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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Caedmon on April 9, 2006, at 16:24:50
I realize that a lot of misinformation is available, on the web and elsewhere. But this intrigued me:
>One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish. "I didn't respond to tricyclics at all five years ago," says Karen, a New Jersey graduate student who has been chronically depressed most of her life. "When I was switched to an MAOI, I responded very well. But I couldn't take the diet. After I finally went off the drug, my friends told me I was always in a daze while I was taking MAOIs, but I wasn't aware of that at the time. I was switched to Prozac four years ago, and I've been taking that ever since." Patients often look dazed or even robotic, much the way Karen had appeared to her friends.>
from http://www.webmd.com/content/Article/87/99355.htm?pagenumber=1
MAOI takers: have you experienced this? Thanks
- C
Going on Parnate in ~16 days
Posted by gardenergirl on April 9, 2006, at 16:34:12
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
Nope, not at all. Weird.
gg
Posted by linkadge on April 9, 2006, at 16:41:46
In reply to Re: MAOIs and feeling drugged » Caedmon, posted by gardenergirl on April 9, 2006, at 16:34:12
Yes, parnate spaced me out. I kindof felt detached. Wish you better luck.
Linkadge
Posted by Declan on April 9, 2006, at 16:54:53
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
Apart from the hypotensive tiredness thing, not at all. MAOIs distinguish themselves by not making you feel drugged, I think,i f you get the dose right and it suits you. I think I'd feel really weird on lots of Parnate, but I wouldn't call that drugged, in that sense, just too stimulated and sleepless.
Declan
Posted by Maxime on April 9, 2006, at 17:36:29
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
I was on Parnate for a couple of years and now I am on it again. It makes me feel energized for the most part, but there are 2 hours in the afternoon where I just want to put my head down.
Maxime
Posted by ed_uk on April 9, 2006, at 18:14:19
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
>One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish
Sounds like part of a advert for the new ADs. Nardil can sometimes make people feel 'drugged' I guess, Parnate less so. It's possible.
Ed
Posted by TylerJ on April 9, 2006, at 18:38:13
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
> I realize that a lot of misinformation is available, on the web and elsewhere. But this intrigued me:
>
> >One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish. "I didn't respond to tricyclics at all five years ago," says Karen, a New Jersey graduate student who has been chronically depressed most of her life. "When I was switched to an MAOI, I responded very well. But I couldn't take the diet. After I finally went off the drug, my friends told me I was always in a daze while I was taking MAOIs, but I wasn't aware of that at the time. I was switched to Prozac four years ago, and I've been taking that ever since." Patients often look dazed or even robotic, much the way Karen had appeared to her friends.>
>
> from http://www.webmd.com/content/Article/87/99355.htm?pagenumber=1
>
> MAOI takers: have you experienced this? Thanks
>
> - C
> Going on Parnate in ~16 days
Drugged and couldn't take the diet, huh? Well I guess I do miss the Banana peels-used to eat 2 or 3 daily. :) Nah...never felt drugged on an MAOI (currently taking 130 mgs of Parnate daily) and the Diet, the only thing I miss is Cheddar cheese. Small price to pay for sanity.Tyler
Posted by ed_uk on April 9, 2006, at 19:05:28
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
Dear C,
The following is not an attack on you :) It's an attack on the dreadful article!!!
http://www.webmd.com/content/Article/87/99355.htm?pagenumber=1
I just read the link. It's awful. VERY predictable. Just the sort of thing you read about MAOIs all the time, invariably written by people who don't know anything about them.
>But for a chocoholic, the dietary restrictions were torture
Many people find that they don't need to avoid chocolate, particulaly American chocolate. The MAOI diet is usually overexaggerated.
>Excess tyramine can cause a sudden, sometimes fatal increase in blood pressure so severe that it can burst blood vessels in the brain.
In patients who suffer a hypertensive crisis, fatalities are very few and far between.
>Because no one knew about the tyramine connection, a wave of deaths from brain hemorrhages swept the country.
A wave? An exaggeration perhaps?
>60 mg/day
60mg is NOT the maximum dose of phenelzine. Another sign that this was written by someone who doesn't know what they're talking about.
>"I call it the 'St. Jude' drug," says psychiatrist Andy Myerson. "It's the drug I use when nothing else works and someone is willing to give up anything in the hope that something will help their depression."
