![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 28. This is the beginning of the thread.
Posted by ross on February 1, 2002, at 21:40:42
im finally tapering off my two AP's and going on Nardil. dam straight. i want to feel and fit in and be able to relax. ive read journal after journal about this med and nothing comes close. i was suppose to do this last month but i chickened out of it because i thought effexor and remeron togehter would kick butt.
any feedback with success on nardil please answer. or bad feedback.
ross:)
Posted by spike4848 on February 1, 2002, at 23:08:04
In reply to SP how do we conquer it??????? Nardil, posted by ross on February 1, 2002, at 21:40:42
> any feedback with success on nardil please answer. or bad feedback.
> ross:)Hey Ross,
I have been on a search for a med/med combo that provides the effect of nardil for a couple of years now. I am not sure it can be done. No one on the board seem to know with 2 exceptions I found .....
Guy named Rick using Serzone/Provigil/Klonopin
Guy in old post using Neurontin/Klonopin/StimulantOther wise Nardil is the tops! Now I am going to try Zoloft/klonopin/provigil to see if that can come close. Maybe Zoloft/Klonopin .... dare I say zyprexa! The last combo is Zoloft/Klonopin/ low dose deprenyl (in the mao-b range only). Like KregPark has said I think you need to hit serotonin, GABA and dopamine. You can do that with Nardil alone or use a combo of more selective drugs.
I just hate the weight gain, sexual side effects, insomnia and memory loss of nardil .... otherwise it is the best med for sp .... for me at least!
Spike
Posted by ross on February 2, 2002, at 10:34:06
In reply to Re: SP how do we conquer it??????? Nardil » ross, posted by spike4848 on February 1, 2002, at 23:08:04
thanks spike. a few questions. i know you answered them in the past for me but
1) how much did you take and how did you take it. meaning t.i.d. or qhs?
2) what did you have on the sidelines incase of a hypertensive reaction?
3) did you stick to the diet religiously?
thanks
ross
Posted by spike4848 on February 2, 2002, at 11:21:13
In reply to Re: SP how do we conquer it??????? Nardil, posted by ross on February 2, 2002, at 10:34:06
> thanks spike. a few questions. i know you answered them in the past for me but
> 1) how much did you take and how did you take it. meaning t.i.d. or qhs?I took 60 mg total ..... usually 30mg in am and 30 mg at noon .... sometime I took the whole 60mg in the morning. You don't have to split the dose despite what the pdr states
> 2) what did you have on the sidelines incase of a hypertensive reaction?
I had clonidine .... small tablet which fit in the wallet
> 3) did you stick to the diet religiously?
At first yes ... then with careful experimenting over the past 4 years I follow I tolerated many foods like pizza, beer-bottled only ... maybe one guiness from tap, small amount of soy sauce on sushi, one glass of red wine. I really just avoid the aged cheese and processed meats.
Spike
> thanks
> ross
Posted by Elizabeth on February 2, 2002, at 13:48:20
In reply to Re: SP how do we conquer it??????? Nardil » ross, posted by spike4848 on February 2, 2002, at 11:21:13
> I took 60 mg total ..... usually 30mg in am and 30 mg at noon .... sometime I took the whole 60mg in the morning. You don't have to split the dose despite what the pdr states
True. I tried dividing the doses in all sorts of ways, hoping to minimize the insomnia. Nothing made a difference.
> I had clonidine .... small tablet which fit in the wallet
I had nifedipine, a gelcap which works very rapidly if you bite it in half and then swallow it. It's important to make sure you get fluids if you take these drugs.
> > 3) did you stick to the diet religiously?
Remember that even a lot of psychiatrists don't realize that a lot of the supposed dietary restrictions are based on absolutely no solid data. I came up with a "short list" based on perusing some journals. I've posted it a few times in the past, you can probably find it by doing some searches.
> At first yes ... then with careful experimenting over the past 4 years I follow I tolerated many foods like pizza, beer-bottled only ... maybe one guiness from tap, small amount of soy sauce on sushi, one glass of red wine. I really just avoid the aged cheese and processed meats.
