Nardil – The Gold Standard for treatment of Social Anxiety
Nardil – The Gold Standard for treatment of Social Anxiety
I have been getting many question's about Nardil so I thought I would write a guide to getting and using this wonder drug
Is Nardil for me?
If you have have trialed various other treatments such as SSRI's, SNRI's TCA, etc. And you have tried CBT with no or minimal result.
If your Social anxiety is long standing and causing you significant distress
If your mature, responsible and prepared to make lifestyle changes such as limiting or ceasing alcohol and recreational drug use.
Then Nardil could well be the drug of choice for you
How do I get Nardil?
Doctors these days are very litigation conscious and risk adverse. Nardil is a medication with the potential for serious and deadly reactions and as such doctors are inclined to trial you on every drug under the sun before even considering a irreversible MAOI such as Nardil if at all. Many people have had great difficulty convincing their Doctor to give them Nardil for exactly these reasons so I will give you an outline of how to obtain a prescription
Approach your Doctor and lay it all on the table.
Tell them of all the treatments that you have tried and have failed. Do your research and speak about Nardil with authority, speak about your knowledge of medication and food interactions and give them some examples. Stay calm, If your acting highly distressed they are unlikely to prescribe it. What is likely will happen is that your doctor will want to trial you on yet another SSRI. You need to be prepared to compromise and negotiate. Ask your doctor if you trial it and it fails again would they be prepared to prescribe it. They are likely to give you a “we'll see” response. This is not good enough, Doctors will keep you going round and round for years if you will let them. Below I have listed the various things you need to discuss with your doctor. Such as:
How your life is currently severely restricted because of your SA
Your previous drug trials and failures
The amount of time it takes to start a new drug, wait for it to take effectiveness and then to taper off and wait for it to wash out again. This can be at least 4 months, most likely 6 months.
If your Doctor gives you an agreement that you can trial Nardil after trying one more drug, it may be reasonable to go with that. If however your doctor hums and ha's or refuses to give you a commitment, I suggest you find a new Doctor because that simply is not good enough. Doctors have an ethical and professional obligation to provide you with adequate treatment and if they are not providing that then you need to look elsewhere.
Approach a Doctor that you have never seen before, tell them that you are from interstate or far out of the area. You need to tell them that you are visiting the area and forgot your medication and that you need a script. Say your on 3 tablets per day which is the starting dose. Most doctors won't ask too many questions and will give you a script for a limited supply. A good plan is to go to a late night medical centre so that they are unable to make a call to the fictitious Doctor who put you on the medication. Once you obtain the script and if you really understand all the indications and contraindications you may start taking them. I then advise you to find a new Doctor within 2 weeks and be up front about what you did. Tell them about your distress and desperation and that you are not in the habit of deceiving doctors. Tell them about how much better you are feeling (and you most likely will be) and ask if they can they manage your care or refer you to someone who can. Considering that you are already on the medication and are telling the Doctor that it is working well, they are likely to continue treating you with it. You need medical supervision. Do not go it alone.
I have got my Nardil, what now?
Ok, you have your Nardil, I am assuming that since you have gone to the effort of getting it that you have also gone to the effort of reading about the drug and food interactions, if not read it now!!
The literature states that it takes up to 4 weeks to take effect however I noticed improvement from the very first dose. For the first few weeks if your metabolism is anything like mine, you may notice a hypomanic effect. You will feel full of energy, talkative, lots of ideas and excitement. While this is somewhat pleasant after feeling like crap for so long, the best is yet to come. As time goes by the hypomania will ease and you will be left with a relaxed contented confident feeling. I had very severe long standing anxiety depression and social phobia. Within about 8 weeks of starting I had a 95% reduction in anxiety, a total absence of depression and can talk to people with ease. Sounds good huh? Read on, now I will bring you back to earth.
After the first 6 weeks where you should be on 3 tablets a day is when you will likely start getting side effects. Here is a list of the main side effects I experienced. You may not get them or you may get all of them and more.
Fatigue – I battled with this for a long long time before realising that I wasn't using the medication correctly (another reason to have a doctor on bored) . I had been keeping the dose low to try to avoid the fatigue that would hit me after lunch but what I should have been doing is increasing the dose. The medical literature states that you need to start at 3 per day and increase it fairly rapidly as fast as side effects will permit to at least 60mg (4 tablets) per day and keep it there for a month. This is to totally destroy the MAO in your brain. After you have done this you slowly reduce the medication to as low as 1 tablet every other day which will keep the MAO from building up again (though I have never heard of anybody who has managed to get by on this low a dose).
