There could be many causes of anxiety. GABA is a common target simply because it's the brain's primary inhibitory neurotransmitter, but something else might need to be addressed. It's never a one-size-fits-all with psychiatric disorders. Further, some people might have anxiety that arose from something pharmacotherapy will never fix, trauma for example. A medication will at best be a band-aid for that.
>anxiety that arose from something pharmacotherapy will never fix, trauma for example
Do you mean such cases of trauma such as during childhood should be addressed with therapies such as CBT if powerful antidepressants don't work as expected?
In my case, years ago, I used to have SSRIs and CBT at the same time to address my chronic depression, OCD and general anxiety disorder. This proved to be to no avail. I threw in the towel with CBT, but I kept taking antidepressants. I tried stronger and stronger medicines until now that I am on Nardil. I'll give it more time, i.e. several months, but I really wonder if one day I'll find a medicine that works.
I meant medication alone isn't going to fix such problems, and neither does turning to alcohol and similar. They are a partial solution. Medications can have a role, but they don't get to the root of the unhappiness. So if a medication makes life easier to endure and allows therapy to work better by easing anxiety or putting you in a better frame of mind then by all means take advantage of both.
> should be addressed with therapies such as CBT if powerful antidepressants don't work as expected
I don't think [Cock and Ball Torture](https://en.m.wikipedia.org/wiki/Cock_and_ball_torture) would be too helpful for cases of trauma.
Just kidding, lol. It's important to note, however, that *some* Cognitive Behavioral therapy protocols aren't helpful for [C-]PTSD, and can in fact make it quite worse (as well as many non-related approaches, such as psychoanalysis...). Trauma-Focused CBT (TF-CBT) is a new protocol known to be helpful. Many swear by EMDR, which works, albeit not for the reasons its proponents and practitioners believe - i.e. the "eye movement" part appears to be totally unnecessary for the success of the technique. For specific personality disorders, Dialectical Behavioral Therapy (DBT) is highly effective, regardless of a trauma history. These include, chiefly, borderline (obviously; the background for the development of the techniques), dependent, and obsessive-compulsive disorders.
I hope to come back and comment further to the OP when it's not 5:45 am and I'm procrastinating sleep!
Edit: psychotherapeutic approaches/interventions that can be indicated for trauma (like PTSD and C-PTSD):
- [Trauma-Focused Cognitive Behavioral Therapy \(TF-CBT\)](https://en.wikipedia.org/wiki/Trauma_focused_cognitive_behavioral_therapy)
- [Narrative exposure therapy \(NET\)](https://en.wikipedia.org/wiki/Narrative_exposure_therapy)
- [Psychodynamic psychotherapy](https://en.wikipedia.org/wiki/Psychodynamic_psychotherapy)
- [Eye movement desensitization and reprocessing \(EMDR\)](https://en.wikipedia.org/wiki/Eye_movement_desensitization_and_reprocessing)
- [Systemic therapy](https://en.wikipedia.org/wiki/Systemic_therapy)
- [Schema therapy](https://en.wikipedia.org/wiki/Schema_therapy)
LOL... I didn't know this alternative meaning for CBT 🤣
Gotta be careful when you search for a CBT professionnal... Avoid if the "therapist" is a lady dressed in black leather, I suppose...⚠️
In my city, albeit a large city, the choice in poor in terms of neuropsychologists, and they address only a number of troubles, with limited choice. Sometimes I think about straight out buying a book and working on such therapies by myself, but with my treatment-resistant ADHD, I have such a hard time reading and understanding what I read... A tutorial of a few pages would be easier, but how to find reliable material when you've already followed such alternative therapies to no avail for several years... It's hard to regain confidence in psychology, EMDR, or hypnosis when all this has never helped.
🤣🤣🤣 a good laugh is therapeutical in its own way, isn't it!
Man, do I get where you're coming from! (Re. thinking of learning and applying the techniques on yourself). The problem is that some particular therapies do require support from someone else, even if it is *you* who know how to do it and have to teach the other person to do their part and support you. Trying to self-apply these would be like climbing on top of a wooden chair and trying to lift it by pulling up (or trying to pull yourself off the ground by pulling your bootstraps up).
So, you even did both hypnosis and EMDR and they have not helped? 🫤 I'm sorry. Wish you had experience some decent advancements by now!