Red wine and bottled beer are okay. So is a small amount of soy sauce. Pizza is usually okay, although I suggest moderation. Tap beer is risky, and aged cheese is the food most commonly associated with hypertensive reactions. I'd avoid sushi, too. I'm not sure what you're referring to when you say "processed meats," although it sounds kind of bad. :-) Meats that have been aged, air-dried, fermented, etc. are also a bad risk.
Good luck with the Nardil. It is a very good drug for all kinds of anxiety, even social phobia (which can be very hard to treat, I think).
-elizabeth
Posted by ross on February 2, 2002, at 15:00:09
In reply to Re: Nardil, posted by Elizabeth on February 2, 2002, at 13:48:20
> I had nifedipine, a gelcap which works very rapidly if you bite it in half and then swallow it. It's important to make sure you get fluids if you take these drugs.
how much would of you have taken if you had a reaction? thanks for telling me to drink alot of fluids. i did not know that.
also Nardil caused you insomnia? i thought it was sedating.
thanks elizabeth
ross
Posted by ross on February 2, 2002, at 15:43:51
In reply to Re: Nardil, posted by ross on February 2, 2002, at 15:00:09
elizabeth,
must i stop taking my zyprexa if i want to go on Nardil? zyprexa blocks the reuptake of serotonin. you know better than i do.
im just thinking of serotonin syndrome.
thanks
ross
Posted by Elizabeth on February 7, 2002, at 14:21:47
In reply to Re: Nardil elizabeth..., posted by ross on February 2, 2002, at 15:43:51
> must i stop taking my zyprexa if i want to go on Nardil?
No. They're used together sometimes. It's fine.
> zyprexa blocks the reuptake of serotonin.
I don't think so. Zyprexa blocks serotonin 2a and 2c receptors. That's not the same as blocking reuptake.
Hope this helps. Take care.
-elizabeth
Posted by Rick on February 8, 2002, at 3:33:18
In reply to Re: Nardil, posted by ross on February 2, 2002, at 15:00:09
> also Nardil caused you insomnia? i thought it was sedating.I thought insomnia was fairly common with Nardil. It had that effect on me, but fairly mild. Other side effects were much worse. I don't recall much sedation during the day, certainly nothing to compare with Celexa. In fact, it was often activating.
Posted by Rick on February 8, 2002, at 5:07:34
In reply to SP how do we conquer it??????? Nardil, posted by ross on February 1, 2002, at 21:40:42
Nardil can be fantastic for lots of people with Social Phobia. It's the gold standard among AD's for SP, even if it gets shunted aside for a couple of valid concerns mixed with tons of exaggerated MAOI paranoia.
As Spike mentions, Klonopin+ Serzone + 100 mg Provigil has been a "wonder cocktail" for my non-depressive SP for well over a year now. Klonopin + Provigil, without the Serzone, is a bit less robust but still a damn powerful treatment for me.
When I first started Klonopin, after trying many other meds including Celexa, Xanax, Neurontin,and lots more, it was a godsend. The combo with Provigil and Serzone takes it to an even higher level, adding welcome new dimensions such as confidence, enthusiam, and proactive sociability to Klonopin's powerful social-fear-allaying powers.
Nothing has ever tested higher than Klonopin in placebo-controlled SP studies, not even Nardil.
See abstract below. But don't take this as a suggestion that you move away from Nardil, because again it works so well for so many social phobics -- certainly far better than heavily-marketed Paxil. And, in case weight gain is a concern for you, I should point out that I started my first-ever earnest diet while taking Nardil, and the pounds came off more easily than I ever expected. (I sometimes wonder if this was helped by the fact that, at the time, I was ignorant of Nardil's reputation for weight gain.)J Clin Psychopharmacol 1993 Dec;13(6):423-8
Treatment of social phobia with clonazepam and placebo.
Davidson JR, Potts N, Richichi E, Krishnan R, Ford SM, Smith R, Wilson WH.
Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710.
Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects.
> im finally tapering off my two AP's and going on Nardil. dam straight. i want to feel and fit in and be able to relax. ive read journal after journal about this med and nothing comes close. i was suppose to do this last month but i chickened out of it because i thought effexor and remeron togehter would kick butt.
> any feedback with success on nardil please answer. or bad feedback.
> ross:)
Posted by Rick on February 8, 2002, at 5:49:06
In reply to Re: Nardil, posted by Elizabeth on February 2, 2002, at 13:48:20
> Remember that even a lot of psychiatrists don't realize that a lot of the supposed dietary restrictions are based on absolutely no solid data.
My pdoc, a real fan of MAOI's, said a general guideline is to avoid food that's "trying to spoil," which would include things like aged cheese and highly fermented beers. Liver falls in there too.
>Pizza is usually okay, although I suggest moderation.
I think the key here is to stick with mozzarella, and especially avoid gourmet pizzas that have aged cheese.
>I'm not sure what you're referring to when you say "processed meats," although it sounds kind of bad. :-)
Processed meat is basically any meat that's been chopped or ground somehow and then reformed. The most common is probably bologna, which is the same meat as hot dogs. Just think, "Oscar Mayer." Interesting that you would say Processed Meats "sounds bad", given that a few months ago there was a report concluding that processed meat consumption greatly increases cancer risk.
I think the only processed meats that would be risky with MAOI's are those that fit your aging/fermenting/smoking etc. description such as salami,pepperoni, summer sausage. I used to make sure my pizzas didn't have pepperoni, but I have to admit that one night I pigged out on a whole pepperoni pizza. Nothing happened, but it was probably a stupid thing to do. Maybe it was unauthentic pepperoni.
Rick
Posted by JohnQ on February 8, 2002, at 17:43:31
In reply to Re: SP how do we conquer it??????? Nardil » ross, posted by Rick on February 8, 2002, at 5:07:34
< Clonazepam and placebo were administered in a double-blind pilot study to 75 outpatients with social phobia. The mean maximum dose of clonazepam was 2.4 mg/day at endpoint (range, 0.5 to 3 mg). Treatment was continued for up to 10 weeks. The results of an intent-to-treat analysis indicated superior effects of clonazepam on most measures. Response rates for clonazepam and placebo were 78.3 and 20.0%. Drug effects were apparent on performance and generalized social anxiety, on fear and phobic avoidance, on interpersonal sensitivity, on fears of negative evaluation, and on disability measures. Significant differences were evident by week 1, 2, or 6, depending upon the rating scale used. Clonazepam was well tolerated in general, although unsteadiness and dizziness were more severe and persistent than was the case for placebo subjects. >
So clonazepam doesn't work instantly? I've used it on an as-needed basis and I found it to be very disapointing (Most I've tried at once is 1.5mg. Not enough?), although combined with generous amounts of alcohol it was pretty good. How long does it usually take to kick in, or how long did it take for you, Rick? Should I give up on it based on my as-needed experiances, or should I give it an AD-like trial?
Posted by Rick on February 10, 2002, at 4:16:32
In reply to Should I give up on Klonopin? » Rick, posted by JohnQ on February 8, 2002, at 17:43:31
> So clonazepam doesn't work instantly? I've used it on an as-needed basis and I found it to be very disapointing (Most I've tried at once is 1.5mg. Not enough?), although combined with generous amounts of alcohol it was pretty good. How long does it usually take to kick in, or how long did it take for you, Rick? Should I give up on it based on my as-needed experiances, or should I give it an AD-like trial?
Taking Klonopin *regularly* instead of as-needed can make all the difference in the world. And that way it prevents anticipatory anxiety from building, too. Even to the extent that it *does* help on an as-needed basis, it takes a good 45 mins to an hour to have any effect...even more if not taken on an empty stomach.
Daily Klonopin kicked in within days for me, but it doesn't work quite that fast for everyone.
