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Dr. Bob is Robert Hsiung, MD,
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Posted by 4WD on April 20, 2008, at 14:34:15
In reply to Re: 6 weeks on Nardil, posted by Fathe on April 19, 2008, at 19:14:57
I am having a major problem with my blood pressure now that I have been on Nardil for a while. My BP has always run low 105/65 or so but that is fairly normal.
But now it is fluctuating. Sometimes it is okay but I am having episodes where it drops to 65/45. I get lightheaded and faint and have to drop down to the floor or sit down at least. Trouble is, as soon as I get up I am faint and have all the symptoms again. It is especially bad when I first wake up in the morning and the first half of the day.
I have been sipping salty water during the day to try to raise it but it doesn't seem to be helping much. It is truly debilitating and makes me scared to drive sometimes. I spend a lot of time just sitting because I can't stand. In church this morning, I had to stay seated during the hymns because I couldn't stand.
I am only on 45mg of Nardil and would consider increasing it eventually (after a 10 week trial at 45) but I am afraid I can never increase it. I wouldn't be able to function because of the hypotension.
Anyone have any suggestions?
Marsha
Posted by kaleidoscope on April 20, 2008, at 15:58:55
In reply to Extremely Low Blood Pressure, posted by 4WD on April 20, 2008, at 14:34:15
Hi Marsha
Your doctor might prescribe a low dose of fludrocortisone to raise your blood pressure. Fludrocortisone cannot be given to anyone with heart disease or peripheral edema (fluid retention eg. in the ankles). Fludrocortisone is a mineralocorticoid hormone which raises blood pressure by retaining sodium. It may cause potassium loss and blood tests will be needed.
Fludrocortisone tends to cause fluid retention initially but this may decrease over time. The dose should be kept as low as is needed to relieve symptoms adequately ie. if BP is still rather low but symptoms are improved the dose should not be increased.
>I am only on 45mg of Nardil and would consider increasing it eventually (after a 10 week trial at 45) but I am afraid I can never increase it.
It doesn't sound like you will need to increase it. Many people require higher doses for optimal benefit but this is only a guide and may not apply to you.
Take care
ed_uk
Posted by Phillipa on April 20, 2008, at 19:46:13
In reply to Re: Extremely Low Blood Pressure » 4WD, posted by kaleidoscope on April 20, 2008, at 15:58:55
Glad you're here to help Marsha. Love PJXO
Posted by undopaminergic on April 21, 2008, at 0:11:52
In reply to Re: 6 weeks on Nardil » SLS, posted by 4WD on April 19, 2008, at 12:43:35
>
> My pdoc has suggested adding Inderal when I take 5mg of Valium instead of having to take 10 mg of Valium at a whack. It does seem to be helping a bit but it's only been two days.
>
> Also, a little nausea ocasionally and a serious problem with hypotension. I have measured it when I was feeling very lightheaded and it has been as low as 70/50. I am drinking a pint a day of salty water to help combat that.
>First, make sure you aren't taking any drugs with hypotensive effects unless they are absolutely necessary. Inderal, for example, is an antihypertensive agent and lowers blood pressure.
Someone else suggested fludrocortisone, and that may very well work. Another suggestion, from PubMed, is metoclopramide. Other options include L-dopa, phenylephrine, ephedrine, and of course stimulants, like methylphenidate. Amphetamine is probably overkill since your depression is almost in remission - you probably don't want to get *too* high.
You need to make sure your doctor knows about your hypotensive problem. It doesn't appear that he does, since he suggested adding Inderal.
Posted by 4WD on April 21, 2008, at 13:17:26
In reply to Re: Extremely Low Blood Pressure » 4WD, posted by kaleidoscope on April 20, 2008, at 15:58:55
Hi Ed,
thanks for the reply. I hate to go on *another* med as I'm already on five. But I told my doctor when I started Nardil that I was willing to put up with*any* side effect if the drug gave me life back. And it has. I think for now I'll continue sipping salt water through the day. I went to my internistlast week and he did some lab work. He told me that the last time he did an electrolyte panel on me my sodium was low. So maybe that's the problem. I'llfind out this week if it's still low. In the meantime it's salty water for me.
