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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by house on June 17, 2002, at 9:32:08
I've tried most of the SSRI's and really never had any success for multiple anxiety disorders. I gave nardil a 5 or 6 week trial once and had great success in weeks 2 and 3 and then it seemed to poop out on me. Should I have tried to augment it with something? Should I have not have given up so easily. Can you take it with Zyprexa?(Which is one of the only meds. that gives me limited relief) Should I try parnate? Right now I'm on prozac. Given its long half life would I really have to wait a full 3 weeks before starting another trial of a MOAI. Any response is much appreciated.
Posted by BK on June 17, 2002, at 20:54:22
In reply to Nardil(Need some thoughts), posted by house on June 17, 2002, at 9:32:08
> I've tried most of the SSRI's and really never had any success for multiple anxiety disorders. I gave nardil a 5 or 6 week trial once and had great success in weeks 2 and 3 and then it seemed to poop out on me. Should I have tried to augment it with something? Should I have not have given up so easily. Can you take it with Zyprexa?(Which is one of the only meds. that gives me limited relief) Should I try parnate? Right now I'm on prozac. Given its long half life would I really have to wait a full 3 weeks before starting another trial of a MOAI. Any response is much appreciated.
Unfortunately, I had the exact response some fifteen years ago. I tried Nardil once again after a six-year hiatus, but it still didn't have the efficacy as it initially did.
Recently, I too was wondering about re-taking Nardil and augmenting it. I realize the dangers of doing so, but I remember vividly that drinking coffee really seemed to give me a great euphoric response while on the drug. Perhaps an augmentation with Adderall would do likewise? When Nardil is working, its an amazing drug.
Posted by missliz on June 18, 2002, at 0:54:38
In reply to Re: Nardil(Need some thoughts), posted by BK on June 17, 2002, at 20:54:22
Hey BK what are you thinking! Nardil with dexamphetamine? Big bad no no! Are you suggesting people blow the tops of their skulls off with super hypertensive crises? You should know better!
Having spent a very happy four years or so on Nardil, may I suggest augmenting with a mood stabilizer. The combination is a lot safer, though not all of them are ok. I used Tegretol with Nardil and it's now on the lethal interactions list. I recently trialed Parnate with a little lithium kicker and it was great. Had to stop becuse of heart trouble.
Sometimes it really is time to find a psychopharmachologist and let a proffessional do her job. Nardil dose adjustment can be tricky and House may just have needed more.
Posted by JonW on June 18, 2002, at 12:50:01
In reply to Re: Nardil(Need some thoughts), posted by missliz on June 18, 2002, at 0:54:38
> Hey BK what are you thinking! Nardil with dexamphetamine? Big bad no no! Are you suggesting people blow the tops of their skulls off with super hypertensive crises? You should know better!
Hi missliz,
Although it's contraindicated in the literature, it is not an uncommon cocktail. Dr. Goldberg and many other experienced pdocs combine these drugs to give many people relief who wouldn't get it otherwise. Here's a link to the tips about this:
http://www.dr-bob.org/tips/split/MAOIs-in-high-doses-and-wi.html
Jon
Posted by missliz on June 22, 2002, at 1:26:09
In reply to Re: Nardil(Need some thoughts) » missliz, posted by JonW on June 18, 2002, at 12:50:01
The operative phrase here is "many other experienced Pdocs". Given the easy availability of various amphetemines in almost any nightclub in America it is the absolute height of irresponsibility for someone to suggest this to a stranger. A properly documented suggestion for house to discuss with her doctor is appropriate; A casual remark that Adderall is just fine with Nardil is an invitation to get somebody killed by encouraging unsupervised experimentation.
You don't know who you're talking to on this or any other psych board and you have no clue how sick they may be or HOW IMPAIRED THIER JUDGEMENT IS! You don't know what her history is or if this is someone who'll just figure a couple of Sudafed, or maybe some crank bought on the corner will work just as well.