Re the alcohol: In the long run, alcohol will *decrease* Klonopin's efectiveness. And large amounts of alcohol can be dangerous with benzos.
You shouldn't feel doped-up on Klonopin. Don't fall prey to the major mispereption that it works by making you feel inebriated and thus disinhibited. Instead you should feel perfectly sober, except that the anxiety is gone or greatly reduced. (Although it's typical to feel a little sedated the first few days to a week, which then goes away.)
Here are some (rambling) thoughts and personal experiences on how to get the most from daily Klonopin:
Everyone requires different amounts. One thing to remember is to take the Klonopin on an empty stomach whenever possible. I started with 3 mg daily (it's uncommon to need more than that), but quickly discovered that 2 mg actually worked BETTER for me. (I now take only 1 mg...it's common to be able to get by on lower doses over time, despite what benzophobes will tell you.) You just may need to experiment with the amounts and dosing schedule. 2.0 sounds like a good starting daily dose, maybe 1.5. I'd suggest that to begin with, you divide your dose into two or three dosings a day. I always took the biggest dose in the morning, and less in the afternoon. I never have liked taking it at night because I'll feel a litle groggy in the morning, and because I want concentrations to be highest when I'm in social setings. I don't know if insomnia is an issue for you, but once you reach steady-state blood levels, early-in-the-day dosing will still help you sleep at night.
Once you reach steady-state, you can start experimenting with less frequent dosing. Until a year ago, I took 1 mg in the morning and .5 at about 2 pm. Now I'm at 1.0 mg, all first thing in a.m. For the first year, I would often take some about an hour beore an extra-challenging event. This mainly took the form of temporary juggling of the dosing schedule, but it's fine to take an extra .25 - 1.0 occasionally. One thing I personally found is that if I take two doses -- of any size -- less than four hours apart, I get a little sleepy. Same goes if I take more than 1 or 1.25 in any single dose.
You should see at least SOME benefit within a few days, or at least within a 7-10 days. If that doesn't happen, and adjusting the dosage or schedule doesn't help either, than you may one of the 20% who don't respond to Klonopin for SP... OR you may be taking other meds (not necessarily psychotropics) that lower Klonopin levels in the bloodstream. These aren't always listed in the interaction checkers. Some -- but not all -- drugs that are inducers of liver enzyme CYP3A4 can reduce Klonopin levels. Certain over-the-counter supplements, especially those with fiber, can reduce absorption of drugs in general.
I bet you'll end up really glad you started taking Klonopin on a maintenace basis.
Rick
Posted by MaKi on February 10, 2002, at 7:43:36
In reply to Re: Should I give up on Klonopin? » JohnQ, posted by Rick on February 10, 2002, at 4:16:32
I take Clonazepam (.25) every once in a while when I need it,
especially if I leave the house. I find it works instantly,
and just so you know, I've never even taken a full tablet as
of yet.MaKi
Posted by Elizabeth on February 10, 2002, at 12:23:46
In reply to Re: Nardil » Elizabeth, posted by Rick on February 8, 2002, at 5:49:06
> My pdoc, a real fan of MAOI's, said a general guideline is to avoid food that's "trying to spoil," which would include things like aged cheese and highly fermented beers. Liver falls in there too.
That's a generally good guideline. I have an actual [evidence-based] list, though, and I think some of them don't fall into your "trying to spoil" category.
> I think the key here is to stick with mozzarella, and especially avoid gourmet pizzas that have aged cheese.
It is important to avoid "sharp" cheeses, yeah.
> Processed meat is basically any meat that's been chopped or ground somehow and then reformed. The most common is probably bologna, which is the same meat as hot dogs.
I think that hot dogs would probably fall under things to avoid [or at least use caution].
> Just think, "Oscar Mayer." Interesting that you would say Processed Meats "sounds bad", given that a few months ago there was a report concluding that processed meat consumption greatly increases cancer risk.
I didn't know that. I guess I have great intuition!
