Source
r/MAOIs•
randomuser025

Nardil not improving attention or motivation

I've been on Nardil for 3 months (and for 2 of these months, on the full dose of 90 mg). While some of my symptoms are improving, it's done absolutely nothing with regard to increasing my motivation or concentration. Has anyone else had this problem with nardil (or parnate) that theres no improvement in concentration or motivation, even after 3 months of being on MAOIs? I'm legitimately afraid at this point I might need to get electroshock therapy.....

Posted Mar 15, 2020, 6:20 AM UTC

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Phil-McGraw•

From my experience, I had more motivation and my concentration was mildly better on Parnate, due to it being more dopaminergic, along with it acting faster and more efficient for depression.

I’d say the best route to augment the efficiency and deal with motivation and concentration is to trial a stimulant or a DRI (Dopamine Reuptake Inhibitor) like Methylphenidate, which are safe and effective to combine with MAOIs under guidance by a doctor who understands the actual medication interactions as opposed to the overstated myths of them.

Likely what you’re experiencing is that Nardil was able to manage and deal with depression in a way that exposed an underlying condition of ADHD, which isn’t treatable with MAOIs alone, and the symptoms you’re experiencing seems likely to be that of ADHD as opposed to Nardil possibly not working. It’s worth giving consideration to, as I’m in the same boat and finding a doctor to trial ADHD while I’m on a MAOI is difficult, so I’m seeing a neurologist with experience pharmacology in a couple months. Best of luck!

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randomuser025OP•

Thanks for your reply.

Unfortunately my psychiatrist belongs to the "MAOIs and stimulants are contraindicated" crowd; I might press him in our next meeting to assess me for ADHD inattentive subtype. Just by looking at the criteria (like "difficulty following rules", "distractible to inner thoughts", and "doesnt like putting effort into activities that require mental effort"), I think I see a lot of my behaviour in this subtype of ADHD. I think it's a definite possibility I might have comorbid ADHD and depression.

I found this interesting message from APSARD on comorbidity between depression and ADHD (https://apsard.org/how-do-we-manage-a-patient-who-presents-adhd-and-comorbid-depression-how-well-do-antidepressants-work-in-this-patient-population/).

Best of luck to you as well.

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spane_44Nardil•

Funny, the criteria you mention fit me too.

I mentioned the possibility of my having some kind of ADHD to my therapist. But he said I was off track and simply wanting to find more labels for myself :/

A few people have mentioned taking modafinil or armodafinil to combat the fatigue and lack of attention that can emerge with Nardil. They can be bought online. Not tried myself, but I'm considering it.

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randomuser025OP•

My sister's a doctor and she says it's always within a patient's right to ask for a second opinion. So if the modafinil doesn't work out, you always have the right to ask another psychiatrist whether you meet the criteria for ADHD.

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spane_44Nardil•

Thanks dude 👍

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dooplissParnate•

To offer a slightly different experience, Parnate did not improve my concentration. I believed it would because of its effects on dopamine. Parnate worked wonders for my social anxiety and depression, but if anything it made my ADHD behaviors slightly worse.

Let me make sure to add some context here; This isn't necessarily a bad thing for me. These days when I get distracted from work, it's different than it used to be. I used to be distracted by negative thoughts leading to rumination. Now when I'm distracted, it's because there are so many things I want to do.

For example, maybe I'll researching a subject I'm interested in, then I'll find out a new album came out that I want to hear. But before the album is finished, I'll become aware of a book that sounds really interesting that I want to read. And then I'll notice it's a beautiful day outside and I want to go out to feel the sunlight.

Also, even if Parnate did make me slightly more distractible, it also made it much easier to work on my concentration. It made me feel like I was really capable of conquering my problems; Beforehand it just kind of seemed hopeless.

I'll second the fact that methylphenidate is safe to take with an MAOI (or at least with Parnate or Nardil). Whether it's effective or not, I'd know nothing about. But it's not a dangerous combination.

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exuberantfish•

If attention and motivation are your main problems I’d kick the nardil and go for adderall. No restrictions on what to eat or drink, extremely effective antidepressant as well as the ultimate focus/motivation drug (besides meth probably). Source: taking adderall for >6 months

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randomuser025OP•

Thanks, I'll try talking to my psychiatrist about it at my next appointment with him. I was looking up the criteria for ADHD (inattentive subtype) and I hit 9/9 criteria. If my psychiatrist says no I'm considering getting a second opinion just to be sure.

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exuberantfish•

Yeah man I can definitely relate. I was depressed because of dopamine deficiency, and also have adhd because of it. Adderall took care of both. Hope you can get it figured out! Your doc may want to start with methylphenidate because it’s not as strong. But it’s a step towards adderall so if it’s not enough, you can move up to adderall

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p3nt0th41Parnate/Dexedrine•

Parnate was better as an antidepressant, however the fatigue & lack of motivation made staying on it difficult. Am now on Dexedrine, nowhere near as good as an antidepressant, however better for apathy and motivation. Also way less side effects.

If your depression is mild and you haven't responded to an SSRI, Dexedrine/Adderall would be my go to. For more severe depression (esp. with suicidal ideation or anxiety), Parnate is the right choice.

Amphetamines generally tend to make anxiety worse over the long term, also they lack the 24/7 coverage that MAOI's provide. So if you wake up at night with ruminating thoughts, amphetamine is useless.

Good luck.

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9outofevery10homes•

Have you tried pure dextroamphetamine?

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exuberantfish•

I have not

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spane_44Nardil•

IMO Nardil's better at treating anxiety. Its rather sedating nature doesn't tend to do much for attention or motivation.

I've found it has made it easier for me to do stuff, simply because I'm not anxious any more. But my tendency towards procrastination has, if anything, gotten worse :/

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randomuser025OP•

Thanks for the informative reply. I told my psychiatrist lack of concentration and motivation are my biggest concerns (and even suggested maybe trying parnate first). I'll try asking him if he'll consider switching me to parnate or ask for a second opinion from another psychiatrist.

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