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Questions and Answers

Q
I have been taking the antidepressant nardil for about 4 years. I had previious ly been on nardil before and had gone off and had become depressed again so I m ay need to continue on it for the rest of my life. I have continued on a very high dose for the past 4 years though, 105 mg. per day, even though I have been com pletely free of depression for 3 years now. I am 6'3" tall and have gone from 220 lbs. to 285 during the last four years.

I would desperately like to lose this weight. I don't think I eat that much more. I get plenty of exercize but it seems like my metabolism has been slowed w ay down.

Are there studies that show what maintanance dose people who respond to nardil require for long term maintanance. I've heard that there are instances where pe ople have gone off nardil or cut down then gone back to the dose that worked be fore only to find that it didn't work for them anymore. Can you comment on this?

Thank you.

A
Your weight gain is an unfortunate, but common, side-effect of Nardil (phenelzine). It may occur with the administration of any member of this group - the monoamine oxidase inhibitors. So switching to another member of the group is unlikely to be of benefit. A possible lessening of this effect might be obtained with a reduction of dosage - your dosage is outside the usual range, 15 to 30 mg./ day ( with extremes of 15 to 90 mg./ day), possibly because of your weight.

You should discuss this with your physician/psychiatrist. I haven't any data on any development of tolerance to phenelzine such as you describe.

If this is not a possibility, your second option would be to switch to another anti-depressant.
1 Tricyclics, e.g. amitriptyline
2 Heterocyclics, e.g. bupropion,
3 Serotonin-reuptake inhibitors, e.g. fluoxetine.

All are effective anti-depressants, but unfortunately not without disadvantages. 1 Is likely also to produce weight gain
2 bupropion probably is the best tolerated but can produce stimulation of the central nervous system, and, depending on dose and individual susceptibility, seizures
3 highly effective but unfortunately with a large list of side-effects (weight gain is not one of them).

You might benefit from consulting a qualified dietician, who, taking into account your medical history and current therapy, will likely come up with modification of your diet.