Willowman: moclobemide MAO and a long history of psychiatric drugs

October 15, 2022

Hi everyone,

As you can hopefully see from my attachment, I have a long history of trying out psychiatric drugs in the hope of feeling better after a childhood best not mentioned, a young adulthood full of ups and downs, crashes and highs and self harming behavior and an adulthood with depression always, severe anxiety in episodes and OCD since I was 12. So all in all a pretty messed up soul here. Oh and I cemented all that misery by marrying a nice but autistic person so I do not have emotional rapport and support, consequentially having an autistic child (on disability and in need of help - by me ofc) and having had a very harsh and demanding work environment which I dropped out because I just didn’t have the strength anymore and now I am being on disability.

I have good in my life. I love my two kids, I love my partner even though it is difficult, I have wonderfully supportive two siblings. No friends because I was so burned when I was in the phase where you usually make friends. Only a couple of nice acquaintances.

On top of it all, my family has a high genetic and familial risk of Alzheimers and I have seen how it is and do definitely fear it a lot. One of the things that keeps me up at night with dread.

I have not come out of the severe anxiety episode that started this spring. It is a tiny bit better, but especially the anxiety induced insomnia is really dragging me down.

My psychiatrist put me on moclobemide after a second try with an SSRI went south and had the same result as the first try, severe anxiety, unbearable agitation and even worse insomnia.

Moclobemide* (mod note: see below info), I dont know. Does it work? Do all my other strategies work? I work a lot, CBT, meditating, EFT… Does the hormone therapy I started work? Is the episode lessening because of time passing? I don’t know. What I can say if it does work it is not very strong. I had panic attacks and insomnia and tension/anxiety despite taking it all those months. Maybe a bit less the last month. I had a couple of good days lately. Don’t know if it was the drug though - this episode comes in waves.

Because I don’t like antidepressants and because I still have insomnia, I thought to reduce the moclobemide. I went from 450mg to 300 without much difficulty. Now I reduced to 150 and am experiencing a spike, although as I said this might be another wave and not the reduction, or it might be withdrawal.

Does anyone have experience with withdrawing moclobemide? It has a very short half life so I thought it should be easier. But just like last time, after four days without it things seem to worsen. How long will a withdrawal last if that is what it is? Should I stick it out or go back on my dose?

I am grateful for any advice. I hope I didnt do anything wrong in this post.

best

Chris

* Moclobemide, sold under the brand names Amira, Aurorix, Clobemix, Depnil and Manerix among others, is a reversible inhibitor of monoamine oxidase (MAO) A drug primarily used to treat depression and social anxiety. It is not approved for use in the United States, but is approved in other Western countries such as Canada, the UK and Australia.Wikipedia

Edited October 15, 2022 by ChessieCat
added drug info

October 19, 2022

Hi there Willowman,

And thank you for getting to your signature.

When did you come off the sertraline? Date. Doses too, if recalled.

And you've been on a whirlwind of medications for the past 10 years, it seems.

Is moclobemide your only medication right now?

We have had members withdrawing from the same class of medications as yours. In fact, I withdrew from one.....Parnate. We don't as yet have a topic specific to withdrawing from the MAOI class of drugs, but the principles would be the same. And I will give you some introductory material today.

I would, if it was me, not do any more tapers, or rapid WD's(withdrawals). And yes, you might want to go up in dose now, in hopes that it will reduce some of your present WDsymptoms. I see you went from 150 mg to 225 mg in September. Date? Any improvement in symptoms? Are you cutting pills now, or how are you managing to get non standard doses?

When do you take your moclobemide each day?

And then here is some introductory material for you to look at. It sounds like you've looked around, but now it will be here, and available to access, in your Introduction topic too.

Here at Surviving Antidepressants, it is recommended that a person taper by no more than 10% of their current dose with at least a four week hold in-between decreases. The 10% taper recommendation is a harm reduction approach to going off psychiatric drugs.

Why taper by 10% of my dosage?

About reinstating and stabilizing to reduce withdrawal symptoms

What happens with WD medications/drugs and when stabilizing:

Brain Remodelling

What is withdrawal syndrome.

Dr.Glenmullen’s withdrawal symptom list.

How is your sleep now? Any improvements?

The Windows and Waves Pattern of Stabilization

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug(s). When the medication is discontinued, the CNS has to undo all the changes it made. The CNS likes stability. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

We don't recommend a lot of supplements on SA, as many members report being sensitive to them due to our over-reactive nervous systems, but two supplements that we do recommend are magnesium and omega 3 (fish oil). Many people find these to be calming to the nervous system.

Magnesium, nature's calcium channel blocker

Omega-3 fatty acids (fish oil)

This is your introduction/journal page where you have now introduced yourself to the community, you can ask questions here regarding your tapering, give updates, and just keep a record of your journey.

Okay, and Welcome aboard,

Love, peace, healing, and growth,

moderator manymoretodays(mmt)

Edited October 19, 2022 by manymoretodays

October 20, 2022

Hello and thank you for the information! I am so glad there are people on the net ready to help. My psychiatrist never has any time.

Dates, yes I forgot the dates.

Sertraline 12th March to 30th April, 12,5mg a week then 25

Moclobemide 150mg 9th to 15th October, 300 on 16th, since 17th 225mg. Symptoms have improved slightly, insomnia is worse.

I have to cut pills I cannot get non standard doses. I take it with my first meal.

I am also on:

75yg Levithyroxine (for Hashimoto)

Hormone replacement therapy

Low dose betablocker

Passion flower extract 520mg to 1040mg as needed

A little beer yeast for B Vitamins

Vitamin B12

Vitamin D 1000iU

silicea and kalium (very low dose)

Magnesium glycinate 300mg

ocasonally zinc and selenium

October 20, 2022

It might be possible to make a liquid from the moclobemide tablets.

@brassmonkey Are you able to assist with deciphering this information please? Thanks.

