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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by cubbybear on March 15, 2004, at 16:26:27
I did it. . .after 20 years of taking Parnate and adhering to the old guidelines of not eating a bit of cheese, I finally took the plunge and put away a whole Pizza Hut pie, with mozzarella, mushrooms and peppers. Result: no hypertensive crisis, and no trip to the emergency room.
Much thanks to the researchers who checked out all the cheeses and declared that mozzarella is safe with MAOIs. I'm going back for seconds!
Posted by djmmm on March 15, 2004, at 16:42:56
In reply to Pizza and Parnate? Yes!!, posted by cubbybear on March 15, 2004, at 16:26:27
> I did it. . .after 20 years of taking Parnate and adhering to the old guidelines of not eating a bit of cheese, I finally took the plunge and put away a whole Pizza Hut pie, with mozzarella, mushrooms and peppers. Result: no hypertensive crisis, and no trip to the emergency room.
> Much thanks to the researchers who checked out all the cheeses and declared that mozzarella is safe with MAOIs. I'm going back for seconds!lol...good for you (seriously) Just be careful about left-over pizza (pizza thats been in the fridge for a couple of days)
here is a link that I have posted before, it shows the tyramine levels of most types of cheese.
Posted by Ilene on March 15, 2004, at 20:10:44
In reply to Pizza and Parnate? Yes!!, posted by cubbybear on March 15, 2004, at 16:26:27
> I did it. . .after 20 years of taking Parnate and adhering to the old guidelines of not eating a bit of cheese, I finally took the plunge and put away a whole Pizza Hut pie, with mozzarella, mushrooms and peppers. Result: no hypertensive crisis, and no trip to the emergency room.
> Much thanks to the researchers who checked out all the cheeses and declared that mozzarella is safe with MAOIs. I'm going back for seconds!I'm glad you are enjoying your visit to LA.
Posted by Ilene on March 15, 2004, at 20:12:17
In reply to Re: Pizza and Parnate? Yes!!, posted by djmmm on March 15, 2004, at 16:42:56
Posted by cubbybear on March 16, 2004, at 16:26:44
In reply to Re: Pizza and Parnate? Yes!!, posted by djmmm on March 15, 2004, at 16:42:56
> lol...good for you (seriously) Just be careful about left-over pizza (pizza thats been in the fridge for a couple of days)
>
thanks for telling me about this. There happens to be a couple of slices left in the fridge that I was going to eat. After reading what you said, I'm going to chuck them out.
Posted by Sad Panda on March 16, 2004, at 18:21:33
In reply to Pizza and Parnate? Yes!!, posted by cubbybear on March 15, 2004, at 16:26:27
> I did it. . .after 20 years of taking Parnate and adhering to the old guidelines of not eating a bit of cheese, I finally took the plunge and put away a whole Pizza Hut pie, with mozzarella, mushrooms and peppers. Result: no hypertensive crisis, and no trip to the emergency room.
> Much thanks to the researchers who checked out all the cheeses and declared that mozzarella is safe with MAOIs. I'm going back for seconds!
>
>Hi Cubbybear,
20 years is along time for one drug, how much Parnate do you take?
Did you see the recent thread on Provolone? The confusing thing is the original Italian Provolone is a hard cheese with some age = don't know how much tyramine, where as there is the American version of Provolone which is a soft/fresh cheese with has little or no tyramine. Very confusing.
Cheers,
Panda.
Posted by cubbybear on March 18, 2004, at 11:58:04
In reply to Re: Pizza and Parnate? Yes!! » cubbybear, posted by Sad Panda on March 16, 2004, at 18:21:33
>
> Hi Cubbybear,
>
> 20 years is along time for one drug, how much Parnate do you take?My maintenance dose is 30 mg/day. I take 20 mg. in early A.M. and 10 mg. around lunchtime.
>
> Did you see the recent thread on Provolone? The confusing thing is the original Italian Provolone is a hard cheese with some age = don't know how much tyramine, where as there is the American version of Provolone which is a soft/fresh cheese with has little or no tyramine. Very confusing.
>
> Cheers,
> Panda.I didn't get to see that. . .I guess someone should get it clarified, or a new analysis taken.
