![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 26 to 50 of 85. Go back in thread:
Posted by ed_uk on May 5, 2006, at 14:22:27
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 4, 2006, at 20:28:45
>And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office
A lot of people who take Zyprexa gain a massive amount of weight, which is usually very difficult to loose. The risk of a heart attack or stroke is much greater in people who are overweight.
>heart attack from an MAOI
Interestingly, Nardil usually produces a decrease in blood pressure and heart rate. MAOIs such as pargyline (Eutonyl) were formerly used to treat essential hypertension.
>Exhaustion of other less dangerous choices are others
Most people who take MAOIs have already tried a large variety of other drugs and found them ineffective or intolerable.
>Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.
If other treatments don't help, what other choices are there?
Ed
Posted by Declan on May 5, 2006, at 19:55:01
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 5, 2006, at 14:22:27
My experience of psych drugs is limited to old APs, benzos, Remeron, MAOIs. I have so little faith in the industry and so little stomach for it that I just couldn't go through the treadmill of all those drugs. If I got agitated depression I'd try Nardil and something; then opiates. I saw my mother go through it, toward maintenance ect. Better to die 5 times over. Cancer was a piece of cake by comparison. She would have agreed.
Declan
Posted by yxibow on May 6, 2006, at 1:49:52
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 5, 2006, at 14:06:46
> >Is there a study?
>
> I think it's pretty obvious than most people do not suffer from severe sinusitis on a regular basis.Probably true -- but its not a fun situation, anyhow, we can go beyond the sinusitis issue and drop it.
>
> >No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD.
>
> There's nothing controlled about delivering an electric shock to the head. Sorry, anyone who thinks otherwise is just deluding themself. ECT is a very crude procedure, even with EEG monitoring etc. Unsurprisingly, psychiatrists who have been involved will have convinced themselves that it is safe - for their own peace of mind if nothing else.No, actually it is the same misinformed information that I am beginning to believe for myself about some use of MAOIs just as there is misinformed use about modern, controlled ECT in institutions that use the most modern equipment, procedures, anaesthetics, and practices. I certainly know there are hospitals around here and other parts of the country I wouldn't want it done in if it came to that.
>
> >I wouldnt go there any more than I would an MAOI.
>
> Neither MAOIs nor ECT are established treatments for OCD or somatoform disorders.......so I wouldn't really blame you.Not established but actually mentioned as a treatment by my doctor for my condition, as an end run use. Plus the fact that ECT has a far more immediate effect on neurotransmitters than any medication.
He would not recommend an MAOI because I am a vegetarian and there are way too many things contraindicated. Like Soy ___ (fill in the blank) for starters.
> >So why post it, I was lost ?
>
> I posted it because it gave information RE the voltage and current used in ECT - which is enough to make my eyes water.
>
> >Mm... ask the millions of Americans who use it daily.
>
> I work in a pharmacy, I am well aware that many people are happy to buy what are effectively placebos (eg. expectorant cough medicines, Sudafed PE) on a regular basis. It is not, therefore, surprising that people should be happy to buy dextromethorphan. It is very easy to convince people that a medication is effective, even when it is not. The recommendation of a friend, the pharmacist or an advertisement.........
I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value, and I buy whatever is the cheapest generic at the local drugstore anyhow. There are some OTC medications that are effective, some not terribly so. Loratadine is fairly harmless and does work. Hydrocortisone for my dry hands on a rare occasion is nice, but not for extended use, plus for contact dermatitis that I got before I wore long sleeves at the garden I volunteer at. Aforementioned, saline solutions are useful for various rhinitis and sinus conditions. Acetaminophen is perhaps the most useful and yet most dangerous as you know it is a popular method for exiting this existence in England. Ibuprofen I find quite effective at 4 or 600 for tension headaches.
But you have some points about placebos -- and they do work after all 33% of the time as studies have shown. And there have been recent articles about OTC medications and effectiveness. I'm not shooting you down on it, I'm only saying I've gained some purpose from some OTC medications. For others, it may do not a darn thing.> >Hmm.. I won't go there because that's character assasination.
I think you misunderstood me. I did not want to comment on your use of codeine for euphoria because I didn't want to hurt your feelings, and I feel you have taken it 180 degrees from what I was intending to say, Ed. I didnt want to offend you and I'm sorry if I did.
> I find your remark offensive. Codeine is effective in making me feel better. I find that it causes very mild side effects, which is more than can be said for the drugs you take.
