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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by ed_uk on February 27, 2005, at 9:28:45
Hi,
I was just thinking, how can we ensure the continued availability of Nardil and Parnate? They have already been discontinued in many parts of the world.
While pharmaceutical companies are pushing their latest money-spiners, how can we educate doctors that MAOIs are still useful?
Ed.
Posted by SLS on February 27, 2005, at 10:04:08
In reply to Something Scary, posted by ed_uk on February 27, 2005, at 9:28:45
> Hi,
>
> I was just thinking, how can we ensure the continued availability of Nardil and Parnate? They have already been discontinued in many parts of the world.
>
> While pharmaceutical companies are pushing their latest money-spiners, how can we educate doctors that MAOIs are still useful?
>
> Ed.
Inject them with reserpine, mecamylamine, and propranolol and ask them if they like the way they feel. Now tell them that Parnate and Nardil are the only drugs that will bring them back into a state of normalcy.lol
- Scott
Posted by Nixon on February 27, 2005, at 10:04:12
In reply to Something Scary, posted by ed_uk on February 27, 2005, at 9:28:45
> Hi,
>
> I was just thinking, how can we ensure the continued availability of Nardil and Parnate? They have already been discontinued in many parts of the world.
>
> While pharmaceutical companies are pushing their latest money-spiners, how can we educate doctors that MAOIs are still useful?
>
> Ed.Hey Ed,
Hope you are doing well. Interesting post. Although I do not take meds in the MAOI class I was checking my new healthcare's drug list. Nardil is the only MAOI avalable and is a "tier 3" drug which means the copay is the about the same as the cost. No other MAOI meds are listed. Evidently healthcare companies may also be considering these drugs obsolete. Good Luck. JN
Posted by SLS on February 27, 2005, at 10:07:36
In reply to Something Scary, posted by ed_uk on February 27, 2005, at 9:28:45
Perhaps we can draft a letter that everyone can send to the e-mail addresses of the drug companies.
- Scott
Posted by ed_uk on February 27, 2005, at 10:24:07
In reply to Re: Something Scary, posted by SLS on February 27, 2005, at 10:07:36
Hi,
>Perhaps we can draft a letter that everyone can send to the e-mail addresses of the drug companies.
Yes, it could be a good idea.
Grrr. Why do I keep hearing the opinion that now we have Effexor and lots of other new drugs we don't need MAOIs anymore? Do doctors seriously think that everyone responds to these drugs? What about the people that don't?
Sometimes I think that many doctors don't prescribe MAOIs because they can't be bothered to educate patients about the diet, drug interactions etc. They like drugs that are 'easy to prescribe'. Or maybe they have been misled into thinking that they are not effective or that they are 'too dangerous'. Perhaps they are not knowledgeable about MAOIs and can't be bothered to teach themselves.
Scott, maybe you should try Nardil again. Or Marplan. What do you think?
Ed.
Posted by SLS on February 27, 2005, at 10:29:03
In reply to Re: Something Scary » SLS, posted by ed_uk on February 27, 2005, at 10:24:07
Hi Ed.
> Scott, maybe you should try Nardil again. Or Marplan. What do you think?
I have been on Nardil numerous times. Unfortunately, I glean very little from it. Marplan I took for only two weeks. I was frustrated and wanted immediate results. I could revisit it in the future, I guess.
What is your impression on the use of Mirapex. I have never seen someone stick with it beyond 6 months or so.
- Scott
Posted by ed_uk on February 27, 2005, at 10:55:15
In reply to Re: Something Scary » ed_uk, posted by SLS on February 27, 2005, at 10:29:03
Hi,
>What is your impression on the use of Mirapex.
It seems to start making people very sleepy after they've been on it for a while. Have you tried it? A bet you have!
Ed.
Posted by linkadge on February 27, 2005, at 12:06:32
In reply to Re: Something Scary » SLS, posted by ed_uk on February 27, 2005, at 10:55:15
The funny thing, is that psychiatrists are still taught that MAOI's are still perhaps the most effective drugs.
That is what my previous newby psychiatrists told me.