I've been more concerned the last few days with getting in contact with my pdoc in New York and hearing what he has to say about Parnate and anaesthesia (for possible minor surgery in the future). This is definitely a bigger hassle to deal with than the food restrictions.
cubbybear
>
>
Posted by Ilene on March 19, 2004, at 10:51:47
In reply to Re: Pizza and Parnate? Yes!! » Sad Panda, posted by cubbybear on March 18, 2004, at 11:58:04
> I've been more concerned the last few days with getting in contact with my pdoc in New York and hearing what he has to say about Parnate and anaesthesia (for possible minor surgery in the future). This is definitely a bigger hassle to deal with than the food restrictions.
> cubbybear
> >
> >
>
I've read contradictory things about MAOIs and anesthetics. The newer, seemingly better-researched material says it's not such a big deal. I just can't find the information right now.From memory: The problem with local anesthesia is with the use of epinephrine (adrenaline) as a vasoconstrictor--or maybe not, according to one source, which said the problem was with norepinephrine.
Anyway, the consequence with a local could be hypertension.
With general or spinal anesthesia, the problem is a drop in blood pressure or a longer period of effect.
>
Post-surgery, you need to be careful if you take a narcotic. Some are safe--oxycodone, codeine, morphine--and some aren't, e.g. meperidine (Demerol).I.
Posted by Sad Panda on March 19, 2004, at 11:25:50
In reply to Re: Pizza and Parnate? Yes!! » cubbybear, posted by Ilene on March 19, 2004, at 10:51:47
> > I've been more concerned the last few days with getting in contact with my pdoc in New York and hearing what he has to say about Parnate and anaesthesia (for possible minor surgery in the future). This is definitely a bigger hassle to deal with than the food restrictions.
> > cubbybear
> > >
> > >
> >
> I've read contradictory things about MAOIs and anesthetics. The newer, seemingly better-researched material says it's not such a big deal. I just can't find the information right now.
>
> From memory: The problem with local anesthesia is with the use of epinephrine (adrenaline) as a vasoconstrictor--or maybe not, according to one source, which said the problem was with norepinephrine.
>
> Anyway, the consequence with a local could be hypertension.
>
> With general or spinal anesthesia, the problem is a drop in blood pressure or a longer period of effect.
> >
> Post-surgery, you need to be careful if you take a narcotic. Some are safe--oxycodone, codeine, morphine--and some aren't, e.g. meperidine (Demerol).
>
> I.
>
>Yes, the wierdo drugs like meperidine & tramadol are SRI's & may cause Serotonin syndrome.
Cheers,
Panda.
Posted by Mr.Scott on March 20, 2004, at 0:26:54
In reply to Re: Pizza and Parnate? Yes!! » Sad Panda, posted by cubbybear on March 18, 2004, at 11:58:04
I just started Parnate. Does anyone know of a good updated list of stuff to avoid somewhere online?
Scott
Posted by Ilene on March 20, 2004, at 10:19:55
In reply to MAOI diet question, posted by Mr.Scott on March 20, 2004, at 0:26:54
http://www.dr-bob.org/babble/20040218/msgs/316177.html
http://www.vh.org/adult/provider/psychiatry/CPS/19.html
http://home.caregroup.org/clinical/altmed/interactions/Nutrients/Tyramine-Contai.htm
Posted by sobeit on March 20, 2004, at 19:13:39
In reply to Re: MAOI diet question » Mr.Scott, posted by Ilene on March 20, 2004, at 10:19:55
I recall there being a scientific report from the Univ. of Toronto regarding tyramine concentration of specific foods. I can't recall the journal name at this time but will see if I can locate it again.
Posted by Mr. Scott on March 20, 2004, at 21:40:32
In reply to Re: MAOI diet question » Mr.Scott, posted by Ilene on March 20, 2004, at 10:19:55
Posted by djmmm on March 21, 2004, at 1:21:06
In reply to Re: MAOI diet question, posted by sobeit on March 20, 2004, at 19:13:39
> I recall there being a scientific report from the Univ. of Toronto regarding tyramine concentration of specific foods. I can't recall the journal name at this time but will see if I can locate it again.
