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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by jealibeanz on July 31, 2006, at 23:52:00
In reply to Re: MAOI fear, posted by Phillipa on July 31, 2006, at 22:56:31
I could ask if there have been any new ADs I gaven't tried, beside Cymbalta. There aren't any others right? Maybe he'd mention EMSAM and give an opinion.
Posted by ace on August 1, 2006, at 0:50:31
In reply to MAOI fear, posted by jealibeanz on July 31, 2006, at 13:53:56
> I just had a presentation give a one slide presentation on depression and medications for a lecture. He, and MD, listed SSRIs as the main treatment. Mayyybe TCAs if carefully monitored. Never MAOIs... too dangerous/lethal. Kinda sad that's the general opinion of doctors.
ABSOLUTE and UTTER RUBBISH!!!!!!!!!!!
Do MAOI's have the same risk of morphological twisting of neurons that SSRI's have...NO!
Do MAOI's have the same potential for cardiotoxicity as TCA's: No!!!!!!
Do MAOI's have any more renal problems than the SSRI's: NO!
Do MAOI's have the horrid w/drawal symptoms of many SSRI's: NO!
Do MAOI's have as many contraindications as SSRI's and TCA's: YES, BECAUSE CLINICAL TRIAL HAVE NOT BEEN DONE ON THEM FOR SO LONG AS TO CONFIRM SAFETY WITH OTHER PSYCHOPHARMACOLOGICAL AGENTS. I HAVE USED OVER 7 'CONTRAINDICATED' MEDS WITH NARDIL, WITH NO PROBLEMS.
MAOI hypertensive risk is very low, despite comments to the contrary.Hypoxia, which has been noted with the SSRI's, is non-existant with the MAOI's
And, despite all the nonsense you will here, MAOI's have just the same, if not less, s/eefects than SSRI's. SSRI's have been noted to cause dyskinesias, diaphoresis, huge weight gain, 'zaps' in different lobes of the brain, total inorgasmia, edema, and so on.
DON'T BELIEVE THE HYPE!MAOI's ARE THE BEST!!!!!!!!!!!!!!!!!!!!!
Posted by jealibeanz on August 1, 2006, at 1:55:30
In reply to Re: fear of stupid 'scholars'!!!!!!!!!!! » jealibeanz, posted by ace on August 1, 2006, at 0:50:31
I don't understand why SSRI's are considered soo safe and commonly used more and more everday to treat every diease state known to man, regardless of depression. There are tons are very very abnormal and unexplicable side effects in a large proportion of patients. I've never experienced the withdrawal so i can't commnet, but it seems to be one of themost dangerous (yet not clinically proven, so who cares, right?) SE's out there. Still hoping that my doc is a little more open minded abolut such things.
Anyway, is there simewhere I can look to find the most recently released ADs?
Posted by UgottaHaveHope on August 1, 2006, at 4:37:23
In reply to Re: fear of stupid 'scholars'!!!!!!!!!!!, posted by jealibeanz on August 1, 2006, at 1:55:30
Go to www.Ensam.com, print it out, and take to doc. Tell him this is cutting edge MAOIs, doesnt have all the restrictions of older MAOIs. Be gentle, but firm. This is your life. You got to stand up If he is cool like you say, he will hear you out. Just know what to say.
Posted by stargazer on August 1, 2006, at 6:43:46
In reply to Print this out and take to your doc, posted by UgottaHaveHope on August 1, 2006, at 4:37:23
I just typed a big long message and lost it so here's a brief summary of it.
That prof should never had said not to ever use MAO's for depression. First of all he is a GP, secondly, he is admittedly a "generalist". He is clearly not in any position to make that statement against using MAO's. He is just unfamiliar with them and considers the newer meds the "gold standard" of treatment.
I have taken MAO's back in the early 80's when only TCA's and MAO's were available. After failing a trial of TCA's (anticholinergic effects)my doc started me on Nardil without any hesitency. Remember the choices were not there. I had an almost immediate good response and took Nardil for many years. Also back then the school of thought was to discontinue an AD once the depression had lifted. The next time my depression surfaced, we tried Nardil and it didn't work. So we tried another MAO with success, either Parnate or Marplan. So my experience then was a good one. Then disaster stuck and Marplan was discontinued by Roche because of all the newer, more effective AD's that had been developed, starting with Prozac, I tried them all. Some worked for awhile, some didn't work, some made me worse and everything in between.
Now, I am back on Marplan, re-released I'm assuming due to the demonstration of those former users who have not achieved the same results with the newer,improved meds. For me, Marplan seems to be working again. It's only been about 2 mos but I have good feeling about it.
I'm glad I tried it again. My doc had no problem prescribing it. He gave me a handout on dietary restrictions and a prescription for Nifedipine, for any BP crises. But the risk is worth it to me if it means feeling whole again and not trying every medication that is developed for the rest of my life.
