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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 56. This is the beginning of the thread.
Posted by TylerJ on March 10, 2006, at 10:40:12
I've noticed that a lot of Babbler's are afraid of MAOI's, unfortunately, do to bad information that just isn't true. True they can dangerous if combined with Tyramine,(hypertensive crisis) but stick to the diet (which is not hard to do) and you should be fine. I know there are other very good antidepressants out there, I just don't want people to miss out on MAOI efficacy because of fear that is usually based on misinformation and false rumors.
MAOI's are particularly useful in treatment of Major depression with atypical features. They also have significant efficacy in anxiety disorders, such as social phobia and panic disorder with agoraphobia and OCD.
They also (Most of the time) work more quickly than other depressants...I always hated that 4-6 wk. wait. For me, parnate worked in 1 wk. And when they work..WOW it's a great experience, that feels wonderful! With ssri's, snri's, TCA's I never even came close to feeling this good. I always told my doc I want something that I can actually feel...finally Parnate, and yes you can actually feel it working. Please, no hard feelings to anyone who refuses to try an MAOI, just trying to be helpful and help others find what I have found. And Yes, I know...just because it works for me DOES NOT mean it'll work for everyone...But if you are still suffering and fed up with the other meds, it's worth a try!Tyler
Posted by Chairman_MAO on March 10, 2006, at 12:18:20
In reply to Many people fear MAOI's...., posted by TylerJ on March 10, 2006, at 10:40:12
I've said it before and I'll said it again:
The MAOIs are the only drugs marketed in the US that, IMHO, are not disingenuously labelled "antidepressants".
Posted by bassman on March 10, 2006, at 16:38:08
In reply to Many people fear MAOI's...., posted by TylerJ on March 10, 2006, at 10:40:12
I've read where some people say they feel better than they ever have in their life after starting MAOI's-and it's great to read from someone that's taken them that you won't instantly die if you have a bite of pizza. To me,and maybe others, not being able to ever have a glass of wine or a beer is a real minus (if you are REALLY suffering, nothing is too much to give up, like sex sometimes with SSRI's). Thanks for the perspective!
Posted by vainamoinen on March 10, 2006, at 17:04:58
In reply to Many people fear MAOI's...., posted by TylerJ on March 10, 2006, at 10:40:12
Any speculation as to why the MAOI's work so much better than the SSRI's?
Is it because they act significantly on dopamine whereas most other AD's work on serotonin, or norepinephrine, but only to a lesser extent if at all on dopamine?
Posted by JaclinHyde on March 10, 2006, at 17:53:42
In reply to Re: Many people fear MAOI's.... » TylerJ, posted by Chairman_MAO on March 10, 2006, at 12:18:20
> I've said it before and I'll said it again:
>
> The MAOIs are the only drugs marketed in the US that, IMHO, are not disingenuously labelled "antidepressants".LOL, 'disingenuously'??? For the sake of all the good people on this board who may be on topamax let's use words we can all understand ;-)
hehe
JH
Posted by bassman on March 10, 2006, at 17:55:49
In reply to Re: Many people fear MAOI's...., posted by vainamoinen on March 10, 2006, at 17:04:58
I don't think so...then Wellbutrin would be the best AD on the face of the earth, because it is directed towards dopamine. Monoamino oxidase may itself just be important to target; but actually no ones know FOR SURE why any of the AD's work-remember when the criticism of TCA's was that they influenced more than one neurotransmitter and were therefore "dirty" and SSRI's were serotonin-selective and so much better? Now we have Cymbalta, etc. that target more than one neurotransmitter (SSNRI) and are the "newest" thing. Remember how Xanax was synthesized to have a short half-life because it was believed that the long half-life of Valium in the body caused dependence? And Xanax is probably the hardest benzo to withdraw from? I think finding the right meds is like finding what flavor jelly bean you like: there is no good theory, you just make reasonable choices until you find the right jellybean or decide jellybeans aren't for you. Or maybe it's all just magic.:>}
Posted by Phillipa on March 10, 2006, at 18:41:56
In reply to Re: Many people fear MAOI's...., posted by bassman on March 10, 2006, at 17:55:49
What if none of them work? Fondly, Phillipa
Posted by JaclinHyde on March 10, 2006, at 19:12:41
In reply to Re: Many people fear MAOI's...., posted by Phillipa on March 10, 2006, at 18:41:56
What I find so sad soometimes is that people totally refuse to consider the MAOI's because of the 'risk' associated with them and yet they don't realize the risk they are taking just by being depressed or full of anxiety. Suicide kills more people then sour cream does to a MAOI user. And the anxiety ridden out there are afraid of everything to begin with (been there, done that.) The big 'risk' in taking an MAOI is getting off the perpetual drug merry-go-round, getting better and living life to its fullest. They're success rate is a whopping 99%. Of course there will be exceptions but having them work is the norm. And they have been around so long that we know the risks they present. I always wonder if, in 10 or 20 years we all will be having 2 headed kids (mine are already like that but the heads are invisible, lol!) from taking the 'new and improved' anti-d's!
