. Unipolar depressive patients of either sex and bipolar depressive women _showed significantly higher platelet MAO activity than controls_.


For me to conclude anything from this is nothing more than theoretical rambling - however, if MAO activity is actually higher than normal in me - an MAO Inhibitor like Nardil could "normalize" it, but not overdo it to the point where I can't eat things like salami.

Having said that... well, let's just say that that was a totally conjectural musing from an armchair scientist.


----------



## Caedmon (Dec 14, 2003)

That's an interesting article. I've never thought about that! 

My general diet plan is to err on the side of caution while starting and very very slowly try some of the foods with lower tyramine content (but that are still on the old diet lists), like bottled domestic beer. I know that in doing pressor tests they will take BP before and after consuming a tiny amount. Depending on results, they increase (either by 100% or 50%). This is probably what I'll do. I'm not sure this is necessary for most people, but I want to do it as kind of a fun experiment. I'm just a geek that way. :b

Thank you for starting this thread, it's been very interesting to read. I don't believe we've had too many threads in this forum on just one medication, with more than 100 replies!


----------



## spaceboy (Mar 5, 2006)

The study I quoted above is from 1980. When I found that study, I also came across a second one (conducted around the same time) that investigated increased MAO activity in depressed patients. I was just searching for that second study when I came across yet another - this from from Pub-Med. It's a study (1986) that relates more to elderly women than the general population - however, it's findings are interesting.



> Platelet monoamine oxidase (MAO) activity was assayed in 42 unmedicated, elderly, RDC depressed, unipolar outpatients over 60 years of age, 17 nondepressed controls, and 17 younger volunteers without psychiatric illness. Elderly depressed women (n = 22) had significantly higher MAO activity than sex- and age-comparable controls. No significant relationships between MAO activity and duration of current depressive episode, duration of illness, or family history of affective disorder were obtained. These results extend to elderly female outpatients the finding that _depression is associated with increased platelet MAO activity_, exceeding the normal age-related increase.


Found on a totally different website - but with an obvious connection to the above study... post menopausal women aren't going to be producing estrogen like their younger counterparts.



> Estrogen also acts as a MAO inhibitor by decreasing the production of MAO. The result is that there is less MAO to destroy serotonin and norepinephrine and hence, there is more of these two neurotransmitters available to be released into the synapse and their activity is increased. This action of estrogen is the same as MAO-inhibitors that are used as a therapy for depression. However, ERT alone may not be effective as an antidepressant but may be helpful as part of a larger regimen. The research for ERT as an antidepressant is not yet conclusive.


Anyway - there seems to be a correlation between higher MAO activity and depression. As I mentioned in an earlier post - if increased MAO activity at least partly underlies my depression (atypical, dysthymic) it may explain why increasing only seratonin (via an SSRI) produced little results, whereas an MAOI like Nardil caused a dramatic improvement.


----------



## living in darkness (Apr 17, 2005)

streetsk8er794 said:


> does anyone have experience smoking marijuana on nardil?


I keep telling myself that I'm not going to talk about this kind of thing anymore- I can only imagine what some of the people here think of me :um, but I have experience smoking marijuana on nardil. A lot of experience. :lol

Ask me anything.


----------



## PBNC (Mar 4, 2006)

I think those of us who are asking are probably mostly just concerned about some kind of bad reaction between the cannabis and MAOI. MAOIs interact with practically everything else, why not pot? 

Like I said, though, I've looked high and low and found nothing. 

Part of the problem is that I haven't been able to find a clear answer on how marijuana actually affects the brain. One source says it creates a big rush of serotonin (that got me worried about serotonin syndrome with an MAOI) but another source says it does NOT affect serotonin, it's all dopamine. :stu I don't know. But I do wonder - if the marijuana DOES create a rush of one neurotransmitter, wouldn't your brain get more benefit from it due to the MAOI?


----------



## streetsk8er794 (Mar 5, 2006)

I doubt marijuana would have any kind of negative reaction while on an MAOI. But, another question... how long did it take you to start feeling the effects of nardil after taking it spaceboy?


----------



## Britney (Mar 22, 2006)

im almost sure he said weeks


----------



## spaceboy (Mar 5, 2006)

six weeks - almost to the day.

It took so long, I almost gave up on it.


----------



## streetsk8er794 (Mar 5, 2006)

did you taper up to the dosage you are on now? meaning, can i just start taking 75 mg the day i start taking it?


----------



## spaceboy (Mar 5, 2006)

You know, I can't remember exactly what my dose was when I first began taking it. I'm pretty sure I was taking something like 45mg or 60mg for the entire six weeks prior to "lift off". During this time I noticed no effect at all. When it first seemed to work, it was so subtle I didn't realize it until the next day. The day after that - wooooo weeeee! Yeah, it'd kicked in all right.


----------



## Britney (Mar 22, 2006)

what did u mean when u said ur brain is turnin to mush spaceboy?


