gollyned: Nardil / phenelzine MAOI protracted withdrawal

[gollyned]

Hi,

 

I'm trying to get off Nardil, an MAOI. I've seen only a couple other posters who've been doing the same. I've been having a very difficult time with this, and I've been trying for over 2.5 years, but have only started keeping records this year. This is the only medication I've had a difficult time getting off of, and I frequently wonder whether I will ever be free of this drug.

 

I started Nardil in April 2019. I gained sixty pounds by the end of the year. I tried to quit in December 2019/January 2020. I tapered over only a few weeks. That first taper was unsuccessful. I went on vacation, then went back to work in February 2022, and found that I could not work. I could not remember anything or get anything done, and I didn't know why. I even had a cognitive skills check done. I had to go back on Nardil, and after six weeks, I could be effective at work again, after harming my reputation.

 

I've had so many attempts at getting off Nardil since then, attempting with my doctor to cross-taper onto other medications, attempting to go slow and avoid withdrawal effects, throughout 2020, and all these attempts ended in disaster. I got a new psychiatrist in January 2021, and stabilized. It is only this year, in 2022, I've tried tapering with this doctor, and I'm going rather slowly, but still too quickly. At this point, I worry that I won't be able to complete the taper within a couple of years, at least, as reductions in dosage have tremendous effects on my cognition and emotions. Each dose reduction is especially difficult because I may not feel the full effects of the dose reduction until a week or two later.

 

I would do anything to get off this hellish medication, which is why I'm here. Nardil has, I'm convinced, cost me the most meaningful relationship of my life, with the obesity and drastic mood swings it has caused me over the years, eventually ending in an impulsive separation. Your support is appreciated.

[Altostrata]

Welcome, @gollyned

 

I see you have been tapering since mid-May. What are your current withdrawal symptoms?

 

We recommend a 10% exponential taper, see Why taper by 10% of my dosage?

Why taper? SERT transporter occupancy studies show importance of gradual change in plasma concentration

 

[gollyned]

Hi @Altostrata,

 

I recently decreased from 24.25mg to 23.6mg, which was apparently too fast for me, though I may have mismeasured a dose or something. I got extremely anxious and suddenly started pining for my ex, desperate to talk to her, when I had been doing fine for months. It was difficult for me to sleep or eat. This abated within a few days when I went back up to 26.375mg, as advised by my psychiatrist. I had been doing OK at that lower dosage, but one day, I drank a third cup of coffee, which seems to have set something off, and the anxious period started.

 

I've found only a few examples of Nardil tapers, so I'm hoping to add to the collection and help others who are having difficulty getting off this medication.

[Altostrata]

Suggest you start to taper your caffeinated beverage intake. It appears you have developed a sensitivity to caffeine.

 

We are well aware of how to taper Nardil, we just haven't published specific information about it. It would be a 10% per month taper like any other psychiatric drug, with the reduction calculated on the last dosage, not the initial dosage. This is an exponential reduction. (If you find information about other ways to taper Nardil, please send me a personal message.)

 

Are you also currently taking

Quote

Risperidone: 1.25mg, Clonazepam: 1.00mg, Lamotrigine: 200mg, Modafinil: 50mg, Zolpidem: 12.5mg

 

If so, please put ALL your drugs in this Interactions Checker and post the report or a link to it in this topic.

 

21 hours ago, gollyned said:

This abated within a few days when I went back up to 26.375mg, as advised by my psychiatrist.

 

Your psychiatrist must be reading this site. We're the only source of this kind of updosing.

 

I see from your signature that the recent decrease from 24.25mg to 23.6mg followed many decreases that would exceed a 10% per month reduction. Suggest you stay within those guidelines. If you want to taper by small amounts more often, you might do this 
Micro-taper instead of 10% or 5% decreases

 

For example, you are currently taking 26.375mg. After you stabilize for several weeks, you might consider reducing again. 10% of 26.375mg would be a reduction of 2.6375mg per month. For convenience, you might want to reduce by 0.5mg per week; after 4 weeks, you'd have reduced by 2mg, well within the 10% amount.

