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Discussion Starter · #1 ·
I've probably posted/asked about this before, but my memory sucks, so ... patience please.

I see a lot of people turning to maoi's on this site, nardil in particular, and I think that's awesome. And I'd like to tap into the collection of minds here that must from time to time consider how the drugs and their minds cooperate and, of main importance, how to maintain efficacy.


So here it is: What are the mechanisms underlying maoi crap-out?
Seems like, if it were just due to tolerance caused by across-the-board down-regulation, then I could just increase the dose and it would work again. Not the case. With both nardil and parnate, there comes a point -- usually some months in -- when continuing to use the med not only doesn't help, it actually hurts things. I get what looks like low, low-grade serotonin-syndrome: fever, myoclonic jerks galore, hyper-sensitivity to every form of stim, ridiculous angst, and general malaise.

So, what have you got? What have you heard? Any solid empirical ground to stand on? Any educated guesses? Anything?
Thanks.
 

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continuing to use the med not only doesn't help, it actually hurts things. I get what looks like low, low-grade serotonin-syndrome: fever, myoclonic jerks galore, hyper-sensitivity to every form of stim, ridiculous angst, and general malaise.
Does this ever go away or does it continue? Or is it so intolerable you have to terminate the dose increase no matter what? Which MAOI are we talking about that this happens?
 

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Discussion Starter · #3 ·
The crap-out/overload phase is so horrible that I have to quit maoi's altogether for at least a few weeks.
It has happened with nardil (60 mg after several months of titrating up) and parnate (about the same amount and time frame).
When I quit during this time I get tremendous relief, but it's just the relief of returning from otherworldly angst to normal suck. I've tried coming back on at 7.5 mg nardil after 4-5 weeks off and what I get is some very immediate efficacy -- no higher dose or time necessary. But it only lasts a couple of days this time, and then I'm back in the suck and have to quit.
 

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Discussion Starter · #4 ·
If maoi crap-out is so common and so many people here use or have used these meds, then people have to be considering these questions.

The only thing that I've heard so far has to do with the enteric coating. That could make some sense as far as absorption and initial efficacy, but why would it cause the drug to work for several months and then do more harm than good?

I'm still experimenting with these meds, keeping my own kind of data. I'll try to attach it some point.

Really any thoughtful feedback can only help me and fellow maoi-users.
 

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sorry to hear about the crap out, did you get any efficacy during your nardil try? (how long and what dosage before crapping out)

One thing that has helped me is to augment it with lamictal, its quiet safe and I feel much better. I have been going up and down between 45mg 53mg 60mg and it seems 53mg is where i get the most relief and at 45mg i sleep better but it seems like it doesn't work so dosage is very tricky with this drug, just saying
 

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I'm not so sure about lamictal being safe. When I tried it I completely lost my sense of smell (anosmia) and thus also the ability to taste food. I was afraid to ever touch the stuff again after that. Food is pretty much the only thing in my life that makes it worth living. I'm not even sure my sense of smell/taste ever went completely back to normal. Be careful with that stuff.
 

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I'm sorry to hear about your lamictal experience but just being around these boards and reading a lot of reviews about its perhaps one of the most benign drugs out there and of course no drug will work for everyone but if you suspect even a small case of bipolarity it is a very safe drug to try (have to be careful not to titrate up too fast). For me it has done a good job and no side effects and I know many MAOI users in person as well as these boards who find it very effective to augment nardil/parnate with lamictal.
 

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Perhaps try a lower dose and keep it steady even if there isn't an obvious benefit at first.

You might consider a mood stabilizer approach to antidepressants i.e. Lamictal, lithium, and unfortunately antipsychotics like seroquel or abilify.
 

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I would definitely be curious to know what brand of Nardil you were/are taking. For me anyways, I can definitely tell a difference between if I've taken Greenstone/Pfizer brand or Gavis brand for my daily dose of Nardil. But contrary to what I've said in the past, I actually kind of think Greenstone feels stronger at least kicking in initially after dose (like more is immediately converted to PEA or something.. idk, just a theory.)

Anyways, Caedmon, I had a question for you relating to this MAOI burn-out topic :) Do you think it's perfectly safe to start immediately at 50mg daily of Lamictal in conjunction with Nardil, as my psych has told me to? Admittedly when she asked if I'd been on Lamictal before without problems I said yes but forgot she probably meant up to a therapeutic dose and for longer than a week's time lol ;P
 

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I would definitely be curious to know what brand of Nardil you were/are taking. For me anyways, I can definitely tell a difference between if I've taken Greenstone/Pfizer brand or Gavis brand for my daily dose of Nardil. But contrary to what I've said in the past, I actually kind of think Greenstone feels stronger at least kicking in initially after dose (like more is immediately converted to PEA or something.. idk, just a theory.)

