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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 20 to 44 of 56. Go back in thread:
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.
Posted by bassman on March 11, 2006, at 19:53:27
In reply to Re: Many people fear MAOI's.... » bassman, posted by Chairman_MAO on March 11, 2006, at 17:43:47
Thanks for your perspective and the reference. The reference you cited states, "Xanax was remarkably potent (down to the microgram range, like LSD), and doctors were actually trusting enough to buy the company's rap that it didn't cause dependence". I wonder why docs didn't see how addictive it was immediately by its short half-life? I think a lot of the very good points you make weren't known, say, 20 years ago. Since I was in the pharmaceutical industry at the time, I can tell you that was the story we were given: Xanax will be less addictive because it has a shorter life time. The proof that people bought that argument- was the tremendous success of Xanax. I find it hard to believe that all the clinicians thought that Xanax would be Hell to withdraw from and allowed it to become a blockbuster drug. Thanks again for your insights!
Posted by bassman on March 11, 2006, at 20:02:04
In reply to Re: Many people fear MAOI's.... » bassman, posted by Chairman_MAO on March 11, 2006, at 17:51:18
Thanks, that is really interesting! Did you know that the number one AD prescribed by pdoc's (but not internists) is Wellbutrin? Sounds like things are pretty out of control...
Posted by tessellated on March 11, 2006, at 20:16:30
In reply to Re: Many people fear MAOI's.... » bassman, posted by Chairman_MAO on March 11, 2006, at 17:51:18
I had a reasonable response to wellbutrin.
Very prosexual etc, not a fantastic chem, but not useless IMHO.I think the benefit to short half lives is that the chem can wash out of your system quickly. if i knew that eating some pills could make me feel nasty for 2 weeks, i probably would think seriously about even touching them.
short half lives are also good for research purposes particularly on treatment resistant forms..
xanax is ok because it lasts just about 10 hours for me. engough to sleep on, but not a weekender.
short half lives have certain benefits. withdrawl is not one of them.
Posted by SLS on March 11, 2006, at 21:15:39
In reply to Re: Many people fear MAOI's.... » bassman, posted by Chairman_MAO on March 11, 2006, at 17:51:18
> 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.
That's pretty much how Wellbutrin has affected me. However, two close friends of mine have achieved remission on this drug. One has atypical depression and the other has a bipolar spectrum psychotic depression. Both people were chronically affected and did not have histories of spontaneous remissions. To be fair, the Wellbutrin is being used in combination with other drugs in both cases. Nevertheless, the antidepressant effect of Wellbutrin was quite evident once it was added. Both people take 300mg.
- Scott
Posted by Phillipa on March 11, 2006, at 21:25:16
In reply to Re: Many people fear MAOI's...., posted by bassman on March 11, 2006, at 20:02:04
Well no wonder wellbutrin made me manic in just one week. So does that mean the MAOI patch is out for me? Love Phillipa
Posted by theo on March 11, 2006, at 22:46:19
In reply to Re: Many people fear MAOI's.... » Chairman_MAO, posted by SLS on March 11, 2006, at 21:15:39
Nevertheless, the antidepressant effect of Wellbutrin was quite evident once it was added. Both people take 300mg.
>
>
> - Scott
>Which version, regular, SR, XL? Which is more effective?
Posted by SLS on March 11, 2006, at 23:37:10
In reply to Re: Many people fear MAOI's.... » SLS, posted by theo on March 11, 2006, at 22:46:19
> Nevertheless, the antidepressant effect of Wellbutrin was quite evident once it was added. Both people take 300mg.
> >
> >
> > - Scott
> >
>
> Which version, regular, SR, XL? Which is more effective?Both people currently take the XL version. One claims that she prefers the SR. The regular version often produces too many ups and downs throughout the day and can lead to dysphoria. The extended release versions are said to be smoother and reported to "feel" more effective by some people.
I've been given samples of the Wellbutrin XL which I am supposed to start taking two days from now. Wellbutrin (regular) has made me feel worse in the past. My doctor would like to see how I respond to it while taking Lamictal at the same time. I guess he wants to see for himself. I am anticipating feeling worse on Wellbutrin XL, despite my never having taken an extended release version or having combined it with the drugs I take currently.
I'll probably end up back on Nardil until something new comes out or when rTMS is approved to treat depression. I'm having a difficult time embracing EmSam (selegiline) as a treatment in my case. I didn't respond to the oral version, and Parnate represents a dead end. Then again... Who knows. A doctor at the NIMH suggested that I revisit selegiline because it is a propargyl derivative, and I once responded to clorgyline, which is also a propargyl MAOI. It's too bad pargyline (Eutonyl), a propargyl selective MAO-B inhibitor, is no longer available. I would have tried it. My guess, though, is that neither selegiline nor pargyline are as broadly effective as Parnate or Nardil. MAO-A seems to be more important when treating severe depression.