 

Your system may be able to recover from 0.5mg decreases within a week. If not, you'd have to make smaller decreases. You'll have to let us know how you're doing.

You can keep reducing by 0.5mg until you get just below 2mg, then you'd change your reduction schedule to remain within 10%/month of that dosage.

[gollyned]

Drug interactions checker: https://www.drugs.com/interactions-check.php?drug_list=2019-0,703-0,1430-0,1647-0,1839-0

 

I will have to do a micro-taper. I cannot split the doses small enough to taper without excessive withdrawal side effects, including feverishness, intense anxiety, restlessness, always being thirsty, unable to think clearly. This is by reducing one-eighth of a fifteen-milligram pill, or 1.875mg, or about 8%.

 

I have 1.75 tablets to go. This will take multiple years. And after that, I may not feel okay. I may need to stay on this medication indefinitely. For now, I will take some time to stabilize.

[Altostrata]

Yes, you could do a microtaper.

 

Does your psychiatrist have anything to say about the rest of your excessive psychiatric cocktail?

[gollyned]

He's focused on my week-to-week wellness and stability. He advocates changing one drug at a time.

 

That means it's mostly up to me to start getting off these medications, which I'm doing slowly, concurrently, and will update him along the way. I would stick to the one-change-at-a-time rule, but then I'd be on these medications forever.

[Altostrata]

When did you start risperidone? In your signature, please add approximates dates you started each drug.

[gollyned]

I started Risperidone in Dec 2021. I had gotten little sleep and entered a hypomanic episode. I've added start dates for each drug in my signature.

[Altostrata]

If I were you, I'd hold at 26.375mg Nardil for a while, to allow your nervous system to recover from the tapering sprint from February-August.

 

3 hours ago, gollyned said:

I started Risperidone in Dec 2021. I had gotten little sleep and entered a hypomanic episode. I've added start dates for each drug in my signature.

 

I am appalled at your cocktail. It has all the signs of a prescription cascade to address drug adverse effects. I'm going to guess risperidone was added after some untoward event involving your antidepressant, such as a drug switch or even a food reaction with Nardil.

 

Quote

 

Central Nervous System (CNS) Drugs

Therapeutic duplication

The recommended maximum number of medicines in the 'Central Nervous System (CNS) Drugs' category to be taken concurrently is usually three. Your list includes five medicines belonging to the 'Central Nervous System (CNS) Drugs' category:

• risperidone
• clonazepam
• lamotrigine
• modafinil
• phenelzine

 

 

We look at drugs as "brakes" vs "accelerators".  Risperidone, clonazepam, lamotrigine, zolpidem are brakes. Modafinil is an accelerator. I'd guess that it was added because you were too dopey from something else added earlier in 2019, or you were fatigued from withdrawal after a drug switch.

 

While you're holding on Nardil, you might be able to reduce one of the other drugs. Are you aiming to reduce your drug burden overall? What times o'clock do you take each of your drugs, with their dosages?

 

15 hours ago, gollyned said:

He's focused on my week-to-week wellness and stability. He advocates changing one drug at a time.

 

That means it's mostly up to me to start getting off these medications, which I'm doing slowly, concurrently, and will update him along the way. I would stick to the one-change-at-a-time rule, but then I'd be on these medications forever.

 

I get it that your psychiatrist doesn't know which end is up with your drug mess, but at least he's cooperative with tapering. IMO, he should be paying me to do his job.

[gollyned]

Yes, risperidone was added last December after I had a hypomanic episode, which I believe was set off by changing doses of my antidepressant, and yes, modafinil was added because I had a difficult time staying awake during the day with Nardil.

 

I am trying to get off the risperidone and the clonazepam, before it becomes too hard to get off either.

 

I take 15mg phenelzine, 50mg modafinil, and 100mg lamictal at 9:00am. I take the remaining phenelzine and 100mg lamictal at 2:00pm. I take the risperidone, zolpidem, and clonazepam at about 9:30pm, before bed.

 

Yes, I now plan to hold at 26.375 for some time. I've had terrible mood swings trying to reduce this last bit, and a ton of anxiety. I can use this time to get off my other medications.