I don't know the statistics but I was under the impression that a considerable number of people still use nardil.
Linkadge
Posted by Optimist on February 27, 2005, at 12:42:17
In reply to Re: Something Scary » SLS, posted by ed_uk on February 27, 2005, at 10:24:07
I think many doctors are worried about lawsuits which influences their prescribing habits. That and negative campains to influence the sale of new drugs.
After being on Parnate for 2 weeks I think a lot of the MAOI drug and food interactions hysteria is overblown. I don't underestimate the seriousness of reactions but overall there's more drugs and foods that are "use with caution" than are down right prohibited.
Prohibited food list:
Draft beer, old cheese, soya sauce, aged meat, Marmite, sauerkrout, banana peelsFoods in moderation:
All other alcohol beverages, mild cheeses, etc...I've only been concerning myself with the prohibited foods so far and have been fine with it. I carry a Nifedipine pill with me just as insurance but haven't had to use it yet.
Prohibited drug list:
Demerol, pseudoephedrine, dextromorthan(sp?)DM, SSRI's, etc...Drugs with caution:
most TCA's, amphetamines, Wellbutrin, Trazodone, caffeine, tyrosine, etc...I've been taking between 400mg-800mg of caffeine a day and haven't experienced any problems as well as 500mg tyrosine in the mornings. I used to take 3g of tryosine but I'm being much more conservative at the moment with it. I have a blood pressure monitor that I have been using frequently to monitor my reactions to certain things.
Brian
Posted by ed_uk on February 27, 2005, at 13:21:45
In reply to Re: Something Scary, posted by Optimist on February 27, 2005, at 12:42:17
From 'A survey of prescribing practices for monoamine oxidase inhibitors (July 1999)'
OBJECTIVE: A survey examined prescribing practices for monoamine oxidase inhibitors (MAOIs) and explored reasons for the widely noted decline in their use.
METHODS: A one-page questionnaire was sent in 1997 to 1,129 members of the Michigan Psychiatric Association. A total of 717 responses were received, for a response rate of 64 percent. Only data from the 573 psychiatrists who were currently practicing were used.
'Ninety-two percent of respondents believed that MAOIs were useful for atypical depression, 64 percent for major depression, 54 percent for melancholic depression, 56 percent for panic disorder, 44 percent for social phobia, 27 percent for dysthymia, 12 percent for obsessive-compulsive disorder, and 19 percent for posttraumatic stress disorder. However, only 2 percent said they would use MAOIs as their first-line treatment in atypical depression, and only 3 percent would use them a first-line treatment in social phobia.'
Posted by Phillipa on February 27, 2005, at 13:49:50
In reply to Re: Survey, please comment, posted by ed_uk on February 27, 2005, at 13:21:45
I believe it's the threat of lawsuits. Also, if the side effects are numerous, they simply don't want to be bothered with a lot of phone calls. I've never even had a pdoc suggest one. Every time I go into a pdoc's office there are clocks, notepads, brochures, pens, clipboards, etc., on the popular new drugs. They are simply brainwashed, and get kickbacks. In my opinion. Are there any drug reps out there reading these Posts? If so, how about responding. Fondly, Phillipa
Posted by ed_uk on February 27, 2005, at 14:23:44
In reply to Re: Survey, please comment, posted by Phillipa on February 27, 2005, at 13:49:50
>Every time I go into a pdoc's office there are clocks, notepads, brochures, pens, clipboards, etc., on the popular new drugs.
It's funny in a kind of nauseating way. Hope you're getting my mail. I sent you one babblemail today and one yesterday.
Ed xxx
Posted by Phillipa on February 27, 2005, at 15:40:23
In reply to Re: Survey, please comment » Phillipa, posted by ed_uk on February 27, 2005, at 14:23:44
Hi Ed! Yes, I've gotten your Babblemail, and I just sent you another one. I guess we're the only ones following "J". Hope you're better, and have a safe trip back to school. Fondly, Phillipa O
Posted by anodyne on February 27, 2005, at 16:07:18
In reply to Re: Something Scary, posted by Optimist on February 27, 2005, at 12:42:17
> I think many doctors are worried about lawsuits which influences their prescribing habits. That and negative campains to influence the sale of new drugs.