MAOI's....better living through chemistry :-)
JH
Posted by sdb on March 10, 2006, at 19:37:27
In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 19:12:41
The fear is maybe due to often occurring sideeffects like:
-weight gain, sweet craving
-hypertensive crisis (tyramine)->hopefully never happens
-total sexualdisfunction~sdb
Posted by TylerJ on March 10, 2006, at 19:42:57
In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 17:53:42
> > I've said it before and I'll said it again:
> >
> > The MAOIs are the only drugs marketed in the US that, IMHO, are not disingenuously labelled "antidepressants".
>
> LOL, 'disingenuously'??? For the sake of all the good people on this board who may be on topamax let's use words we can all understand ;-)
>
> hehe
> JH
>
>
Lol...I agree..some people like to impress, don't you think? :)Ty
Posted by TylerJ on March 10, 2006, at 19:47:30
In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 19:12:41
> What I find so sad soometimes is that people totally refuse to consider the MAOI's because of the 'risk' associated with them and yet they don't realize the risk they are taking just by being depressed or full of anxiety. Suicide kills more people then sour cream does to a MAOI user. And the anxiety ridden out there are afraid of everything to begin with (been there, done that.) The big 'risk' in taking an MAOI is getting off the perpetual drug merry-go-round, getting better and living life to its fullest. They're success rate is a whopping 99%. Of course there will be exceptions but having them work is the norm. And they have been around so long that we know the risks they present. I always wonder if, in 10 or 20 years we all will be having 2 headed kids (mine are already like that but the heads are invisible, lol!) from taking the 'new and improved' anti-d's!
>
> MAOI's....better living through chemistry :-)
>
> JHGood stuff..thanks.
Ty
Posted by JaclinHyde on March 10, 2006, at 20:13:10
In reply to Re: Many people fear MAOI's...., posted by sdb on March 10, 2006, at 19:37:27
> The fear is maybe due to often occurring sideeffects like:
> -weight gain, sweet craving
> -hypertensive crisis (tyramine)->hopefully never happens
> -total sexualdisfunction
>
> ~sdbWell, except for the hypertensive crisis you could be talking about any antidepressant out there on the market today. And you could probably include hypertension in any description of Wellbutrin plus a slight risk of seizures to boot. Plus if you are talking about Parnate then weightLOSS is much more probable then weight gain :-)
JH
Posted by RobertDavid on March 10, 2006, at 21:44:30
In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 20:13:10
I'm saw my psychiatrist yesterday and I'm trying my first MAOI, EMSAM (when it's at the pharmacy). I have SP with some depression. If EMSAM doesn't work I'll be going to Nardil then Parnate.
I'm hopeful it will work though, my doc thinks it will particularly if I blend it with the klonopin I now take. Ultimately I'll try it in mono therapy, but if I need both, great.
Though we did review the significant food restrictions for MAOI's such as aged cheeze, he told me not to worry about it. That I just needed to watch certain other meds like SSRI's, certain pain killers, etc. He suggested that even at higher doses of 30 and 40mgs there shouldn't be food issues, it's just that it wasn't approved without food issues at those doses.
He also suggested that the side effects of EMSAM will be even less than SSRI's and other anti depressants. So an MAOI without diet concerns, fewer side effects (weight gain, libido issues) that may help my anxiety and depression, I'm going for it. Lastly, the once a day steady dosing via the patch.
