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What Causes Mood Swings While On Nardil?
Question: I know it's an older medication with lot's of precautions but I'm considering Nardil. Currently taking effexor xr and my biggest issue is feeling extremely cold emotionally and socially detached.
I've read Nardil is less likely to do this. Thoughts?
I've read Nardil is less likely to do this. Thoughts?
Brief Answer:
You are right
Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.
You are right in saying that MAOI, the oldest category of antidepressants, have less propensity to cause emotional coldness and social detachment. In addition they are found good in individuals who fail to respond to newer class of antidepressants such pristiq, effexor, lexapro and others.
Having said this I feel you need to consider the side effect profile of Nardil as you will need to follow a long list of precautions in compare to newer medications.
I take this opportunity to consider the option of wellbutrin among the newer antidepressants as it has less possibility of causing this side effects which are of your greatest concern.
I hope this helps you.
I will be glad to answer you further.
Thanks and regards.
You are right
Detailed Answer:
Dear XXXXXXX
Thanks for using Healthcaremagic.
You are right in saying that MAOI, the oldest category of antidepressants, have less propensity to cause emotional coldness and social detachment. In addition they are found good in individuals who fail to respond to newer class of antidepressants such pristiq, effexor, lexapro and others.
Having said this I feel you need to consider the side effect profile of Nardil as you will need to follow a long list of precautions in compare to newer medications.
I take this opportunity to consider the option of wellbutrin among the newer antidepressants as it has less possibility of causing this side effects which are of your greatest concern.
I hope this helps you.
I will be glad to answer you further.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Doctor. I have tried Wellbutrin both with an SSri and with the lamictal I take regularly. It had some helpful attributes but was not sufficient to offset the side effects. That would be a different post about Wellbutrin.
Is cross-tapering possible at all or is a complete wash out of all other drugs, including Lamictal, necessary before starting. I've heard they have relaxed some of the restrictions.
Also, is there a way to predict my reaction to Nardil based on past performance with other drugs? I've tried most and I'm extremely sensitive to meds. Serotonergics can have strange side effects, but non-serotonergic drugs tend not to help with anxiety, night terrors, and ultimately mood.
Is cross-tapering possible at all or is a complete wash out of all other drugs, including Lamictal, necessary before starting. I've heard they have relaxed some of the restrictions.
Also, is there a way to predict my reaction to Nardil based on past performance with other drugs? I've tried most and I'm extremely sensitive to meds. Serotonergics can have strange side effects, but non-serotonergic drugs tend not to help with anxiety, night terrors, and ultimately mood.
Brief Answer:
You need a wash out period
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
Unfortunately we are not in position to predict wither effects or side effects in precise manner. This is because we have no experience of using MAOI in past. Infact nardil is very different medication in compare to newer antidepressants. It acts on mono amine oxidase and thus increases level of all near transmitters metabolised by this which includes dopamine, serotonin and noradrenaline.
Regarding wash out yes you need to discontinue all antidepressants before trying Nardil. The Lamictal can be continued as it does not have potential interaction with Nardil.
I hope this assists you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
You need a wash out period
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
Unfortunately we are not in position to predict wither effects or side effects in precise manner. This is because we have no experience of using MAOI in past. Infact nardil is very different medication in compare to newer antidepressants. It acts on mono amine oxidase and thus increases level of all near transmitters metabolised by this which includes dopamine, serotonin and noradrenaline.
Regarding wash out yes you need to discontinue all antidepressants before trying Nardil. The Lamictal can be continued as it does not have potential interaction with Nardil.
I hope this assists you further.
If you have any further query, I would be glad to help you.
If not, you may close the discussion and if possible you may rate the answer for my future patients.
In future if you wish to contact me directly, you can use the below mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I am doing some research on Nardil and moclobemide (which is not available in the US) while waiting to start treatment with my new doctor.
In the meantime I want to exhaust all the possibilities with effexor before the withdrawl process. I am guessing that increasing the dose of effexor will neither solve my loss of libido or emotional coldness.
I am adding on some (5 mgs bid) buspar just to see what happens. Typically buspar ends up making me extremely irritable and somewhat sad after a week or so of taking it. I'm not sure if it is the metabolite or some other mechanism of the drug.
