Willowman: moclobemide MAO and a long history of psychiatric drugs

[ChessieCat]

That's why Alto said to move part of the dose by 1 hour each day.

 

 

 

https://www.nps.org.au › medicine-finder › apo-moclobemide

APO-Moclobemide - NPS MedicineWise

Oct 12, 2021Moclobemide is usually taken twice a day (e.g. morning and evening), at the end of a meal. Take this medicine at about the same time each day. Taking it at the same time each day will have the best effect. It will also help you remember when to take it. How long to take it for Continue taking your medicine for as long as your doctor tells you.

[Altostrata]

Thanks, @ChessieCat! 

[Willowman]

17.11.

7:00 anxiety spike about 20 mins after medication 

Relatively ok day

really bad anxiety and nervousness/tension between 11.00 and 3.00 (unusual)

palpitations

very painful neck

16:00 1,35mh bisoprolol

ok evening

19:40 magnesium 300mg

20:20 went to bed fell asleep quickly (too early but I cannot stay awake later)

22:30 woke up fell asleep again

 

18.11.

1:30 woke up, tension, slight anxiety 

took 260mg passion flower

2:45 cannot fall back asleep

small naps (I think, not sure ) while meditating and listening to sleep stories

4:10 woke up again, tired and anxious but not as anxious as last night 

wondering if the moclobemide kept my illness going during the last few months

6:15  breakfast, 75mg moclobemide 

7:45 75 mg moclobemide 

relatively good morning 

another midday anxiety spike

palpitations

16:00 1,25mg bisoprolol

19:30 magnesium 300mg

21:00 went to bed, melatonin spray

Short nap (I think not sure), 21..45 startling up with intense anxiety 

 

 

 

 

 

[Altostrata]

Are you taking 75mg moclobemide at 6:15 a.m. every day?

[Willowman]

1 hour ago, Altostrata said:

Are you taking 75mg moclobemide at 6:15 a.m. every day?

I was taking 150mg and as you suggested changed to 2x75mg

[Willowman]

Question: I am always very disappointed if I have a good day where I can think about my fears without a panic attack and then I can’t sleep and/or am waking up in the night and it’s all back. 
 

Is this normal in withdrawal?

 

Can a waves and windows pattern be very quick- like a window of a day and then a wave again?

[Altostrata]

19 hours ago, Willowman said:

Question: I am always very disappointed if I have a good day where I can think about my fears without a panic attack and then I can’t sleep and/or am waking up in the night and it’s all back. 
 

Is this normal in withdrawal?

 

Many people find the waves and windows frustrating.

 

20 hours ago, Willowman said:

Can a waves and windows pattern be very quick- like a window of a day and then a wave again?

 

Please read this topic again The Windows and Waves Pattern of Stabilization

 

[Willowman]

19.11.

sleep very interrupted, 5 mins naps, until about 2am then a longer phase of about 2 hours, palpitations 

4:00 got up, tired, very anxious and tense

6:15 breakfast 75mg moclobemide 

8:30 75 mg moclobemide 

Tense and anxious until about 9, better until about noon, slight anxiety spike at noon until about 2pm

okish after, v. Tired and foggy

16:00 1,25 mg bisoprolol

19:30 fell asleep sitting up, went to bed

 

I hope this is the right form of notes. May I ask another two questions? Now that I am writing this down, the reality of how bad it still all is hits me even more.

 

You have a lot of experience with people who have mental health issues, take medication(s) and withdrawal. I am wondering two things:

 

Is it possible a big part of this is still withdrawal from only five weeks of sertraline? I had inner tension and anxiety/dread before. After about two weeks of taking 25mg (12,5mg seemed to go ok) it got much worse. I came off passion flower in an unorderly way (I hadn’t found this site yet) at the same time, though. With your experience, would you say what I have is withdrawal or my original illness (whatever it is, general anxiety, depression or perimenopause or both)?

 

And secondly, also just in your experience of course, will I ever return to the state I was in before this happened? I look at pictures from “before” and get so depressed thinking “ Oh, I was still normal then, I could still enjoy life then”. Now it’s a constant struggle, I have this horrible insomnia and am scares this existential dread will never go out of my head again  - after all, my brain keeps sending me these thoughts every day and night since 9 months now. I wonder if it’s even possible to not think about these things anymore like before.

[Willowman]

My psychiatrist wants me to try agomelantine because my sleep is so bad. I am trying to resist. 

[ChessieCat]

I suggest that you do your own research.  That way you can make an informed decision.  Also research non drug options; if it was me I would be giving these a really good try first before even considering taking a drug.

