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New pdoc switched my dx from Bipolar 2 to MDD. He wants me off of Effexor (which I have been on for 15 years) and on Nardil, an MAOI that is archaic and full of warnings but is apparently stronger. He is doing this because I have never been feeling more suicidal than ever. The only thing keeping me going is that I don't  want to hurt my family. But no one understands MDD but the people here on CB. Back to Nardil, lots of things scare me but one of the biggest is all the medications you cant take with it. One is morphine. What the hell will happen if I get in a car accident and need morphine, will they give me ibuprofen or Tylenol? Also, there will need to be a 2 week washout of the Effexor before I can start the Nardil and I think that time period will put me over the edge. There are periods of the day when I feel decent then almost suddenly I am suicidal; wtf. I don't understand this. The only time I feel peaceful is in bed or laying on the couch watching television. I feel that my MI is getting worse and my hope is dwindling. I have a well thought out suicide plan and even letters to my wife and kids in the event I do it. This should probably be a blog but I am hoping for some insights from others who have or are possibly going through this. Thanks for reading this; I am already feeling better just sharing this with others who are "in the know."

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Hi Twidder,

Sorry you're feeling so bad. Nardil is considered a very effective antidepressant even though it's old and requires you to follow a diet fairly strictly. I once took an MAOI so I can say that the diet isn't as bad as it appears.

The two-week washout period is a real concern. Is there any way you could talk to your doctor about doing this switch inpatient? That way you would be save and there is the possibility that they could start you on the MAOI sooner (while monitoring your BP closely).

About med interactions, yes there are quite a few, but don't rely on online interaction checkers to make this decision. Those online checkers include every possible interaction even if it is just theoretical and not really seen in clinical practice. Your best bet would be to bring up these concerns with your pdoc. I am positive that there are ways that doctors deal with people taking MAOIs who need other meds. As I mentioned, they have been around for forever.

I strongly encourage you to keep in close contact with your pdoc and to go to the ER if you feel very suicidal. There is hope. You won't feel this way forever.

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Thanks jt07 for your insights; they make great sense. I know you are not a pdoc but from reading some of your other posts I have great respect for your opinions. Do you think Nardil has more antidepressant effects then Effexor? Why did you stop your MAOI? And you are very intuitive, I did check the online drug interaction websites and it scared the crap out of me,

Neitherdeadnorliving, I am sorry you too feel suicidal without any periods of relief; that must be unbearable. It's been a year or two since the Effexor alone has been not effective enough for me. Maybe I should listen to you and jt07 and my pdoc and just go on the Nardil; I'll give it more thought.

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Thanks jt07 for your insights; they make great sense. I know you are not a pdoc but from reading some of your other posts I have great respect for your opinions. Do you think Nardil has more antidepressant effects then Effexor? Why did you stop your MAOI? And you are very intuitive, I did check the online drug interaction websites and it scared the crap out of me,

I took my MAOI  as a young teenager and that's been some time ago so its difficult to remember exactly why I stopped it. I'm guessing I stopped it because it didn't help me much. That's not saying that an MAOI won't work for you; it's just that antidepressants never did help me much. I have found that anticonvulsants suit my particular brain chemistry better. And Abilify.

As to the efficacy of Nardil, I can't speak from first-hand experience as I took Marplan. From what I gather on the web, it is a very good antidepressant which is at least as good as Effexor and maybe better. If my cocktail stopped working for some reason and my doctor wanted to put me on it, I'd be willing to give it a try.

Don't let what you read on the web scare you. Rely on what your doctor tells you because he has real-world experience prescribing these drugs, and I'm certain he wouldn't prescribe something that he didn't think was safe.

Edited by jt07
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