![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 85. Go back in thread:
Posted by Crazy Horse on May 2, 2006, at 10:08:21
In reply to THIS IS MY STORY, CrazyHorse, anybody, posted by UgottaHaveHope on May 1, 2006, at 21:44:08
Hi Michael,
I'm sorry you are suffering so terribly. I know what you mean about being afraid of fear, and also your haunted hse. analogy was good...been there too.
My advice is different, because your story sounds a lot like mine, especially when i first started having probs many years ago. I think an MAOI could be extremely helpful, moai's have significant efficacy in anxiety disorders, such as social phobia, panic disorder with agoraphobia and obsessive compulsive disorder. For me the maois (Nardil and especially Parnate) have worked when everything else has failed. I used to have horrible gut wrenching anxiety, panic attacks, ruminations, and with Parnate these symptons are gone. I've gone from useing 10-12 mgs of ativan a day (very high dose) to only taking 1.5 mgs a day..this in 3 months on parnate. Also, now there is EMSAM to consider, look at what it has done for Robert.
Anyway, something to consider and maybe talk to your pdoc about. Also, i would increase your Klonopin for now...you need it. And seroguel is also excellent if it still works for you. I wish you the very best Michael...feel free to ask me anything! May God bless you.
Monte
Posted by UgottaHaveHope on May 2, 2006, at 12:23:36
In reply to Re: THIS IS MY STORY, CrazyHorse, anybody » UgottaHaveHope, posted by Crazy Horse on May 2, 2006, at 10:08:21
For GAD, I was taking 200mg Seroquel at night, and then 1-2mg Klonopin per day.
She suggested I take 300mg Seroquel at night, and 1-2mg of Klonopin per day. She also wrote me a prescription of 20mg Paxil per day.
I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious) MAOIs (she said too many restrictions) and ENSAM (never heard of it). I didn't know if I needed to try those meds, but I thought I would ask.
Thoughts, please?
Posted by yxibow on May 2, 2006, at 14:25:06
In reply to Re: Went to pdoc today ... what do you think?, posted by UgottaHaveHope on May 2, 2006, at 12:23:36
> For GAD, I was taking 200mg Seroquel at night, and then 1-2mg Klonopin per day.
>
> She suggested I take 300mg Seroquel at night, and 1-2mg of Klonopin per day. She also wrote me a prescription of 20mg Paxil per day.There's more than one way to solve or mitigate some psychiatric disorders. She may have a reason for using an atypical antipsychotic. It might not be my first choice for GAD but if it is at least partially working than there is some cause for it. Seroquel is the least likely to cause side effects of them and the least likely for TD. Mainly have to watch your weight (as I do with it) a little bit. Not nearly as bad in that arena as Zyprexa which also has positive benefits but raises lipid profiles differently. Zyprexa may not make you as sleepy as Seroquel but it can give some people major cholesterol problems and myself it gave bad tremors. Otherwise I'd still use it.
Paxil is one of the more sedating SSRIs before Luvox (most sedating), and has a more appealing profile for anxiety than other SSRIs. It does require that you adhere to the dose because the half life isn't as good and coming down off of it requires slow attention. Some people will say that's horrid and I'm sure they've had bad experiences but if you taper properly it shouldn't be as bad an issue. Everything has its tradeoff.
Not increasing the Klonopin instead of the Seroquel -- mm... not quite 6 of one and half a dozen of the other but somewhere inbetween.
> I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious)If you have anxiety like me but also have some mild depression, Wellbutrin will eventually set your head on fire and cause you to ruminate at night. Its loosely based on a long unused diet drug called Tenuate which is loosely connected to amphetamines.
MAOIs (she said too many restrictions)
Yes, some people on here -- in fact a suprisingly large number -- but I recognize that some people have bad depression and sometimes you hear the worst, take MAOIs. They're dangerous without supervision and attention to detail and don't let people who take them let you think they're candy for the brain. They require a special diet, and pills to keep around in case you have a hypertensive crisis on some kind of cheese (example).
and ENSAM (never heard of it)She may not be in the most up to date circle. ENSAM is another MAOI but in patch form. It is seligiline, Eldepryl, based in a transdermal absorption package. At low doses it is supposed to be less but not fully restrictive of diet. At higher doses, that is not the case.
. I didn't know if I needed to try those meds, but I thought I would ask.
Leave the MAOIs for when you've been through others. My 2c anyhow. Do you really want to not take cough syrup, sudafed, and various OTC meds?
>
> Thoughts, please?
Tidings-- Jay
Posted by Crazy Horse on May 2, 2006, at 14:40:22
In reply to Re: Went to pdoc today ... what do you think?, posted by UgottaHaveHope on May 2, 2006, at 12:23:36
> I asked pdoc about Wellbutrin (she said it wouldn't be good for me, or would probably make me more anxious) MAOIs (she said too many restrictions) and ENSAM (never heard of it). I didn't know if I needed to try those meds, but I thought I would ask.
