Nine years on Nardil - Social Anxiety Forum
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post #1 of 175 (permalink) Old 03-05-2006, 05:06 PM Thread Starter
 
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Nine years on Nardil


I take an MAOI (Nardil) that does a marvelous job of alleviating chronic mild depression (a.k.a dysthymia) and social anxiety. Iíve been on it for over 9 years so I have a lot of experience with it.

I began taking it primarily to alleviate social anxiety. However, social anxiety and depression, in me, often seem to work in tandem, creating a vicious cycle which can make life very uncomfortable - and this dynamic duo had been putting me through the grinder for quite awhile.

When I first looked into medication treatments I began by trying a couple of the SSRIs. Unfortunately, they did little more than make me feel excessively wired, doing nothing for my SA whatsoever. After this, I became a bit more desperate and began digging deeper. In my research, I found material that spoke very positive things about the treatment of SA using MAOIs. I determined at that point, that if it was the last thing ever I did, I had to try it.

Unfortunately, the MAOIs are like the Desoxynģ (pharmaceutical methamphetamine occassionally used to treat ADHD) of anti-depressants. A ďlast lineĒ treatment. So lemmee tell ya - getting doctors to prescribe it is like pulling teeth. And this is a damned shame. As one psychiatrist put it, ďthe MAOIs are supremely effective anti-depressantsĒ. And when he says supremely, heís not being rhetorical.

So, I begged and pleaded - and pleaded and begged - with a couple of docs before landing a prescription. Once I got it, I had to wait a full six weeks (with fingers crossed) for it to work, but when it did - holey moley - the effect it had was astonishing. It vaporized my depression/social anxiety combo like a scrap ship around the perimeter of a south pacific nuclear test site. Finding Nardil was like finding the freakiní Grail. I found myself thinking things like ďFree at last! Free at last! Thank God Almighty, Iím free at last!Ē

Yessir, Nardil made a HUGE impression on me when I first took it. It energized me and allowed me to feel better than Iíd ever felt as an adult. Itís hard to describe in words what it was like to be able to go to parties and participate in things like play-acting games - to be able to let go, forget myself, act silly, and join in the fun. It was also awesome to have a group of friends throw me birthday parties for the first time in my life (because I actually had a group of friends to throw it.) And I could carry on conversations without feeling awkward, constantly thinking about myself, and wondering what to say. And it was great being able to go to job interviews without having my heart pound out of my chest, my palms sweat buckets, and my voice quaver.

As for me... I have an excellent tolerance of them - very minimal side effects. Less side-effects than I experienced with the SSRIs. At higher doses Nardil can even have a gentle soothing quality. (The increase in GABA?)

Another thing (and shhhh... donít tell anybody, especially my doctor) - but I eat whatever I want with impunity. Everything on the do not touch list - cheese, aged meats, chocolate, avacados, you name it. I discovered that I could do this by inadvertently eating a piece of cheese once. Realizing I had done this, I panicked a bit, then sat around waiting to die of a stroke. But, gee... no hypertensive reaction. Nothing. So I ate more cheese and still - nothing. After this experience, I gleefully put pizza back on the menu.

Over time, Iíve tried out all the other ďoff-limitĒ foods and noticed zero ill effects from any of them - with a couple exceptions: red wine gives me a very mild hypertensive reaction - and... at a fundraising event once, with *donated* beer, I drank half a glass from a keg that was flat and tasted slightly off. This, most definitely gave me a hypertensive reaction. (Tap beers apparently can be dangerous if thereís a buildup of fermentation.)

While foods are one thing, over-the-counter drugs are entirely another. A thoughtless moment found me swallowing a small cup of Nyquil when I was sick. I didnít check the label. Oops. It contains a number of ingredients that donít mix with MAOIs. Headache, lotsa sweating, and a noticeably increased heartrate were the result. I made it through o.k. - but the worst part is the anxiety - wondering if youíre going to, you know, die. Medical literature and doctors do their best to scare you - and this is doubtless for good reason. Not everyone is likely to tolerate them so well. (I read somewhere, that the actual number of people who have significant problems with food interactions are roughly 1 in 4. I also imagine that, if you are in poor health and at risk for stroke to begin with, an MAOI induced hypertensive reaction will break the camelís back.)