It all sounds to good to be true. Hopefully it will be, If not, I'm with those of you who deal with the issues of Nardil/Parnate. All I care about anymore is quality of life. I'll gladly trade a few side effects for something that actually works.
Posted by Phillipa on March 10, 2006, at 22:10:49
In reply to Re: Many people fear MAOI's...., posted by RobertDavid on March 10, 2006, at 21:44:30
If it's anything like the natural hormone cream I'll jump on the bandwagon too. I know you will all keep us informed. I really really hope it all it's supposed to be Fondly , Phillipa
Posted by jedi on March 10, 2006, at 23:58:28
In reply to Re: Many people fear MAOI's...., posted by bassman on March 10, 2006, at 16:38:08
> I've read where some people say they feel better than they ever have in their life after starting MAOI's-and it's great to read from someone that's taken them that you won't instantly die if you have a bite of pizza. To me,and maybe others, not being able to ever have a glass of wine or a beer is a real minus (if you are REALLY suffering, nothing is too much to give up, like sex sometimes with SSRI's). Thanks for the perspective!
Hi bassman,
When Nardil broke my first major depression, almost ten years ago, it was like being struck by lightning. It did take four or five weeks to happen. But, I went from being hopelessly lost and on the verge of dying one day to being full of hope and energy the next. Since then I have had 2+ major depressions, each coming while trying to find a substitute for Nardil. My main problem with the med is weight gain from severe, sweet carbohydrate cravings. Up and down 80+ pounds multiple times is not really good on the health. Weight gain is also one of the symptoms of atypical depression for which Nardil is the gold standard. There is a school of thought that if you have atypical depression and social anxiety, you are not considered treatment resistant until you have had a six week trial on Nardil.On the diet thing. It is grossly overstated almost everywhere but here. The trouble is what is safe for me while on MAOIs may kill someone else. With that said, domestic bottled beer(Yech!)causes me no problems. White and pink wine have never bothered me even a little. I can eat mass quantities of pizza and chocolate with no problem. Aged cheeses and meats are the worst offenders. And, I guess you won't find me eating bananna peels on Nardil. Most over the counter cold remedies are off limits. Live with it or go get some real stuff(narcotics) from your GP.
I bought some codeine cough syrup once while in Canada. Codeine is sold over the counter in Canada. In small print that I could not read without eye glasses were the words "pseudoephedrine HCL". No MAOI warnings at all. The pharmacist at a major chain in Canada and the US said the cough syrup was fine with phenelzine. Obviously, she was wrong. I don't believe Nardil is subscribed enough in Canada for the pharmacist to know the danger. They are used to the reversable and less potent MAOIs in that country. Well, a trip to the ER and a very expensive CT scan convinced me to always read the fine print. I believe that users of MAOIs have to be a little more knowledgeable about their medications than the average person. The meds are just too dangerous to skip the "due diligence". This comes from a person that has been in the ER twice, over a period of 10 years, for food and drug reactions while on MAOIs I probably did not have to go to the hospital in either case, but better safe than sorry.
Some of my experiences,
JediPS Here is a MAOI diet that I have found no fault with. It was created by an early poster, Elizabeth. That lady must have a photographic memory. She is recognized by many of the early readers and posters on this board to be the "guru of treatment resistant depression". Hopefully, she still looks in occasionally to see that the information she provided is still helping people today.
Link:
http://www.dr-bob.org/babble/20010814/msgs/75408.html
Posted by valene on March 11, 2006, at 8:24:13
In reply to Re: Many people fear MAOI's...., posted by sdb on March 10, 2006, at 19:37:27
sdb,
I do fear the weight gain, sweet craving, etc. and I am hypersensitive to many medications not only psych. meds.I wonder if the claims about EMSAM having few if any side effects, or less than the SSRI's is really true? It would be almost a miracle drug if it works.
I am pretty much hooked on a small dose of xanax. I have been advised by my pdoc that I can updose this but am reluctant due to the difficulty of tapering xanax down.