>
> Thoughts, please?She's right about the Wellbutrin. Paxil is a good med, it helped me for a couple of years. She sounds like she is not "up to date" on maoi's however. The restrictions are not burdensome at all..the only thing i miss is Cheddar Cheese. And never even heard of EMSAM...Hmmmmm.
Go with the Paxil Michael...i think it could help you a lot. Best wishes!
Monte
Posted by ed_uk on May 2, 2006, at 15:54:53
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 2, 2006, at 14:25:06
Hi J
>Do you really want to not take cough syrup, sudafed, and various OTC meds?
J, OTC cough syrups don't work. At best, they are minimally useful. Having to avoid dextromethophan is a trivial concern for someone who is severely depressed. Sudafed is not very effective. Moreover, nasal congestion is a minor issue compared with severe anxiety or depression.
Regards
Ed
Posted by ed_uk on May 2, 2006, at 15:57:27
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 2, 2006, at 14:25:06
None of the most useful OTC drugs are contra-indicated with MAOIs eg. acetaminophen, ibuprofen, loratadine, beclomethasone nasal spray, clotrimazole cream etc.
Ed
Posted by yxibow on May 3, 2006, at 1:00:23
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 2, 2006, at 15:54:53
> Hi J
>
> >Do you really want to not take cough syrup, sudafed, and various OTC meds?
>
> J, OTC cough syrups don't work. At best, they are minimally useful. Having to avoid dextromethophan is a trivial concern for someone who is severely depressed. Sudafed is not very effective. Moreover, nasal congestion is a minor issue compared with severe anxiety or depression.Sudafed is not very effective for some but its better than Sudafed PE. If I have severe sinus congestion, it's better than nothing.
True, for severe depression, I agree that an MAOI can be useful, but its a last resort, at the level of ECT. You just don't start there, its not just OTC stuff that can affect your body on such a drug. The thought of a medication in your body that could cause hypertensive crisis and a hospital visit which here would put you back $1000 just to walk in, is mind boggling. This isn't social medicine, you have to remember, Ed.
And you're right, some of the OTC medications are not as effective as prescribed ones -- but we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.Tidings
-- Jay
Posted by ed_uk on May 3, 2006, at 10:33:59
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 1:00:23
Hi J
>Sudafed is not very effective for some but its better than Sudafed PE.
OK, but neither med is particularly useful. Pseudoephedrine is minimally effective as best. Other, more effective treatments are available for allergic rhinitis. If you have a cold, buy some tissues and drink some hot lemon :) The cold will go away on its own. Medication is not required!
>True, for severe depression, I agree that an MAOI can be useful, but its a last resort, at the level of ECT
MAOIs should be tried before ECT in all severely depressed patients who are able to understand the restrictions, assuming that they have no contra-indications. Don't forgot Jay, that ECT involves the application of a large electric shock to the head.....repeatedly. When used carefully, MAOIs are relatively safe. The only time things start to go wrong is when patients are not properly informed RE the diet and drug interactions etc.
http://www.thymatron.com/main_home.asp
>The thought of a medication in your body that could cause hypertensive crisis.....
Right, so don't take the meds which interact. Ensure that all care-providers understand that you are taking an MAOI and that drug interactions may occur. Although MAOIs have some very major drug interactions (eg. with SSRIs), many of the alleged drug interactions do not exist. MAOIs do not, for example, interact with the epinephrine used in local anesthetic mixtures in dentistry.
>You just don't start there
No, you can try several other meds first. Patients should not, however, be forced to try every other drug in existence before being prescribed an MAOI. Nardil and Parnate are too effective to be ignored.
>we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.
Dextromethorphan is minimally effective. In most people it is probably completely ineffective, it is highly unlikely to help you get to work. Dextromethorphan is not an especially valuable medication. Severe coughs due to bacterial pneumonia require antibiotics. Cough suppressants like dextromethorphan should not be used in pneumonia. Mild coughs not associated with pnemonia do not benefit from antibiotics - medication is not required. The cough will go away on its own. Back to the hot lemon......
OTC codeine is rarely used in the UK. Not a great loss. Low doses of codeine are relatively ineffective as a cough supressant. As is the case with dextromethorphan, codeine must not be used in patients with pneumonia. Mild coughs are best left untreated. They don't normally last long anyway.
Ed
Posted by ed_uk on May 3, 2006, at 11:00:54
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 1:00:23
Hi J
As someone who's had many coughs and colds, I can safely say that although annoying, colds are hardly comparable in importance to major mental illness!
Ed
Posted by yxibow on May 3, 2006, at 23:19:54
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 3, 2006, at 11:00:54
> Hi J
>
> As someone who's had many coughs and colds, I can safely say that although annoying, colds are hardly comparable in importance to major mental illness!
