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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by Colleen D. on January 27, 2006, at 19:26:28
I've taken ADs since 1998. Here's the list:
Zoloft
Effexor
Remeron
Elavil
doxepin
LexaproI'm still using doxepin for nerve pain and insomnia. Effexor pooped out on me and the rest have proven themselves ineffective during fair trials. As far as the MAOI dietary recommendations go:
Chianti wine and vermouth, beer, whiskey, etc. - no problem; I only drink a beer or two when I am really depressed. Soy products are not a big deal either. Cheese - I could give to up in exchange for relief. It sounds like cream cheese and cottage cheese are okay. Fish - I have developed a distaste for most of it over the years. I have probably eaten too much over the course of my lifetime on the shores of Lake Huron. I don't consume ginseng. Protein extracts - I like fresh meat cooked at least medium. I could avoid cold cuts with little problem. Sauerkraut - I only cooked it for my soon-to be- ex. Shrimp paste - I've never eaten it. Canned soups - no problem there. Brewer's yeast or extracts - no biggie.
What else does one's pdoc consider when deciding if you are or are not a good candidate for MAOIs?
Any info is greatly appreciated.
Colleen
MDD, OCD, GAD and SP
Posted by CK1 on January 27, 2006, at 19:54:17
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
Coleen,
Definitely do not take MAOI's unless you are suicidal. I BEGGED my doctor to try Nardil and he finally gave in, but it had the worst side effects of any drug I've ever tried. They are sooooo potent and, yes, I believe they are dangerous. Seriously, try other things before going to MAOI's. You think SSRI's have side effects.........uhhhhh, not even close! Just keep that in mind.....
Posted by Phillipa on January 27, 2006, at 19:57:38
In reply to Re: When to consider MAOI therapy?, posted by CK1 on January 27, 2006, at 19:54:17
CK1 and you did so much research first!!!! Fondly, Phillipa
Posted by CK1 on January 27, 2006, at 20:14:19
In reply to Re: When to consider MAOI therapy? » CK1, posted by Phillipa on January 27, 2006, at 19:57:38
yea.....it seemed like the "wonder drug" didn't it! Ha! I was so enthusiastic that Nardil would crush the anxiety but it instead made me not able to function for a week AND my lips hurt for weeks afterwards from the dystonic reaction. Doctors are hesistant about MAOI's for a good reason.
I thought I was "back to normal" for the past 2 months, but I suddenly became really anxious this week and I realize that something needs to change. Heck, benzos seem to be the only things that really help now so we'll see.
Posted by gardenergirl on January 27, 2006, at 20:55:57
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
I've had an excellent response from Nardil, and my side effects have been manageable. The worst for me is probably weight gain. I admit I haven't been addressing that, but I really need to.
But the relief I've finally experienced, which I never got on SSRI's has been worth the occasional inorgasmia, hyperreflexia (that one is actually a bit amusing), urinary retention, and edema.
I haven't had much of a problem with the diet, either, although I did get a couple of horrible headaches after eating dressing with broth from the giblets at Thanksgiving and a cheescake with Tia Maria in it. I miss blue cheese, but I can live without it. I have a card printed out with my dietary restrictions, and I give this to waiters at restaraunts when eating out to make sure what I order is safe. No problems with that, either.
When I have a cold, I wish I could take a decongestant, but antihistamines and mint oil seem to help.
Whatever you decide, I hope you find some relief.
gg
Posted by Jedi on January 28, 2006, at 2:12:54
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
> I've taken ADs since 1998. Here's the list:
>
> Zoloft
> Effexor
> Remeron
> Elavil
> doxepin
> Lexapro
>
...
Colleen,
For treatment resistant atypical depression and anxiety: nothing beats Nardil with clonazepam. Everyone is different; because some people have bad side effects from a medication does not mean you will. I am not a PDOC but I would use MAOIs as a 2nd line and not a last resort for atypical depression. They have saved my life.
Good Luck,
Jedi
Posted by blueberry on January 28, 2006, at 4:43:49
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
Colleen,
Could you please tell me about doxepin? I am interested in it for sleep only. What dose do you take? Morning hangover? Side effects during the day? How fast for it to put you to sleep? Sleep quality?
I'm really sorry you feel bad. I have no experience with MAOIs. They seem to be like everything else...they work great for some people and lousy for others...some people get intense side effects and some don't.