 

Sleep problems - that awful withdrawal insomnia

 

Things to consider:

• find out what type of drug it is
• do a search on SA for that drug (drug name and also common brand names)
• side effects of the drug
• interaction of the drug with current drugs/supplements
• what would you do if you start taking it and you have a bad reaction
• will going off the drug too quickly cause withdrawal symptoms
• generally when trying something new SA suggests only trying a small dose first to see how you react, and only make one change/try one thing at a time

 

Drug.com Interactions Checker

Medscape Drug Interaction Checker

 

[ChessieCat]

1 hour ago, Willowman said:

My psychiatrist wants me to try agomelantine because my sleep is so bad. I am trying to resist. 

 

Agomelatine, sold under the brand names Valdoxan and Thymanax, among others, is an atypical antidepressant most commonly used to treat major depressive disorder. One review found that it is as effective as other antidepressants with similar discontinuation rates overall but less discontinuations due to side effects.Wikipedia

 

AND

 

From https://www.nps.org.au/medicine-finder/valdoxan-tablets#2.-what-should-i-know-before-i-use-valdoxan?

5. What should I know while using VALDOXAN?

Your liver function

VALDOXAN is processed by the liver. Before you started taking VALDOXAN a blood test was required to check your liver function. While you are taking VALDOXAN you will need further blood tests to check your liver continues to function properly. These tests should be performed:

• before the start of treatment and before a dose increase to 50mg (dose should only be increased by your doctor).
  and then around:
• 3 weeks,
• 6 weeks,
• 12 weeks and
• 24 weeks.

These blood test results will help your doctor decide whether VALDOXAN is suitable for you. VALDOXAN may sometimes affect the results of these blood tests.

You may also have tests to check that your liver is working properly if you start to take medicines that interfere with how the body processes VALDOXAN.

Talk to your doctor about how much alcohol you drink.

[Willowman]

Thank you! Also for the tips how to introduce a change. I feel tapering off two meds is enough change currently.

 

Yes I saw it is liver toxic apparently. I also had my liver monitored when I was taking wellbutrin.

 

I want to go drug free, but I feel I can never heal with this awful insomnia. I wonder why it’s not improving at all, on the contrary, it seems to worsen. Have others experienced that as well?

 

 I don’t want to add a new drug while I am still tapering off moclobemide and also of passion flower. In fact I want to be as drug free as possible . Obviously I still have to take levithyroxine otherwise I would just fade and die, and a betablocker as needed for blood pressure - it is very low dose though. I am still on the fence about hormone replacement- it seems to be useful for people with my genetic disposition towards Alzheimer to lower the risk somewhat, as well as lower the risk for bone and heart issues, on the other hand it most certainly affects mood and is very hard to get right.

 

My quest to feel better physically and  mentally and have a calm heart and a mind full of acceptance is proving extraordinarily difficult.

 

Let me state again that I am very grateful for your help. My doctor doesn’t listen to me, I can’t find one who does and I don’t know anyone who has experience with multi medication use and withdrawal.

 

Most psychiatrists just pile on the drugs and hope for the best. I really had to put my foot down for them to even consider taking me off moclobemide when it’s not helping and even says on the description it may increase anxiety, my main issue.

[manymoretodays]

Willowman, when is the last time you got your thyroid levels checked?  Makes sense to me, to have those checked soon and adjust that medication with that doctor if needed.  Who knows....maybe that is affecting things now?  I thought I was hypothyroid once while on meds and some of the lab results pointed that direction.  I briefly took Armour or amor thyroid pills.  And then did not.  In more recent years my thyroid functions fine.  Moral of story:  drugs and WD both do seem to effect thyroid function.  Might be something you could do a site search on to read more.  I think Karma's Introduction thread is very informative too....around thyroid function and medications.  Okay.  I see you healing and getting drug free in time....with the other drugs.  L, P, H, and G.  mmt

[Altostrata]

As explained repeatedly, it appears many of your symptoms might be from taking moclobemide incorrectly, once a day. 

 

If I were you, I would continue to move 75mg moclobemide later by ONE HOUR each day, until you are taking it at 7:45 p.m., 12 hours after the morning dose.

 

If you wish to switch drugs instead, please talk to your doctor. We do not assist in drug switches or additions for therapeutic reasons.

 

20 hours ago, Willowman said:

And secondly, also just in your experience of course, will I ever return to the state I was in before this happened?

 

We cannot guarantee you will return to the state you were in pre-1997, when you started on psychiatric drugs.

[Willowman]

20.11.
 