Iíve gone off my med a couple times in the past, feeling quite ďcuredĒ. But, sure enough, give it a couple months and there I am - lethargic, low energy, of mood most foul... and highly self-conscious around people once again. Totally bogus. A couple months of this and, forget it... Iím back on the meds. Like an ever valiant warrior, the MAOI charges back on the scene to subdue the twin spectres of depressed mood and social inhibition. What a champ!

I will add, however, that Nardil is not perfect. In and of itself, it wonít make your life a totally fabulous, all-the-time-happy bed of roses. Nor will it turn you into a ď10Ē on the social scale. And life will still have its vicissitudes. But it can very much assist you in finding a far more comfortable existence. Itís a boost. And, hopefully, the boost it gives will find you flowing into a better scene. Cuz, believe me, thereís nothing like a more extended social circuit to alleviate anxiety and quell depression. Thatís what youíre ultimately seeking. Increase your social circle, solidify friendships, and establish a sense of belonging - and youíll have found the worldís best anti-depressant. At least thatís been my experience.

Iíve kept Nardil around for 9 years because it continues to serve as buffer, boost, and brake. On really low maintenance doses it provides a bit of a buffer (Iím on a very low maintence dose about 90 - 95% of the time). When I need a boost, I boost it. And it most definitely will put the brakes on a more precipitous decline. This last aspect is actually one of itís nicer anxiety reducing effects. Just knowing that itís available and that it works, helps keep a lid on anxiety.

Anyway, thatís my word on Nardil after nine years. A++
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post #2 of 175 (permalink) Old 03-05-2006, 07:39 PM Thread Starter
 
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I'm new to this forum, having just discovered it a couple of days ago. I haven't dug around here too much, but I've been surprised to discover that there's not all that much posted about Nardil. In my experience it's been remarkably effective.

Also - since I've been on it for a bit over nine years without much trouble, it's "scary" reputation (to me) has long seemed overblown. Which is not to say ignore the warnings. Definitely heed the warnings - but one may find, over time, that the dreaded hypertensive reaction from eating the wrong foods appears virtually non-existent. Though I don't doubt that, for some people, it can be a big problem.

If I had more problems with food interactions than I do, I donít know if Iíd still be using them. It can be really hard to monitor exactly what you eat, especially when eating at restaurants. (and having to avoid common things like cheese will make other people curious - and you might not want to explain the reason why, for example, you donít eat pizza.) Also, you might be liable to do what I did and unthinkingly down something as seemingly benign as Nyquil. For me, this wasnít that big of a deal - headache and a bit of discomfort - but someone else might end up kicking the bucket. In general, it seems that if someone is at risk for a stroke to begin with - stay away from the MAOIs.

Anyway - I just had to write a post giving a big thumbs up for Nardil.
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post #3 of 175 (permalink) Old 03-05-2006, 07:41 PM
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I wish I could get a script for nardil =p




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post #4 of 175 (permalink) Old 03-05-2006, 07:57 PM Thread Starter
 
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You have to work at it. You have to make the decision, and take full responsibilty for it. I had to switch doctors and find someone more specialized. Even then I had to virtually get on my knees and beg. (Most doctors know very little about it beyond the worst-case scenarios they've heard. But heck - even with my experience, if I was a doctor, I'd be nervous about prescribing it, cuz you never know how it might turn out in another person.)

At the time I was seeking a prescription, however, I couldn't have cared less if Nardil was pharmaceutical PCP - once I'd read of it's efficacy, I was absolutely determined to get it. My social anxiety/depression had made life way too painful for way too long. To be honest, I was isolated, desperate, and near suicidal. I couldn't seem to find a way out. Potentially deadly food interactions? What the hell... I needed some relief. Period. And I found it.
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post #5 of 175 (permalink) Old 03-05-2006, 10:20 PM
 
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I went through many of the SSRI's, a benzo and an anti-psychotic before I was precribed Nardil, and it is the first medication that has made any difference, and a large one at that.