Every time you post on a board like this you take on a responsibility not to put bad ideas into the heads of potentially unstable people. All us with psychiatric illness get enough crap from the rest of the world with out such thoughtlessness from our own. Most people want support and shared practical experience, not oneupmanship on psychopharm trivia.Miss Liz
Oh, my own famous fabulous psychopharm guy, who knows Ivan,thinks the Adderall/ Nardil combo is an absurd risk. As a liscenced physician well known for working with MAOIs I think he's well qualified to comment.
Posted by JonW on June 22, 2002, at 7:31:47
In reply to Resposible posting » JonW, posted by missliz on June 22, 2002, at 1:26:09
You make an excellent point, misslizz. I nearly alway urge people to be working with a pdoc when I know they're not -- for their safety and to hasten their length of treatment. I certainly don't support taking any form of amphetamine (or anything for that matter) without the knowlege of a pdoc. I suppose it's difficult to provide this kind of information without the risk that someone will leave their pdoc in the dark. However, what if someone takes this information to their pdoc and they work on a "cocktail" that greatly improves their quality of life?
I don't think my post was "irresponsible". I wasn't suggesting that someone take an MAOI + stimulant combination on their own. I was only pointing out that this combination is used and by many well respected pdocs. Dr. Goldberg, himself, recently posted a message here supporting the use of adding a stimulant to an MAOI:
http://www.dr-bob.org/babble/20020525/msgs/107593.html
In general, I think it's better to talk about things than not. I don't think anything I said implied that I was advocating someone *not* be working with a pdoc. And I presume that after reading this thread most people would understand that there is some risk involved with an MAOI + stimulant "cocktail".
Just my opinion, but I think we should talk about potentially helpful things -- even if they are potentially dangerous.
Jon
> The operative phrase here is "many other experienced Pdocs". Given the easy availability of various amphetemines in almost any nightclub in America it is the absolute height of irresponsibility for someone to suggest this to a stranger. A properly documented suggestion for house to discuss with her doctor is appropriate; A casual remark that Adderall is just fine with Nardil is an invitation to get somebody killed by encouraging unsupervised experimentation.
> You don't know who you're talking to on this or any other psych board and you have no clue how sick they may be or HOW IMPAIRED THIER JUDGEMENT IS! You don't know what her history is or if this is someone who'll just figure a couple of Sudafed, or maybe some crank bought on the corner will work just as well.
> Every time you post on a board like this you take on a responsibility not to put bad ideas into the heads of potentially unstable people. All us with psychiatric illness get enough crap from the rest of the world with out such thoughtlessness from our own. Most people want support and shared practical experience, not oneupmanship on psychopharm trivia.
>
> Miss Liz
>
> Oh, my own famous fabulous psychopharm guy, who knows Ivan,thinks the Adderall/ Nardil combo is an absurd risk. As a liscenced physician well known for working with MAOIs I think he's well qualified to comment.
Posted by ShelliR on June 22, 2002, at 16:22:19
In reply to Resposible posting » JonW, posted by missliz on June 22, 2002, at 1:26:09
If all suggestions on this board came from strangers, there would be no suggestions at all.
I agree with Jon. You would have a hard time getting Nardil with a stimulent *without* talking to a doctor first. Nardil requires a prescription and isn't found on the street. So of course it was not a suggestion by Jon to take drugs without
the influence of a pdoc.We who are struggling to find a drug in help us, absolutely need the type of information that Jon is presenting. Sometimes our doctors don't know about something or something or the suggestion just doesn't come to them. We don't all have access to wonderful doctors, yet even a mediocre pdoc can do research, whatever, to respond to our suggestions.
I think you should really think about what you are saying before making unfair and harsh accusations.