1:19 woke up

napped a bit without really noticing I think

2:30 wokre up with unusually bad anxiety, wandered around employing all my techniques 

4;50 gave up on sleep

6:00 breakfast, 75mg moclobemide 

6:15 estrogen gel

bad anxiety spike around 8.30 again

9:30 75mg moclobemide 

outdoors a lot that day walking, very tired, many small anxiety attacks

15:30 1,25mg bisoprolol

18:30 magnesium 300mg

19:00 fell asleep wherever I was therefore went to bed, 200mg progesterone 

short wake ups at unknown time in the night

 

5 hours ago, manymoretodays said:

Willowman, when is the last time you got your thyroid levels checked?  Makes sense to me, to have those checked soon and adjust that medication with that doctor if needed. 
 

 

 

It may be mt thyroid is fluctuating. I adjusted from 100myg to 75 since October 2021 because my levels were suddenly too low, I get it checked every three months, atm all seems good. I do have autoimmune inflammation so it’s unlikely to go away, the thing with hashimotos is you never know when it flares and you are suddenly hyperthyroid only to be hypo when the flare is over. Well you know from feeling badly.

[Willowman]

On 11/20/2022 at 11:44 PM, Altostrata said:

As explained repeatedly, it appears many of your symptoms might be from taking moclobemide incorrectly, once a day. 
 

 

sorry

On 11/20/2022 at 11:44 PM, Altostrata said:

We cannot guarantee you will return to the state you were in pre-1997, when you started on psychiatric drugs.

I never thought you could guarantee that but I wanted to know if your experience provided some frame of reference. I will just read through the materials on your site. Thank you

[Altostrata]

I can guarantee you that you will not turn back the clock. You cannot step in the same river twice. However, you could build a different life in the present.

[manymoretodays]

Willowman,

Updates?  How are you?  How is the split dosing going?

 

Best.  L, P, H, and G,

mmt

[Willowman]

Hello manymore,

 

I was getting insecure about getting on people’s nerves so I stopped posting.

 

I have stopped the moclobemide completely now (since 10 days ago) and am experiencing some withdrawal but not too severe. Some waves of anxiety and panic. But then I get some windows of feeling better than when I was on it!

 

I have started with agomelatine 25mg nightly though and it does help sleep. Which was extremely important to me. I plan to take it only for a couple of weeks until the internal clock has hopefully reset. It feels very natural, I am not foggy during the day and don’t get the zonked out tiredness like from quetiapine or dominal.

 

I do get a bit of hypomania sometimes in the morning, don’t know if it’s from agomelatine or withdrawal.

 

If I may I will post again once I am ready to go off agomelatine.

 

best

 

chris

[Willowman]

Ironically, I likely spoke too soon.

 

The moclobemide hasnt given me too much withdrawal - I think. At this point, who knows where the awful anxiety and morning dread is coming from.

 

I thought valdoxan was working out for me, but the day before tomorrow I had severe anxiety in the early hours and tnesion and nervousness during the day. And today, the waking up and not being able to go back to sleep because of anxiety was back. With valdoxan. So maybe it already stopped working - not even two weeks in- or the lesser anxiety was an effect of less moclobemide or it was something else altogether.

 

If sleep doesn’t improve again, I might as well go off valdoxan. So many people tell me they have been helped greatly by their psych meds. I wonder if that is placebo or what is special about my metabolism that they don’t help me and never really did??

[Willowman]

I am also trying to get off the betablockers since my blood pressure is ok without them (I had to go dowm from 50mg metoprolol to 1,25mg bisoprolol two motnhs ago already) and I don’t want ro take what my body doesn’t need.

 

But I have the feeling this causes extra issues with anxiety. Is this possible? Does going off long term betablockers use cause withdrawal symptoms?
 

Tonight I tried without valdoxan. I am back to waking up very anxious every hour or so. However that was starting with the medication as well.

 

There must be something about my metabolism or mind that makes psych meds work for a week or so and then stop…am I the only one?

[Willowman]

Manymore and Alto and others,

 

please don’t think I don’t appreciate your advice - I am just so so desperate and going through what I perceive as torture.

 

As I said I stopped the moclobemide in favor of valdoxan. And I didn’t want to get on your nerves because you said I need to get off all meds. And I think you were probably right..valdoxan helped me for a week and now the nights are worse than ever! I am awake now for the second time tonight, after falling asleep exhausted at 8.30pm. First wake up at 9.15, second at 11pm. Horrible. And super anxious now and ofc dead tired.

 

This is not working, obviously. Valdoxan again doesnt seem to be the miracle sleep drug it was touted to be.

