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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by Ilene on December 19, 2003, at 17:43:52
My pdoc and I have agreed that if my desipramine level is adequate (I had a blood draw yesterday) and I don't feel better by mid-January I will start an MAOI, probably Parnate. I'm nervous! I'm worried about efficacy and sides. I've tried nearly everything else (about a dozen meds), so I feel like this is my last chance. I've been on meds for over 16 years and I now have constant suicidal ideation.
So--what have your experiences been? How well do they work? How tolerable are they? Any poop-out?
Thank you in advance.
Ilene
Posted by brussell on December 19, 2003, at 18:09:06
In reply to MAOI users--experiences please, posted by Ilene on December 19, 2003, at 17:43:52
My situation is very similar to yours.
I am only on my third week of Parnate, and it does seem to be helping (40mg/day--right now).
I can say that it is one of the most tolerable AD's I have ever used. The only SE's I've noticed are increased sensitivity to cold and fatigue. The fatigue is annoying but it seems to wear off with time. Most importantly for me, the Parnate doesn't make me feel stupid or emotionally "not there" the way the SSRIs and Effexor did.
If you are not getting results from your current ADs, I think you should definitely try it. Why wait till January? (Just make sure you get the other AD's out of your system before starting.)
One other thing: make sure you don't go to 30mg/day and stop. That is a standard dose, but many people have to go higher.
P.S. The diet thing is way overblown. It's not that restrictive (though you need to take it very seriously). And really, if one is suicidally depressed, who cares about cheese, wine, or beer, or mouldy leftovers?
Posted by Ilene on December 19, 2003, at 20:54:54
In reply to Re: MAOI users--experiences please, posted by brussell on December 19, 2003, at 18:09:06
> My situation is very similar to yours.
>
> I am only on my third week of Parnate, and it does seem to be helping (40mg/day--right now).
>
> I can say that it is one of the most tolerable AD's I have ever used. The only SE's I've noticed are increased sensitivity to cold and fatigue. The fatigue is annoying but it seems to wear off with time. Most importantly for me, the Parnate doesn't make me feel stupid or emotionally "not there" the way the SSRIs and Effexor did.
>I have fatigue problems anyway, but I'd rather be fatigued and undepressed than unfatigued and depressed. Neither the SSRIs nor Effexor made me feel especially stupid or emotionally vacant. I went years without an orgasm, though, and got kind of twitchy.
> If you are not getting results from your current ADs, I think you should definitely try it. Why wait till January? (Just make sure you get the other AD's out of your system before starting.)
>Because one needs to take an adequate dose for a long enough period of time (usually 6 weeks) before giving up on an AD.
> One other thing: make sure you don't go to 30mg/day and stop. That is a standard dose, but many people have to go higher.
>I'll remember that.
> P.S. The diet thing is way overblown. It's not that restrictive (though you need to take it very seriously). And really, if one is suicidally depressed, who cares about cheese, wine, or beer, or mouldy leftovers?
I'm not much of a drinker (I don't metabolize alchohol well--it's genetic) so I hardly drink more than a glass of wine at a time. I suppose I should be eating all my cheddar now.
What about weight gain and sexual problems? I've actually been losing weight (I think it's from anxiety). Another 5 pounds and my BMI will be normal. Just think of it--mental illness can improve your health!
Ilene
Posted by brussell on December 19, 2003, at 22:44:10
In reply to Re: MAOI users--experiences please » brussell, posted by Ilene on December 19, 2003, at 20:54:54
Parnate has a reputation for being one of the only ADs that is not associated with weight gain or sexual dysfunction. It's similar to Welbutrin in that respect. So far, this has been my experience, as well.
Posted by wsj on December 19, 2003, at 22:59:58
In reply to MAOI users--experiences please, posted by Ilene on December 19, 2003, at 17:43:52
on parnate 39 days after 5 years of dif ssri's. currently taking 70mg/day. so far it has worked as good as ssri's w/o the s/e. i would defintely recommend you give it a try.
wsj
Posted by cubbybear on December 20, 2003, at 0:41:01
In reply to Re: MAOI users--experiences please » Ilene, posted by wsj on December 19, 2003, at 22:59:58
I've had nothing but terrific experiences with Parnate for nearly 20 years!! \My side effects (lowered blood pressure, increased craving for sweets/carbohydrates, dry mouth) disappear after the first couple of weeks. I've never experienced sexual dysfunction from Parnate; however, I'm one of the few who experience weight gain. For me though, this is a great benefit since severe depressiion causes my appetite to suffer and my weight drops quickly. I would recommend Parnate any day. Any other questions, please ask me.