This is from the Journal of Clinical Psychopharmacology, research done at the Univ of Toronto.
..."Fifty-one food samples were evaluated for tyramine content by liquid chromatography. Food samples included a selection of sausages, beverages, sliced meat products, including chicken liver, and some fruits, including raspberries, bananas, and banana peels. Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included chicken liver aged 9 days (63.84 mg/30 g), air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). Of the foods analyzed in this study, only those with high tyramine content per serving should continue to be absolutely restricted. All other foods are either safe for consumption or safe in moderation. The data provided should be combined with the data from other similar analytical studies to develop a list of foods that should be absolutely restricted. A more accurate list of restricted foods may enhance patient dietary compliance."
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8889911&dopt=Abstract
also: http://www.migraeniker.dk/Engelsk/triggers/Tyraminmigraene-english.htm
Posted by cubbybear on March 22, 2004, at 12:27:53
In reply to Re: Pizza and Parnate? Yes!!, posted by Sad Panda on March 19, 2004, at 11:25:50
I finally contacted my (genius) pdoc over the phone and he said that any anaesthetic,local or general, can not contain a stimulant,such as epinephrine.
Posted by sobeit on March 23, 2004, at 15:51:15
In reply to Re: MAOI diet question, posted by djmmm on March 21, 2004, at 1:21:06
> > I recall there being a scientific report from the Univ. of Toronto regarding tyramine concentration of specific foods. I can't recall the journal name at this time but will see if I can locate it again.
>
> This is from the Journal of Clinical Psychopharmacology, research done at the Univ of Toronto.
>
> ..."Fifty-one food samples were evaluated for tyramine content by liquid chromatography. Food samples included a selection of sausages, beverages, sliced meat products, including chicken liver, and some fruits, including raspberries, bananas, and banana peels. Foods that were found to have dangerously high concentrations of tyramine (> or = 6 mg/serving) included chicken liver aged 9 days (63.84 mg/30 g), air-dried sausage (7.56 g/30 g), soy sauce (0.941 mg/ml), and sauerkraut (7.75 mg/250 g). Of the foods analyzed in this study, only those with high tyramine content per serving should continue to be absolutely restricted. All other foods are either safe for consumption or safe in moderation. The data provided should be combined with the data from other similar analytical studies to develop a list of foods that should be absolutely restricted. A more accurate list of restricted foods may enhance patient dietary compliance."
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8889911&dopt=Abstract
>
>
> also: http://www.migraeniker.dk/Engelsk/triggers/Tyraminmigraene-english.htm
>
>
>
Hey, my memory is still in working order! Thanks, for posting the Univ. of Toronto abstract and address
Posted by Mr. Scott on March 24, 2004, at 21:13:53
In reply to Re: MAOI diet question, posted by sobeit on March 23, 2004, at 15:51:15
I generally experience anxiety, agitation, restlessness and other akathesia/mania/anxious/panic type side effects upon taking antidepressants. ALL OF THE ANTIDEPRESSANTS, and Wellbutrin is THE WORST. This phenomenon requires me to take larger doses of benzodiazepines and consider adding in all kinds of stuff like Lithium or Anticonvulsants.
I experience this as well on Parnate. Would you MAOI takers tolerate this or move on to an alternative diagnoses and or treatment. It's been a week at 10mg.
Thoughts appreciated.
Scott
Posted by Ilene on March 24, 2004, at 22:12:42
In reply to MAOI question, posted by Mr. Scott on March 24, 2004, at 21:13:53
> I generally experience anxiety, agitation, restlessness and other akathesia/mania/anxious/panic type side effects upon taking antidepressants. ALL OF THE ANTIDEPRESSANTS, and Wellbutrin is THE WORST. This phenomenon requires me to take larger doses of benzodiazepines and consider adding in all kinds of stuff like Lithium or Anticonvulsants.
>
> I experience this as well on Parnate. Would you MAOI takers tolerate this or move on to an alternative diagnoses and or treatment. It's been a week at 10mg.
>
> Thoughts appreciated.
>
> Scott
Parnate is the most activating of the three MAOIs available in the US. I've read it can have amphetamine-like effects. Nardil is the most sedating. Marplan is in the middle.If I were you, I'd discuss a change to one of the other two with your pdoc. It will probably require a wash-out period.