Blurred vision: I noticed this when I was increasing the dose, it resolved after a few weeks
Urinary retention: If you increase the dose too fast or too high (like I did) you may start to have trouble urinating. This can become so severe that you need to be catheterised. If this is happening to you I suggest you drop back the dose a little for a few weeks and then try raising it with one tablet every other day.
Constipation: I have found all the antidepressants I have ever taken have given me constipation and Nardil is no exception. Drink loads of water, eat lots of fruit and veggies and talk to your doctor of pharmacist about an appropriate laxative. I find movicol to work well.
(Nardil Farts really stink too)
Postural Hypertension: This can be very annoying and disabling. It is a side effect that will pass and another reason why you should increase the dose fairly slowly. There is plenty of info on the net about how to treat it but I would suggest Salt tablets and increased fluid intake as a good start. Get up from lying down slowly and if you are walking around and you get a hypo episode you can go into a squatting position which will stop you from fainting.
Sexual Dysfunction: This is a real *****. I found for the first couple of months I had no interest in sex at all which is good in a way because I couldn't perform if I wanted to. I had trouble getting an erection at first but this passed. However anorgasmia (inability to cum) is still effecting me about a month after upping the dose from 3 to 4 tablets a day.
I don't have a partner at the moment so maybe that would help, my sex drive is still reduced from what it was (which wasn't that high anyway).
Its a bit of a catch 22, you need Nardil to get out there to find and keep a partner, but Nardil stops you performing in the sack. What do you want more, effortless orgasms or an otherwise full life?
Yoshimbine is meant to help with desire and orgasm (however its illegal in australia)
Good old alcohol I think good help as well. In any case, its still worth it. If your a guy keep in mind that woman fake it all the time, you might have to as well for a while. If your a chick, well at least you won't be alone.
There are other side effects people get but these are the ones I had to deal with and I may have forgotton some that have come and gone but these are the ones that I feel I can write on with some authority.
This is a partial list of what is off limits on a MAOI
Beer (including alcohol-free or reduced-alcohol beer)
Caffeine (in excessive amounts)
Cheese (except for cottage cheese and cream cheese)
Chocolate (in excessive amounts)
Dry sausage (including Genoa salami, hard salami, pepperoni, and Lebanon bologna)
Fava bean pods
Pickled, fermented, aged, or smoked meat, fish, or dairy products
Spoiled or improperly stored meat, fish, or dairy products
Wine (including alcohol-free or reduced-alcohol wine)
Yeast extract (including large amounts of brewer's yeast)
However I have eaten and drunk most of these things without problem. You however may be different. If you are going to experiment with eating some of these foods I highly recommend you eat only a very very small amount and wait at least an hour to see if there is a reaction.
Salami, aged cheese, yeast extract (such as vegemite, marmite) red wine are things I habitually avoid as they are very high in tyramine.
Problems with the “new” Nardil
You will find a lot of information on the net about Pfiser changing the formula of Nardil a few years back and how it doesn't work properly anymore. This info is all particular to the US. Australia and the UK is still getting exactly the same Nardil we always have which seems to be much like the “new Nardil” sold in the states. In any case, my advice is to ignore it. There are plenty of people getting good results on the “new “ Nardil.
This is yet another reason why litigation conscious and risk averse Doctors are extremely reluctant to prescribe this drug. Nardil has many and varied drug interactions that can result in almost any Symptom you can think of.
Make no mistake, Nardil is a dangerous drug to mix with other drugs legal and illegal. Drugs that you mixed with no problem in the early stages of taking Nardil may react strongly and in unexpected ways later on in treatment when MAOI A and B are more fully inhibited. There is no way I could list every drug and every interaction so I will try to give a brief overview focusing on recreational drugs as you of course have a doctor on bored for all the perscribed drugs
Potentially Deadly Mix's
DXM – Found in cough syrup. DXM is used as a recreational drug (though I found nothing pleasant about it) as well for its legitimate purpose of being an antiexpecterant. MAOI's strongly potentate DXM. I once took a tiny drop as an experiment years ago when I was on a different MAOI. The reaction was extremely strong and floored me in a very unpleasant and scary way. Deaths have resulted from this combination, do not mess with it.
MDMA (aka ecstasy) Again another drug that reacts violently with MAOI's . You are almost guaranteeing yourself a trip to the morgue if you mix these 2 drugs. Do not do it.