From:

http://www.rlandrews.org/pdf_files/handbk_of_enteralfeeding.pdf

Moclobemide
(APS, Generics,
PLIVA, Ratiopharm,
Sandoz)
Tablets
150 mg, 300 mg
APS brand tablets do not disintegrate readily in water
but will disperse in water if shaken for 5 minutes. The
resulting fine white dispersion flushes via an 8Fr NG
tube without blockage.2

From:

https://go.drugbank.com/drugs/DB01171

https://hmdb.ca/metabolites/HMDB0015302

Water Solubility

1.12 mg/mL

From:

https://www.adooq.com/moclobemide.html

Solubility *

In vitro	DMSO	52 mg/mL (193.49 mM)
	Water	Insoluble
	Ethanol	10 mg/mL (37.21 mM)

Edited October 20, 2022 by ChessieCat
added more info

October 20, 2022

Thank you. I will taper more slowly. Although I don’t know if a solution is possible with the pills I get. I thought since I have only been on it three 1/2 months it would be easier.

The insomnia is driving me nuts, it’s getting worse instead of better. I wake up every night with fear and dread, always with the same thoughts. Several times. I wish I coupd sleep through at least 6 hours again. But this is probably the illness as such, it never got much better on moclobemide.

I am now trying out if going back on passion flower will help it. I am not too happy with it, though, since I have already been taking it for 12 years. I am scared about long term effects of the plant itself and also of the titan dioxide and other additives in all medication. On the other hand pasion flower is supposed to be neuroprotective. Oh, and I am also worried about dependency. Doctors say it is not addictive but I don’t know, why shouldn’t herbs be addictive too. But then, having severe anxiety, I am anxious about everything.

Best

chris

October 21, 2022

Hi Willowman,

Careful with Passionflower. It's just that most of us do tend towards being hypersensitive to so much. With 12 years usage, it would make sense to me, to do some form of taper off it, rather than just jump off completely. You might find more in topic. If not, consider decreasing by just small amounts of the whole periodically, and try to do a 10% or less taper off each prior dosage.

Here's our topic: Passion flower

You may have well built up tolerance and it has just stopped working for you at this point.

Have you tried any magnesium products yet? Links to omega3's and magnesium are in my first post.

More on tapering FAQ's here: Important topics in the Tapering forum and FAQ's

19 hours ago, Willowman said:

Thank you. I will taper more slowly. Although I don’t know if a solution is possible with the pills I get. I thought since I have only been on it three 1/2 months it would be easier.

Unfortunately, with your previous history on and off psychoactivess, chances are that yes......you will need to taper slowly now off the MAOI, after you get to a stabler place. WD stability can be a bit different from just going back to your best.

stability

Considerations about "Stability", Stop Jumping Around

19 hours ago, Willowman said:

The insomnia is driving me nuts, it’s getting worse instead of better. I wake up every night with fear and dread, always with the same thoughts. Several times. I wish I coupd sleep through at least 6 hours again. But this is probably the illness as such, it never got much better on moclobemide.

I think this is WD(withdrawal). Have you had a chance to look at that PDF of Dr. Glenmullen's symptom list? Maybe that's what you meant.

Tips to help sleep: so many of us have that awful withdrawal insomnia

start at the first post ^

Early-morning waking- managing the morning cortisol spike

And also from Symptoms and Self Care, the forum here

Non-drug techniques to cope with emotional symptoms

Ways to cope with daily anxiety

Sudden fear, terror, panic, anxiety, or sensory overload from withdrawal

Yes, wishing you sleep, blessed sleep, of long durations, each and every night very soon.

L, P, H, and G,

mmt

Edited October 21, 2022 by manymoretodays
added links

October 22, 2022

I have forgotten to take any moclomide yesterday - I had to take a blood test in the morning and then later it was too late. And I slept much better (weirdly) but I woke up with REALLY bad anxiety. So I think either my original illness is back or I have withdrawal.

Likely withdrawal.

Reading through the pages here I get the feeling one shouldn´t play around. I have made this mistake in my fear and pain. I started two things at the same time (Hormone replacement and moclobemide), so I never know what is what, I used some supplements, got anxious, quit using them, started to change my thyroid medication, went back on the original dose, took passion flower, stopped it again, took melatonin, stopped it again...

My whole system is totally scrambled and I am feeling SO badly.

I am so anxious, insomniac and down. I am scared I broke my brain and will get illness later in life. I guess I am just scared, period.

Can you help me to find stability again? Should I quit all supplements and just taper the moclobemide? Should I stop passion flower? It seems to help a little, but yes, I think I developed a tolerance and maybe even a dependence of some sort. Can you develop dependence on herbs?

By the way congratulations for quitting smoking!

Best

Chris

October 22, 2022

This is a new one for me, never heard of it before. I did a little research and will use the information you provided.

The best way would be to use DMSO. It is available online. You would need four and a half mL to dissolve 225mgai of medication.

Next best for making a solution would be ethanol. It would require 22.5mL of ethanol to dissolve a 225mgai tablet. Which is equivalent to .75oz. That much alcohol will have some effects that could interfere with daily life for a few hours and is not a good amount to consume during ADWD.

Which brings us back to water. This drug is insoluble in water but appears to make a very nice suspension if allowed to soak for several minutes. I usually recommend soaking for several hours when making a suspension or solution, so that is not a problem. I would try working with a 1:5 dilution ratio (1mgai to 5mL water) for right now. That would give a dose of about 45mL, which is a manageable size. As the dose gets smaller the dilution ratio can be adjusted as needed.

Hope that helps.

October 26, 2022

Titled: Passion Flower Dependency on herbs possible?

Hello,

Apart from the moclobemide which I am slowly tapering because I am not even sure it doesn’t make the anxiety and insomnia worse, I have an issue with passion flower.

Because I suffer from anxiety, the psychiatrist suggested passion flower extract. I researched it a bit and the internet was quite enthusiastic how well it works while being relatively harmless.

I took around 520-1080mg passion flower extract, the recommended dose, for 12 years. I asked my doc multiple times if this is ok to do long term he always said yes.

Sometimes I stopped for a week or so because I forgot, but I would notice irritability. Nothing much else.

I have a high alzheimer risk and read recently that long term benzo use will increase it further. Since they write that passion flower is „similar in action“ to benzos I thought I had better stop.

Well. I don’t know if this terrible time of panic attacks and insomnia was caused by this. But I am using it again I just cant bear this anxiety anymore. After four days, I feel a bit calmer. Not well but calmer.

So my question is: Can herbs cause depency? If so, I probably need to taper this instead of just stopping right? And if I understand correctly I had better taper the moclobemide first and then start with passion flower instead of both at the same time?