I noticed that all your meds except doxepin are serotonin based. It might be worth looking at anything that targets other neuro's besides serotonin. Just as one example, something like prozac + zyprexa, because the combo has significant norepinephrine and dopamine enhancement. Anything different.
It might be an idea to try things with a rapid onset before trying something slower. For example, a few days trial of ritalin, then adderall. A few days trial of xanax (whether it makes sense or not).
On the natural side, cheap and fast acting trials could include DL-Phenylalanine 500mg with breakfast. Tyrosine 250mg-500mg 1 to 3 times a day. Rhodiola Rosea herb (dopamine and serotonin). If any are to help, they will do so in 1 to 3 days usually. Maybe even st johns wort, except that it is slow acting...though it does boost dopamine, norepinephrine, and gaba function in addition to serotonin.
Anyway, I'm wishing you a smooth day. When you get a chance, could you please share with me your answers to my questions about doxepin? Thanks!
Posted by willyee on January 28, 2006, at 4:57:35
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by blueberry on January 28, 2006, at 4:43:49
Responders to maois seem to be totaly UNrespondent to srris,i am one,i have responded to parnate,deprenyl,and molcimide partialy.
Nardil unfortuantly i dident but there is a deep rooted issue with nardil and its reformulation so i guess half of us never really tried to praised GOLD nardil since we all are using the reformulated one.
Moais for me dont cause hardly any side effects,other than im immune to them at this point.But i remember it was the lack of side effects and strong postive effect that made me feel parnate was gonna end my depression for good.So i think that poster above is a bit fiesty,i understand his postion being through such a negative experieance,but he has to understand maois might not be for everyone,i dont think this is the case a docter doesent use it.
Docters tend to use the newest medications,they are visited by saes people,that go to seminers etc.
They also wanna bring back results for these companies,so its unlikly a p doc is gonna dig up a dusty old medication,especialy if they never used it before,and have to worry about a single patient on it.
As far as diet goes,i think honestly you will either have a p doc willing to write it or you wont,if they are willing then they will work with you on the no no list.If they already are dead set aganist it,the restriction list will only strengthen there case since they never had any intention on giving it to you in the first place.
Last yess they are potent,but not more than wellbutrin or the ssris i took,in fact my problem is at this point parnate are like m&ms to me,i have to take a very hig dose to feel it,and this i dnt like since i feel taking random doses is heading towards that non-therputic recreational window of using them,this i dont want.
Posted by ed_uk on January 28, 2006, at 7:33:23
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
Hi Coleen
In your experience, how does doxepin (Sinequan) compare with amitriptyline (Elavil)?
Ed
Posted by Colleen D. on January 28, 2006, at 10:00:18
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by blueberry on January 28, 2006, at 4:43:49
Hi! Thanks for your suggestions. I really appreciate it!
About the doxepin, my GP recommended it after I had had enough of natural and other OTC sleep aids. I first tried trazodone and it gave me an awful hangover and an extreme urge to eat the following day. Doxepin works really well for me. I take it about an hour before bedtime and it helps me sleep all night long. I have no side effects and zero sleepiness the next morning. 25mg is the dosage I take and it is really inexpensive too...about $6 per month. It's worth a try at this cost.
Good luck!
Colleen
Posted by Colleen D. on January 28, 2006, at 10:03:59
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by ed_uk on January 28, 2006, at 7:33:23
Hi Ed!
Doxepin is much better for me. Elavil makes me want to eat A LOT when I take even a small dose at bedtime for insomnia. But I think Elavil makes me fall asleep faster.
Posted by Colleen D. on January 28, 2006, at 10:06:14
In reply to Re: When to consider MAOI therapy?, posted by CK1 on January 27, 2006, at 19:54:17
Hi again!
Yikes!!! It sounds like you had an awful experience with Nardil. Thanks for sharing your story with me.
Colleen
Posted by Colleen D. on January 28, 2006, at 10:10:55
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by gardenergirl on January 27, 2006, at 20:55:57
Thanks gg!
I like to hear all the pros and cons before I go to my pdoc with a proposal. I'm glad to hear the Nardil is helping you. Had you tried a lot of other ADs (SSRI and/or TCAs) before Nardil?
Colleen
Posted by Colleen D. on January 28, 2006, at 10:15:24
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by Jedi on January 28, 2006, at 2:12:54
Wow!
Thanks for your reply. I love my clonazepam and would have a hard time giving it up, so it's good to know that it blends well with Nardil. I truly understand that everyone is different. Had I let the horror stories from this board affect me, I would never had tried Effexor and would have missed out on the wonderful relief it gave me for over 1.5 years.
