![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Check on August 14, 2006, at 18:23:26
I am currently thinking about trying an MAOI for my treatment-resistant, atypical depression and I am wondering if anyone has any advice as to which one would be best. I have tried lexapro, zoloft, wellbutrin, cymbalta, adderall, and effexor to no avail. I am nervous and depressed most of the day and have obsessive tendencies. So far (correct me if I'm wrong) it seems that:
Nardil has the best reputation for one such as myself, but since it was reformulated in 03 there are doubts about its efficacy. It also is the most sedating MAOI but the best for social anxiety (which I have). I have also read that its hydrazine group makes it very hard on the liver.
Parnate is metabolized into amphetamine and is the most activating of the MAOIs. It doesn't cause weight gain, but can cause agitation and is the touchiest about tyramine rxns.
Marplan seems to be the middle of the road drug lacking the more extreme pros and cons of the other two.
I've read a little about moclobemide and selegline, but they don't seem to pack the same punch as the older MAOIs. So far I'm thinking about marplan. Any advice would be much appreciated.
Thanks
Posted by Phillipa on August 14, 2006, at 20:04:07
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
What country are you in? The EMSAM patch is in the USA. And a lot of good responses so far. Love Phillipa
Posted by laima on August 14, 2006, at 23:44:20
In reply to Re: Which MAOI? » Check, posted by Phillipa on August 14, 2006, at 20:04:07
> What country are you in? The EMSAM patch is in the USA. And a lot of good responses so far. Love Phillipa
The EMSAM might be an easy one to start off with, as it is a touch safer and simpler interaction-wise than some of the others.
Posted by silvercoin on August 15, 2006, at 13:14:56
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
> I am currently thinking about trying an MAOI for my treatment-resistant, atypical depression and I am wondering if anyone has any advice as to which one would be best. I have tried lexapro, zoloft, wellbutrin, cymbalta, adderall, and effexor to no avail. I am nervous and depressed most of the day and have obsessive tendencies. So far (correct me if I'm wrong) it seems that:
>
> Nardil has the best reputation for one such as myself, but since it was reformulated in 03 there are doubts about its efficacy. It also is the most sedating MAOI but the best for social anxiety (which I have). I have also read that its hydrazine group makes it very hard on the liver.
>
> Parnate is metabolized into amphetamine and is the most activating of the MAOIs. It doesn't cause weight gain, but can cause agitation and is the touchiest about tyramine rxns.
>
> Marplan seems to be the middle of the road drug lacking the more extreme pros and cons of the other two.
>
> I've read a little about moclobemide and selegline, but they don't seem to pack the same punch as the older MAOIs. So far I'm thinking about marplan. Any advice would be much appreciated.
>
> Thanks
I am currently taking Marplan and have tried both Nardil (only the newer version) and Parnate. I tend to recommend Nardil out of all of these because it is more widely used than Marplan, and there is more data and experience regarding dosage. Both of these drugs are hydrazine derivatives that can cause hepatotoxicity, but this is relatively rare. I think both of them also have some tendency to induce weight gain, but not everyone will experience this. All of the MAOIs have a tendency to cause insomnia, and Parnate is probably the worst one. My experience has been that if MAOI insomnia is not dealt with, severe afternoon drowsiness can result. I have had pretty good luck with Seroquel but also require a particular sleep/relaxation CD in order to get any amount of sleep.Todd
Posted by Maxime on August 15, 2006, at 17:26:36
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
I think you have to flip a coin. Seriously. My friend had the worst social anxiety ... couldn't leave the house. So her pdoc put her on Nardil ... she couldn't function.
Then she tried Parnate. She got her life back. AND it made her gain weight.
You just have to try. Nardil seems like the best one to try first ... so perhaps that's the one to try first. But don't be disappointed if it doesn't help. There is always Parnate.
Good luck and let us know what you choose.
maxime
Posted by Tom Twilight on August 16, 2006, at 7:03:00
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
Hey Check
I have to say I think I'm with Maxine
I would try Parnate firstIts funny that I should say this because I'm taking Nardil, but I have to say I found Parnate much more tolerable.
I would infact be taking Parnate if I didn't live in this godforsaken country (the UK)
The things to consider with Parnate is that it causes greater tyramine sensitivity, also it causes worse insomnia.
I have to say I didn't find Parnate very activating.Marplan for me was a bit of a waste of time.
It has milder side effects but I think it's weaker.
Good luck anyway!
Posted by silvercoin on August 16, 2006, at 9:57:07
In reply to Re: Which MAOI?-Maybe Parnate, posted by Tom Twilight on August 16, 2006, at 7:03:00
> Hey Check
>
> I have to say I think I'm with Maxine
> I would try Parnate first
>
> Its funny that I should say this because I'm taking Nardil, but I have to say I found Parnate much more tolerable.
>
> I would infact be taking Parnate if I didn't live in this godforsaken country (the UK)
>
> The things to consider with Parnate is that it causes greater tyramine sensitivity, also it causes worse insomnia.