Benzos are safe to mix with MAOIs.
If you experience mania when you take an AD, then shouldn't you be taking a mood stabilizer? (As you said, lithium or an anticonvulsant.)
I'm getting better results now that I've added lithium to the mix (also taking Risperdal, Neurontin, and Klonopin, and Florinef for dysautonomia/low blood pressure). I don't know if this boost is permanent, though, and if you've read some of my other posts you might have noticed my thyroid seems to have gone south.
Posted by gardenergirl on March 25, 2004, at 8:02:32
In reply to Re: MAOI question » Mr. Scott, posted by Ilene on March 24, 2004, at 22:12:42
Mr. Scott,
Sorry to hear that your SE's are troublesome. I think Ilene's advice is sound. Forgive me for asking what may be an obvious question, but how much caffeine do you take in each day? AD's combined with caffeine can intensify the stimulating effects. Since I went on Nardil, even though it is the most sedating, I have limited my caffeine intake to one cup of coffee or one can of diet coke per day. Then I switch to decaffeinated stuff. That has really helped me with restlessness I sometimes get, particularly at night.Good luck!
gg
Posted by Sad Panda on March 25, 2004, at 8:38:55
In reply to MAOI question, posted by Mr. Scott on March 24, 2004, at 21:13:53
> I generally experience anxiety, agitation, restlessness and other akathesia/mania/anxious/panic type side effects upon taking antidepressants. ALL OF THE ANTIDEPRESSANTS, and Wellbutrin is THE WORST. This phenomenon requires me to take larger doses of benzodiazepines and consider adding in all kinds of stuff like Lithium or Anticonvulsants.
>
> I experience this as well on Parnate. Would you MAOI takers tolerate this or move on to an alternative diagnoses and or treatment. It's been a week at 10mg.
>
> Thoughts appreciated.
>
> Scott
>
>Are you BP2? Have you tried Lithium or Lamictal instead of AD's ?
Cheers,
Panda.
Posted by Mr. Scott on March 25, 2004, at 21:25:51
In reply to Re: MAOI question, posted by Sad Panda on March 25, 2004, at 8:38:55
Yes I am BPII. My doctor seems to think Lithium and anticonvulsants wont do the trick for depression though and that they are really only good for manic side symptoms with the exception of Lamictal. He also said Akathesia never occurs on antidepressants however... I'm sure you've seen the front page headlines regarding that issue this week. I don't have tremendous confidence in him at this point. He says he doesn't want to "rob me of my highs." At this point in the game my highs are pretty brief and generally turn into sickening agitation. I did best clinically on an SSRI/clonazepam combo, but that was years ago and now after they took me off of benzo's I cant tolerate ANY antidepressant. Currently I'm back on Tranxene (7.5mg), but that doesn't cut it as a mood stabilizer or an anxiolytic. I also take 450mg of Lithium and 600mg of Trileptal. I'd like to try Lithium and Clonazepam and then add in an AD if it's still necessary. My life is currently an absolute nightmare. I'm 29 years old and fully self-sufficient and my mom still said she'd give me a birthday present of 3 months in the psych ward of my choice if thats any indication of how well I'm doing. Since the age of 14 I've never been able to tolerate an AD without the induction of mixed or rapid cycling symptoms and yet I'm far more depressed than I am manic. I consume way too much caffeine out of necesity in order to be productive regularly consuming 5 cups and thensome. Whoever said it was right that at night it hits me and I start to climb the walls in an agitated state of hell with or without the antidepressants. I appreciate your input very much. I'm not trying to be dramatic, but for the last 3-4 years I've been in hell and not afraid to say so here on babble. I'll take any advice you folks can give me back to my doctor for discussion if you have any. Thank You!