For one off use. Over time, the codeine that is converted into morphine in your body will become habit forming. Sure, you can get off of it, just watch trainspotting -- and its not like heroin, but its not an approved use for the medication. That's why they banned it all over the US here because people were using it for stuff other than bad coughs.
Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either. I have a horrible disorder that nobody yet on this planet have I met has and I don't relish taking 6 medications a day to palleate it and not even cure.
A lot of people take meds to feel better. A lot of people enjoy a glass of wine on an evening.I enjoy your Blackthorn cider. I have no issue there.
I guess you've been brainwashed by the 'war on drugs' etc,
definately not... see below
which is particularly interesting considering that amount of diazepam you take.
I have no desire to take 170mg of diazepam a day. It has reached the same steady state as the slightly more than 8mg of clonazepam I was taking. I could theoretically be more engaged with society and not need to pay as much attention at the wheel (we all should pay attention at the wheel though), but would I be in danger of wanting to commit suicide because the lights returned back as bright as they were in 2001? Its an unanswered question.
I think you're feeling hurt -- I'm not brainwashed by the war on drugs; I dont think people using small quantities of marijuana should be prosecuted, this country spends way too much time on it and I support all initiatives to legalize medical use of marijuana, considering it was legal until the 1930s in this country.
I've never used so-called illegal drugs but if I didn't have a bevy of polypharmacy on board always in my life I wouldn't mind trying marijuana, so you don't have my views at all correct there.
Just the same this isn't a forum for discussing drugs not legal in either of our countries so I can't go further without getting a Dr Bob comment.
At the same time, shooting up heroin is not my idea of something that should be sold over the counter. And meth labs defy all logic -- I can't imagine why someone would want to be barely coherent and climbing the walls -- I've seen people on crystal, as you know it is prevalent in the gay community. And people have an opinion that somehow exstacy is no worse than popping a Prozac and GHB is child's play. I've seen someone on Ketamine too, and that is just mind boggling also.So, "softer drugs", aka marijuana, possibly your one off use of codeine with a strong caveat, alcohol, tobacco (though I think it should be erased from this planet because it drives up healthcare costs in this country and to watch people die of it is cringe making -- and it seems to be on the rise in the club community here), possibly khat (although that goes into the more hardcore stimulant range....), a light "poppy tea" like you brits used to make (and I mean light) -- okay, for those of age.
"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
Dont create a rift with us, Ed -- I think you are having a bad day or are totally misinterpreting me over my banter on medications which is my right as much as yours here on Dr Bob. We are on the same track personally and I've told you that in babblemail. And I will tell you that again.Sincerely, and tidings
-- Jay
Posted by ed_uk on May 6, 2006, at 10:15:21
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 1:49:52
>Like Soy ___ (fill in the blank) for starters.
Certain soy products are contra-indicated with MAOIs, others are not.
>I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value
Mild coughs are self-limiting, giving the false impression of drug efficacy.
>I'm only saying I've gained some purpose from some OTC medications.
Some OTC medicines are very effective. I was just making a the point that cough medicines are not generally very helpful. Recovery occurs naturally but is attributed to the medication.
>codeine for euphoria
I find it somewhat mood elevating but non-sedating. It tends to make me want to exercise. You are making assumptions.
>habit forming
Rather like cider then......
>trainspotting
I've seen it. As a film, it is intended to be very dramatic. Alcohol withdrawal is often more severe than opioid withdrawal - *many* people are addicted to alcohol.
>Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either.
I'm sorry that you thought that, it was not my intention. It was not me who brought up the subject of character assasination.
>banned it all over the US
LOL, I suppose what they do in the US must be right ;-)
>I think you're feeling hurt
Yes, I am
>"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
You can't divide drugs into 'good' drugs and 'bad' drugs J. This type of oversimplistic classification reflects a lack of knowledge and understanding. Diamorphine (Heroin) and other potent opioids are very important drugs in the treatment of severe pain. Ketamine is used as an analgesic in emergency medicine. GHB (Xyrem) is used to treat narcolepsy with cataplexy. Cocaine is used during ENT surgery.
Ed
Posted by ed_uk on May 6, 2006, at 10:44:54
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 1:49:52
>"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
'Crystal' methamphetamine is closely related to amphetamine (Adderall) - which is widely prescribed by psychiatrists in the US, especially to children. Methamphetamine itself (Desoxyn) is also occasionally prescribed by pdocs in the US.
Ed
Posted by yxibow on May 6, 2006, at 13:01:46
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 10:15:21
> >Like Soy ___ (fill in the blank) for starters.