----------



## spaceboy (Mar 5, 2006)

Here's a post from dr-bob.org that seems to corroborate the length of time Nardil took to work - and the sudden, rapid appearance of it's effects when it takes hold.



> Posted by JaclinHyde on March 7, 2006, at 19:11:49
> In reply to Re: Trying MAOI for first time » Gregor, posted by TylerJ on March 7, 2006, at 12:45:52
> 
> I have tried every @#$% drug out there and believe me NOTHING compares to the MAOI's. They're da bomb  The big guns. I love marplan first but had to stop it due to being bipolar. I am on Parnate now which is working equally as well. Nardil worked too but made me too groggy and I gained too much weight on it. Parnate worked the fastest, I felt relief in about a week. Nardil was my first and took me 6 weeks to feel better. But when I did....WOW! It was as sudden as a gut punch.
> ...


----------



## streetsk8er794 (Mar 5, 2006)

Im very interested and psyched to try my nardil. Im just waitin for it to come in the mail, probalby another week or so. But, I will definitely make a journal in this forum so you guys can get a feel for the drug (the ones not on it obviously). All I can say is though, I cannot wait to start dating girls again....


----------



## spaceboy (Mar 5, 2006)

Britney said:


> what did u mean when u said ur brain is turnin to mush spaceboy?


Hi Britney,

Actually, I didn't say that my brain was turning to mush - I was just wondering what the long term consequences might be from using a drug like Nardil, so I said "I don't know if Nardil is causing my brain to slowly turn to mush or not."

I've yet to come across any bad long term consequences posted, but you never know. On forums you'll not infrequently find people posting of negative consequences from particular psyche meds. From first person accounts I've come across in forums, the amphetamines (like Adderal) and the benzodiazapines seem to produce a somewhat high number of reports of negative mental effects like impaired cognition, memory problems, difficulty sustaining focus, etc.

I don't know the long term effects from taking an MAOI, but I certainly wonder. For the time being, however, since it's still useful, I still continue to take it.


----------



## poisonedspirit (Dec 28, 2003)

Anyone know if forum member *zzzuhumuha* is ok? I notice she hasn't posted on the forum for a while, at the time she was just starting on Nardil if I remember correctly, hope she is ok.


----------



## No Limit (Dec 6, 2005)

Well looks like I'll be Nardil myself by the end of the month. I went to see a psych doc today. This is my first visit with him. I brought up MAOIs towards the end of the session and actually said it was a good idea to try taking them. I did give me the laundry list of SSRIs that I've been taking for the past two years. I wanted to start taking it today, but he wanted me to taper off the current SSRIs that I'm taking for two weeks. Hopefully I can be a success story too.


----------



## Caedmon (Dec 14, 2003)

No Limit said:


> Well looks like I'll be Nardil myself by the end of the month. I went to see a psych doc today. This is my first visit with him. I brought up MAOIs towards the end of the session and actually said it was a good idea to try taking them. I did give me the laundry list of SSRIs that I've been taking for the past two years. I wanted to start taking it today, but he wanted me to taper off the current SSRIs that I'm taking for two weeks. Hopefully I can be a success story too.


It sucks! I have the green light for Parnate, but I still have to wait a couple of weeks (2-3) to wash out, before I can start. Waiting is the hardest part!


----------



## PBNC (Mar 4, 2006)

I'm jealous of those of you starting MAOIs soon. I next see my doc on April 11 and I know (from our last appointment) that she is going to want to try Effexor. I'm willing to give it a try, but if it doesn't work, I want Parnate, dang it!


----------



## Caedmon (Dec 14, 2003)

PBNC,

Don't give up!

Most people go onto MAOIs after they've been on a lot of other meds, had a recent thyroid test, and are pretty responsible and self-aware. For example, my laundry list would include:

Zoloft
Wellbutrin
Lexapro
Cymbalta
Buspar
Effexor
Topamax
Klonopin
Valium
Selegiline
Ritalin
Lamictal
Risperdal
Trazodone
Prozac
Hydroxyzine
... and possibly some other stuff that I can't recall
... and 2 1/2 years of psychotherapy
... and yoga, meditation, most herbal supplements
... and fish oil, exercise, and self-help books

Not saying you have to be on all that for MAOIs to be appropriate. It's just that, an MAOI is not 'firstline' treatment. 

You could try this: bring up the issue of Parnate. You can only ask, it won't hurt. Ask about it, and if she says yes, then you got it. If she says no, bring up something along these lines: You'll give Effexor a shot, and *meanwhile* you'll adhere to a low-tyramine diet as well as the drug restrictions necessary for an MAOI trial. Then you have some options:

1. Effexor works. So, then you can just stay on Effexor.
2. Effexor doesn't work, but you don't manage the diet/drug restrictions either. Try another RI like Cymbalta.
3. Effexor doesn't work, but the diet/drug stuff isn't a big problem. Try Parnate.