Sounds like the sort of pdoc who starts a severely depressed patient on an SSRI after they've previously tried every single SSRI, at every possible dose, in every possible combination without a hint of relief. Give up anything? Like cheese? How awful! The hope that something might help? Well yes, an MAOI antidepressant IS likely to help.
>They (MAOIs) are especially good if you seem mildly depressed, if you become depressed more gradually, or if your primary complaints are boredom.......
Mildly depressed? Bored? Who wrote this?
>One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish. "I didn't respond to tricyclics at all five years ago," says Karen, a New Jersey graduate student who has been chronically depressed most of her life. "When I was switched to an MAOI, I responded very well. But I couldn't take the diet. After I finally went off the drug, my friends told me I was always in a daze while I was taking MAOIs, but I wasn't aware of that at the time. I was switched to Prozac four years ago, and I've been taking that ever since." Patients often look dazed or even robotic, much the way Karen had appeared to her friends.
Sounds like an advert for Prozac to me. Dazed and robotic? Has the author ever prescribed an MAOI? Severely depressed patients may well appear dazed. So lets blame the MAOI. After all, docs seem to blame them for everything else. Funny how, when I was dazed on Paxil, no one considered that it might be due to the Paxil. This sort of 'case report' really is remarkably nauseating in a world where we're constantly surrounded by the glowing faces advertising the latest psych meds on television.
>"A lot of patients are resentful about the diet they have to follow," explains Dr. Myerson. "They tend to blame the doctor when they can't eat their favorite foods, and many people simply won't follow the diet." Other mental health experts point out that MAO inhibitors often interfere with the relationship between doctor and patient, because people feel so resentful about their side effects and diet that they don't want to talk to their doctor during therapy.
OK, now this really is the dumbest thing I ever read. Who are these 'mental health experts'? Are they currently writing on WebMD warning that psychiatry's latest wonder drugs may interfere with doctor-patient relationships when patients loose their libido to such an extent that their marriage disintegrates. I have noticed many times that patients who suffer side effects on MAOIs are actually less resentful than patients who suffer side effects on newer meds. It would appear that patients on MAOIs are the only people who are being properly warned that side effects may occur. A doctor's dismissal of a patients side effects (or withdrawal symptoms) is what leads to people being resentful.
>Their relatively risky profile makes them a poor choice for potentially suicidal patients who might intentionally take an overdose.
Oh, a bit like Effexor then? - which can cause serious cardiac arrhythmias, convulsions and serotonin syndrome in overdose.
>At very low doses, the MAOIs can have toxic effects on the heart, unlike Prozac, which is not considered toxic even at very high doses.
Back to the Prozac ad again. I have never heard of MAOIs being cardiotoxic. Reference please?
>Studies have shown that MAOIs are not associated at all with suicide in nonsuicidal patients, as opposed to most other antidepressants. In a 1991 Harvard University study of 1,017 depressed people, 63 nonsuicidal patients took an MAOI and none became suicidal.
:)
>"I've seen a few miracle cures with these drugs," one psychiatrist noted. "And they're particularly good if people suffer from panic attacks in addition to depression."
Perhaps he'd see a few more if he prescribed them more often!
>Furthermore, if you have hypertension or heart problems, the MAOIs might be for you because at therapeutic doses, they can lower blood pressure. In contrast to the tricyclic antidepressants, MAO inhibitors have little negative effect on heart rate.
Nardil tends to lower heart rate slightly. TCAs tend to increase heart rate.
>Tolerance
Some people develop a tolerance to MAO inhibitors. This could mean that the drug will work for you at first, but you could suddenly become depressed again in the middle of treatment.Errrrr excuse me, why don't other classes of ADs have a tolerance warning? Many people find that other ADs 'poop out'.
>They are very good at treating eating disorders—but the weight gain they often cause can be counterproductive. Prozac, on the other hand, is just as effective as an eating-disorder treatment, without the unwanted side effects. In one recent study of 400 women, Prozac cut down on eating binges in 63 percent of the responders and vomiting in up to 57 percent.
Back to Prozac.....