>
> Certain soy products are contra-indicated with MAOIs, others are not.I know -- but its too hard for a vegetarian who eats products made from all parts of a soybean -- isolates, TVP, protein powder, tofu, soy sauce, teriyaki, edamame, yuba, okara, tempeh, etc. Not to mention nutritional yeast. Plus on top of this eating out at really nice restauraunts around here.
>
> >I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value
>
> Mild coughs are self-limiting, giving the false impression of drug efficacy.
>
> >I'm only saying I've gained some purpose from some OTC medications.
>
> Some OTC medicines are very effective. I was just making a the point that cough medicines are not generally very helpful. Recovery occurs naturally but is attributed to the medication.Of course, that I agree with you. I have no ideation that DXM is going to "cure" my corona virus.
>
> >codeine for euphoria
>
> I find it somewhat mood elevating but non-sedating. It tends to make me want to exercise. You are making assumptions.Curious... well excercise is good as I know. Bleh, the cereal monster visited this morning. I always eat too much breakfast.
>
> >habit forming
>
> Rather like cider then......Mm... actually I haven't drunk much since I've been to the gym -- its added calories. But I do enjoy some cider now and then. No alcoholic here. I will admit I drunk myself under the table in college due to my homesickness and dysthymia and was the only time of twice I ever even marginally threw up in my life from alcohol. The sulfur dioxide doesn't help in a hangover either.
>
> >trainspotting
>
> I've seen it. As a film, it is intended to be very dramatic. Alcohol withdrawal is often more severe than opioid withdrawal - *many* people are addicted to alcohol.True on both counts.
>
> >Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either.
>
> I'm sorry that you thought that, it was not my intention. It was not me who brought up the subject of character assasination.I brought it up because I was deliberately trying not to hurt you and it got turned around. Anyhow, bygones.
> >banned it all over the US
>
> LOL, I suppose what they do in the US must be right ;-)No -- not always. I still think codeine (with APAP or Ibuprofen to discourage morphine seeking) should still be sold with signing some federal book or something, but we're not a centralised country.
> >I think you're feeling hurt
>
> Yes, I amI am sorry to hear that.
>
> >"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
>
> You can't divide drugs into 'good' drugs and 'bad' drugs J. This type of oversimplistic classification reflects a lack of knowledge and understanding. Diamorphine (Heroin) and other potent opioids are very important drugs in the treatment of severe pain. Ketamine is used as an analgesic in emergency medicine. GHB (Xyrem) is used to treat narcolepsy with cataplexy. Cocaine is used during ENT surgery.
Again, this is all due to the re-cre-a-tional use of all above said medicines and I can divide soft use and hard use quite easily as already mentioned for use outside the medical establishment. There I believe I think you missed the point. I am talking about recreational use only of medications which this time I will use the word properly -- adult supervision, i.e. Schedule II injectable medications.
Heroin has no medical use in the US and is so banned for any use of it. There are plenty of morphine related narcotics available for pain management. I was not talking about pharmaceutical use, I was talking about so-called recreational use of it, which involves unclean needles, disease, and abject poverty and grand theft and so on.
Ketamine has use in veterinary medicine and pediatric anaesthesthisia. I was referring to the clandestine diversion of this drug to people I have known in the past who should know better than to crush, snort, chew, whatever, this substance under no supervision. Its horribly dangerous then. It is a chancy choice of anaesthetic even when used properly in a medical setting.
GHB has been recently reintroduced as Xyrem with very stringent guidelines. It is not childsplay and again, we're talking about diversion to recreational use which when combined with alcohol leads to coma and death. And has been used like other potent agents (yes, Valium and Ambien and other substances too, Ed, I'm not forgetting that...) to subdue individuals to do sexual harm to them.
Cocaine is used mostly only as a topical anaesthetic here and has largely been replaced by other synthetic drugs related to it. It is also schedule II because it can be diverted to largely "white collar crime" where people snort their noses into cartilage oblivion.
And finally, the explosion of your flat mate below or a fire that ruptures through a housing development because some organic chemistry people who should know damn better, are mixing up a pot of methamphetamines, is BAD. And unfortunately that has led to scheduling of pseudoephedrine which only hurts and insults the sinusitis sufferer.And if there is a final issue -- it is the use of unsterile needles to use these substances clandestinely, and the unknown content of "manufactured" exctasy which could contain other things besides MDMA including rat poison and drano or whatever else they have lying around to cheapen it.
So no, no hard drugs to people of any age, especially the young.