Methamphetamine/dexamphetamine: Another potentially deadly mix. There is some literature on the net of Doctors combining small doses of dexamphetamine with Nardil in treatment resistant depression however you can bet it was done in an impatient setting with access to all the appropriate treatments only minutes away. There are reports of people dying after mixing only 10mg of dexamphetamine with Nardil http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1845739/
Alcohol: Among the many things to avoid on the MAOI diet list is alcohol, particularly beers.
Personally I have mixed alcohol of various kinds with Nardil without a Hypertensive reaction.
In fact I have had very much the opposite, very strong hypotensive reactions. I would advise limiting your alcohol intake.
Hallucinogens: Cannabis, LSD, Magic mushrooms. There is very little information on the net regarding interactions with these drugs. Some sources say Nardil inhibits the effect of these drugs, some say it potentates their effect.
I have used all of these substances on several occasions whilst on Nardil and found the effect to be pretty much zero. Does not make it stronger or weaker. However if you are planning on trialing this combination I would advise caution and using the very lowest dose to start with.
It comes down to this:
Your suffering, you have tried so many medications but nothing has worked. Doing the same thing over and over and expecting a different result is insanity.
So you have ethical problems about lying? You don't feel strong enough to stand up to your Doctor? Basically it comes down to this. This is your life and it is ending one day at a time. (love fightclub) How much time do you really think you have to be arseing about? How much time do you want to be suffering alone rather than going out and living you life, finding a partner and making some money?
The longer this kind of Phobic anxiety and depressive tendency's goes on the more it becomes entrenched into your personality and the harder it is to change.
You can be a whiney little passive victim of the medical system and spend your life posting on forums like this about how **** you feel or you can take charge and work the system in ways I have outlined above. Whatever you do, I guarantee you that if your a passive and compliant patient who looks to Doctors with awe you will be on the SSRI merry go round for years to come. Its in your hands.
I have gone to great lengths in this post to give you an idea what being on Nardil entails, but maybe the best thing to do is to give you my personal testimony.
Nothing did nothing short of changing my life. My social anxiety has waxed and waned over the years but it has always been there and has always limited my life, more often than not severely.
This is a story of how I was in the past year leading up to me taking Nardil. There were times before this that I was even worse, when I lived like a hermit for years, through my best years (late teens and early 20's) I was very sick and suicidal then. I am in my early 30's now.
Before I started Nardil I hated going on public transport, I would get panic attacks, be nervous about making eye contact with people, nervous about sitting next to people. I found the whole thing extremely stressful and more than once got off early to walk because I felt so confined and anxious.
On a weekend I would get invited out with people but I nearly always turned them down because I knew I would have to drink heaps of alcohol to even come close to enjoying myself and then suffer even worse panic attacks for days to come because of the alcohol.
I would get attacks of social anxiety to the point where I would become highly anxious around my family and good friends that I have known for years. I would become mute and couldn't speak. To the point where it was nothing short of strange. I would feel so embarrassed about this and I would get flashbacks of this embarrassment which would stop me in my tracks as I walked down the street.
Work was a nightmare, it took all my will to force myself to go in a few times per week, I would often do night shifts so I didn't have to interact with people. Night shifts would make my SA worse, it was all crap. I couldn't remember anyone's name, I constantly felt like I was doing a bad job no matter how hard I tried and as such I didn't want to try, I resented my job because it made me feel so bad. I couldn't build relationships with my work colleagues and became totally overwhelmed even with a light workload. I took heaps of sick days, I quit multible jobs. I suffered migraines, I could only breath through my mouth because my nose was always blocked. I had fibromyalgia, I was always full of aches and pains. I finished work utterly mentally and emotionally exhausted. It was hell and for no good reason. The job was not that hard, I just couldn't stop stressing out and panicing about it.
I had huge amounts of trouble sleeping, my thoughts would race, I would get stupid songs repeating over and over in my head that wouldn't go away and drove me insane. I had terrible nightmares, I slept in longer and longer every day and had huge trouble dragging myself out of bed. Even a small disturbance in my sleep would make my mental state even worse.
I was so depressed, I felt so lonely all the time, constantly dissatisfied I hated the world and was extremely anti about everything and everyone. I would always find the worst in everything. I always felt low and down, I literally dragged my feet and was so obviously depressed. I would have trouble speaking and be just sad and down. Whenever the depression lifted the anxiety would get worse and vice vesa. I went through a long periods of lying in bed, hardly eating and not even washing.
I would get disturbing and bizarre OCD symptoms that were hugely socially disabling even on top of my anxiety.