Thank you

Chris

Edited October 26, 2022 by manymoretodays
merged to Introduction, title added

October 27, 2022

Hi Willowman, @Willowman

Have you found your way back here yet? This is your Introduction page, AND the best place for your questions regarding you, and your case.

So.....also, just one Introduction per member. I merged your recent post here. You had started a new Introduction post with it.

Here's our topic: Passionflower

And there is not a ton of information around it in the topic, just some members experiences, and a moderators advice to start low and go slow.

1 hour ago, Willowman said:

Because I suffer from anxiety, the psychiatrist suggested passion flower extract. I researched it a bit and the internet was quite enthusiastic how well it works while being relatively harmless.

I took around 520-1080mg passion flower extract, the recommended dose, for 12 years. I asked my doc multiple times if this is ok to do long term he always said yes.

Sometimes I stopped for a week or so because I forgot, but I would notice irritability. Nothing much else.

I have a high alzheimer risk and read recently that long term benzo use will increase it further. Since they write that passion flower is „similar in action“ to benzos I thought I had better stop.

Well. I don’t know if this terrible time of panic attacks and insomnia was caused by this. But I am using it again I just cant bear this anxiety anymore. After four days, I feel a bit calmer. Not well but calmer.

So my question is: Can herbs cause depency? If so, I probably need to taper this instead of just stopping right? And if I understand correctly I had better taper the moclobemide first and then start with passion flower instead of both at the same time?

So I quoted you to better answer your question. Yes, some herbs do cause dependency, and yes........you best taper if you have found dependency with the passionflower. I think you answered your question as to if it causes dependency.......as it sure seems that it did with you. When you came off it you got some WD symptoms, and so.......yes it can cause dependency.

Where did you find the information that passion flower action is similar to benzo action? This can be helpful if you have a reference, to other members too. And so please share. We often depend on members to help us find references, so we'd appreciate it a lot. ***and just editing in now, I can look too, when I have some time.....right now swamped though, so remind me if need be.

However, we deal mainly with the psychoactive drugs here and I don't think that we'd neccessarily treat your passionflower like a benzo or "brake" and have you taper it last........although that is just my thought now.

Were the panic attacks related to a mochlobemide taper at all? Did you completely rule that out?

I do see where you mentioned WD symptoms from stopping passionflower CT. Insomnia, irritability, and panic.

When you restarted the passion flower did you start at the higher dose? You might have tried a lower dose first. With reinstatements of drugs anyway.....it's often best to start low, and to find the lowest dose that helps relieve WD symptoms.

We can also see if we can get some more input on your questions too, from others.

Okay, thanks. Have you seen the responses to you above this post, prior to today? Just want to be sure you have seen them, thanks.

L, P, H, and G,

mmt

Next reply......Willowman, would you just note what you are taking at present by name and dose, and the time taken.

Sorry I missed your post with the missed dose. Those can take a couple of days to recover from sometimes. Symptoms should mellow out some once you got your regular scheduled dose in, and then just a little bit of wobbly -ness, wavy-ness, until your system gets a steady state of your drug again. So hopefully that is settling now? And yes, WD.

Thank you on the congrats for quitting smoking. Still off the dumb cigs! Hurray!

Edited October 27, 2022 by manymoretodays
added notification, ****additional

October 27, 2022

Thank you for your answer! Yes I read all the previous answers and took them to heart.

i apologize for making a new post this forum works differently than the ones I am used to.

Moclobemide taper gave me intense depression but not really increased panic. Although it is hard to say because anxiety attacks and panic are a daily thing. However the panic started months before I even started with moclobemide and was made much worse with sertraline with my doctor insisting „this cannot be“ .

Insomnia is very bad. My doc insists I start seroquel…I haven’t yet but I am starting to relent. It’s been months now without proper sleep.

Here is an article about passion flower having a similar action as benzodiazepines

https://www.calmclinic.com/supplements-for-anxiety/passion-flower

I had found more like it.

Thank you so much for your help!

October 27, 2022

Willowman,

Oh no, no ........not Seroquel??!!!

And that's okay, your boo boo post. You are new.

Has all this set in though since you went to 225 mg of Moclobemide?? If that is the case, then you would be better off doing an updose of Moclobemide now. Maybe not all the way back to 300 mg, but perhaps to 260 mg. A halfway updose would be 37.5 mg added to your present dose, or 262.5 mg for a total dose. When did you do the decrease to 225 mg of Moclobemide?

-about-reinstating-and-stabilizing-to-reduce-withdrawal-symptoms/

or we could go less.

The new symptoms could be due still to WD. They don't always set in, the symptoms all at once, all the same.

Is this the doctor who doesn't believe in WD?

Better to avoid Seroquel if you can. You do hope to get drug free one day, don't you? I hope that for you.

Seroquel is an AP, and antipsychotic, sometimes called a neuroleptic, and boy howdy......if you can avoid getting started with that it would be so nice. It's tough as any other too, to taper from and get off. You can look it up at Drugs.com, and just get an idea of the side effects and that might sway you.

When did you take the sertraline? Add some more dates and to your signature. The month, or the day and month. It's reading confusing to me......as it sounds/reads like you could be on excitalopram now. So get some dates in front of the drugs, and make clear the time frames of usage, from start to finish.

AccountSettings/signature/edits/updates

49 minutes ago, Willowman said:

nd was made much worse with sertraline with my doctor insisting „this cannot be“ .

It's possible you had a reaction to the sertraline then. If it made it worse. And you might still be recovering from that.

Can you get a new doctor?

How long have you been back on the passion flower?

And thanks for sharing the reference, I'll look at it, and even add it to our topic, when time allows.

Okay sleep. Have any of the tips helped?

Tips to help sleep: so many of us with that awful withdrawal insomnia

Definitely limit computer, cell phone devices, etc several hours before bedtime

It's okay to have the t.v. droning in the background if that might help you dose

Have you tried a little melatonin, start low, .25 or .50 mg. I like the sublingual, under the tongue dissloving kind. And then take it, shut out the lights and it might help get you to sleep.

Listen to meditations, audio only.

I'm trying to remember what else, Alto has some great tips..........check that link again.

Let me know what you think about doing an updose in Moclobemide.

