Questions and Answers
My father has been taking Nardil for more than 13 years with remarkable results. He has generalized anxiety disorder which has mostly remained in remission with the medicine. He has no other conditions, but does smoke cigarettes.
Over time he has had to increase his dose of the medicine from initially two 15 mg. pills a day, to currently seven 15 mg. pills daily spread out over the day. We wonder if this represents breaking through of his symptoms or perhaps tachyphylaxis regarding this medication. He has never had an untoward reaction to the medication, however, obviously this is a high dose of this medicine.
Can you help us explain why the need to increase it, and if there is another drug which might accomplish the same result for him. Unfortunately, when he tapers the medicine, he becomes quite dysfunctional, such that another medicine would probably best be added to the current med., so that the nardil could be tapered without the disabling symptoms if at all possible. Otherwise he would probably need hospitalization during the transition due to suicidal tendencies which occur when the medicine is withdrawn.
I know that the SSRI medicines and tricyclics are dangerous to mix with Nardil, however I am aware that this is done in practice with some success. You can probably see our current dilemma in that the medication is beginning to fail once again and axiety/depressive symptoms are begining to reoccur.
Thanks in advance for you help. By the way my father is 55 years old.
Hi ... sorry to hear about your father. Breakthrough or tachyphylaxis ? Can't say. The usual dose range of Nardil (phenelzine, a MAO inhibitor) is 30 - 90 mg./day, so he's up there.
The usual practise in switching from a MAOI to a tricyclic antidepressant is to have a drug-free period of two weeks. However this seems impractible for your father.
Severely depresed patients may benefit from the very cautious concomitant administration of a TCA and an MAOI. However the risk of adverse effects must be carefully weighed against the expected benefits. Patients should be cautioned by their physician, in terms they understand, regarding the posssibility of adverse drug reactions.
Best wishes