Anyways, Caedmon, I had a question for you relating to this MAOI burn-out topic :) Do you think it's perfectly safe to start immediately at 50mg daily of Lamictal in conjunction with Nardil, as my psych has told me to? Admittedly when she asked if I'd been on Lamictal before without problems I said yes but forgot she probably meant up to a therapeutic dose and for longer than a week's time lol ;P
I guess your doctor can absorb that liability, but it wouldn't bother me to start at 50. :)
 

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I attribute the loss of effect mostly to two things with MAOI; tolerance and minor hypomania.

Tolerance do grow with MAOIs for the majority of users, the longer you're on it the more apparent this becomes. I do find there's still therapeutic effects in play even if tolerance grows potently, but it becomes less effective. I have to take a higher dose the longer I'm on it. That's why there's a need to drop dosage or quit the medication for a few days or week every now and then, to lessen the tolerance. As tolerance grows, less and less of the substance reaches the region in the body where it gives the useful effects.

A lot of people do also have minor or full blown hypomania with MAOIs, this period can last from a few days or many months, when this disappears people believe its pooped out, which is not the case. Hypomania was never meant to be the therapeutic effect of the drug. Many people don't even know they're a little hypomanic, because life feels so good and natural. I believe these two routes are many that experience, but they don't even know it. And then they scream furiously; MAH MAOIS POOPED OUTZ!!!

Of course there are other reasons as well, but most people can be put in either of these two categories.
 

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Discussion Starter · #12 ·
Thanks for the ideas.

Lamictal supplementation is an idea that I'm considering. It was something that was suggested to me at one point by a 2nd opinion doc way back, but I remember I shut that down pretty fast. I told her that I had tried it once before as a stand-alone and it didn't help then so I saw no reason to believe that it would help as a supplement. But I also remember that I didn't stick with lamictal too long. It didn't make me feel bad per se, just different, and I needed something to give me pretty immediate relief, so I quit after about a week. That's all I remember.

So, why do so many people use it to supplement maoi's? What's the mechanism supposed to be? I guess that I could see it maybe preventing those ultra-suck, hyper-sensitivity phases of maoi use for me.

I'm a little worried about memory and focus with lamictal though. I already take lyrica, so I know what a med can do to your cognitive abilities.

As far as different brands of nardil are concerned, I tried both of the major ones distributed in the US and remember beginning a search for another non-domestic brand, but for some reason I never finished it. There might be something to the brand business, but I couldn't tell the difference because I was going through such abrupt, distinct phases with nardil as time passed anyway -- I couldn't get a stable feel for it.
 

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I wouldn't be overly concerned with the brands of Nardil. having been on gavis and greenstone both and as of recently switching between the two frequently at equal doses to compare effect, there really isn't much of one that I can discern.

Did you go through with the Lamictal supplementation, Govinda? If so please keep in touch with me :) i'm highly curious to know how it goes.
 

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So, why do so many people use it to supplement maoi's? What's the mechanism supposed to be?
Lamictal modulates voltage sensitive sodium channels. It modulates electrical neurotransmission of the brain cells (as opposed to chemicals like serotonin, dopamine, etc). The electrical impulse kind of travels down the axon and pops the chemical neurotransmitters out the other end. (Kinda.) If the impulses are firing nicely, then the chemicals pop out the way they should.

Adding a medication that works in a different way can round out the crazy-med package.

I think I got that right. You might want to audit it.

2) Lamictal reduces glutamate release. I guess that's a good thing. I'm still trying to understand it. Anyway - again, it's another angle to treat depression.
 

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Discussion Starter · #15 ·
I haven't done the lamicatal supplementation yet. I've been in the thick of trying to make an maoi switch from parnate to nardil -- a move of desperation really.

I'm about to decide where to live, whether or not to stay with my girlfriend, and what I can do with my life, so I really desperately want to feel at least relatively calm and interested in life. I was hoping to ride the effects of nardil through this transitional phase and then switch back to something else once it almost inevitably craps-out.

But it's not working that well. I'm sitting in a library right now and every time someone walks by my head automatically points somewhere else and I pretend to be deep in thought. Even tiny, casual nothing encounters are making me panic: just a few hours ago I felt like I was going to vomit or cry when I was faced with the proposition of asking the gas station clerk for $8 at pump 7. And I'm in that place where just imagining social encounters makes me nervous.

I think that I once again overshot some neurochemical balance. Here's the concise version of my past few pharmaceutical months:
parnate crashes after 3-5 months of being helpful; try to wash-out for a month but can't stand to be off maois for more than a couple weeks (think there are some really ****ty rebound effects going on here); inch back onto parnate from time to time, usually 2.5 - 10 mg; I get some warm glowing feelings for a day or two and get excited, then the over-serotonined feelings described above; switch over to nardil, try 7.5 mg or less/day; this actually works for 7-8 hrs for the 1st couple days, I feel calm, even, interested in life (not ecstatic or manic though); then the same cycle. And that's where I'm at today. I felt horrible on the way over here and couldn't decide if it's because I didn't have enough nardil or had too much (I only had 7.5 mg yesterday).

I feel so crushed. Nardil is such a tease with me. Maybe I'll work it out though.
 
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