You can use those tips from brassmonkey to get the non-standard dose needed too. Do you have a good supply of moclobemide to work with now? And what strength tablet or capsule do you have?

More tips on tapering, for if you want to take part of your dose in liquid:

-how-to-make-a-liquid-from-tablets-or-capsules/

-using-an-oral-syringe-and-other-tapering-techniques/

And indexed topics here: Important topics in the Tapering forum and FAQ's

Sending sleep, relief from bad anxiety, and healing,

Best, L, P, H, and G,

mmt

Edited October 27, 2022 by manymoretodays

October 27, 2022

Q: Did you see this post in the Passion Flower topic:

On 9/19/2018 at 4:00 PM, brassmonkey said:

Many people have success with Passionflower. Start with a small dose and build up a bit if needed. Some people have reported that it only works for a few weeks and then you need to take a break from it for a while.

October 27, 2022

ChessieCat yes I saw it but I wish I had seen it years ago. I don’t think it stopped working but the effect became a lot less.

Manymore, this is why I resisted seroquel- but I am really desperate to sleep again. Do you think I could try for two weeks to „reset the clock“ so to say or will that already be too long? I would like to avoid adding another drug…but I have to sleep.

Hm, no, I don’t think the withdrawal from moclobemide still gives me these symptoms. If anything the anxiety got a bit less. Depression increased though. I haven’t changed the 225mg yet so I haven’t started the smaller increments yet. Sertraline now - that was a horror. Same as with escitalopram. Just hell. But it was only a couple of weeks more than half a year ago can this still be withdrawal?

I tried to make my signature more comprehensive - did that work?

October 27, 2022

Q: What non drug methods have you tried/using?

https://getselfhelp.co.uk/sleep-insomnia-self-help/

Here is a list of Alto's favourite sleep topics:

TV or computer use in evening can disrupt sleep: Bright light signals the brain that it's daytime

What is the sleep cycle?

Tips to help sleep -- so many of us have that awful withdrawal insomnia

Sleep and withdrawal

Path to Better Sleep FREE online for everyone from the US Veterans Administration

Music for self-care: Calms hyperalertness, anxiety, aids relaxation and sleep

Melatonin for sleep: Many people find it helpful

October 27, 2022

And here is another information page on Moclobemide from Drug Bank:

Moclobemide: Uses, Interactions, Mechanism of Action: Drug Bank Online

Yes. Thank you on the signature.

How much passion flower are you taking now?

Me, I'd try with something like melatonin first, before Seroquel. I have no idea just how this doctor would dose you with the Seroquel.

Maybe we should confer further here, and appreciate Ccats help too. Excellent sleep tips above!

Before we confer further, would you try to do some NOTES?

They are easier than you think. Time on the left. Then.....on the right note your drug by name, and dose, also your supplement(s) by name and dose. Keep going with times on the left, even when it isn't a drug or supplement time, and on the right note your symptoms as they occur throughout the day and night. You can describe them first, and then rate intensities of them if you'd like, using a 1-10 scale type thing.

https://www.survivingantidepressants.org/topic/1779-recording-drug-schedule-and-symptoms-to-track-patterns-and-progress/#comment-567765

and here is an example of what it would look like(and more)😞

Time and dosage for all drugs taken throughout the day, psychiatric and non-psychiatric.

- Following each dose, note any symptoms. If you are having a reaction to the drug, it may take hours for a symptom to show up -- that's why we ask you to keep notes all day long.

- If you're not taking any drugs, your symptoms throughout the day.

- Your sleep pattern. Since so many drugs disturb sleep, if you find you're waking in the middle of the night, it could be from a drug you took earlier in the evening. If you're not taking any drugs, there may be ways you can improve your sleep.

And so forth. A diary, in chronological order, looking something like this:

Example:

DATE:

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

I know, I am making you work hard, but this should help us, help you.

And it is sleep time here. I'll try to send some to you.

Best, L, P, H, and G,

mmt

Edited October 27, 2022 by manymoretodays
bolded ?

October 27, 2022

Ok I will do that and get back to you. Thank you for your help! I appreciate it.

I am taking 260mg now, 1 standard capsule. Highest allowed dose is 4 capsules.

I“ll try melatonin again but I already did.

May I ask again if 2 weeks of seroquel would already send me down the next hole? I am just thinking I need to reset my circadian clock somehow.

I will try the sleep tips! Thank you.

best

October 28, 2022

1 hour ago, Willowman said:

May I ask again if 2 weeks of seroquel would already send me down the next hole? I am just thinking I need to reset my circadian clock somehow.

I think it just complicates things, and likely you'd have yet another drug to taper off from. I'm going with the concept that it is always best to treat WD, if possible, with the same drug that precipitated it. And I know it's not clear to you that is the case. I think it is real likely though.

And thanks, your signature is clearer.

So you have just been back on the passion flower for 7 days now I see, from your signature. I mean that could go paradoxical I imagine, meaning it would give the opposite of the intended effect.

And okay I copy, you'll try the updose of 260 mg moclobemide, from 225 mg.

And will do NOTES. Yay.

I posted the Drug Bank information, as I was reading down and like the other MAOI drugs, it has the potential for interactions with other drugs and supplements, and tyramine in some foods and drink. It does list benzo's right at the top of the interaction section.

20 hours ago, manymoretodays said:

And here is another information page on Moclobemide from Drug Bank:

Moclobemide: Uses, Interactions, Mechanism of Action: Drug Bank Online

I hate to see you making too many variable changes at once, so I'd stay put with everything now with the exception of the increase in moclobemide.

The rule of 3KI's: simple, slow, stable

Keep your dosing times stable. Report for sure, at the very least your times, and then drugs(include the beta blocker) and supplements by name and dose. It's not a stretch to keep going however, and note symptoms throughout the 24 hour period to the right of times too.

Okay, lets see where you are at tomorrow via NOTEs. You could post today's tomorrow.

Best, L, P, H, and G,

mmt

Edited October 28, 2022 by manymoretodays

October 28, 2022

I will just let me clarify I am taking 260mg passion flower not moclobemide. I am not taking a benzo.

I wanted to go down to 150 next week

October 28, 2022

Oh, sorry for the confusion.

I was looking at your signature and saw passion flower at 450 mg. And then was just comparing the passion flower action to benzo action, and speculating on if it did interact with the moclobemide, as so many things do.

