![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Questionmark on April 10, 2003, at 1:20:00
Sorry, i know many of you are probably sick of answering all these MAOI-related questions, but... if you could answer some more it would be very appreciated. (i'm just gonna rattle em off as i think of them so there wont be much order, sorry). Oh, and a breif overview: i have major depression, inattentive ADD, anxiety problems (SP/SA), and, as i just recently learned, obsessive compulsive personality disorder. My appetite is dead and i need to gain weight. i've tried a number of med types but not MAOIs or TCAs. As far as prescription meds go, i want to be on nothing or an MAOI. im 22.
1) First, do you think an MAOI could be helpful for this crap without impeding anything else (as is always the case for me w/ any other med)? Is there salvation in a pill?
2) For those who have been on one a long time (multiple years), did it work well for you for all that time? i know they're often quite beneficial for awhile at first, but i wonder if there's some kind of brain adaptation or anything that can occur and result in "poop out" or whatever.
3) How about moderate dose Nardil with low-dose selegeline? You think that might be a good (and possible) combo?
4) How was your memory and cognitive faculties with an MAOI?
5) Here's an important one. If you were ever on awhile and quit, was the withdrawal pretty bad? How long were you on it, what dose, how long off?
6) What side effects remained even as time went on? What if any made you quit? Were there any subtle side effects that really bothered you?
7) Do you think they (esp Nardil or Parnate) might be bad for you-- particularly your brain? Do you think they might be neurotoxic at all, or hepatotoxic, or cause any permanent changes in the body?
8) Can one go on an MAOI for awhile and then quit without having to suffer from more severe depression and whatever else? I.e., how long do withdrawal-type effects last?
9) This concept never used to bother me much, but for some reason it really does nowadays... If i take a drug that makes me a happier person, a better person, a more hopeful and confident and naive person, and one who can be more easily satisfied with life, then this person is not really me then right? i become someone who i am not. Of course this is the case with things as simple as even caffeine, but still (i have been trying to really reduce psychoactive substance use, including caffeine-- and she was always my greatest love, and..) at least occasional, controlled manipulation of personality is not quite as severe as an overhaul that is daily (as w/ an antidepressant). But anyway, do you think this is ... wrong, i guess? Am i being untrue to myself if i become a different person? Funny how one can hate himself so severely and yet still care so much about this sh*t. But, what you say?
10) If they are irreversible inhibitors or MAO, why is it necessary to take it more than once a day? Does it make much difference if you just took it once/ day?
*** SO SORRY for how long this is. Even if you just answer some of this i thank you. Pleeease provide some input/advice though?. This tired drowning dog will be truly grateful.
Posted by jack smith on April 10, 2003, at 10:04:49
In reply to Important but less common MAOI questions. Please?, posted by Questionmark on April 10, 2003, at 1:20:00
> 9) This concept never used to bother me much, but for some reason it really does nowadays... If i take a drug that makes me a happier person, a better person, a more hopeful and confident and naive person, and one who can be more easily satisfied with life, then this person is not really me then right? i become someone who i am not. Of course this is the case with things as simple as even caffeine, but still (i have been trying to really reduce psychoactive substance use, including caffeine-- and she was always my greatest love, and..) at least occasional, controlled manipulation of personality is not quite as severe as an overhaul that is daily (as w/ an antidepressant). But anyway, do you think this is ... wrong, i guess? Am i being untrue to myself if i become a different person? Funny how one can hate himself so severely and yet still care so much about this sh*t. But, what you say?
>I don't know much about your other questions but this one struck a cord with me. It depends on how you define self. I suggest you do some reading in the buddhist tradition. The Dalai Lama in one of his books specifically uses the example of antidepressant medication as proof that the self is not just the brain, it is something much bigger and more complex than just that. . . . "Ethics for a New Millenium" --I think it is called. I hope that double quotes works. So using meds in my minds does not at all change who you are anymore than getting a cast for a broken leg changes who you are. "Self" is a much more complex thing than just the brain. Just my thoughts. BTW, I am Jewish, not Buddhist so I am not trying to proselytize here. I sense a redirect.
JACK
Posted by jack smith on April 10, 2003, at 10:17:19
In reply to Re: Important but less common MAOI questions. Please?, posted by jack smith on April 10, 2003, at 10:04:49
Let me try this again--the book is called "Ethics for the New Millennium" Alright, I think I got it right this time, Dr. Bob.
