Side effects when first starting Nardil can be difficult for many, but not all patients. Remember many side-effects dissipate over time. When Nardil begins to work, the tremendous gains you stand to make far outweigh the side-effects. We must keep in mind that depression and anxiety are serious illnesses themselves, which can result in death, so some side-effects from an exceptionally good medication is a reasonable trade-off. Finally, everyone is different when it comes to what they suffer in terms of side-effects; you may suffer many of the below, or you may suffer only one or two. I have even seen cases where people have reported suffering none.
Start-up (First weeks or months of treatment)
- Hypotension (low blood pressure)
The following side effects are the most common and effect many people:
- Fatigue (usually in the afternoon)
- Weight gain
- Poor short term memory
- Twitching while falling asleep
The following side effects affect some but not everyone:
- Sweating more, sensitivity to heat
- Feel physically weaker, especially in the legs
The biggest issue when starting Nardil is the hypotension (low blood pressure). This can be troublesome, especially upon standing up. A few times I even fell over during the night and hit my head. However, this will go away in a few months. I would recommend purchasing an automatic blood pressure monitor (I recommend Omron) which will also be useful in monitoring for a hypertensive crisis later on.
Long term, the biggest problem will be insomnia and fatigue (yes Nardil causes both!). Before Nardil I could easily sleep 9 hours, on Nardil I sleep an average of 4 – 5 hours a night which is a 50% reduction. Annoying yes, but worth the price. However the insomnia can also be treated with benzodiazepines on occasion (I recommend Nitrazepam). Some people even use antipsychotics or tricyclic antidepressants to help with insomnia.
Many people also experience fatigue, particularly in the afternoon. This can also be challenging as you’ll sometimes struggle to stay awake. However this can be slightly tweaked by taking the bigger part of the dose in the evening (at the cost of more insomnia).
The insomnia/fatigue ratio can be tweaked a little depending on when you take your doses. If you prefer less fatigue (at the cost of more insomnia) then take 1/3 in the morning and 2/3 at night, vice versa if you prefer less insomnia but are happy to take more fatigue as a trade off.
Weight gain is also one of the biggest long term issues with people on Nardil. However it can be managed through diet and exercise, although you may have a few remaining pounds. Nardil can cause you (especially at the start of treatment) to crave sweets, and can also slow down your metabolism (maybe also from less anxiety?), and cause fluid retention.
Many people on Nardil also experience poor short term memory. While this can be frustrating at times, you can learn to deal with it by writing things down etc.
The twitching issue isn’t really bothersome, just a weird side effect most people on Nardil get. Expect to get some laughs as you nod off to sleep on the train!