There are a lot of people in this thread who are making a big effort to slag off Nardil. It's not a drug for everyone, I made that clean in the original post. It has some full on side effects that are difficult to get past.
Some people here seem to have a chip on their shoulder about the drug and are determined to demonize it much has mainstream psych has done.
Its good to get peoples imput on there experience with Nardil positive or negative but all I am hearing is that nardil is crap because of x y z but the suggestions for alternatives are what?
(great, the most harmful addictive drug known to man after tobacco)
Clonazepam ( well noted for its tendency to cause depression with long term use)
(addictive, destabilizing, psychosis inducing medications that are contraindicated in anxiety disorders)
Un-named combinations of drugs
( If you have a combo that has helped as many people as nardil please feel free to share it)
So far the only suggestion that has some merit for treatment resistant SA in this thread is antidepressant combinations that I mentioned above. If you search the net you will find case reports of such successful combinations but only that. Case reports which really don't mean much.
I think it is worth a try if you can find a doctor to do it but it is an exceeding tricky and time consuming process where you could be better off sticking with a MAOI like nardil and giving yourself a few months to get past the side effects. And don't forget, that there is PLENTY of evidence and reports of severe and fatal reactions from antidepressant combinations, just do a search.
What is the evidence supporting combinations of antidepressants?
Combinations involving monoamine oxidase inhibitors with stimulants, tricyclics and SSRIs are well known to have potentially lethal consequences.17 Toxicity may be serious, and includes serotonin syndrome (nervousness, confusion, tremor, restlessness, sweating, hyperreflexia, shivering and myoclonus).
The combination of tricyclic antidepressants with SSRIs is less effective than raising SSRI dose alone.22 A double-blind study did not show any difference between monotherapy and fluoxetine–desipramine combination.23 Furthermore, drug interactions are likely, as some SSRIs inhibit tricyclic metabolism through the cytochrome P450 system, increasing the risk of cardiotoxicity, seizures and delirium.
Two double-blind placebo-controlled trials have shown that adjunctive mianserin augments response to SSRIs in resistant major depression.24,25 Another large study found no advantage of sertraline plus mianserin over sertraline alone, and combination was associated with increased sedation and weight gain.12
A double-blind study enrolled 26 patients who had not responded to SSRIs, venlafaxine and bupropion at various doses for variable but prolonged periods. Patients then received mirtazapine or placebo augmentation for 4 weeks. Mirtazapine augmentation resulted in a 64% rate of response, compared with 20% for placebo; side effects were not marked.26
In 2001, a large double-blind study of patients resistant to citalopram compared adjunctive bupropion with buspirone. Both adjuncts were associated with improvement, but bupropion (not available as an antidepressant in Australia) was superior and better tolerated (there was no comparison group of patients continuing on citalopram only).20 These studies do not constitute persuasive evidence in favour of antidepressant combinations.
There is little evidence to support use of antidepressant combinations. Risk of toxicity and drug interactions mandate that combinations be used as a last resort, and only in specialist settings.
Combining antidepressant treatments
Although there are advocates for combining antidepressants with different receptor profiles for presumed added efficacy, there is scant scientific evidence for the effectiveness of such combinations over treatment with a single efficacious drug. In contrast, there is an abundance of data on toxic and fatal interactions, especially those that lead to cardiac arrhythmias, or the serotonin syndrome. In due course, there may be support for the use of some combinations in particular circumstances, but the balance of evidence at this time suggests that there may be increased risk to the patient with doubtful increased benefit. Augmentation of antidepressant response with drugs like lithium may be an option in patients whose response is otherwise inadequate.
Objective: Many patients with depression remain poorly responsive to antidepressant monotherapy. One approach for managing treatment-resistant depression is to combine antidepressants and to capitalize on multiple therapeutic mechanisms of action. This review critically evaluates the evidence for efficacy of combining antidepressants. Method: A MEDLINE search of the last 15 years (up to June 2001), supplemented by a review of bibliographies, was conducted to identify relevant studies. Criteria used to select studies included (1) published studies with original data in peer-reviewed journals, (2) diagnosis of depression with partial or no response to standard treatments, (3) any combination of 2 antidepressants with both agents used to enhance antidepressant response, (4) outcome measurement of clinical response, and (5) sample size of 4 or more subjects. Results: Twenty-seven studies (total N = 667) met the inclusion criteria, including 5 randomized controlled trials and 22 open-label trials. In the 24 studies (total N = 601) reporting response rates, the overall mean response rate was 62.2%. Methodological limitations included variability in definitions of treatment-resistant depression and response to treatment, dosing of medications, and reporting of adverse events. Conclusion: There is limited evidence, mostly in uncontrolled studies, supporting the efficacy of combination antidepressant treatment. Further randomized controlled trials with larger sample sizes are required to demonstrate the efficacy of a combination antidepressant strategy for patients with treatment-resistant depression.