I've been struggling severely from my C-PTSD as of recently, it's disabled me a lot. Even though the medications are working for what they should - depression/bipolar disorder and ADHD - the emotional side of things brought about by complex trauma has been hard to endure and get around. Phenelzine helps to a small extent, but I'm finding myself using paracetamol every day, corticosteroids a few times a week and antinoradrenergic drugs very often as well (such as right now - I took both clonidine and doxazosin and am still resisting sleep).
Maybe we could get in touch and discuss ways to work this out (the psychological aspects of what holds us back). It's an idea I can see potential in. Depending on how you feel about it, send me a message in the chat, and _\~let's get the ball rolling_ - shall we?
P.s.: I'm editing my previous comment and appending additional therapies that can be indicated for trauma, other than TF-CBT and EMDR, that I know of.
Right, I tried hypnosis and EMDR a few years ago, to no avail. Thank you, yes, I'll PM you. I had a look at the additional techniques you added to your earlier message.
Me? No. I can't go on NTP for a couple of days without having hypomania or mixed episodes, it seems. Tricyclics and other potent pro-noradrenanergic drugs are highly contraindicated in bipolar disorders...
This is my 6th month on Nardil and I am just this month seeing massive improvement in my anxiety. Also, this isn’t a drug that passively works. You kind of need to take it out for a spin. I would recommend putting yourself in some very minor anxiety triggering situations and try to see if you can function. Then you will see what Nardil can do.
Was your decline of anxiety progressive, in a linear progression, or by stages? Did you have only a mild decline of anxiety since the beginning, and after a long time, suddenly a huge drop?
It was progressive but kind of accelerated like a snowball rolling down a hill.
I had violent, catastrophic depression and and anxiety when I started Nardil. Now I’m back to living my life.
Neurotransmitters are mind-boggingly complex. Nardils gaba mechanism can actually make anxiety disorders worse in some cases. The relationship between neurotransmitters and mental illness is not at all straightforward. So just because one doesnt respond to nardil, that does not mean you might not respond to something else that is more conventional, or in general.
One important note: not all anxieties are equal.
Anxiety is a symptom, not a condition or disease - in the same fashion as fever. It can be present in one of the so-called "anxiety disorders" _(general anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias...)_; it can be a symptom of low blood sugar, sleep deprivation, hypertensive crises, \[hyper|hypo\]thyroidism, medication and substance use, some infections, mixed mood episodes in mood disorders, and of course it can also be non-pathological (i.e. normal circumstantial anxiety). It's also a specifier of both major depressive disorder (MDD) and bipolar disorder (BD) (termed "with anxious distress" in the DSM-5\[-TR\], with three severity classifications). It's certainly an aspect of trauma and stressor related disorders (such as PTSD) and other disorders including a few personality disorders, OCD, autism, and ADHD.
With just that in mind, the point can be further stressed that there are many ways to address anxiety, depending on its etiology. For some, pro-noradrenaline drugs are great (clomipramine, \[des\]venlafaxine, amitriptyline...). For others, SRIs _(fluoxetine and sertraline aren't actually too selective, but they are often used; citalopram and escitalopram are perhaps the most selective, and they also stand out from all the others by being direct inhibitors of the serotonin transporter - all others are allosteric, that we know of)_. For others, one or a combination of drugs classified as "mood stabilizers", a very diverse group. For others, MAOIs. Or amphetamines. Or thyroid hormone. Or noradrenaline blockers; vitamins and minerals supplementation...
There are five main cases that come to mind right now that explain why Nardil wouldn't work well for anxiety:
1. You're trying to address an anxiety disorder other than social anxiety disorder, panic disorder or agoraphobia (phenelzine really shines for those three, but has a variable and overall low effect size for other anxiety disorder such as GAD);
2. You have bipolar disorder and the use of phenelzine is precipitating anxiety and mixed states. [It took me eight years of being treated for MDD until finding out I have bipolar disorder](https://www.reddit.com/r/MAOIs/comments/14p9yo0/my_10year_journey_into_bipolar_2_diagnosis_and/)
3. Your dose is too high. See: [Phenelzine (Nardil)'s effectiveness over anxiety does NOT raise linearly with the dose!](https://www.reddit.com/r/MAOIs/comments/18v0s51/phenelzine_nardils_effectiveness_over_anxiety/)
4. Your pills' coating are not gastric-resistant. How do you know? Unless you're putting them inside \*good quality\* enteric capsules yourself, they are not. The old Parke-Davis Nardil Nardil (pre-2001) had a hard coating that was resistant to the acidic stomach environment; so was the Lupin generic phenelzine that was discontinued in November 2022. Every single option in the market today uses just a tint (or a film called Opadry, in the case of Neon in Europe), so the drug begins to dissolve in the stomach... Releasing phenethylamine (PEA). This effect is minimized if phenelzine passes through the stomach intact and begins being absorbed in the gut.