^ See what she thinks about that as a treatment plan. I don't know if it will work, but it's what I was going to suggest to my pdoc because I thought he'd say 'no'. 

If she rebuffs any attempt to try out Parnate, for various reasons (some good, some bad) then you enter into the stage where you write polite letters and bring in journal articles. If that also completely fails, then you either go along with her ideas (which might actually be sound advice, btw), or find a new doctor.

Those are my thoughts anyway.


----------



## streetsk8er794 (Mar 5, 2006)

did Nardil make it any easier to talk to the opposite sex? im on it now btw. this is my 1st day!


----------



## apprentice1 (Feb 9, 2005)

streetsk8er794 said:


> did Nardil make it any easier to talk to the opposite sex? im on it now btw. this is my 1st day!


What is your dosage, streetsk8er794, if I may ask?


----------



## streetsk8er794 (Mar 5, 2006)

Ok, let me tell you how day 1 went. I recieved my medication late in the day so I started taking them late in the day. I took my 1st 15mg pill at 4:30 pm, my second at 10:00 pm, and the 3rd at 4:00 am because I had a late night out. Now, I didnt notice any side effects what so ever, but I was also smoking weed the whole day. I did notice however, that my high was smoother than usual. Most of the time when I get high I start worrying alot and phase out. I didnt this time. However, Im almost possible its placebo as its very unlikely to experience any positive effects on my 1st day. Im hoping to stay on 45 mg (three, 15mg pills) for 3 days, then taper to 60 mg for 3 days, then start taking 75 mg on my 7th day. Ill update daily.


----------



## living in darkness (Apr 17, 2005)

Hey guys, I picked up my Nardil yesterday and the pharmacist told me that the Nardil patch should be available soon! :banana

This will stop the weight gain, and you won't have the dietary restrictions!!

The patch has been available for awhile in Europe, we're just waiting for the FDA to approve it for the US. This isn't a regular pharmacy, it's for a State mental health unit. So, if the gov mental health agencies are getting the patch, I'm sure private doctors and regular pharmacies will have it soon.

streetsk8er, that's a lot of Nardil to start with! Seriously, I would start with only 15mg for a week, go up to 30mg for a week or two, then 45, up to 60. You should notice a _big difference_ after being on 60mg for a few weeks. It does take awhile to start working but it is _so worth it_!

I tried posting something about smoking weed on Nardil, but the moderators took it down. Since you were able to get away with mentioning weed, I'll try one more time. Marijuana should have no harmful interactions with Nardil. That's coming straight from my pharmacist. Remember, those guys actually have more training then doctors when it comes to medication. I'll just leave it at that, and maybe it won't be censored this time.


----------



## PBNC (Mar 4, 2006)

Just to clarify, the "Nardil patch" is actually selegline (sp?), which is a different MAOI, and only patients using the lowest dose will be free of the dietary restrictions.


----------



## apprentice1 (Feb 9, 2005)

I am remembering what my psychiatrist said about Parnate being what they used to call "mother's little helpers" and I said I came from that time and thought he meant to be talking about "black beauties"...speed. Mild, but effective. He also made it sound attractive by saying it is a lot like cocaine...now, my observations after a couple or three weeks...it is speed. For me it has made my depression go away, thank god. It doesn't have a long half-life, disputably between 2.5 and four hours and I would say three to four for the first dose is about right. I seem to have a hypotension reaction then, after the first dose wears off and need to sleep for about three to four hours in the afternoon...not good.. No matter how much, okay, one or two, that I take at this time helps...I have to, if I can, lie down. I think if I checked my blood pressure, it would be the cause. I checked it at the doctor's on my last visit after one 10mg. of Parnate and 1mg. of xanax and it was 115 over something quite reasonable...my doctor said I would live a long life...I see staggering differences in the dosages people take and when and have come to the conclusion that this drug is like cocaine, used to be called "mother's little helper", will bring you up when you want to be up and it doesn't last very long, so it lets you down...but then you can take the next dose after awhile and come right back up...I am packing for Brussels for the week-end from Munich, it is ten pm. and I have been out to drinks (white wine mixed with perrier, not a wine-spritzer) and dinner with my long-time (23 years) friend, during which, after sleeping (I just have to lie down and shut off, I don't sleep the whole time... two hours or so), took a half a xanax, a bit later with dinner a Parnate and another half a xanax and now I am home happily packing away, doing my e-mails, laundry etc., without the faintest apprehension or anxiety about the trip alone to Brussels tomorrow in the morning...I say, take 'em when you need 'em, leave 'em when you don't...for me taking more at one time (meaning two instead of one) made absolutely no difference...I got buzzed and came down and crashed. Crashing could be because of eating a pizza with the little crushed red peppers and having a hypo-tension reaction...I don't know. I am also being checked in a couple of weeks for sleep apnea which could lead to the need for sleeping in the afternoon around 2:00pm for a couple of hours and feeling tired in the evening. At least Parnate helps everything except the nap in the afternoon...I am happy to have come across it and be allowed to try it.