 

I have taken it now 10 or 11 days. Do you think I can still just stop or do I need to taper?

I so much regret not following your advice and trying another drug in my desperate attempt to find relief. 

I probably went off the moclobemide too quickly, too. Although I have to say I was feeling better without it for almost 10 days before this downward spiral started. 
 

May I still ask for your support now going through withdrawal of moclobemide, valdoxan and the betablocker? Please. 
 

If you decide to continue helping me, what do you need me to do? Start over with the notes? Redose a medication?

[manymoretodays]

Hi Willowman,

I did just see your PM, and had seen your recent posts.

I do prefer to keep it all out here, and yes.......I can try and help when time allows.

 

Oh.  So you just jumped at 75 mg of moclobemide on the 28th of November.  6 days ago now.  Did you try to stay with the split dosing at all?

 

And then you started up with Agomelatine/Valdoxan on the 30th.......4 days now.  Did you overlap the 2 drugs?  I quoted below what you said in one of your last posts, and you are saying 10-11 days.

 

I'm not even very familiar with that drug.   It does look like we have a topic:

Tips for tapering off Valdoxan/agomelatine

and then there are some administrative and staff, comments on it, and tapering tips too.  So have a look.

 

6 hours ago, Willowman said:

I have taken it now 10 or 11 days. Do you think I can still just stop or do I need to taper?

 

 

6 hours ago, Willowman said:

I probably went off the moclobemide too quickly, too. Although I have to say I was feeling better without it for almost 10 days before this downward spiral started. 
 

May I still ask for your support now going through withdrawal of moclobemide, valdoxan and the betablocker? Please. 
 

If you decide to continue helping me, what do you need me to do? Start over with the notes? Redose a medication?

 

What do you think Willowman......I mean I am not trying to be mean, or belittle......but honestly.......

Referring to your "I probably went off the moclobemide to quickly" statement.

Yes, WD can and does set in, if not immediately, sometime in 10 days, or even a month.

 

If you have been regular with the betablocker to date, you do need to stay put with that right now would be my best suggest.  Rather than begin a taper off that while your nervous system is in chaos.

Tapering Beta Blockers or Alpha Blockers

Tips for tapering off propranolol

(there is a bit about clonidine ^ too)

 

6 hours ago, Willowman said:

May I still ask for your support now going through withdrawal of moclobemide, valdoxan and the betablocker? Please. 
 

If you decide to continue helping me, what do you need me to do? Start over with the notes? Redose a medication?

 

Are you going in and actually seeing a psychiatrist or other doctor when you make all your drug changes?  Please don't put us in the position of playing us Willowman.......I mean, going to see your doctor and then coming in after absences and changes, and asking us to fix it all???

Someone is prescribing for you, and honestly right now I think you should ask them what to do.  Not us.

 

I'm willing to look at updates.  And yes, if you'd like to post NOTES again, great.  And if I knew the solution and a quick one for you.......I'd give it.....in a heartbeat.

More than happy to help with any non-drug coping as well.  And general support.  That's me anyway.

 

And please don't doubt.....that I really want to see you get better and heal some day.  And I think it is possible.  So hang on, hang in.  And sleep.....oh my.......sending sleep once again for you.......just rest if that's the best you can do, eyes shut, in the dark.......imagine healing.

I'll also put you in, again, for conferencing with other staff now.

 

Best I can do right now.

L, P, H, and G,

mmt

Edited December 5, 2022 by manymoretodays

[Willowman]

I understand where you are coming from and I can honestly say I am not playing you. I am scared myself I don’t remember things properly. I don’t know if it’s the lack of sleep or withdrawal but I really don’t remember the dates correctly. I only overlapped the drugs for one day and I had a little more than a week worth of valdoxan so I calculated back. I think I have to write every little thing down. My medium and longer term memory is not working. I hope that’s not already dementia setting in!

 

I will go back on the betablocker. It is too awful now with everything else going on. In an attack of anxiety I thought maybe it contributes to my issues. I will try to get off that one another time. I think with what the doctor did, changeing my dose from 50mg metoprolol to 1,25mg bisoprolol after 10 years on the metoprolol already made things chaotic. As far as I understand, the dose is much lower. She took me of metoprolol cold turkey at first but I had to go back since I experienced bad tachycardia and anxiety that time as well.

 

I did the split dosing of moclobemide for a few days, yes, but it didn’t seem to do anything.

