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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by football on April 2, 2007, at 2:52:00
Thanks in advance.
Posted by iforgotmypassword on April 2, 2007, at 3:46:19
In reply to What is safe to augment with Nardil?, posted by football on April 2, 2007, at 2:52:00
i augmented parnate with desipramine for a few days, and it was notably effective combatting avolition, amotivation and cognitive paralysis, but wasn't a cure-all for any of these for me, maybe for someone else, or if i had stayed on maybe my response would have been more complete. despite putting more executive and volitional drive into me, i still felt as emotionally foggy as usual. maybe a difference here also would have been felt had i stayed on it.
i didn't stay on it, as it my own idea and no doctor was supervising it and approving that as a presciption for me. (despite an inpatient doctor who said he has done it, and would try it with me, but i was not in the hospital long enough.) there may be risks doing it alone without supervision, maybe cardiovascular or manic, so i wouldn't just recommend trying it yourself without talking to a doctor that's open to more advanced psychopharmacology. TCA+MAOI used to be used much more often before SSRIs and all of that stuff, i think.
presumably if parnate can be combined with desipramine, nardil can too.
i have heard of nardil being combined with nortriptyline, as well, likely here (SLS?), and if anything, if that can be done safely, there would be less to worry about with desipramine, as it has zero serotonergic effect practically.
nortriptyline may be more effective in some cases as it adds in 5HT2a blocking without D2 antagonism, though it is more anticholinergic than desipramine (may possibly be an annoying issue for some people), less norandrenergic (may not be a downside, at certain doses it may be equivalent to desipramine low-dose), and may also be a weak-ish antihistamine if i remember correctly.
i find that the norepinephrine reuptake effect of desipramine just as effective at low dose 50-100mg than at high dose 150-300mg. if you were doing this, you may easily not need any more than 50 (a typical starting dose even, i think) or maybe you would do well at even 25mg. it may be possible that the lower the better with this as even desipramine is anticholinergic, desipramine was the first drug to give me a bit of urinary retention.
anyway, in the end desipramine may possibly be more safer than nortriptyline for MAOI augmentation, and this is worth noting. still, nortriptyline has been used safely with MAOIs before... they both are worth asking about.
Posted by Honore on April 2, 2007, at 9:33:16
In reply to Re: What is safe to augment with Nardil? » football, posted by iforgotmypassword on April 2, 2007, at 3:46:19
You probably need to be careful with augmenting with tricyclics. It depends a lot on how sensitive you are to other serotonergic drugs, among other things. I got a mild but rather disturbing case of serotonin syndrome by taking trazadone (not a tricyclic) and cymbalta together, which is a combination that probably works for some people (or my pdoc wouldn't have prescribed it).
So how these drugs interact is highly individualized.
Honore
Posted by UgottaHaveHope on April 2, 2007, at 10:28:35
In reply to Re: What is safe to augment with Nardil?, posted by Honore on April 2, 2007, at 9:33:16
Football, why do you want to augment Nardil with something else?
Read near the bottom
Posted by Quintal on April 2, 2007, at 12:34:33
In reply to Re: TCA + MAOI, posted by UgottaHaveHope on April 2, 2007, at 10:28:35
What does he mean by this:
__________________________________________________The irony is that mixing a TCA (one which is not also an SRI) with an MAOI makes it safer! This is because the ‘cheese’ reaction (potentially catastrophic hypertension) requires that the provoking dietary component (the amino acid tyramine) must first enter the pre-synaptic nerve, from whence it displaces noradrenaline which then mediates the hypertension. Tyramine is actively moved into the pre-synaptic nerve by the very same ‘reuptake’ mechanism that is blocked by TCAs, which are ‘NRIs’.
__________________________________________________Is he saying that it's much more difficult for the tyramine to enter the pre-synaptic nerve once the noradrenaline transporter is blocked, therefore lower risk of hypertensive crisis? Why isn't reboxetine used instead of TCAs - interactions?
Q
Posted by football on April 2, 2007, at 16:16:09
In reply to Re: TCA + MAOI, posted by UgottaHaveHope on April 2, 2007, at 10:28:35
> Football, why do you want to augment Nardil with something else?
