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post #21 of 244 (permalink) Old 02-05-2010, 02:21 PM
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Originally Posted by Ehsan View Post
SAD is shown to depend on various neurotransmitters, receptors, hormones, neuropeptides, special brain regions, amino-acids, enzymes ...

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.
why not?
It may act on receptors we arent aware off, i disagree that for example prozac+wellbutrin+gabatril would be as effective as nardil because you cover the same neurotransmitters.

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post #22 of 244 (permalink) Old 02-05-2010, 02:42 PM
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It may act on receptors we arent aware off, i disagree that for example prozac+wellbutrin+gabatril would be as effective as nardil because you cover the same neurotransmitters.
every drug do something that we don't know

nardil release DA. there are many meds that are more potent than nardil.
nardil increase serotonin level. there mre than 50 meds that do this with higher potency

on the other hand there are many things that nardil can't do.
for example nardil can't affect CRF, Oxytocin, NMDA receptors, cortisol, GHB receptors ...

how many papers have compared nardil with other meds? when?
almost all of papers are considering monotherapy. how many papers have evaluated combination of three or more meds in SAD?
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post #23 of 244 (permalink) Old 02-05-2010, 03:23 PM
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The what combo would you consider as effective as nardil? (with amphetamines, benzo's etc ruled out, as i do beleive those are more effective, but some ppl dont want addictive meds).

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post #24 of 244 (permalink) Old 02-05-2010, 04:11 PM
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The what combo would you consider as effective as nardil? (with amphetamines, benzo's etc ruled out, as i do beleive those are more effective, but some ppl dont want addictive meds).
i haven't any answer yet. also nardil isn't available in my country so i can't compare my experiences with it.

nardil is likely more effective than everything i've tried to date but it's almost impossible that we can't find some combination better than it. the reasons are clear
1) nardil does not affect many neurotransmitters, receptors, hormones, neuropeptides ...
2)nardil is not selective at various subtype of one recptor(e.g. various 5-HT receptors)
...

anyway, nardil has helped many peoples with severe SAD who didn't respond to other meds and is likely the best for monotherapy in SAD.
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post #25 of 244 (permalink) Old 02-05-2010, 04:52 PM
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Nardil may be effective but the side effects make it suck. I have no doubt a much more effective combination than Nardil could be put together. Combinations are the best IMO, instead of pushing one "system" (e.g. serotonin) to the extreme and incurring side effects, you can use lower doses of each component and balance it perfectly. Assuming it's done safely. Meds like Nardil may affect multiple systems but the balance/ratio will always be rigid and not open to adjustment.


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post #26 of 244 (permalink) Old 02-05-2010, 09:20 PM
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I'm not really convinced that there's a combination of non addictive meds that can match nardil, ive been reading about combo's too and never found one with seems to have the same high succes rate.

Considering that Nardil completely abolishes SA in those that respond to it, id say that the neurotransmitter ratio's are 100% perfect.

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post #27 of 244 (permalink) Old 02-06-2010, 02:54 AM Thread Starter
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Its good in theory to grab a handfull of different meds and mix up your own cocktail, but the reality of it is that as soon as you start doing so you increase the chance of drug interactions.

Added to that, you also have concerns about tolerance, even if you find a mix of 3 meds that work, you have 3 different drugs you can develop a tolerance to and if one stops working then the whole mix is down the drain.

As for the neurotoxicity of benzos, I will admit that the issue does seem to be up in the air, but here is a thread discussing it

http://www.bluelight.ru/vb/showthread.php?t=360514
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post #28 of 244 (permalink) Old 02-06-2010, 09:02 AM
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I personally do beleive that things like benzo's, amphetamines etc are long term solutions, but those meds are not for everyone, and not everyone wants to be on such meds, the alternative for them is Nardil.
I'm 100% sure you cant recreate nardil with mixing other non addictive meds, garbage+garbage= still garbage.

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post #29 of 244 (permalink) Old 02-06-2010, 09:25 AM
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Selegiline + clonazepam + escitalopram? None of those are seriously mentally addictive like opioids or stimulants. Nardil is just a mix of various mechanisms of action, if drugs are combined to replicate them, the same effects can be achieved.


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post #30 of 244 (permalink) Old 02-06-2010, 09:35 AM
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Originally Posted by zendog78 View Post
Its good in theory to grab a handfull of different meds and mix up your own cocktail, but the reality of it is that as soon as you start doing so you increase the chance of drug interactions.
If meds are added individually, increased slowly starting with a low dose, and then kept at a constant dose, there shouldn't be any problematic drug interactions. Assuming you don't combine any obviously bad interaction drugs, and monitor the effects closely so you can adjust dose if necessary due to metabolic interactions. Once a constant dose is reached for all everything should become stable.

Quote:
Added to that, you also have concerns about tolerance, even if you find a mix of 3 meds that work, you have 3 different drugs you can develop a tolerance to and if one stops working then the whole mix is down the drain.
But the same would apply to tolerance forming to individual components of Nardil's mechanism of action.