Posted by MelD on December 20, 2003, at 9:53:12
In reply to MAOI users--experiences please, posted by Ilene on December 19, 2003, at 17:43:52
Same story here - years on Ssris with little or no relief. Now on Parnate for almost a year and depression free for the first time in my life! I agree the diet is no big deal. So far all ive found that is absolutely forbidden is very aged cheese, such as old cheddar, blue cheese, that has the mold right in it, sauerkraut, fava beans and tap beer. All else to eat and drink has been no problem to me. Ive had other cheesses, pizza with pepperoni, salami, sausage, beer, wine of all kinds, liquor, chinese food. But do ask if you have questions about a specific food. You must also avoid decongestants and certain prescription pain meds and a few herbal things. Of course, everyone seems to have their own tolerance level to some degree, so a little careful experimentation will be called for when starting out.
A terrific link for your questions is a group where all of us take Maois and at least one person always can answer your question about side effects, dosages, the diet, whatever:
http://health.groups.yahoo.com/group/maois/
As you can tell, im a big fan of Maois. Best of luck to you. Melodie
Posted by SLS on December 20, 2003, at 10:20:07
In reply to Re: MAOI users--experiences please, posted by MelD on December 20, 2003, at 9:53:12
> Ive had other cheesses, pizza with pepperoni,
I experienced a serious tyramine reaction to eating 2 thin slices of pepperoni on a pizza. Pounding occipital headache - the works. In the same way that everyone is different in the way they react to medications, so too is the way different individuals reacts to any one food. Not only that, but any one individual can react differently to the same food on different occasions. It is good to have a healthy respect for the seriousness and frequency of food reactions with MAOIs. One should probably familiarize himself with the diet rules well enough to know when they are breaking them. However, I agree that the usually quoted diets are overstated and include too many perfectly safe foods.
- Scott
Posted by Ilene on December 20, 2003, at 10:29:44
In reply to Re: MAOI users--experiences please, posted by MelD on December 20, 2003, at 9:53:12
I'm starting to feel more positive. Especially hearing from you folks who have been taking them for years and years. I know our friend Ace is a big fan of MAOIs--Nardil, specifically--but I thought there would be more people who had problems w/ sides or poop-out, or for whom they just didn't work.
The only drugs that *really* worked for me--desipramine and prozac--both pooped out after a few years. That was a *long* time ago.
Ilene
Posted by cybercafe on December 20, 2003, at 10:30:33
In reply to MAOI users--experiences please, posted by Ilene on December 19, 2003, at 17:43:52
> My pdoc and I have agreed that if my desipramine level is adequate (I had a blood draw yesterday) and I don't feel better by mid-January I will start an MAOI, probably Parnate. I'm nervous! I'm worried about efficacy and sides. I've tried nearly everything else (about a dozen meds), so I feel like this is my last chance. I've been on meds for over 16 years and I now have constant suicidal ideation.
>
> So--what have your experiences been? How well do they work? How tolerable are they? Any poop-out?
>
> Thank you in advance.
>
> Ilene
i love parnate. best med i have ever taken. no side effects at 8 weeks.i also had suboptimal results from other meds(SSRIs, Effexor), plus annoying side effects
Posted by myclonic_jerk on December 20, 2003, at 12:02:47
In reply to Re: MAOI users--experiences please, posted by cybercafe on December 20, 2003, at 10:30:33
Hi,
Has anyone been prescribed either Nardil or (preferrably) Parnate in the UK?
I'd like to trial Parnate, but I have a suspicion that it's not available in the UK.Thanks,
MJ.
Posted by cubbybear on December 21, 2003, at 1:46:13
In reply to Re: MAOI users--experiences please, posted by SLS on December 20, 2003, at 10:20:07
>
> I experienced a serious tyramine reaction to eating 2 thin slices of pepperoni on a pizza. Pounding occipital headache - the works.Scott--you make a good point about different people reacting differently to different foods. You probably know that I've taken Parnate for many years. I've never had a hypertensive crisis and that's no doubt a result of not eating ANY cheese, etc.