Posted by djmmm on April 10, 2003, at 21:21:47
In reply to Important but less common MAOI questions. Please?, posted by Questionmark on April 10, 2003, at 1:20:00
> Sorry, i know many of you are probably sick of answering all these MAOI-related questions, but... if you could answer some more it would be very appreciated. (i'm just gonna rattle em off as i think of them so there wont be much order, sorry). Oh, and a breif overview: i have major depression, inattentive ADD, anxiety problems (SP/SA), and, as i just recently learned, obsessive compulsive personality disorder. My appetite is dead and i need to gain weight. i've tried a number of med types but not MAOIs or TCAs. As far as prescription meds go, i want to be on nothing or an MAOI. im 22.
>
> 1) First, do you think an MAOI could be helpful for this crap without impeding anything else (as is always the case for me w/ any other med)? Is there salvation in a pill?Nardil cured my social anxiety and major depression...after trying every med and combo...I'm 24, been on meds since I was 15-16
> 2) For those who have been on one a long time (multiple years), did it work well for you for all that time? i know they're often quite beneficial for awhile at first, but i wonder if there's some kind of brain adaptation or anything that can occur and result in "poop out" or whatever.
I took nardil for a couple of years and only switched to parnate because of availability problems with Nardil...I find both drugs equally as effective
>
> 3) How about moderate dose Nardil with low-dose selegeline? You think that might be a good (and possible) combo?Most likely the Nardil will be enough...I wouldn't combine the two
>
> 4) How was your memory and cognitive faculties with an MAOI?no problems...
>
> 5) Here's an important one. If you were ever on awhile and quit, was the withdrawal pretty bad? How long were you on it, what dose, how long off?Yes the withdraw is bad...as bad as effexor, in my opinion...not having Nardil for a day gave me horrible nightmares, etc.
>
> 6) What side effects remained even as time went on? What if any made you quit? Were there any subtle side effects that really bothered you?Some sexual side-effects (not as pronounced as with the SSRIs, etc)...No side-effect, short of an allergic reaction should make you quit, but to answer your question, Nardil, for me, was almost side-effect free...in the initial first few weeks I experienced some minor hypotension, but that passed...never had a hypertensive reaction, never changed my diet.
>
> 7) Do you think they (esp Nardil or Parnate) might be bad for you-- particularly your brain? Do you think they might be neurotoxic at all, or hepatotoxic, or cause any permanent changes in the body?Phenelzine is a hydrazine derivative, which is widely known to be a carcinogen...MAOIs have caused hepatotxicity...they are not neurotoxins, in fact inhibition of MAO-B preserves neuronal integrity by preventing the breakdown of Dopamine into hydrogen peroxide (H2O2), which causes oxidative damage.
> 8) Can one go on an MAOI for awhile and then quit without having to suffer from more severe depression and whatever else? I.e., how long do withdrawal-type effects last?
I don't know...everyone is different...I think the general rule (for major depression) is to stay on a medication about a year AFTER you feel "better," to lessen the risk of relapse. Some people never experience withdraw...For example, I never gained any weight on Nardil, which is supposedly a common side-effect...Your reaction to a MAOI, and discontinuation of a MAOI will almost certainly be different than the "next guy"
> 9) This concept never used to bother me much, but for some reason it really does nowadays... If i take a drug that makes me a happier person, a better person, a more hopeful and confident and naive person, and one who can be more easily satisfied with life, then this person is not really me then right? i become someone who i am not. Of course this is the case with things as simple as even caffeine, but still (i have been trying to really reduce psychoactive substance use, including caffeine-- and she was always my greatest love, and..) at least occasional, controlled manipulation of personality is not quite as severe as an overhaul that is daily (as w/ an antidepressant). But anyway, do you think this is ... wrong, i guess? Am i being untrue to myself if i become a different person? Funny how one can hate himself so severely and yet still care so much about this sh*t. But, what you say?
We have all thought of that...but the state of depression, meaning chronic, debilitating, life altering depression (or severe social phobia, so severe that you can't live your life normally) Is not a "natural" state of life.... Antidepressants are intended to relieve symptoms, not cure problems, They should be used only to get you to a point where YOU can begin to heal yourself.
