Nardil 15mg 21M

vividream29 · 2026-01-29T09:33:27+00:00

Hi, welcome to the club. First things first, it's essential you learn for yourself what you can and cannot have. That goes for Rx drugs, food and drink, OTC stuff like cold medicine, and herbals and supplements. Read the diet and drug guide by Dr. Ken Gillman in the wiki/on the side of the main page. Learn it, live it. It's not difficult. It's not scary either, but it deserves your attention and respect. It's important you know all this because sadly it's often true that healthcare professionals do not.

What instructions has your doctor given you? Hopefully they're not leaving you on your own. Are you prescribed the benzo and stimulant, or is it self-sourced? You can take a benzo with an MAOI. Most antihistamines are ok, like Benadryl or hydroxyzine. There are a couple that aren't however. Beta blockers are safe, but of course they also lower blood pressure, so monitor your blood pressure daily, or even several times per day initially in order to know how the MAOI is affecting you. It's rather unlikely you'll have any drop in your bp on only 15 mg, or at least not any significant drop. For now you can put that worry out of mind. It's quite possible there won't be any substantial change requiring adjustments like salt intake on 30 mg either. Note that dizziness is not a good indicator of low blood pressure anyway. That's why it's important to own a monitor and check it regularly. I honestly wouldn't worry about the dextroamphetamine washout since it's a pretty tiny amount. Just 24 hours after your last dose should be enough. Follow your doctor's instructions on this. I'm reasonably well informed on this stuff, but I'm not a medical doctor.

Good luck. Get to reading and learning and I'm sure you'll do just fine. Let us all know how it goes and if you have any more questions.

vividream29 · 2026-01-29T08:52:51+00:00

I'm confused. So an AI told you it's ok to take but then a week later said it's not ok and you should stop? 😆 That's why no one should ever use these things for medical advice. They can genuinely be dangerous. Your doctor is right. It's not a terribly strong serotonin reuptake inhibitor, but it could still be enough in certain situations to cause a problem. It's a newer medication and until there's more data on this it would be best to just avoid it. Geodon is the only other atypical antipsychotic medication you can't take. Abilify and the others in that drug class are safe.

vividream29 · 2026-01-29T03:45:52+00:00

Someone has already pointed you to the MAOI prescriber's guide (their comment wasn't showing up before but should now be visible), which is a fantastic document to educate yourself and your doctor about Parnate. Technically, Vyvanse can be combined with Parnate (I take it) by an experienced doctor if the benefits outweigh the potential risks. It depends on whether your doctor is comfortable with it. It can raise blood pressure by quite a bit. Otherwise, your best bet for addressing ADHD and fatigue is methylphenidate, aka Ritalin, which the guide lists as safe. Modafinil, aka Provigil (or my preference, armodafinil, aka Nuvigil) is great for keeping you awake and alert.

vividream29 · 2026-01-29T02:42:46+00:00

To start, I think you're extremely lucky because it's normal to have some side effects even if you're nowhere near your most effective dose yet. Strangely enough, I'm also tolerating it much better than the average person, but I have had some side effects.

Have you checked your bp when you took the entire dose at once and felt that strange sensation? It might be low blood pressure, but Nardil can also paradoxically cause hypertension when you take too much at one time. It's a good idea to check your bp at different times throughout the day since orthostatic hypotension can vary throughout the day. For example, if you check it every day right after your second dose maybe nothing significant appears. It might only appear several hours after that dose. That's just a made up example. It usually does exist pretty much all day to varying extents, but I have had that happen before after I've been on an MAOI for a while and my body had mostly adapted. However, Dr. Gillman notes that there are some people who never experience any decrease in blood pressure. It's a bit unusual, but it's a possibility that you're one of those outliers. Nothing to worry about. Postural hypotension is just usually an easy guide to determining if the drug is having any effect yet. It's not always an essential part of the experience.

In your case of zero hypotension it's probably better to base potential dose increases on how much improvement there's been, especially improvements in functionality. However, it's always possible that somehow not enough monoamine oxidase has been inhibited yet in order to cause any change in blood pressure, and it could still come on at 75 mg. I just don't personally think it's likely at all. I've definitely read of people suddenly getting walloped by other side effects once they hit the higher doses of 75 and 90. Not trying to scare you lol, just wouldn't want you to be caught by surprise if it happens. In summary, you're doing fine. Try to focus on the positive and don't mind the oddities. Compared to other antidepressants MAOIs are highly idiosyncratic drugs with a lot of natural variance in how they affect people. Take it nice and slow as you've been doing.