Now for the first time, I would like to see what happens if I sample a small pizza, because the recent research indicates that fresh mozarella is OK.On the other hand--what you said raises a question: how can you be sure your hypertensive crisis was the result of the pepperoni and not the cheese? Did you do OK with pizza previously, then suddenly got the headache after adding the meat?
It seems to be me that if just one or two people can get a bad reaction from eating a small pizza, then all those new revised guidelines about fresh mozarella being OK are probably "not so" OK. What do you think?
I'm also curious to know what your BP was during the hyp. crisis and how you handled it.
Thanx
cubbybear
Posted by cubbybear on December 21, 2003, at 1:58:56
In reply to Re: MAOI users--experiences please, posted by MelD on December 20, 2003, at 9:53:12
. Now on Parnate for almost a year and depression free for the first time in my life! I agree the diet is no big deal. So far all ive found that is absolutely forbidden is very aged cheese, such as old cheddar, blue cheese, that has the mold right in it, sauerkraut, fava beans and tap beer. All else to eat and drink has been no problem to me. Ive had other cheesses, pizza with pepperoni, salami, sausage, beer, wine of all kinds, liquor, chinese food. But do ask if you have questions about a specific food. You must also avoid decongestants and certain prescription pain meds and a few herbal things. Of course, everyone seems to have their own tolerance level to some degree, so a little careful experimentation will be called for when starting out.
Mel--The wording of your post makes it sound as if you willingly subjected yourself to try every one of the various foods on the list to see what would happen. Now really, did you do that?
Nevertheless, I'm finding the posts for this topic especially interesting this time around because right here we see how one person had a hypertensive crisis from a pepperoni pizza and you say you did fine with all these other foods. After 20 years on Parnate, I've never seen quite the likes of this. Now I don't know what to make of these revised guidelines.
Another thing--would you happen to know exactly what herbal medications (besides St. James Wort) are contraindicated?
In the area of pain meds, I have a list of only about 2 or 3 that are supposedly OK (Percocet, Dilaudid), yet I get conflicting answers about codeine. What's your understanding about codeine? And which other pain meds have you heard are OK?
Thanks to you and anyone else who can answer these questions.
cubbybear
Posted by SLS on December 21, 2003, at 9:56:48
In reply to Re: MAOI users--experiences please » SLS, posted by cubbybear on December 21, 2003, at 1:46:13
Hi Cubbybear.
> > I experienced a serious tyramine reaction to eating 2 thin slices of pepperoni on a pizza. Pounding occipital headache - the works.
> Scott--you make a good point about different people reacting differently to different foods. You probably know that I've taken Parnate for many years. I've never had a hypertensive crisis and that's no doubt a result of not eating ANY cheese, etc.> Now for the first time, I would like to see what happens if I sample a small pizza, because the recent research indicates that fresh mozarella is OK.
The inexpensive processed mozzarella is fine to eat. Most pizzarias use this. However, some pizzarias also use parmesan cheese when making the sauce. I would try to stay away from using a lot of parmesan, but I have never worried about the small amount that might be found in the sauces. I've never had a problem with Pizza Hut. I just stay away from the pepperoni and sausage.
> On the other hand--what you said raises a question: how can you be sure your hypertensive crisis was the result of the pepperoni and not the cheese? Did you do OK with pizza previously, then suddenly got the headache after adding the meat?
Exactly. I had eaten plain cheese pizza from this same restaurant all of the time. I was quite amazed at how little pepperoni it took to induce a reaction.
> It seems to be me that if just one or two people can get a bad reaction from eating a small pizza, then all those new revised guidelines about fresh mozarella being OK are probably "not so" OK. What do you think?
Remember, some pizzas contain other types of cheeses and perhaps meat extracts. After having been on and off MAOIs for the last 20 years, I am confident that most cheese pizzas are OK to eat. Just be careful with the toppings. Inexpensive processed American cheese is OK, but cheddar is not. Ricotta is generally OK. Try to stay away from expensive imported aged cheeses.
> I'm also curious to know what your BP was during the hyp. crisis and how you handled it.
I don't know what my BP was. I was at work during a busy day and was rushed to eat lunch as quick as possible. I was just careless. I had taken two bites of a slice of pepperoni pizza before I realized my error. Within ten minutes, a pounding headache developed in the back of my head near the base of the skull. It felt worse when I sat, so I remained standing for about 45 minutes until the reaction subsided. I gambled that the crisis would pass without medical intervention. I like to carry around a capsule of nifedipine, a calcium channel blocker, just in case I should encounter another reaction. Some people recommend biting the capsule open before swallowing. Others claim that it is better to swallow it whole. I don't know if nifedipine readily passes through the buccal or sublingual membranes, so I would want to swallow the majority of it. Maybe someone else can shed some light on this issue.