Thanks again,
Marsha
Posted by 4WD on April 21, 2008, at 13:38:15
In reply to Re: 6 weeks on Nardil, posted by undopaminergic on April 21, 2008, at 0:11:52
Hi,
My pdoc knows about the hypotension but it had not gotten as bad when I last talked to him. I will be talking to him on Thursday and I will stress to him the extent of the problem. He suggested the Inderal as a trial to see if I took it with my Valium in the morning whether it would help with my anxiety. It didn't and it made me more depressed the two days i tried it. So I'm not taking it now.
I think a lot of the stimulants you mentioned may be contraindicated with Nardil. In any case, I'd rather not have to tr eat it with another drug. Sipping salty water though the day seems to help.
> >I'm hanging in there though. It's worse during the first part of the day and gets better as the day goes along. I hope it will balance itself out, as I get more and more used to the Nardil. Who knows - maybe it will go away. I've only been on the Nardil for less than 7 weeks. Lots of people have said the side effects subside with time so maybe this one will.
Thanks for you response.
Marsha
>
> First, make sure you aren't taking any drugs with hypotensive effects unless they are absolutely necessary. Inderal, for example, is an antihypertensive agent and lowers blood pressure.
>
> Someone else suggested fludrocortisone, and that may very well work. Another suggestion, from PubMed, is metoclopramide. Other options include L-dopa, phenylephrine, ephedrine, and of course stimulants, like methylphenidate. Amphetamine is probably overkill since your depression is almost in remission - you probably don't want to get *too* high.
>
> You need to make sure your doctor knows about your hypotensive problem. It doesn't appear that he does, since he suggested adding Inderal.
Posted by octothorpe on April 21, 2008, at 19:35:21
In reply to 6 weeks on Nardil, posted by 4WD on April 17, 2008, at 18:14:04
I think you can get salt tablets at your pharmacy. I've read the recommended amount is 600-1800 mg twice per day for about 8 weeks, for MAOI-induced hypotension. Perhaps that would be more convenient than drinking salt water. Of course you would want to talk to your doctor about it, drink plenty of liquids, and monitor your blood pressure.
I have heard that sleeping with your head higher than your feet may help. Have also heard there are support hose that can be purchased that may also help with the hypotension.
I am also on Nardil since February 28 - now at 75 mg having titrated up very slowly. I am not having to deal with hypotension (at least not yet :).
I hope this passes for you.
Best regards,
Tom
Posted by deniseuk190466 on April 22, 2008, at 9:37:01
In reply to 6 weeks on Nardil, posted by 4WD on April 17, 2008, at 18:14:04
Hi Marsha,
How long was it before you noticed that the Nardil was working?
Thanks....Denise
Posted by 4WD on April 22, 2008, at 18:15:43
In reply to Re: 6 weeks on Nardil » 4WD, posted by octothorpe on April 21, 2008, at 19:35:21
Hi,
Thanks for your response. When I posted my request for info or suggestions, I was really looking for a
non-drug solution. The salt tablets might be a good idea. I have had some trouble figuring how how muchh salt water to drink - a pint, two pints? But I am doing much better today.I don't mind the inconvenience of drinking the salt water. I just mix up a pint jar of it every day and take sips periodically through the day. I don't make it so salty that it's too nasty tasting to drink.
I think a pint and a half a day might be about right. It would probably easier to calibrate how much salt I was getting if I took the tablets though. I will call the pharmacy and ask if they sell salt tablets.
Thanks for the recommendation.
Marsha
Posted by 4WD on April 22, 2008, at 18:24:21
In reply to Re: To Marsha, posted by deniseuk190466 on April 22, 2008, at 9:37:01
> Hi Marsha,
>
> How long was it before you noticed that the Nardil was working?
>
> Thanks....DeniseIt was about five weeks. During the second and third week, I noticed a distinct lessening of anxiety but that has gone away now and I'm back to having to take my full amounts of benzos.
Then during the fourth week, I think I started to feel a little better but it didn't really kick in until the 5th week. It's kicked in more since then - it will be seven weeks on Thursday.
I am truly doing so well. I am so glad I was willing to try Nardil and put up with the side effects (which I'm still having). I told my pdoc that I was willing to endure any side effect to get my life back and sure enough, I have my life back. I wish I had tried Nardil years ago.
