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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by ace on January 6, 2003, at 21:52:41
Nardil is rumoured to have an onset of action usually between 4-8 weeks. Much slower than TCA's, SSRI's, and Parnate.
2 questions:1. How long did Nardil take to work for you? At what dose? How long were you at THIS particular dose?
2. Did its onset of action come in a 'zap' or over a few days/weeks?
Thankyou all.
Posted by clay on January 7, 2003, at 0:18:33
In reply to NARDIL: onset of action - please answer!, posted by ace on January 6, 2003, at 21:52:41
I'v been on it for 18 years. As I recall, it took about three weeks at 60mgs and I started feeling better. 45mgs is the maintainence dose that works well for me and allows me to live a normal life.
A year and a half ago, I dropped back to 30mg/day for about 3 months and felt fine and then it hit me suddenly like a ton of bricks. It took about 2 weeks at 60mgs and started feeling better again.
Since then, I alternate 45mg one day and 60 the next etc and can probably soon taper down to 45mg dailey with no problems.
Clay
Posted by djmmm on January 7, 2003, at 8:59:07
In reply to NARDIL: onset of action - please answer!, posted by ace on January 6, 2003, at 21:52:41
I noticed a profound difference in a week or two...FWIW, Parnate should be included, along with Remeron and Effexor as "faster" onset antidepressants.
I believe MAOIs have tested faster because of some evidence they have a direct effect on the stimulation of catecholamines. Effexor and Remeron are unique in that they effect the opioid system.
Posted by ace on January 7, 2003, at 22:55:05
In reply to Re: NARDIL: onset of action - please answer!, posted by djmmm on January 7, 2003, at 8:59:07
> I noticed a profound difference in a week or two...FWIW, Parnate should be included, along with Remeron and Effexor as "faster" onset antidepressants.
Djmm - were the effcts all in one? Or did they come slowely in addition to your first therapeutic 'zap'?
> I believe MAOIs have tested faster because of some evidence they have a direct effect on the stimulation of catecholamines. Effexor and Remeron are unique in that they effect the opioid system.
How can you explain those who it takes 6-8 weeks? Faster acetylators? (Nardil being metabolized for the most part by acetylation)
Do you believe some people NEED 90mg to inhibit 85% (thereaputic effect) of MAO?
Have you personally heard stories of long thereaputic lag-time?All the very best.
Posted by djmmm on January 8, 2003, at 12:09:41
In reply to Re: NARDIL: onset of action - please answer! » djmmm, posted by ace on January 7, 2003, at 22:55:05
well, unfortunately, acetylation (of Nardil) only accounts for a small portion of metabolism.
I can't explain the wide range of response times, however, MAO activity is not always directly correlated with response rates.
Phenelzine, in particular, has a number of active metabolites (including phenylacetic acid and p-hydroxyphenylacetic acid) with direct effects on the GABA and dopamine systems (which may elicit a positive response totally independent of MAOI activity)
I do believe that some people need a higher dose (90mg), but this dose isn't common. Most people respond to 45-60mgs.
I have heard of very long lag times (8 wks) but, again, this isn't common. I think it dependes on the time spent on ramping up to a theraputic dose.
Posted by ace on January 9, 2003, at 2:17:57
In reply to Re: NARDIL: onset of action - please answer!, posted by djmmm on January 8, 2003, at 12:09:41
> well, unfortunately, acetylation (of Nardil) only accounts for a small portion of metabolism.
This statement is in stark contrast to every psychopharacological monograph I've seen on Nardil.> I can't explain the wide range of response times, however, MAO activity is not always directly correlated with response rates.
Do you have any idea what else is?
> Phenelzine, in particular, has a number of active metabolites (including phenylacetic acid and p-hydroxyphenylacetic acid) with direct effects on the GABA and dopamine systems (which may elicit a positive response totally independent of MAOI activity)Are these metabolites definately active? I thought it was never known that Nardil have active metabolites.
> I do believe that some people need a higher dose (90mg), but this dose isn't common. Most people respond to 45-60mgs.
45mg is the starting dose. Have you heard of people responding on this dose? I'd assume it would take ages to respond on this dose. It's not seen as a therapeutic dose, is it?
> I have heard of very long lag times (8 wks) but, again, this isn't common. I think it dependes on the time spent on ramping up to a theraputic dose.
Djmmm - Do you think it is plausible that, REGARDLESS OF NARDIL TAKEN BEFORE HAND (say at 30/45mg) FOR AT WHATEVER TIME FRAME, some OR MOST need people need 4 weeks on 60 mg? For instance, one can spend 2 weeks on 30/45mg, but there must be an addition 4 weeks on 60mg after this for clinical response. Once again, in every standard Nardil monograph I see this.Thanks for all your help. We learn heaps this way! Happy new year, Djmmm.
Posted by Vanessa on January 12, 2003, at 0:30:49
In reply to NARDIL: onset of action - please answer!, posted by ace on January 6, 2003, at 21:52:41
I started Nardil at 4 pills (60 mg) a day and had a dramatic response on day 5. I had much more energy and started functioning again. I stayed at that dose only for about a week and a half because I developed severe insomnia. But that went away after the dose was reduced. I went down to 45 mg day and stayed on that dose.
The affects of Nardil definitely came "as a zap." In fact, I can remember the very moment it kicked in, and this was 20 years ago. Although it began working quickly, it was kind of chaotic
for a while: some days it seemed to work better than others, etc. It felt to me that it took a few months to "smooth out." Nevertheless, once the drug had kicked in on day 5, I was totally free of severe depression.
Posted by djmmm on January 13, 2003, at 16:09:39
In reply to Re: NARDIL: onset of action - please answer! » djmmm, posted by ace on January 9, 2003, at 2:17:57
Acetylation is a minor metabolic pathway. Ring hydroxalation and N-Methylation account for many metabolites....Ethylbenzene, p-tyramine, p-OH-phenelzine, Phenylethylidene hydrazine, N-methylphenelzine, 1-2 phenylethyldiazene, PEA, phenylacetic acid, p-hydroxyphenylacetic acid
This is the end of the thread.
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