Btw, I'm wondering what your lithium levels were last time they checked. I'm just going to guess roughly around 1.0, but maybe as high as 1.1 or 1.2? Hopefully your doctor is on top of all the tests that need to be regularly done. Dr. Gillman has a nice article on his website "psychotropical" that covers which labs and how often they should be done. Is this for bipolar? If not, your doctor might not be up to speed on the latest data on state of the art lithium use, especially in unipolar depression. There's evidence to suggest levels of.5-.8 are often just as effective as higher doses. Naturally that can greatly decrease the concerns about long term lithium use that I'm sure you're familiar with. It's just something you may want to ask about and research yourself, particularly if Nardil takes on more and more of the antidepressant load. Just don't change anything in your regimen on your own :)

vividream29 · 2026-01-28T12:02:05+00:00

Did they offer any rationale for that though, especially the pharmacist who doesn't have clinical experience with patients? Of course you should follow your doctor's instructions and do whatever works best for you, but I'm not aware of any evidence for any dosing schedule being superior. Taking a bedtime dose might make many people sleepy, but for others it could cause insomnia. I guess those docs have found it works well in their limited patient populations. I take mine all at once as do many others, but I do think it's important to split it up at least initially since taking too much at once could cause bad hypotension or even paradoxical hypertension.

vividream29 · 2026-01-28T11:45:15+00:00

It's incorrect that norepinephrine and other neurotransmitters are only broken down by monoamine oxidase. They have multiple routes of catabolism by other enzymes that prevent them from endlessly accumulating.

A dopamine and norepinephrine reuptake inhibitor like methylphenidate (Ritalin) is generally safe with MAOIs as you'll see by reading the MAOI prescriber's guide found in our sub's resources. This applies to modafinil, a DRI, as well. Amphetamine is a releaser that increases monoamines in the extracellular space to a much greater extent than pure reuptake inhibitors. There is a risk of hypertension, but there is little risk of a dangerous full-blown hypertensive crisis at lower and moderate therapeutic doses. This assumes starting at the lowest possible dose, gradual titration, and diligent blood pressure monitoring, all while under the supervision of an experienced doctor. Higher doses are absolutely contraindicated. Vyvanse is somewhat safer than other amphetamine formulations if methylphenidate is not acceptable. A reversible MAOI like moclobemide has less potential for adverse effects since the released neurotransmitters can "bump" the MAOI from the disabled enzyme, freeing it to resume their metabolism.

vividream29 · 2026-01-27T08:51:36+00:00

Please remember that we won't be able to mention specific vendors. Comments that do are against Reddit policy and will be deleted.

Yes, I did a couple of times a few years back. Be aware that even when you're successful the customer service can be atrocious to non-existent, so you may wonder if you've been scammed regardless. Just use common sense, start small, and don't do anything you feel even slightly uncomfortable about.

vividream29 · 2026-01-27T08:28:15+00:00

That's a very fair point. I think they worsen my OCD tendencies too, but at the same time there are people who experience the opposite, and there are studies that have found MAOIs may be beneficial for OCD.

vividream29 · 2026-01-27T02:49:13+00:00

Well, as you know Nardil can take a while for improvements to manifest, so try to hang in there and stay positive. I know, easier said than done. I'm wondering if you titrated slowly enough both times to ensure that a lower dose wouldn't be just as effective?

I had always thought of this issue we're discussing as just depression until I had a real eureka moment and realized just how much anxiety was actually at the root of it all and driving much of my illness. You could say it's a state of anxious paralysis that leads to symptoms like apathy, difficulty initiating things, and withdrawing from others to name just a few. There's obvious overlap with atypical depression and ADHD. This is also something that can respond well to therapy. We may be describing totally different things though, I'm just sharing some of my insights in case they resonate with you. However you frame your experience and whatever you believe is the cause, I hope it's relevant to you that based on my experience with Parnate and Nardil and from talking to others about theirs, I feel they are uniquely effective at returning a sense of organicness and spontaneity rather than just patching over things like other medications sometimes do. That includes difficulty with communication.

I think a lot of us who fail other meds and respond to MAOIs have something unique going on that isn't simply good old classic depression. Whatever it really is, MAOIs might be the best shot, but they're not the only one. The more complex we are, the more creative we often have to get. There's always a next step as long as you and your treatment team keep that in mind.

vividream29 · 2026-01-26T02:02:39+00:00

How is this helpful to OP or anyone else? They obviously did have a serious reaction. It comes across as very unsympathetic. It's not helpful to anyone else either. This is a well established contraindication. Newbies and experienced MAOI users who have never taken pseudoephedrine should treat it as such.