>
> 10) If they are irreversible inhibitors or MAO, why is it necessary to take it more than once a day? Does it make much difference if you just took it once/ day?Well, when I took Nardil I took it all at once, in the morning...Parnate I take 2x a day, once in the morning, and once before noon....The multi-day dose schedule was implemented for several reasons: side-effects, half-life, metabolism, and the wide variety of immediate effects from the medication.. for Nardil, this effect centers around GABA, and for Parnate, the immediate effects may be linked to catecholamine release. In theory, once adaquate MAO inhibition is achieved, a single dose every other day, or a low dose once a day schedule is is enough to maintain adaquate MAOI
>
> *** SO SORRY for how long this is. Even if you just answer some of this i thank you. Pleeease provide some input/advice though?. This tired drowning dog will be truly grateful.I think if there is any time to try a MAOI it is now, Younger people (our age) tend to have fewer side-effects.
Posted by ace on April 11, 2003, at 23:34:54
In reply to Important but less common MAOI questions. Please?, posted by Questionmark on April 10, 2003, at 1:20:00
> Sorry, i know many of you are probably sick of answering all these MAOI-related questions, but... if you could answer some more it would be very appreciated. (i'm just gonna rattle em off as i think of them so there wont be much order, sorry). Oh, and a breif overview: i have major depression, inattentive ADD, anxiety problems (SP/SA), and, as i just recently learned, obsessive compulsive personality disorder.
I'd recommend you forget the labels. Just look at symptom by symptom. These labels are abstractions, IMO. For eg - every OCD person might have a similiar brain chemistry prob, but I think there are significant differences in every OCD'ers aetiology.
My appetite is dead and i need to gain weight. i've tried a number of med types but not MAOIs or TCAs. As far as prescription meds go, i want to be on nothing or an MAOI. im 22.
>
> 1) First, do you think an MAOI could be helpful for this crap without impeding anything else (as is always the case for me w/ any other med)? Is there salvation in a pill?I believe there is. Or maybe two or three pills combined. Salvation should be understood as the end of your mental illness symptoms. Not something beyond this.
And yes, your syptoms sound very well matched to MAOI therapy - esp Nardil.> 2) For those who have been on one a long time (multiple years), did it work well for you for all that time? i know they're often quite beneficial for awhile at first, but i wonder if there's some kind of brain adaptation or anything that can occur and result in "poop out" or whatever.
I have been on Nardil nearly 6 months. I do not believe in 'poop-out'.
> 3) How about moderate dose Nardil with low-dose selegeline? You think that might be a good (and possible) combo?
No idea.
> 4) How was your memory and cognitive faculties with an MAOI?
At first, when raising doses, shocking. But it wore off in a week or two. Just some minor memory hick-ups I think now.
> 5) Here's an important one. If you were ever on awhile and quit, was the withdrawal pretty bad? How long were you on it, what dose, how long off?
>
> 6) What side effects remained even as time went on? What if any made you quit? Were there any subtle side effects that really bothered you?Constipation - since passed
Anorgasmia - sort of passing now - but I use Bethenachol for that usually with success (now).
> 7) Do you think they (esp Nardil or Parnate) might be bad for you-- particularly your brain? Do you think they might be neurotoxic at all, or hepatotoxic, or cause any permanent changes in the body?No.
> 8) Can one go on an MAOI for awhile and then quit without having to suffer from more severe depression and whatever else? I.e., how long do withdrawal-type effects last?
I ve heard of people going off an MAOI and sustaing the therapeutic effects. I havent really heard this with many others but.
> 9) This concept never used to bother me much, but for some reason it really does nowadays... If i take a drug that makes me a happier person, a better person, a more hopeful and confident and naive person, and one who can be more easily satisfied with life, then this person is not really me then right? i become someone who i am not. Of course this is the case with things as simple as even caffeine, but still (i have been trying to really reduce psychoactive substance use, including caffeine-- and she was always my greatest love, and..) at least occasional, controlled manipulation of personality is not quite as severe as an overhaul that is daily (as w/ an antidepressant). But anyway, do you think this is ... wrong, i guess? Am i being untrue to myself if i become a different person? Funny how one can hate himself so severely and yet still care so much about this sh*t. But, what you say?
I understand this idea and quite some time it used to eat at me. For me it was just anothe sx of OCD. It might just be OCD and no answer will ever satisfy you.
But..Firstly - if you take psychoactive drugs - you are being your self by taking them, sort of understand?
Second..most importantly we are talking about diseases here which are like breaks in the leg. If you put a stitch in a cut hand are you not being yourself?
> 10) If they are irreversible inhibitors or MAO, why is it necessary to take it more than once a day? Does it make much difference if you just took it once/ day?I take 30mg 3 times a day.
> *** SO SORRY for how long this is. Even if you just answer some of this i thank you. Pleeease provide some input/advice though?. This tired drowning dog will be truly grateful.No probs dude. Let us know how you go.