You've been on the 2 together before, but.......anything is possible with sensitized nervous systems.

So that's good then that you are lowering the dose of passion flower.

And then I thought you had decided on doing an updose to 260 mg total of moclobemide. So that IS clearer.

Okay then. You will try some NOTES then? And then I will further confer on updosing and if there are other ideas. I'm going to wait until you post some NOTES first.

I hope I answered good enough on why I wouldn't start Seroquel now. I know you have asked a couple times now.

And you will try a little melatonin I understand. Consider the lactum, or milk peptides, if no help with melatonin. Again, it's late for me to be modding now and I'm tired. I think you'll find gentle alternatives to melatonin in the links already provided.

Sending sleep when it's that time for you. I am fortunate that most always I can get my restorative, healing sleep. Only a little disruption during my acute WD.

Best. Zzzzzzzzzzzzzzz

Edited October 28, 2022 by manymoretodays

October 30, 2022

I am having a horrible nigjt the worst since a long time. Maybe I should wait with reducing moclobemide to 150mg.

I tried making notes I hope this is useful. Thank you for trying to help I feel so abandoned by doctors. They are like „the 2-3 standard drugs don’t work? You are on your own then-„

sorry about the formal I copy pasted this and don’t kbow how to change the formatting.

Started 28.10. evening

19.30 progesterone and passion flower 260mg and magnesium 300mg

20.30 got tired, went to bed, fell asleep a while after (21.00?)

1:30 woke, not too anxious, but couldn’t go back to sleep. Counted a few hundred sheep. Drifted a bit and looked at clock again at

4:00 Got up for a bit because my back hurt from lying still. Not too anxious, but a few waves of it rising.

4:20 Read a bit, started meditation, sudden anxiety spike 4:50. Jolted up.

5:30 Tried resting again

6:00 gave up and got up

6:30 estrogen gel

7:15 breakfast and very small amount of weak coffee

7:15 225mg moclobemide

7:19 slight anxiety spike

8:05 had to take Acetylcysteine 600 mg for a bad cough

8:15 bad anxiety spike (read something about the ancient past triggering my existential anxiety). Increased agitation and arousal on and off. Better for a bit.

10.00 Another spike, intrusive fear thoughts.

11:00 better
Midday: nice, slightly happy feeling around midday.

Good afternoon and evening (still bad cold)

20:30 progesterone and magnesium glycinate 300mg and passion flower260mg

21:15 went to bed. Anxiety spike and feeling too hot and palpitations when trying to fall asleep. Intrusive fear thoughts (i have existential anxiety and got informed of the death of an acquaintance today, ofc this has to pop into my head at night)

22:00 still not asleep and anxious so got up again, bad cough makes it hard too

22:15 used melatonin spray one pump (1 mg melatonin, a bit passon flower and lemon balm)

23:15 still no sleep

24:00 no sleep, anxiety rising

1:00 no sleep

Nodded off a bit only tp be jolted awake from a nightmare

2:00 on and off a few mins sleep but waking again with strong anxiety

Edited October 30, 2022 by ChessieCat

October 30, 2022

12 minutes ago, Willowman said:

sorry about the formal I copy pasted this and don’t kbow how to change the formatting.

Immediately after you paste the text, at the bottom left of the reply box will appear "Paste as plain text". Click on it. This will change the pasted text to the default.

If there is any special formatting, eg italic, bold etc, that will be lost and you will need to do that manually using the reply box formatting at the top of the box.

Edited October 30, 2022 by ChessieCat

October 30, 2022

Heh, just happened to be on Willowman,

Okay, so.......

On 10/27/2022 at 8:23 PM, Willowman said:

I wanted to go down to 150 next week

You were referring to the moclobemide here? Down from 225 mg now?

A 10% decrease is the highest decrease that we'd recommend from the previous dose.

To calculate a 10% taper from 225 mg looks like this:

And that would be:

225 mg X 0.90 = 202.5 mg or round up to 203 mg and that is what a 10% decrease would be.

I don't think you should go down to 150 mg of moclobemide. That's a jump. You may be having the symptoms you are having now from doing such a large taper in September and in August. It might have caught up with you. Tapering by more now, certainly is not the answer or solution to your symptoms.

That is why I suggested an updose, and came up with doing an updose of about 1/2 of the decrease you had recently done.

And updose from 225 mg present to 260 mg, with daily NOTES and observations so we can help.

Were you talking about moclobemide in the first quote.

17 minutes ago, Willowman said:

Maybe I should wait with reducing moclobemide to 150mg.

I think you were, as most recent you posted ^.

If it were me, I sure would not do another large decrease from 225 mg of moclobemide now, to 150 mg.

I've been where you are at now, even with the lousy sleep, and lot's of symptoms of ?anxiety, and even thought the same thing that less would help. It will not. I believe you would worsen your WD, by doing that. I don't know why we get irrational, but many of us do make the mistake of thinking a faster taper will somehow help the cummulative WD, that's come on from previous too fast tapers.

Is this what you are taking for your cough???

NAC(N-acetyl-cysteine or N-acetylcysteine

I believe it might be. Scroll down and read, in the 3rd post down, Altostrata our founder here, and very experienced, goes into some of the pluses and minuses of it.

From your notes, it might have helped, or might have hindered. I find it hard to draw any conclusions from just one day of NOTES.

They did post okay, your copy did. The NOTES. You got about a day and 1/2 done. Keep doing them please Willowman. Separate them by date, so it's clear.

I cannot understand why you would chance another supplement, right after changing dose with the Passion Flower, and while we are trying to do some decent observations! I get you saying you took it for your cough......I mean I guess I do.

The rule of 3KI's: keep it simple, slow, and stable

This ^ will make clearer what I am saying above.

And I get, that maybe you didn't know. You didn't know what you were taking. Or.....you feel desperate for sleep and less of the anxious fears. I know this is not the kind of WD stable you wish to maintain at.

Try and stick with the NOTES. And yay, thank you Ccat for helping with that.

Try and stay put with just the moclobemide and the lowered passion flower dose, same time, same dose. No additions, no changes.

I'll get you in for conferring now. And personally think an updose of moclobemide is worth trying. I did want to check on by just how much to updose though, or confer with others on that.

