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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 32 to 56 of 85. Go back in thread:
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
Posted by ed_uk on May 9, 2006, at 15:35:13
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 9, 2006, at 1:10:04
Hi J
>it seems to come up quite often
Yes, I was feeling annoyed :(
>wanting to feel euphoria
You don't know what I was wanting to feel - you never asked. Where do you draw the line between feeling better and feeling euphoric? How do you know I was euphoric?
>due to diversion
Diversion refers to the act of obtaining prescription medications to sell. People don't 'divert' OTC medications.
>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.
Antipsychotics are indeed useful in the treatment of schizophrenia. Nevertheless, I wouldn't be at all surprised if most prescriptions for APs (especially in the US) were off-label. Most people with schizophrenia are not violent, however seriously ill they are. Pharmaceutical companies make vast profit on atypical APs - they are greatly overpriced. Research is expensive, but it does not justify the ridiculously high costs of atypical APs.
Regards
Ed
Posted by yxibow on May 9, 2006, at 17:25:47
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 9, 2006, at 15:35:13
> Hi J
>
> >it seems to come up quite often
>
> Yes, I was feeling annoyed :(
>
> >wanting to feel euphoria
>
> You don't know what I was wanting to feel - you never asked. Where do you draw the line between feeling better and feeling euphoric? How do you know I was euphoric?I don't know, Ed, we laid this to rest in email and its coming out again, its getting obsessive, honestly and with a caveat of neutrality because I know I'm going to be hit again over the head...
But you're right, I have no idea if you were feeling better, feeling better because of euphoria, or feeling euphoric.
>
> >due to diversion
>
> Diversion refers to the act of obtaining prescription medications to sell. People don't 'divert' OTC medications.Codeine phosphate used to be OTC but one would have to sign a book, typically, in different states. I'm talking about diversion in the US. That is still diversion from its intended purpose and the intended purpose of what I would label as a nebulous nonexistant category at the time of cat VI. It no longer exists here so its a non issue. I'm viewing things from here, not there, Ed.
And oh boy do people divert OTC medications, thats why some states have now made Sudafed a prescription! I mean blast all, you have to get your doctor to sign a mommy and daddy note. *** meth addiction. Enough said.
If someone figures a way to divert OTC levmetamfetamine that will go too. Not that its a particularly used nasal decongestant.>
> >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.
>
> Antipsychotics are indeed useful in the treatment of schizophrenia. Nevertheless, I wouldn't be at all surprised if most prescriptions for APs (especially in the US) were off-label. Most people with schizophrenia are not violent, however seriously ill they are."Catatonic" "Vast majority." That means "most all people." I just said it!
Pharmaceutical companies make vast profit on atypical APs - they are greatly overpriced. Research is expensive, but it does not justify the ridiculously high costs of atypical APs.
Every new medication that comes out in the US, ed, costs between $2 and $3 a pill. You can complain as we do till the cows come home but only Canada and the UK have caps. Do I think granisetron should cost $50 a pill?? But it has to do partly (aforementioned) with supply and demand, and as far as schizophrenic medication, there are so many variations in disorders and so many caveats of EPS and TD and the like that have to come in to play that they are just plain expensive to produce.
I dont like it more than anybody else but on the other hand I wouldn't want a end-all happy pill for antidepression that cost only $1 million to produce to come to market. That would scare me and suggest that they tested it on like 2 patients.
Anyhow. Go petition the FDA, but you're not likely to get anywhere.
Cheers
-- Jay
Posted by Caedmon on May 9, 2006, at 19:30:31
In reply to Re: MAOIs » Jost, posted by Don_Bristol on May 8, 2006, at 19:42:34
Hi Don,
The figures you quoted, were they from http://www.emedicine.com/EMERG/topic318.htm ? You posted a link to the aapcc's website, but I honestly couldn't make heads or tails of anything on it.
I think it's important to note that those figures to do not differentiate among overdose, drug, and food interactions. It is my understanding that drug interactions tend to be the most dangerous and possibly more common, too.
> >> Dying from an MAOI-related hypertensive
> >> reaction is extremely rare.
>
> > http://www.acnp.org/G4/GN401000046/CH046.html
> > states that[yxibow]: Dying 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>>
I think those statistics noted a rate for both CVA and death.
Maybe it's just me, but I perceived your post as quite unecessarily negative. I take an MAOI and I have eaten out. Pleasure is not "lost". I have to ask what's in the food I'm eating sometimes, that's all. Many people do that for a variety of health reasons.
When you say "if it is necessary to come to an MAOI -- well, that's between you and your doctor," the tone (which is always difficult to percieve just through writing), seems to be one of, "Oh well, if you want to do something so silly, be my guest, but it's not responsible." That's just how I read it. Maybe you could clarify, if I am reading it wrong. (I have "rejection-sensitive" depression and social phobia, so I can be reading into things without cause.) Otherwise, it does seem to be a sort of judgement call on behalf of others, without really knowing their situations... and I always feel this is risky in boards like these, where stories and advice on mental health are shared.
How many antidepressants do you believe people should try first, before trying an MAOI?
In my own case, I considered ECT. But the cost is prohibitive, and I already am suffering from memory problems secondary to depression. An MAOI seemed much more logical.
Be well,
- C
Posted by Phillipa on May 9, 2006, at 19:49:36
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 9, 2006, at 17:25:47
Jay are you saying most schizophrenics are catatonic? I've never seen that. Most are out of reality. Hearing voices in their heads and delusinal. Did I read you wrong? And why the dicussion of codeine. So what if someone takes it to feel better. People drink alchohol to feel better or euphoric as you call it and it's legal. I think this discussion has gotten out of hand. Maybe E-mail would be better. I thought this was on MAOIS? Love Phillipa
Posted by Declan on May 9, 2006, at 20:34:24
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 9, 2006, at 17:25:47
Posted by Jost on May 9, 2006, at 23:27:19
In reply to Re: MAOIs, posted by Caedmon on May 9, 2006, at 19:30:31
> Hi Don,
>
> The figures you quoted, were they from http://www.emedicine.com/EMERG/topic318.htm ? You posted a link to the aapcc's website, but I honestly couldn't make heads or tails of anything on it.
>
The figures Don quoted, unless I'm mistaken (which I might be) were from a "Summary of fatal exposures reported to TESS in 2002" published in the Am J. of Emergency Med.However, the Summary, as I read it, noted only one death from an maoi, ie parnate; and the cause of death was "ther. err."--ie therapist error, rather than an adverse drug reaction.
Possibly, Don's statistics are from another source. However, the type of AD associated with the highest number of fatalities on this report, by far, was tricyclics, particularly. amitriptyline. Is this the most widely prescribed tricylic?
Most of the deaths were intentional. There are a few other causes, such as "malicious," "adv. react." and "ther. err." The number of adverse reactions is so small that it would seem hard to draw any conclusions from this one report.
Last night I came across a paper--I can't find it now--that suggested that deaths from tricyclics were greater in absolute numbers than those from maois, although a somewhat greater proportion of the maoi fatalities were intentional. The difference didn't seem so great as to make the argument that maois are to be avoided at all costs. Obviously, care must be taken in their use..
I'd be interested in Don's sources, though.
Jost
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