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NHS prescriptions

nardilanti-depressants prescription nhs

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#1 killersoup1

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Posted 14 May 2017 - 08:33 PM


Hello everyone,

This is my first proper post on this site, so apologies if I am not writing this in the appropriate place. I have a few questions I would like to ask, regarding anti-depressant prescriptions (particularly Nardil) under the NHS. 

Short History: 

- 21 year old Male, been suffering from anxiety, ADD and depression all my life
- Been on several anti-depressants and so forth over the last 4 years, including Lexapro, Brintellix, Wellbutrin, Effexor, Remeron, Lamictal and Abilify
- Did not respond positively to any of the above medications, at both low and high doses, even when used in different combinations (e.g. Lexapro and Wellbutrin)

- Been using Ritalin and Concerta as needed for revision, unfortunately this does not help with my depression or motivation all that much

- I occasionally use Clonazepam, 0.5mg 2x per day, interchangeably with Phenibut at 1 gram 2x per day for anxiety (I never take them together, and never exceed 2 days of use per week for fear of GABA down-regulation) 

 

The Problem: 
 

I am a University student seeing a private psychiatrist in the UK. After dropping all other stimulants and meds besides 5mg Abilify (which I will go off of at some point), I had convinced my psychiatrist to prescribe Nardil as a last resort, starting at 45mg for 2 weeks and then 60mg for four weeks. The effects of Nardil haven't been all that noticeable, besides some insomnia and bloating. I would definitely like to try a higher dosage, as I hear some people have only experienced benefits at 75 to 90mg per day. The issue is, despite using a private psychiatrist, I get the medication through the NHS, and the NHS guidelines state the starting dose as 45mg per day and the upper dose at 60mg per day, and my psychiatrist so far is standing by these guidelines as he has no prior Nardil experience.

My Questions: 

1. Are the NHS dosage guidelines rigid, or is the maximum dosage inevitably up to the discretion of the individual doctor?

2. Have any of you guys been prescribed above the NHS's suggested maximum dosage for anti-depressants, particularly Nardil?
3. If so, how did you manage to convince your doctor to raise the dosage? Any reputable Nardil studies out there I could present to the doc?

4. To those who have had success with Nardil, did it take any of you guys longer than 4 weeks on 60mg before noticing any benefit? 
5. Lastly, have any of you had success through combining Nardil with other medications, when Nardil on its own was ineffective? 
 

If the doctor continues to refuse to raise the dosage above 60mg, should I: 
 

A. Stay on the 60mg dose for longer and hope for some results (having already been on 45mg for 2 weeks and 60mg for 4 weeks)? 
B. Augment the Nardil with another Anti-depressant/mood stabiliser for some sort of synergy/potentiation
C. Switch to Parnate, which has a NHS recommended maximum dose of 30mg per day (although not sure how this compares in strength to 60mg Nardil)?

Any knowledge, help or feedback would be appreciated very much! look forward to hearing back from you guys.



#2 Mind_Paralysis

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Posted 14 May 2017 - 09:14 PM

I suggest you DITCH Nardil and switch ASAP to Parnate - why are you even BOTHERING with Nardil, when you KNOW it's the more sedating of the two MAOI's in use? Tranylcypromine (parnate) is far, far more activating, and actually has similar effects to Amphetamine, but at 1/10th the strength.

 

Hell, you might as well go with Selegiline, which metabolises with a smidgen into META-amphetamine! >>; D

 

The National Health Services in the UK actually approved it for depression way back in 2014! It's readily available! GOGOGOGOGOGGOGOGOGOGOGOOO!!!

 

http://www.slam.nhs....-patches-update


Edited by Stinkorninjor, 14 May 2017 - 09:15 PM.


#3 killersoup1

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Posted 17 May 2017 - 12:02 PM

Can some more people please chime in on this? In particular: 

 

- anybody have success in convincing their doc to go above NHS guideline doses for anti-depressants? 
- did it take any of you guys more than 4 weeks on Nardil 60mg before feeling anything positive at all? 
- anybody have success in combining Nardil with mood stabilisers/anti-depressants after little success with just the Nardil? 

 

PS: To Stinkorninjor - Cheers for the reply. I've sent you a message and would appreciate your feedback!

 

 


anyone?



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#4 Finn

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Posted 18 May 2017 - 05:31 AM

NHS prescription framework specifies that 75 - 90 mg dose range is for hospital patients only, doctor probably looked at similar instruction text when prescribing, if he has no prior Nardil exprience, I'd say it is hard to see how he would prescribe "institutionalized patients only" dosage for it.

 

http://www.hey.nhs.u.../phenelzine.pdf

15 mg 3 times daily, increased if necessary to 4 times daily after 2 weeks (hospital patients, max. 30 mg 3 times daily),

 

 

 

For tranylcypromine (Parnate) and the third irreversible non-selective MAOI still used, isocarboxazid (Marplan) phrasing "close supervision" is used for higher than NHS standard doses, which might be more open for interpretation. 

 

https://www.hey.nhs....ylcypromine.pdf

https://www.hey.nhs....ocarboxazid.pdf

 

Parnate is probably the better of those for ADHD.


Edited by Finn, 18 May 2017 - 05:32 AM.

  • Agree x 1

#5 killersoup1

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Posted 18 May 2017 - 01:23 PM

Cheers for that reply mate, was spot on. That is bad news for me though :(

Once again, anyone manage to get their doc to prescribe MORE THAN 60mg in the UK? 

Thanks guys!!!



#6 Mind_Paralysis

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Posted 18 May 2017 - 02:31 PM

Cheers for that reply mate, was spot on. That is bad news for me though :(

Once again, anyone manage to get their doc to prescribe MORE THAN 60mg *PARNATE* in the UK? 

Thanks guys!!!

 

Hmm, but we just told you that Parnate and Selegiline are better MAOI-picks than Nardil... soo... why not just SHIFT to Parnate for a while, and see if that works better than Nardil?

 

Remember, those other peeps trying out Nardil, they're probably mostly afflicted with Social Anxiety, and not ADHD - their brains work fundamentally different from yours.

 

Seriously mate, give Parnate a try instead - instead of going with a potentially dangerously high dosage of Nardil, you could be going with a perfectly safe dosage of Parnate! = )
 



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#7 killersoup1

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Posted 18 May 2017 - 03:09 PM

Sorry mate I should have clarified my conditions. I suffer from GAD, SAD, MDD, ADD and BPD - the whole lot. So aside from the ADD, Nardil seemed suited for me. I will definitely be trying Parnate next if Nardil doesn't do the trick. I am using it mainly for the relief of my SAD and MDD.
 







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