Shelli
Posted by missliz on June 23, 2002, at 3:27:47
In reply to Re: Resposible posting » missliz, posted by ShelliR on June 22, 2002, at 16:22:19
'Scuse me, but I didn't make any harsh or unfair accusations. Read my post again. I'm not just bipolar, but a former employee of NAMI Friends. Having actually been paid to deal with an awful lot of actively sick people I know just how common unsupervised experimentation is and just how rampant street drug use is among the seriously psychiatricly ill. There are too many dual diagnoses people around who'll take anything in any combination, and then put blue cheese dressing on it to see if that warning is bogus too. I've seen many things posted at this site that I find absolutely hair curling.
Choice of words and how information is couched are the most important skills pdocs learn as they start residecy (at a decent program) and I would think that psych lifers would have picked up the appropriate forms by the second hospitalization. Do you want to be responsible for putting bad ideas into the heads of people with impaired judgement? Somebodys cerebral bleed is mighty bad karma to bring down on yourself. Watch what you say and say it appropriately. "You should ask your doctor about..." is the easiest form of this. It's called an admonition in the trade . It sets boundaries for behaviors and avoids another word you may want to become familiar with- liability. That would be a legal term.
I think that if you ask Dr. Goldberg about this whole issue he'll back me up.Miss Liz
Posted by JonW on June 23, 2002, at 8:26:39
In reply to Re: Resposible posting, posted by missliz on June 23, 2002, at 3:27:47
>too. I've seen many things posted at this site that I find absolutely hair curling.
So why choose this thread to speak up about? I was simply providing information that may be valuable to you, house, or others reading the thread. I doubt anyone would consider the intention of my post to support self-medication. If I knew house was thinking of self-medicating I absolutely would have spoken out about getting to an expert pdoc -- and I've done this in several of my posts in the past. I'm sure there are people here who would use potentially dangerous combinations of drugs on their own, but why should this keep me and others from providing information to those who are under the care of a good pdoc. I know many expert pdocs use this combination, and I even provided a link for you to the tips section about this.
>up the appropriate forms by the second hospitalization. Do you want to be responsible for putting bad ideas into the heads of people with impaired judgement? Somebodys cerebral bleed is mighty bad karma to bring down on
'Scuse *me* but I do think this is a harsh and unfair accusation. I really can't see how my post does anything more than provide information. However then, what about the good karma from giving someone information to take to their doctor that leads to a "cocktail" that improves their quality of life. Someone else in this thread said it better, but the risk of suicide in an ongoing depression is far greater than the risk of abusing potentially invaluable information.
>yourself. Watch what you say and say it appropriately. "You should ask your doctor about..." is the easiest form of this. It's called an admonition in the trade . It sets
Are you a doctor yourself? In any event, if I thought house was self-medicating I would have urged him to get to an expert pdoc. As a contributer I make the presumption that the people I post to are under the care of their pdoc (unless I know otherwise) and as a patient I intelligently sift through the posts and do research and then ask my own pdoc to determine what may or may not be true. Are all of *your* posts on psycho-babble phrased "you should ask your doctor about.."? I would hate to think you don't live up to your own standard...
> I think that if you ask Dr. Goldberg about this whole issue he'll back me up.
Actually, in the post I referenced before,
http://www.dr-bob.org/babble/20020525/msgs/107593.html
he didn't say "you should ask your doctor about.." Probably because he made the presumption that people on this site are under the care of a pdoc and have read the FAQ -- have you read it?
Jon
p.s. This is not an insult, but you may want to ask yourself just how "fabulous" your own pdoc is. There is a difference between a nice and knowledgeable pdoc and a "best of the best" pdoc. The "best of the best" would not call the combination of an MAOI + stimulant absurd when it is apropriate.
Posted by krazy kat on June 23, 2002, at 10:05:35
In reply to Re: Resposible posting, posted by missliz on June 23, 2002, at 3:27:47
are true, miss liz, and "Scuse me" is a bit uncivil, imho.
I can't and shouldn't take you at your word, any more than I can take others on boards at theirs'. But if someone has been posting to a board for awhile, such as Jon and Shelli, one does develop a sense of security because there are indications that that poster is 'who' they say they are.
Please be civil - your tone seems unnecessarily "tart".