How are you? I haven't heard from you for a while but then I haven't been spending a lot of time on BAbble lately either. I have a really spotty wireless connection and it's very difficult to post. I can only post when the computer decides to let me.
Hope you are okay. But you must not be doing all that great if you are thinking about Nardil. I promise you, I am a big proponent of it now.
Marsha
Posted by iforgotmypassword on April 22, 2008, at 20:25:44
In reply to Re: To Marsha » deniseuk190466, posted by 4WD on April 22, 2008, at 18:24:21
i know my posts of this nature are tiring. i was just wondering if nardil shows any "good signs" from the beginning, 4WD or anyone else that may have experience.
even 2-3 weeks is a very hard wait for me. especially when i need a med to work so i can remember to take my medication even...
present urgent demands, i think i have clinched failure that i can't avoid. it so humiliating, and i wish i could move from this city and hide.
i just stay in bed barely aware, not being able to keep track of even minor content to my life, especially feelings. i may as well stop communicating at this point, drop my employment programme and shut off my cellphone indefinitely.
ugh, on-topic...:
does anyone know if nardil fights thought hardening, executive dysfunction, tardive EPS-rigidity?
it is both gaba-ergic and dopaminergic... possibly a great positive.
yet it's serotonergic effects have always made me worry that nardil could cause me further damage. parnate caused tics and was ineffective, but is that dopaminergic side effect related as with stimulants. is the serotonergic effect of nardil different i.e. something i can ignore.
i worry about nardil's famous history of poop-ing out will mean further disabling damage to me. lamotrigine may prevent poopout?
i worry about what seems to be significant indirect anticholinergic effect, when my cognition is already in shambles, of little usefulness, ruins days when i do function/execute a bit. forgetting and forgetting, and my communication always useless.
sorry for any mess, inappropriate etiquette, or asking to much.
Posted by undopaminergic on April 22, 2008, at 20:58:41
In reply to Re: 6 weeks on Nardil, posted by 4WD on April 21, 2008, at 13:38:15
The substances mentioned are contraindicated with MAOIs due to fears of hypertensive responses, but in this case, increased blood pressure is precisely what is desired. (I'm just pointing that out for your information rather than to convince you of the superiority of any particular solution.)
>
> I think a lot of the stimulants you mentioned may be contraindicated with Nardil. In any case, I'd rather not have to tr eat it with another drug. Sipping salty water though the day seems to help.
> > >
>> >
> > Other options include L-dopa, phenylephrine, ephedrine, and of course stimulants, like methylphenidate. Amphetamine is probably overkill since your depression is almost in remission - you probably don't want to get *too* high.
Posted by octothorpe on April 23, 2008, at 6:56:04
In reply to Re: 6 weeks on Nardil » octothorpe, posted by 4WD on April 22, 2008, at 18:15:43
> Hi,
>
> Thanks for your response. When I posted my request for info or suggestions, I was really looking for a
> non-drug solution.I had read the entire thread. Salt tablets = salt, so are no more of a drug than drinking salty water. Your choice, though.
1/4 teaspoon salt = 600 mg sodium; 1/2 teaspoon salt = 1200 mg sodium; 3/4 teaspoon salt = 1800 mg sodium; 1 teaspoon salt = 2400 mg sodium
Glad you're feeling better.
Posted by 4WD on April 23, 2008, at 15:19:55
In reply to no acute effects of nardil? » 4WD, posted by iforgotmypassword on April 22, 2008, at 20:25:44
Hi.
Nardil caused a definiite lessening of anxiety during the second and third weeks. I think I felt a little better during the fourth week. After five weeks, it finally kicked in, sometime during the fifth or 6th week. Believe me, it was worth the wait. I have my life back now and I've been on it seven weeks tomorrow. I feel like a completely different person. The depression is almost entirely gone - most of the time I feel great.
> i just stay in bed barely aware, not being able to keep track of even minor content to my life, especially feelings. i may as well stop communicating at this point, drop my employment programme and shut off my cellphone indefinitely.
You need help. Whatever AD you are on, it's obviously not working.
>
> does anyone know if nardil fights thought hardening, executive dysfunction, tardive EPS-rigidity?Not the tardiveEPS rigidity that I'm aware of. The only thing i can think of to help that is to stop whatever med is causing it.