It is worth it for now.............SG
Posted by jealibeanz on August 1, 2006, at 11:18:18
In reply to Print this out and take to your doc, posted by UgottaHaveHope on August 1, 2006, at 4:37:23
Ahhh such a good plan, but scarey! I'd almost be better at walking up to an uncaring doc who doesn't know me, b/c I'd have no problem arguing! But an uncaring stranger wouldn't trust me enough or would believe that I should try a handful of other SSRis first!
Posted by jealibeanz on August 1, 2006, at 11:24:16
In reply to Marplan, worth it then and now, posted by stargazer on August 1, 2006, at 6:43:46
Is Marplan like Parnate? I know Nardil is good for thosw w/anxiety, but that it can cause weight gain. Have you experienced this with Parnate, Marplan, or others? What side effects do you have and are willing to deal with?
Posted by mworkman on August 1, 2006, at 13:53:55
In reply to Re: Marplan, worth it then and now, posted by jealibeanz on August 1, 2006, at 11:24:16
> Is Marplan like Parnate? I know Nardil is good for thosw w/anxiety, but that it can cause weight gain. Have you experienced this with Parnate, Marplan, or others? What side effects do you have and are willing to deal with?
I think Marplan is more like nardil than parnate.
Posted by kimcrazylady on August 1, 2006, at 13:58:10
In reply to Re: Marplan, worth it then and now, posted by jealibeanz on August 1, 2006, at 11:24:16
What bullcrap. Parnate is the ONLY drug that has worked for me, ever. I've tried them all, too. I don't follow the diet carefully and have taken meds that are on the "forbidden" list (given by a doctor, no less). The old lists are totally outdated and as another said, no one has done any new studies. Heck, I've had several surgeries, have no issues at the dentist (he uses a nov. without the eppy) and I get so pissed every time I hear people, especially doctors, spew sh*t like this.
Grr. Sorry for the few cuss words, but these drugs can be SO SAFE. I've been on and off Parnate for years and I even have high Blood Pressure and an aneurysm. Still no problems.
Tell the doc to do some research. Have him start here.
Posted by jealibeanz on August 1, 2006, at 17:09:10
In reply to Re: Marplan, worth it then and now, posted by mworkman on August 1, 2006, at 13:53:55
Have you had any side effects?
Posted by jealibeanz on August 1, 2006, at 17:14:19
In reply to Re: Marplan, worth it then and now, posted by kimcrazylady on August 1, 2006, at 13:58:10
He barely talked about depression or the medications, but had a one line bullet listing SSRI, TCAs, and MAOIs. His ad lib comment was not to use MAOIs ever.
Such a surprising remark since we're told about all sorts of very dangerous medications that we may consider using for particular diseases when all else fails. He's said many times that a given drug is dangerous and very seldom used, but never completely excluded it from use. I wonder why he even included MAOIs if he felt this way. However, he is a pathology prof, not psych or pharm. I may have a different presentation in those classes.
Posted by stargazer on August 1, 2006, at 23:31:06
In reply to Re: Marplan, worth it then and now, posted by jealibeanz on August 1, 2006, at 17:14:19
Right now on 30 mg Marplan, Lamictal 200 and Risperdal 0.25 I'm having SE's of dizziness and alot of vague sx that I'm not sure if they are caused by the meds or something else. I'm having thoughts that I may have a particular neurological disease that I read about, since I've been falling frequently the last few months, even prior to starting Marplan. I'm having a complete physical tomorrow for some of these concerns. Actually, I haven't felt physically well for a long time and I guess I have always attributed it to depression. Physically I have always been healthy, so now I'm scared about all these vague symptoms that are probably nothing but which have me worried with what it could be.
I say to my doctor I don't feel depressed but he is convinced I am since when I see him I start crying. I don't feel that is always indicative of depression. Sometimes even trying to say I'm not depressed fails to convince him. Sometimes I don't know myself.
Sorry to digress...I do feel the MAO's have less SE's than the SSRI's, etc. Mostly I had headache, lethargy, dizziness and sometimes no SE's other than no response.
SG
Posted by Tepiaca on August 2, 2006, at 11:47:34
In reply to MAOI fear, posted by jealibeanz on July 31, 2006, at 13:53:56
> I just had a presentation give a one slide presentation on depression and medications for a lecture. He, and MD, listed SSRIs as the main treatment. Mayyybe TCAs if carefully monitored. Never MAOIs... too dangerous/lethal. Kinda sad that's the general opinion of doctors.
No no , a MAOI have been the only drug that has helped me cure my depression. You only have to be careful with certain kind of food and other meds. But that is so easy. I have no problems following diet restriction because I can even eat things that say in the list is restrcited.
