Introduction [KG]

When I edit these stories and add an introduction to them, I frequently get into a state where my blood is boiling. This is because I am so upset and distressed by the hopeless treatment that people are given. This story illustrates several points, 1st is that phenelzine (nardil), although less used by some, is a very effective MAOI, and is uniquely effective for some types of anxiety symptoms (especially social anxiety in the absence of depressive illness), and other phobic and anxious symptoms in the presence of depression. As in this instance it is frequently life changing, transformational is a word people often use in describing its effect. The next point illustrated is that affective illnesses beginning after the child-birth (usually symptoms start within 3 weeks), especially when they are the first occurrence of such illness in the peoples’ lives, invariably indicate biological depressive illness which requires proper antidepressant treatment, usually more than just SSRI.

To give such people repeated courses of SSRIs when the response is poor or non-existent, as it frequently is, is nonsensical and constitutes poor practice, very poor practice.

I think I was always a child that worried, concerned for the welfare of my siblings and always considerate of my parents never having to worry about my whereabouts, or causing any need for concern or distress.

I therefore gained the family name of Anxious Annie. But it was many years before this turned into what would be classed as a mental illness.
For me, my mental health issues began after the birth of my first child. I had a joyous pregnancy feeling elated and well but after a long and traumatic birth I was exhausted. On day 3 when my milk came in and the hormones are raging it was like a switch was flicked in my brain and I was overwhelmed with panic, anxiety and rumination. It was later described to me as a pregnancy which is called the pinks followed by the blues, but it was much more than just the baby blues I would suffer.

Postnatal depression or as postnatal anxiety which was a more apt description for me. I sought the help of an early childhood nurse and psychologist during this time. It lasted for a good six months after the birth of my first child, although I continued to be a fairly anxious person it was not in impacting my life to a great degree. I had my second child 3 years later and once again had a repeat experience of postnatal anxiety coming on very hard and fast on day 3 post birth. It lasted the best part of the year. I struggled again but somehow managed to get through my postnatal anxiety after my first and second children without medication1.

About 3 years after my second child, my marriage broke down after years of alcohol abuse from my husband which had exacerbated my ongoing anxiety and finally ended our marriage. I was at an all-time low and my anxiety was extremely high. Within a short period my anxiety overwhelmed me to the point one day I had what I would later come to know as a panic attack. This was a very frightening experience and led me to seek professional help. This was the beginning of a very long and arduous journey. I initially sought help from my GP who prescribed ‘Aropax’ 20mg an SSRI, which within a week it increased my level of anxiety to almost unbearable. I returned to my GP who changed me onto ‘Prothiaden’ [an old ‘TCA’], starting on 50mg which didn’t worsen my high anxiety and agitation but did not have much of an effect, so I contacted my GP and she advised that I upped the dose by 100 mg which I did and a day later I fainted in the shower (I was to learn as the years went on a lot about dosage and how to titrate medications and now know this was too big an increase in a short space of time and had affected my blood pressure, hence the faint).

It was at this time my life was pretty much falling apart and I was unable to cope with day-to-day life and caring for my two children. After some deliberation and fear I agreed to be admitted to a psychiatric unit. This was my first interaction with a psychiatrist and a mental health team. During my 6 week stay in this unit, I was trialed on various medications including Prozac SSRI, Paxil SSRI, Mellaril anti-psychotic, Xanax benzodiazepine, all of which had no lasting effects on my high levels of anxiety, agitation and panic.

 
After discharge I returned home for a couple of weeks but my mental health declined further and I returned to my parents in another state, a very distressing thing to do in your 30’s as a mother of her own children I could no longer care for. After a short time staying with my parents, which did not help and caused them enormous distress I was admitted to another psychiatric unit. I was then trialled on 20 different SSRI medications over the next 6 weeks2, all of which made me much more agitated and anxious and eventually I was put on Olanzapine an antipsychotic and discharged. During this stay I lost 20kgs sure to my inability to swallow food due to my tight throat from anxiety.

I returned to my home and sought out another psychiatrist who was recommended to me. He was a very experienced psychiatrist and upon first hearing my story and my symptoms, his words resonated with me when he said ‘I think that you are suffering from a very agitated depression and panic disorder’. This was the first time that someone had actually said this to me rather than depression and for me this absolutely fitted what I was feeling, not depressed but highly highly, agitated, restless and unable to sleep or relax. He discussed with me that he thought I would do best on a MAOI class of anti-depressant called Nardil (Phenelzine) which had particularly good results with anxiety and the symptoms I was describing. To confirm his diagnosis he wanted me to be seen at the Mood Disorders clinic by Professor Gordon Parker and his team. At the mood disorders clinic I had a roundtable discussion with Professor Parker, a number of psychiatrists and psychologists and mental health workers. I once again told my story and the distress I was feeling and they all took notes, went away to discuss my case collaboratively and professor Parker returned and advised me that they had all wholeheartedly agreed that Nardil was the right choice for me and reassured me that even though at this stage I had trial 25+ medications this would be the one that would actually make a difference. I was so unwell by this stage I was willing to give anything a go.

Nardil the wonder drug!

I began a course of Nardil the next day and within that week I began to feel my anxiety levels easing. My psychiatrist at the time also prescribed a regime of sleeping tablets and benzodiazepines to relieve me in the short term until Nardil completely kicked in. I cannot tell you the relief that Nardil provided. It was truly like a wonder drug within a matter of weeks. I was back to the person that I had been before. I began to reengage in my life and over the next couple of months, manage to care for my children, and return to my normal home life.
It has now been almost 30 years that I have been taking Nardil and I have managed to raise my sons as a sole parent and see them finish their schooling, complete further education onto successful careers and lives. I have had an extensive career in health, studying and furthering my education and travelling the world. I have been happily married for over 20 years now and although I am still vulnerable to stressors, with the help of Nardil which I increase at these times and ongoing care of a supportive and empathetic psychiatrist, life has been good.

I have also supported friends, colleagues and people I meet through the MAOI community to trial a MAOI all of who have also successfully been treated through to in many cases full remission.

I cannot recommend treatment with an MAOI highly enough. It is sad that is often seen as a last line of treatment where I could have saved myself many years of suffering had it been offered to me earlier.

I am forever thankful to Dr Gillman and his website PsychoTropical for the education, support, care and persistence in providing, updated, accurate, scientifically researched and peer reviewed information he provides. It is through his education and guidance I have complete faith in MAOIs.