I love you Nardil
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post #6 of 175 (permalink) Old 03-06-2006, 05:44 PM
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Re: Nine years on Nardil


Quote:
Originally Posted by spaceboy
Unfortunately, the MAOIs are like the Desoxynģ (pharmaceutical methamphetamine occassionally used to treat ADHD) of anti-depressants. A ďlast lineĒ treatment. So lemmee tell ya - getting doctors to prescribe it is like pulling teeth.
I had a GP who was absolutely thrilled with the idea of making me his first MAOI patient ever. I declined to try Nardil, despite his extreme enthusiasm for it. My psychiatrist doesn't think much of MAOIs as an anxiety treatment, though the most effective pill for depression he thinks. I'm not sure what to think of Nardil. It's hard enough to find anyone who's ever tried it to get any feedback on it. Finding someone with 9 years on it is a first for me.
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post #7 of 175 (permalink) Old 03-06-2006, 07:04 PM Thread Starter
 
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Hello UltraShy,

Well, I've been digging through some of the older posts on this site and there's a fellow on here named "workman" who's been on it 16 years and relates his good experience with it.

I have to admit - I'm really surprised at how few posts there are on this forum regarding Nardil. For social anxiety and depression - the MAOIs rock. The SSRIs that I tried seemed like toys in comparison. Maybe-sorta-kinda antidepressants. With an old MAOI like Nardil, lemmee tell you, there ainít no half-steppiní and no messiní around. You wonít find yourself asking questions like ďGee... is it working yet?Ē. Nosirree. When Nardil kicks in - you know it. Nardil is p.o.t.e.n.t. And the best part of itís potency is that - hot diggity dog! You can finally be yourself around other people.

Look into the history of the MAOIs a bit and you'll have to wonder at the stats. Iproniazid (an MAOI, the very first drug marketed as an anti-depressant, and a chemical relative of Nardil) was first released in 1957.
(below I'm quoting from Listening to Prozac by Peter Kramer.)
"Approximately 400,000 depressed patients were treated with iproniazid in the first year. Unfortunately, 127 if these patients developed jaundice. Given the prevalence of viral hepatitis, this was probably a small number of cases for the population involved, but the manfacturer thought (wrongly) that it had a more potent antidepressant coming to market, so, rather than fight the bad publicity, it withdrew ipronizaid. Ipronizaids's reputation had been fatally tainted by the report of side effects, and it was never heard from again."

400,000 presciptions for an MAOI written in the first year. This was before doctors were even aware of the possibility of negative food interactions. In other words - no one was warned, and no one was being careful. And were people dying left and right from hypertensive crises? No. The drug was removed from the market because 127 patients developed jaundice and the manufacturer thought that there was a link.

There's no doubt that you can get a hypertensive reaction - but in my nine years, they've been very rare - and generally mild. You have to be either very susceptible to the "cheese reaction" - or already at high risk for a stroke.

I assume that doctors generally only hear "people have died from stroke!" having no idea what the actual numbers on it might be. So, whoooaaa! Scary, dangerous drug! Stay away! Let's try, um... prozac, or wellbutrin or something. It might not work for SA - but at least no one's died from eating cheese.

But dang. What a shame that its reputation is so bad. Because it works. It works really well. I've taken it for nine years, and paid for it out of pocket (I don't have insurance) for that reason, and that reason only.

<><><><><><>

Also, Nardil is a drug long off patent. There's very little economic incentive to promote it much or even study it. There's a little discussion of this at http://www.socialfear.com/ssri_failure_in_sp.html
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post #8 of 175 (permalink) Old 03-06-2006, 08:28 PM
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Well I've been thinking long and hard about MAOIs trying to find every bit of information about it on the internet. I'm trying to schedule an appointment to see a psychiatrist because I was told to go through one of them to get an MAOI perscription. The only thing that sort of holds me back from taking MAOIs is the diet restrictions. I do drink protein shakes since I workout in a gym on a regular basis and I really do like cheese especially if it's melted on a pizza or sandwich.

To Spaceboy: Did you have to give up eating some foods in order to try this medicine? Is eating a little cheese even off limits?

"Trying and failing is better than failing to try"
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post #9 of 175 (permalink) Old 03-06-2006, 08:49 PM Thread Starter
 
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First, a correction to my earlier post. The 16 year Nardil user I mentioned wasn't workman .... it's a forum member named Captain Woodchuck. Search for posts by him if you're curious.
<><><><><><><>

No Limit,
I mentioned my virtually non-existent problems with food interactions in my first post. Very, very few problems. Pizza, with extra cheese, please. Make it a large. I know what a hypertensive reaction is like, and I experience nothing of the sort when eating pretty much everything on the list.