>For social phobics, for whom the idea of a social occasion can produce a range of negative emotions and symptoms, MAOIs (especially Nardil) can be very helpful. In fact, studies suggest that about 70 percent of people who are social phobics respond to MAOIs. Recent research has suggested that PROZAC may also be effective for this problem.
Anyone noticing a pattern here?
Regards
Ed
Posted by linkadge on April 9, 2006, at 19:23:59
In reply to Oh please...... » Caedmon, posted by ed_uk on April 9, 2006, at 19:05:28
"Soon after scientists developed tricyclic antidepressants, another group of chemicals very different from the tricyclics rolled out of the laboratory—the monoamine oxidase (MAO) inhibitors. These new drugs affected the same neurotransmitters (serotonin and norepinephrine) that the tricyclics did, but they also affected dopamine"
I thought the MAO inhibitors were the first class of antidepressants to be introduced.
Linkadge
Posted by greywolf on April 9, 2006, at 19:33:53
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
I took Nardil for many months. After taking every SSRI, SNRI, NDRI, TCA, you could name, we tried an MAOI.
Not only was the diet ridiculously easy to deal with, Nardil had the fewest side effects of ANY AD I'd ever taken. And by few, I mean almost none. Just a slight bit of sluggishness early on, but absolutely nothing like Effexor, Prozac, Imiprimamine, Clomipramine, Luvox, Paxil, Serzone, Wellbutrin, Trazadone, etc. Additionally, the sexual SEs were minimal.
Nardil was great for a while, but eventually its performance diminished for me. Don't let that article scare you off. I wasn't too impressed with it.
Posted by Caedmon on April 9, 2006, at 20:54:39
In reply to Oh please...... » Caedmon, posted by ed_uk on April 9, 2006, at 19:05:28
Ed, I got the same impression reading the article too. I was just curious to know if that particular passage was reflective of others' experiences.
I agree, I've learned to take a lot of what I read about MAOIs with a grain (or a hunk) of salt.
Link, I thought MAOIs were developed first too. Specifically as a tuberculosis drug (ipronazid? too lazy to google), but then imipramine was discovered about a year later?
- C
Posted by JaclinHyde on April 9, 2006, at 23:48:31
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
I have read this quote from this lady and frankly I think she is the only one I have heard say she felt drugged. This is not the norm, imho.
JH
Posted by Phillipa on April 10, 2006, at 0:07:16
In reply to Re: MAOIs and feeling drugged, posted by JaclinHyde on April 9, 2006, at 23:48:31
Glad to hear that. Love Phillipa
Posted by Caedmon on April 10, 2006, at 1:48:05
In reply to Oh please...... » Caedmon, posted by ed_uk on April 9, 2006, at 19:05:28
LMAO, Ed, I just reread the article and you're right, the references to Prozac were more than subtle. I wonder if one of the authors is on Eli Lilly's payroll.
Read the next article linked from it, on bipolar disorder:
http://www.webmd.com/content/article/87/99356.htm"your doctor may want to add Prozac or another antidepressant"
"In about 30 percent of manic-depressives, lithium smooths out the periods of mania but it doesn't control the episodes of depression. If this is your problem, your doctor may combine Prozac (or another SSRI) with lithium."
"The newest drug to be approved is the schizophrenia drug Zyprexa (olanzapine), which was approved in March 2000 by the FDA for the short-term treatment of acute manic episodes associated with bipolar disorder. Research suggests it provides better control of symptoms than Depakote." [What odd wording. Article is dated to 2001; I believe Seroquel is now the new kid on the block.]
"Zyprexa caused a few side effects; those that were reported included dry mouth, drowsiness, dizziness, and loss of strength. However, the FDA cautions that life-threatening pancreatitis has occurred in some adults and children." [You forgot metabolic syndrome and stellar weight gain - by far the biggest complaints.]
"Conclusion: We've seen how lithium and Zyprexa can be of great help in the treatment of manic-depression, especially early in the course of the disease."
That amused me. Hope it does you.
- C
Posted by cecilia on April 10, 2006, at 2:13:05
In reply to Oh please...... » ed_uk, posted by Caedmon on April 10, 2006, at 1:48:05
When I clicked on that link it was full of advertisements for vagal nerve stimulation. Guess who must have partnered up with the Prozac people? They had a questionaire about whether VNS was right for you which included a question about whether you asked yoiur pdoc about meds advertised on TV. Guess we're going to be seeing some VNS commercials pretty soon....Cecilia
Posted by Questionmark on April 10, 2006, at 2:30:56
In reply to Oh please...... » Caedmon, posted by ed_uk on April 9, 2006, at 19:05:28
Great points, Ed. You're completely right.