And "soft drugs" like marijuana, I have no issue with. The government here does. If it were regulated like tobacco you'd see far less automatic weapons fire against the public. You are lucky in the UK with strict guns laws, and Canada too. Here, well... we'll get arguments about the 2nd amendment which is a whole different boiling pot.
So that's my point -- recreational use of hard drug substances which leads to thousands of wasted dollars, grand theft, murder, etc, and legitimate medical uses.
Tidings-- Jay
Posted by yxibow on May 6, 2006, at 13:04:38
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 10:44:54
> >"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
>
> 'Crystal' methamphetamine is closely related to amphetamine (Adderall) - which is widely prescribed by psychiatrists in the US, especially to children. Methamphetamine itself (Desoxyn) is also occasionally prescribed by pdocs in the US.
>
> EdAi, ya. Eddy dearest. We're talking about recreational use with unclean needles and exploding buildings, posted in the other message. I know about legitimate, if sometimes questioned use of Ritalin and other such substances in childhood ADHD. Legitimate manufacturers don't pass out syringes filled with HIV or blow up their plants in neighbourhoods.
Enough said.
-- tidings
Jay
Posted by ed_uk on May 6, 2006, at 16:36:39
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 13:01:46
>Heroin has no medical use in the US and is so banned for any use of it. There are plenty of morphine related narcotics available for pain management.
........all of which are used recreationally. Pharmacologically, there's nothing specifically bad about Heroin compared to say, hydrocodone or oxycodone. Heroin is schedule 1 in the US due to historical reasons, not pharmacologic reasons.
>So that's my point -- recreational use of hard drug substances which leads to thousands of wasted dollars, grand theft, murder, etc, and legitimate medical uses
OK, but what does that have to do with OTC codeine?
Regards
Ed
Posted by ed_uk on May 6, 2006, at 16:41:08
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 13:04:38
>Legitimate manufacturers don't pass out syringes filled with HIV or blow up their plants in neighbourhoods.
I wasn't saying that illegal manufacture of methamphetamine is ok. What I was saying is that the drug methamphetamine itself is not 'all bad'. In some cases, making drugs illegal creates more problems than it solves, particularly with respect to impure drugs being sold by dubious dealers.
Ed
Posted by Phillipa on May 6, 2006, at 20:00:17
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 16:41:08
Certainly no expert here but I was taught that methadone does more physical harm to the body then heroin. Is that true? Love Phillipa
Posted by yxibow on May 6, 2006, at 21:22:53
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 16:36:39
> >Heroin has no medical use in the US and is so banned for any use of it. There are plenty of morphine related narcotics available for pain management.
>
> ........all of which are used recreationally. Pharmacologically, there's nothing specifically bad about Heroin compared to say, hydrocodone or oxycodone. Heroin is schedule 1 in the US due to historical reasons, not pharmacologic reasons.I'm not talking from a pharmacological view, I think you're basing your views and learned knowledge on pharmacology against my views that people shouldn't be shooting up heroin in public parks and crackheads doing all sorts of things in burnt out houses, infecting themselves and others.
Pharmacologically, by prescription, and cautious and judicious usage of any part of papaver somniferum and sythetics, is completely different. I think I've expressed in my previous views the difference between legitimate use, diversion, and people who cook up dirty batches of heroin and methamphetamine (especially the latter) and blow up houses in the midwest here.
> >So that's my point -- recreational use of hard drug substances which leads to thousands of wasted dollars, grand theft, murder, etc, and legitimate medical uses
>
> OK, but what does that have to do with OTC codeine?I don't think I said it has anything to do with OTC codeine, you must be reading from an earlier message. I don't consider the amount of codeine given in OTC codeine a hard drug, though it is still converted to morphine in the body. I consider diversion of it what led to its expulsion from pharmacies here. Doesn't mean that I wouldn't want to "feel good" like you have to admit you have done on occasion, but it would be considered diversion here if we still had legal laws that allowed its use for cough purposes only. I think that's why you're asking me.
- tidings eddy
-- Jay
Posted by yxibow on May 6, 2006, at 21:39:17
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 16:41:08
> >Legitimate manufacturers don't pass out syringes filled with HIV or blow up their plants in neighbourhoods.
>
> I wasn't saying that illegal manufacture of methamphetamine is ok. What I was saying is that the drug methamphetamine itself is not 'all bad'. In some cases, making drugs illegal creates more problems than it solves, particularly with respect to impure drugs being sold by dubious dealers.