- Scott
Posted by JaclinHyde on March 12, 2006, at 0:03:47
In reply to Re: Many people fear MAOI's.... » Chairman_MAO, posted by SLS on March 11, 2006, at 21:15:39
Wellbutrin brought back my hypochondria after having it lay dormant for over 20 years and gave me a non stop menstrual period. Should have taken out stock in tampax (sorry guys.)
JH
Posted by Chairman_MAO on March 12, 2006, at 0:47:32
In reply to Re: Many people fear MAOI's.... » Chairman_MAO, posted by SLS on March 11, 2006, at 21:15:39
Have you heard of anyone who gets a better effect from bupropion than long-acting methylphenidate, d-amphetamine, or desipramine?
I often wonder whether the people who do well on Wellbutrin simply aren't aware of how much better some other medications are, much like buspirone vs. diazepam.
Posted by Chairman_MAO on March 12, 2006, at 0:51:22
In reply to Re: Many people fear MAOI's.... » theo, posted by SLS on March 11, 2006, at 23:37:10
I wish some of these doctors would TAKE Wellbutrin so they could feel how dysphoric it is. The reason it lacks abuse potential is simply because, in reality, it has an abysmal therapeutic index. Severe depression, IMHO, often requires more like 600-900mg of this drug. I have no idea how anyone tolerates that level of anxiety.
I strongly urge you to try buprenorphine along with an MAOI.
Posted by Chairman_MAO on March 12, 2006, at 1:26:01
In reply to Re: Many people fear MAOI's...., posted by bassman on March 11, 2006, at 19:53:27
These clinicians suffered from a profound lack of insight, then. What other rationale is there for using methadone (a long-acting opioid) in treating dependency? Why do people tend to find Wellbutrin XL, Concerta, etc. more tolerable than the IR forms? Why is it that cigar smokers tend to have an easier time quitting than cigarette smokers? What about those who take cocaine via IV vs. buccally?
Pharmaceutical companies are not exactly known for their scruples. Methaqualone was supposedly the "non-addictive" barbiturate replacement, and yet it is almost universally preferred by drug abusers! Heroin was billed as the non-habit-forming morphine.
Diazepam could be more addictive for some given that it is more lipophilic, so it kicks in faster and is more psychologically reinforcing. However, in practice its multiple active metabolites probably make up for this. Upjohn simply made it all up, just like Eli Lilly completely fabricated the "chemical imbalance" rationale for Prozac's efficacy.
Any user of benzodiazepines for round-the-clock anxiolysis will naturally take however many doses per day necessary to maintain consistent blood levels. By Upjohn's argument, heroin would not induce dependence--unlike methadone. Absurdity!
Posted by cecilia on March 12, 2006, at 1:49:18
In reply to Re: Many people fear MAOI's...., posted by JaclinHyde on March 10, 2006, at 19:12:41
I'm glad that MAOI's work for you, but I don't understand why you keep saying the success rate is 99%. It's closer to 50%. Please, if you have a link to a reputable study showing a 99% success rate, I'd be very curious to see it. Cecilia
Posted by cecilia on March 12, 2006, at 2:51:14
In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 12, 2006, at 1:49:18
I mean, quite aside from the fact that no treatment for depression has ever shown anywhere near a 99% success rate, it would be virtually impossible to have a placebo controlled trial that showed this. The only way it could be done would be to have only a 1% placebo success rate, and I've never heard of any AD study that had anywhere near that low a rate of placebo success. Most AD studies have at least a 30% placebo success rate, so even in the extremely unlikely event that a study showed a 99% success rate, if you subtracted the 30% placebo sucess you'd only get a 69% success rate. Cecilia
Posted by theo on March 12, 2006, at 6:58:28
In reply to Re: Many people fear MAOI's.... » theo, posted by SLS on March 11, 2006, at 23:37:10
> I'll probably end up back on Nardil until something new comes out or when rTMS is approved to treat depression. I'm having a difficult time embracing EmSam (selegiline) as a treatment in my case. I didn't respond to the oral version, and Parnate represents a dead end. Then again... Who knows. A doctor at the NIMH suggested that I revisit selegiline because it is a propargyl derivative, and I once responded to clorgyline, which is also a propargyl MAOI. It's too bad pargyline (Eutonyl), a propargyl selective MAO-B inhibitor, is no longer available. I would have tried it. My guess, though, is that neither selegiline nor pargyline are as broadly effective as Parnate or Nardil. MAO-A seems to be more important when treating severe depression.