I isolated so much, spent huge amounts of time on the internet. I would constantly trawl forums looking for the magic something that would cure me. I would constantly ruminate about the meaning of life and what I should do with my life rather than living it.
I tried everything and I mean everything, ssri, tricyclics, TCA's, SNRI's, mood stabilisers, antipsychotics, stimulants, every herbal thing you can imagine as well as a huge variety of recreational drugs. I tried psychotherapy, CBT, hypnosis. Nothing worked.
This huge list of things I listed above are no longer an issue. My anxiety is 95% gone, no panic attacks, no depression.
This is my third time on Nardil, the other times I tried it and stopped it because of the side effects. This time I am working through them.
Life is sweet, I love coming to work and am making great money and putting in big hours.
No aches and pains, no migraines, I can have a few drinks without massively paying for it the next day. I have hope and plans for the future. I go on dates, I make new friends. I dont care what people think about me anymore.
I have a life
I love life.
Please do not suffer any longer, I read some of the posts on this site and my heart goes out to you, because I used to be there.
If all else fails, give Nardil a go. I know the side effects sound a little scary, but the fact is that when you feel good, you can cope with these things. I would cope with a lot more to stay on this medication.
Enough said...for now
EDIT: December 2010
After one year of battling side effects I have given up on nardil. This thread is basically a record of my journey with it.
In a nutshell, it helped me at a time when I really needed it. And maybe some good has come from taking it.
Long term solution... not for me
February 2011 Back on Nardil
The anxiety was just all consuming, I couldnt work, I couldnt do anything.
Tried metformin to control the weight gain - I would be sick with hunger all the time.
I would have to eat to get to sleep, I would wake up to use the toilet in the middle of the night (thanks to the fluid retention nardil caused) and I would again be too hungry to get back to sleep so I would eat again. Then I would wake up ravenous in the morning.
I went from 78kg - 92kg on top of that my stomach was distended like I was pregnant.
I did this while eating healthy foods (I am a nurse and a qualified fitness instructor so I know what healthy is) I just ate so much of it.
I trained 2 hours per night 4 night per week in Krav maga - Incredibly physically demanding.
I would regularly almost pass out because of the random hypotensive episodes I had.
I would constantly pass gas
My bowels were so compacted that I could not move them in anything like a normal manner. I had to use enemas and drink bulk hot water and take laxatives for every explosive bowel movement.
At my Doctor prescribed me dexamphetamine in the hope of combating the postural hypotension. I ended up manic for 6 months until I returned the script to my doctor and told him to take them away from me.
Don't get me wrong, Nardil is an amazing drug that did help me. It seems that every time I take it and get a more normal life for 6 months or so, I come out the other end a stronger person.
All this stuff that happened to me...it happened because I kept taking it, because it was worth it. When it gets to the point of not being worth it, stop.
You will lose the weight as I did (10kg loss in one month!) and everything will go back to normal....whatever that is.
I have been off nardil for about 4 months (Feb 2012) . I have stopped working, a luxury I can no longer afford. So I may have to do it all again
Thanks for reading
I can not stop ppl encourage enough to try Nardil!! There's far too litle talk about nardil on this board and far too much talk about SSRI's that usually arent very effective.
Try Nardil folks!
Awesome post zendog78!;)
I dont have experience with MAOI's myself (yet) as i'm trying other things first, however i do know that nardil is VERY effective for social anxiety.
I was on Nardil for a time. It was very effective with Xanax, but I was so apathetic, tired, and sexually dysfunctional that it kind of wasn't worth it. Plus it's a bit ridiculous when the wrong food can kill you. I heard our Prime Minister is on an irreversible MAOI.
And the drug interactions... Wow. Don't take ANYTHING (pharmaceuticals, supplements, herbs, recreationals, etc.; legal or otherwise) unless you know for sure how it interacts. Be vigilant at all times -- even for stuff like energy drinks (some have ingredients such as supplements/herbs). Street drugs in particular should be avoided altogether as you don't know what exact chemicals you are ingesting. Cannabis should be fine, though it may further reduce blood pressure (I've smoked plenty of weed on Nardil). Some types of alcoholic beverages can interact very badly with Nardil, and in all cases there'd probably be a boost in respiratory / circulatory / nervous system depression. Benzos or opioids with Nardil would probably carry the same risk to an even greater extent, so dose would have to be chosen very carefully if at all. Some opioids (such as pethidine) could cause a very bad interaction with Nardil. Dextromethorphan (DXM) also interacts badly (in some cough syrup). Some decongestants contain stimulants that interact badly. Ketamine and nitrous MAY be okay but there may be potential for bad respiratory / circulatory / nervous system depression or other interactions: caution is advised. Some tryptamine-related psychedelics (LSD, mushrooms, DMT, etc.) should PROBABLY be fine with Nardil but they may receive a VERY BIG boost in effects, or they may not work at all. Some tryptamines would interact very badly (e.g. AMT). Phenylethylamine-related psychedelics/stimulants (mescaline (and associated cacti), 2C-*, amphetamine, methamphetamine, MDMA ("ecstasy") etc.) have potential for very bad interactions. Cocaine also interacts badly. L-tryptophan, 5-HTP, L-tyrosine, [D]L-phenylalanine, phenibut and picamilon may interact badly.