>
> Ed
>
I agree only in part -- I agree that making marijuana illegal since the drug act of oh what was it 1934 -- and the hilarious movies about it in the thirties that you can see clips of in "Grass" has lead to driveby shootings, Mexican and central american mafias, armed immigrants growing and destroying National Forest property here in Southern California growing clandestine pot fields and shooting forest rangers who should be focusing their energy elsewhere in our parks. But we're talking about its use and sale in either limited amounts to consenting adults of age, or restricted use to those who suffer from chronic illnesses such as glaucoma and MS.
The drug known as methamphetamine is not all bad, neither are some of the other medications in the phenethylamines. Epinephrine, salbutamol, buproprion, pseudoephedrine, and crazily enough chemically, levmetamfetamine, the levorotoratory steroisomer of meth thought not to be terribly psychoactive, sold OTC for nasal decongestant use within this past decade.
Methamphetamine is not illegal. It has very limited and restricted use as Desoxyn (C-II). We're talking about what you exactly said, illegal manufacture, distribution to people who have little knowledge of what they're doing to their bodies other than wasting away.-- tidings
Jay
Posted by Declan on May 7, 2006, at 1:04:18
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 21:22:53
Hi Jay
Until 1968 heroin was OTC (in small doses) in Australia. Hard drugs/soft drugs....it's all nonsense IMO. People here abuse petrol. The modern world is bad and likely to get worse....just dreadful.
Declan
Posted by Declan on May 7, 2006, at 2:35:14
In reply to Re: MAOIs, posted by Declan on May 7, 2006, at 1:04:18
I read (The Spectator) that up to the 1950s opium was available through *greengrocers*.
Posted by Declan on May 7, 2006, at 2:53:29
In reply to Deregulation » Declan, posted by Declan on May 7, 2006, at 2:35:14
The referrence was to the UK
Posted by Don_Bristol on May 7, 2006, at 6:34:43
In reply to Re: MAOIs » yxibow, posted by Caedmon on May 5, 2006, at 12:47:58
>> Dying from an MAOI-related hypertensive
>> reaction is extremely rare.> http://www.acnp.org/G4/GN401000046/CH046.html
> states that
I would add this link"Toxicity, Monoamine Oxidase Inhibitor"
http://www.emedicine.com/EMERG/topic318.htmand these official statistics from 2002 might be worth looking at:
http://www.aapcc.org/2002_poison_center_survey_results.htm2
Posted by ed_uk on May 7, 2006, at 11:02:22
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 21:22:53
Hi Yxi
>Doesn't mean that I wouldn't want to "feel good" like you have to admit you have done on occasion
I'm not 'admitting' anything. I don't like that you're talking to me as if I've been a 'naughty boy', sorry :(
I don't want to talk about it anymore.
Ed
Posted by Jost on May 8, 2006, at 15:33:58
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 7, 2006, at 11:02:22
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.
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.
Posted by Jost on May 8, 2006, at 21:35:58
In reply to Re: MAOIs » Jost, posted by Don_Bristol on May 8, 2006, at 19:42:34
>
>
>
>
> 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'm not sure what PMFJI means. Could you clarify.I certainly wouldn't have written what I wrote if I hadn't used Maois, though.
I was on parnate for three years, at a very high dose, without any adverse reaction.
Let me clarify. My implication wasn't that anyone was "weak=willed" at all. Discipline isn't a matter of will-- in my book. It's a lot of things situational, habitual, temperamental-
I would think most people eat this or that without thinking whether it has fermented soy or cheese in it or if it's been sitting out too long-- I'm pretty careful, and I found myself occasionally almost eating things without thinking.
That's all I meant-- you do have to be a bit on guard about stuff, which isn't natural, and is a habit you have to work a little to get on track. But I also think it's a habit, and not so hard to develop for most.
I can see that "have little discipline" could have carried a meaning I didn't intend-- it wasn't put precisely. I meant that most people are more than able to be that careful and thoughtful. I meant that it is a bit unnatural to interrogate every piece of food you put into your mouth during the course of a day.
I don't criticize people who are less able take that approach to food.-- I had an eating binge phase--
There may be some deaths on maois and I'm all for finding ones that are safer-- no argument there. However, I also think that the brain effects of ECT are soft-pedalled, and wouldn't do that myself, under any circumstances. But it is an individual decision, absolutely.
My Psych D was very convinced that deaths from Maois were overstated. He used them a lot for a long time and only had one death--a suicide, which occurred on a plane, where there wasn't any medical help nearby. But he's the expert, not me.
Again, he focussed on certain types of red wine. I didn't ask what types, as I don't drink red wine.