Scott
Posted by Sad Panda on March 26, 2004, at 6:52:07
In reply to Re: MAOI question - Bipolar II, posted by Mr. Scott on March 25, 2004, at 21:25:51
> Yes I am BPII. My doctor seems to think Lithium and anticonvulsants wont do the trick for depression though and that they are really only good for manic side symptoms with the exception of Lamictal. He also said Akathesia never occurs on antidepressants however... I'm sure you've seen the front page headlines regarding that issue this week. I don't have tremendous confidence in him at this point. He says he doesn't want to "rob me of my highs." At this point in the game my highs are pretty brief and generally turn into sickening agitation. I did best clinically on an SSRI/clonazepam combo, but that was years ago and now after they took me off of benzo's I cant tolerate ANY antidepressant. Currently I'm back on Tranxene (7.5mg), but that doesn't cut it as a mood stabilizer or an anxiolytic. I also take 450mg of Lithium and 600mg of Trileptal. I'd like to try Lithium and Clonazepam and then add in an AD if it's still necessary. My life is currently an absolute nightmare. I'm 29 years old and fully self-sufficient and my mom still said she'd give me a birthday present of 3 months in the psych ward of my choice if thats any indication of how well I'm doing. Since the age of 14 I've never been able to tolerate an AD without the induction of mixed or rapid cycling symptoms and yet I'm far more depressed than I am manic. I consume way too much caffeine out of necesity in order to be productive regularly consuming 5 cups and thensome. Whoever said it was right that at night it hits me and I start to climb the walls in an agitated state of hell with or without the antidepressants. I appreciate your input very much. I'm not trying to be dramatic, but for the last 3-4 years I've been in hell and not afraid to say so here on babble. I'll take any advice you folks can give me back to my doctor for discussion if you have any. Thank You!
>
> Scott
>Hi Scott,
AFAIK Akathesia is a side effect of AP's & related to dopamine caused by AP's, how bad are your symptoms? When you say you have tried all AD's, have you tried NE only TCA's like Desipramine or Nortriptyline?
Cheers,
Panda.
Posted by Ilene on March 26, 2004, at 9:32:53
In reply to Re: MAOI question - Bipolar II, posted by Mr. Scott on March 25, 2004, at 21:25:51
Perhaps you should get a psychopharmacology consult. (I had one lined up, but then I wound up in the hospital and they put me on lithium anyway.)
Why were you taken off benzos? They are extremely useful.
It's interesting that you say you drink a lot of coffee. I used to drink it regularly, then got so I couldn't tolerate it, but for the past few weeks I find I *need* to drink it. I usually drink 48 oz (3 pints) a day. It's hard on my stomach, and sometimes makes me anxious, but it gives me a little boost. I've been extremely lethargic. (It may be my thyroid. I hope so, because that can be fixed.) There was a long thread on coffee about a month ago. I think most people found it had slight AD effects.
Sorry for rambling on...
Posted by Mr. Scott on March 27, 2004, at 23:11:57
In reply to Re: MAOI question - Bipolar II » Mr. Scott, posted by Sad Panda on March 26, 2004, at 6:52:07
Well...Again I'm assuming it's akathesia and not mixed bipolar symptoms which it could be. The fact that dystonia (muscle stiffness, rigidity, and restlessness) are present I assume it's Akathesia though. But to answer your question, I've never used a highly specific NE med. Wellbutrin however was the worst chemical I ever put in my body. That and marijuana are probably the worst chemicals to ever get inside my body.
Would it be strange for Parnate to be sedating???
Posted by Mr. Scott on March 27, 2004, at 23:26:51
In reply to Re: MAOI question - Bipolar II » Mr. Scott, posted by Ilene on March 26, 2004, at 9:32:53
I got taken off the benzos (klonopin) by a doctor who didn't like them. She said...If I was anxious I could take Zoloft and if I was bipolar I could take Lamictal, but that psychiatry "could do better than benzodiazepines."
The combo of Zoloft & Klonopin was great for my head. It made me gain 30 pounds, shot my cholesterol over 330, and gave me intense digestive distress that NEVER went away. So I left the doctor who took me off benzos and went to another doctor where I restarted that same combo. I eventually developed the neurological side effects I now get from all SSRI's beginning with severe apathy and ending with restless agitation and near disabling muscle aches.
I decided I didn't want that anymore and came off those meds again. Since then there's been only band aid solutions and new diagnoses because of my intolerance to ssri's.
Always feel free to ramble.
Scott
This is the end of the thread.
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