- Scott
Posted by MelD on December 21, 2003, at 16:00:24
In reply to Re: MAOI users--experiences please » MelD, posted by cubbybear on December 21, 2003, at 1:58:56
> . Now on Parnate for almost a year and depression free for the first time in my life! I agree the diet is no big deal. So far all ive found that is absolutely forbidden is very aged cheese, such as old cheddar, blue cheese, that has the mold right in it, sauerkraut, fava beans and tap beer. All else to eat and drink has been no problem to me. Ive had other cheesses, pizza with pepperoni, salami, sausage, beer, wine of all kinds, liquor, chinese food. But do ask if you have questions about a specific food. You must also avoid decongestants and certain prescription pain meds and a few herbal things. Of course, everyone seems to have their own tolerance level to some degree, so a little careful experimentation will be called for when starting out.
>
> Mel--The wording of your post makes it sound as if you willingly subjected yourself to try every one of the various foods on the list to see what would happen. Now really, did you do that?
> Nevertheless, I'm finding the posts for this topic especially interesting this time around because right here we see how one person had a hypertensive crisis from a pepperoni pizza and you say you did fine with all these other foods. After 20 years on Parnate, I've never seen quite the likes of this. Now I don't know what to make of these revised guidelines.
> Another thing--would you happen to know exactly what herbal medications (besides St. James Wort) are contraindicated?
> In the area of pain meds, I have a list of only about 2 or 3 that are supposedly OK (Percocet, Dilaudid), yet I get conflicting answers about codeine. What's your understanding about codeine? And which other pain meds have you heard are OK?
> Thanks to you and anyone else who can answer these questions.
> cubbybear
>
Thanks for pointing this out, cubby - i reread my post and it isnt clear. What i have done is try something i wanted to eat from the forbidden list a bite at a time. It is obvious, to me, if something is going to cause a reaction because i feel it in my head immediately. The things i listed as taboo are things that i would never try because as far as im concerned they are bona fide no-nos for obvious reasons. As for the herbs, a lot of people are interested in ginseng, and that is bad news with Maois.
As for the pain meds, that has NOT been revised to my knowledge, and the newer meds can be even worse than the older ones. I would still refuse codeine. Hope this is clearer. Thanks, MelPS: re the pepperoni and salami - some of these dried sausages are aged as well as dried and more fermentation is involved. I would not trust dried sausage from a "gourmet" shop that imports it, but the run of the mill kind you get here in America seems to be no problem. Same with most cheeses.
Posted by ace on December 21, 2003, at 23:33:57
In reply to MAOI users--experiences please, posted by Ilene on December 19, 2003, at 17:43:52
Posted by gardenergirl on December 22, 2003, at 8:34:45
In reply to Re: MAOI users--experiences please » cubbybear, posted by MelD on December 21, 2003, at 16:00:24
I have been on Nardil (45mg) for about 3 months now. I was initially extremely careful about the diet. Now I am looking into the research more to see what I can try. I recently tried a cheese and veggie pizze, making sure that the cheese was just mozzarella or provolone, as sometimes restaurants use a cheese blend which can include parmesan or asiago. So far, I have not had any problems with the mozzarella or provolone. That first piece of pizza in three months was awesome!
However, I did have a reaction on Thanksgiving day. My aunt had used the giblets for the dressing and then added the broth to the gravy. I had a pounding headache which lasted for about an hour and a half. By the time I got to a BP monitor, it had subsided.
Interestingly, I also was recovering from some serious dental work at the time and thought the pain was from too much chewing. The dentist had given me Vicoprofen (codeine and ibuprofen), and I had been taking that for about four days. I checked this out on a software program I have called epocrates, which stated no interactions between the Nardil and the pain med.
Despite the diet and med restrictions (which includes the herb ephedra, if I'm not mistaken), I would definitely recommend Nardil. It is the only AD that has worked for me. I would rather be "high maintenance" when out to eat than to be depressed all the time.
Good luck!
