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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 9 to 33 of 43. Go back in thread:
Posted by Dan Perkins on November 20, 2004, at 0:49:32
In reply to Re: more MAOI diet questions, posted by sfy on November 19, 2004, at 19:51:37
Not so sure the nifedipine is a good idea. I was prescribed it by my pdoc but the preponderance of research and anecdotal information that I have come across show that you are better off not taking it in the event of a hypertensive crisis.
>But if you do go the MAOI route, your pdoc should prescribe a supply of nifedipine to carry just in case. If he/she doesn't then he has no business prescribing MAOI's.
Posted by KaraS on November 20, 2004, at 3:11:20
In reply to Re: more MAOI diet questions, posted by Dan Perkins on November 20, 2004, at 0:49:32
Once I commit to starting the Parnate I will be very careful diet-wise. If it means consuming only bottled beer and a small amount of it, then I'm more than willing to pay that price for my mental health. I have no problem giving up any of the other foods on the list either. I just want to be sure that I can identify them in foods prepared by someone else.
Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
Posted by King Vultan on November 20, 2004, at 11:01:15
In reply to Re: more MAOI diet questions, posted by KaraS on November 20, 2004, at 3:11:20
>
> Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.The authors (Perry and Lund) of a paper on MAOI adverse effects I have posted links to in the past also wind up discouraging the use of nifedipine. This is inspite of the fact that they state that "In all 29 cases of hypertensive crisis, the nifedipine was rapidly effective and no ADRs (adverse reactions) were noted even when the nifedipine was taken for the wrong reasons. No patient noted a rapid remission of the headache unless and until the nifedipine was taken." It should be noted that they seem to be referring to nifedipine taken sublingually (under the tongue); I have read other views elsewhere that the nifedipine pill should be crushed between the teeth and swallowed. I guess it's the latter method I would tend to use myself if I were in a situation where I was forced to use the nifedipine. However, I am not expecting to have to actually use it, given that I seem to be relatively careful and conscientious about the dietary and drug restrictions.
Todd
Posted by Iansf on November 20, 2004, at 13:25:56
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 20, 2004, at 11:01:15
> Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
>My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
Posted by KaraS on November 20, 2004, at 13:51:38
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 20, 2004, at 11:01:15
>
> >
> > Also, re: nifedipine, I hadn't heard any controversy about it's use for hypertensive crises. Has anyone of you ever taken it before? If so, how did it work? I read that reboxetine is actually good for countering this problem but I don't know if it's good after-the-fact or just prophylactically.
>
>
> Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
>
> The authors (Perry and Lund) of a paper on MAOI adverse effects I have posted links to in the past also wind up discouraging the use of nifedipine. This is inspite of the fact that they state that "In all 29 cases of hypertensive crisis, the nifedipine was rapidly effective and no ADRs (adverse reactions) were noted even when the nifedipine was taken for the wrong reasons. No patient noted a rapid remission of the headache unless and until the nifedipine was taken." It should be noted that they seem to be referring to nifedipine taken sublingually (under the tongue); I have read other views elsewhere that the nifedipine pill should be crushed between the teeth and swallowed. I guess it's the latter method I would tend to use myself if I were in a situation where I was forced to use the nifedipine. However, I am not expecting to have to actually use it, given that I seem to be relatively careful and conscientious about the dietary and drug restrictions.
>
> Todd
So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
Posted by KaraS on November 20, 2004, at 13:55:16
In reply to Re: nifedipine » King Vultan, posted by Iansf on November 20, 2004, at 13:25:56
> > Yes, there are different schools of thought on nifedipine and MAOIs. My GP does not think it's a very good idea, and I know that one of this specialities is blood pressure meds, and he probably does have legitimate reason for concern. My pdoc--from whom I got the prescription--seems to be less concerned, but he said that ideally, the prudent thing to do is to visit a hospital emergency room if a hypertensive crisis occurs. The problem with that is the anecdotes I've read from people who have done this and suffered horribly because the people at the hospital were ignorant and/or did not take their symptoms seriously, and the patients did not receive proper (or any) treatment.