----------



## streetsk8er794 (Mar 5, 2006)

> streetsk8er, that's a lot of Nardil to start with! Seriously, I would start with only 15mg for a week, go up to 30mg for a week or two, then 45, up to 60. You should notice a big difference after being on 60mg for a few weeks. It does take awhile to start working but it is so worth it!


actually, the dose Im starting on is the recomended dose on the bottle and the recommended starting dose for most doctors that prescribe it.


----------



## Debop (Jun 11, 2005)

*MAOI Patch availability*

Does anyone know if the MAOI patches are available in the UK


----------



## streetsk8er794 (Mar 5, 2006)

*Day 2 On Nardil:*

Took one tablet at 1:20 pm, 8:00 pm, and 2:02 am. Still, no side effects present. Actually, I've been able to think a little more clearly, which leads me to believe it might do something for my ADHD.


----------



## spaceboy (Mar 5, 2006)

The patches you're talking about are Selegiline. It was just recently approved by the FDA.

http://www.fda.gov/bbs/topics/NEWS/2006/NEW01326.html



socialfear.com said:


> Eldepryl (selegiline): Currently selegiline is not used much in the USA except in the treatment of Parkinson's Disease, where it used at low dose (5-10mg/day) to boost the effects of L-DOPA. At low doses, selegiline is a selective MAO-B inhibitor (boosting mainly dopamine in the brain). At higher doses (20mg and up), selegiline also inhibits MAO-A, and has powerful antidepressant effects and a profile similar to Parnate. Currently the FDA is evaluating a "transdermal patch" delivery method of selegiline (20mg/day) for approval as a new (new patent) antidepressant. The main advantage of the patch delivery is a lack of need for dietary restrictions. Some Dr's believe an FDA approval on the patch could lead to a significant increase in use of the MAOI's. Certainly a new patent on any MAOI (patch or no) - would change the information we get about the "efficacy and safety" of the agent.


More info here:
http://www.biopsychiatry.com/selemort.htm


----------



## spaceboy (Mar 5, 2006)

apprentice1 said:


> I am remembering what my psychiatrist said about Parnate being what they used to call "mother's little helpers" and I said I came from that time and thought he meant to be talking about "black beauties"...speed.


I doubt that Parnate was the "mother's little helper". It was probably something like methamphetamine.


> Methamphetamine (MA) is a derivative of amphetamine, which was widely prescribed in the 1950s and 1960s as a medication for depression and obesity, reaching a peak of 31 million prescriptions in the United States in 1967.


http://www.amphetamines.com/methamphetamine/index.html


----------



## Nae (Nov 10, 2003)

Mmmm...I believe "Mother's Little Helper" is in reference to valium. The Rolling Stones released a song in the late 1960s named "Mother's Little Helper"

_"Men just aren't the same today"
I hear ev'ry mother say
They just don't appreciate that you get tired
They're so hard to satisfy, You can tranquilize your mind
So go running for the shelter of a mother's little helper
And four help you through the night, help to minimize your plight_


----------



## redkit (Mar 14, 2006)

Dear spaceboy, 

I am very happy for you.
I had read that most effective antidepressants for social anxiety are parnate and nardil.
You are the first real witness I have met.
I live in Turkey and in my country no MAOI exist except for the reversible MAO inhibitor , a newer one, moclobemid ( brand name in Turkey is Aurorix and brand name in Canada is Manerix ).
Moclobemid is as good as SSRI's but has very below effectiveness than old MAOI's have.
In Turkey social anxiety patients are very unlucky because they dont have any chance to reach Parnate or Nardil.


----------



## streetsk8er794 (Mar 5, 2006)

*Day 3 on Nardil

Took 1 tablet at 1:00 pm, 8:00 pm, and 1:30 am. Drank lots of beer (bottled beer), and smoked plenty of weed, and I experienced no interactions or side effects.*


----------



## Caedmon (Dec 14, 2003)

streetsk8er794 said:


> Took 1 tablet at 1:00 pm, 8:00 pm, and 1:30 am. Drank lots of beer (bottled beer)


The fast dose titration and haphazard approach to the diet strikes me as very unwise. I would not, under any circumstances, consider taking 45mg phenelzine right away, even if my doctor told me to. 45mg is the minimum _therapeutic _dose, it is not a starting dose. And I would not, under any circumstances, drink "lots of beer" if I didn't know how I would react to small amounts.

What is your blood pressure before and after taking Nardil? Systolic and diastolic.


----------



## streetsk8er794 (Mar 5, 2006)

Bottled American beer according to the new and updated MAOI diet restrictions is fine to drink, it contains little to no tyramine. Also, 45 mg IS NOT a high starting dose. That is what many and most people start at. Please stop telling me that people.


----------



## Thunder (Nov 5, 2003)

> Drank lots of beer (bottled beer)


Wine and domestic bottled or canned beer are considered safe when consumed in _moderation_.


