My 2 year experience taking Nardil - Pros and Cons - Social Anxiety Forum
 
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post #1 of 17 (permalink) Old 01-26-2011, 01:58 PM Thread Starter
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My 2 year experience taking Nardil - Pros and Cons


Hi everybody, I'm new to the SAS forum, but I did regularly read people's comments and discussions here a couple of years back, particularly on this medication forum. I picked up much information and knowledge from people's personal experiences posted here about Nardil, and would now like to now share a part of my experience with Nardil after 2 years of taking it.

Please do feel free to ask any questions or let me know how your experience has been similar or different.


I'm from the UK but despite a nearly zero-MAOI policy in this country, I did manage to get Nardil Prescribed to me but it was under quite rare circumstances:

My Doctor had previously prescribed me SSRIs and Tricyclics but to no effect and it seemed there was very little chance that she would prescribe me something like MAOIs if I asked her to do so; She didn't take my complaints of SA seriously and was very aloof to any suggestions I would make.

However, after I'd read so many "wonder stories" about Nardil on social anxiety forums and sites, I decided it was worth a try to convince her that this medication was likely to work for me, so I prepared a wealth of internet-researched paperwork and references about Nardil to bring with me to help persuade her to prescribe it to me.

Finally when I arrived for my appointment I ended up seeing a duty Doctor because my actual Doctor was away on her annual vacation. the replacement doctor was covering her for the entire summer period and I could see straight away that she was very young and seemed to be a little inexperienced. I pitched her with the "Nardil Proposal" all the same. (One of the main things I took specific attention to was stressing that I fully understood the importance of following a strict tyramine-free diet, which I think gave her confidence that I was not going to be a high risk to her).
After looking in her big medical book (that all UK doctors have) she hesitantly said OK and filled out a prescription for me.

So I'm pretty sure that the main reasons for me managing to get prescribed Nardil was due to:

1) The inexperience of the replacement duty Doctor
2) Making a very good case based on research that I had printed from the internet as to the effectiveness of Nardil for SA - and showed it to her as proof
3) I explained that I knew all the implications and food constraints of taking an MAOI and would 100% strictly adhere to them


I took them for two years and only recently stopped in September 2010. It definitely wasn't a miracle drug for my social-anxiety. It did help inadvertently, but it didn't eliminate most of my SA symptoms. However it did really help me in numerous other ways that other meds have never came close to.

Here a few of my personal pros and cons with 2 years of Nardil:

Pros:
- Actually made me feel happy for the first time in many years
- Cleared up a huge amount of depression like no other med has done before or since
- Made me feel extremely motivated at work and home like I hadn't felt in years
- Because of the above effects, it had a very positive impact on my social life and general wellbeing hence reducing symptoms of SA
- So potent that I could actually feel it hit me shortly after taking it (especially with a hot drink like tea which is what I always ended up doing)

- I feel that the food and drink contraindications are HUGELY overstated and I can confirm that after 3 months of being overly paranoid about what I ate, I completely disregarded this. I ate everything and anything including strong chesses, exotic French dishes & wines and never had any negative effects whatsoever. I even (stupidly) went out on an all-night binge, drinking and doing a substantial amount of cocaine (I know it was stupid and would definitely NOT recommend it while on MAOIs) but it still had no adverse effect on me or present any symptoms of a Hypertensive crisis.
However I should note that I did feel what I believe to be the onset of a Hypertensive Crisis on one occasion when I had a Mojito which had rum in it, so it's definitely wise to stay away from dark spirits like rum and obviously the extremely moulded foods like blue cheese.


Cons:
- It didn't eradicate most of the symptoms of SA. For example: Problems of public speaking or job interviews it would not help anxiety at all
- In some cases (particularly after taking the drug in the afternoon for some reason) I would have problems with stringing sentences together even more than usual and jumble up words much more often
- In many cases it would actually make my brain and thoughts spin faster which made me even more nervous and jittery
- In nervous situations it would make me overheat and sweat alot - especially on my face and forehead. This became a really big problem for me.
- It doesn't take long to build up a tolerance, and those great effects I felt for the first 6 months with 1 x 15mg tablets, then start to take 2 x 15mg tablets in one go to make you feel that. (I started at 45mg per day and eventually got to 90mg per day)
- Urinating - esp. in public toilets and at work
- Once my tolerance had built up and I couldn't get any higher doses prescribed, I eventually had to go without taking it for a few days at a time (sometimes a week) to lower my tolerance and to ration my supplies.
- Eventually after 2 years, I ended up with the same problems I had before taking Nardil and had barely any effect on me at all.