>
> After being on Parnate for 2 weeks I think a lot of the MAOI drug and food interactions hysteria is overblown. I don't underestimate the seriousness of reactions but overall there's more drugs and foods that are "use with caution" than are down right prohibited.
>
> Prohibited food list:
> Draft beer, old cheese, soya sauce, aged meat, Marmite, sauerkrout, banana peels
>
> Foods in moderation:
> All other alcohol beverages, mild cheeses, etc...
>
> I've only been concerning myself with the prohibited foods so far and have been fine with it. I carry a Nifedipine pill with me just as insurance but haven't had to use it yet.
>
> Prohibited drug list:
> Demerol, pseudoephedrine, dextromorthan(sp?)DM, SSRI's, etc...
>
> Drugs with caution:
> most TCA's, amphetamines, Wellbutrin, Trazodone, caffeine, tyrosine, etc...
>
> I've been taking between 400mg-800mg of caffeine a day and haven't experienced any problems as well as 500mg tyrosine in the mornings. I used to take 3g of tryosine but I'm being much more conservative at the moment with it. I have a blood pressure monitor that I have been using frequently to monitor my reactions to certain things.
>
> Brian
I hear you, two weeks on Nardil (45mg) here. I have had almost everything on the "moderation" list - in moderation - with no problems. I even had Marmite(brewers yeast), although I didn't realize it until after I ate it. I was very low in the ingredients list on some packaged soup mix that I used in cooking.I have had no side effects at all other than feeling a bit foggy, which seems to be getting better. I am still not experieincing what some people have expressed here in terms of help with my social anxiety but hoping that things will improve with continued use.
-Dan
Posted by ed_uk on February 27, 2005, at 16:12:50
In reply to Re: Something Scary, posted by anodyne on February 27, 2005, at 16:07:18
Hi Dan!
I like you're posting name :-)
Are you taking Nardil for social phobia? Don't worry that you're not getting the benefits yet, it too early to see much improvemnt and the dose is still low.
Btw, what country do you live in?
Keep posting, I'd like to hear how you do,
Best of look,
Ed.
Posted by anodyne on February 27, 2005, at 16:38:25
In reply to Re: Something Scary » anodyne, posted by ed_uk on February 27, 2005, at 16:12:50
> Hi Dan!
>
> I like you're posting name :-)Thanks.
>
> Are you taking Nardil for social phobia?Yes. And I've tried just about everything else. I am still taking a small doese of Klonopin. What about you, Social Phobia?
>Don't worry that you're not getting the benefits yet, it too early to see much improvemnt and the dose is still low.
That's good to hear. It took a lot for me to give an MAOI a try - this site helped to educate me - and I REALLY want this to work out.
>
> Btw, what country do you live in?The U.S - but I spell like English is a second language:)
>
> Keep posting, I'd like to hear how you do,
> Best of look,
> Ed.Same to you. Take care. -Dan
Posted by snapper on February 27, 2005, at 18:46:35
In reply to Re: Something Scary » ed_uk, posted by Nixon on February 27, 2005, at 10:04:12
> Hope you are doing well. Interesting post. Although I do not take meds in the MAOI class I was checking my new healthcare's drug list. Nardil is the only MAOI avalable and is a "tier 3" drug which means the copay is the about the same as the cost. No other MAOI meds are listed. Evidently healthcare companies may also be considering these drugs obsolete. Good Luck. JN> how sad. how very very sad. (no pun intended)
what is ironic is that I have read more than once that atypical depression is really much more common than true melacholic depression in general and the maoi's are just the ticket for many of us on this board. $$$$$$$$ its' all about f***i&G money we DONT need more tweaked up or finely tuned SSRI's.....what we need is more meds like the maoi's , and ones w/o the risk that one could quite possibly die if they eat a fair portion of cheddar cheese or God forbid a 'Fava Bean' . I am sorry if I sound like I am on a soap box but I truly believe these things. Oh, & also while I am at it ...it might be reasonable to guess that if we had safer and EFFECTIVE maoi type meds, many of us on this board would not need to be spending ridiculous amounts of time looking, hoping, and searching for that perfect med or combo. Don't get me wrong I love Babble like most every one else but I would gladly forsake this website if I could just have a ' normal' brain. Maybe someday...Maybe someday!! sigh!!!!
thanks for reading this and listen to me ramble!!