[Altostrata]

18 minutes ago, gollyned said:

I take 15mg phenelzine, 50mg modafinil, and 100mg lamictal at 9:00am. I take the remaining phenelzine and 100mg lamictal at 2:00pm. I take the risperidone, zolpidem, and clonazepam at about 9:30pm, before bed.

 

Taking batches of drugs at the same time increases likelihood of drug-drug interactions.

 

How long have you been taking 26.375mg Nardil? (That's the correct amount?)

 

 How do you feel after you take risperidone, zolpidem, and clonazepam at about 9:30 p.m.? What is your sleep pattern?

[gollyned]

My mistake, it's 26.25, not 26.375.

 

At this point, I've been taking 26.25 only a few days -- I've updated my signature to account for August. I've twice now failed to go down to 24.375, which is only 1/8 of a tablet down. Each time, the symptoms were the same. I'd feel feverish, anxious, couldn't eat, and started ruminating obsessively about my ex.

 

Last time, once I went back up to 26.25, these symptoms remitted within a few days. I'm still waiting to see if the same happens this time. Once I'm stable on 26.25mg, I will work to reduce Risperidone and Clonazepam.

[Altostrata]

20 hours ago, Altostrata said:

How do you feel after you take risperidone, zolpidem, and clonazepam at about 9:30 p.m.? What is your sleep pattern?

 

[gollyned]

I go to bed after taking risperidone, zolpidem, and clonazepam at about 9:30pm, and may listen to an audiobook or read a book for about half an hour before falling asleep at 10:00pm, and sleeping until about 7:00am, when my dawn simulator wakes me up. I normally do not wake up overnight.

 

Some days, if I'm feeling especially anxious at night, I take the clonazepam earlier, around 8:00pm or 8:30pm.

[Altostrata]

On 9/5/2022 at 1:53 PM, gollyned said:

I take 15mg phenelzine, 50mg modafinil, and 100mg lamictal at 9:00am. I take the remaining phenelzine and 100mg lamictal at 2:00pm. I take the risperidone, zolpidem, and clonazepam at about 9:30pm, before bed.

 

How long have you been taking clonazepam only once a day?

 

How often do you feel "especially anxious at night"? What time does it occur? What does this feel like?

 

The combination of 15mg phenelzine, 50mg modafinil, and 100mg lamictal at 9:00 a.m., and phenelzine and 100mg lamotrigine at 2 p.m. -- the modifinal is supposed to counteract drowsiness from phenelzine, is that correct? What is the lamotrigine supposed to do?

 

Did you ever take the later phenelzine at night?

[gollyned]

I've been taking clonazepam once daily since March 2021.

 

I feel anxious starting at about 8:00pm. I feel hot, and notice I'm clenching my jaw. This happens every night. Since this year, I've been going to bed much earlier than I'm used to, around 9:00pm, 9:30pm, or 10:00pm at the latest, whereas I'm used to going to bed around 11 or midnight. Often I find I want to get to bed starting at 8:30pm. I want to get to bed as soon as I can so I can take my zolpidem and escape the anxiety and rumination.

 

Yes, the modafinil was prescribed to counteract the drowsiness from phenelzine. I don't know if I need it for this purpose any more, but I've tried going without modafinil on weekends, and I felt terrible. Extremely low energy, more worrisome than usual, more rumination.

 

The lamotrigine was prescribed because I had a diagnosis of bipolar disorder. I don't think it's a valid diagnosis. The only manic episodes I've had were antidepressant-induced. I haven't removed it because I've been focusing on getting off the other drugs first -- I've never experienced side effects from it, so removing it isn't my top priority.

[Altostrata]

Please keep daily notes of times o’clock you take your drugs, their dosages, and your symptoms throughout the day. We need to know how you feel before and after taking each drug, and your symptoms in between. Post 24 hours of notes at a time in this topic, in a simple list format with time o’clock on the left and notation (symptom or drug and dosage) on the right. This can show if your symptoms are adverse effects from one of your drugs.