5. Vitamin B6 deficiency. Or folate, magnesium, B12, calcium and others. Mainly vitamin B6 though. Not only it is required for the metabolism of phenelzine _and_ the formation of phenylethylidenehydrazine (PEH), but it's also crucial in the synthesis of GABA itself. _(And other neurotransmitters)_. What good is inhibiting GABA-T (the enzyme that catabolizes GABA) when very little GABA is being synthesized to begin with?
Refer to these two Google Drive folders if you're curious:
[Testing enteric capsules \(partial\)](https://drive.google.com/drive/u/0/folders/1OWGDsjPimlFrKUIQf9zepRQZrHEmIOfx)
[Phenelzine - brands research \(partial\)](https://drive.google.com/drive/u/1/folders/1DMqR01tKiXcuKrnOmIByvfjYFeOP-437)
I'm 2 months at 60mg into treatment and I'm also impatient because I haven't felt any improvement in terms of anxiety either. I'm still so damn anxious... I thought it would have kicked in by then... Still waiting for one more month before coming to conclusion.
There could be many causes of anxiety. GABA is a common target simply because it's the brain's primary inhibitory neurotransmitter, but something else might need to be addressed. It's never a one-size-fits-all with psychiatric disorders. Further, some people might have anxiety that arose from something pharmacotherapy will never fix, trauma for example. A medication will at best be a band-aid for that.
>anxiety that arose from something pharmacotherapy will never fix, trauma for example Do you mean such cases of trauma such as during childhood should be addressed with therapies such as CBT if powerful antidepressants don't work as expected? In my case, years ago, I used to have SSRIs and CBT at the same time to address my chronic depression, OCD and general anxiety disorder. This proved to be to no avail. I threw in the towel with CBT, but I kept taking antidepressants. I tried stronger and stronger medicines until now that I am on Nardil. I'll give it more time, i.e. several months, but I really wonder if one day I'll find a medicine that works.
I meant medication alone isn't going to fix such problems, and neither does turning to alcohol and similar. They are a partial solution. Medications can have a role, but they don't get to the root of the unhappiness. So if a medication makes life easier to endure and allows therapy to work better by easing anxiety or putting you in a better frame of mind then by all means take advantage of both.
> should be addressed with therapies such as CBT if powerful antidepressants don't work as expected I don't think [Cock and Ball Torture](https://en.m.wikipedia.org/wiki/Cock_and_ball_torture) would be too helpful for cases of trauma. Just kidding, lol. It's important to note, however, that *some* Cognitive Behavioral therapy protocols aren't helpful for [C-]PTSD, and can in fact make it quite worse (as well as many non-related approaches, such as psychoanalysis...). Trauma-Focused CBT (TF-CBT) is a new protocol known to be helpful. Many swear by EMDR, which works, albeit not for the reasons its proponents and practitioners believe - i.e. the "eye movement" part appears to be totally unnecessary for the success of the technique. For specific personality disorders, Dialectical Behavioral Therapy (DBT) is highly effective, regardless of a trauma history. These include, chiefly, borderline (obviously; the background for the development of the techniques), dependent, and obsessive-compulsive disorders. I hope to come back and comment further to the OP when it's not 5:45 am and I'm procrastinating sleep! Edit: psychotherapeutic approaches/interventions that can be indicated for trauma (like PTSD and C-PTSD): - [Trauma-Focused Cognitive Behavioral Therapy \(TF-CBT\)](https://en.wikipedia.org/wiki/Trauma_focused_cognitive_behavioral_therapy) - [Narrative exposure therapy \(NET\)](https://en.wikipedia.org/wiki/Narrative_exposure_therapy) - [Psychodynamic psychotherapy](https://en.wikipedia.org/wiki/Psychodynamic_psychotherapy) - [Eye movement desensitization and reprocessing \(EMDR\)](https://en.wikipedia.org/wiki/Eye_movement_desensitization_and_reprocessing) - [Systemic therapy](https://en.wikipedia.org/wiki/Systemic_therapy) - [Schema therapy](https://en.wikipedia.org/wiki/Schema_therapy)
LOL... I didn't know this alternative meaning for CBT 🤣 Gotta be careful when you search for a CBT professionnal... Avoid if the "therapist" is a lady dressed in black leather, I suppose...⚠️ In my city, albeit a large city, the choice in poor in terms of neuropsychologists, and they address only a number of troubles, with limited choice. Sometimes I think about straight out buying a book and working on such therapies by myself, but with my treatment-resistant ADHD, I have such a hard time reading and understanding what I read... A tutorial of a few pages would be easier, but how to find reliable material when you've already followed such alternative therapies to no avail for several years... It's hard to regain confidence in psychology, EMDR, or hypnosis when all this has never helped.