----------



## JayJay (Nov 18, 2003)

Has it done anything for your anxiety or depression yet? I think I might have ADHD too so I'm glad to hear it's letting you think clearer.


----------



## streetsk8er794 (Mar 5, 2006)

its done nothing for my depression or general anxiety, but I think i can feel it working in social situations. But Im willing to bet that its just placebo. And I didnt drink LOTS of beer, I had maybe like 7 or 8. So...


----------



## PBNC (Mar 4, 2006)

Seven or eight isn't a lot?! :fall I would be on my butt....then again, I don't drink. :b


----------



## streetsk8er794 (Mar 5, 2006)

[/u][/b]Day 4 on Nardil:

Took a tablet at 12:00 pm, 8:45 pm, and 2:30 am. Drank a 32 oz of Old English malt beverage. So far, keeping up with the diet is not even requiring effort. Who eats pickled herring?! Yuck! Anyways, still NO side effects what so ever.


----------



## streetsk8er794 (Mar 5, 2006)

Day 5 On Nardil:

Took my doses at 12:00 pm, 10 pm, and 3 am. Still no side effects. Usually, I would be freakin at work tonight because its a busy s aturday night, but I actually didnt do too bad. If its any indication of things to come, then I cant wait for this stuff to really kick in.


----------



## streetsk8er794 (Mar 5, 2006)

FOR THOSE OF YOU FOLLOWING MY DAILY JOURNAL, IVE MADE A NEW THREAD IN MEDICATIONS CALLED "NARDIL: A NEW BEGINNING?"


----------



## living in darkness (Apr 17, 2005)

streetsk8er794 said:


> Drank a 32 oz of Old English malt beverage.


Ah, the classics...


----------



## No Limit (Dec 6, 2005)

I'm part of the club now. Just started taking my 15mg dose today. I'm not expecting anything immediate like Klonopin, but hopefully this can replace the Klonopin which I really don't want to use long-term.


----------



## workman (Mar 5, 2004)

That is a lot of drinking. Maybe it doesn't effect the Nardil, but it is just bad in general.

I do find that before, and now again, drinking is more appealing on nardil. Not for anxiety, maybe the nardil increases the feel good effects or something. I don't know.


----------



## streetsk8er794 (Mar 5, 2006)

I think ive smoked every day on Nardil so far with no bad effects. Ive also drank about almost every 3rd day, which, I know, is not smart, but I hang out with seniors in high school and freshmen in college, so Im in that stage if ya know what i mean.


----------



## workman (Mar 5, 2004)

What are you smoking? I looked on an interaction checker and nicotine isn't contridicted with nardil. Marjiuana(sp) probably won't cause a reaction either. Of course, alcohol, cigarettes, and marjuana probably aren't that great for your health in the first place, but I don't think they will cause a hypersensitive crisis.

Anyway, I've been taking 30 mg of nardil for about a week an 45 for a couple of days and it seems to already be helping out already. The prescription I got said to start out at 45 mg so I don't see a problem starting there(I left out that I had alread started taking 30 for a week... woops  ) My philosphy is to get to the dose that is going to help you as soon as possible since these drugs take so long to kick in. Just watch out and try not to go overboard with contradicted food/meds. Try them(if you are going to at all) out slowly and see how they effect you. I don't know what the best drugs to counteract a hypersensibie crisis are, but you might want to ask your doc about getting something incase an emergency does come up. I have beta-blockers and benzos for other reasons and I think they would help with a hypersensitive crisis if I did get one. beta-blockers lower your blood pressure, so they are probably best, but there is probably something better out there. idk.

I'm not the safest/smartest person, so don't take my suggestions as fact or as being safe. Just remember, nardil can put you in the emergency room or in the worst case in a coffin.


----------



## apprentice1 (Feb 9, 2005)

I have found the combo of Parnate, xanax and drinking dangerous. Different strokes for different folks. It didn't take much white wine for me to black out and later found out I got "extremely aggressive" with a friend. I could never hurt anyone with sticks and stones, but I know sometimes I have a pretty sharp-bladed tongue when drinking. It generally happens when I forget to eat before or while drinking and then only two or three times a year, but it just happened. I wanted to mention it because I am disappointed that 'we' go back to drinking as soon as we find out it probably won't kill us.' It is definintey contra-indicated with most anti-depressives. I used to drink on Prozac until I was dancing in the street talking long distance...to figure out there was a dangerous connection. I know I am spanking my own butt here, and I am embarassing myself admitting that I drink to excess sometimes and disappointing others who post here, but I am only human and also got used to, over the years, self-medicating myself with alcohol. It was the only treatment I could afford. I just think we are not going the right way. If anything I would say up the dose. leave the booze if you are sure you can do that. Upping the dose and still boozing is definitely dangerous in my opinion.


----------



## apprentice1 (Feb 9, 2005)

Can anyone tell me the difference in dosing between Parnate and Nardil?