 

And it was a misunderstanding between me and my doctor, she wanted me to take both drugs cumulatively and I thought she wanted to replace one with the other. I am in medical care, however, they seem to be very unknowledgeable as regards withdrawal and safe switching or going off medication. For my doctor, cold turkey or very fast tapering is not an issue and everything that ensues is just „the original illness”

 

Thank you for still being willing to help. I feel I am falling quickly and don’t know left from right anymore. I wish I could turn back time to February and not take sertraline- or better to 1997.

 

I will just post the 24 hour notes and hope you can make sense of what is going on with me.

[Willowman]

Just one question before I resume with the notes. Seeing I am reacting so much to leaving off the bisoprolol, could it be that part of my issues during the last few weeks were caused by being changed from 25mg xr metoprolol twice daily to 1,25 mg bisoprolol once?

 

And reading through my own posts I don’t understand myself. 

[Altostrata]

Our official position is: You do not need to go off your drugs. If you want to continue taking them with their adverse effects, by all means, keep taking them.

 

We help people go off their drugs only if they want to go off their drugs.

 

If you are continually adding or changing drugs, we cannot help you. Let us know when you have decided not to seek a drug cocktail solution, stopped changing your drugs, and mean to go off your drugs.

[Willowman]

Well, I am off the moclobemide and I am going to go off the valdoxan tomorrow. Since it doesn’t work and I don’t want these drugs in the first place. The  I will only be on passion flower, herbal teas, melatonin spray. And magnesium gkycinate and omega 3 since this was recommended here.

 

It is beyond horrible not to be able to sleep though. I am back at 1-2 hours a night and being dead tired but too anxious, sweaty etc to sleep.

 

It may all still be withdrawal from the mix I exposed my body to. Or it may be the original illness…

 

I am going back on bisoprolol, though, since it obviously was a bad idea to put betablocker withdrawal on top of all else. My doc never even believed it could cause insomnia, anxiety, racing heart etc because my blood pressure was still ok. But I am certain it can.

[Altostrata]

We provide peer support for a gradual taper of psychiatric drugs, in order to minimize the risk of withdrawal symptoms.

 

If withdrawal symptoms are not a concern for you, you can go off your drugs any way you wish. You may have to cope with withdrawal symptoms, we do not have any miracle remedies for them.

 

 

[Willowman]

I understand Alto. I am glad I didn‘t go off the moclobemide cold turkey - my psychiatrist wanted me to. And I didn’t go off cold turkey because I found this site.
 

But I did go off it quicker than you recommended and off the passion flower too.
 

When I told the psychiatrist about the increased insomnia and nighttime anxiety I developed about 10 days after going off moclobemide  - probably because it was still way too fast - she said that that isn’t withdrawal but the original illness….

 

I think it is withdrawal and I can only hope it doesn’t last too long

 

And I would still be glad if you could support me when I go off the agomelatine. Currently I don’t dare to. I shouldn’t have started with it but I was so desperate with the insomnia…and now it didn’t help and I have to go off another drug

[Altostrata]

You added agomelatine November 28. What was your doctor's plan for you to go off?

 

We are very reluctant to go to the trouble of advising you to be played against your doctor, whom you pay for their services.

[Willowman]

I understand, Alto. Agomelantine was less given for anxiety, my main problem, and more for being able to sleep. This insomnia has developed into a big issue. Since my anxiety is worst at night, it will fuel that and also, severe sleep deprivation is no joke.

 

No one can live a meaningful life on 2-3 hours sleep a night. This has been going on for months now. 
 

My doctor has not communicated a plan for going off, I am going to ask her. That will probably not be an issue anyway since the insomnia is bad with or without agomelatine.

[Altostrata]

Please take any questions about agomelatine to your doctor.

[Willowman]

Just wanted to tell you I am now free of any psychotrophic drugs except passion flower since December 10

 

and I don’t plan to introduce any anymore

[manymoretodays]

Hi Willowman,

Well.

How are you doing?

Is your sleep any better?

 

L, P, H, and G,

mmt

[Willowman]

Anxiety is still on and off but getting better during the day. Way fewer panic attacks although I think a wave started yesterday and I had one yesterday plus inner tension and nervousness.

 

The nights I am a different person or so it feels. Can fall asleep all right 90% of nights. But I will relentlessly wake up all the time and not get more than 4-5 hours of sleep altogether and broken at that. The insomnia and nighttime anxiety and palpitations and waking up in a cold sweat are the worst symptom, withdrawal or otherwise.

 

I read that can take a long time to resolve. It’s hard to bear.

[Willowman]

I am now trying to implement a strict sleep window. As yet, it doesn’t work but I hear it takes time. Function on 4 hours of sleep is hard.

 

Also, I recently notice depression increasing. Is this a possible withdrawal symptom?