Hope I've responded to all your point.
Jost
Posted by Jost on May 8, 2006, at 21:43:38
In reply to Re: MAOIs, posted by Jost on May 8, 2006, at 21:35:58
Also, I'm not in total agreement about trying every other last AD.
I did try a lot of them, and certainly think it' makes sense to start with an SSRI and maybe cymbalta, rather than go to parnate or nardil first. But I also don't think maois are such drugs of last resort, that you only try if every other option has been exhausted and then some.
Jost
Posted by yxibow on May 9, 2006, at 1:09:44
In reply to Re: MAOIs » Caedmon, posted by Don_Bristol on May 7, 2006, at 6:34:43
> >> Dying from an MAOI-related hypertensive
> >> reaction is extremely rare.
>
> > http://www.acnp.org/G4/GN401000046/CH046.html
> > states thatDying is rare, you're right. However the chance of a stroke and unilateral or bilateral neurological damage is higher. Its worse than death. Its immobilization and life debilitating. But I'm not trying to scare those on MAOIs who have proper instructions from their doctors, and who do not eat the foods that would make themselves vulnerable. As one pointed out, eating out is a difficulty and a pleasure lost. But if it is necessary to come to an MAOI -- well, that's between you and your doctor
Tidings-- Jay
Posted by yxibow on May 9, 2006, at 1:10:04
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 7, 2006, at 11:02:22
> Hi Yxi
>
> >Doesn't mean that I wouldn't want to "feel good" like you have to admit you have done on occasion
>
> I'm not 'admitting' anything. I don't like that you're talking to me as if I've been a 'naughty boy', sorry :(
>
> I don't want to talk about it anymore.
>
> EdAnd I don't either, but it seems to come up quite often, almost obsessively or with transference. You're not a naughty boy for wanting to feel euphoria. Its just a statement of fact, Eddy. Its why its not allowed here in the US any more due to diversion and the DEA -- I can't feel your euphoria.
Gosh I dont know how to put it any other way that I dont care about your minor use of the drug, its a major extended use that I think you could benefit from some drug, I dont know what, other than this.
I told you that you're hurting and I've offered in email to listen to what is going on. Your a good guy, there's no naughty boy coming from here. We've talked about this in private and I think you know what I am trying to say. If you don't, I'm sorry, and I wish I knew more why you are hurting.
There is plenty of ongoing research by the way of sigma and mu receptors by the way, as I have mentioned. Maybe something that doesn't form addiction but addresses those will come of it.You're right, companies spend billions on antipsychotics, but the reason is clear -- the schizophreniform disorder spectrum (and BP I as well) is the largest psychiatric problem by percentage and while the vast majority are catatonic (unfortunately), there are violent behaviours that lead to awful endings like air marshalls taking down people who turn out later to be mentally ill. It doesn't mean that major depression should be overlooked.
Sincerely and lied to rest as I already have,Yours Truly
-- Jay
Posted by Don_Bristol on May 9, 2006, at 14:48:31
In reply to Re: MAOIs, posted by Jost on May 8, 2006, at 21:35:58
> My Psych D was very convinced that deaths from
> Maois were overstated. He used them a lot for a
> long time and only had one death--a suicide,
> which occurred on a plane, where there wasn't any
> medical help nearby. But he's the expert, not
> me.Hiya. I am not sure that your psych doc would be a greater expert than the official stats on MAOI deaths. The figures I mentioned are taken directly (by me) from those stats.
I don't mean to say that I am suddenly a greater doc then yours (no chance) but that there are a non-trivial number of deaths and severe/moderate outcomes from adverse reactions with MAOIs.
I think some MAOI takers, such as yourself and myself too, are less sensitive than usual to the effects of tyramine. Yet other users are probably more sensitive. It's risk & chance ("hemorrhagic roulette"?) and the chance of the downside occuring can be a big worry for some people as it is one way and there is not going to be any bouncing back.
You mention less dangerous MAOIs and I too woul dlike to see them. Moclobemide seems to max out quickly (it did in me) and some say it has only a weak effect.
Take care there.
Don
Posted by ed_uk on May 9, 2006, at 15:22:01
In reply to Re: MAOIs » Jost, posted by Don_Bristol on May 8, 2006, at 19:42:34
Hi Don
>there is a good case for trying the less-lethal ADs first and then moving towards MAOIs if nothing else works
I have never heard of MAOIs being used until a variety of other ADs have been tried. Have you?
You seem concerned about MAOIs. I thought you took Parnate?
Regards
Ed
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