> >
>
> My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
Posted by Iansf on November 20, 2004, at 19:13:12
In reply to Re: nifedipine » Iansf, posted by KaraS on November 20, 2004, at 13:55:16
> >
> > My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
>
> How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
>
>
As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis, yet if there were a large amount you'd think the taste would make its presence evident.
Posted by SLS on November 20, 2004, at 19:34:26
In reply to Re: nifedipine » KaraS, posted by Iansf on November 20, 2004, at 19:13:12
Hi.
> As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis,
The amount of tyramine that can cause a hypertensive event can be measured in milligrams. It doesn't take much. My only hypertensive reaction came from taking a single bite out of a pepperoni pizza. I ingested probably 1 1/2 pieces of thinly sliced pepperoni. The headache was pretty classic - pounding and eminating from the base of the skull in the back (occipital). I was taking Parnate 60mg at the time. I believe that it was the pepperoni because the plain pizzas coming from the same restaurant had not given me any problems. The appearance of the "cheese" reaction is rather unpredictable. That's why it should be respected.
- Scott
Posted by gardenergirl on November 20, 2004, at 21:48:59
In reply to Re: nifedipine, posted by SLS on November 20, 2004, at 19:34:26
Turkey giblets in the gravy and dressing
gg
Posted by King Vultan on November 21, 2004, at 10:13:19
In reply to Re: nifedipine » King Vultan, posted by KaraS on November 20, 2004, at 13:51:38
>
>
> So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
>
>Yes, I do carry it (2 x 10 mg). Since I also carry Parnate with me so that I can take it throughout the day, it is no additional inconvenience to carry the nifedipine.
Todd
Posted by KaraS on November 21, 2004, at 15:54:25
In reply to Re: nifedipine » KaraS, posted by Iansf on November 20, 2004, at 19:13:12
> > >
> > > My experience at the emergency rooms was certainly unpleasant. I was made to feel as if I was wasting their time.
> >
> > How awful for you. It's not bad enough we have to deal with all of the ignorance around depression itself, but then to have to deal with the ignorance about this kind of immediate serious medical condition is unimaginable. What food did you eat that created the experience to begin with?
> >
> >
> As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis, yet if there were a large amount you'd think the taste would make its presence evident.Maybe you had one of those spontaneous hypertensive crises. How frightening. How long were you on it before that happened? I'm assuming you went off of the medication at that point?
Posted by KaraS on November 21, 2004, at 15:58:01
In reply to Re: nifedipine, posted by SLS on November 20, 2004, at 19:34:26
> Hi.
>
> > As far as I know, none. I couldn't trace the crisis to any food or drug. Of course, it's possible there was some ingredient I didn't know about in something I ate. It would be rare for a tiny amount of something to cause a crisis,
>
> The amount of tyramine that can cause a hypertensive event can be measured in milligrams. It doesn't take much. My only hypertensive reaction came from taking a single bite out of a pepperoni pizza. I ingested probably 1 1/2 pieces of thinly sliced pepperoni. The headache was pretty classic - pounding and eminating from the base of the skull in the back (occipital). I was taking Parnate 60mg at the time. I believe that it was the pepperoni because the plain pizzas coming from the same restaurant had not given me any problems. The appearance of the "cheese" reaction is rather unpredictable. That's why it should be respected.
>
>
> - Scott
That's amazing. What does one do when the problem occurs? How long does it last? Did you take something or ride it out? Did you go to an emergency room?
Posted by KaraS on November 21, 2004, at 16:01:29
In reply to Re: nifedipine, posted by gardenergirl on November 20, 2004, at 21:48:59
> Turkey giblets in the gravy and dressing
>
> gg
Hi gg,I'll ask you the same questions I asked Scott:
Was that the only crises you've had? what did you do about it? Did you take nifedipine? Did you go to an emergency room? How long did it last? It must not have been that awful as you still continued on the medication.K
Posted by KaraS on November 21, 2004, at 16:04:30
In reply to Re: nifedipine » KaraS, posted by King Vultan on November 21, 2004, at 10:13:19
>
> >
> >
> > So, do you carry it just in case or not? I wonder why they don't recommend taking it given all the positive things you said about it.