I discovered my lack of food interactions during my first year and have been pretty non-chalant about it ever since. I don't know why I happen to be so lucky in this regard - I just am.

Like I said though, you'd be well advised to stick to the rules at first. Don't go flagrantly violating what your doctor tells because you read some guy on the internet saying he's had next to no problems with it. I suspect people are quite different in their tolerance levels.
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post #10 of 175 (permalink) Old 03-06-2006, 09:27 PM Thread Starter
 
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If you read some of the posts of Captain Woodchuck, you'll find him mentioning some of his experiences with food interactions and hypertension. He seems to have a bit less tolerance than I do. His posts might be better to pay attention to in this regard, cuz I don't know... maybe I just have an unusually good tolerance.

When I started investigating my food reactions, tiny bits at a time - eventually getting to the point where I pretty much gobble down anything - I have to admit, I started wondering "What? Is this a joke?" regarding all the scary stories I'd heard. When I first went on Nardil, my doc tried to put the fear of god in me. (and my first doc wouldn't even prescribe it.)

But, hey, once again - everybody reacts differently to these things. I have no doubt that the scary stories I've heard have actually happened to some people. For example, I was told by my psychiatrist of one woman who had a stroke from eating a bar of chocolate. I don't doubt that the story was true - and my psychiatrist told it to me for a very good reason.

However, jeepers... I eat chocolate all the time now. Entire bars. Large bars. Entire, large bars of dark chocolate with nuts and dried blueberries. Mmmmm. No headache. No sweating. No increased heartrate. Nothing. 8 and half years of this and I'm still alive.
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post #11 of 175 (permalink) Old 03-06-2006, 09:47 PM
 
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I didn't take nardil for 16 years. I did take it, but it caused all the nasty side effects all other AD's do for me. I didn't get any food interactions. I ate whatever, I did avoid really aged protiens. But beer from tap, cheese, stuff like that did bother me.
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post #12 of 175 (permalink) Old 03-06-2006, 09:49 PM Thread Starter
 
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Yeah, sorry. I confused you with Captain Woodchuck. My mistake. Ooops.
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post #13 of 175 (permalink) Old 03-07-2006, 12:38 AM Thread Starter
 
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Anyone interested in a more detailed description of side effects that I've experienced (those I had earlier on, but went away - and those I still experience)? Also - anyone interested in hearing about my "dosing strategy"?
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post #14 of 175 (permalink) Old 03-07-2006, 06:37 AM
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Sure. It'll probably help in my decision on whether to try out MAOIs.

"Trying and failing is better than failing to try"
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post #15 of 175 (permalink) Old 03-07-2006, 12:54 PM
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Quote:
Originally Posted by spaceboy
Also, Nardil is a drug long off patent. There's very little economic incentive to promote it much or even study it.
Nardil is about 45 years old, so the patent ran out decades ago, but there is still no generic version of it available. It's so rarely used that no generic drug company sees enough profit motive to try to make their own copy of it.
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post #16 of 175 (permalink) Old 03-07-2006, 12:59 PM
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Quote:
Originally Posted by spaceboy
Anyone interested in a more detailed description of side effects that I've experienced (those I had earlier on, but went away - and those I still experience)? Also - anyone interested in hearing about my "dosing strategy"?
Yes, I'm very interested. Please do tell. It's not likely I'm going to find anyone else with as much Nardil experience as you.

Two issues I'd be most interested in are any sexual side effects (which seems very common with the vast majority of ADs) and weight gain.

Also, what is this "dosing strategy" you speak of?

Thanks for any information you can provide.
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post #17 of 175 (permalink) Old 03-07-2006, 06:18 PM
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You are our current Nardil King. Good to hear that it helps you.

I'm interested in what Ultrashy mentioned. Esp. dosing since you seem to be able to get away with a fairly low dose (I understand that many people have to go up to 90 mg.) I'd also be interested if you +/- experienced side effects of sedation, hypomania, increased sweating, or dry mouth.

Drug-drug interactions worry me far more than the food restrictions. I am pretty much a walking pill, so anything as extreme as a monoamine oxidase inhibitor is going to be a massive lifestyle change. If I did go on an MAOI my first choice would actually be Parnate.

Medication-related posts are for brainstorming purposes only. Talk to your doctor.