>
>
> - ScottI wish a Nardil patch was available, that could be taken in small doses without food restriction. I want to try the EmSam patch but hate to stop everything just to try something new. How did the oral Selegiline make you feel? Did it help at all?
Ted
Posted by SLS on March 12, 2006, at 8:09:44
In reply to Re: Many people fear MAOI's.... » SLS, posted by theo on March 12, 2006, at 6:58:28
> I wish a Nardil patch was available, that could be taken in small doses without food restriction. I want to try the EmSam patch but hate to stop everything just to try something new. How did the oral Selegiline make you feel? Did it help at all?
Hi Ted.
I don't remember Eldepryl doing anything positive or negative. Then again, I didn't go higher than 30mg.
I don't know if there would be any advantage to using a patch for delivering Nardil. I should think that the dosage necessary to treat depression would be too high to be able to eliminate the tyramine diet. I'm not sure, though.
I'm not sure the hypertensive reaction to foods is completely understood. I would treat any MAOI with respect, regardless of selectivity or reversibility.
- Scott
Posted by SLS on March 12, 2006, at 8:18:49
In reply to Re: Many people fear MAOI's.... » SLS, posted by Chairman_MAO on March 12, 2006, at 0:51:22
> I wish some of these doctors would TAKE Wellbutrin so they could feel how dysphoric it is. The reason it lacks abuse potential is simply because, in reality, it has an abysmal therapeutic index. Severe depression, IMHO, often requires more like 600-900mg of this drug. I have no idea how anyone tolerates that level of anxiety.
I had taken 600mg for several weeks, and 900mg for several weeks more. I did not experience any anxiety at all. I did experience dysphoria, though. What is interesting is that I also experienced a withdrawal rebound improvement when I discontinued it.
> I strongly urge you to try buprenorphine along with an MAOI.
My first hurdle is to get my doctor to prescribe Nardil in combination with the nortripyline I am currently taking. Once I accomplish that, I'll then plant the seed of using buprenorphine. He seems to think that there is a synergy between Wellbutrin and Lamictal. I guess I should let him take his best shot at this point. I am trying to prepare myself for the dysphoria and general worsening of my condition that I anticipate will be induced by Wellbutrin. I don't see how Lamictal - or any other drug - would change so profoundly how my brain reacts to Wellbutrin. However, it is hard for me to pass up any reasonable treatment at this point. We'll see.
Have you ever heard of Wellbutrin affecting vision?
- Scott
Posted by ed_uk on March 12, 2006, at 10:18:14
In reply to Re: Many people fear MAOI's.... » theo, posted by SLS on March 12, 2006, at 8:09:44
Hi Scott
>I don't know if there would be any advantage to using a patch for delivering Nardil.
I don't think it would eliminate the risk either, but I do expect it would reduce tyramine sensitivity to some extent. I not sure whether it would be possible to administer phenelzine transdermally though, many drugs are not suitable for this method of administration. There are many reasons for this eg. some drugs cannot be absorbed in adequate quantities via the skin.
Regards
Ed
Posted by Phillipa on March 12, 2006, at 16:57:42
In reply to Re: Many people fear MAOI's.... » bassman, posted by Chairman_MAO on March 12, 2006, at 1:26:01
Wait a minute I take offense to that statement. I've been on a benzo for over 30yrs and have always taken the lowest I could. It's just recently that my pdoc raised my valium to 20mg at night only. And I only take it at night because of the long half life. Fondly, Phillipa
Posted by JaclinHyde on March 12, 2006, at 19:49:34
In reply to Re: Many people fear MAOI's....Jaclin Hyde, posted by cecilia on March 12, 2006, at 1:49:18
> I'm glad that MAOI's work for you, but I don't understand why you keep saying the success rate is 99%. It's closer to 50%. Please, if you have a link to a reputable study showing a 99% success rate, I'd be very curious to see it. Cecilia
First of all I don't 'keep' on saying it. If I am not mistaken this is the second time out of I don't know how many posts that I mentioned that. And it is a figure that I DO remember reading somewhere on the web and will dig for again. In the meantime here is one which states a 70% success rate, not 50% like you think....
"Current research suggests that the monoamine oxidase inhibitors (MAOIs), especially phenelzine, are the most highly effective medications for treating social phobias. In studies, about 70% of subjects improve significantly within four weeks. Occasionally, however, a social phobic can experience an exaggerated response to an MAOI and become too talkative, outgoing or socially uninhibited. In that case the prescribing physician will lower the medication dosage or stop it altogether."
JH
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