🤣🤣🤣 a good laugh is therapeutical in its own way, isn't it! Man, do I get where you're coming from! (Re. thinking of learning and applying the techniques on yourself). The problem is that some particular therapies do require support from someone else, even if it is *you* who know how to do it and have to teach the other person to do their part and support you. Trying to self-apply these would be like climbing on top of a wooden chair and trying to lift it by pulling up (or trying to pull yourself off the ground by pulling your bootstraps up). So, you even did both hypnosis and EMDR and they have not helped? 🫤 I'm sorry. Wish you had experience some decent advancements by now! I've been struggling severely from my C-PTSD as of recently, it's disabled me a lot. Even though the medications are working for what they should - depression/bipolar disorder and ADHD - the emotional side of things brought about by complex trauma has been hard to endure and get around. Phenelzine helps to a small extent, but I'm finding myself using paracetamol every day, corticosteroids a few times a week and antinoradrenergic drugs very often as well (such as right now - I took both clonidine and doxazosin and am still resisting sleep). Maybe we could get in touch and discuss ways to work this out (the psychological aspects of what holds us back). It's an idea I can see potential in. Depending on how you feel about it, send me a message in the chat, and _\~let's get the ball rolling_ - shall we? P.s.: I'm editing my previous comment and appending additional therapies that can be indicated for trauma, other than TF-CBT and EMDR, that I know of.
Right, I tried hypnosis and EMDR a few years ago, to no avail. Thank you, yes, I'll PM you. I had a look at the additional techniques you added to your earlier message.
Are you on nortriptyline as well?
Me? No. I can't go on NTP for a couple of days without having hypomania or mixed episodes, it seems. Tricyclics and other potent pro-noradrenanergic drugs are highly contraindicated in bipolar disorders...
Hey Marc - need help check dms PLEASE
This
This is my 6th month on Nardil and I am just this month seeing massive improvement in my anxiety. Also, this isn’t a drug that passively works. You kind of need to take it out for a spin. I would recommend putting yourself in some very minor anxiety triggering situations and try to see if you can function. Then you will see what Nardil can do.
Wow... Such a long time... Six months...😔
But my anxiety started coming down in Week 3. I just wasn’t aware of it.
Was your decline of anxiety progressive, in a linear progression, or by stages? Did you have only a mild decline of anxiety since the beginning, and after a long time, suddenly a huge drop?
It was progressive but kind of accelerated like a snowball rolling down a hill. I had violent, catastrophic depression and and anxiety when I started Nardil. Now I’m back to living my life.
This is so encouraging... Good for you. At last a medicine that changes your life for the best 💪😉
Neurotransmitters are mind-boggingly complex. Nardils gaba mechanism can actually make anxiety disorders worse in some cases. The relationship between neurotransmitters and mental illness is not at all straightforward. So just because one doesnt respond to nardil, that does not mean you might not respond to something else that is more conventional, or in general.
What are you taking isocarboxazid for, if you don’t mind me asking?
Ocd, mdd, gad. Its also helped unintentionally for body pain and headaches.