Val> The fear is maybe due to often occurring sideeffects like:
> -weight gain, sweet craving
> -hypertensive crisis (tyramine)->hopefully never happens
> -total sexualdisfunction
>
> ~sdb
Posted by TylerJ on March 11, 2006, at 9:09:34
In reply to Re: Many people fear MAOI's...., posted by sdb on March 10, 2006, at 19:37:27
> The fear is maybe due to often occurring sideeffects like:
> -weight gain, sweet craving
> -hypertensive crisis (tyramine)->hopefully never happens
> -total sexualdisfunction
>
> ~sdbI've experienced a lot more side effects from ssri's, snri's, and TCA's, including weight gain, carb and sweet craving, anorgasmia, nervousness, tremor, severe dry mouth, impotence, constipation, sleep paralysis, ravanous appetite-gained 50 lbs on Paxil, and on top of this not a whole hell of a lot of help with my depression and anxiety.
On Parnate after one month I have reduced, but not dangerously reduced appetite-lost 10 lbs of which I needed to, My Libido is great w/ no anorgasmia or erection probs, no dry mouth , no constipation, no hypertension probs, the only side effect i'm having is insomnia..being treated successfully with Trazodone and benadrl. And best of all, I have no Depression, No Anxiety, no OCD, and No Social Phobia. :) Take care.
Tyler
Posted by JaclinHyde on March 11, 2006, at 10:53:19
In reply to Re: Many people fear MAOI's.... » bassman, posted by jedi on March 10, 2006, at 23:58:28
> When Nardil broke my first major depression, almost ten years ago, it was like being struck by lightning.
> Link:That's how it was with me too...like lightning. I went to bed feeling like dying and woke up the next morning feeling like living. The term 'gradual improvement' does not apply :-)
JH
Posted by naughtypuppy on March 11, 2006, at 11:07:01
In reply to Re: Many people fear MAOI's.... » bassman, posted by jedi on March 10, 2006, at 23:58:28
This was probably the same "major pharmacy chain" that I went to. After reviewing the meds that I had outstanding prescriptions on, the pharmacy manager raised a big stink about my dentist presribing codeine because his computer told him that there was an interaction between Parnate and codeine which is not true. His brilliant computer also did not warn him about my more recent prescription of Prozac nor of the interaction between an SSRI and a MAOI which did not dawn upon him because the computer did not warn him. Whats the first thing they tell you about SSRI's and MOAI's? The reason I was to reluctant to start a MOAI was that the first thing it says on those all those sheets that the pharmacies hand out in capital letters is "DO NOT USE CONCURRENTLY WITH AN SSRI", which gave me the impression that they were really dangerous, as well as articles written by so called "professonals" that they were the med of last resort. Maybe it was just the other meds that were dangerous.
Posted by TylerJ on March 11, 2006, at 12:23:00
In reply to Re: Many people fear MAOI's.... » jedi, posted by naughtypuppy on March 11, 2006, at 11:07:01
> This was probably the same "major pharmacy chain" that I went to. After reviewing the meds that I had outstanding prescriptions on, the pharmacy manager raised a big stink about my dentist presribing codeine because his computer told him that there was an interaction between Parnate and codeine which is not true. His brilliant computer also did not warn him about my more recent prescription of Prozac nor of the interaction between an SSRI and a MAOI which did not dawn upon him because the computer did not warn him. Whats the first thing they tell you about SSRI's and MOAI's? The reason I was to reluctant to start a MOAI was that the first thing it says on those all those sheets that the pharmacies hand out in capital letters is "DO NOT USE CONCURRENTLY WITH AN SSRI", which gave me the impression that they were really dangerous, as well as articles written by so called "professonals" that they were the med of last resort. Maybe it was just the other meds that were dangerous.
I 100% agree with you. My Pharmicist told me I could not take antihistamines w/Parnate, she also said no Caffiene at all..LOL. I just wanted to say "SHUT UP"! I do what my doctor says to do! Some Pharmacists can be very annoying. Oh, by the way I didn't tell her to shut up...I just smiled and ignored he. :)
Tyler
Posted by TylerJ on March 11, 2006, at 12:38:09
In reply to Re: Many people fear MAOI's....jedi, posted by JaclinHyde on March 11, 2006, at 10:53:19
> > When Nardil broke my first major depression, almost ten years ago, it was like being struck by lightning.
