If you managed to get a prescription for Nardil, congratulations! A bright future lies ahead! This page will give you a rough guide on starting Nardil for the first time.
How long does it take to work?
After starting Nardil it takes an average total of 6 to 8 weeks to kick in. This is based on a dose of 60mg for 4 – 6 weeks. For some people it may be sooner, while for others it may take longer. Some people also require a higher dose than 60mg before they receive any benefit.
I had a rollercoaster ride when first starting on Nardil. It first destroyed my social anxiety after approximately 7 weeks, then 2 weeks later it significantly reduced my depression. For many, it would seem that Nardil has an effect on GABA first, followed by dopamine, serotonin, and norepinephrine.
Throughout the journey, it was rather up and down because it took longer to reach full remission on my depression. At times I thought it was working well, but then the depression quickly returned. It didn’t fully destroy my depression consistently until about the 18-week mark (4.5 months). This was also when the euphoria kicked in at its strongest. The euphoria then lasted approximately 2 – 3 months. After the euphoria, many people falsely assume it has “stopped working”. However it is just a return to the usual state of the antidepressant effect.
Some people report that it destroys both their anxiety and depression at the same time, while for others (like myself) it can destroy the anxiety first, then later the depression. But when Nardil does kick in, it usually does so very quickly and you’ll certainly know about it. Most people claim it is like someone has flipped a switch in their brain.
Since it usually takes 4 – 6 weeks to work at 60mg, your goal will be to titrate up to 60mg as fast as possible. The official guide from Pfizer recommends to start on 45mg. However, most people find this to be too quick and suffer more hypotension as a result.
I used the following titration schedule, but you may have to slightly adjust yours if you can’t handle the side effects at the start (particularly hypotension).
Day 1: 15mg
Day 2: Increase to 30mg
Day 6: Increase to 45mg
Day 16: Increase to 60mg
At this stage hold it at 60mg for up to 6 weeks (42 days). If there is no benefit after 6 weeks at 60mg, increase to 75mg. If still no benefit after 3 weeks at 75mg, increase to 90mg.
I went up to 75mg for about 3 weeks, but the side effects became too unbearable (especially hypotension and insomnia). Therefore, I was forced to lower it back down to 60mg, then 45mg soon after.
Once it kicks in, stay at the current dose if you can handle the side effects. I made the mistake of playing around with the doses too much and this is probably why it was a rollercoaster for me. Only attempt to go down to 45mg as a “maintenance dose” once you’ve been steady on an effective dose for some time. However if the side effects are really too unbearable, you may have no choice but to go down to 45mg early (which was the case for me).
The hypotension will ease after about the first 2 – 3 months. See here for more details on side effects.
I ended up settling on 45mg for most of the time I’ve been on Nardil, but occasionally bumped it up to 60mg if I started feeling worse. I found that 45mg was right on the threshold, and only just worked most of the time. Everyone has a different therapeutic threshold, and it will take some time to find the right balance of efficacy vs side effects. However, most people find the sweet spot at around 60mg.
Keep in mind this is just a rough guide for the average person. Some people require as high as 90mg before they reach their therapeutic threshold.
When to dose
I highly recommend splitting your doses by twice a day to reduce both hypotension (at the start) and insomnia/fatigue. I personally take my dose in the morning and early evening. Although you won’t be able to stop the insomnia/fatigue completely, you can somewhat choose which one will be less severe. For example, if you were on 45mg but preferred slightly less insomnia at the cost of slightly more afternoon fatigue then you can take 2 tablets in the morning and 1 in the evening. If you would prefer slightly less fatigue at the cost of more insomnia, then you’d take 1 tablet in the morning and 2 in the early evening.
Having said that, there are some people who manage to take their entire dose all at once without any problem, so you’ll just have to see what works best for you.