>
> EdI didnt -- but hypertensive crises are real. And deadly, potentially. I didnt say every last hoop had to be gone through, but they're serious medication.
It's not just MAOIs that contraindicate OTC medications -- warfarin, and other drugs too. My Dad has to use Nasonex for his use of doxazosin for BPH because he can't take anything else.
And ECT has never killed a patient in its modern use here at UCLA. Yes, there is a chance of short term memory loss because it is a controlled (emphasis on control, this isnt 1950) seizure and there are always risks of general anaesthesia (which I'm paranoid I'll admit -- never have taken), but it may be even more effective than any drug itself because of its immediacy in changing of body chemistry.
As far as codeine, well, when my Dad was a professor when they still handed it out, he could go to class and actually teach on it. We're not talking complicated pneumonic infections, just a bad hoarse throat.
Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
Thats just my 2c-- J
Posted by yxibow on May 3, 2006, at 23:34:29
In reply to MAOIs » yxibow, posted by ed_uk on May 3, 2006, at 10:33:59
> OK, but neither med is particularly useful. Pseudoephedrine is minimally effective as best. Other, more effective treatments are available for allergic rhinitis. If you have a cold, buy some tissues and drink some hot lemon :) The cold will go away on its own. Medication is not required!
Of course it will go away on its own, I'm talking about people with severe sinusits for which it helps and it is now making these people feel like criminals with restrictions in some states because of the meth lab idiots.
Blowing a tissue a hundred times is hard on the nose.
I agree there are other treatments that can work -- I find that preservative free saline (sometimes pressurized) is quite effective for sinus passage clearance without the jumpiness of pseudoephedrine. Doesn't mean that some people haven't been helped by it though.
> MAOIs should be tried before ECT in all severely depressed patients who are able to understand the restrictions, assuming that they have no contra-indications. Don't forgot Jay, that ECT involves the application of a large electric shock to the head.....repeatedly.Repeatedly, to whatever level necessary, this is true. ECT is a controlled seizure.
>
> http://www.thymatron.com/main_home.aspActually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> >The thought of a medication in your body that could cause hypertensive crisis.....
>
> Right, so don't take the meds which interact. Ensure that all care-providers understand that you are taking an MAOI and that drug interactions may occur.And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
> >we don't have the luxury any more unlike you in England of going into a pharmacy and getting codeine for a bad cough. The last time that was available was in the late 60s in some of the states here. So DXM is all there is, to be able to get into work and function at half capacity.
>
> Dextromethorphan is minimally effective. In most people it is probably completely ineffective, it is highly unlikely to help you get to work. Dextromethorphan is not an especially valuable medication.For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
Severe coughs due to bacterial pneumonia require antibiotics. Cough suppressants like dextromethorphan should not be used in pneumonia. Mild coughs not associated with pnemonia do not benefit from antibiotics - medication is not required. The cough will go away on its own. Back to the hot lemon......
Where did I asy antibiotics or pneumonia? If you have strep, you have strep -- Augmentin, Penicillin V, etc.> OTC codeine is rarely used in the UK. Not a great loss. Low doses of codeine are relatively ineffective as a cough supressant.
Hmm... I seem to remember you using OTC codeine :)
Just my 2c from this side of the pond
-- Jay
Posted by ed_uk on May 4, 2006, at 13:56:18
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 3, 2006, at 23:34:29
>I'm talking about people with severe sinusits
OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
>ECT is a controlled seizure.
That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
>Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
>And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
>For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
>Hmm... I seem to remember you using OTC codeine :)
Yep, I took it because it makes me feel better, not to treat a cough.
Ed
Posted by ed_uk on May 4, 2006, at 14:45:25
In reply to Re: Went to pdoc today ... what do you think? » ed_uk, posted by yxibow on May 3, 2006, at 23:19:54
>And deadly, potentially.
Yes, but death is extremely unlikely. An MAOI-induced hypertensive crisis can be treatment relatively easily. A lot more people will have died of heart attacks, strokes etc following the use of atypical APs such as Zyprexa.
>It's not just MAOIs that contraindicate OTC medications - warfarin, and other drugs too
I'm not quite sure what you're saying here. MAOIs do not interact with warfarin.
>Yes, there is a chance of short term memory loss
There is a chance of long term memory loss, as many patients who've had ECT will tell you.
>risks of general anaesthesia
Modern anesthesia is very safe. The anesthesia used for ECT is brief, and relatively 'light'. The main risks come from having an electric shock to the head.
>Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
At what point did I suggest that MAOIs should be used casually? In order to take an MAOI safely, the patient requires knowledge, not 'adult supervision'. If a patient was about to 'jump out of the window', admission to hospital would probably be appropriate. MAOIs are particularly suitable for severe atypical depression and/or social phobia. You do not need to be suicidal to take an MAOI.