I had one HP crisis a 2 years ago , because I ate a chiken that was spoiled, But the med didnt cause thi , I caused bacause I already know it was spoiled and I thougth nothing bad would happen. You have to be careful sometimes. But in general it very very easy
tep
Posted by jealibeanz on August 2, 2006, at 12:26:24
In reply to Side effects of MAO's, possible physical cause for, posted by stargazer on August 1, 2006, at 23:31:06
Did you have any weight gain with any of them? Are you treated by a pdoc?
Posted by jealibeanz on August 2, 2006, at 12:36:30
In reply to Re: MAOI fear » jealibeanz, posted by Tepiaca on August 2, 2006, at 11:47:34
I don't mind food restrictions, as long as the med is helping.
I question whether I should even present the depression to my doc now. I have serious insomnia and also anxiety. He may think the depression to due to that, rather than depression itself. I don't feel this way though. I've been depressed almost a whole year, which a little remission around Nov/Dec (when I was taking Effexor, huh, guess there's a link!).
Most of this time my insomnia was well treated. I also have a history, but then again he may think that this is more likely due to my history of anxiety.
This is all speculation though. I haven't even mentioned the idea to him or even hinted at it. Ughhh 2 weeks til my appointment and I may chicken out. On the other hand, I am about ready to drop out school because I'm so unhappy/tired/hopeless.
I'll definitely tell him that there's no way I'm going back to school unless I think I may sleep more than 2-4 hours a night b/c the lack of rest is killing me. That's definitely understandable. But I don't know what else to say to drive the point home.
Posted by nickguy on August 2, 2006, at 12:58:53
In reply to Re: MAOI fear, posted by jealibeanz on August 2, 2006, at 12:36:30
if your not willing to talk about your depression with him, then your not going to get an MAOI like you want, and your not going to get any better. I really don't understand the hesitation there.
Posted by jealibeanz on August 2, 2006, at 13:57:36
In reply to Re: MAOI fear, posted by nickguy on August 2, 2006, at 12:58:53
Just thinking outloud (or typing) here. Yeah, obviously I need to tell him. I'm just wondering if I would have to wait to fix the sleep thing til anyone would want to treat depression.
Posted by nickguy on August 2, 2006, at 16:11:37
In reply to Re: MAOI fear, posted by jealibeanz on August 2, 2006, at 13:57:36
insomnia is half the time a symptom of depression, so must likely no.
Posted by jealibeanz on August 2, 2006, at 16:38:25
In reply to Re: MAOI fear, posted by nickguy on August 2, 2006, at 16:11:37
Yeah, which is why I'm surprised it's not discussed. I've been taking Lunesta for 1 yr and Xanax for months! Maybe he's thinking it, but not actually saying it. He knows I didn't like ADs in the past. I suppose there isn't necessarily a need for him to look at me a say I'm depressed, esp. since the symptoms are being treated (or attempted to be), just not w/ADs. Obviously he's aware that nobody likes to be labelled as such.
It also hasn't helped that I began treatment with his PA, then had to see him 6 months later. A lot had gone on w/ diagnosis and treatment of uncontrolled insomnia, anxiety, depression, ADHD. Not a terribly stable year.
So the initial relationship involving all these problems was not built with him, who I hadn't seen in a couple of years. Now I plan to stay w/ him since continuity is best, plus my PA can't presribe Xanax himself and that just gets a little messy. I'm sure he's more comfortable turning me over to the doc who takes responsibility for controlled drugs.
Posted by nickguy on August 2, 2006, at 18:58:47
In reply to Re: MAOI fear, posted by jealibeanz on August 2, 2006, at 16:38:25
your situation is a little unclear to me, but I think I can say this: don't forget that your paying him, he's at your service your not under his control. My feeling is that if you want a certain treatment, and the doctor refuses without legitimate reason, it's time to search for a more rational, intelligent doctor. I changed doctors and now basically have the freedom to experiemt with pyschiatric drugs just to compare and contrast what's best for me.
You seemed to express that it would be difficult to bring the topic of depression and AD's up. Just a thought- sometimes it's easier to talk to somebody you don't know, a new pysch, about these things. I think sometimes with people we are familiar with we have the inclination to want them to like us and not be distressed. Anyway, I wish you good luck...I can see through your posts that your struggling and I hope you hang in there and dont take any sh*t from these doctors.
Posted by jealibeanz on August 2, 2006, at 19:45:58
In reply to Re: MAOI fear, posted by nickguy on August 2, 2006, at 18:58:47
Yes, it is easier, which is why in April I went to a pdoc, with nooo success. So I then tried two new GP's, absolutely nothing! They all don't me I had no depression/anxiety, no matter what symptoms I described. They were all very pro SSRI, but I made it cleat that I was not.