Snapper
Posted by ed_uk on February 28, 2005, at 8:15:09
In reply to Re: Something Scary and Very sad!!, posted by snapper on February 27, 2005, at 18:46:35
Hi!
>we DONT need more tweaked up or finely tuned SSRI's
Quite right, we most certainly DO NOT need any more SSRIs!!! We've already got plently of SSRIs. What we need is something innovative, we don't need any more 'me too' drugs.
Ed.
Posted by Dinah on February 28, 2005, at 9:47:49
In reply to Re: Something Scary and Very sad!! » snapper, posted by ed_uk on February 28, 2005, at 8:15:09
Sign me to the list. I'd be happy to write the drug companies. We have good anti-anxiety medications, huge advances in migraine medications, but the current anti-depressants are horrible, IMHO. They need to funnel some money in that direction, instead of thinking they have the ultimate answer already.
Posted by willyee on March 2, 2005, at 0:02:40
In reply to Something Scary, posted by ed_uk on February 27, 2005, at 9:28:45
> Hi,
>
> I was just thinking, how can we ensure the continued availability of Nardil and Parnate? They have already been discontinued in many parts of the world.
>
> While pharmaceutical companies are pushing their latest money-spiners, how can we educate doctors that MAOIs are still useful?
>
> Ed.I dont think its directly the p-docs.I believe (and im sure not everyone agrees) that the pharm companys are the spine of the industry,the core.
Like the other poster mentioned,you see pads,pens,etc and most of all samples!!! In docters office as a result of who runs the industry,the pharm companys!
If your a p-doc you have a new medication presented to you,a consistent visit from a rep of the medication,who keeps you informed of the medication,encourges you to use it,provides free samples,then what are you likly to use? This medication or a much older one where you more than likly will have to read up on and learn yourself,one which no one but the patient is encourgaging,...it doesent give Maois a fair chance.
Maybe its not so much they feel we are uninformed,maybe a good number of p-docs themselves arent too informed on them,since they are not mainstream,and not a part of their everyday experieances,maybe the lack of expereiance and knowledge the docs themselves have discourage them from using them.I know i have come across docs who were not up to par on them.
Maybe the folks who do get them prescribed without asking are the ones who have older docs,who remember when they were mainstream and are themselves familiar and comfortable with it.
Like any profession,you will be most familiar with what you interact with daily,they see so many patients on these meds they prob know very well the course the med generaly takes,and feel comfortable with it.
Slap on a little discouragment from the industry, along with time consuming work re-amping their knowledge,it is easy to see why an unfamiliar docter would not see it in his interest at all to prescribe them.This once again spins back to the pharm company.
Also think what would happen if a doc began prescribing them,and his records show a decline in prescriptions of the newer "encouraged meds" im sure a doc with low numbers will not make visiting reps too pleased.
I think it might be more complex than the docter simply fearing the paitent on them.I mean even now you have meds adapting dangerous reputations,such as paxil addiction etc,i doubt this makes a doc relcutctant,or luvox and the big columbine scare,once again i doubt if most docs are reluctant with this newer med,i just dont think in general it comes down to a docs concern of use by the patient more so than a load of other hush hush factors.
Either way the thought of either parnate or nardil being obsolete is more than scary,its horrid,a crime.I have spoken to the country and i dont believe parnate anyway is in any consideration for that to happen.At least not here in the U.S
Lastly once again i dont think people should not value their docs,i do HOWEVER think we need to tone down the who "dont do anything without talking to your doc" this was adapted when we dident have the internet with a zillion resources,this was adapted when the docs had accsess to more than a paitent could get.With the internet now this is not the case.So if youre a responsable adult,and you feel comptent,then why rest your emotional state soly on a two week wait basis,where you get 5-10 mintues of treatment time.
