Posted by Racer on May 9, 2007, at 11:54:44
In reply to FOUR misconceptions about the GREATNESS of MAOIs, posted by UgottaHaveHope on May 4, 2007, at 23:53:03
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> 1. Most pdocs dont even bother to study any of the drugs from the pre-Prozac era. With no knowledge of MAOIs and only rumors of its dangers, they think "why try that old drug when the new ones must be better because they are new." What great logic.I will disagree that this is true of *most* pdocs. It seems to be true of most GPs, and many pdocs. Many other pdocs may consider MAOIs only after other medications have been tried unsuccessfully. Saying "most," though, may be an unfair generalization. The last four pdocs I've seen all discussed MAOIs with me. It's possible that it would be more accurate for your to write something a little more focussed on your own experience: "most pdocs I've seen haven't bothered..."
It's true, though, that MAOIs are not used as frequently as newer drugs, for a variety of reasons, and that many pdocs don't have as much experience using them. I'm only trying to point out the generalization.
> 2. The alleged "deadly" MAOI diet, which is a joke. You have to give up cheese and soy sauce, which I dont like doing.
First, as you say, *you* haven't had reactions to small amounts of soy sauce or cheese. Mileage varies. 'Nuf said.
But what I will point out is that many people would find the MAOI diet more onerous than you seem to. And many other people have other issues which might make the diet a problem, as well. My T, who is a Certified Eating Disorders Specialist, would hit the roof at the suggestion of an MAOI for her clients, because of the diet -- she says it's counterproductive for eating disorder treatment, and I think she's right.
My point, though, is pretty simple here: what may not be a problem *for you,* may be a serious problem for someone else. Let's be respectful of those people who would not find the diet manageable.
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> 3. "MAOIs are deadly." Yes, they can be dangerous when mixing with other drugs, BUT so can SSRIs (see Anna Nicole Smith's son). In other words, MAOIs are no more dangerous than anything else.Actually, that's not quite true. I won't belabor the point, but MAOIs -- and TCAs, for that matter -- are more deadly *in overdose* than SSRIs. Yes, there are odd reactions to any drug. That's not what most doctors are concerned with regarding the safety of MAOIs -- they're concerned with suicide attempts, in patients who are depressed and possibly more prone to attempts on their own lives. And the newer antidepressants are absolutely safer than the older ones.
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> 4. The Nardil weight gain: I can only speak for myself, but I have lost 10 lbs. in my first five weeks on Nardil because of exercise and healthy eating habits. I realize some people may gain weight no matter what on Nardil,From what I've seen on these boards, and from what I've read in the literature, and even from what doctors have told me, you seem to be in the minority on this. Maybe it has something to do with the fact that you've been taking it for only a short time?
Regardless, though, since many people do report gaining weight -- often considerable amounts of weight -- on Nardil, how about respecting their experience, by avoiding either a generalized comment on the weight gain, or the suggestion -- which I suspect you didn't realize your comments could be seen as making -- that the weight gain is their own fault? Weight gain is a serious issue for many people, people without eating disorders, and it's something that even a lot of doctors will blame the patient for. It's easier than saying, "well, I have a drug that will help with the depression -- but you'll gain a lot of weight, and I won't be able to help you with that part..."
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> PS. I can't leave without saying this: Meds + therapy (specifically CBT) is the best combination to healing or recovery.CBT is a fine form of therapy. It is not helpful for everyone. Meds and therapy have consistently been shown to be superior in combination than either is alone. But I don't think we can say that any specific model is the best. Many studies use CBT because it's easier to standardize for research purposes. That doesn't mean it's the best model out there.
Michael, I'm very happy that you're so enthusiastic about MAOIs, and I hope they work for you. I even think it's great that you're encouraging other people to consider trying them, as well. I just want to caution you that sometimes what you say may not come across quite as you mean it to.
For instance, I know how I might react to a post like this if I weren't in my current pretty-OK state. I consider Parnate sometimes -- BECAUSE I could use it as an excuse to restrict, and therefore lose weight. But I know that I won't be taking any MAOI anytime soon, and sometimes when I read something with strong encouragement to try one, I "hear" criticism, that it's my own fault I'm not getting relief because if only I'd be less rigid and try this drug I'd get better. That it's unreasonable of me to consider the dietary restrictions to be a problem -- despite the fact that I eat pickles nearly daily, and use soy sauce in dinner several times a week. That weight gain "shouldn't" be a big deal, since getting over the depression "should" be the only thing I care about. Can you put yourself into my skin for a minute, or the skin of someone else like me?
I hope Nardil is as great for you as you're hoping. I just want you to see that your enthusiasm may not be communicating quite what you have in mind to everyone, in hopes that you may learn something from it. Maybe it will help you communicate your enthusiasm in a way that does get your point across even more effectively.
Peace.
poster:Racer
thread:755932
URL: http://www.dr-bob.org/babble/20070509/msgs/757106.html