Ed
Posted by Crazy Horse on May 4, 2006, at 17:29:20
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 4, 2006, at 13:56:18
> >I'm talking about people with severe sinusits
>
> OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.
>
> >ECT is a controlled seizure.
>
> That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.
>
> >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> Well of course! Manufacturers of ECT machines will inevitably downplay the risks!
>
> >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
>
> Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.
>
> >For a mild cough I'll again say its all we have without having to go fill out forms and see doctors and waste time. It works, for a mild cough that would interfere with an average daily workday where you have to talk alot.
>
> Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
>
> >Hmm... I seem to remember you using OTC codeine :)
>
> Yep, I took it because it makes me feel better, not to treat a cough.
>
> Ed
>
>LOL...Ed you are too good, i don't know why people would even challenge you. Your pharmacology knowledge FAR EXCEEDS MINE, but i do know enough to know that you are absolutely correct in what you said. And as a former (Yuck!) ECT participant...you nailed that on the head also. It's only because they temporarily paralyze you that you don't thrash around violently with the induced seizure. The extremely severe headache after the treatment indicates to me that the electricity isn't just a mild dose as they tell you that it is. Misconceptions and lack of education about MAOI's are the #1 reason people and Doctors are afraid to use them..i think anyway. It's unfortunate and sad because they can be, and are so effective for some people...myself included. :)
Monte
Posted by yxibow on May 4, 2006, at 20:18:27
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 4, 2006, at 13:56:18
> >I'm talking about people with severe sinusits
>
> OK, but how is this relevent? The vast majority of patients who are considering taking an MAOI do not suffer from sinusitis.Is there a study ? One will never know. There are few other things that will control it other than saline or steroidal use which is always an iffy thing even if nasal steroids are relatively harmless, they can still cause HPA axis issues and that is nothing good to add to severe depression.
>
> >ECT is a controlled seizure.
>
> That would be a euphemism. Potent muscle relaxants are necessary during ECT to prevent violent convulsions. People used to break their back during ECT, the convulsions were so severe. I think this gives you a good idea of what sort of seizure is being induced.No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD. I didn't say it was something to take lightly... I wouldnt go there any more than I would an MAOI.
> >Actually the FAQ on the link with the ECT machine you showed points out the positive benefits that I aforementioned in the other reply and the rarity of severe complications.
>
> Well of course! Manufacturers of ECT machines will inevitably downplay the risks!So why post it, I was lost ?
> >And suppose you've been hit by a car? I'd highly suggest a medical wristband that says MAOI.
>
> Indeed, such wristbands can be obtained easily, and cheaply. Only a minority of drugs used in emergency medicine need to be avoided - Demerol being the obvious example. Epinephrine is not contra-indicated.Good, we agree here.
> Let's compare: mild cough versus severe untreated mental illness. Which is most likely to lead to people needing to take time off work? Given dextromethorphan's minimal effectiveness, it is not likely to help someone go to work. Simple linctus would do just as well.
Mm... ask the millions of Americans who use it daily. I agree, its not a great drug. Its not terribly powerful. In fact its quite weak, deliberately so, almost punitively, to discourage abuse which does still exist (yuck).
> >Hmm... I seem to remember you using OTC codeine :)
>
> Yep, I took it because it makes me feel better, not to treat a cough.Hmm.. I won't go there because that's character assasination.
Posted by yxibow on May 4, 2006, at 20:28:45
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 4, 2006, at 14:45:25
> >And deadly, potentially.
>
> Yes, but death is extremely unlikely. An MAOI-induced hypertensive crisis can be treatment relatively easily. A lot more people will have died of heart attacks, strokes etc following the use of atypical APs such as Zyprexa.And death with ECT is also extremely likely when done at proper research institutions who have been practicing it for years. And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office a lot quicker than would cause deadly heart and brain issues with simple tests, as opposed to something that requires the golden hour to the hospital if you're about to have a heart attack from an MAOI.
> >It's not just MAOIs that contraindicate OTC medications - warfarin, and other drugs too
>
> I'm not quite sure what you're saying here. MAOIs do not interact with warfarin.No, I was implying that other drugs besides MAOIs are also a problem with OTC medication. It was just a side tangent.
> >Yes, there is a chance of short term memory loss
>
> There is a chance of long term memory loss, as many patients who've had ECT will tell you.Again -- that comes back to the argument of what is better, severe depression, or the chance, whatever it is, of cognition issues. It may be worse with ECT, but you're still balancing risky things with MAOIs.
> >risks of general anaesthesia
>
> Modern anesthesia is very safe. The anesthesia used for ECT is brief, and relatively 'light'. The main risks come from having an electric shock to the head.It is -- about 1 in 10000 die, usually from improper monitoring, idiopathic reactions, or lack of monitoring medications that may interfere.
