Posted by Elizabeth on April 19, 2002, at 4:47:36
In reply to Re: MAOI'S, posted by djmmm on April 18, 2002, at 8:41:20
About the MAOI diet: a lot of people seem to get away with just ignoring it. I think this is probably because most of the foods are obscure -- not the kind of things that Americans typically come across.
I actually had a full-blown hypertensive crisis after eating some falafel that turned out to be made with fava beans. (This was in 1996?7? when I was taking Nardil.) I actually had some hemorrhaging in my right lung, and I had to stay in bed for a few days to wait for it to heal. My blood pressure was something like 240/120, though, and even then I didn't have a stroke or anything (so don't panic if yours gets to 140/90, for example!). I also had a minor reaction after drinking tea that turned out to have ephedrine in it (how was I supposed to know what "ma huang" is?). This time my BP wasn't dangerously high, something like 160/90, I think. As you see, there's a big gap between normal blood pressure (supposedly 120/80, I think women's tends to run a tad lower) and very dangerous high blood pressure.
Also, Parnate, by itself and without any food involved, made my blood pressure go up about 30 minutes after taking it. I found that I could use it without any major increase in BP or noticeable side effects if I took only 10 mg in any single dose. When I took 20 mg of Parnate at once, the rise in BP wasn't really dangerous, but it did cause a nasty headache that took me out of commission for a while. A few people just have this reaction to Parnate. It's been hypothesized that Parnate itself has some amphetamine-like actions (chemically, it closely resembles amphetamine); if this is correct, it could explain the spontaneous rises in blood pressure (although this reaction is not all that common).
A note about brief vs. sustained hypertension: If your blood pressure always (i.e., at baseline) runs at 160/90, for example, that's considered high and you need to see a doctor and try to lower it (often you can do this just by eating better, quitting smoking, exercising, etc.; some people with more serious hypertension will need drugs or even surgery). A hypertensive episode caused by an MAOI-food interaction, on the other hand, is brief -- even if untreated, it will usually just go back down on its own without any damage, and any risks go away as soon as your BP is back to normal.
An early symptom that I recall was this tingling or prickly feeling on my scalp, like my hair was standing on end. That was a consistent predictor of elevated blood pressure, and I'd experience it with relatively small rises in BP (before things got out of hand). In addition to the symptoms already mentioned, I also experienced nausea and profuse sweating -- I felt really warm and I think I had a fever. My heart rate was slowed down, not sped up (this was probably an attempt by my cardiovascular system to compensate for the vasoconstriction). Also my pupils were very dilated and I was sensitive to light.
Most people can use nifedipine, a calcium channel blocker (a type of antihypertensive drug), to lower BP rapidly, if necessary. (I wish I'd gotten some when I first started taking MAOIs; it would have saved me a lot of trouble.) Nifedipine comes in a gelcap which will work very rapidly if you bite it in half and then swallow it. Your doctor should be able to advise you as to when you should take it; when I was prescribed it, I think that I was told to take it if my systolic pressure went above 160 or diastolic above 90 or 95. (I don't recall these figures precisely, but it was something close anyway.) Note that you need to be able to take your blood pressure in order to determine whether you need to take nifedpine. A lot of pharmacies carry small, portable BP monitors. Manual ones (easy to learn to use, though it takes more practice to be able to use them on yourself) cost maybe $20 or so, digital ones (very easy to use) are more like $75 or more. You shouldn't take nifedipine unless you know that your BP is at the point where your doctor said to take it; if you turn out to be mistaken, your BP could get very low. Some people (such as those who've had recent heart attacks), are at risk for serious reactions to immediate-release nifedipine and need either to find an alternative or to be extra-cautious about what they eat.
Some other comments:
> What types of side effects did you have with Nardil?
In general, MAOIs actually *decrease* your blood pressure (unless you eat the wrong thing or take a drug that interacts with them). This is very common. It's also common for your BP to decrease when you get up from sitting or lying down, especially when you first get up in the morning after you've been lying down for a long time. (This is called orthostatic hypotension.) Low blood pressure can make you feel dizzy, weak, or fatigued.
Insomnia is another common side effect. I found that it was hard to stay asleep: I'd wake up after a few hours and feel rested. Something sort of similar happened when I was depressed, but it was a bit different -- I'd wake up feeling miserable, rather than rested and ready to start the day as I did with the MAOIs. The insomnia often led to daytime sleepiness later on -- I'd start getting tired again around mid-afternoon. This was pretty inconvenient! The afternoon tiredness is also common.
Weight gain is common with Nardil, though not with Parnate. I found that Nardil caused me to crave sweets. I never had a weight problem before I took Nardil, so I didn't even notice until it was too late! Watch out for this one. It can creep up on you.
MAOIs can cause sexual dysfunction, just as SSRIs do. I think Parnate is less likely to be a problem here.
Another side effect of MAOIs is that most people stop dreaming altogether. This bothers some, although most don't really notice.
Like all antidepressants, MAOIs can trigger mania in people who are predisposed in that direction. Watch out for this one in particular if you have a personal or family history of bipolar disorder.
Some people get peripheral edema, swelling (particularly around the feet or ankles) caused by fluid retention. Lying down with your feet elevated can help alleviate this. If it's really bad, a doctor can prescribe something for it. This is another side effect more common with Nardil than with Parnate.
There are a bunch of random side effects that people sometimes get from MAOIs, but these are the main ones that I can think of. The only side effects that I recall having besides those listed above were tremor and twitching. I didn't have problems with mania, fluid retention or edema, or sexual dysfunction. The hypotension was very noticeable at first, but I adjusted to it once I'd been taking the MAOI for a couple of weeks. Overall, I found the MAOIs quite tolerable.
> I am very anxious about taking an MAOI, but I feel it is my last hope.
You don't need to fear MAOIs -- and one of the best ways to combat fear is to educate yourself. I hope some of the stuff that I and others have explained in this thread has helped you feel more confident that you will be able to deal with whatever situation might come up.
A little while ago I posted a list of dietary restrictions that is very brief and simple -- maybe it was in another thread, but if you'd like I'll repost it. (Every now and then I post this list because someone wants to know about the dietary restrictions.) After the fava bean incident, I went to the med school library and made copies of some recent articles about food-drug interactions with MAOIs, and this is how I put together my "short list." I never had problems with food interactions after that. The "short list" includes all foods and drinks that people taking MAOIs have good reason to avoid.
Also, there are lots of things you can try if traditional antidepressants don't seem to work for you. So while MAOIs work for a broad range of conditions, you needn't consider them your last hope.
> If I was to spontaneously have *any* of the above symptoms, I would go to the hospital, or would take the appropriate measures to get my blood pressure down (medication your Dr. would provide you in emergency)...luckily, I have never had to do so.
Some of the symptoms of sudden hypertension might be caused by something else entirely, so I wouldn't suggest going to the hospital based on just one symptom. (Having a bad headache, for example, isn't necessarily a reason to go to the hospital or to take nifedipine -- although if you ever experience this particular sort of headache, you'll be able to recognize it if it happens again. It's very distinctive.) That's why I think it's a good idea to be able to monitor your BP if you're taking an MAOI. Of course, if you have a whole bunch of symptoms, that would be reason to seek help, but you don't always get that much warning: by the time it's clear, based on the symptoms, that it's high blood pressure, you might not have time to get to a hospital. (Again, unless you can check your BP, I don't recommend using nifedipine.)
Hope this is helpful.
-elizabeth
poster:Elizabeth
thread:103144
URL: http://www.dr-bob.org/babble/20020416/msgs/103501.html