- kk
Posted by BK on June 23, 2002, at 13:06:45
In reply to Re: Nardil(Need some thoughts), posted by missliz on June 18, 2002, at 0:54:38
It appears my posting has really struck a cord with you! First, I think you need to re-read my posting a bit more carefully. I did not suggest, point blank, of mixing Nardil and Adderal. Rather, I posed it as a question (note "?" after the sentence). Secondly, both Nardil and Adderal require prescriptions, thus I’m assuming any cocktailing would be done under Dr’s supervision. Finally, I too have read articles where the augmentation of a MAO has proved effective in the treatment of drug resistant depression. Certainly, this is not a first line of treatment, but something that should be considered when other, more conventional, forms of drug treatment have failed.
I don't pretend to be a physician. Rather, I'm one of the many thousands who have not been helped by AD’s or have been helped only temporarily. Thus, I use this site to elicit "out of the box" thinking that may be of use or at least worthy of further investigation. I've tried many of the suggestions offered herein, and always under my Dr's supervision. Most contributors of this site are incredablely knowledgeable and caring. And, unlike most physicians, they have first hand knowledge of the frustrations of the disease and the unpleasant effects of the drugs used to treat the disease. Reading about other’s experiences, which are similar to mine, and were not always mentioned by my Dr., has been very helpful and comforting.
In the future, I will preface my comments with words of caution where applicable. I wholeheartedly apologize to anyone who might have misinterpreted my posting as a tested form of treatment, rather then a thought provoking question as was my intent.
You need to drop the sarcasm and try a more thoughtful approach. To attack someone who took time to respond is not what this forum is all about.
Posted by Vanessa on June 23, 2002, at 23:07:15
In reply to Re: Nardil(Need some thoughts), posted by BK on June 23, 2002, at 13:06:45
> It appears my posting has really struck a cord with you! First, I think you need to re-read my posting a bit more carefully. I did not suggest, point blank, of mixing Nardil and Adderal. Rather, I posed it as a question (note "?" after the sentence). Secondly, both Nardil and Adderal require prescriptions, thus I’m assuming any cocktailing would be done under Dr’s supervision. Finally, I too have read articles where the augmentation of a MAO has proved effective in the treatment of drug resistant depression. Certainly, this is not a first line of treatment, but something that should be considered when other, more conventional, forms of drug treatment have failed.
>
> I don't pretend to be a physician. Rather, I'm one of the many thousands who have not been helped by AD’s or have been helped only temporarily. Thus, I use this site to elicit "out of the box" thinking that may be of use or at least worthy of further investigation. I've tried many of the suggestions offered herein, and always under my Dr's supervision. Most contributors of this site are incredablely knowledgeable and caring. And, unlike most physicians, they have first hand knowledge of the frustrations of the disease and the unpleasant effects of the drugs used to treat the disease. Reading about other’s experiences, which are similar to mine, and were not always mentioned by my Dr., has been very helpful and comforting.
>
> In the future, I will preface my comments with words of caution where applicable. I wholeheartedly apologize to anyone who might have misinterpreted my posting as a tested form of treatment, rather then a thought provoking question as was my intent.
>
> You need to drop the sarcasm and try a more thoughtful approach. To attack someone who took time to respond is not what this forum is all about.I can only share with you my experience. After several years on MAOIs, their effectiveness dramatically lessened. I became suicidally depressed. It has taken years for me to come up with a combination that is somewhat effective. I stayed on Nardil, but have augmented it with zyprexa, wellbutrin, dexedrine, vivacil and yohimbe -- all "no nos" and all under my doctor's care. I thank god for the Internet, becauses some of these meds that help are ones I suggested to my doctor, who is an excellent psychopharmacologist, after research on the Internet. Obviously, I am not suggesting that it is OK for everyone with a complicated depression to follow my formula. We are all different. What I am saying is that if my doctor had followed this whole business of rigid, black and white rules about combining meds, I would still be in the quicksand and more than ready to die.
This is the end of the thread.
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