One important note: not all anxieties are equal. Anxiety is a symptom, not a condition or disease - in the same fashion as fever. It can be present in one of the so-called "anxiety disorders" _(general anxiety disorder, social anxiety disorder, panic disorder, agoraphobia, specific phobias...)_; it can be a symptom of low blood sugar, sleep deprivation, hypertensive crises, \[hyper|hypo\]thyroidism, medication and substance use, some infections, mixed mood episodes in mood disorders, and of course it can also be non-pathological (i.e. normal circumstantial anxiety). It's also a specifier of both major depressive disorder (MDD) and bipolar disorder (BD) (termed "with anxious distress" in the DSM-5\[-TR\], with three severity classifications). It's certainly an aspect of trauma and stressor related disorders (such as PTSD) and other disorders including a few personality disorders, OCD, autism, and ADHD. With just that in mind, the point can be further stressed that there are many ways to address anxiety, depending on its etiology. For some, pro-noradrenaline drugs are great (clomipramine, \[des\]venlafaxine, amitriptyline...). For others, SRIs _(fluoxetine and sertraline aren't actually too selective, but they are often used; citalopram and escitalopram are perhaps the most selective, and they also stand out from all the others by being direct inhibitors of the serotonin transporter - all others are allosteric, that we know of)_. For others, one or a combination of drugs classified as "mood stabilizers", a very diverse group. For others, MAOIs. Or amphetamines. Or thyroid hormone. Or noradrenaline blockers; vitamins and minerals supplementation... There are five main cases that come to mind right now that explain why Nardil wouldn't work well for anxiety: 1. You're trying to address an anxiety disorder other than social anxiety disorder, panic disorder or agoraphobia (phenelzine really shines for those three, but has a variable and overall low effect size for other anxiety disorder such as GAD); 2. You have bipolar disorder and the use of phenelzine is precipitating anxiety and mixed states. [It took me eight years of being treated for MDD until finding out I have bipolar disorder](https://www.reddit.com/r/MAOIs/comments/14p9yo0/my_10year_journey_into_bipolar_2_diagnosis_and/) 3. Your dose is too high. See: [Phenelzine (Nardil)'s effectiveness over anxiety does NOT raise linearly with the dose!](https://www.reddit.com/r/MAOIs/comments/18v0s51/phenelzine_nardils_effectiveness_over_anxiety/) 4. Your pills' coating are not gastric-resistant. How do you know? Unless you're putting them inside \*good quality\* enteric capsules yourself, they are not. The old Parke-Davis Nardil Nardil (pre-2001) had a hard coating that was resistant to the acidic stomach environment; so was the Lupin generic phenelzine that was discontinued in November 2022. Every single option in the market today uses just a tint (or a film called Opadry, in the case of Neon in Europe), so the drug begins to dissolve in the stomach... Releasing phenethylamine (PEA). This effect is minimized if phenelzine passes through the stomach intact and begins being absorbed in the gut. 5. Vitamin B6 deficiency. Or folate, magnesium, B12, calcium and others. Mainly vitamin B6 though. Not only it is required for the metabolism of phenelzine _and_ the formation of phenylethylidenehydrazine (PEH), but it's also crucial in the synthesis of GABA itself. _(And other neurotransmitters)_. What good is inhibiting GABA-T (the enzyme that catabolizes GABA) when very little GABA is being synthesized to begin with?
Great post. People really need to stop talking about anxiety like it’s a uniform conglomerate.
Refer to these two Google Drive folders if you're curious: [Testing enteric capsules \(partial\)](https://drive.google.com/drive/u/0/folders/1OWGDsjPimlFrKUIQf9zepRQZrHEmIOfx) [Phenelzine - brands research \(partial\)](https://drive.google.com/drive/u/1/folders/1DMqR01tKiXcuKrnOmIByvfjYFeOP-437)
I'm 2 months at 60mg into treatment and I'm also impatient because I haven't felt any improvement in terms of anxiety either. I'm still so damn anxious... I thought it would have kicked in by then... Still waiting for one more month before coming to conclusion.
I’m sorry to hear that. Have you thought about increasing more? Do you suffer from GAD, social anxiety or both?
Both. I'll see my psychiatrist in a few days, I'll see if he decides to increase the dose.
Are you on any other meds? Have you experienced any side effects to cap you at this dosage?
The same reason one wouldn’t respond to any antidepressant: we don’t know.