>
> Read near the bottom
>
> http://www.psychotropical.com/maois_full.shtmlI remember reading one of Ace's posts (The Nardil King) where he mentioned that despite the Nardil being extremely effective, he added a couple of other drugs for maximum benefit.
Posted by FredPotter on April 2, 2007, at 16:57:03
In reply to Re: TCA + MAOI, posted by UgottaHaveHope on April 2, 2007, at 10:28:35
Michael that's a great document. I'm sending a copy to my GP for his leisure-time reading. The author seems to favour tranylcypromine which I take to be Parnate
Fred
Posted by FredPotter on April 2, 2007, at 17:04:46
In reply to Re: TCA + MAOI » UgottaHaveHope, posted by FredPotter on April 2, 2007, at 16:57:03
After nearly two weeks on Nardil I am groggy, zonked and clumsy. Does this go away? Last night I knocked over a pile of CDs and cassettes breaking the case of Beauty and the Beat by George Shearing and Peggie Lee. This is an unacceptable side effect! You've made me think about adding just half a pill of Nortryptiline which I just happen to have in my bathroom
Fred
Posted by Quintal on April 2, 2007, at 17:09:50
In reply to Nardil side effects, posted by FredPotter on April 2, 2007, at 17:04:46
I've had a sneaking suspicion for a while that Nardil is a 'dumb drug' like TCAs and benzos, so TCA + Nardil..........
Q
Posted by UGottaHaveHope on April 2, 2007, at 17:26:42
In reply to MAOI + SNRI? » UgottaHaveHope, posted by Quintal on April 2, 2007, at 12:34:33
His email address is listed on that website and he's answered every question I sent him. Seems like a great guy. Michael
Posted by gardenergirl on April 2, 2007, at 22:56:13
In reply to Nardil side effects, posted by FredPotter on April 2, 2007, at 17:04:46
I was clumsy at first. My movement almost felt like I was drunk though I didn't feel and wasn't drunk. It went away after a week or two if I remember correctly. I don't remember being groggy or zonked cognitively, but I did still need afternoon naps, which to me meant 2+ hours. Provigil takes care of that.
I also remember early awakening in the beginning. When it got to be about 4:00 a.m., I started taken Ambien and that helped, too.
Good luck.
Namaste
gg
Posted by FredPotter on April 3, 2007, at 20:48:12
In reply to Re: Nardil side effects » FredPotter, posted by gardenergirl on April 2, 2007, at 22:56:13
Thanks gg Trouble is here in New Zealand, Provigil is very expensive. Over the internet it looks pretty expensive, but perhaps it's worth it, just to get past the next 2 weeks. I've done 2 weeks on Nardil too. I am also a very clumsy typist at the moment, like a monkey typing out Shakespeare.
No cognitively I feel a bit hyper and won't put up with any sh*t from anybody.
Fred
Posted by gardenergirl on April 6, 2007, at 13:15:06
In reply to Re: Nardil side effects » gardenergirl, posted by FredPotter on April 3, 2007, at 20:48:12
> Thanks gg Trouble is here in New Zealand, Provigil is very expensive.
I would imagine. It's the highest insurance co-pay for me. I can save money by getting a 90 day supply by mail--$90 total, versus filling a 30 day prescription at the local pharmacy--$75 for just the 30 days. I had to get my pdoc to re-write the last prescriptions he gave me because he forgot to write them for 90 days. I wasn't about to pay that much more for fewer pills. My Nardil, Lamictal, and Ambien are all the same, since they don't have generics. Thank God for insurance. I just checked the retail price for Provigil according to my mail order pharmacy, it looks like about $270 total for 30 days at a pharmacy (75 for me and 194 for my husband's employer). It's kind of daunting, though, to see that for one year, it's almost $2900, and that my husband's company picks up all but $360. I'll have to be extra nice at the next Christmas party. ;)
> Over the internet it looks pretty expensive, but perhaps it's worth it, just to get past the next 2 weeks. I've done 2 weeks on Nardil too. I am also a very clumsy typist at the moment, like a monkey typing out Shakespeare.
LOL, I hope that's getting better. Good visual image, though.
>
> No cognitively I feel a bit hyper and won't put up with any sh*t from anybody.Sounds good, as long as you aren't assuming everything is sh*t. :)
Namaste
gg
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