A ton of verbage above. Just seeking clarity and trying trying to be clear with you now. Some of it might be language difficulty.......lost in translation? I don't know.

This post should help with your sleep. Post more NOTES clearly delineating the day, or day change. You should write am or pm next to the times too, or that can get confusing. Otherwise you did great! Good job.

L, P, H, and G,

mmt

October 30, 2022

Thank you so much for your time and patience.

I am sorry if I am confused, I am really feeling badly and had almost no sleep for several nights plus this really bad cough. Would you really like me to keep posting such long notes? Would you like me to do that daily?

Yes I was thinking tapering down would help me. You caught me. It is hard to wrap my head around the possibility that this could be WD. And I just want to get rid of this drug…

I didn’t add another supplement I really have a very bad congestive cough. I got to take something for it. I didn’t know it had psych effects and obviously neither had the prescribing doc. Ugh. I will have to take it for a few days still.

Otherwise I will stay on 225mg moclobemide and 260mg passion flower until this stabilizes. How long is this in your experience?

Yes I am desperate especially for sleep but also for this constant anxiety to stop. And I am scared I am just keeping it high with moclobemide. I usually feel especially anxious about 1-2 hours after taking it.

October 30, 2022

27 minutes ago, manymoretodays said:

This post should help with your sleep. Post more NOTES clearly delineating the day, or day change. You should write am or pm next to the times too, or that can get confusing. Otherwise you did great! Good job.

I know. It's wearing you down the lack of sleep and symptoms. Do the best you can with whatever non-drug coping you can Willow. In itself, no, it's not going to make your outcome worse.

Post another day or more of NOTES. I've got you in for conferring with the rest of the staff now. If it was me, I'd want to go with an updose of the moclobemide, and I think that may help.

Any many thank yous to staff already giving input with your case. ChessieCat and brassmonkey both! It's awesome.

Do the NOTES. Study the information above, so you understand and can prepare to do some non-standard dosing. I don't think it's wise at all to keep making the big changes that you have been making with the moclobemide.

Sending sleep and calm.

October 31, 2022

I did read the articles you referenced. On sleep (downloaded a cbti app the veterans site recommended - it gave me a warning of getting less than 5 hours sleep and to see a doctor haha well the only thing he has for me is seroquel). On passion flower. And on tapering. Thing is I am too anxious to cut up my tablet and try to dissolve it and my doctors don’t want me to either. So it is 75mg jumps because that’s half a 150mg tablet, the lowest dose.

But I will wait another few weeks before I get to 150 I think. Too unstable right now.

Physical sickness ofc doesn’t help. I am curious what the Acc (NAC) is going to do. The couple hours almost normalcy was nice but not if I have to pay with even worse nights.

Do you know if existential anxiety can even go away after being present daily and nightly for a year? I am in the grips of a bad „will this last forever“

Notes continued

4:00 Took my levithyroxine 75 (I take this every day for hashimotos, forgot before)

4:30 gave up on sleep. Less anxiety than during the night (sleep anxiety??) but very tired and sick. Meditated/nodded a bit, woke up to a dreamlet of a big spider chasing me and crawling up my neck! My brain is wired wrong lol.

6:00 got up, estrogen gel

6:30 breakfast with a very small amount of coffee,

7:00 moclobemide 225mg, acc 600mg (for coughing not as supplement)

Tired, but not as tired as I thought I would be, anxiety low level

- Lying about with a bad cold, occasionally a few mins naps, anxiety quite ok and sometimes even a faint happy feeling

13:00 Slight anxiety spike after food. Too spicy? Had to get up and move to distract myself from intrusive thoughts.

13:30 Short nap, woke up with a fear jolt like often

normal levels in the afternoon and evening

19:45 progesterone and 250mg passion flower

21:00 went to bad, coughing badly tho

uneasy nap around 22.30

0.20 woke up anxious and sweaty with my usual intrusive thought

vague idea of having had nightmarish dreams

1:30 woke up again medium anxious . But too anxious to close my eyes and try to sleep again.

2:15 melatonin spray (with mini amounts of passion flower and lemon balm)

Napped after while

4:15 woke up, anxious thought first thing

As you can see I am really suffering. Especially the wormlike thoughts which cause anxiety and the insomnia

This is not really how thngs should be after four months of medication and therapy.

I find it curious that NAC seems to be giving me a few short hours of feeling better but then obviously raises anxiety. How is it a cough medication does that which my antidepressants don’t (I read the referenced article). I get the feeling the docs really still know next to nothing.

October 31, 2022

It is so hard to think moclobemide could be making all this worse but reducing it also could.

I so wish I had never touched the sertraline which sent me into this spiral. Before the anxiety was unpleasant bit manageable. After five weeks of akathisia, anxiety and insomnia and the reawakening of my existential anxiety, it all went down the drain. And I was only on 25mg!

October 31, 2022

I need to edit to the notes:

5:30 Severe! Anxiety spike. Cannot sit still, feel terrible. Also ofc because of the bad night. Still ongoing.

Would you like me to continue the notes? What is this?? Is this a wave from the reduction of moclobemide? Or the original illness?

It is a shame that the cyclical HRT I am on complicates things - I am not sure if the hormones make things better or worse anxietywise. Seems to me from my own notes theough the last few weeks though that there are always ups and downs independent of that or anything else I do

October 31, 2022

Hi Willowman,

Okay, I'll copy them all together here. I do need a date to put somewhere. Henceforth, please add a date.

Notes continued

Date would go here. Thanks for doing the military time, that helps.
4:00 Took my levithyroxine 75 (I take this every day for hashimotos, forgot before)

4:30 gave up on sleep. Less anxiety than during the night (sleep anxiety??) but very tired and sick. Meditated/nodded a bit, woke up to a dreamlet of a big spider chasing me and crawling up my neck! My brain is wired wrong lol.

6:00 got up, estrogen gel

6:30 breakfast with a very small amount of coffee,

7:00 moclobemide 225mg, acc 600mg (for coughing not as supplement)

Tired, but not as tired as I thought I would be, anxiety low level

- Lying about with a bad cold, occasionally a few mins naps, anxiety quite ok and sometimes even a faint happy feeling

13:00 Slight anxiety spike after food. Too spicy? Had to get up and move to distract myself from intrusive thoughts.