That's by no means an exhaustive list. If you haven't tried a drug with Nardil before, my advice is to "test the water" with a very low dose, then work your way up. Then if there is an interaction, it will be of minimal magnitude. Obviously this step can be bypassed if a doctor is instructing you. Always get drugs from a source of certified purity, composition, dose, etc.. Some supplement companies I know of are independently analysed for purity. Pharmacy-obtained drugs obviously are ideal. Street drugs are a huge risk.
If you are not careful and meticulous with what you put in your body on Nardil, you will eventually come to regret it. The same applies to quite a few meds. A good approach is to take as few drugs/supplements/herbs/etc. as possible, get those you do take from legit sources (if not, then test every new "batch" carefully), and if you're taking anything with potential for bad interactions, use the low dose testing procedure for any new drugs / combinations. Remember also that metabolic interactions alter the levels and rate of clearance of anything you take, so monitor the effects closely.
Wasnt there a study that showed that reboxetine prevented hypertensive crisis from tyramine rich food? Apart from that it may be a good addon as it would reverse the hypotension caused by too little noradrenaline.
Yeah I heard about that too.
Hm..sounds good enough for me! I'm willing to try ANYTHING right now!
Thank's for all that information, Zendog78!
Personally, I also agree and wonder if NRI's might help reduce the postural hypotension, since it's supposedly induced by MAOIS decreasing noradrenaline activity via octopamine.
I was on Dexamphetamine for about 2 years. They took over my life, made me paranoid, addicted, absolutly crazy in fact. I had a hell of a time coming off them. And dont kid yourself, there is really no doubt anymore that they are nerotoxic, even at theraputic levels.
I love and hate the things, I know that if I came accross a bottle and had one I would be straight back to being dysfuntional and dependent on them, even taking a low dose of 3 or 4 tablets a day. Which is all I really ever took.
They are bad ****ing news.
And if you talk about offsetting them with something like clonazepam, you should realize that there is now plenty of evidence that they are neurotoxic as well.
Amphetamines feel great....for a while..but they screw your body up. You can feel that there is something toxic going on. Bad bad news.
If the side effects of Nardil ever became too much I may consider getting maybe 2.5mg of dexamphetamine compounded with each 15mg nardil tablet to boost it up and let me get by on a lower dose (with medical supervison of course)
Dexies do make you feel fantastic...for a while. But every time I go back to them, the time period it takes for me to go from coping to a total **** up gets shorter
well, it's true that nardil doesn't work for quite a few people who give it a reasonable trial (i.e., as part of an illicit-drug-free and moderately sober lifestyle).. but certainly if one tries to combine it with everything under the sun (especially given it's propensity for so many med interactions), and then reports it doesn't work and that the combination of two controlled substances works better for him, i think that might say more about the subject reporting the data but hardly anything about the possible effectiveness or ineffectiveness of the medication :)
imo nardil is one of the best meds when we compare meds singly coz it affects many subsystems together.
however we can find many equivalent or even better combinations.
Doesn't seem worth it. I have fairly severe SA, not as severe as Zendog, but nevertheless.
Many psychiatric conditions are based on control, OCD etc. I have a fear of any drug permanently controlling how I think..which is in part why I have never tried, nor will try, an MAOI. Perhaps ironically, I take xanax. But I know when xanax is done and out of my system - not affecting me. And I don't take it every day.
I suppose if ones SA is really bad enough, nardil would be a godsend. I have SA pretty bad, but not that bad.
As to whoever said clonazepam is neurotoxic, I would like evidence.
Alcohol doesn't come close to the relief xanax gives me, SA wise. With alcohol, at the first feeling of not being in control, I have to stop drinking, as it causes panic.
nardil is not a unique med. it work on some brain neurotransmitters, ... like many other meds do.
there are more than 200 psychoactive meds. you can make some combination that work similar or even better for you.
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