I was tapering quite successfully from a MAOI (Nardil) when suddenly the brand was changed and most users reported poor absorption. Given i was dont to a small dose I practically cold turkeyed right off it.
I then managed to get a hold of the old brand but reinstating at my old dose isnt working. i get 3-4 days of relief before i plunge back into WD's. I moved up by a 1/4 more - same thing.
Any advice on what I should try do next?

Hi @mererest if you plan to post on the forum please start an introduction topic for yourself first. Posts are restricted until this is done.

Sudden shifts in brands often cause this, this is not unusual. We suggest performing a crossover when changing brands. So 25/75, 50/50, 75/25 for a week at a time, then 0/100 for another week or so before commencing tapering.

Sometimes reverting back to original brand doesn't settle things down straight away, increasing the dose is yet another change whilst you are destablised. My advice, hold where you are and let those waves and windows you note in your post above settle down. You want to have symptoms of around 1-3/10 for a consistent period before tapering further.

Please do make an intro thread so we can discuss this all over there as you need.

Hi chippy

thanks for your response and I will make an introduction post.

Just with regards to your advice on cross tapering to a new brand - with the MAOI i am on, that wasnt possible as there was no notification the new brand was coming and given its an older medication, there is only one option and the medication needs to be ordered per script. No chemist holds stock. So I had no indication of the new brand nor did I have any stock left of the old one. Unfortunately everyone on this medication lives in an anxious state as global shortages have occured in the past.

re: increasing the dose. I got that advice from the old forum - Surviving Antidepressants. Ive only increased it minimally to try and find the dose that will stabilize me. The tiny dose of a MAOI is more complex than other AD's given the irreversible inhibition of MAO.

I am a 45 year old male from Australia who was placed on a MAOI some 4 years ago. Whilst the medication worked well the side effects of severe sweating and weight gain led to major health issues. Was on a very slow hyperbolic tapering regime however the medication was recently changed to a different brand which has been ineffective for many users of Nardil. This effectively made my small dose turn into a somewhat cold turkey (at least for the last little bit)

I was able to procure the old brand of Nardil and have attempted to reinstate without much luck.

Hoping to connect with the community here to gain some insights and help.

Thanks

Edited August 11Aug 11 by SarahMc

Welcome to the forum!

 

This is a volunteer-run, community forum aimed at helping those who are tapering and/or experiencing difficulties with psychiatric medications and withdrawal syndrome. We are not medical professionals and cannot offer medical advice. We simply offer support and opinions which you could use as talking points with a medical provider knowledgeable in withdrawing off psychiatric medications.

 

Please familiarise yourself with the forum rules and the disclaimer located here: Guidelines

 

Please make sure your signature is kept up to date with your drug history. This will allow members to see some basic information about your drug history and situation so that they may help you best. Information on how to do this is located in the FAQs section above, but here is a direct link: Update Signature

Once this is done, future posts made by you will have this signature turned on by default. For this reason please keep it clear but condensed as possible.

Please use the format outline here Preferred signature/drug history format

In particular, can you please update your signature to indicate (1) the year you started taking Nardil and at what dose (and any dose changes in the 4 years you were on it prior to your taper); (2) how your taper has progressed, including dates and dosages, and what dose you are on now; and (3) your psych med history prior to Nardil, and any other psych meds you are on now.

I'm so sorry to read about the tough time you've had recently you will find plenty of support here for sure.

I see that you've posted already in a different section of this forum and that @Chippy has given you some good advice. I think he's right and that what you need to do now is hold your dose until your nervous system has a chance to stabilize before making any further reductions. Stability is generally considered a long period of time with symptoms at between a 1-3/10 severity (10 being very severe).

 

In the mean time this is what I would do if I were you:

 

-Stay Hydrated 

 

-Eat a good clean whole food diet, avoiding processed foods and sugars.

 

-Stay away from caffeine, alcohol and antihistamines and any other psychoactive substances.

 

Supplements are to be avoided initially, as they often irritate our nervous systems. Try to get your nutrition through food.

 

Down the line, you may wish to introduce Fish Oil and Magnesium. Those who can tolerate them have found them calming to the nervous system. Be careful try one at a time and start low and see how you get on should you choose to try them.

 

A daily walk is very important as much as you can manage, if you can manage it. Gets you your fresh air and Vitamin D does wonders for your mind!

 

You are very welcome here and I hope you find the site supportive.

21 hours ago, mererest said:

Hi chippy

thanks for your response and I will make an introduction post.

Hi and thank you for starting your own thread.

I have moved the posts from the rI topic to here to keep it all together for you.