> I have to say I didn't find Parnate very activating.
>
> Marplan for me was a bit of a waste of time.
> It has milder side effects but I think it's weaker.
> Good luck anyway!
I'm taking 50 mg/day of Marplan and am trying to decide if I should ask my doctor next week when I see him if we can up my dosage to the max of 60 mg/day or stay where I am. I've been at this level for about 6 weeks and am functioning well, but the AD effect is definitely way short of what I've experienced on Nardil in the past at 75-90 mg/day. Perhaps one of the reasons that Marplan has pretty much fallen by the wayside is that it may indeed be weaker than Nardil. My doctor used to use both of them extensively and does not feel that either one is clearly superior; rather, some people simply seem to respond better to one than the other. Since I am actually doing pretty well, I'm finding it a bit hard to justify a dosage increase. An increase in insomnia or other adverse effects might be counterproductive.Todd
Posted by Tom Twilight on August 16, 2006, at 12:26:30
In reply to Re: Which MAOI?-Maybe Parnate, posted by Tom Twilight on August 16, 2006, at 7:03:00
It was unfair of me to characterise Marplan as "weaker" than Nardil.
Some people respond very well to itThe dose of Marplan can be pushed up to 100mgs+ I believe
Posted by kimcrazylady on August 17, 2006, at 11:48:10
In reply to Marplan correction, posted by Tom Twilight on August 16, 2006, at 12:26:30
I like Parnate, even though I can't take it late in the day or I will suffer insomnia. It has made me gain weight, but I'll take that over being a vegetable.
I've never tried Nardil, but the Parnate has worked for me. However, this time it's not as successful. Grr. I want to add something, but have no idea and my doc isn't being very helpful.
Kim
Posted by psychobot5000 on August 18, 2006, at 11:57:58
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
Hi,
In a large analysis of the efficacy of different psychiatric medications, moclobemide scored lowest, below SSRIs. It is simply much weaker than Parnate, Marplan, or Nardil, which had the best results of any drugs, in the same study.
I really wouldn't waste your time on moclobemide. Selegiline/EMSAM is a different thing, however.
Nardil does sound appropriate to me, for your nervous and obsessive tendencies. As for liver health, Marplan is the worst, followed by Nardil. Parnate is a maybe.
Anyway, just keep in mind that Marplan is probably more damaging to the liver than Nardil. Hepatoxicity seems to be rare, but don't choose Marplan over Nardil for that reason.
Response seems to be very individual. Any of them would probably be a good choice, except moclobemide. I had best results with selegiline.
Best,
P-bot
Posted by Denise190466 on August 21, 2006, at 7:08:35
In reply to Re: Which MAOI?-Maybe Parnate, posted by Tom Twilight on August 16, 2006, at 7:03:00
Hi Tom,
What's the reason for your not being able to take Parnate? I don't understand what being in the UK has to do with it?
By the way, whereabouts in the UK are you from?
Denise
Posted by Check on August 23, 2006, at 11:51:07
In reply to Which MAOI?, posted by Check on August 14, 2006, at 18:23:26
Hey,
Thanks for the advice. I think I'm going to give EMSAM a try as my first MAOI; I'll find out how well it works after I see my doc at the end of this month.Check
Posted by jealibeanz on August 25, 2006, at 21:54:33
In reply to Re: Which MAOI? » Check, posted by Maxime on August 15, 2006, at 17:26:36
What do you mean she couldn't function? She was too tired?
Funny how so many will say Parnate doesn't cause weight gain. It's like the SSRI's though. They effect everyone in a different manner.
Posted by Tomatheus on August 25, 2006, at 22:18:58
In reply to Re: Which MAOI?, posted by psychobot5000 on August 18, 2006, at 11:57:58
> In a large analysis of the efficacy of different psychiatric medications, moclobemide scored lowest, below SSRIs. It is simply much weaker than Parnate, Marplan, or Nardil, which had the best results of any drugs, in the same study.
>
> I really wouldn't waste your time on moclobemide. Selegiline/EMSAM is a different thing, however.P-bot,
Actually, a meta-analysis conducted by Lotufo-Neto et al. (1999) found moclobemide to be "somewhat less effective" than the older MAOIs, approximately just as effective as the tricyclics, and, "at the least, comparable to the SSRIs in both efficacy and tolerability." So, even though I agree with your assessment that moclobemide probably wouldn't be a best first choice as far as MAOIs go (especially in the U.S., where EMSAM is available as a "less risky" MAOI), I think that the available evidence suggests that moclobemide tends to be just as effective as the SSRIs (not less effective) in the treatment of depression.
Tomatheus
==
REFERENCE
Lotufo-Neto, F., Trivedi, M., & Thase, M. E. (1999). Meta-analysis of the reversible inhibitors of monoamine oxidase type A moclobemide and brofaromine for the treatment of depression. Neuropsychopharmacology, 20, 226-247.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.