>
>
> yet it's serotonergic effects have always made me worry that nardil could cause me further damage. parnate caused tics and was ineffective, but is that dopaminergic side effect related as with stimulants. is the serotonergic effect of nardil different i.e. something i can ignore.Ii don't know. I do know that SSRI's didn't help me and Nardil does. So I suspect that it would not affect you the same way.
>
> i worry about nardil's famous history of poop-ing out will mean further disabling damage to me. lamotrigine may prevent poopout?I heard the opposite. That nardil is known for it's longevity.
>
> i worry about what seems to be significant indirect anticholinergic effect, when my cognition is already in shambles, of little usefulness, ruins days when i do function/execute a bit. forgetting and forgetting, and my communication always useless.That's depression talking.
>
> sorry for any mess, inappropriate etiquette, or asking to much.Don't worry about that stuff. That's what we're here for - to listen, offer support and advice. You are not asking too much.
Marsha
Posted by 4WD on April 23, 2008, at 15:28:07
In reply to Re: 6 weeks on Nardil » 4WD, posted by octothorpe on April 23, 2008, at 6:56:04
Hi,
When I said a non-drug approach I didn't mean salt tablets. i wouldn't consider that a drug. It was that a couple of people posted actual medications that might raise blood pressure. I didn't want another med (more side effects probably and more pills to take). I agree with you that salt tablets are not a drug. You just misunderstood.
Wow. Thank you for the info on how many mg of salt are in a teaspoon etc. I was planning to post to you and ask if you knew. You read my mind. Thanks.
Marsha
Posted by 4WD on April 23, 2008, at 15:34:41
In reply to Re: 6 weeks on Nardil, posted by undopaminergic on April 22, 2008, at 20:58:41
> The substances mentioned are contraindicated with MAOIs due to fears of hypertensive responses, but in this case, increased blood pressure is precisely what is desired. (I'm just pointing that out for your information rather than to convince you of the superiority of any particular solution.)
But it would be hard to figure out how much to take. I don't want my BP to go too high. And I'd rather not be on *another* drug. On five already.
>
> > > Other options include L-dopa, phenylephrine, ephedrine, and of course stimulants, like methylphenidate. Amphetamine is probably overkill since your depression is almost in remission - you probably don't want to get *too* high.
>
Yeah, i definitely can't do amphetimines. or really any stimulant. I used to abuse amphetamines back 20 years ago and now my body reacts completely weird if I take them - or any other stimulant. Plus - there's the fact that I have an anxiety disorder and sure don't want to make that worse. And I don't think I really need a stimulant. I feel great most of the time - lots of energy and motivation.Thanks for your response.
Marsha
Posted by octothorpe on April 24, 2008, at 8:35:33
In reply to Re: 6 weeks on Nardil » octothorpe, posted by 4WD on April 23, 2008, at 15:28:07
Posted by Jedi on April 25, 2008, at 1:14:21
In reply to 6 weeks on Nardil, posted by 4WD on April 17, 2008, at 18:14:04
Hi Marsha,
I'm so glad that Nardil is helping you feel better. It is the only med that has ever worked for me. Everybody is different, but I've tried lowering my dosage of Nardil slowly several times. As soon as the MAO inhibition goes below a certain level for a period of time, my major depression returns. I keep trying because several of the side effects still bother me even after being on Nardil for most of eleven years. Luckily for me, when I raise my dosage back up to 75 or 90mg the depression remits faster than when I first started the medication. I believe this is because I still have some MAO inhibition built up in my system. The PDR is often wrong, same as PDOCs and MDs.
Good luck and be well,
Jedi...
> The older doctor who used to prescribe Nardil a lot told me something very interesting. In fact, he read it to me from the PDR. It said that once complete remission has been achieved on Nardil, the dosage should be lowered slowly by one pill a day over a period of time. It even said that you should go as low as one pill a day or even one every other day and the Nardil would still maintain it's efficacy. I don't think I'd go to one pill every other day but it's exciting to think that after I've achieved complete remission, I can go down to 30mg a day instead of 45. Maybe that will lessen the side effects. And then if I don't feel depression creeping back in, I'll try going to 15 mg a day.
...