I am now no longer taking Nardil (since September) and have been unemployed since around that time also. I find it exceptionally hard to get motivated and am very depressed. I am thinking about starting them again and I know my tolerance would be way down now (still have a whole unopened pack in my fridge!) but I also want to see what it would feel like going back to work without being on medication.


Any comments would be much appreciated
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post #2 of 17 (permalink) Old 01-26-2011, 02:29 PM
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It must be incredibly disappointing when a drug that worked miracles for your depression and general sense of well-being stops working. I can't imagine sinking back into that pit after being so much improved.

If a MAOI, SSRIs, and tricyclics haven't helped (for any length of time, at least), it seems fairly likely that you have a bipolar spectrum disorder, which commonly occurs together with social phobia.

I'd go back and ask (or, more tactfully and perhaps effectively, gently suggest) your doc to put you on a mood stabilizer like lamotrigine, valproic acid, carbamazepine, oxcarbamazepine, lithium, etc. You might find that the SSRIs (in particular) and tricyclics that once did nothing will help to boost your mood once the mood stabilizer is titrated up and working. You could also try reintroducing Nardil or Parnate, or try the selegiline-based Emsam (or selegiline itself, ideally with DLPA to potentiate it), and these might really work, and largely continue to work.

Unfortunately, this is a condition that will likely require polypharmacy to effectively treat. Then again, social phobia often is, too.
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post #3 of 17 (permalink) Old 01-26-2011, 02:30 PM
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Thanks for sharing your experiences with Nardil.

Is it correct...you took 1-2 tablets a day?
That`s a VERY low dose.
Normally...you need at least 3 tablets (45mg).
For many people it`s 4-6 tablets (60-90mg) if you want to get rid of SA.
That`s probably why you could drink so much and use cocaine without a hypertensive crisis.

btw, it`s in your fridge? It must be Archimedes Nardil, right? (aka Concord/Link).
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post #4 of 17 (permalink) Old 01-26-2011, 02:30 PM
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Are you glad you were prescribed Nardil? Was it worth it? Did it overall help you in the long-term?
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post #5 of 17 (permalink) Old 01-26-2011, 02:32 PM
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Originally Posted by micmac28 View Post
Are you glad you were prescribed Nardil? Was it worth it? Did it overall help you in the long-term?
Sorry to intrude, but I don't think something that stops working helps in the long-term.
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post #6 of 17 (permalink) Old 01-26-2011, 02:53 PM Thread Starter
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Originally Posted by bmwfan07 View Post
It must be incredibly disappointing when a drug that worked miracles for your depression and general sense of well-being stops working. I can't imagine sinking back into that pit after being so much improved.

If a MAOI, SSRIs, and tricyclics haven't helped (for any length of time, at least), it seems fairly likely that you have a bipolar spectrum disorder, which commonly occurs together with social phobia.

I'd go back and ask (or, more tactfully and perhaps effectively, gently suggest) your doc to put you on a mood stabilizer like lamotrigine, valproic acid, carbamazepine, oxcarbamazepine, lithium, etc. You might find that the SSRIs (in particular) and tricyclics that once did nothing will help to boost your mood once the mood stabilizer is titrated up and working. You could also try reintroducing Nardil or Parnate, or try the selegiline-based Emsam (or selegiline itself, ideally with DLPA to potentiate it), and these might really work, and largely continue to work.

Unfortunately, this is a condition that will likely require polypharmacy to effectively treat. Then again, social phobia often is, too.
Hi there and thats for the reply

Yes indeed it is a shame that it did cease to work over time. But again - it didn't actually get rid of most of my SA symptoms, it mainly helped with depression, but was extremely potent in that sense (at least for a time).

What would make you say that my disorder could potentially be a bipolar spectrum disorder? How does that differ from 'regular' depression?

Thanks
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post #7 of 17 (permalink) Old 01-26-2011, 03:13 PM Thread Starter
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Originally Posted by leon21 View Post
Thanks for sharing your experiences with Nardil.

Is it correct...you took 1-2 tablets a day?
That`s a VERY low dose.
Normally...you need at least 3 tablets (45mg).
For many people it`s 4-6 tablets (60-90mg) if you want to get rid of SA.
That`s probably why you could drink so much and use cocaine without a hypertensive crisis.

btw, it`s in your fridge? It must be Archimedes Nardil, right? (aka Concord/Link).