----------



## Caedmon (Dec 14, 2003)

Hi apprentice1, I actually don't think the doses are all that different. The Physician's Desk Reference states that the maximum dosage is 60mg up to 2 months; however, when I read what people had to take to get their depression or anxiety into remission it is usually higher. 40 to 90 mg sounds much more inline with "real-world" results. I think somewhere on this thread or the other one, I wrote about people on as much as 200mg of tranylcypromine + stimulants for treatment-resistant depression, which is pretty hardcore; I think it depends on the response.

If you got just absolutely NO response on the lower dose, there is justification for going up past 100, but if you DID, and it was just partial/intermittent, I think I would go up to maybe 90 and then augment with something. Pushing up to higher doses unnecessarily is probably just going to increase the risk of addiction.

The PDR is a legal document, and the doses are set by the manufacturers. My guess is that GSK (who makes Parnate in the U.S.) is either not that interested in conducting research to reevaluate the dose or else there could be a liability issue - because Parnate can be very addictive! Parnate makes even normal people, without depression, "feel good" so there can be some reinforcing action there.

I would stick with what Dr. Stahl recommends in Essential Pharmacology: the Prescriber's Guide, to go up to 80. (He says 80, my psychiatrist says 90... meh, go with whichever you want.) Then wait, and wait, and if you aren't getting a complete response then augment with:
_
"- A stimulant such as d-amphetamine or methylphenidate...
- Lithium
- Mood stabilizing anticonvulsants
- Atypical antipsychotics...
- Although generally prohibited, a heroic but potentially dangerous treatment for severely treatment-resistant patients is for an expert to give a tricyclic/tetracyclic antidepressant other than clomipramine simultaneously with an MAO inhibitor...
- Amoxapine may be the preferred tricyclic/tetracyclic antidepressant to combine with an MAOI in heroic cases due to its theoretically protective 5HT2A antagonist properties"_

- pp. 472-475

I might add in there that Wellbutrin (bupropion) has in some cases been added to Parnate (and there's no evidence in the literature of an interaction), and that other treatments are definitely worth a shot as well such as aerobic exercise, omega-3 fatty acids, or light therapy, all of which have a lot of evidence for depression and to a lesser extent, anxiety. Obviously where anxiety or insomnia are concerns, you can also add in benzodiazepines, trazodone, eszopiclone etc. and heck, you could probably add in bupenorphine if you had a doctor crazy enough to accomodate.

BTW all those augmentation strategies should apply to Nardil as well. But Nardil is harder to augment, because it carries a higher risk of serotonin syndrome due to somewhat stronger MAO-A inhibition. So anything acting on serotonin (this is mainly those TCAs, Lithium, and trazodone; also Lamictal) you may want to either avoid or use with stellar caution.


----------



## streetsk8er794 (Mar 5, 2006)

Ive been on Nardil for about 23 days now, and Im noticing a HUGE difference in my social anxiety. It is almost non-existent. I am starting to develop a cirlce of friends and it is wonderful. But, my general anxiety is still really, really bad. My question is this: is it possible for Nardil to have fully kicked in yet, or is this just the beginning?


----------



## apprentice1 (Feb 9, 2005)

streetsk8er794 said:


> Ive been on Nardil for about 23 days now, and Im noticing a HUGE difference in my social anxiety. It is almost non-existent. I am starting to develop a cirlce of friends and it is wonderful. But, my general anxiety is still really, really bad. My question is this: is it possible for Nardil to have fully kicked in yet, or is this just the beginning?


I'm wondering if you go to sleep after taking a Nardil at 2,3, or 4 in the morning!? Wait, 4 in the morning is not normal, but neither are you...I think that's what I like about you. After 23 days, how much are you taking now? As far as my anxieties is concerned, this past week-end, even with beautiful weather, nothing could get me out of the house and then when I had to get out to go grocery shopping, I walked circles around the areas in the neighborhood where I know people would be sitting outside at streetside cafes and might recognize me and say hello. Even Parnate hasn't gotten me that far, yet. HOWEVER, when I AM already outside, mostly at work, I do find that it is way easier to 'stand my ground' with fellow employees who want to chit-chat when there is nothing to do. I am fascinated 'listening' to your posts!


----------



## streetsk8er794 (Mar 5, 2006)

Yeh man the Nardil is great for social anxiety, but I feel like Im strung out on coke all the time, I think my dose is too high. Im on 75 mg right now, but Im goin back down to 60mg. Ill let ya know whats up...


----------



## PBNC (Mar 4, 2006)

Can you describe how you're feeling for those who don't know what the description "strung out on coke" would entail? :b Do you mean hyper, jittery, nervous, anxious.....?


----------



## streetsk8er794 (Mar 5, 2006)

Sure man, lol, sorry. I forgto that not everyone has tried coke haha. Anyways, yeh I feel really jittery like I cannot sit still at all. It's really actually quite weird. But, it is not a pleasant feeling.