> >
> >
>
> Yes, I do carry it (2 x 10 mg). Since I also carry Parnate with me so that I can take it throughout the day, it is no additional inconvenience to carry the nifedipine.
>
> Todd
>
>
So you've obviously weighed the pros and cons of nifedipine and decided the pros have it. I shouldn't think it would be much of an inconvenience particularly if you think it would be helpful.Kara
Posted by KaraS on November 21, 2004, at 18:00:08
In reply to Re: nifedipine, posted by gardenergirl on November 20, 2004, at 21:48:59
> Turkey giblets in the gravy and dressing
>
> gg
Actually, now that I think about it, why should this cause a problem unless the giblets were aged?
Posted by gardenergirl on November 21, 2004, at 19:50:52
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 21, 2004, at 16:01:29
I think liver of any kind for some reason has more tyramine in it. But I could be wrong.
I got a terrible headache, but I attributed it at the time to some dental work I had done that week. I took a Vicoprofen that had been prescribed by the dentist, but it didn't help at all. I just rode it out. My cousin is a massage therapist, and she tried to help, but nothing did. I finally left early, and by the time I got home my BP was running about 129/75, which is a tiny bit high for me, but still normal.
I used to get migraines a lot, which actually have gone away with Nardil. So this wasn't any worse. I didn't realize it might have been a hypertensive crisis (or maybe just concern? ;) until a week or two later.
I've never had another one.
gg
Posted by KaraS on November 22, 2004, at 3:05:33
In reply to Re: nifedipine, posted by gardenergirl on November 21, 2004, at 19:50:52
> I think liver of any kind for some reason has more tyramine in it. But I could be wrong.
>
> I got a terrible headache, but I attributed it at the time to some dental work I had done that week. I took a Vicoprofen that had been prescribed by the dentist, but it didn't help at all. I just rode it out. My cousin is a massage therapist, and she tried to help, but nothing did. I finally left early, and by the time I got home my BP was running about 129/75, which is a tiny bit high for me, but still normal.
>
> I used to get migraines a lot, which actually have gone away with Nardil. So this wasn't any worse. I didn't realize it might have been a hypertensive crisis (or maybe just concern? ;) until a week or two later.
>
> I've never had another one.
> gg
Thanks, gg.I went out to dinner tonight and I looked at the menu as if I were on Parnate already. I thought I understood what was safe and what wasn't but then I looked at the menu and it was all a blur to me. I got very scared that I wouldn't be able to handle this. Were you overwhelmed at first too? Also, how much nifedipine do you carry with you? How much would you take if you were to experience a problem?
Kara
Posted by gardenergirl on November 22, 2004, at 8:08:19
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 22, 2004, at 3:05:33
Hi Kara,
Yes, it was a bit overwhelming at first. Do you cook? If you do it helps, cause you can have some idea already of the basics that go into certain dishes. The things I find that are the trickiest are salads, sauces, and multi-ingredient dishes like pastas, casseroles, crab cakes, etc. You can't go wrong with a steak, baked potato, and salad without cheese and dressing on the side.I don't carry nifedipine. I started out getting Nardil from my GP, and we never considered it. My pdoc didn't suggest it, and since reports have been mixed, and I am very very careful, I feel okay without it. I do wear a bracelet and have told a trusted few people at work and school what it means, so that if I do have to go to the ER, hopefully it wouldn't be so bad. It may help that I am a psych. intern, too. That may give me some credibility in the ER. Although I could be raving mad at the time.
I guess I mostly don't worry about it, because I think I have the restrictions managed well.
Good thought about acting as if you were already on Parnate. I "practiced" the diet restrictions while washing out my Celexa and Wellbutrin to make sure I could really do it. It was easier than I thought, although I do miss Irish Cheddar and Brie. :(
gg
Posted by KaraS on November 22, 2004, at 16:07:52
In reply to Re: nifedipine » KaraS, posted by gardenergirl on November 22, 2004, at 8:08:19
> Hi gg,
> Yes, it was a bit overwhelming at first. Do you cook? If you do it helps, cause you can have some idea already of the basics that go into certain dishes.I don't cook much but I do have some idea of what goes into making various dishes.