Colleen
Posted by Colleen D. on January 28, 2006, at 10:18:13
In reply to Re: When to consider MAOI therapy?, posted by willyee on January 28, 2006, at 4:57:35
Hi willyee!
Thanks for sharing your MAOI story. I'm sorry to hear that you did not find lasting relief. As far as I'm concerned, they are worth a try to get out of the funk I'm in. Best wishes to you!
Colleen
Posted by bennyj on January 28, 2006, at 13:06:24
In reply to When to consider MAOI therapy?, posted by Colleen D. on January 27, 2006, at 19:26:28
I would encourage to try a maoi if your doc is open to it...mine was a little reluctant at my suggestion to try nardil but he eased up on it after I showed him I did a bit of research into it (nardil is besti for social phobia over ssri's in the literature). SSRI's and SSNR's, although working initially for depression, have always ended up increasing anxiety horribly for me...as they can do for bpII patients. But nardil doesnt do this to me, it provides a nice lift in my depression even at a small dose. The diet restrictions are not difficult at all...for me I can dabble a little with cheeses and soy products without much of an impact...headaches are a warning. If you do start make sure you have adhered to the basic diet for a week or so prior to starting. Your doc may wish to bring you off that tricyclic for sleep though...adverse reaction could be possible.
keep smiling,
Bennardil 30mg
lamactil 25mg
trazodone 150mg> I've taken ADs since 1998. Here's the list:
>
> Zoloft
> Effexor
> Remeron
> Elavil
> doxepin
> Lexapro
>
> I'm still using doxepin for nerve pain and insomnia. Effexor pooped out on me and the rest have proven themselves ineffective during fair trials. As far as the MAOI dietary recommendations go:
>
> Chianti wine and vermouth, beer, whiskey, etc. - no problem; I only drink a beer or two when I am really depressed. Soy products are not a big deal either. Cheese - I could give to up in exchange for relief. It sounds like cream cheese and cottage cheese are okay. Fish - I have developed a distaste for most of it over the years. I have probably eaten too much over the course of my lifetime on the shores of Lake Huron. I don't consume ginseng. Protein extracts - I like fresh meat cooked at least medium. I could avoid cold cuts with little problem. Sauerkraut - I only cooked it for my soon-to be- ex. Shrimp paste - I've never eaten it. Canned soups - no problem there. Brewer's yeast or extracts - no biggie.
>
> What else does one's pdoc consider when deciding if you are or are not a good candidate for MAOIs?
>
> Any info is greatly appreciated.
>
> Colleen
> MDD, OCD, GAD and SP
Posted by gardenergirl on January 28, 2006, at 13:49:23
In reply to Re: When to consider MAOI therapy? » gardenergirl, posted by Colleen D. on January 28, 2006, at 10:10:55
> Thanks gg!
>
> I like to hear all the pros and cons before I go to my pdoc with a proposal. I'm glad to hear the Nardil is helping you. Had you tried a lot of other ADs (SSRI and/or TCAs) before Nardil?
>
> ColleenHi Colleen,
I tried a number of SSRI's, and then Celexa with
Wellbutrin before going to Nardil. I never tried any TCA's. Once I got the diagnosis of atypical depression and heard that MAOI's were the gold standard, I did some research (found Babble along the way) and asked my GP for it.He went ahead and prescribed it, but I don't think he really knew what he was giving me. I do know he trusted that I knew and was prepared for it.
When I started seeing a pdoc, I was afraid that she'd make me go through a bunch of med trials before giving me Nardil, but she kept me on it. I was very lucky to find two docs willing to work with me that well.
Good luck,
gg
Posted by gardenergirl on January 28, 2006, at 13:55:02
In reply to Re: When to consider MAOI therapy? » Colleen D., posted by bennyj on January 28, 2006, at 13:06:24
> If you do start make sure you have adhered to the basic diet for a week or so prior to starting. Your doc may wish to bring you off that tricyclic for sleep though...adverse reaction could be possible.
That's a good idea. When I washing out the Celexa, I "practiced" the diet to make sure I could handle it before I committed to Nardil.
gg
Posted by tallwaters on January 28, 2006, at 15:58:30
In reply to Re: When to consider MAOI therapy? » bennyj, posted by gardenergirl on January 28, 2006, at 13:55:02
after reading your posts and looking things I know I'm atypical. I've been labeled bipolar. recently I was given loratabs for pain and ended up drug seeking because it gave me such relief. I told my p- doc he wasn't suprised. But not the answer he said.