Your docter is not gonna read a million dociments,or follow a speicifc drug,or seek out individuals to gather experainces for you,this is a 24 hr job,and who better for that job then yourself!
As long as we dont question the docters,or make it clear to them we want to play a role in our treatment,then i doubt things will change,and a patients request of a maoi will continue to be patrionized away only to instead aggressivly recomend a ssri.
I know i had to go through 2 docters,one flat out refused,and put me back on buspar and lithium,two drugs i totaly failed on rather than prescribe parnate,i was still timid then and agreed.
Of course i got worse,and decedid i would not take another med but parnate,and when i did get it i had a remission in 48 hrs,something every cocktail of ssris failed to do in over 4 years.Sorry for the long post its just such a close touchy topic for me since i lived it and seen how hard it can be to get a medication u feel can help,and how hopless it can feel when no matter how hard you try,you are made to feel guilty for continuing to seek it,and go home with more pocket emptying repeat unsuccessful medications.
Posted by banga on March 2, 2005, at 6:35:14
In reply to Re: Something Scary, posted by willyee on March 2, 2005, at 0:02:40
As in all things it is probably a combination of factors. For some pdocs, probably the drug reps do shower with information and samples; however I have had a few pdoc who clearly do not associate much with drug reps--no pens, notepads or samples ever from them. ANd none of those ever even mentioned MAOIs. EVer.
Lawsuit potential I think is a large part of it. If you think about it, the pdocs are constantly showered with literature and studies saying that SSRIs are a safer, less side-effect riddled option. MAOIs, and to a lesser extent TCAs are called old and dirty and that wording does not sit well on the mind and tongue.
However, since they are so cheap to make and there is a small market for them, one would hope noone is in a hurry to be rid of them completely.Also, think of how little of the current research uses MAOIs in the study---hence no fresh information on their use, efficacy and danger..
Posted by ed_uk on March 2, 2005, at 6:46:18
In reply to Re: Something Scary, posted by banga on March 2, 2005, at 6:35:14
>Sorry for the long post its just such a close touchy topic for me since i lived it and seen how hard it can be to get a medication u feel can help,and how hopless it can feel when no matter how hard you try,you are made to feel guilty for continuing to seek it,and go home with more pocket emptying repeat unsuccessful medications.
I totally know what you mean. Last Monday I saw a new pdoc, he said the only drug he would prescribe was Effexor- a drug that I have tried before and failed.
Ed.
Posted by Phillipa on March 2, 2005, at 15:49:04
In reply to Re: Something Scary to willyee, posted by ed_uk on March 2, 2005, at 6:46:18
Willyee, What is the columbine scare with Luvox? As you stated now that we have the Internet, there is all this info available to us. So, an example is What is the columbine scare. I can't believe I became so brainwashed while working in psych that I actually thought it was the patients fault if their med didn't work. Well, either they must have stopped it, or they're not doing something right. I never saw an MAOI rx'd, and the only TCA's rx'd were for the pts that didn't have insurance because they were cheap. Fondly, Phillipa
Posted by willyee on March 2, 2005, at 21:35:26
In reply to Re: Something Scary to willyee, posted by Phillipa on March 2, 2005, at 15:49:04
> Willyee, What is the columbine scare with Luvox? As you stated now that we have the Internet, there is all this info available to us. So, an example is What is the columbine scare. I can't believe I became so brainwashed while working in psych that I actually thought it was the patients fault if their med didn't work. Well, either they must have stopped it, or they're not doing something right. I never saw an MAOI rx'd, and the only TCA's rx'd were for the pts that didn't have insurance because they were cheap. Fondly, Phillipa
Eric Harris one of the young teens invovled in the columbine school shooting massacare was either on luvox,or had been on it.......i remember because for a short time i believe his defense used that as a argue point.
Posted by Phillipa on March 2, 2005, at 22:12:11
In reply to Re: Something Scary to willyee, posted by willyee on March 2, 2005, at 21:35:26
Thanks. Fondly, Phillipa
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