> I think the only processed meats that would be risky with MAOI's are those that fit your aging/fermenting/smoking etc. description such as salami,pepperoni, summer sausage.
Interestingly, no significant levels of tyramine were found in pepperoni pizzas when a bunch of researchers went out and tested them. (Just a bit of trivia.) I'd be careful if trying pepperoni, though.
> I used to make sure my pizzas didn't have pepperoni, but I have to admit that one night I pigged out on a whole pepperoni pizza. Nothing happened, but it was probably a stupid thing to do. Maybe it was unauthentic pepperoni.
It's important to know that sometimes you can "get lucky" and not have a reaction to something that is, nonetheless, potentially dangerous. Like I said -- be careful if you try stuff like that.
(Nardil made me want to pig out a lot, too, BTW. :-} )
-elizabeth
Posted by Elizabeth on February 10, 2002, at 12:34:43
In reply to Re: Should I give up on Klonopin? » JohnQ, posted by Rick on February 10, 2002, at 4:16:32
Klonopin doesn't take weeks to work, but it can take an hour or so. So it's not that great as an "emergency" pill, but you can use it only on days when you have special (advance) reason to think you'll need it (like job interviews, etc.)
Taking it regularly (a fixed dose 2-3 times daily) can work very well for a lot of people. Especially for something that's pretty much chronic, like social phobia. CBT can sometimes help you to reduce your dose (or even discontinue it altogether). A lot of people find they need less over time, also.
One thing about Klonopin is that a lot of people don't "feel" it "kicking in," so they assume it's not working. The effect is more subtle than, say, Xanax. So you should give it a little time and try monitoring your progress to see if it's helping. Get a pdoc or therapist to help you. The point is that just becuase you don't feel sedated or spacey or whatever doesn't mean it's not doing anything.
You should never ever stop taking it abruptly if you've been using it regularly. This could cause unpleasant side effects and possibly even dangerous reactions, like seizures.
And yes, drinking with Klonopin is bad, not to mention dangerous.
-elizabeth
Posted by Rick on February 10, 2002, at 12:44:22
In reply to Re: Should I give up on Klonopin?, posted by MaKi on February 10, 2002, at 7:43:36
Amazing how diferently these meds can work for differet people, isn't it? Even when they're all responders. Severity of the disorder, body chemistry, body mass, non-active ingredients, external stimuli, and of course specific disorder and subtype, etc. all make a difference.
Are you taking as-needed clonazepam for social phobia? If not , what?> I take Clonazepam (.25) every once in a while when I need it,
> especially if I leave the house. I find it works instantly,
> and just so you know, I've never even taken a full tablet as
> of yet.
>
> MaKi
Posted by MaKi on February 10, 2002, at 13:52:15
In reply to Re: Should I give up on Klonopin? » MaKi, posted by Rick on February 10, 2002, at 12:44:22
I take Clonazepam as needed for my Panic Disorder.
Posted by Elizabeth on February 13, 2002, at 18:44:58
In reply to Re: Should I give up on Klonopin?, posted by MaKi on February 10, 2002, at 13:52:15
> I take Clonazepam as needed for my Panic Disorder.
That's interesting. My impression (and personal experience) has been that even when taken on an empty stomach, clonazepam doesn't work fast enough to be used on an as-needed basis for panic attacks. I haven't had that problem in quite some time; when I did, I used alprazolam.
-elizabeth
Posted by MaKi on February 13, 2002, at 18:55:09
In reply to Re: Klonopin » MaKi, posted by Elizabeth on February 13, 2002, at 18:44:58
Hi Elizabeth, it's too bad that you didn't have much
success with Klonopin as I did. Maybe it's all in my
head but as far as I have experienced, it's working not
that bad on me. As I said before, I just take it before
I head out the door, before I get anxious and it seems
to settle me down for a while.Good Luck,
MaKi
Posted by kregpark@yahoo.com on February 15, 2002, at 3:45:21
In reply to Re: Nardil » Elizabeth, posted by Rick on February 8, 2002, at 5:49:06
Nardil and Klonopin can also be combined to excellent effect. for Social Phobia.
