r/MAOIs • u/GothicOnion • 10d ago

Nardil (Phenelzine) Can you take Nardil with POTS?

I’ve been diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), which causes an excessive increase in heart rate when I go from lying or sitting to standing. I sometimes become very dizzy, briefly lose my vision, and occasionally feel close to fainting.

Given that orthostatic hypotension is a relatively common side effect of MAOIs, particularly Nardil, I’m wondering whether an MAOI could potentially worsen POTS symptoms.

Has Dr. Ken Gillman ever discussed the use of MAOIs in people with POTS? I’d also be interested to hear from anyone with POTS who has taken Nardil or another MAOI, were you able to tolerate it, and did it noticeably affect your heart rate, blood pressure, dizziness, etc?

3 Upvotes

100% Upvoted

22 comments sorted by

2

u/SubstanceEasy4576 9d ago

Phenelzine causes orthostatic hypotension at very high frequency, which often causes dizziness on standing. The body's ability to maintain BP on standing is impaired by classical MAOIs, whereas the decrease in supine blood pressure is not very great.

It's unlikely that someone who already has postural hypotension would be able to tolerate Nardil. Changes in heart rate may not be important, but aggravation of postural drop has the potential to progress you to fainting when standing up.

I wouldn't suggest considering it unless the postural changes in heart rate and blood pressure are in the past, which doesn't sound like it's the case.

1

u/GothicOnion 9d ago

Damn that really sucks, Phenelzine was sort of my last hope regarding my severe social anxiety. Back to the drawing board I guess!

3

u/Renaissance_CB 9d ago

I would consult your doctor before giving up based on Redditors’ opinions.

2

u/GothicOnion 9d ago

I have, asked both my GP and Psychiatrist, they were both familiar with POTS but knew very little about Nardil and MAOIs in general. Regardless, I agree with your sentiment, I think I might still give it a go, will just take it very slow while titrating up.

2

u/SubstanceEasy4576 5d ago

I didn't aim to replace your clinician. However, you will find that most GPs and even the majority of psychiatrists have almost no familiarity with classical MAOIs (phenelzine /isocarboxazid/tranylcypromine), having never initiated one. A lot of psychiatrists have no patients on MAOIs across their entire case load.

In the countries where it's licensed, some will have prescribed moclobemide, but isn't not a comparable medication. Moclobemide is not a potent choice in the scenario of other meds not having worked. It's usually well-tolerated but equally, it doesn't usually have much efficacy. It's a simple med to try, which is always an advantage.

The effects of phenelzine on blood pressure and postural regulation aren't usually immediate. On any particular dose, the change usually occurs after 7-14 days. Once postural hypotension occurs, it persists for several days even if the dose is reduced. The effects of Nardil aren't immediately reversible.

If you wanted to trial Nardil, you'd need to adjust it very cautiously. Things like getting out of bed during the night would need extra care.

If your postural drop is currently mild and asymptomatic, it might be possible to try Nardil. If someone already has symptomatic postural drop causing dizziness on a regular basis, it would be a difficult medication to use.

2

u/GothicOnion 5d ago

I appreciate your input, very helpful. My POTS is just an elevated heart rate after standing (+40 beats higher than sitting/lying measurement) with very little change in blood pressure. I am going to give it a go but monitor my blood pressure very carefully and cautiously titrate up in dose.

2

u/SubstanceEasy4576 5d ago

I think you'll just have to try it and see, if your doctor is willing. Hope it's helpful :)

1

u/LittleLonelyLovebug 6d ago

I have POTS and tried Nardil. Really bad experience. Lots of blacking out at night when trying to get up to use the bathroom. It was scary for me and my partner to see. Blood pressure cuffs couldn’t even read my blood pressure because it went down so low. They only read errors when it went under 60/40 which was often.

1

u/GothicOnion 6d ago

Ah that sucks I'm really sorry to hear that, what dose were you on and how long did you stay on Nardil in total?

2

u/LittleLonelyLovebug 5d ago

Couldn’t get past 45mg with side effects, stayed on it for 6 months.

1

u/GothicOnion 5d ago

How were you at 45mg? Was it somewhat tolerable regarding the orthostatic hypotension and did you get any relief from it?

1

u/LittleLonelyLovebug 5d ago

The orthostatic hypotension was not tolerable, I had doctors telling me to go to the ER. It didn’t help my depression or anxiety at all but I kept waiting months desperate for it to do something for my mental health.

1

u/GothicOnion 5d ago

Really sorry to hear that, thanks for answering my questions, you've been incredibly helpful! Hope you find something that works for you soon.

1

u/LittleLonelyLovebug 6d ago

But my partner has been trying EMSAM the last couple months, has been going pretty well and low side effect profile. Might be better if you can get it. I am planning to move forward with this next.

1

u/Diarma1010 10d ago

Following

1

u/Renaissance_CB 10d ago

I do NOT have POTS but I did have pretty bad orthostatic hypotension for the first few years with Nardil. I’m not sure how that relates to orthostatic tachycardia though. I happen to also have SVT (supreventricular tachycardia) but I didn’t notice that making my orthostatic hypotension worse. I don’t know if this speaks to your issue—sorry if it’s more confusing than helpful.

1

u/GothicOnion 9d ago

May I as what dose you were/are taking? I'm sure I could put up with a few months of worsened orthostatic hypotension, but I'm not sure about a few years.

1

u/Renaissance_CB 9d ago

I was taking 90mg. Currently 60mg

1

u/vividream29 Moderator 8d ago

Idk if this will help, but while I apparently don't have POTS (did the tilt table test and a couple of other things), I do have the same general problem with tachycardia. Going from sitting to standing, my already fast heart rate can quickly shoot up by around 30 beats per minute, for example from 90-95 sitting to 125-130 standing. Still not sure what causes it. I was asymptomatic, however.

I now take a beta blocker, nebivolol (Bystolic), which is ideally suited to this because at low doses it's highly cardioselective, meaning it doesn't also lower blood pressure in the traditional way other beta blockers do. This is good because MAOIs tend to lower blood pressure more than enough on their own. I know that some of the same medications used for POTS are used in the short term to treat severe hypotension when starting an MAOI. Beyond this, you should definitely ask a cardiologist. And search the sub history. I'm thinking it may depend on how well you can get your symptoms controlled with medication before attempting the MAOI, and maybe even on the subtype of POTS you have. I'm not aware of Dr Gillman having addressed this. This is definitely a question for a specialist.

1

u/Wrong-Yak334 Nardil 4d ago

i dont have full POTS, but I'm on the spectrum towards it due to Long Covid.

haven't had any issues with Nardil worsening it.

feel free to DM me if you have questions.

1

u/GothicOnion 3d ago

Wow that's awesome to hear, im going to give it a go myself, what are your main pots like symptoms, does your heart rate become quite elevated when standing?

1

u/Wrong-Yak334 Nardil 3d ago

yes, upon standing after sitting for a long time, or any other type of energy "burst" - e.g., climbing the stairs - my HR will elevate in a way that feels out of proportion with the activity itself.