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post #31 of 244 (permalink) Old 02-06-2010, 10:48 AM Thread Starter
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Nardil has a reputation for not causing tolerance and even when it does occur it seems like a short drug holiday will restore the effects.
There are people who have been taking it for 30 years plus and it still works unlike ssri's.
Why do you think there continues to be a market for several new antidepressants every year? Because they are they are ineffective and you develop tolerance to them.
The longest I ever had anything work was citalopram which worked great for about 5 months and then ok for about another 8 months. I also believe citalopram left me with permanent tardive dyskenesia.
I had such a hell of a time getting off it, I tried so many times and I went crazy every time I stopped, nobody told e about withdrawl...****ing doctors.
I remember when I did get off them I was walking down the street and I was thinking "man, I feel so depressed" and then I stopped and went wow, I feel depressed, I actually feel something!
Nasty nasty life numbing drugs

Nardil on the other hand, one thing I noticed is that I can not just feel emotions instead of being emotionally anesthetized, I feel more fully.
When I have felt sad, appropriately so because of a movie, sad news whatever, I feel a deeper more complete more full sadness. A healthy kind of sadness, I guess sadness minus the distress.
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post #32 of 244 (permalink) Old 02-06-2010, 11:27 AM
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Originally Posted by euphoria View Post
Selegiline + clonazepam + escitalopram? None of those are seriously mentally addictive like opioids or stimulants. Nardil is just a mix of various mechanisms of action, if drugs are combined to replicate them, the same effects can be achieved.
I highly doubt it, i have a huge "hall of ****" in my basement, a room were i throw all meds that i consider garbage, and i threw in selegiline and escitalopram there a long time ago, and from what ive read, the meds that are in my hall of **** are even worthless in combination.

My hall of fame is a differend story. Even Nortriptyline is in my hall of fame because it has some potential in combination with other meds.
Nortriptyline+MAOI+Amphetamine is probably the most effective combo for depression.

Disclaimer: I am not a professional, all my advice is based on my own research and experiences.

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post #33 of 244 (permalink) Old 02-06-2010, 11:49 AM Thread Starter
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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?

Alcohol
(great, the most harmful addictive drug known to man after tobacco)
Clonazepam ( well noted for its tendency to cause depression with long term use)

Amphetamines
(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.
Quote:
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.

Quote:
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.
http://www.mja.com.au/public/issues/..._pgfId-1091868

Quote:
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.
http://www.australianprescriber.com/...e/22/5/108/11/

Quote:
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.
http://cat.inist.fr/?aModele=afficheN&cpsidt=13857143
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post #34 of 244 (permalink) Old 02-06-2010, 12:03 PM
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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?

Alcohol
(great, the most harmful addictive drug known to man after tobacco)
Clonazepam ( well noted for its tendency to cause depression with long term use)

Amphetamines
(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.





http://www.mja.com.au/public/issues/..._pgfId-1091868



http://www.australianprescriber.com/...e/22/5/108/11/


http://cat.inist.fr/?aModele=afficheN&cpsidt=13857143
seems you are trying to prove 2+2=5
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post #35 of 244 (permalink) Old 02-06-2010, 02:44 PM Thread Starter
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Ba? Wa?
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post #36 of 244 (permalink) Old 02-07-2010, 10:28 AM
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How about Parnate + Lyrica? I'm going to give that one a go very soon.
Pregabalin seems interesting. increases GABA and decreases glutamate.two goals with one stone!
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post #37 of 244 (permalink) Old 02-07-2010, 10:31 AM Thread Starter
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That could be a very good combo I think, give it a go. I found Parnate helped a lot with my anxiety but it made me depressed (go figure). I kinda of enjoyed it though as I had this deadpan wit and a "I don't give a ****" persona.
Very very reactive to tyramine, heaps more than nardil so be carefull
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post #38 of 244 (permalink) Old 02-07-2010, 11:04 AM
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Who knows! Maybe if it works then I won't have to resist infatuation anymore! YAY!
Why are you doing that, by the way?


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post #39 of 244 (permalink) Old 02-07-2010, 01:41 PM
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Good luck with the Parnate.


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post #40 of 244 (permalink) Old 02-07-2010, 02:41 PM
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Short answer: Too socially anxious. (LSAS 130+, can't get out of home without 3-4 mg Xanax + 40 mg Inderal).

I'm failing miserably because I know deep inside that this is one of those once-in-a-lifetime chances. I HOPE that Parnate works.
dude, i didnt know what u meant about that until u clarified....i can totally feel you man. this has happened to me multiple times, sometimes its not so obvious, but other times it would become really clear what i was missing/avoiding, its so painful dude. especially when its only anxiety, that causes me to throw amazing opportunities down the drain. I really hope the Parnate works 4 you too.

Because I know that here today, the Black Knights,..... will emerge victorious, once again.
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