Many people who do not want to take Nardil at a high dose can take it a lower dose (ie; 45-60mg) with a side effect profile usually superior to similar doses of Paxil, Zoloft, or Celexa.
Nardil 45-60 will produce a good antidepressant effect and will work synergistically with Klonopin for anti-SP effect.
Reboxetine, in a new double blind study for panic disorder, produced dramatic results in efficacy. Social function was also improved. Reboxetine has shown improved social function, motivation, and drive in a number of studies.
I have not trialed Reboxetine. I did sample 1mg added to 60 Nardil + 2.75 Klonopin. Acutely my subjective sense was good. Just as described, it was energizing without noticable anxiety or even any euphoria as I've experienced on initiation or increasing doses of Provigil.
It may be that Reboxetine will work well for some Social Phobics when added to an SSRI or MAOI.
To early to say if combining an MAOI and Reboxetine is safe, but according to one study with rats adding Reboxetine to Parnate was both efficatious and elimated tyramine toxicity to produce hypertensive symptoms with Parnate.
Reboxetine is awaiting approval in the US. It may be that there the long delay is due to possible release of a different type of antidpressant with a behavior effect profile similar to Reboxetine.
Social Phobia is Very Treatable with limited or no side effects.
Ray
Posted by kregpark@yahoo.com on February 15, 2002, at 3:54:24
In reply to Re: Should I give up on Klonopin?, posted by MaKi on February 10, 2002, at 7:43:36
Right on MaKi!
The way you do it sounds great to me.
Although I take Klonopin on a sustained basis I also get an immediate effect (empty stomach, great with ice cold Diet Coke! ) God that sounds good, the Diet Coke I mean, gotta get one now.
Ray
> I take Clonazepam (.25) every once in a while when I need it,
> especially if I leave the house. I find it works instantly,
> and just so you know, I've never even taken a full tablet as
> of yet.
>
> MaKi
Posted by MaKi on February 15, 2002, at 11:54:20
In reply to Re: Should I give up on Klonopin? Right on Maki!! » MaKi, posted by kregpark@yahoo.com on February 15, 2002, at 3:54:24
Thanks Ray, glad you agree with me. I'm happy to
hear that it's working well for you as well. Like
I said before, drugs don't work the same for everyone,
I guess we might just be a few of the lucky ones.Take care,
MaKi
Posted by paulk on April 17, 2002, at 1:50:04
In reply to Re: Nardil foods » Rick, posted by Elizabeth on February 10, 2002, at 12:23:46
I think there is more than what we know going on with MAOIs and the banned food list. Before I start here – please don’t take this as a suggestion to eat food on the list – my hunch is that the blood pressure crisis problem is very dependent to the individual.I was having a lot of problems with low blood pressure (BTW Viagra used with Nardil caused me to have fainting spells for 3 days! – Something that is not in the PDR) so I decided to try to raise my blood pressure with sharp cheddar cheese. (Again don’t try this yourself). (I have never been able to find tyramine in health food stores or on line anywhere so I resorted to the cheese. If anyone knows of a source of tyramine supplements please let me know.)
My diastolic pressure would get so low when I stood that my doc could not measure it. I started out by taking my blood pressure 4 times a day while lying down. My diastolic ranged 60 to 80. I started out with a very small slice of cheese three times a day and worked it up to 8 slices three times a day – with out getting any blood pressure help. I then tried Ramona cheese with the same result.
Seeing that I don’t know what the tyramine content was- this really doesn’t prove anything, but only suggests testing with purified tyramine.
Anyone who is thinking of cheating on their MAOI diet should consider the following:
Tyramine content could vary drastically from one block of cheese to the next. Don’t assume that if you got away with a restricted food one time, that you can completely ignore the guidelines.
If you are destined to cheat always start off with very, very small amounts of the food followed with a blood pressure check. An automatic blood pressure cuff used 1, 2 and 3 hours after eating restricted foods that shows a rise of the diastolic pressure above 90 is a big hint that you better stick with the program.