My meds: Parnate, Lamictal, Wellbutrin, trazodone
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post #18 of 175 (permalink) Old 03-07-2006, 07:14 PM
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i did some research on many different sites and it seems that Nardil is even more effective than Klonopin, without the addictiveness!!! I am very curious as to how much you take and how many pills a day you have to take? Also, is it expensive?

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post #19 of 175 (permalink) Old 03-07-2006, 07:25 PM Thread Starter
 
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O.k. Here's a brief run down of side-effects.

To start with: They come in 15mg pills. The highest recommended dose is 6 pills daily, or 90mg. When I say ďhigher doseĒ in describing side effects, Iím referring to 4 - 6 pills a day, or 60mg to 90mg.

Push the dose up to 90mgs daily and, believe me, you can zap your social anxiety very effectively. Run of the mill chit-chat in social situations is effortless. Thoughts are freely available, and - whadda ya know - you can just say them as they pop into your head. (Hey, what a novelty!) Even with complete strangers, people Iíve just met at a party for example, I can be quite chatty and outgoing - joking and laughing.

I donít, however, particularly care to be on a high dose for too long because thatís obviously when I experience side effects the most. The worst of the side effects (for me) is insomnia. Get my dose up to 90mgs and sleeping can become a real problem. Not being able to sleep after youíve been awake for a long time (or only being able to sleep for a couple hours) is uncomfortable. You might feel worn out - but you can still lie in bed wide awake. Insomnia is a definite problem on higher doses.

Other side effects.

Weight gain - yes. Iím fortunate in that Iím naturally thin, so adding a bit of weight is not an issue. It almost makes me seem more appropriately ďfilled outĒ. Iím going to roughly guage my weight gain at about 10 pounds - from roughly 160 to 170lbs. When I first noticed the increase in weight, I wondered if it was going to stop, or if Iíd just keep adding the pounds. It leveled off after about 10 pounds, and over numerous years, my weight has been very stable. When Iíve gone off Nardil, sure enough, Iíve started shedding those extra pounds.

(Side effect thatís gone away) Sexual dysfunction. (male) This took somewhere in the neighborhood of 2 to 3 years to become less of a problem. Itís also a side effect that is way more noticeable on higher doses. Back in the day, on a higher dose, I could get an erection without problems, but orgasm was pretty, um... hard to come by. You might surprise a lady with your stamina... however, sheíll also wonder whatís going on. I havenít had nearly the problem with this in recent years than I did initially.

(Side effect thatís gone away) Standing up quickly and getting light-headed. (again, a higher dose issue) This was a side effect that was never entirely predictable - and something I havenít experienced in a long time - but I can recall experiencing it well into my 2nd year. Basically, itís like - if youíre sitting down and you suddenly get up... woooo... be careful. You can get seriously light-headed and dizzy. Youíll need to quickly sit back down again or you can keel over. I learned to be careful when standing up - doing it slowly, or in ďstagesĒ. For whatever reason, this side effect has entirely gone away. (I play softball in the summer, and have done so for 7 or 8 years, and Iíve never had a problem with dizzyness being caused by sudden movement while playing.)

Because of the increase of side effects (particularly insomnia), I reserve higher doses for special situations like parties or job interviews, or moving into a new job. Remember, for anti-depressants, it takes a little while for increased dosage to be felt, so you have to plan ahead. For example, if thereís a party Iím going to on Friday, Iíll start working my dose up a couple days in advance so that it ďpeaksĒ on the day of the party. (This is my ďdosing strategyĒ in a nutshell. Maintenance dose... boost when needed. But I have more to say about it, which Iíll post soon.)

Also, I'll add that after being on them for so long, their effect on me is well known and predictable. In other words, the gigantic, huge, glorious excitement I experienced when I first took them (from being able to socialize far more smoothly) is now a routine phenomena. And frankly, I get tired of taking the stuff. Hell, I got tired of taking the stuff after a few months. But I still do.

In taking any of these medications, you have to do a cost/benefit analysis. To me the benefits of greatly increased social comfort and better overall mood far outweighs the cost in terms of both money and side effects.
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post #20 of 175 (permalink) Old 03-07-2006, 08:32 PM
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jesus man, six friggin pills a day!!?? that seems like a lot for a single medication. what do you get like 180 pills at a time?

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