It's almost amusing-- if it weren't so irritating and sad.i love how the dietary restrictions are always so overplayed too. Yeah, because i'd much rather deal with anxiety, intense chronic despair, and general psychological turmoil than have to give up the cheeses i like.
Posted by JaclinHyde on April 10, 2006, at 13:49:50
In reply to Re: Oh please...... » ed_uk, posted by Questionmark on April 10, 2006, at 2:30:56
Great comments and right on the money. Did you ever think of taking your act on the road.
"Please welcome ed_uk, psychotropic medicinal genius and comedian!!" (:::wild applause:::) ;-)
Again, I bow to the master,
JH
Posted by TylerJ on April 10, 2006, at 14:33:15
In reply to Oh please...... » Caedmon, posted by ed_uk on April 9, 2006, at 19:05:28
As usual, Great job Ed!! You are definitely our "Team Captain" when it comes to Psychoparmacology. :)
Tyler
Posted by Tom Twilight on April 10, 2006, at 14:55:24
In reply to Re: MAOIs and feeling drugged » Caedmon, posted by ed_uk on April 9, 2006, at 18:14:19
Admittedly my experience of MAOIs is rather limmited.........
Still I never felt drugged on Marplan, the only MAOI I've tried so far.
If you want to feel druged take a sedating Trycyclic!
Posted by ed_uk on April 10, 2006, at 14:59:00
In reply to Oh please...... » ed_uk, posted by Caedmon on April 10, 2006, at 1:48:05
Hi C :)
LOL yes, I am highly amused!
It's really sad though, that psychiatry is virtually 'owned' by the pharmaceutical industry. Look at Lexapro. Why is it being prescribed so frequently in place of generic SSRIs which are 20 times less expensive? Is it because it has any major clinical advantages over inexpensive SSRIs like generic citalopram (Celexa)? NO!!!!!!!!!!!!!!!! It's because so many doctors are so incredibly susceptible to sucessful advertising campaigns.
Regards
Ed
Posted by ed_uk on April 10, 2006, at 15:01:29
In reply to Re: Oh please...... » ed_uk, posted by Questionmark on April 10, 2006, at 2:30:56
>Yeah, because i'd much rather deal with anxiety, intense chronic despair, and general psychological turmoil than have to give up the cheeses i like.
Having to give up ones favourite cheeses is apparantly particularly detrimental to the doctor-patient relationship!!!
Regards
ed
Posted by ed_uk on April 10, 2006, at 15:02:16
In reply to Re: Oh please......ed_uk, posted by JaclinHyde on April 10, 2006, at 13:49:50
Aww thanks JH, that was so nice :)
Ed
Posted by ed_uk on April 10, 2006, at 15:03:13
In reply to Re: Oh please...... » ed_uk, posted by TylerJ on April 10, 2006, at 14:33:15
Thanks Tyler!!! :)
Ed
Posted by tygereyes on April 10, 2006, at 15:50:01
In reply to MAOIs and feeling drugged, posted by Caedmon on April 9, 2006, at 16:24:50
Parnate makes me feel like I'm on speed - not like I'm on a downer.
> I realize that a lot of misinformation is available, on the web and elsewhere. But this intrigued me:
>
> >One of the big problems with MAO inhibitors is that they may make you feel drugged and sluggish. "I didn't respond to tricyclics at all five years ago," says Karen, a New Jersey graduate student who has been chronically depressed most of her life. "When I was switched to an MAOI, I responded very well. But I couldn't take the diet. After I finally went off the drug, my friends told me I was always in a daze while I was taking MAOIs, but I wasn't aware of that at the time. I was switched to Prozac four years ago, and I've been taking that ever since." Patients often look dazed or even robotic, much the way Karen had appeared to her friends.>
>
> from http://www.webmd.com/content/Article/87/99355.htm?pagenumber=1
>
> MAOI takers: have you experienced this? Thanks
>
> - C
> Going on Parnate in ~16 days
This is the end of the thread.
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