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Dr. Andrew Rynne

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2871 Questions

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Posted on Tue, 12 Feb 2019 in General Health
Question: I hope you are getting paid by the question. I am having a bad time managing my nardil withdrawal and the regimen that will take its place. I am going to ask each concern separately. Sorry for bothering you so much but I like that you are complete in your considerations and not dismissive :)

I started taking tianeptine sulfate today. I had to order online as a "supplement" that comes in 25mg capsules. I am still on 20 mg Nardil...I am hoping it will help with my complete Nardil withdrawal OR that it can provide some relief from the apathy and detachment side effects I get on the Nardil, and that I can return to a therapeutic dose of Nardil.

I think it is technically contraindicated with MAOI but I ready about several patients taking a full dose of nardil AND Tianeptine with a lot of benefits regarding anhedonia, apathy, anxiety. I am hoping I can keep my dose low and not risk addiction or tolerance because the Nardil is still in my system. It is also supposed to help with irritable bowel syndrome.

Anyway, I took half a capsule today after lunch. It didn't increase energy or drive and made me feel a little stupid and nervous. I think I should continue for a few days and see if things improve...What is your opinion? I started low partially because I am taking Lamictal also and fish oil, both of which reduce clearance of tianeptine according to Drugbank.com.

Would a full 25mg dose of sulfate make me feel better? maybe a switch to tianeptine sodium because it acts faster and will give a better indication if it works?

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Follow up: Dr. Ashok Kumar 0 minute later
I hope you are getting paid by the question. I am having a bad time managing my nardil withdrawal and the regimen that will take its place. I am going to ask each concern separately. Sorry for bothering you so much but I like that you are complete in your considerations and not dismissive :)

I started taking tianeptine sulfate today. I had to order online as a "supplement" that comes in 25mg capsules. I am still on 20 mg Nardil...I am hoping it will help with my complete Nardil withdrawal OR that it can provide some relief from the apathy and detachment side effects I get on the Nardil, and that I can return to a therapeutic dose of Nardil.

I think it is technically contraindicated with MAOI but I ready about several patients taking a full dose of nardil AND Tianeptine with a lot of benefits regarding anhedonia, apathy, anxiety. I am hoping I can keep my dose low and not risk addiction or tolerance because the Nardil is still in my system. It is also supposed to help with irritable bowel syndrome.

Anyway, I took half a capsule today after lunch. It didn't increase energy or drive and made me feel a little stupid and nervous. I think I should continue for a few days and see if things improve...What is your opinion? I started low partially because I am taking Lamictal also and fish oil, both of which reduce clearance of tianeptine according to Drugbank.com.

Would a full 25mg dose of sulfate make me feel better? maybe a switch to tianeptine sodium because it acts faster and will give a better indication if it works?

doctor
Answered by Dr. Ashok Kumar 20 hours later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for posting and updating me with new information.

First of all it is completely true that Nardil need to be out of the system before we get proper dose of Tianeptine. This is not only technically important, it also tells us that we do not know when tianeptine will work when used with nardil (no studies available in this regard).

Since you have already started tianeptine and no side effects observed till time I feel it will be better to get some time before increasing dose to higher side. The effective dose of tianeptine is 25-50 mg per day and often it is prescribed as 12.5 mg three times a day. Considering this you can attempt dose increase after three days (completion of more than 5 half lifes with tianeptine which determines attainment of steady plasma level) to 25 mg per day. This is important because any expected side effect will be obvious by this time and increasing dose after this time will keep you on safer side.

I am also of the opinion that this should be given a fair trial and feeling nervous is likely a self limited side effect of limited duration.

In regard to your next question if it is possible tianeptine sodium should be used as all the brands of tianeptine are sold as tianeptine sodium in medical market. Even personally speaking I always used tianeptine sodium for treatment of depression in my home country.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for posting and updating me with new information.

First of all it is completely true that Nardil need to be out of the system before we get proper dose of Tianeptine. This is not only technically important, it also tells us that we do not know when tianeptine will work when used with nardil (no studies available in this regard).

Since you have already started tianeptine and no side effects observed till time I feel it will be better to get some time before increasing dose to higher side. The effective dose of tianeptine is 25-50 mg per day and often it is prescribed as 12.5 mg three times a day. Considering this you can attempt dose increase after three days (completion of more than 5 half lifes with tianeptine which determines attainment of steady plasma level) to 25 mg per day. This is important because any expected side effect will be obvious by this time and increasing dose after this time will keep you on safer side.

I am also of the opinion that this should be given a fair trial and feeling nervous is likely a self limited side effect of limited duration.

In regard to your next question if it is possible tianeptine sodium should be used as all the brands of tianeptine are sold as tianeptine sodium in medical market. Even personally speaking I always used tianeptine sodium for treatment of depression in my home country.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 23 minutes later
thank you.

The nervousness and confusion continued until I took an afternoon dose of ritalin (2.5 mgs) and my afternoon nardil dose (7.5 mgs) . I did not like the sensation.

The feeling was familiar to when I've added glutamate (??) drugs WHILE TAKING LAMOTRIGINE....zoney confused and nervous. I am thinking mainly of sarcosine (supplement) and modafinil. This is just a theory, but the sensation is similar. I want to take about Lamictal in a separate post because it is a weird drug.

I have no desire to take the tianeptine again today and deal with the bad feeling if it is the main effect of the drug mechanisms. Is the hope to provide a lift of energy, reduction of anxiety, improved cognition? I know these symptoms got a little worse today after I took my lamictal.




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Follow up: Dr. Ashok Kumar 0 minute later
thank you.

The nervousness and confusion continued until I took an afternoon dose of ritalin (2.5 mgs) and my afternoon nardil dose (7.5 mgs) . I did not like the sensation.