Ace.
Posted by Questionmark on April 12, 2003, at 2:16:49
In reply to Re: Important but less common MAOI questions. Please? » Questionmark, posted by ace on April 11, 2003, at 23:34:54
By the way, i just got a prescription for Parnate today: 20mg/day start and leading to 40mg/day after a few weeks. i'm still pretty reluctant to start it though. i feel that it's probably going to have to be a long-term commitment if i do start it.
Do i embrace the lie of happiness, or stay with the truth-- that is, that life is a curse and i is a wretched waste.? Truth or happiness?
Truth or happiness?
Posted by cubbybear on April 12, 2003, at 5:49:39
In reply to Important but less common MAOI questions. Please?, posted by Questionmark on April 10, 2003, at 1:20:00
I've had 18 years of experience with Parnate for major depression and anxiety, so let me jump into the discussion here. I can help with some of your questions.
> 2) For those who have been on one a long time (multiple years), did it work well for you for all that time? i know they're often quite beneficial for awhile at first, but i wonder if there's some kind of brain adaptation or anything that can occur and result in "poop out" or whatever.
I went through phases, in which, let's say, I'd stay on regular daily doses for 3 years or more. No poopout. No loss of efficacy. The drug is a trusted, reliable friend and lifesaver.
How was your memory and cognitive faculties with an MAOI?
I never noticed a problemHere's an important one. If you were ever on awhile and quit, was the withdrawal pretty bad? How long were you on it, what dose, how long off?
I was on it for many months or years at a stretch. When I decided I wanted to try a "drug holiday", I did a gradual phaseout from my dose of 40 mg to zero over a period of about 3-4 weeks. I never experienced any withdrawal problems while tapering off. I did notice a change in my sleep patterns however, after it was out of my system.
>
What side effects remained even as time went on?No side effects remained after I went off it.
What if any made you quit? Were there any subtle side effects that really bothered you?
In my case, side effects were occasional low blood pressure or light-headedness, mostly at the beginning; increased craving for sweets and carbohydrates which led to weight gain (which I desperately needed), and dry mouth sometimes. None of these side effects were a problem
>
> 8) Can one go on an MAOI for awhile and then quit without having to suffer from more severe depression and whatever else? I.e., how long do withdrawal-type effects last?
You're really asking two different kinds of questions here. The first relates to a RECURRENCE of depression. As is the case with numerous people, after you've had your first depressive episode, the odds increase that you will have another one, and the odds keep increasing, so these days doctors are (rightfully) recommending continuous use of anti-depressants to prevent recurrences or relapse. Your second question concerns withdrawal symptoms, which I never had upon discontinuation (e.g. such as one would experience trying to quit taking narcotics).>
>... If i take a drug that makes me a happier person, a better person, a more hopeful and confident and naive person, and one who can be more easily satisfied with life, then this person is not really me then right? i become someone who i am not.
I believe it's quite the contrary. When you're depressed, you are NOT yourself. Your neurochemistry has become imbalanced and you cannot enjoy life. By taking a pill, you are helping to restore the proper chemical balance. Think of it as analogous to a diabetic who must take insulin to maintain proper sugar levels in the blood. Taking the insulin doesn't change him/her into someone "different.">
If they are irreversible inhibitors or MAO, why is it necessary to take it more than once a day? Does it make much difference if you just took it once/ day?
The idea of "irreversible" has nothing to do with whether you take one, two or three pills. It's a complex medical topic unrelated to dosages.
And I strongly advise you--do NOT take only one pill a day. It will do nothing for you. Two pills (20 mg. probably won't do much either). According to the manufacturer, 30 mg./day is the "standard" dose. I take 40 mg. with no problems and the safe maximum is actually 60 mg.
Good luck and be patient. .it takes a few weeks to kick in, i.e. for the full benefits to be obtained.
Posted by Dr. Bob on April 14, 2003, at 19:31:20
In reply to Re: Important but less common MAOI questions. Please?, posted by jack smith on April 10, 2003, at 10:17:19
Posted by cubbybear on April 15, 2003, at 3:08:22
In reply to Re: Important but less common MAOI questions. Please?, posted by jack smith on April 10, 2003, at 10:04:49
Hi Jack,
Did you ever make the switch to an MAOI? I know you were considering it. How have you been doing these days?
Posted by Questionmark on April 15, 2003, at 23:52:23
In reply to Re: Important but less common MAOI questions. Please?, posted by cubbybear on April 12, 2003, at 5:49:39
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.