I guess I'm hoping it will help with apathy and the coldness. Also I have been taking stimulants to help with mood/concentration for a couple months and I am drinking too much on them. Buspar has always helped my reading and concentration and hopefully I can take the adderall or ritalin less.
Can I expect to have a different reaction with buspar this time on the effexor? I'm a little afraid of overstimulation from the combined NE actions.
In the meantime I want to exhaust all the possibilities with effexor before the withdrawl process. I am guessing that increasing the dose of effexor will neither solve my loss of libido or emotional coldness.
I am adding on some (5 mgs bid) buspar just to see what happens. Typically buspar ends up making me extremely irritable and somewhat sad after a week or so of taking it. I'm not sure if it is the metabolite or some other mechanism of the drug.
I guess I'm hoping it will help with apathy and the coldness. Also I have been taking stimulants to help with mood/concentration for a couple months and I am drinking too much on them. Buspar has always helped my reading and concentration and hopefully I can take the adderall or ritalin less.
Can I expect to have a different reaction with buspar this time on the effexor? I'm a little afraid of overstimulation from the combined NE actions.
Brief Answer:
I think NO
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I understand that you are having multiple trial with buspar and the results were disappointing over the period of time. Although there is no such metabolism but it is possible that you are slow responder and you developed side effects after a long time.
Having said this in my view there is much more possibility for similar reaction as in past irrespective of presence of effexor or not. I am of this opinion because irritability and over activation are the known side effect of Buspar and in my view they will not be stopped in presence of other medications provided other medians have antagonistic properties.
I hope this clarifies further.
Thanks and regards.
I think NO
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I understand that you are having multiple trial with buspar and the results were disappointing over the period of time. Although there is no such metabolism but it is possible that you are slow responder and you developed side effects after a long time.
Having said this in my view there is much more possibility for similar reaction as in past irrespective of presence of effexor or not. I am of this opinion because irritability and over activation are the known side effect of Buspar and in my view they will not be stopped in presence of other medications provided other medians have antagonistic properties.
I hope this clarifies further.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
THANKS.
I stopped the buspar after some pretty nasty anger after two days. It must be the metabolite given how quick it manifested. One definite upside is that I notice a desire to exercise. Not sure what component of the buspar is responsible for that but I would love to find out. Other 5ht1-a agonists (viibryd, brintellix) didn't have that kind of effect. Perhaps it is from the DA or NE action? Thoughts?
Also, I am closer to deciding on a MOA inhibitor. Have you found it useful in cases of borderline personality and/or complex trauma?
Is Nardil the way to go or should I try parnate/emsam patch?
I stopped the buspar after some pretty nasty anger after two days. It must be the metabolite given how quick it manifested. One definite upside is that I notice a desire to exercise. Not sure what component of the buspar is responsible for that but I would love to find out. Other 5ht1-a agonists (viibryd, brintellix) didn't have that kind of effect. Perhaps it is from the DA or NE action? Thoughts?
Also, I am closer to deciding on a MOA inhibitor. Have you found it useful in cases of borderline personality and/or complex trauma?
Is Nardil the way to go or should I try parnate/emsam patch?
Brief Answer:
It is most probably dopamine
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I am glad to know that the nasty anger episodes are almost over and you are moving on positive direction.
The second point "One definite upside is that I notice a desire to exercise" is most prabaly due to dopamine as the increased energy and increased desire for any pleasurable activities is contributed by dopamine neurotransmitter.
The usefulness of MAI in complex trauma is well experienced and I am lucky to have one patient but I never used in pure borderline personality disorder. It must be effective in neurotic symptoms in addition to anxiety. There is some evidence in favor of controlling anger by MAOI.
Having said this I will prefer the patch over the tablet as it ensures optimum concentration of medication along with option of stopping it immediately when required.
I hope this answers you appropriately.
In case you have any further questions use my url and post directly to me.
This will ensure continuity of care and regularity of service.
My url is http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Wish you great health ahead.
Thanks and regards.
It is most probably dopamine
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me.
I am glad to know that the nasty anger episodes are almost over and you are moving on positive direction.
The second point "One definite upside is that I notice a desire to exercise" is most prabaly due to dopamine as the increased energy and increased desire for any pleasurable activities is contributed by dopamine neurotransmitter.