> > Link:
>
> That's how it was with me too...like lightning. I went to bed feeling like dying and woke up the next morning feeling like living. The term 'gradual improvement' does not apply :-)
>
> JH
>
>Ditto...when it kicked in after about 1 week...I was like WOW...I feel Great! The other AD's other than MAOI's, work S-L-O-W-L-Y too slowly in my opinin and I never felt a surge of relief even close to Parnate. Matter of fact I really couldn't tell if they worked at all. But, They're safe, and clean w/few side effects (Yeah Right!) who cares if they're safe if they don't work FOR ME at least. Suger pills don't have side effects either. Now don't get me wrong, I'm talking about ME. These drugs ssri', snris, TCA's can be and ARE very effective for many, many people.
Tyler
Posted by TylerJ on March 11, 2006, at 14:35:57
In reply to Re: Many people fear MAOI's...., posted by vainamoinen on March 10, 2006, at 17:04:58
> Any speculation as to why the MAOI's work so much better than the SSRI's?
>
> Is it because they act significantly on dopamine whereas most other AD's work on serotonin, or norepinephrine, but only to a lesser extent if at all on dopamine?
MAO (Monoamine Oxidase)destroys many neurotransmitters. MAOI antidepressants (e.g.,Nardil, Parnate. EMSAM) inhibit MAO, thus prolonging the life of the neurotransmitters-increasing neurol flow of noreadrenaline, dopamine, serotonin, acetylcholine, and GABA.
SSRI's bock serotonin reuptake into presynaptic nerve terminals, leading to enhanced serotonergic neurotransmission.
I think I'll go with the MAOI for obvious reasons. :)Tyler
Posted by sdb on March 11, 2006, at 15:23:25
In reply to Re: Many people fear MAOI's.... » vainamoinen, posted by TylerJ on March 11, 2006, at 14:35:57
"And best of all, I have no Depression, No Anxiety, no OCD, and No Social Phobia. :) Take care."
Is it what you have without Parnate above?
~sdb
Posted by Chairman_MAO on March 11, 2006, at 17:43:47
In reply to Re: Many people fear MAOI's...., posted by bassman on March 10, 2006, at 17:55:49
No honest and competent clinician or psychopharmacologist ever believed that the long half-life is what caused dependence. It is a brute fact that drugs which raise the seizure threshold and sedate induce dependence. Even before the mechanism of diazepam was elucidated in the 1980s, people knew that benzodiazepines were quite similar to barbiturates and alcohol. Moreover, it stands to reason--and seems borne out in people's experiences with venlafaxine/paroxetine vs. fluoxetine, nordiazepam vs. alprazolam, phenobarbital vs. pentobarbital, etc., that drugs with short t1/2 have more intense withdrawal syndromes due to rapid elimination.
Very few drugs are ever synthesized with a purpose in mind. Drugs are discovered mostly through brute for synthesis of myraid compounds. That triazolobenzodiazepines happen to bind more tightly to the receptor (and thus induce MORE vicious dependence) is "merely" the way it is, no more, no less. It could have been different for all we know, but it isn't.
Excellent primer on the benzodiazepines:
http://www.etfrc.com/benzos1.htm
Posted by Chairman_MAO on March 11, 2006, at 17:51:18
In reply to Re: Many people fear MAOI's...., posted by bassman on March 10, 2006, at 17:55:49
I also forgot to add that Wellbutrin is an analog of Tenuate (diethylpropion), an aminoketone diet pill and psychostimulant. The company invested money, so they had to find a use for the drug somehow. It is nothing more than a dysphoric, weak stimulant. Moreover, at the doses used clinically, it only blocks the DAT about 20%, i.e. it's hardly a dopaminergic drug at all. The primary mechanism of its "antidepressant efficacy" is probably enhanced noradrenaline release. Hydroxybupropion is also an NE uptake inhibitior.
Bupropion's affinity for the DAT is in the MILLIMOLAR range, IIRC (negligable activity).The bottom line is that bupropion certainly wasn't "directed" toward anything any more than amphetamine was "directed" toward dopaminergic neurons when it was first synthesized in 1887.
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