13:30 Short nap, woke up with a fear jolt like often

normal levels in the afternoon and evening

19:45 progesterone and 250mg passion flower

21:00 went to bad, coughing badly tho

uneasy nap around 22.30

Date would go here, it's a new day

0.20 woke up anxious and sweaty with my usual intrusive thought

vague idea of having had nightmarish dreams

1:30 woke up again medium anxious . But too anxious to close my eyes and try to sleep again.

2:15 melatonin spray (with mini amounts of passion flower and lemon balm)

Napped after while

4:15 woke up, anxious thought first thing

5:30 Severe! Anxiety spike. Cannot sit still, feel terrible. Also ofc because of the bad night. Still ongoing.

October 31, 2022

Then we've got the previous note of 28th of October:

Started 28.10. evening

19.30 progesterone and passion flower 260mg and magnesium 300mg

20.30 got tired, went to bed, fell asleep a while after (21.00?)

1:30 woke, not too anxious, but couldn’t go back to sleep. Counted a few hundred sheep. Drifted a bit and looked at clock again at

4:00 Got up for a bit because my back hurt from lying still. Not too anxious, but a few waves of it rising.

4:20 Read a bit, started meditation, sudden anxiety spike 4:50. Jolted up.

5:30 Tried resting again

6:00 gave up and got up

6:30 estrogen gel

7:15 breakfast and very small amount of weak coffee

7:15 225mg moclobemide

7:19 slight anxiety spike

8:05 had to take Acetylcysteine 600 mg for a bad cough

8:15 bad anxiety spike (read something about the ancient past triggering my existential anxiety). Increased agitation and arousal on and off. Better for a bit.

10.00 Another spike, intrusive fear thoughts.

11:00 better
Midday: nice, slightly happy feeling around midday.

Good afternoon and evening (still bad cold)

20:30 progesterone and magnesium glycinate 300mg and passion flower260mg

21:15 went to bed. Anxiety spike and feeling too hot and palpitations when trying to fall asleep. Intrusive fear thoughts (i have existential anxiety and got informed of the death of an acquaintance today, ofc this has to pop into my head at night)

22:00 still not asleep and anxious so got up again, bad cough makes it hard too

22:15 used melatonin spray one pump (1 mg melatonin, a bit passon flower and lemon balm)

23:15 still no sleep

24:00 no sleep, anxiety rising

Must be the 29th of October begins here:

1:00 no sleep

Nodded off a bit only tp be jolted awake from a nightmare

2:00 on and off a few mins sleep but waking again with strong anxiety

October 31, 2022

And okay, I will leave those be separated from narratives. That should help.

On 10/19/2022 at 10:15 PM, Willowman said:

I am also on:

75yg Levithyroxine (for Hashimoto)

Hormone replacement therapy

Low dose betablocker

Passion flower extract 520mg to 1040mg as needed

A little beer yeast for B Vitamins

Vitamin B12

Vitamin D 1000iU

silicea and kalium (very low dose)

Magnesium glycinate 300mg

ocasonally zinc and selenium

And you should get all your drugs and supplement in the NOTES when you do them. Spell them out too. I saw ACC for ? acetycholine. We really do need to get a good objective picture of what is happening before and after you take your medications(and supplements).

You are doing good so far with them. As always, I will say MORE NOTES. Because I know, you can, do them now, and I do want another look at your case.......and this helps, the NOTES. I am the NOTE fairy godmother, or something.

I have one more reply to do next, in regards to some of what I am seeing in your narratives.

October 31, 2022

18 hours ago, Willowman said:

I did read the articles you referenced. On sleep (downloaded a cbti app the veterans site recommended - it gave me a warning of getting less than 5 hours sleep and to see a doctor haha well the only thing he has for me is seroquel). On passion flower. And on tapering. Thing is I am too anxious to cut up my tablet and try to dissolve it and my doctors don’t want me to either. So it is 75mg jumps because that’s half a 150mg tablet, the lowest dose.

But I will wait another few weeks before I get to 150 I think. Too unstable right now.

Physical sickness ofc doesn’t help. I am curious what the Acc (NAC) is going to do. The couple hours almost normalcy was nice but not if I have to pay with even worse nights.

Do you know if existential anxiety can even go away after being present daily and nightly for a year? I am in the grips of a bad „will this last forever“

17 hours ago, Willowman said:

It is so hard to think moclobemide could be making all this worse but reducing it also could.

I so wish I had never touched the sertraline which sent me into this spiral. Before the anxiety was unpleasant bit manageable. After five weeks of akathisia, anxiety and insomnia and the reawakening of my existential anxiety, it all went down the drain. And I was only on 25mg!

18 hours ago, Willowman said:

I find it curious that NAC seems to be giving me a few short hours of feeling better but then obviously raises anxiety. How is it a cough medication does that which my antidepressants don’t (I read the referenced article). I get the feeling the docs really still know next to nothing.

I am glad that you are reading the topics Willowman. And that bodes well, that you can read now, and organize a little bit. WD can be so harsh and some of us are really confused early on and cannot always read how we once did, or organize well. Maybe that was just me, but I don't think so.

Look at neuroemotions too please. They are tough. There's more in that topic, other links to helping manage them.

And you are sick with a cough now. Other illness symptoms? Like fever, congestion, fatigue, etc? This makes it even more of a challenge right now. When did illness symptoms start? We may need to just baby along a bit, until you are clearing from this illness, ? infection. Have you been checked out for the cough and any other new illness symptoms?

And no, I don't want to support your making big changes again in your moclobemide. You've certainly been on it long enough to have established a type of physiologic dependency, and so........it IS best to go with harm reduction. Our 10% or less, taper guide.

Are you just not feeling like this could be WD?

It sounds like that.

All I can say is review some of the previous links to you. I am pretty certain you are in a WD symptom and situation now.

Here's your signature history:

From 2010 to now

- six weeks on escitalopram stopped 2010

- two months on mirtazapine 45mg stopped 2011

- Elontril/wellbutrin 150mg and 300mg, about a year stopped 2013

- Agomelatine, Venlafaxine short trial periods in 2010

- Passion flower 10 years, 450mg, stopped Feb 2022 reinstated october 20 2022

- Beta blocker, low dose, 12 years, still current

- Tianeptine, 4 months, stopped 2015

- Sertraline 5 weeks, from March 15 to April 30 2022

- since June 2022 moclobemide 150mg, 300 mg on August, 450 mg late August, 300mg September, back to 225 currently since October 14th

You've got a history going back 12 years now, of believing in these kind of drugs........and it's very likely they have only kept you in symptoms really. It's the truth. Not only mine, but many others.......and many others who are doctors and psychologists and investigative reporters, and data collectors. These drugs do not cure anything.