> >Sure, if your life depended on what is essentially adult supervision and your doctor was sure you were going to jump out of the window, you couldn't exist in life otherwise, then an MAOI is awfully appropriate. But the casual use of them I think is personally dangerous.
>
> At what point did I suggest that MAOIs should be used casually? In order to take an MAOI safely, the patient requires knowledge, not 'adult supervision'.I was being a bit overboard, and didnt mean it pejoratively. Serious knowledge though.
If a patient was about to 'jump out of the window', admission to hospital would probably be appropriate.
...where an MAOI might be administered in a safe environment.
MAOIs are particularly suitable for severe atypical depression and/or social phobia. You do not need to be suicidal to take an MAOI.
No... but that's one criteria. Exhaustion of other less dangerous choices are others.
Its really tomato, tomahto, because I just can't see the idea of a medication that you have to carry along the equivalent of an anti-hypertensive, a nitroglycerin like tablet necklace to stop a crisis that could kill you in rush hour traffic. Alot who have had their lives changed around will disagree, and that's fine. Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.
Posted by Caedmon on May 5, 2006, at 12:47:58
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 4, 2006, at 20:28:45
> >And death with ECT is also extremely likely when done at proper research institutions who have been practicing it for years. And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office a lot quicker than would cause deadly heart and brain issues with simple tests, as opposed to something that requires the golden hour to the hospital if you're about to have a heart attack from an MAOI.>>
Dying from an MAOI-related hypertensive reaction is extremely rare.
http://www.acnp.org/G4/GN401000046/CH046.html
states that:"The actual morbidity associated with administration of the irreversible MAOIs is difficult to determine. However, it has been estimated that, of the 3.5 million patients that had used tranylcypromine by 1970, about 50 persons reportedly had cerebrovascular accidents and 15 of these individuals died."
>> Its really tomato, tomahto, because I just can't see the idea of a medication that you have to carry along the equivalent of an anti-hypertensive, a nitroglycerin like tablet necklace to stop a crisis that could kill you in rush hour traffic. Alot who have had their lives changed around will disagree, and that's fine. Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.>>See, I'm used to carrying around tablets and medicines. I generally have an albuterol inhaler in my backpack in case I have an asthma attack. I also have a bottle with a few diazepam 5mg tablets in them, for anxiety. I just add the nifedipine tablets to the diazepam bottle - they're pretty distinct: the former are small, flat, orange, and round and the latter are oblong, oval-shaped pink capsules.
So far on Parnate it's been amazingly easy to adjust. Eating out is the area that requires the most vigilance - having to ask "what kind of cheese is it" is embarrassing for this social phobic. Well, I'll live. :-)
- C
Posted by ed_uk on May 5, 2006, at 13:46:08
In reply to Re: MAOIs » ed_uk, posted by Crazy Horse on May 4, 2006, at 17:29:20
Hi Monte
You're right. The electric shock used in ECT is *not* small :( I dread to think what such as large electric shock does to the delicate neural tissue. It doesn't bear thinking about.
Ed
Posted by ed_uk on May 5, 2006, at 14:06:46
In reply to Re: MAOIs, posted by yxibow on May 4, 2006, at 20:18:27
>Is there a study?
I think it's pretty obvious than most people do not suffer from severe sinusitis on a regular basis.
>No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD.
There's nothing controlled about delivering an electric shock to the head. Sorry, anyone who thinks otherwise is just deluding themself. ECT is a very crude procedure, even with EEG monitoring etc. Unsurprisingly, psychiatrists who have been involved will have convinced themselves that it is safe - for their own peace of mind if nothing else.
>I wouldnt go there any more than I would an MAOI.
Neither MAOIs nor ECT are established treatments for OCD or somatoform disorders.......so I wouldn't really blame you.
>So why post it, I was lost ?
I posted it because it gave information RE the voltage and current used in ECT - which is enough to make my eyes water.
>Mm... ask the millions of Americans who use it daily.
I work in a pharmacy, I am well aware that many people are happy to buy what are effectively placebos (eg. expectorant cough medicines, Sudafed PE) on a regular basis. It is not, therefore, surprising that people should be happy to buy dextromethorphan. It is very easy to convince people that a medication is effective, even when it is not. The recommendation of a friend, the pharmacist or an advertisement.........
>Hmm.. I won't go there because that's character assasination.
I find your remark offensive. Codeine is effective in making me feel better. I find that it causes very mild side effects, which is more than can be said for the drugs you take. A lot of people take meds to feel better. A lot of people enjoy a glass of wine on an evening. I guess you've been brainwashed by the 'war on drugs' etc, which is particularly interesting considering that amount of diazepam you take.
Posted by ed_uk on May 5, 2006, at 14:22:27
In reply to Re: Went to pdoc today ... what do you think?, posted by yxibow on May 4, 2006, at 20:28:45
>And as far as Zyprexa -- the lipid profile issues can be detected at your doctors office
A lot of people who take Zyprexa gain a massive amount of weight, which is usually very difficult to loose. The risk of a heart attack or stroke is much greater in people who are overweight.