I wish it was I feel so good. He tried adderall because I'm so lethargic. It doesn't do anything but make me feel sick on top of being depressed. my Body feels like 10 tons. I can't keep up the house . I'd rather buy pajama's then clothes. I mentioned maoi to him last time and that I might end up on one and he said you might.. he mentioned something about a patch with all the restrictions. but I hear Nardil is the best. I have a family and they need me. I'm tired of feeling guilty.
I've been sick with anxiety and depression since I was 3. A very long history.
I'm grateful for your input.
Rainee
Posted by Tomatheus on January 28, 2006, at 16:12:59
In reply to Re: When to consider MAOI therapy?, posted by CK1 on January 27, 2006, at 19:54:17
CK1,
I will begin this post by saying that I do not think that you are trying to mislead others here. I'm sorry to hear that you had such a terrible reaction to Nardil, and I'm glad that you shared your experience.
But... between the extremes of your post and some of Ace's posts, it seems some of the things that have been said about Nardil on this board as of late (a minority of the Nardil-related statements, but still too many in my opinion) are not quite accurate. First, we had Ace, who quoted a doctor as saying that Nardil had a 95 percent success rate. And now, you're saying that patients should only take MAOIs if they're suicidal. Clearly, the truth has to lie somewhere in between the two extremes. I've read several studies in the psychiatric literature on the efficacy of Nardil. And even though I can't recall the exact efficacy range of Nardil from the studies, I can assure everyone here that 95 percent is far above the top of the drug's efficacy range, based on the studies that I've read. But it is also clear from the psychiatric literature and from the reports of patients on this site that some patients who do not respond favorably to other meds respond remarkably well to MAOIs. If MAOIs were reserved exclusively for suicidal patients, it is my belief that a lot of patients currently in remission (as a result of taking MAOIs) would still be highly symptomatic if they were denied these medications. So, even though MAOIs -- like most meds -- can cause adverse reactions in some patients, they have been known to be a blessing for others.
Finally, I seem to recall from reading your posts on Nardil that you were actually taking Adderall with your Nardil. Do I remember your posts correctly? If I do, I find it highly disturbing that you failed to mentioned this detail in the post that you just made here. Even though you still may not have responded well to Nardil alone, I do not think it is fully accurate to report having an adverse reaction to Nardil (or any medication) without mentioning that you were also taking a med that is officially contraindicated with the Nardil. Just like Ace's doctor's comment that Nardil's success rate is 95 percent, I think that your statements about Nardil (when taken as a whole) do not accurately reflect the drug's effects.
Tomatheus
Posted by willyee on January 28, 2006, at 16:48:23
In reply to Re: When to consider MAOI therapy? » CK1, posted by Tomatheus on January 28, 2006, at 16:12:59
After visiting the nardil activism group,post after post of VETERAN users,i have to believe that the reformulation plays a big role here.
According to numerous users the medication took on a entirly different effect afterwoards,i keep track there cause if they are able to do the unthinkable and win over pzifer and the old one comes back,then i will quickly jump on trying it.
Posted by Tomatheus on January 28, 2006, at 22:30:24
In reply to Re: When to consider MAOI therapy?, posted by willyee on January 28, 2006, at 16:48:23
> After visiting the nardil activism group,post after post of VETERAN users,i have to believe that the reformulation plays a big role here.
Willyee,
I am in complete agreement with you. In fact, I actually just finished writing a lengthy post on this very topic. If you're interested, check out the URL below:
http://www.dr-bob.org/babble/20060122/msgs/603926.html
Tomatheus
Posted by tallwaters on January 29, 2006, at 10:31:55
In reply to Re: When to consider MAOI therapy? ggirl, posted by tallwaters on January 28, 2006, at 15:58:30
Posted by tallwaters on January 29, 2006, at 10:33:49
In reply to The above message was to gardnergirl.. (nm), posted by tallwaters on January 29, 2006, at 10:31:55
Posted by gardenergirl on January 29, 2006, at 14:13:17
In reply to Re: When to consider MAOI therapy? ggirl, posted by tallwaters on January 28, 2006, at 15:58:30
Glad my input helped. It was quite a relief for me to get the right diagnosis, particularly since I felt depressed, but my symptoms were a little off from the usual.
Good luck,
gg
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