----------



## nickguy (Feb 14, 2006)

what the hell are you supposed to do when you take an MAOI and you get sick? (like a cough or cold) It seems like all the medicines interact with MAOI's.


----------



## PBNC (Mar 4, 2006)

Eh....I usually just suffer through colds anyway and focus on lots of sleep, water, and nose blowing. I don't like using OTC stuff.


----------



## Caedmon (Dec 14, 2003)

nickguy said:


> what the hell are you supposed to do when you take an MAOI and you get sick? (like a cough or cold) It seems like all the medicines interact with MAOI's.


Medicines with dextromethorphan (cough suppressant) are contraindicated; but it hardly matters, because DXM doesn't work any better than placebo. (A Rx for something such as codeine _is _fine, and it works.)

Orally-administered nasal decongestants (e.g. pseudoephedrine, phenylephrine), are also contraindicated. This is the main interaction that is disadvantageous. But you can still use steroid nasal sprays or saline sprays. You can also use Vick's vaporub.

Antihistamines, guaifenesin (expectorant), OTC pain relievers, etc. are all fine.


----------



## nickguy (Feb 14, 2006)

I heard you have to wear a braclet that lets doctors know (if your taken to the emergency room) that you can't have pain killers? Is that true? 

Sorry to keep asking questions. :stu


----------



## Caedmon (Dec 14, 2003)

I wear a bracelet. (It came in the mail just Wednesday in fact.) It's a good idea, not everyone does though. The bracelet is wise, in the unlikely event that EMTs would do something bad, but mainly it's a good thing to wear so that anaesthesiologists know what to use and what not to.

There aren't too many drugs that would interact in emergency medicine. Among painkillers it's mainly Demerol and Tramadol that are no-no's - you can take others. There are some anesthetics that interact, although a smart anaesthesiologist can easily work around it. Hypodermic epinephrine is not contraindicated, as it is a direct-acting sympathomimetic (unlike ephedrine) - so, asthmatics and those in anaphylactic shock needn't worry.


----------



## apprentice1 (Feb 9, 2005)

You should just sign your name, "Dr. Caedmon"...!!!!!!!!!!!!!! You are pretty smart, sir.


----------



## apprentice1 (Feb 9, 2005)

Well, I can relate now to spaceboy's dosing methods. I never went up to 90mg. but I topped out now at 60mg. and am busy trying to figure how to go down from there. It seems to be the same sort of PRN dosing as with benzos that works best.


----------



## tooker (May 1, 2006)

Caedmon said:


> Medicines with dextromethorphan (cough suppressant) are contraindicated; but it hardly matters, because DXM doesn't work any better than placebo. (A Rx for something such as codeine _is _fine, and it works.)


DXM is no more effective than placebo? I just bought some Robitussen cough gels hoping they would help my nasty cough. Guess not.. :nw


----------



## nickguy (Feb 14, 2006)

DXM is by no means a placebo. It's actually a pretty strong drug, especially when taken in large amounts.


----------



## No Limit (Dec 6, 2005)

OK, so I ate 4 slices of cheese pizza last night. Sounds crazy, but I was hungry and because of that I forgot the little thing about limiting cheese intake when taking Nardil and realized it just after eating my 3rd slice. Anyway I felt fine before going to sleep, but I took 2 50mg tablets of Atenonol (a beta-blocker) just in case something might happen while I was asleep. Well I just woke up right now (it's about 7:30am as I'm typing this message) and I feel just fine.


----------



## workman (Mar 5, 2004)

It depends on what type of cheese you had. It is really only aged cheese that will cause a major reaction. Like the fine fancy stuff people sometimes buy. Most american cheese is ok. Only if you go to like a really fancy pizza place is where you should watch out. They might use the better aged type cheese. Everyone is different though, and you never know what might cause a reaction. It is good that you probably good that you took a beta blocker, better safe than sorry.


----------



## gurlzrmyantidrug (Jun 3, 2009)

Are there any side effects to Nardil?

Im worried when I see the words... 'loss of sex drive'


----------



## ThirdEyeGrind (Feb 7, 2006)

gurlzrmyantidrug said:


> Are there any side effects to Nardil?
> 
> Im worried when I see the words... 'loss of sex drive'


Yes, eventually you'll experience daytime sleepiness but night time awakeness lol, constipation, your uring smelling like the drug (which is just nasty), and the sexual side effects are pretty bad at first but all, or most of these side effects go away with time. I've been on Nardil for about a month now (maybe a little longer), and its extremely hard to reach the big O. My arm has to be about as fast as a jackhammer (sorry if that sicked anyone out). But from what I remember, in a couple months, all these side effects slowly fade away. The only side effect that seems permanent to me is the inability to dream when I go to bed. I haven't has a dream since I started Nardil. I use to absolutely love dreams but now its just, I take my Seroquel, I pass out, and I wake up. No dreams at all. And thats all the information I can give you (based on my experiences with Nardil).