Sorry if I was unclear in the post - I meant that each time I took my separate dose in a day it would be 1 x 15mg at a time out of 4-a-day to begin with, and then as I got to higer tolerance levels I would be taking 2 x 15mg per dose - so basicly taking two tablets at a time.

The highest prescription dose I got to would be 90mg a day -which is extremely rare in the UK because you can only get past 45 or 60 under serious doctor's discretion. But because my doctor knew so little about the medication, and after the duty doctor first prescribing it to me (and then her continuing) she did never check her medical book where it would've advised against putting my medication past that threshold.

I think the reason I didn't get a hypertensive crisis when using Cocaine had more to do with the fact that at that point I had built up such a heavy tolerance to Nardil that I could practically eat a slab of blue cheese and still feel fine! (coincidentally the indicant with the mojito cocktail was after only a few months of being on Nardil so my tolerance was probably low then)

And yes I believe it is the Link Pharmaceutical brand - always has to be kept in fridge, but used to just keep the day's dose in my pocket when at work.
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post #8 of 17 (permalink) Old 01-26-2011, 03:20 PM
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So you started with 60mg (15mgx4) a day? And the highest dose was 90mg a day?
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post #9 of 17 (permalink) Old 01-26-2011, 03:20 PM
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What would make you say that my disorder could potentially be a bipolar spectrum disorder? How does that differ from 'regular' depression?
A lot of new research and theory revolves around the idea that the various mood disorders exist on a spectrum, with garden-variety, uncomplicated unipolar major depressive disorder on one end, and manic-depression (AKA bipolar 1) on the other.

Seeming major depressive disorder that fails to improve with multiple rounds of anti-depressants (called treatment-resistant depression, or TRD), and that is complicated by the presence of anxiety disorders, particularly social phobia, OCD, and panic disorder (in order from highest prevalence in BSDs to lowest) is most likely not actually "unipolar" depression, in the classic sense of the term or, more pertinently, as far as treatment goes.

I'll take a stab in the dark and presume that your depression is of the atypical variety. Do you have a worse mood at night, hypersomnia (sleeping too much), possible carb cravings with possible overeating, very low energy and low motivation/apathy/anhedonia, interpersonal rejection sensitivity, and possible mood reactivity to positive or negative events?

This major depressive syndrome with atypical features is indicative, in over 75% of cases, of a soft bipolar disorder, currently lumped into the bipolar 2 diagnosis. When you add other comorbidities into the mix, especially social phobia, this becomes even more likely, and when you factor in failed or "pooped-out" trials of antidepressants, it makes a pretty good case that your treatment, forgetting for a minute about diagnoses, should involve a mood stabilizer because there's clearly something else going on. There is probably a cyclical nature, even if it isn't a discernible pattern, to your depression, and it comes and goes with no apparent reason. That jives with the original concept of manic-depression that Emil Kraeplin hypothesized over a hundred years ago. Unfortunately, contemporary, mainstream psychiatry seems to have shed a lot of his ideas over the years, but there's a movement to revisit a lot of those extremely prescient concepts.

Anyway, I hope this makes some sense, and I'd definitely recommend speaking to your psychiatrist about trying a mood stabilizer.
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post #10 of 17 (permalink) Old 01-26-2011, 03:23 PM Thread Starter
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Originally Posted by micmac28 View Post
Are you glad you were prescribed Nardil? Was it worth it? Did it overall help you in the long-term?
I definitely think it helped pull me out of a real low point of my life, and gave me huge amounts of determination and energy at a new job I landed shortly after starting Nardil. I guess I paid less attention than I should have to my underlying problems of SA and should have used that time to get NLP or at least some self-help programs before the drug became ineffective.

But if I could go back would I have still taken it? Absolutely. It did help me out big time - even if only for a while. But as for it being a drug that takes away many symptoms of SA I would say it didn't for me - it actually created a few more at times - but it increased my overall wellbeing and happiness and energy in general which as a result, brought my life to a better place (for a time).
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post #11 of 17 (permalink) Old 01-26-2011, 03:30 PM Thread Starter
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So you started with 60mg (15mgx4) a day? And the highest dose was 90mg a day?
I started at 45mg and gradually moved to 90mg as my tolerance increased.
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post #12 of 17 (permalink) Old 01-26-2011, 03:40 PM Thread Starter
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Originally Posted by bmwfan07 View Post
Seeming major depressive disorder that fails to improve with multiple rounds of anti-depressants (called treatment-resistant depression, or TRD), and that is complicated by the presence of anxiety disorders, particularly social phobia, OCD, and panic disorder (in order from highest prevalence in BSDs to lowest) is most likely not actually "unipolar" depression, in the classic sense of the term or, more pertinently, as far as treatment goes.