The feeling was familiar to when I've added glutamate (??) drugs WHILE TAKING LAMOTRIGINE....zoney confused and nervous. I am thinking mainly of sarcosine (supplement) and modafinil. This is just a theory, but the sensation is similar. I want to take about Lamictal in a separate post because it is a weird drug.

I have no desire to take the tianeptine again today and deal with the bad feeling if it is the main effect of the drug mechanisms. Is the hope to provide a lift of energy, reduction of anxiety, improved cognition? I know these symptoms got a little worse today after I took my lamictal.




doctor
Answered by Dr. Ashok Kumar 24 hours later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for reverting back to me.

First of all I must stress out that one day experience is neither sufficient nor effective to make a valid decision about usefulness of medication. Feeling nervous and confused is unlikely to be related with tianeptine and drug interaction could be possible cause for the experience. I mean to say that it is too early to decide against tianeptine as it takes time and perceived effects are largely unrelated with use of tianeptine.

Tianeptine being an novel antidepressant does not impact cognition and with virtue of neuroplasticity and effect on opioid receptors increases wellbeing albeit after a week of use.

I hope this helps you to undersdtand that possible problem and future outcomes of tineptine.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Follow up

Detailed Answer:
Hello,
Thanks for reverting back to me.

First of all I must stress out that one day experience is neither sufficient nor effective to make a valid decision about usefulness of medication. Feeling nervous and confused is unlikely to be related with tianeptine and drug interaction could be possible cause for the experience. I mean to say that it is too early to decide against tianeptine as it takes time and perceived effects are largely unrelated with use of tianeptine.

Tianeptine being an novel antidepressant does not impact cognition and with virtue of neuroplasticity and effect on opioid receptors increases wellbeing albeit after a week of use.

I hope this helps you to undersdtand that possible problem and future outcomes of tineptine.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Ashok Kumar 22 hours later
Ok...I will order some tianeptine sodium to see if it is a good solution and then switch the sulfate. I am having terrible problems with confusion as I'm discontinuing the Nardil, hopefully that will help.
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Follow up: Dr. Ashok Kumar 0 minute later
Ok...I will order some tianeptine sodium to see if it is a good solution and then switch the sulfate. I am having terrible problems with confusion as I'm discontinuing the Nardil, hopefully that will help.
doctor
Answered by Dr. Ashok Kumar 35 hours later
Brief Answer:
Most likely

Detailed Answer:
Hello,
Thanks for follow up.

There is good possibility that tianeptine sodium will act as saviour for you as it unlilely to increase confusion and sedation which is most problematic during withdrawal of Nardil.

In addition I feel that rather than decreasing the afternoon dose of Nardil take the night dose for reduction for preference. This might help in decreasing confusion to some extent.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
Most likely

Detailed Answer:
Hello,
Thanks for follow up.

There is good possibility that tianeptine sodium will act as saviour for you as it unlilely to increase confusion and sedation which is most problematic during withdrawal of Nardil.

In addition I feel that rather than decreasing the afternoon dose of Nardil take the night dose for reduction for preference. This might help in decreasing confusion to some extent.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Ashok Kumar 3 days later
I am on day 4 of tianeptine. Mood has not dropped and my cognition seems a little better. I don't have any stomach issues. I prefer the sulfate; it does not give me a terrible headache 3 hours after dose.

I am still fighting with racing brain and the inability to engage in my work (in response to the reduction in Nardil) as well as increasing impatience/anger, and verbal communications. Nardil was helping with these.

If I did return to therapeutic dose of nardil, might the tianeptine help with social apathy, numbness, and compulsiveness side effects?

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Follow up: Dr. Ashok Kumar 0 minute later
I am on day 4 of tianeptine. Mood has not dropped and my cognition seems a little better. I don't have any stomach issues. I prefer the sulfate; it does not give me a terrible headache 3 hours after dose.

I am still fighting with racing brain and the inability to engage in my work (in response to the reduction in Nardil) as well as increasing impatience/anger, and verbal communications. Nardil was helping with these.

If I did return to therapeutic dose of nardil, might the tianeptine help with social apathy, numbness, and compulsiveness side effects?

doctor
Answered by Dr. Ashok Kumar 8 hours later
Brief Answer:
The possible answer is yes

Detailed Answer:
Hello,
Thanks for reverting back to me.

I am glad to know that initial bad experience with tianeptine is under control and there is better cognition with each passing day. Even I hope that the things will be much better with passage of time as alike every other antidepressant tianeptiine takes time to show its effect.

Racing brain and inability to concentrate at work can be helped with tianeptine itself and I feel there is no harm in increasing the dose of nardil back to therapeutic level for time being and when there is better control an another attempt can be made to decrease the dose of nardil.

There is good possibility that apathy and numbness will be better with tianeptine irrespective of presence or absence of nardil in your prescription.

I mean to say that while keeping an optimistic attitude the nardil can be increased for time being to deal with racing thoughts and inability to engage with work.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Ashok Kumar 0 minute later
Brief Answer:
The possible answer is yes

Detailed Answer:
Hello,
Thanks for reverting back to me.

I am glad to know that initial bad experience with tianeptine is under control and there is better cognition with each passing day. Even I hope that the things will be much better with passage of time as alike every other antidepressant tianeptiine takes time to show its effect.

Racing brain and inability to concentrate at work can be helped with tianeptine itself and I feel there is no harm in increasing the dose of nardil back to therapeutic level for time being and when there is better control an another attempt can be made to decrease the dose of nardil.

There is good possibility that apathy and numbness will be better with tianeptine irrespective of presence or absence of nardil in your prescription.

I mean to say that while keeping an optimistic attitude the nardil can be increased for time being to deal with racing thoughts and inability to engage with work.

I hope this answers you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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