21 hours ago, mererest said:

ust with regards to your advice on cross tapering to a new brand - with the MAOI i am on, that wasnt possible as there was no notification the new brand was coming and given its an older medication, there is only one option and the medication needs to be ordered per script. No chemist holds stock. So I had no indication of the new brand nor did I have any stock left of the old one. Unfortunately everyone on this medication lives in an anxious state as global shortages have occured in the past.

Yes I totally understand and this has happened a number of times to members on the forum but with other drugs, it often does not go well. The thing we suggest folk do is try to get a stock of the orginal drug so they can perform the crossover even if that involves ringing around many places. You were not to know. Many didn't before you. It is a real trap.

21 hours ago, mererest said:

re: increasing the dose. I got that advice from the old forum - Surviving Antidepressants. Ive only increased it minimally to try and find the dose that will stabilize me. The tiny dose of a MAOI is more complex than other AD's given the irreversible inhibition of MAO.

From what I was understanding changing brands was what destablised you? So moving doses to try to help you stablise would not have made sense if I understand what happened to you correctly. Updosing is done to help the brain when a taper is too fast by giving a little of the dose back that it is missing. In your case, from what I can see, you are having issues due to the switch. So switching back to the original drug and holding makes sense to me.

21 hours ago, mererest said:

I was able to procure the old brand of Nardil and have attempted to reinstate without much luck.

I am sorry to hear. As said moving doses whilst destablised will likely not have helped. Ive seen others really affected by brand switches and it takes some time for them to settle back down again. I think given enough time you will find this will ease for you.

I am glad you found us. Chippy

Yes changing brands destabilized me but its a little more complex then just a change of tablet. I was already on a miniscule dose and from all reports from others on MAOI forums, the new brand, whilst I'm confident is not faulty, appears to be not quite as potent due to how people are metabolizing the formula. So in effect the very small dose that I had been stabile on for over a year was effectively ripped away cold turkey because the new brand didnt provide the necessary dose.

4 hours ago, Chippy said:

I am sorry to hear. As said moving doses whilst destablised will likely not have helped. Ive seen others really affected by brand switches and it takes some time for them to settle back down again. I think given enough time you will find this will ease for you.

I am glad you found us. Chippy

Thanks, I really hope you are right.

42 minutes ago, mererest said:

Yes changing brands destabilized me but its a little more complex then just a change of tablet. I was already on a miniscule dose and from all reports from others on MAOI forums, the new brand, whilst I'm confident is not faulty, appears to be not quite as potent due to how people are metabolizing the formula. So in effect the very small dose that I had been stabile on for over a year was effectively ripped away cold turkey because the new brand didnt provide the necessary dose.

I think this is one factor that can be the case for lots of switches.

43 minutes ago, mererest said:

Thanks, I really hope you are right.

The body is smart, keep the faith @mererest.

When you get a second could you update your signature for us? Thanks

So since we spoke last I stabalised for a few days but since yesterday I have gone back down a little again. Just want this nightmare to end.

1 hour ago, mererest said:

So since we spoke last I stabalised for a few days but since yesterday I have gone back down a little again. Just want this nightmare to end.

I'm sorry for the recurring wave but very glad to hear you had balanced days, hold on to it @mererest they will come back bigger and brighter.

1 hour ago, mererest said:

So since we spoke last I stabalised for a few days but since yesterday I have gone back down a little again. Just want this nightmare to end.

I am sorry to read, it is good things have settled for you though, keep holding that dose and find a nice stable place. Nothing last for ever, just one day at a time.

Unfortunately things are still not settling and now I dont believe this is the regular ups and downs of reinstatement as might be the case with SSRI's and SNRI's.

MAOI's are different and every time I get a wave, its accompanied by blood pressure spikes, headaches and blurred vision. Something with the MAOI inhibition isnt firing correctly and these waves seem to be a symptom of that.

Is there anyone on this forum who has more information about MAOI;s?

15 minutes ago, mererest said:

Unfortunately things are still not settling and now I dont believe this is the regular ups and downs of reinstatement as might be the case with SSRI's and SNRI's.

MAOI's are different and every time I get a wave, its accompanied by blood pressure spikes, headaches and blurred vision. Something with the MAOI inhibition isnt firing correctly and these waves seem to be a symptom of that.

Is there anyone on this forum who has more information about MAOI;s?

Hey @mererest I'm sorry things haven't settled for you yet, hopefully it will happen soon enough.