>heart attack from an MAOI
Interestingly, Nardil usually produces a decrease in blood pressure and heart rate. MAOIs such as pargyline (Eutonyl) were formerly used to treat essential hypertension.
>Exhaustion of other less dangerous choices are others
Most people who take MAOIs have already tried a large variety of other drugs and found them ineffective or intolerable.
>Its just not my choice and I dont think it should be any doctor-patient relationship's first choice either.
If other treatments don't help, what other choices are there?
Ed
Posted by Declan on May 5, 2006, at 19:55:01
In reply to Re: Went to pdoc today ... what do you think? » yxibow, posted by ed_uk on May 5, 2006, at 14:22:27
My experience of psych drugs is limited to old APs, benzos, Remeron, MAOIs. I have so little faith in the industry and so little stomach for it that I just couldn't go through the treadmill of all those drugs. If I got agitated depression I'd try Nardil and something; then opiates. I saw my mother go through it, toward maintenance ect. Better to die 5 times over. Cancer was a piece of cake by comparison. She would have agreed.
Declan
Posted by yxibow on May 6, 2006, at 1:49:52
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 5, 2006, at 14:06:46
> >Is there a study?
>
> I think it's pretty obvious than most people do not suffer from severe sinusitis on a regular basis.Probably true -- but its not a fun situation, anyhow, we can go beyond the sinusitis issue and drop it.
>
> >No, its not a euphemism, its exactly what it is according to my doctor who has I think two decades more experience than myself as an MD.
>
> There's nothing controlled about delivering an electric shock to the head. Sorry, anyone who thinks otherwise is just deluding themself. ECT is a very crude procedure, even with EEG monitoring etc. Unsurprisingly, psychiatrists who have been involved will have convinced themselves that it is safe - for their own peace of mind if nothing else.No, actually it is the same misinformed information that I am beginning to believe for myself about some use of MAOIs just as there is misinformed use about modern, controlled ECT in institutions that use the most modern equipment, procedures, anaesthetics, and practices. I certainly know there are hospitals around here and other parts of the country I wouldn't want it done in if it came to that.
>
> >I wouldnt go there any more than I would an MAOI.
>
> Neither MAOIs nor ECT are established treatments for OCD or somatoform disorders.......so I wouldn't really blame you.Not established but actually mentioned as a treatment by my doctor for my condition, as an end run use. Plus the fact that ECT has a far more immediate effect on neurotransmitters than any medication.
He would not recommend an MAOI because I am a vegetarian and there are way too many things contraindicated. Like Soy ___ (fill in the blank) for starters.
> >So why post it, I was lost ?
>
> I posted it because it gave information RE the voltage and current used in ECT - which is enough to make my eyes water.
>
> >Mm... ask the millions of Americans who use it daily.
>
> I work in a pharmacy, I am well aware that many people are happy to buy what are effectively placebos (eg. expectorant cough medicines, Sudafed PE) on a regular basis. It is not, therefore, surprising that people should be happy to buy dextromethorphan. It is very easy to convince people that a medication is effective, even when it is not. The recommendation of a friend, the pharmacist or an advertisement.........
I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value, and I buy whatever is the cheapest generic at the local drugstore anyhow. There are some OTC medications that are effective, some not terribly so. Loratadine is fairly harmless and does work. Hydrocortisone for my dry hands on a rare occasion is nice, but not for extended use, plus for contact dermatitis that I got before I wore long sleeves at the garden I volunteer at. Aforementioned, saline solutions are useful for various rhinitis and sinus conditions. Acetaminophen is perhaps the most useful and yet most dangerous as you know it is a popular method for exiting this existence in England. Ibuprofen I find quite effective at 4 or 600 for tension headaches.
But you have some points about placebos -- and they do work after all 33% of the time as studies have shown. And there have been recent articles about OTC medications and effectiveness. I'm not shooting you down on it, I'm only saying I've gained some purpose from some OTC medications. For others, it may do not a darn thing.> >Hmm.. I won't go there because that's character assasination.
I think you misunderstood me. I did not want to comment on your use of codeine for euphoria because I didn't want to hurt your feelings, and I feel you have taken it 180 degrees from what I was intending to say, Ed. I didnt want to offend you and I'm sorry if I did.
> I find your remark offensive. Codeine is effective in making me feel better. I find that it causes very mild side effects, which is more than can be said for the drugs you take.
For one off use. Over time, the codeine that is converted into morphine in your body will become habit forming. Sure, you can get off of it, just watch trainspotting -- and its not like heroin, but its not an approved use for the medication. That's why they banned it all over the US here because people were using it for stuff other than bad coughs.
Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either. I have a horrible disorder that nobody yet on this planet have I met has and I don't relish taking 6 medications a day to palleate it and not even cure.
A lot of people take meds to feel better. A lot of people enjoy a glass of wine on an evening.I enjoy your Blackthorn cider. I have no issue there.
I guess you've been brainwashed by the 'war on drugs' etc,
definately not... see below
which is particularly interesting considering that amount of diazepam you take.
I have no desire to take 170mg of diazepam a day. It has reached the same steady state as the slightly more than 8mg of clonazepam I was taking. I could theoretically be more engaged with society and not need to pay as much attention at the wheel (we all should pay attention at the wheel though), but would I be in danger of wanting to commit suicide because the lights returned back as bright as they were in 2001? Its an unanswered question.
I think you're feeling hurt -- I'm not brainwashed by the war on drugs; I dont think people using small quantities of marijuana should be prosecuted, this country spends way too much time on it and I support all initiatives to legalize medical use of marijuana, considering it was legal until the 1930s in this country.
I've never used so-called illegal drugs but if I didn't have a bevy of polypharmacy on board always in my life I wouldn't mind trying marijuana, so you don't have my views at all correct there.
Just the same this isn't a forum for discussing drugs not legal in either of our countries so I can't go further without getting a Dr Bob comment.
At the same time, shooting up heroin is not my idea of something that should be sold over the counter. And meth labs defy all logic -- I can't imagine why someone would want to be barely coherent and climbing the walls -- I've seen people on crystal, as you know it is prevalent in the gay community. And people have an opinion that somehow exstacy is no worse than popping a Prozac and GHB is child's play. I've seen someone on Ketamine too, and that is just mind boggling also.So, "softer drugs", aka marijuana, possibly your one off use of codeine with a strong caveat, alcohol, tobacco (though I think it should be erased from this planet because it drives up healthcare costs in this country and to watch people die of it is cringe making -- and it seems to be on the rise in the club community here), possibly khat (although that goes into the more hardcore stimulant range....), a light "poppy tea" like you brits used to make (and I mean light) -- okay, for those of age.
"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
Dont create a rift with us, Ed -- I think you are having a bad day or are totally misinterpreting me over my banter on medications which is my right as much as yours here on Dr Bob. We are on the same track personally and I've told you that in babblemail. And I will tell you that again.Sincerely, and tidings
-- Jay
Posted by ed_uk on May 6, 2006, at 10:15:21
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 1:49:52
>Like Soy ___ (fill in the blank) for starters.
Certain soy products are contra-indicated with MAOIs, others are not.
>I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value
Mild coughs are self-limiting, giving the false impression of drug efficacy.
>I'm only saying I've gained some purpose from some OTC medications.
Some OTC medicines are very effective. I was just making a the point that cough medicines are not generally very helpful. Recovery occurs naturally but is attributed to the medication.
>codeine for euphoria
I find it somewhat mood elevating but non-sedating. It tends to make me want to exercise. You are making assumptions.
>habit forming
Rather like cider then......
>trainspotting
I've seen it. As a film, it is intended to be very dramatic. Alcohol withdrawal is often more severe than opioid withdrawal - *many* people are addicted to alcohol.
>Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either.
I'm sorry that you thought that, it was not my intention. It was not me who brought up the subject of character assasination.
>banned it all over the US
LOL, I suppose what they do in the US must be right ;-)
>I think you're feeling hurt
Yes, I am
>"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
You can't divide drugs into 'good' drugs and 'bad' drugs J. This type of oversimplistic classification reflects a lack of knowledge and understanding. Diamorphine (Heroin) and other potent opioids are very important drugs in the treatment of severe pain. Ketamine is used as an analgesic in emergency medicine. GHB (Xyrem) is used to treat narcolepsy with cataplexy. Cocaine is used during ENT surgery.
Ed
Posted by ed_uk on May 6, 2006, at 10:44:54
In reply to Re: MAOIs » ed_uk, posted by yxibow on May 6, 2006, at 1:49:52
>"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
'Crystal' methamphetamine is closely related to amphetamine (Adderall) - which is widely prescribed by psychiatrists in the US, especially to children. Methamphetamine itself (Desoxyn) is also occasionally prescribed by pdocs in the US.
Ed
Posted by yxibow on May 6, 2006, at 13:01:46
In reply to Re: MAOIs » yxibow, posted by ed_uk on May 6, 2006, at 10:15:21
> >Like Soy ___ (fill in the blank) for starters.
>
> Certain soy products are contra-indicated with MAOIs, others are not.I know -- but its too hard for a vegetarian who eats products made from all parts of a soybean -- isolates, TVP, protein powder, tofu, soy sauce, teriyaki, edamame, yuba, okara, tempeh, etc. Not to mention nutritional yeast. Plus on top of this eating out at really nice restauraunts around here.
