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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by michael on May 23, 2002, at 22:59:30
I know that 2 weeks is the standard washout period prior to starting an MAOI for most Psych meds.
Is it the same w/dexedrine, or is a few days (3 days? 5 days?) sufficient if dexedrine is the only med being "washed-out", given its shorter half life?
I thought the full 2 weeks was not necessary for dexedrine, but given the gravity of the potential complications, wondering if anyone has more concrete info to that effect... before I make any decisions. Thanks. michael
Posted by kayjay on May 24, 2002, at 13:42:27
In reply to MAOI dexedrine, posted by michael on May 23, 2002, at 22:59:30
Hi Michael,
I started with Parnate after one day of being off of dexedrine. I had no problems.
kayjay
Posted by Psydoc on May 25, 2002, at 12:33:41
In reply to Re: MAOI dexedrine, posted by kayjay on May 24, 2002, at 13:42:27
There are many medication "no-nos" which are far from being absolute. While the combination of an MAOI and a stimulant such as Dexedrine is potentially dangerous, the combination has been used by many psychiatrists when treating people with hard-to-treat depressions. Adding large doses of Dexedrine on top of full doses of an MAOI is dangerous, but adding small doses and gradually increasing the dose has provided relief for many people not helped by conventional means.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%> Hi Michael,
>
> I started with Parnate after one day of being off of dexedrine. I had no problems.
>
> kayjay
Posted by michael on June 22, 2002, at 4:57:27
In reply to Re: MAOI dexedrine, posted by Psydoc on May 25, 2002, at 12:33:41
> There are many medication "no-nos" which are far from being absolute. While the combination of an MAOI and a stimulant such as Dexedrine is potentially dangerous, the combination has been used by many psychiatrists when treating people with hard-to-treat depressions. Adding large doses of Dexedrine on top of full doses of an MAOI is dangerous, but adding small doses and gradually increasing the dose has provided relief for many people not helped by conventional means.
>
> Best regards . . .
>
> Ivan Goldberg
> psydoc@psycom.net
> %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%Dr. Goldberg,
Thank you very much for your above response to my previous question. If you (or anyone else here…) can spare the time, I have some quick follow-up q’s …
[1] What is considered a "full dose" of parnate?
[2] Would the addition of Dexedrine to parnate make sense only if there was at least a partial response to the parnate alone?
In my case, I'm currently taking 60mg Parnate (30mg bid) w/little response... I worked up to 20mg Dexedrine (which has been my usual dose either alone or as an augmenter) on top of the parnate, with no problems. [& no significant difference from dex by itself]
[3] Would increasing the parnate dose (to 80mg? or a "full dose"?) monotherapy (i.e. w/o the Dexedrine) be an advisable/logical next move to discuss w/my pdoc?
Thanks (to all) for any thoughts... michael
p.s.
[ - my symptoms are primarily fatigue & general malaise (always feel crummy & run-down/wiped out), lack of energy & motivation/initiative, along w/focus & concentration difficulties... all of which also contributes to a less than “bright” mood, as well…...The Dexedrine is extremely helpful & doesn't keep me from sleeping, but it is very noticeable when it wears off... hoping to find something that will help persistently, w/o the lapses in relief inherent w/dex...]
Posted by Psydoc on June 22, 2002, at 6:06:04
In reply to Re: MAOI dexedrine » Psydoc, posted by michael on June 22, 2002, at 4:57:27
> Dr. Goldberg,
>
> Thank you very much for your above response to my previous question. If you (or anyone else here…) can spare the time, I have some quick follow-up q’s …
>
> [1] What is considered a "full dose" of parnate?A fulldose of Parnate is about 130 mg/day. Please see: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2710808&dopt=Abstract
>
> [2] Would the addition of Dexedrine to parnate make sense only if there was at least a partial response to the parnate alone?I generally add Dexedrine when the dose of Parnate (or another MAOI) cannot be increased any more because of the severity of side-effects, and significant depression remains. Only then do I add Dedxedrine, Ritalin, or Wellbutrin.
>
> In my case, I'm currently taking 60mg Parnate (30mg bid) w/little response... I worked up to 20mg Dexedrine (which has been my usual dose either alone or as an augmenter) on top of the parnate, with no problems. [& no significant difference from dex by itself]
>
> [3] Would increasing the parnate dose (to 80mg? or a "full dose"?) monotherapy (i.e. w/o the Dexedrine) be an advisable/logical next move to discuss w/my pdoc?If I had a partient who came to me taking Parnate and Dexedrine in doses similar to the ones you mention, I would probably slowly increase the Parnate, rather than stop the Dexedrine and then increase the parnate.
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by 3 Beer Effect on June 23, 2002, at 3:01:10
In reply to Re: MAOI dexedrine, posted by Psydoc on June 22, 2002, at 6:06:04
Every psychiatry/psychopharmacology textbook i've every read said NEVER, EVER, EVER COMBINE AN MAOI WITH A SYMPATHOMIMETIC like Dexedrine, Adderall etc!!!
Very dangerous, very unsound advice! A unexpected hypertensive reaction could occur so fast from that combination, the patient could easily die before help arrives, IF he or she was even conscious to call the paramedics.
I hope nothing unfortunate happens as a result of this truly terrible advice.
3 Beers...............
Posted by Phil on June 23, 2002, at 5:41:19
In reply to This is the most dangerous advice i've seen here!!, posted by 3 Beer Effect on June 23, 2002, at 3:01:10
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2056139&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3997787&dopt=Abstract
http://www.psycom.net/depression.central.html
3 Beer Effect,
Two links to PubMed studies and a link to Dr. Goldberg's site. I think he knows very well of what he speaks.