Posted by 4WD on April 25, 2008, at 14:56:01
In reply to Re: 6 weeks on Nardil » 4WD, posted by Jedi on April 25, 2008, at 1:14:21
Hi Jedi,
Thanks for answering. I'm glad to know about your experience with lowering Nardil. I do know that most people on this board stay on their maintenance dose and don't try to lower it when they are better. It's really just a thought or a possibility. I will probably try going from 45 to 30 after I have been in full remission for several weeks. If the depression comes back, I won't wait a heartbeat before raising the dose again.
The side effects bother me too especially the hypotension. Well the constipation, lack of libido (which I've had for years anyway due to depression and meds), the anorgasmia, all these bother me. But as I told my pdoc when I asked to be put on Nardil: I'm willing to put up with any side effect if the Nardil gives me my life back. And it has and I am willing to put up with the side effects. In fact, I had some lab work done last week and two of my liver enzymes have become slightly elevated from the Nardil. You know what? I don't care. If my liver enzymes are a little too high, well, that's just too bad. Nothing is going to take my life back away from me now that I have experienced what life can be like on Nardil.
Not that I don't still get depressed. I have days or spells where I am still depressed. And it does't help my anxiety at all. But I am still so very much better.
Marsha
> Hi Marsha,
> I'm so glad that Nardil is helping you feel better. It is the only med that has ever worked for me. Everybody is different, but I've tried lowering my dosage of Nardil slowly several times. As soon as the MAO inhibition goes below a certain level for a period of time, my major depression returns. I keep trying because several of the side effects still bother me even after being on Nardil for most of eleven years. Luckily for me, when I raise my dosage back up to 75 or 90mg the depression remits faster than when I first started the medication. I believe this is because I still have some MAO inhibition built up in my system. The PDR is often wrong, same as PDOCs and MDs.
> Good luck and be well,
> Jedi
>
> ...
Posted by undopaminergic on April 26, 2008, at 16:39:25
In reply to Re: 6 weeks on Nardil » Jedi, posted by 4WD on April 25, 2008, at 14:56:01
>
> But as I told my pdoc when I asked to be put on Nardil: I'm willing to put up with any side effect if the Nardil gives me my life back. And it has and I am willing to put up with the side effects. In fact, I had some lab work done last week and two of my liver enzymes have become slightly elevated from the Nardil. You know what? I don't care. If my liver enzymes are a little too high, well, that's just too bad. Nothing is going to take my life back away from me now that I have experienced what life can be like on Nardil.
>Elevated enzymes may not be significant, but if it were to result in serious and irreversible liver dysfunction, it would be a different matter. There are some supplements, such as SAMe (S-adenosylmethionine), methionine and N-acetylcysteine, that could potentially be useful in protecting the liver when taken along with Nardil (or acetaminophen/paracetamol and other drugs with hepatoxic potential).
Posted by 4WD on April 26, 2008, at 19:10:45
In reply to Re: 6 weeks on Nardil, posted by undopaminergic on April 26, 2008, at 16:39:25
>
> Elevated enzymes may not be significant, but if it were to result in serious and irreversible liver dysfunction, it would be a different matter. There are some supplements, such as SAMe (S-adenosylmethionine), methionine and N-acetylcysteine, that could potentially be useful in protecting the liver when taken along with Nardil (or acetaminophen/paracetamol and other drugs with hepatoxic potential).I hadn't heard about methionine being liver protective. Or maybe I did a long time ago when I used to abuse opiates and got a lot too much tylenol in my system. I think I'll try the milk thistle first. It somehow seems more benign than methionine or N-acetylcysteine. If the milk thistle doesn't work and my enzymes are still elevated when I go back for retesting, I will try the big guns. Or maybe I will buy some methionine now. Would it be a good idea to take milk thistle AND methionine? Remember that only two enzymes were elevated and one of those was only 1 point above normal and one was 15 above normal.
I believe that it may also just be my body adjusting to the Nardil and I believe that when I go back for retesting my enzymes will have returned to normal. I'm certainly not worried about one point above normal. But I believe that things will straighten themselves out (with God's help) and they will have returned to normal or at least to a level which is not an issue.