The things I find that are the trickiest are salads, sauces, and multi-ingredient dishes like pastas, casseroles, crab cakes, etc. You can't go wrong with a steak, baked potato, and salad without cheese and dressing on the side.Yes, I'm sure I would start out by eating the most basic kinds of foods - although even with steak, they can so easily add some kind of teriaki or steak sauce that would be dangerous. Obviously people here go out to eat and everyone seems to manage so I know intellectually that it's very manageable. Just wish I weren't so scared and unsure of myself in this case.
> I don't carry nifedipine. I started out getting Nardil from my GP, and we never considered it. My pdoc didn't suggest it, and since reports have been mixed, and I am very very careful, I feel okay without it. I do wear a bracelet and have told a trusted few people at work and school what it means, so that if I do have to go to the ER, hopefully it wouldn't be so bad. It may help that I am a psych. intern, too. That may give me some credibility in the ER. Although I could be raving mad at the time.LOL
Yes, I'd get a medic alert bracelet and/or necklace and I'd get something to measure my blood pressure too. Telling some trusted people is a good thing but I'm doing temp work and looking for a job so I won't be able to tell anyone for a while.
> I guess I mostly don't worry about it, because I think I have the restrictions managed well.
>
> Good thought about acting as if you were already on Parnate. I "practiced" the diet restrictions while washing out my Celexa and Wellbutrin to make sure I could really do it. It was easier than I thought, although I do miss Irish Cheddar and Brie. :(Well, I didn't exactly practice it. I looked at the menu and panicked - but it's a start I guess. I'm sure I will miss more than a few things but they're well worth giving up if it means some relief from my (adult) life-long depression.
Thanks again for all of your help!
Kara
Posted by gardenergirl on November 22, 2004, at 18:13:28
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 22, 2004, at 16:07:52
Anytime. Are you definitely planning to start Parnate? When do you wash out, and when do you start, if so.
You know, I have a BP monitor at home, but I wonder if it might be better to carry in my car. Although I wonder if cold or heat might mess it up. Luckily, I am interning at a university health clinic, so I can get my BP taken anytime. I should ask if they stock nifedipine.
gg
Posted by KaraS on November 22, 2004, at 19:08:03
In reply to Re: nifedipine » KaraS, posted by gardenergirl on November 22, 2004, at 18:13:28
> Anytime. Are you definitely planning to start Parnate? When do you wash out, and when do you start, if so.
Right now I'm just starting selegiline with DLPA. I'll give that 2-3 weeks and then when that doesn't work, I think I'll try Parnate (after at least a 2 week wash out period). I have to talk my doctor into it as well. Last message from him he wanted Nardil but I think Parnate would be better for my anergic depression. He said that you can't even find Parnate anymore. I called the local Walgreens and they have it. I can also order it cheaper from Canada. I think it may be making a bit of a comeback from when he last got his information. So we'll see.
How long have you been on Nardil? Did you ever try Parnate? Had you also tried a million other ADs that did virtually nothing for you before you tried the Nardil?
> You know, I have a BP monitor at home, but I wonder if it might be better to carry in my car. Although I wonder if cold or heat might mess it up. Luckily, I am interning at a university health clinic, so I can get my BP taken anytime. I should ask if they stock nifedipine.
>
> ggYou're certainly in the best place to get assistance should you need it. I have a feeling you won't need it though.
Take care,
KaraP.S. Could you see any reason why I couldn't use dried milk in my coffee or buy Kefir or those soy type yogurts while on an MAOI?
Posted by gardenergirl on November 22, 2004, at 21:43:03
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 22, 2004, at 19:08:03
>
> How long have you been on Nardil? Did you ever try Parnate? Had you also tried a million other ADs that did virtually nothing for you before you tried the Nardil?I've tried a number of SSRI's, and most recently was on Celexa and Wellbutrin. None of them gave me the relief from atypical depression like Nardil. I started Nardil because that's what the GP picked out of MAOI's. It must be about 14-15 months on it now at 60 mg. I tried 75 mg and couldn't tolerate it...too restless and horrible insomnia. 67.5 was okay, but gave me a lot of edema.