----------



## gurlzrmyantidrug (Jun 3, 2009)

thanks for the heads up april  pun intended

as far as the biochemistry of nardil goes, what neurotransmitters or inhibitors are involved?


----------



## Medline (Sep 23, 2008)

Mainly the levels or Serotonin, Norepinephrine, Dopamine and GABA are increased. Also others, which I won't list all.


----------



## bezoomny (Feb 10, 2007)

Is it true that you can't take methylphenidate or amphetamine while on Nardil or Parnate?


----------



## Medline (Sep 23, 2008)

In general these combinates are clearly contraindicated, because of the risk of a hypertensive reaction. But it has been done in clinical settings and several people on www.dr-bob.org/babble are on eg. Parnate + Amphetamine or other combinations. You would have to start with a low dose of the stimulant and see how you react (measuring blood pressure & pulse rate).



> Combining stimulants with monoamine oxidase inhibitors: a review of uses and one possible additional indication.Feinberg SS.
> 
> Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY, USA. [email protected]
> 
> BACKGROUND: Among antidepressant augmentation strategies, the addition of a stimulant to a monoamine oxidase inhibitor (MAOI) has received little attention in the literature in recent years because of the diminished clinical use of the latter and concerns of precipitating a hypertensive crisis or other serious complication. Despite that fact, experienced clinicians continue to use this combination for a variety of indications after other options have failed. This article reviews these reported uses and presents a case suggesting another possible indication. METHOD: A MEDLINE search was conducted for articles published from 1962 to December 2003 using relevant search terms (psychostimulant, stimulant, amphetamine, dextroamphetamine, pemoline or methylphenidate, atomoxetine, bupropion, monoamine oxidase inhibitor, and selegiline). A manual search was conducted of cross-references and other relevant recent psychiatric sources (2000-2003). RESULTS: The described uses of the MAOI-stimulant combination have included treatment of refractory depression and the MAOI-related side effects of orthostatic hypotension and daytime sedation. No documented reports were found in the recent literature of hypertensive crises or fatalities occurring when the stimulant was cautiously added to the MAOI. Also presented here is another possible indication for this therapeutic regimen: treatment of attention-deficit/hyperactivity disorder in an adult patient whose major depression had uniquely responded to the MAOI tranylcypromine. CONCLUSION: As in other fields of medicine, potentially hazardous medication combinations are utilized in psychiatry after cautiously weighing the danger of the treatment against the morbidity and risk of not adequately addressing the illness. Particularly, as the potential arrival of the apparently safer transdermal selegiline may increase the use of MAOIs, we feel this combination deserves additional controlled study.


----------



## stickpimp (Sep 20, 2015)

Help! I cant decide if this medication is right for me. 

I don't have completely dehabilitating social anxiety, but I definitely have moderate anxiety.

Normal day to day conversations are a decent challenge. I can just manage them. But Im largely unable to enjoy myself and be relaxed in social situations. Public speaking, classroom participation, make me crap my pants with fear. I've always been that way. 

Im scared of the sexual side effects, and since I don't like the idea of taking meds in the first place... worried about withdrawal when I want to come off.

On the other hand, the past 2 years of my life have been pretty sub-par, filled with anxiety and mild depression. It's better now, but I still cant relax in social situations unless I drink alcohol.

Any tips or advice?


----------



## rm123 (Mar 21, 2016)

stickpimp said:


> Help! I cant decide if this medication is right for me.
> 
> I don't have completely dehabilitating social anxiety, but I definitely have moderate anxiety.
> 
> ...


I'm not an expert on Nardil, but if you're able to semi fuction at least in social situations (having your anxiety increase in front of a group is v common even among neurotypicals) are you sure you want to deal with the restrictions of phenelzine? You could possibly not be able to have a drink again.

I'm not trivialising your anxiety, only you can judge how debilitating it is, but phenelzine's side effects are so extreme that most docs won't even consider it unless they've run through every other medication and treatment option. But then there are others who experience no side effects on phenelzine, so it is up to you to judge its potential pros and cons
_Posted via Mobile Device_


----------



## newboki (Sep 13, 2009)

stickpimp said:


> Help! I cant decide if this medication is right for me.
> 
> I don't have completely dehabilitating social anxiety, but I definitely have moderate anxiety.
> 
> ...


You are the only one that knows how severe is your anxiety and if you want to give a nardil a try. And without trying nardil you have no chance of knowing how you are going to respond to it. Maybe it would help you maybe not only way to know is to try it and also how desperate are you. But again you know the best good luck.


----------



## 546617 (Oct 8, 2014)

Damn we really should support Nardil , make a gofundme or something so we can advertise it.. imagine how popular it would get.. lol.. cant let this awesome maoi die out. #Team Nardil


----------



## InFlames (Nov 20, 2015)

I've been on it eight and the stuff just stopped working a couple years ago.Even upped my dose to 120 but the side effects were too much.


----------