I'll take a stab in the dark and presume that your depression is of the atypical variety. Do you have a worse mood at night, hypersomnia (sleeping too much), possible carb cravings with possible overeating, very low energy and low motivation/apathy/anhedonia, interpersonal rejection sensitivity, and possible mood reactivity to positive or negative events?

This major depressive syndrome with atypical features is indicative, in over 75% of cases, of a soft bipolar disorder, currently lumped into the bipolar 2 diagnosis. When you add other comorbidities into the mix, especially social phobia, this becomes even more likely, and when you factor in failed or "pooped-out" trials of antidepressants, it makes a pretty good case that your treatment, forgetting for a minute about diagnoses, should involve a mood stabilizer because there's clearly something else going on. There is probably a cyclical nature, even if it isn't a discernible pattern, to your depression, and it comes and goes with no apparent reason. .
I was extremely taken aback reading this description as it very much hits the nail on the head with regards to my moods and symptoms, OCD, eating & sleeping habits etc.

Is there any link you could refer me to for further reading on this? Also how do you know so much about this area?

Thanks
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post #13 of 17 (permalink) Old 01-26-2011, 03:46 PM
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I was extremely taken aback reading this description as it very much hits the nail on the head with regards to my moods and symptoms, OCD, eating & sleeping habits etc.

Is there any link you could refer me to for further reading on this? Also how do you know so much about this area?

Thanks
I'm glad you identified with what I said--it makes the process likely easier. I've accumulated my knowledge from various places... including reading studies, books, Web sites, anecdotes from forums and elsewhere, doctors, and lots of other sources. I'm not really an expert, though, and I'm certainly not a clinician.

You can read about this bipolar "spectrum," in a more general sense, from Dr. Jim Phelps' very informative Web site at http://www.psycheducation.org. I also suggest reading his book, Why Am I Still Depressed?
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post #14 of 17 (permalink) Old 01-26-2011, 04:18 PM Thread Starter
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Originally Posted by bmwfan07 View Post
I'm glad you identified with what I said--it makes the process likely easier. I've accumulated my knowledge from various places... including reading studies, books, Web sites, anecdotes from forums and elsewhere, doctors, and lots of other sources. I'm not really an expert, though, and I'm certainly not a clinician.

You can read about this bipolar "spectrum," in a more general sense, from Dr. Jim Phelps' very informative Web site at http://www.psycheducation.org. I also suggest reading his book, Why Am I Still Depressed?
Thanks for this link; I'm reading the article now and it summarises so extremely well what I experience. This will be very useful to me
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post #15 of 17 (permalink) Old 01-26-2011, 06:22 PM
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Thank you for your sharing your experiences with us
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post #16 of 17 (permalink) Old 01-26-2011, 06:44 PM
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Damn, it didn't help with public speaking? What medication does? If there is any. If there isn't there really should be. Public speaking is like 90% of my SAD.

Maybe you can afford to wait. Maybe for you there's a tomorrow. Maybe for you there's a thousand tomorrows, or three thousand, or ten. So much time you can bathe in it, roll around in it, let it slide like coins through your fingers. So much time you can waste it.
But for some us there's only today. And the truth is, you never really know.


"Life isn't about waiting for the storm to pass, It's about learning how to dance in the rain."
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post #17 of 17 (permalink) Old 01-26-2011, 07:09 PM Thread Starter
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Damn, it didn't help with public speaking? What medication does? If there is any. If there isn't there really should be. Public speaking is like 90% of my SAD.
Hi Blujay,

No, it definitely didn't help at all with social activities like public speaking; I was very disappointed in that too. As I said, at times it could often create more anxiety related symptoms, like my face pouring with sweat under high pressure situations, and also making my mind race even more than usual when nervous - which consequentially impaired my speech; Definitely not good when undertaking public speaking roles.

But because of the massive increase in energy, drive, motivation and feelings of wellbeing, it had many more positive effects on my quality of life than from not taking it.

As for your question on the drug that helps public speaking? Theres only one I know of that absolutely works, but unfortunately causes too many other problems to even be viable: Alcohol.

Alcohol has got me through almost every job interview I have ever attended. But it sure isn't something that can work on a long term basis such as every day at work; Believe me, I've tried.

I do feel for you - especially on the public speaking thing; That has got to be my all time worst SA nightmare. I ended up leaving college over that one.
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