Phil
Posted by Anna P. on June 25, 2002, at 19:17:48
In reply to This is the most dangerous advice i've seen here!!, posted by 3 Beer Effect on June 23, 2002, at 3:01:10
I just want to say: did you know that is also possible to combine MAOI with the tricyclic as well under a supervision of a specialist?
I had a problem because the pharmacy refused to sell me both drugs as their computer showed there is a dangerous interaction between these two. Books say it's not possible, but still IT IS POSSIBLE under a supervision of a specialist for the treatment-resistant people.
Anna P.
Posted by Psydoc on June 25, 2002, at 21:38:01
In reply to Re: 3 Beers, did you know...?, posted by Anna P. on June 25, 2002, at 19:17:48
Those who wish to know more about combined MAOI-TCA treatment can check-out the following MEDLINE abstracts:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7560546&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3997787&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6376486&dopt=Abstract
Best regards . . .
Ivan Goldberg
psydoc@psycom.net
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Posted by SLS on June 26, 2002, at 20:48:46
In reply to Re: 3 Beers, did you know...?, posted by Anna P. on June 25, 2002, at 19:17:48
In the past, I have taken:
Parnate 120mg + desipramine 300mg + Dexedrine 20mg + Synthroid
Parnate + Wellbutrin
Parnate + desipramine + Parlodel
I have also combined Nardil with tricyclics
*** VERY IMPORTANT ***
I have not seen anyone successfully combine either Parnate, Nardil, or Marplan with a SSRI or other potent serotonin (5-HT) reuptake inhibitor. I would like to know if anyone else has.
In an act of despiration, I decided once to try adding a small amount of Effexor (venlafaxine) to the Parnate 120mg + desipramine I had been taking. I chose Effexor as a representative of potent 5-HT reuptake inhibitors because it has the shortest half-life - just in case my brain should be offended. It was. I only took 18.75mg. But within fifteen or twenty minutes, I became delerious, babbling nonsense, and unable to stand. It was pretty intense. Fortunately, my parents were in the house. I asked them to take my temperature. It was elevated by about a degree Farenheit, so I wasn't too worried. The reaction subsided within an hour. I got my answer, though. SSRIs, Effexor, and clomipramine are probably best avoided when taking an irreversible MAOI.
Although I would be plenty scared to try it, some Canadian doctors report the successful treatment of TRD patients with a combination of moclobemide (reversible MAOI) with SSRIs. I think Joffe and Bakish are the names most often involved.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8294388&dopt=Abstract
However, there are these:
Posted by ShelliR on June 27, 2002, at 12:22:19
In reply to Re: 3 Beers, did you know...?, posted by SLS on June 26, 2002, at 20:48:46
Scott,
I'm so glad to see you on the board. Only I'm not happy that you are still seaching for a workable combination.
I am mostly in the same boat. After trying ECT unsuccessfully, I am now tirating up on lamictal--
willing to go to 800mg --that's what Ivan Goldberg
suggested might be successful- I emailed him and actually got a response. My new pdoc has also seen sudden improvement at 600mg. I am also still taking 30mg nardil. That's the highest I can tolerate.I also went to a pain doctor and told him about my
combination of pain and depression. We tried several opiates and am taking oxycontin again, soon to switch to methodone. I don't like the idea of taking oxycontin or methadone, especially because my dose is very high--a lower dose just doesn't work. I'm switching because of the cost of oxy. When buprenorphine finally comes out in sublingual form I will try that.But that is the only way that I can live through my horrible pain, and on most days I am able to work. I am so hoping that the very high level of lamictal with nardil (my only successful combination in the past) works again and I can drop the methadone.
Anyway, it's so good to see your name. Keep in touch if you can; I know many days it feels too bad and too hopeless to try to write.
Today is a good day for me.Shelli
Posted by DiscoPuppy on July 4, 2002, at 14:41:55
In reply to This is the most dangerous advice i've seen here!!, posted by 3 Beer Effect on June 23, 2002, at 3:01:10
Sometimes your posts just push my button. I'm probably gonna be banned from posting for a week, but what the hell. . .
If I remember correctly, you're only something like 23 or 24 years old. I assume you are NOT a doctor. Under most circumstances, not nearly old enough to become an MD, let alone criticize one. I don't mean to judge but I think it's incredibly disrespectful and pompous to "correct" someone who has gone through medical school, done their residency, etc., etc.
You're most certainly entitled to your own opinion, but don't be correcting a doctor or telling him he's wrong.
Oh by the way, I *DO* know someone who has been prescribed 90mg Nardil + 5mg Dexedrine.
> Every psychiatry/psychopharmacology textbook i've every read said NEVER, EVER, EVER COMBINE AN MAOI WITH A SYMPATHOMIMETIC like Dexedrine, Adderall etc!!!
>
> Very dangerous, very unsound advice! A unexpected hypertensive reaction could occur so fast from that combination, the patient could easily die before help arrives, IF he or she was even conscious to call the paramedics.
>
> I hope nothing unfortunate happens as a result of this truly terrible advice.
>
> 3 Beers...............
Posted by Vanessa on July 6, 2002, at 19:05:29
In reply to Re: This is the most dangerous advice i've seen here!! » 3 Beer Effect, posted by DiscoPuppy on July 4, 2002, at 14:41:55
I take dexedrine and Vivactil with Nardil, with no problems. I have a good, experienced doctor. The first time I read about combining
MAOIs with tricyclics (and maybe with Dexedrine, I don't remember)was in a medical textbook
written by Dr. Jerrold Bernstein. I believe he was associated with Harvard and Mass General.
This is the end of the thread.
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