Go to our Current Events forum to read or see more. If you can get to the Home Page here, and then scroll on down, you'll see. I am not alone in my opinion.

Can you use mild hot/warm herbal teas with honey or try a salt water gargle if your throat is sore? I've never heard of NAC for coughs, but alas, it is apparently so, as it was recommended for you? Just try going a bit more really natural with what you use right now, while we are trying, trying to help you. Can you share information from here with your doctor? I don't want to do a your doctor says this and we say that kind of thing.

Do you wish to taper down and maybe some day be drug free? This is important. If not, what are you doing here? There are other sites that might better fit your present needs.

I do hope you'll stay but I am wondering just where you are at now with what you want to do?

It's your choice if you want to keep on the merry go round of ever changing drugs and supplements. It is.

Alright. Have I said enough? Likely so. 3 replies.......

Best. L, P, H, and G,

mmt

November 1, 2022

Thank you for your reply and for being patient with me!

Ok I will make more notes I just don’t want to get on your nerves. And I was certainly very confused at least three months, so everyone tells me. You don’t really notice yourself. My mind was in fear induced withdrawal from the world.

Acc is acetylcysteine and it is often used for coughs. I have a bad bronchitis right now but it seems to be improving slightly. No fever, but congested and general malaise. Some sort of virus going around.

Yes Iwant to be drug free. They don’t help and certainly did me a lot of harm. I would like to taper but I am just scared of everything atm and the idea of making a mistake dissolving a tablet which is not really water soluble scares me. What if ot makes the medication act weird or if my kids get to a lost crumb, that sort of thing, Did I mention I also have OCD lol.

I do believe I am in WD but it is just so contrary to what the general narrative is. Please bear with me. I am from a classic „school medicine“ family.

What convinces me most is that I will have good days and then suddenly crash badly for a day or two for no obvious reason at all.

I will be back with more notes.

Thank you so much for your time, patience and energy!!

November 2, 2022

More notes:

31.10.

Very bad crash day after 2 nights with almost no sleep. Severe anxiety and confused.

19:45 Progesterone, Passion flower 360mg, 300mg Magnesium

20:30 went to bed, sleep around 21.00

1.11.

2:05 awake, not too anxious, but very awake. Got up around 3:00

Thinking, meditation, napping, levithyroxine

5:20 got up, anxiety rising but manageable

6:00 estrogen

6:15 breakfast, 225mg moclobemide, 1000iE D3/K2 and B12, potassium (v small amount), beer yeast - I take these every morning. Zinc (extra because cold)

6:45 Acetylcysteine 600mg

Relatively good day for a change probably because I slept more

16.00 betablocker

20.00 progesterone, magnesium 300mg, passion flower 260mg

Wasn’t that tired and coughing prevented me from sleep so I slept around 23.30 ugh

1:15 woke up

fell asleep around 1:15

3:15 woke up

anxiety high. Worked on it a bit, nap

4:15 woke again what a horrible night

Anxiety sky high. I don’t know why. Also this insomnia is really making me sick.

More notes? I will go on making them if you like.

November 3, 2022

On 10/31/2022 at 7:40 PM, Willowman said:

I do believe I am in WD but it is just so contrary to what the general narrative is. Please bear with me. I am from a classic „school medicine“ family.

I know, don't I know......it is hard. I was from that same school.

Do you always take your thyroid medication at 2 am? And if so, why?

20 hours ago, Willowman said:

1.11.

2:05 awake, not too anxious, but very awake. Got up around 3:00

Thinking, meditation, napping, levithyroxine

And are you changing doses of passion flower too? Why? Urgh. Here is something of interest. With the interaction of passionflower and the other MAOI type drugs:

FROM https://www.stlukes-stl.com/health-content/medicine/33/000922.htm

Monoamine oxidase inhibitors (MAO inhibitors or MAOIs) -- MAO inhibitors are an older class of antidepressants that are not often prescribed now. Theoretically, passionflower might increase the effects of MAO inhibitors, as well as their side effects, which can be dangerous. These drugs include:

Isocarboxazid (Marplan)
Phenelzine (Nardil)
Tranylcypromine (Parnate)

Doesn't that make you nervous, or wonder just how the NAC might interact or interfere with you improving.

Yes. More NOTES.

You need to get a full 24 hours done AND posted. Full names of drugs and supplements and doses. You missed the name of the betablocker and dose......solly, and you are not even close to posting full days.

Get in the habit of taking your drug(s) at the same time or times every day(or night).

That's really important.

And as we are observing, through your notes, even more important.

We need to see all those hours in a day and night accounted for when you do them, so........then we can see what is happening with your symptoms both before and after you take your drug(s), supplements, hormones, whatever.......

I'm not annoyed.....maybe a little, but don't worry about that. I can step away now from my computer if that happens.....just briefly.

I just want you to help us so we might help you. That's all. And I want another opinion, and another to look at your case. So I need clear, concise, good NOTES done and posted. Meantime you will learn and discover too, how to better manage I hope.

Okay, keep them coming, the NOTES. Meantime, hoping your cough clears and you are getting well from that.

Best, L, P, H, and G,

mmt

November 3, 2022

Hello,

no I am not changing the dose of passion flower. I went take one capsule of 260mg at night, 1/4 of the maximum dose. If I type anything differently it’s a typo, sorry.

I tried coming off it but it really doesn’t work atm same time I am reducing moclobemide. I will try again once I al off. My platelets are very low anyway. I am worried about the long term effects anyway.

I will try to do better with the notes.

Hm. Why do I take my thyroid medication in the middle of the night? It developed together with the insomnia because levithyroxine is affected by so many supplements and drugs and food and I am to take it as soon as I wake up. But yes it creates a bit of a changing schedule.

Thank you for taking the timw foe me. I am trying.

I‘ll be back with more notes.

Willowman: moclobemide MAO and a long history of psychiatric drugs

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