triffid113
Day of the Square Peg
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)An alternative way to increase BH4 levels, besides reducing its consumption by ammonia, is to reduce its consumption in the production of neurotransmitters by using the prescription monoamine oxidase inhibitor (MAOI) phenelzine (Nardil). Nardil prevents the breakdown of neurotransmitters and thus reduces the amount of BH4 that must be used to make those neurotransmitters in the first place.
I use only 7.5mg (1/2 tablet - tricky to cut) first thing in the morning drunk with ~250mg sodium ascorbate in a large glass of water (I crush the very unpleasant tasting half tablet in my mouth with some of the liquid). I additionally have to use at least 200mg of caffeine tablets - taken with or after breakfast (and often times more in the afternoon, e.g., 100-200mg extra) - to offset the paradoxically tiring effect that Nardil initially has... It's actually ultimately energizing.
Nardil, even when taken in the morning in such a small dosage, causes sleep problems for me at night that are overcome by using 0.25mg (1/2 tablet) of clonazepam (Klonopin) together with 500mg niacinamide (which reduces the amount of Klonopin necessary), and magnesium citrate (e.g., 200mg or more). (I also take these with sodium ascorbate in water.)
Nardil (and caffeine) in the morning, and Klonopin (and niacinamide and magnesium) at night, have given me some semblance of a life, after many years of not having one. I've been doing this regime for some 3 months now with very consistent results. (I'd tried Nardil a couple years ago with only an initial temporary success because I didn't understand how to use it.)
Nardil has previously been explored in published literature trials for CFS / ME with only modest results. I'm not sure that the researchers were aware of the apparently critical (at least for me) importance of caffeine, though.
Note that Nardil, by increasing the levels of BH4, is indirectly acting as a potent antioxidant.
I've not noticed any food interactions using the 7.5mg amount. Unfortunately, many doctors are reluctant to prescribe MAOI's, since when they first came out (many decades ago), a number of deaths occurred in patients taking much larger dosages who also ate preserved and/or other contraindicated foods (when the food interaction problem wasn't initially understood by the medical/scientific community). Hypertensive crisis I think is the primary worry, and my blood pressure, like the majority of people with CFS / ME, runs low, making a problem less likely anyway.
Nardil is very definitely NOT acting as an antidepressant in my case, and I doubt that 7.5mg would be considered a therapeutic antidepressant dose (typical dosage in depression is more like 45 to 90mg, if I remember correctly).
Do you know if (1) nardil has any benefit if you are COMT +/+ (like me)? (2) How nardil would work with someone who was homozygous for MAO A, as my father was?