What really has my interest is that I have always craved sharp cheddar cheese and wonder if it is because it is a monoamine precursor. Perhaps tyramine could be used as a depression treatment?
Posted by Rick on April 18, 2002, at 0:32:51
In reply to Nardil and tyramine foods » Elizabeth, posted by paulk on April 17, 2002, at 1:50:04
>An automatic blood pressure cuff used 1, 2 and 3 hours after eating restricted foods that shows a rise of the diastolic pressure above 90 is a big hint that you better stick with the program.
While sitting (not sure about lying) BP at/below 120 systolic and 80 diastolic is healthiest, 90 diastolic is far from an alarming reading for everyone. While lower is always better (to a point), blood pressure can vary markedly throughout the day, with the average being the key measurement. Many people with normal BP will be well above 120/80 at certain moments during the day. The typical sitting-BP goal doctors use in anti-hypertensive therapy -- which is not usually attained, by the way -- is an average of 140/90. But again, lower is even better, and I think more aggressive goals are being recommended of late.
When Nardil promptly turned me from hypertensive (typically 145-150/95-100) to hypotensive, my pdoc suggested eating more salt. Didn't work (I didn't expect it to, since there's no evidence I'm salt-sensitive). So then he gave me florinef, an oral corticosteroid which quickly moved me up into the low-normal range, with no side effects at all. I forget the details, but I've read that for some reason florinef doesn't have the risks typically associated with sustained corticosteroid use, although I personally didn't want to keep taking it -- especially since I was a baseline hypertensive at the time (losing some weight has readily remedied that, BTW). In any event, if Nardil causes severe and unrelenting hypotension, florinef certainly seems like a safer and much more predictable remedy than purposely ingesting tyramine! One article I read on MAOI's said that the initial hyotension than can occur is eventually replaced by a paradoxical *increase* in blood pressure. Hard to believe, but maybe it's true...I certainly didn't take Nardil long enough to find out.
The key factor in a hypertensive crisis is a *sudden and substantial rise* in BP, much more so than the actual resulting pressure. So a sudden rise to 150/100 for person A could pose much greater immediate risk than a rise to 190/120 for person B.
Rick
>
> I think there is more than what we know going on with MAOIs and the banned food list. Before I start here – please don’t take this as a suggestion to eat food on the list – my hunch is that the blood pressure crisis problem is very dependent to the individual.
>
> I was having a lot of problems with low blood pressure (BTW Viagra used with Nardil caused me to have fainting spells for 3 days! – Something that is not in the PDR) so I decided to try to raise my blood pressure with sharp cheddar cheese. (Again don’t try this yourself). (I have never been able to find tyramine in health food stores or on line anywhere so I resorted to the cheese. If anyone knows of a source of tyramine supplements please let me know.)
>
> My diastolic pressure would get so low when I stood that my doc could not measure it. I started out by taking my blood pressure 4 times a day while lying down. My diastolic ranged 60 to 80. I started out with a very small slice of cheese three times a day and worked it up to 8 slices three times a day – with out getting any blood pressure help. I then tried Ramona cheese with the same result.
>
> Seeing that I don’t know what the tyramine content was- this really doesn’t prove anything, but only suggests testing with purified tyramine.
>
> Anyone who is thinking of cheating on their MAOI diet should consider the following:
>
> Tyramine content could vary drastically from one block of cheese to the next. Don’t assume that if you got away with a restricted food one time, that you can completely ignore the guidelines.
>
> If you are destined to cheat always start off with very, very small amounts of the food followed with a blood pressure check. An automatic blood pressure cuff used 1, 2 and 3 hours after eating restricted foods that shows a rise of the diastolic pressure above 90 is a big hint that you better stick with the program.
>
> What really has my interest is that I have always craved sharp cheddar cheese and wonder if it is because it is a monoamine precursor. Perhaps tyramine could be used as a depression treatment?
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