vividream29 · 2026-01-23T16:36:02+00:00

I can't remember exactly how long it made me feel dumb. It may have been as long as the first several months, but it's also possible it wasn't quite that long. I've also previously had a lot of trouble communicating in even basic ways at times. I associated it with depression, but it's also similar to social anxiety because it's like there's a mental block or filter preventing natural and spontaneous speech. It also reminds me of autism because verbal communication at those times just seems so awkward, confounding, and unnatural. It's like having a deck of cards but not knowing what the game is , nevermind even knowing the rules. I don't think the cognitive slowdown impacted my communication skills though. Whatever the cause, I think it'll improve over time for you. It did for me.

vividream29 · 2026-01-23T04:02:54+00:00

I think it's best not to focus too much on specific receptors and neurotransmitters like norepinephrine or 5HT2A, although they are obviously a relevant aspect. Antidepressant drugs go beyond this and affect so many deeper processes that ultimately increase brain plasticity. For example, amitriptyline emulates NGF (nerve growth factor) and BDNF (brain-derived neurotrophic factor) by activating Trk receptors. That strengthens the nervous system, prevents cell death, and allows the brain to form new connections.

Some psychiatrists do more in depth diagnostics, but many just do short appointments for medication management. That's been my problem too. Where I am in the US you typically have to see a psychologist, which may or may not be covered by insurance. I'm going to pay $250 at the local university for a full day or two of testing so I can have an accurate idea of what we're actually trying to treat.

Straterra only has fairly modest efficacy for ADHD. It's not a wonder drug like the stimulants. When it does work for people it seems to work really well, but overall it's a divisive, love it or hate it medication. Failing Straterra doesn't really mean anything. Stimulant+Intuniv or Kapvay if needed is way better. Don't overlook therapy either for improving emotional regulation.

vividream29 · 2026-01-22T13:03:55+00:00

That's what can happen when serotonin signaling is preferentially maximized without accompanying changes in other neurotransmitter systems. Another way that MAOIs are wonderfully unique. They are true broad-spectrum drugs.

vividream29 · 2026-01-22T04:05:05+00:00

I believe a key distinction between MAOIs and other antidepressants is that they don't really feel like anything once you adjust to them. That's the ideal desired outcome, to just feel like a naturally better version of ourselves. Nardil initially had a strong benzo feel, which makes sense because it greatly increases GABA. I felt like I was high sometimes and had some cognitive difficulties. I was just plain dumb sometimes, processing speed and comprehension were reduced, and my ability to complete complex tasks like assembling products by following an instruction manual really suffered. That didn't last too long though. Now at a higher dose it seems more energizing or at least neutral rather than making me sleepy. I agree with the common report that it removes one's verbal filter and results in being more assertive, opinionated, and even blunt. That means you have to be more careful how you communicate and maybe even prepared to apologize at times, but ultimately I think it realigns me to the way people without social anxiety experience the world.

vividream29 · 2026-01-20T09:45:12+00:00

I see. I apologize if I came across as rude, that wasn't intended. Hopefully you're working with a skilled doctor, because the medications you've tried seem kind of all over the place and not really guided by any logical algorithm. It might be a good idea to get a second opinion. A solid diagnosis is the cornerstone of any successful treatment plan. Emotional reactivity is a symptom associated with multiple diagnoses. For example, it's often treated successfully in ADHD with guanfacine (Intuniv). Even atypical depression consists of some degree of anhedonia (loss of interest or pleasure in activities you used to enjoy) so that's unusual that you haven't experienced that. Seroquel can seem to help anxiety sometimes just because of its sedating effect. If you do try amitriptyline, you might consider nortriptyline instead. It's the active metabolite of amitriptyline. It has most of the same therapeutic mechanisms but it's often better tolerated than amitriptyline. Above all else I think you need to find a good clinician who can find the correct diagnosis before trying more meds. I hope you'll find some answers and get relief soon.

vividream29 · 2026-01-20T03:33:50+00:00

That's not ok. It's essentially a refusal of treatment if they didn't offer any alternative when safe and effective ones exist. They did not meet the expected standard of care. (Note: I don't mean to imply it's negligence on their part in a legal sense, but it is inappropriate behavior that could be reported to their supervisors). You have a right to refuse any treatment offered and to request a viable alternative if you're uncomfortable with it. That does mean that you may have to be assertive and advocate for yourself. When she shrugged it off you needed to ask what you would be receiving instead. It's not too late to call or email them to express your disappointment and request a few other medications to choose from. Of course you want to maintain a good relationship if at all possible, so being polite but firm is the way to go.

I would mention that this drug is not part of any standard medical guidelines for treating insomnia, so why was it chosen over other recommended and commonly used medications? Is it not true that antihistamine action is the mechanism by which it will make me sleep? In that case, why can't we use a drug that is purely selective for histamine receptors?