Never tried Parnate. I did talk to my pdoc about switching, mostly due to weight gain. She looked it up and said while reading the book, "if weight gain is an issue, than Nardil is the drug of choice." That makes no sense to me. I'm wondering if what was there was about someone who NEEDS to gain weight, in which case, shoot yes, Nardil will do it. So I may ask her to check again, although the idea of washing out Nardil to switch to Parnate is kind of scary.
>
> P.S. Could you see any reason why I couldn't use dried milk in my coffee or buy Kefir or those soy type yogurts while on an MAOI?Dried milk should be fine, I don't know what Kefir is. I eat yogurt without a problem, although I will not eat it after the expiration date. I don't know enough about soy yogurt to answer your question. I tend to stay away from soy stuff, mostly because the stuff I've tried tasted ucky, not because of the Nardil. :)
gg
>
Posted by KaraS on November 23, 2004, at 1:01:32
In reply to Re: nifedipine » KaraS, posted by gardenergirl on November 22, 2004, at 21:43:03
>
> >
> > How long have you been on Nardil? Did you ever try Parnate? Had you also tried a million other ADs that did virtually nothing for you before you tried the Nardil?
>
> I've tried a number of SSRI's, and most recently was on Celexa and Wellbutrin. None of them gave me the relief from atypical depression like Nardil. I started Nardil because that's what the GP picked out of MAOI's. It must be about 14-15 months on it now at 60 mg. I tried 75 mg and couldn't tolerate it...too restless and horrible insomnia. 67.5 was okay, but gave me a lot of edema.
>
> Never tried Parnate. I did talk to my pdoc about switching, mostly due to weight gain. She looked it up and said while reading the book, "if weight gain is an issue, than Nardil is the drug of choice." That makes no sense to me. I'm wondering if what was there was about someone who NEEDS to gain weight, in which case, shoot yes, Nardil will do it. So I may ask her to check again, although the idea of washing out Nardil to switch to Parnate is kind of scary.
Yeah, from what I've read about it and heard here, Parnate is the one less likely to cause weight gain. Are you gaining a lot of weight on Nardil? I've heard that some people have trouble exercising while taking it. That can't help with weight gain either. They both seem to have their plusses and minuses. Parnate seems to cause more insomnia. It seems we always have to balance weight gain with insomnia with these meds.
> > P.S. Could you see any reason why I couldn't use dried milk in my coffee or buy Kefir or those soy type yogurts while on an MAOI?
>
> Dried milk should be fine, I don't know what Kefir is. I eat yogurt without a problem, although I will not eat it after the expiration date. I don't know enough about soy yogurt to answer your question. I tend to stay away from soy stuff, mostly because the stuff I've tried tasted ucky, not because of the Nardil. :)
>
> ggI've become addicted to the soy yogurts. They taste like regular yogurt but without the sharp bite. You might like them even if you don't like other soy products. Actually they were an acquired taste for me so maybe not. I'd hate to give them up but I'm sure I can find some other food addiction to replace them. There's always chocolate!
BTW, what is the marmite yeast stuff? Is it just something from the health food store that some people take as a supplement or do people actually cook with it? I don't suppose it's something we'd have to worry about being used in a dish at a restaurant, would we?
Kara
Posted by ed_uk on November 23, 2004, at 6:35:15
In reply to Re: nifedipine » gardenergirl, posted by KaraS on November 23, 2004, at 1:01:32
Hi,
Marmite is quite popular in England but I think it's horrible! People usually put it on toast or sandwiches.
Ed
Posted by KaraS on November 23, 2004, at 14:22:37
In reply to Re: Marmite, posted by ed_uk on November 23, 2004, at 6:35:15
> Hi,
>
> Marmite is quite popular in England but I think it's horrible! People usually put it on toast or sandwiches.
>
> EdIs it kind of like vegemite?
Do I not have to worry that a restaurant would be using it to cook with?
K
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