The usefulness of MAI in complex trauma is well experienced and I am lucky to have one patient but I never used in pure borderline personality disorder. It must be effective in neurotic symptoms in addition to anxiety. There is some evidence in favor of controlling anger by MAOI.
Having said this I will prefer the patch over the tablet as it ensures optimum concentration of medication along with option of stopping it immediately when required.
I hope this answers you appropriately.
In case you have any further questions use my url and post directly to me.
This will ensure continuity of care and regularity of service.
My url is http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386
Wish you great health ahead.
Thanks and regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thank you...
1) If not MOAI, what do you prefer with Borderline patients? I know that therapy is a big part, but combined with the trauma there is a lot of anxiety, obsessiveness, rage, cognitive disturbances, dissociation, and night terrors that aren't helped by therapy. I know lamictal is popular but after 10 years it seems to have turned on me and I get adverse effects. Most of the antipsychotics worsen my dissociation and lack of apathy.
2) my understanding is that emsam is a transdermal version of parnate? And parnate is more focused on DA and NE than serotonin. Am I correct? I haven't done well with NE-focused drugs such as desipramine, cymbalta, serzone, etc., which is why I was thinking Nardil, even though it has more side effects. Is my thinking correct here?
1) If not MOAI, what do you prefer with Borderline patients? I know that therapy is a big part, but combined with the trauma there is a lot of anxiety, obsessiveness, rage, cognitive disturbances, dissociation, and night terrors that aren't helped by therapy. I know lamictal is popular but after 10 years it seems to have turned on me and I get adverse effects. Most of the antipsychotics worsen my dissociation and lack of apathy.
2) my understanding is that emsam is a transdermal version of parnate? And parnate is more focused on DA and NE than serotonin. Am I correct? I haven't done well with NE-focused drugs such as desipramine, cymbalta, serzone, etc., which is why I was thinking Nardil, even though it has more side effects. Is my thinking correct here?
Brief Answer:
Pleaser read below
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me with relevant questions.
Regarding treatment choices in borderline patients SSRI group of medications are my first choice. I understand that they have their limitations but for anxiety, obsessive symptoms, aggression and dissociation they are my first choice. Sometime when it is absolutely necessary I add low dosage of be benzodiazepines such as clonopin or xanax.
Yes the antipsychotics are also used but I use them as last resort as the anxiety symptoms are often get worsen with use of most antipsychotics.
Regarding your next question, Emsam (slegeline), parnate (tranylcyppromine) and nardil (phenelzine) are different medications although from the same group. Among these I feel emsam is better option as it has selective MAOI inhibitor in compare to other two molecules which are non selective. The mechanism of action is with dopamine and noradrenaline and there is no action over serotonin. The same is not true for nardil and parnate as they have some serotonergic properties.
I need to acknoeldge here that not acting of NE drugs in the past from different category is not a point when we use MAOI inhibitors such as Wmsam. This is because here the mechanism is completely different and there is potential to have positive outcome.
I hope this helps you further.
Thanks and regards.
Pleaser read below
Detailed Answer:
Dear XXXXXXX
Thanks for reverting back to me with relevant questions.
Regarding treatment choices in borderline patients SSRI group of medications are my first choice. I understand that they have their limitations but for anxiety, obsessive symptoms, aggression and dissociation they are my first choice. Sometime when it is absolutely necessary I add low dosage of be benzodiazepines such as clonopin or xanax.
Yes the antipsychotics are also used but I use them as last resort as the anxiety symptoms are often get worsen with use of most antipsychotics.
Regarding your next question, Emsam (slegeline), parnate (tranylcyppromine) and nardil (phenelzine) are different medications although from the same group. Among these I feel emsam is better option as it has selective MAOI inhibitor in compare to other two molecules which are non selective. The mechanism of action is with dopamine and noradrenaline and there is no action over serotonin. The same is not true for nardil and parnate as they have some serotonergic properties.
I need to acknoeldge here that not acting of NE drugs in the past from different category is not a point when we use MAOI inhibitors such as Wmsam. This is because here the mechanism is completely different and there is potential to have positive outcome.
I hope this helps you further.
Thanks and regards.
Note: For further guidance on mental health, Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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