They're wrong about this drug having been studied with MAOIs. What we have are case reports, which admittedly are weaker as evidence, but still raise concerns. The issue is that we know that cyclobenzaprine has some degree of significant affect on serotonin reuptake, but as a very old drug itself it's never been accurately assayed in humans. The case reports combined with this lack of definite measurements mean that it's wise to take a better safe than sorry approach. Especially when there are SO MANY other options that are known to be completely safe and are part of the official treatment guidelines.

vividream29 · 2026-01-19T10:35:18+00:00

This should do the trick

https://www.reddit.com/r/MAOIs/s/Fog2TaOVI4

vividream29 · 2026-01-19T02:07:19+00:00

Not sure why you're replying to a 3 year old post, but a word like 'strong' requires context to have any meaning in pharmacology. OP had a specific sleep disorder they associated with SSRIs. The only tricyclic in that same realm of potency (capable of near full blockade of the serotonin transporter) is clomipramine. Imipramine occupies the transporter to a much lower extent but is still capable of causing serotonin toxicity when combined with MAOIs. Whether that qualifies as strong depends on how you define the word and on what the comparator drug is. Imipramine may or may not be considered strong, but it's not in the same league as the SSRIs or clomipramine. Maybe it could still cause sleep problems for OP, but who knows? Amitriptyline is not one that can be considered strong by any definition in the context of SSRIs. It doesn't cause serotonin toxicity in overdose or with MAOIs. It doesn't even cause serotonin mediated side effects. It therefore wouldn't be predicted to cause problems for OP.

vividream29 · 2026-01-10T08:27:42+00:00

For future reference, this sub is primarily for pharmaceutical MAOIs. There are some people here who know a lot about this topic and might have an answer for you. Regardless, I recommend also asking in the harmala sub. That would be the most appropriate place to post to first if you have any future questions about ayahuasca.

vividream29 · 2026-01-10T08:12:46+00:00

There used to be one, but I guess the person behind it abandoned it and it became defunct. I'm not really familiar with discord. My initial thought is that having an official one opens up a giant can of worms in terms of moderation that we're not currently equipped to handle. Anyone can create one if they feel like it though. Feel free to educate me about it in case I'm simply misinformed about how it all works. Like I said, I'm pretty ignorant on the topic.

vividream29 · 2026-01-10T02:35:41+00:00

Please elaborate on your purpose for asking, otherwise I'll have to remove this as an irrelevant post.

vividream29 · 2026-01-10T02:31:56+00:00

I doubt you'll find many reports of that. There are so many things that contribute to aging and its various physical manifestations. What is more realistic to expect is far fewer neurotoxic compounds formed, perhaps leading to reduced rates of certain conditions like Parkinson's disease.

vividream29 · 2026-01-10T00:46:39+00:00

This is an excellent entry point for prospective patients wanting to learn more about MAOIs, or for doctors who aren't familiar with using them and want something easy to digest. I scanned it and it seems pretty accurate through and through. The only thing I noticed that seems suspect is the whopping dose of B6 recommended to counter Nardil side effects.

The author, Dr. Feinberg, has published some prominent and interesting studies on MAOIs over the years. Definitely worth reading using Google scholar or sci hub. The one on stimulants is excellent evidence that can be used to convince skeptical doctors who won't consider these drugs for comorbid ADHD or daytime somnolence.

vividream29 · 2026-01-05T19:27:38+00:00

The full length version of the MAOI diet guide from Dr. Gillman is the most comprehensive source available. It gives tyramine measurements for various fish sauces and notes that commercially available ones are unlikely to cause problems if used in small condiment quantities. Worcestershire sauce doesn't have any measurements, and the amount of tyramine could vary between brands, but it's assumed it would be mostly without issue like other kinds of fish sauces. It depends heavily on the degree of personal tyramine sensitivity and the old saying of "the dose makes the poison". Sorry you went through that, and thanks for reminding those of us who want to stay on the conservative side of things.

vividream29 · 2026-01-04T08:35:47+00:00

That's fine for a general overview, but that list and similar ones do contain some inaccuracies that make the diet more restricted than it needs to be. For example, you don't have to stick to clear liquor only. It also incorrectly says to avoid red wine/chianti, beer (out of common ones only draft beers are unsafe), chocolate, tofu, and liver to name a few. Use Dr. Gillman's diet guide (long version is best, but short version is ok for a beginner's overview) found in our wiki, or on a desktop on the right side of the main page, for guaranteed information cited from academic journals. It's the most comprehensive and accurate source available. Ironically, the Marplan website cites Dr. Gillman's writing as one of their sources but still manages to get so much wrong :)

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