Marsha
Posted by Phillipa on April 26, 2008, at 19:45:15
In reply to Re: 6 weeks on Nardil, posted by 4WD on April 26, 2008, at 19:10:45
Marsh did you try med checker for safety? google it and add your meds. Love Phillipa
Posted by Questionmark on April 27, 2008, at 2:09:31
In reply to Re: 6 weeks on Nardil » 4WD, posted by Jedi on April 25, 2008, at 1:14:21
Jedi is right. You cannot lower Nardil to 1 pill a day after achieving remission (unless you never needed a normal Nardil dose in the first place) without suffering the consequences. That is pure bunk. It is a myth-- just like the idea that you can't eat raspberries or bananas or raisins or coffee or chocolate with Nardil. And yes, as Jedi very wisely points out, the PDR *IS* often wrong, as are MDs and psychiatrists (and boy do i mean often). I'm sorry, but if you are on the minimum effective Nardil dose to achieve remission, you cannot even lower the dose without eventually noticing it (might take a month, but not much longer). Just my opinion. But i strongly believe that.
Yeah, believe me, i used to be really excited by that idea/ those statements too. Then i realized how bs it was. (Can i say "bs"? If not i apologize).
Oh, and the whole mg per kg thing (i.e., mg Nardil per kg body weight)? Bunk. I used to think it was true too (they said it was!), but think about it! How freaking ridiculously over-simplistic and medically naive is that?! Sure, it doesn't matter who the person is or how severe their condition is, all that matters is that they 1 mg Nardil (or however many it was) per kg of body weight! Who are these morons who come up with this and how do they get MDs??!
Ok sorry i'll shut up now.
> Hi Marsha,
> I'm so glad that Nardil is helping you feel better. It is the only med that has ever worked for me. Everybody is different, but I've tried lowering my dosage of Nardil slowly several times. As soon as the MAO inhibition goes below a certain level for a period of time, my major depression returns. I keep trying because several of the side effects still bother me even after being on Nardil for most of eleven years. Luckily for me, when I raise my dosage back up to 75 or 90mg the depression remits faster than when I first started the medication. I believe this is because I still have some MAO inhibition built up in my system. The PDR is often wrong, same as PDOCs and MDs.
> Good luck and be well,
> Jedi
>
> ...
> > The older doctor who used to prescribe Nardil a lot told me something very interesting. In fact, he read it to me from the PDR. It said that once complete remission has been achieved on Nardil, the dosage should be lowered slowly by one pill a day over a period of time. It even said that you should go as low as one pill a day or even one every other day and the Nardil would still maintain it's efficacy. I don't think I'd go to one pill every other day but it's exciting to think that after I've achieved complete remission, I can go down to 30mg a day instead of 45. Maybe that will lessen the side effects. And then if I don't feel depression creeping back in, I'll try going to 15 mg a day.
> ...
Posted by undopaminergic on April 27, 2008, at 4:41:58
In reply to Re: 6 weeks on Nardil, posted by 4WD on April 26, 2008, at 19:10:45
>
> >
> > Elevated enzymes may not be significant, but if it were to result in serious and irreversible liver dysfunction, it would be a different matter. There are some supplements, such as SAMe (S-adenosylmethionine), methionine and N-acetylcysteine, that could potentially be useful in protecting the liver when taken along with Nardil (or acetaminophen/paracetamol and other drugs with hepatoxic potential).
>
> I hadn't heard about methionine being liver protective. Or maybe I did a long time ago when I used to abuse opiates and got a lot too much tylenol in my system. I think I'll try the milk thistle first. It somehow seems more benign than methionine or N-acetylcysteine. If the milk thistle doesn't work and my enzymes are still elevated when I go back for retesting, I will try the big guns. Or maybe I will buy some methionine now. Would it be a good idea to take milk thistle AND methionine?
>Statistically speaking, I think taking multiple supplements would increase the probability of including the "right" one that is most effective against Nardil toxicity. There seem to be no studies at all addressing this issue.
Posted by 4WD on April 27, 2008, at 8:21:15
In reply to Re: 6 weeks on Nardil » 4WD, posted by Phillipa on April 26, 2008, at 19:45:15
> Marsh did you try med checker for safety? google it and add your meds. Love Phillipa
Phillipa,
Safety of what? Drug interactions? Or the liver thing or what?
Marsha
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