Back Up

So my mood has been "blech" for the past week. Yes, there are things that have happened in my life to contribute to it, but I still feel that a medication adjustment is necessary. I'm so blah at work that it's hard to engage and be interested in work. I have numerous interviews coming up for new projects and I can feel that there is no sparkle. My muscles are tense, I feel irritable. I'm going to increase the Nardil to 67.5mg. I wonder if any side effects will return since my body is now well-adjusted to the medication.

Up, then back down

Several weeks ago I increased the Nardil to 75mg because I still was not feeling relief from the underlying sadness, the dysthymia. I started at the end of August at around 67.5 mg, and in mid-September went all the way up to 75mg. I did notice some more aggravation of the existing side effects: lots of gas and release of gas, lower sex drive and more orgasm difficulty. These are problematic at my age and life situation. I'm single and dating. Can you imagine? These two side effects are embarrassing! However, even more detrimental, I started noticing that I didn't feel many emotions. My friend even mentioned this to me. I don't want to feel like a drone! I took 75mg for 11 days. I didn't notice any improvement in the dysthymia. In fact, I had a horrible week while on 75mg, in part due to the end of the summer, a season that I love so much. So I went down to 60mg. It's been 5 days on 60mg and I feel the side effects ameliorating a bit, my emotions returning, and no worsening of the dysthymia.

My very first hypertensive crisis

At about 1:00am this morning, after I returned from picking someone up, I lay down in bed to go to sleep. I noticed my heart was pumping very strong and fast. I was short of breath. Ok. So it will pass. Is this an MAOI hypertensive crisis coming on? I started getting scared. Was my anxiety only aggravating it, or was I simply just anxious and panicky about my heartbeat? It wasn't until the severe headache emanating from the back of my neck that I knew something was very wrong. It was my very first MAOI hypertensive crisis. What had I eaten? The only thing I can think of was that at 12:00am I had eaten some Monterey Jack cheese. I've eaten this cheese before with no problem, so what gives? This time it was not melted; I ate it straight from the bag in the fridge. So I know what caused it. I took a Nifedipine tablet, bit into it, and drank the tasty insides. I figured this is pretty serious so I took a cab a few blocks to Pennsylvania Hospitals ER. The nurse took my blood pressure and it was high. Really high. 193/101. Whoa. So I waited for the doctor, which took like 1.5 hours. And during that time my blood pressure went down to a relatively healthy 137/83. I asked them to send me home. They did. I am home now. I need to go to sleep!

7 pounds and excess water

I was at my uncle's house today. He has a scale. I haven't stepped foot on a scale in months. Today I weighed in, without jeans on, at 160. I gained about 7 pounds since being on Nardil. Imagine carrying around a 7 pound dumbell. That's a lot of extra weight in 2 months on Nardil. For me it is mostly carried in my abdomen, and I really don't like how that feels and looks! And, today, my Dad noticed that me feet looked swollen. Lo and behold another side effect of Nardil: pedal edema. Fortunately my intestinal system is now "regular" let us say. And since splitting the Nardil 30mg at midday and 30mg in the evening, I've felt my physiology returning more to normal. When I exercise my heart feels like it is beating properly -- strong and fast. Maybe this might help bring down the weight. That and stopping my crazy consumption of frozen yogurt everyday!

Now I know what side effects are

I've been blessed to have taken many different medications over the past 10 years with few side effects. Effexor did raise my blood pressure a bit, Prozac made me get motion sickness, Lithium gave me tremors at high doses, and Abilify made me restless. Granted some of these side effects were not tolerable, so the dose was reduced or the medication stopped completely.

But nothing compares to Nardil in terms of the strange stages/packages of side effects that I've felt over the past 1.5 months. Now I see what the doctors are talking about. It all started with the extreme thirst, the dizziness, the balance problems, the feeling of being high, the euphoria. This was all on 45mg of Nardil. These sides effects passed. Then, after increasing the dose to 60mg, it moved on to afternoon sleepiness to the point of not being able to function much at work during these episodes. Then came the slight weight gain (I am very fit, except my abdomen is noticeably bigger), the constipation, and the anorgasmia. Pain the the ass. And now the fatigue in terms of when I exercise. I get tired very, very quickly. I can't run two blocks without having to stop. I feel like Nardil has slowed down my physiology to the point that my heart rate is lower than it should be, even when exercising.

Well, I haven't been on this medication for too long, so I look forward to what most people say about these side effects: they will pass.

Super trough

For the past 10 days or so I've been in and out of a horrid state of atypical depression. I say atypical because, again, you would probably not realize that I was depressed unless you spent a lot of time observing me. It did make working difficult, and my motivation and cognitive capabilities were definitely a lot lower. For two of the days I did something different. Rather than ride my bike I came home and sat on the couch and watched TV. It was actually a pleasant change. I watched Friends for the first time in years. I forgot how funny Joey Tribiani is. But having suicidal feelings wasn't a very pleasant change. A few days ago I saw my psychiatrists who increased the Nardil to 60mg. I pray that this helps alleviate this atypical depression. So far the side effects have pummeled me. From about 1pm to 5pm at work I am a ZOMBIE. I am falling asleep. I can barely think. I walk like I'm drunk. I drink coffee and tea all day, to no avail. I may need to get an IV to feed me caffeine directly. Maybe that might help. This is an expected side effect of the Nardil that I pray passes soon. I have never felt this level of sedation. Granted, it's quite possibly the combination of depression and medication that is making me feel this way.

The joy (or pain) of hypomania

I do believe that my recent euphoric episode was sort of a Nardil-induced hypomania (Or was it? Read on). I am not bipolar, and no doctor has ever suspected so. I talked to a friend yesterday who said she had a two-week hypomania episode. For her it manifests itself as becoming super productive, but forgetting about the rest of the world. My "hypomania," or whatever you want to call it, left me feeling exhuberant and giddy. I was super funny, super productive, super confident, and super friendly. So what's so wrong with all of this? As "good" as it felt, there was no peace inside all of this good feeling. Something was driving me, and it wasn't me.

...Or was it really medication-induced? I also had a lot of reason to be giddy. One of my core longings is love. There is a long story behind this, but it's not right for this blog. So just before my "hypomania" I had three potential dates. One came through and it was a fun time. Imagine someone walking around in the desert for a decade thirsty and finally he finds water. Well that's an exaggerated way to compare how I felt. I was so happy to finally feel like I'm getting somewhere in this area of my life which has been largely non-existent. That's sure to make me happy, right? How about hypomanic? If my theory were correct, then I guess I would have been hypomanic during the dating period. Well, turns out I was depressed the week I went out on the date. Even the day of the date I was depressed, but I managed to pull myself up and have a decent time. Perhaps along with the wonderful feelings of dating there are also real feelings of fear and distress that come along with it. Thus the fluctuation between depressed and giddy. Who knows.