This info might help:

MAOIs (Monoamine Oxidase Inhibitors) are an older class of powerful antidepressants. They work by blocking monoamine oxidase—an enzyme responsible for breaking down dopamine, norepinephrine, and serotonin in the brain.

When someone experiences reinstatement symptoms—meaning they stopped or lowered an MAOI, experienced severe withdrawal, and then reintroduced/re-started the medication—the body goes through a distinctive adaptation phase.

Reinstatement can bring rapid relief from withdrawal, but it also triggers a wave of physical and psychological sensations as the nervous system readjusts.

1. The "Re-adaptation" Phase (First Few Days)

When an MAOI is reintroduced after a period off, the rapid surge in neurotransmitters typically stops severe withdrawal symptoms (like severe brain fog, mood crashes, or electric sensations) within 24–72 hours. However, the system is abruptly forced back into an altered state:

* Severe Post-Dose Fatigue or Sudden Insomnia: Re-inhibiting monoamines can cause sudden daytime drowsiness right after taking a dose, or conversely, hyperarousal and fragmented REM sleep at night.

* Orthostatic Hypotension (Postural Dizziness): A classic MAOI reaction where blood pressure drops sharply upon standing, causing lightheadedness, faintness, or unsteady legs.

* Headaches & Warm Flushes: Vasodilatory changes as norepinephrine levels rapidly build back up.

2. Physical & Neurological Sensations

* Muscle Jerks (Myoclonus): Sudden, involuntary twitching or jerking of the arms or legs, especially when lying down or trying to sleep.

* Gastrointestinal Distress: Nausea, abdominal tightness, or sudden changes in digestion as serotonin receptors in the gut are rapidly re-stimulated.

* Paresthesia: Tingling, "pins and needles," or burning sensations on the skin.

3. Emotional & Cognitive Shifts

* Paradoxical Agitation or Anxiety: Before mood stabilizes, reintroducing the drug can cause temporary inner restlessness (akathisia) or heightened anxiety.

* Cognitive "Wipeout": Brain fog or a feeling of being spaced out or disconnected while the brain recalibrates.

Critical Safety Warnings During Reinstatement

* Dietary Tyramine Restrictions apply IMMEDIATELY: The moment an MAOI is reintroduced, you must strictly follow the low-tyramine diet (avoiding aged cheeses, cured meats, tap beer, fermented foods). Re-inhibiting the enzyme removes the body's protection against tyramine, which can cause a sudden, life-threatening spike in blood pressure (hypertensive crisis).

* Serotonin Syndrome Risk: If any other serotonergic medication or supplement (like an SSRI, SNRI, St. John's Wort, or certain pain meds) was started while off the MAOI, reintroducing the MAOI without a proper washout period can trigger life-threatening Serotonin Syndrome.

ok thanks that helps to a degree so I am glad you shared it.

In my case my BP is rising as opposed to falling.

hopefully things begin to settle for me.

6 hours ago, mererest said:

hopefully things begin to settle for me.

I hope this happens soon @mererest

I had an appointment with my Doctor and he said raise the dose by another half a tablet. I am so confused as to what to do and today has been a very hard day. I was so close to a panic attack.

I feel helpess and scared.

50 minutes ago, mererest said:

I had an appointment with my Doctor and he said raise the dose by another half a tablet. I am so confused as to what to do and today has been a very hard day. I was so close to a panic attack.

I feel helpess and scared.

I am so sorry you are scared we totally understand and are here for you.

I would suggest you don't increase your dose, from our experience this could make you much worse. Doctors don't understand alot of the time and try switching drugs and increasing doses to try to 'treat' the symptoms but just make them worse unfortunately.

yeah im going to hold for now but its just weird because today was the worst wave of all and by now, at least according to the information here, I should be slowly getting a bit better.

2 hours ago, mererest said:

yeah im going to hold for now but its just weird because today was the worst wave of all and by now, at least according to the information here, I should be slowly getting a bit better.

It's normal to have worse days than before, but the thing you should be focusing on is the average, not just if the worst day was worse than the worst day a few months.

again the fact you have waves and windows mean you are improving, keep holding ❤️

Remember symptoms are just symptoms.

@mererest I had my worst days to date at over 4 months of holding. Sometimes these things are just random, but it doesn’t mean you aren’t improving or that you won’t improve with more time. This process is really hard and requires unimaginable patience, but we’ll get there. I agree that holding is the best path for you right now.

thanks guys. I really hope so

@mererest unfortunately the outcomes when dealing with these drugs can be very unpredictable.

There's often no clear, obvious right answer that guarantees symptom relief. What we do have though, is observations about what has worsened people and this is typically a bit more reliable.