Anyway, that's how I made it back to my regular GP. He's nice enough to humor me with prescriptions, whether or not he is sure how much it'll help, and listen to my complaints without judgement.
What are you confused about in terms of my status of meds/diagnosis/concerns. Just ask. I don't mind.
Posted by nickguy on August 2, 2006, at 22:29:43
In reply to Re: MAOI fear, posted by jealibeanz on August 2, 2006, at 19:45:58
That makes it a bit more clear.I still can't understand how if you truly feel pain and anxiety, that a doctor could just say, "you don't have a problem." That's a serious problem. Also, our situation seems more complicated than something a GP could handle. (meaning not the one that you like, but the other two you mentioned you had no success with) However, I can't stress enough how important it is to go PDOC shopping if you can. Trying one with no sucess and giving up is selling yourself short. It is simply amazing the different philosophy's some pdocs have. I have one now who trusts me to experiment with different Benzodiazepam drugs to see which works best, and has an maoi or stimulant for future plans. take that, versus, my previous one who diagnosed me as bi-polar with basically no evidence, and refused any meds remotely related to controversy... (addiction, risks, ect)
One difficult thing about your situation, is that you really don't want SSRI's. (I can completely relate with you there) But Unless you tell them that you've tried atleast two or three of them, not many will be willing to go to maoi's or even TCA's. If you decide to go to a new psychiatrist, bring a list of meds you taken, and add the ssri's on the list, that way you wont have to bother.
Posted by jealibeanz on August 3, 2006, at 1:44:50
In reply to Re: MAOI fear, posted by nickguy on August 2, 2006, at 22:29:43
I actually don't feel as if my situation is thaattt complicated or severe, I just protray my feelings/experience in a magnified/exaggerated tone on here. Doesn't any problem, no matter how big or small, feel like the worst thing in the world, simply b/c it's happening to us?
As far as the other docs not treating me... I honestly just think it was a fluke. Also, I was a new patient to each of them and there's no way you'd want to give someone a benzo/stimulant/MAOI on first meeting, even though I'd given them a history of past meds. They just were being overly cautious. It's understandable they'd want to protect themselves from the DEA/malpractice suits. My own doc would much more take the risk of being questioned for any "out of the box" treatments, b/c he wants to help me as a person, not just the physiology of some stranger off the street.
Posted by nickguy on August 3, 2006, at 22:21:03
In reply to Re: MAOI fear, posted by jealibeanz on August 3, 2006, at 1:44:50
> I actually don't feel as if my situation is thaattt complicated or severe, I just protray my feelings/experience in a magnified/exaggerated tone on here. Doesn't any problem, no matter how big or small, feel like the worst thing in the world, simply b/c it's happening to us?
Depression is not just a problem, its a life encompassing suffering.. from my experience atleast, and I really think doctors who don't understand this should not be practicing.
> As far as the other docs not treating me... I honestly just think it was a fluke. Also, I was a new patient to each of them and there's no way you'd want to give someone a benzo/stimulant/MAOI on first meeting, even though I'd given them a history of past meds. They just were being overly cautious. It's understandable they'd want to protect themselves from the DEA/malpractice suits. My own doc would much more take the risk of being questioned for any "out of the box" treatments, b/c he wants to help me as a person, not just the physiology of some stranger off the street.
I'm not aware of many malpractice suits concering stimulants or benzodiazepams, other than instances of death or illness, with stimulants mainly regarding children, and for benzos it's mostly instances of allergic reactions. With a quality pyschiatrist, if you mention anxiety and explain how it's affecting your life, they'll most likely prescribe a benzodiazepam. What I've learned after many years of this game, is that shopping and finding a quality PDOC, and being honest with him= sucess
Posted by jealibeanz on August 3, 2006, at 23:19:51
In reply to Re: MAOI fear, posted by nickguy on August 3, 2006, at 22:21:03
Actually my doc does seem to genuinely care and understand the gravity of major anxiety, which is why he has no problem with my daily Xanax. He's the only person I've ever met with this attitude.
The other doctors I've seen think they're terrible/addictive and have no use for them. My lecturers seem to feel the same way too. Godforbid, if any of my faculty knew I had Xanax, daily!, they'd probably suggest drug rehab, immediate counseling, an SSRI, and withdrawal from the program. They all love those SSRIs!
So anyway, I'm sure he'd understand the gravity of depression. He's certainly done so with my insomnia and anxiety. And his PA was very concerned when I had cry spells and a major depressive episode last fall due to a med raction.
I'm actually now going through a similar experience since I stopped and restarted Straterra. Bad idea. Guess I need to tell him about this little experiment of mine. I always like to experiment a little or have the feeling that I'm the one in control of my prescriptions.
This is the end of the thread.
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