Posted by cubbybear on December 25, 2003, at 1:32:02
In reply to Re: MAOI users--experiences please » SLS, posted by SLS on December 21, 2003, at 9:56:48
>. After having been on and off MAOIs for the last 20 years
Hi Scott, I was re-reading your post and what you said really got me thinking. When you say MAOIs, do you mean Parnate as well as Nardil? How much experience have you had with Parnate? If you've had long term success with it, when did you first start taking it and where were you situated back then? Are you still in the same city and can you still obtain it as readily now?
Hang on here--I have more questions--am really dying to know:
To what extent have you encountered pdocs now who attempt to get you to stop MAOIs and switch to the latest and greatest SSRIs?
Have you had any experience with any other ADs? (I've had disappointing results with Remeron and Zoloft and positively horrid results with Moclobemide).Previously, we talked about the forbidden foods. Have you ever needed a pain killer for severe pain and run into a problem with that, while taking an MAOI?
And what about anesthesia for surgery?
(This last one has me concerned, since at some time in the future I might need another colonoscopy and it seems that the commonly used anaesthetics are contraindicated with MAOIs.) It's virtually impossible for me to get answers to these questions here in Thailand, since MAOIs are not available here and the doctors have no experience with it.
If you've had experience with MAOIs for nearly 20 years, perhaps we're nearly age mates; I was 35 when I first started Parnate in 1984. I'm curious to know all about your history with it, as I don't think I've ever communicated with anyone else (via Psychobabble or in person) who's been on an MAO as long as I have. So maybe we can share experiences.cubbybear
Posted by SLS on December 25, 2003, at 15:52:25
In reply to Re: MAOI users--experiences please » SLS, posted by cubbybear on December 25, 2003, at 1:32:02
Hi Cubbybear.
> >. After having been on and off MAOIs for the last 20 years
> Hi Scott, I was re-reading your post and what you said really got me thinking. When you say MAOIs, do you mean Parnate as well as Nardil?I've been on a bunch of different drugs. I've tried both Parnate and Nardil. I live in the US, so there is no problem buying it locally.
> How much experience have you had with Parnate?
The only treatment that was really successful for me was a combination of Parnate 60mg + desipramine 150mg. Unfortunately, when I began to develop mania while taking these, the doctor asked that I discontinue both drugs. When I later relapsed into depression, he declined to put me on both drugs again. Instead, he tried Parnate monotherapy. By the time we got around to I no longer respond to the original combination.
I find that Nardil does more to address anhedonia than does Parnate. I'm sure this is something that differs from person to person.
> Have you had any experience with any other ADs? (I've had disappointing results with Remeron and Zoloft and positively horrid results with Moclobemide).Moclobemide made me feel much, much worse.
I don't happen to have a good list of contraindicated foods or drugs available to post here. There are a bunch of sites on the Internet that can provide the information you are looking for. I wish I knew of a definitive source.
Sorry I couldn't be of more help.
- Scott
Posted by SLS on December 26, 2003, at 20:46:41
In reply to Re: MAOI users--experiences please » SLS, posted by cubbybear on December 25, 2003, at 1:32:02
Here's a great link listing MAOI food and drug interactions:
http://home.iprolink.co.nz/~felicity/Maoi-diet.pdf
- Scott
Posted by cubbybear on December 26, 2003, at 23:58:20
In reply to Re: MAOI users--experiences please » SLS, posted by SLS on December 26, 2003, at 20:46:41
> Here's a great link listing MAOI food and drug interactions:
>
> http://home.iprolink.co.nz/~felicity/Maoi-diet.pdf
>
> - ScottHi Scott,
Thanks for the great link.
cubbybear
Posted by SLS on December 27, 2003, at 8:29:38
In reply to Re: MAOI users--experiences please » SLS, posted by cubbybear on December 26, 2003, at 23:58:20
> > Here's a great link listing MAOI food and drug interactions:
> >
> > http://home.iprolink.co.nz/~felicity/Maoi-diet.pdf
I noticed that pepperoni was placed in the category of foods that are safe to eat. I think this is wrong for two reasons. I experienced an unequivocal tyramine reaction headache after eating two small slices. Also, it seems to me that pepperoni should be included in their list of "summer sausages" that should be avoided. Pepperoni is a type of salami and is considered to be a dry sausage. I am disappointed to see this important inaccuracy. You would think that more definitive work in this area would have been done by now, 45 years after the introduction of MAO inhibitor drugs.- Scott
This is the end of the thread.
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