Posted by JohnB on December 2, 1999, at 22:33:31
In reply to nardil vs. parnate, posted by JIM on December 2, 1999, at 18:17:36
Hi, I've tried three of the non-reversible, non-selective MAO inhibitors, as well as another MAO inhibitor which loses its selectivity above 10-15 mg/day. What I can tell you are primarily my personal experiences and what I've read in the research. Please keep in mind that many effects, both therapeutic and side effects, vary greatly from individual to individual.
Regarding Nardil, I found it extremely effective for my social phobia, but only at doses of 60 mg/day and above. I did not find therapeutic benefit at so-called "maintenance" doses of 30 to 45 mg/day. Further, I am not aware of any research (or any pscyhopharmacologist, for that matter) which suggests a lower dose does not result in decreased efficacy. Unfortunatelyl, I also experienced fairly significant weight gain - about 12 lbs. For me, that's alot, as my metabolic rate is fairly high, and I don't crave carbohydrates. My carbohydrate craving on Nardil was my biggest problem - I couldn't pass up a donut or ice cream, or anything else for that matter. Sexual dysfunction, both erectile and orgasmic dysfunction, were pretty severe. Unfortunately, my psychodoc and I did not try any antidotes other than Periactin, which I found of no benefit. I understand that certain dopamine agonists are used as antidotes to both of these problems, such as amantadine or bromocriptine (hopefully I've spelled these correctly), but I imagine there use is contraindicated in the official drug literature. My psychdoc, who is a good psychopharmacologist, prescribed bupropion, which has a dopaminergic effect, while I was taking parnate and looking for additional efficacy. Unfortunately, I have not tried Bupropion (Wellbutrin) while I've been on Nardil. Again, this is contraindicated in the drug literature, but experienced and knowledgable psychopharmacologists believe they can cautiously manage this combination with some patients. Bottom line, I have yet to return to Nardil, but am toying with the idea. It's really hard to resist it's efficacy. If it weren't for the side effects, I'm sure it would be one of the top medications for anxiety disorders.
Regarding Parnate, I found it much less effective than nardil, but without the weight gain and complete sexual dysfunction. I did experience an annoying dry mouth, as well as some cognitive dysfunction - mostly a slowing down in my speech (not a slurring, which would suggest possible serotonin syndrome or hypertensive crisis). My voice mail messages became notoriously slow, and difficult to wade through, even when listeners used the "speed up" feature. I also found insomina to be a problem, if I titrated the dosage too quickly. You need to start very slowly, in the a.m., and stop your caffeine intake. Bottom line on Parnate, not enough efficacy for its somewhat tolerable side effects, at least for me.
Marplan - I'm still waiting for therapeutic benefit at 80 mg/day. No weight gain and very limited sexual dysfunction so far - about 1 month. I've just recently worked my way up to 80 mg/day - so I'll give it another few weeks or so, hoping the efficacy will "kick-in." In the meantime, I've noticed a pleasant side effect, in which my normally patient personality is even more patient. Almost nothing is able to irritate me. This suggests, to me, a strong serotonin effect (which 5HT subtypes - I haven't a clue), though I do understand that a serotonin deficit may lead to aggressive behavior. I am hoping that the efficacy will be equivalent to Nardil, as both are hydrazine (indicating a GABA effect), as well as non-selectible (for MAO-A or MAO-B) and irreversible.
Selegiline, another MAOI, I tried at 60 mg/day. It loses its selectivity for MAO-B above 10-15 mg/day. It's a non-hydrazine. As such, I was hoping for some benefit in the range of parnate, or, possibly, somewhat more, but without parnate's side effects. I experienced no unpleasant side effects. In fact, my sexual urge was increased to the point that it was frequently difficult to focus on certain work issues. On second thought, this was an unpleasant side effect, though it's hard to think of it that way. I also felt somewhat increased coginitive functioning, but this could have been a placebo effect, or just the absence of cognitive dysfunction, which is common among all central nervous system depressants - but to varying degrees. Bottom line here - no efficacy, very, very unfortunately.
Lastly, I can emphasize enough how these are just my experiences. I've heard and read of people who actually lose weight on Nardil. Further, I've never seen any side effects as occuring 100%, though some do seem to go under-reported vs what I see in the "official" drug literature.
Good luck.
JohnB :)
poster:JohnB
thread:16095
URL: http://www.dr-bob.org/babble/19991123/msgs/16116.html