>
> >I've found guaifenesin effective and dextromethorphan effective for coughs over what I would consider a placebo value
>
> Mild coughs are self-limiting, giving the false impression of drug efficacy.
>
> >I'm only saying I've gained some purpose from some OTC medications.
>
> Some OTC medicines are very effective. I was just making a the point that cough medicines are not generally very helpful. Recovery occurs naturally but is attributed to the medication.Of course, that I agree with you. I have no ideation that DXM is going to "cure" my corona virus.
>
> >codeine for euphoria
>
> I find it somewhat mood elevating but non-sedating. It tends to make me want to exercise. You are making assumptions.Curious... well excercise is good as I know. Bleh, the cereal monster visited this morning. I always eat too much breakfast.
>
> >habit forming
>
> Rather like cider then......Mm... actually I haven't drunk much since I've been to the gym -- its added calories. But I do enjoy some cider now and then. No alcoholic here. I will admit I drunk myself under the table in college due to my homesickness and dysthymia and was the only time of twice I ever even marginally threw up in my life from alcohol. The sulfur dioxide doesn't help in a hangover either.
>
> >trainspotting
>
> I've seen it. As a film, it is intended to be very dramatic. Alcohol withdrawal is often more severe than opioid withdrawal - *many* people are addicted to alcohol.True on both counts.
>
> >Now you're character assassinating me about the medication regime that I disdain, Ed, and that's not fair either.
>
> I'm sorry that you thought that, it was not my intention. It was not me who brought up the subject of character assasination.I brought it up because I was deliberately trying not to hurt you and it got turned around. Anyhow, bygones.
> >banned it all over the US
>
> LOL, I suppose what they do in the US must be right ;-)No -- not always. I still think codeine (with APAP or Ibuprofen to discourage morphine seeking) should still be sold with signing some federal book or something, but we're not a centralised country.
> >I think you're feeling hurt
>
> Yes, I amI am sorry to hear that.
>
> >"Hard drugs" - X, K, GHB, Crystal, Heroin, Cocaine -- bad. bad bad. Explosive buildings bad. Poverty and driveby shooting bad. All around bad.
>
> You can't divide drugs into 'good' drugs and 'bad' drugs J. This type of oversimplistic classification reflects a lack of knowledge and understanding. Diamorphine (Heroin) and other potent opioids are very important drugs in the treatment of severe pain. Ketamine is used as an analgesic in emergency medicine. GHB (Xyrem) is used to treat narcolepsy with cataplexy. Cocaine is used during ENT surgery.
Again, this is all due to the re-cre-a-tional use of all above said medicines and I can divide soft use and hard use quite easily as already mentioned for use outside the medical establishment. There I believe I think you missed the point. I am talking about recreational use only of medications which this time I will use the word properly -- adult supervision, i.e. Schedule II injectable medications.
Heroin has no medical use in the US and is so banned for any use of it. There are plenty of morphine related narcotics available for pain management. I was not talking about pharmaceutical use, I was talking about so-called recreational use of it, which involves unclean needles, disease, and abject poverty and grand theft and so on.
Ketamine has use in veterinary medicine and pediatric anaesthesthisia. I was referring to the clandestine diversion of this drug to people I have known in the past who should know better than to crush, snort, chew, whatever, this substance under no supervision. Its horribly dangerous then. It is a chancy choice of anaesthetic even when used properly in a medical setting.
GHB has been recently reintroduced as Xyrem with very stringent guidelines. It is not childsplay and again, we're talking about diversion to recreational use which when combined with alcohol leads to coma and death. And has been used like other potent agents (yes, Valium and Ambien and other substances too, Ed, I'm not forgetting that...) to subdue individuals to do sexual harm to them.
Cocaine is used mostly only as a topical anaesthetic here and has largely been replaced by other synthetic drugs related to it. It is also schedule II because it can be diverted to largely "white collar crime" where people snort their noses into cartilage oblivion.
And finally, the explosion of your flat mate below or a fire that ruptures through a housing development because some organic chemistry people who should know damn better, are mixing up a pot of methamphetamines, is BAD. And unfortunately that has led to scheduling of pseudoephedrine which only hurts and insults the sinusitis sufferer.And if there is a final issue -- it is the use of unsterile needles to use these substances clandestinely, and the unknown content of "manufactured" exctasy which could contain other things besides MDMA including rat poison and drano or whatever else they have lying around to cheapen it.
So no, no hard drugs to people of any age, especially the young.
And "soft drugs" like marijuana, I have no issue with. The government here does. If it were regulated like tobacco you'd see far less automatic weapons fire against the public. You are lucky in the UK with strict guns laws, and Canada too. Here, well... we'll get arguments about the 2nd amendment which is a whole different boiling pot.
So that's my point -- recreational use of hard drug substances which leads to thousands of wasted dollars, grand theft, murder, etc, and legitimate medical uses.
Tidings-- Jay
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