Posted by Don_Bristol on May 8, 2006, at 19:42:34
In reply to Re: MAOIs, posted by Jost on May 8, 2006, at 15:33:58
> IMO you can't equate, or in any way closely compare, Maois and ECT. The fears about food restrictions are pretty overstated.
>
> I can see being concerned about giving it to people who either have very little discipline about what they eat, or those who have are unusually sensitive to it. Otherwise, there are only a few restrictions, eg soy products, cheese, certain wines--and I would think most people would be able to monitor effectively.
>
> Of course, the drug interactions are such that you need to have some indication, in case of emergency.
>
> Given how effective they are as ADs, and how many people might benefit, and how controllable food and drug interactions are-I think Maois should be prescribed much more often than they are.
>
> To put them into the same category as a treatment that causes memory loss of greater or lesser severity in almost everyone who has it--seems extreme.
>
> Jost.
>
Hi Jost. PMFJI. From what you write I sense you have not taken any MAOIs. I am not sure of the mortality rate of ECT but my impression is that it is far less than that of people who have died or been left with heart/brian damage after a serious adverse reaction to food + MAOI.From the figures in the 2002 AAPCC TESS ANNUAL REPORT in "American Journal of Emergency Medicine" (vol 21, number 5, Sept 2003) there were 81 moderately serious outcomes of MAOI + food and 28 major or death. One third were intentional with the remainder being unintentional. The figures for 2001 are slightly higher.
The statement you make about "very little discipline about what they eat" is rather astonishing. You then refer to a list which strangely includes "certain wines" perhaps because of the old canard about chianti. You might want to dig out some old statements by someone who I recall who found themselves in ER after eating a single slice of pepperoni on a pizza. That person may have been unusually sensitive to that combo of MAOI + pepperoni but I doubt they were necessarily weak willed or "ill disciplined" about their diet as you seem to suggest.
I do agree with you that the typramine interaction with MAOIs is generally overstated and as a result many physicians have shied away from using an MAOI because of their fears. I agree MAOIs chould be more widely used but there is a good case for trying the less-lethal ADs first and then moving towards MAOIs if nothing else works.
Just my 2 cents worth.
Good luck.
poster:Don_Bristol
thread:639045
URL: http://www.dr-bob.org/babble/20060504/msgs/641525.html