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Posted by josephine grandoni on November 12, 2006, at 17:39:52
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
The patch bypasses the stomach and goes directly to the blood stream therefore you would not have the dietary restrictions that pertain to mao inhibitors. The naltrexone is off-label..you could look up 'low dose naltrexone' or LDN...there is an organization that is trying to get it approved for a variety of problems. It helps with self-destructive behavior. I'm in New York. What are you taking now?
Posted by Phillipa on November 12, 2006, at 19:42:27
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 12, 2006, at 17:39:52
Very true but go to the official website EMSAM and 9 and l2mg patches follow the dietary guideline. I know it bypasses the gut which is one reason I love the idea of it as I took bioidentical hormones in cream form. And I couldn't tolerate the pill but somehow something you can see is soothing to me. I once posted here that if you ripped it off the med would be gone but then other EMSAM posters said it lasts for around 9 days. Are you on it? I'll love to hear from you. I'm an old Yankee Ct. Babblemail me and e-mail supplied. Love Phillipa
Posted by elanor roosevelt on November 13, 2006, at 11:36:59
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
i am also going to my doctor today
i will get a lecture because i have been withdrawing from parnate without seeking his advice
paranate was on of those drugs that fro me, convinced me i was so f**cked up and such a loser-- that it took me too long to realize it was the drugthe sadness and despair i have experienced on parnate makes me sucpicious of the entire category of drugs
-- i have not heard one good report here on emsam
(which the pharma companies are pitching like crazy to the docs)Nardil seems the one MAOI that I hear positive statements about
would love to know what you end up doing
i wish you the best
Posted by Phillipa on November 13, 2006, at 19:32:31
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by elanor roosevelt on November 13, 2006, at 11:36:59
Very true Eleanor even Robert David is off it now. No side effects just didn't need it. And Ed_uk highly recommends nardil for anxiety. Love Phillipa
Posted by josephine grandoni on November 13, 2006, at 20:55:26
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » elanor roosevelt, posted by Phillipa on November 13, 2006, at 19:32:31
i GOT ON THE WEB SITE FOR THE PATCH AND YOU ARE RIGHT..IT IS THE SAME DIETARY RESTRiCTIONS...i AM SURPRISED.. sorry for the caps...I haven't found any difference betweeen Nardil and Parnate but Parnate did not have the sexual side effects that Nardil did...above a certain dose...and, I could not get Nardil. I like Parnate, but I am always looking for a better drug...any recommendation?
Posted by stargazer on November 13, 2006, at 22:52:53
In reply to Re: MAO EXPERTS/USERS...Recommendations??????, posted by josephine grandoni on November 13, 2006, at 20:55:26
Eleanor, Phillipa, Josephine, et al...
I saw my pdoc today and although I wanted to try Nardil first, he suggested we start with Emsam. I could have pushed for Nardil, but I'm also interested in trying Emsam, so why not start there.
There are no dietary restrictions for the 6 mg patch so that is an advantage over Nardil. I was reading the insert tonight and a few items caught my eye. The biggest adverse effect was for skin reaction to the patch, around 22%. I will read again tomorrow and post about some of the other things I read. There was info on weight gain comparing Emsam to a placebo and there really wasn't any difference, I think it was around 2%, so that did not seem like a major adverse effect, as some here had suggested.
My pdoc said I have to be off Cymbalta X 14 days but after reading the insert I believe it said a 1 week period of washout, so I have to verify this and call him if I'm correct. Thank God I can read this stuff, although the print is so small, it takes forever to find the relevant data and then to understand it. If what I read is true, I can start Emsam this week rather than waiting until next week. I hope I can start this week,no time is like the present. I may start a new thread on Ensam since SLS isn't taking it and the thread doesn't really help with knowing who is taking it and how others are faring on it. I hope there are some with good results since so many have panned it. I am optimistic that there is a good chance for success.
Good night all. Time to take my seroquel which I will stay on for now. I think my pdoc is afraid for me to come off it, even though we're not sure what it is doing, for fear that I will plunge again, even if my relative stability is from a placebo effect.
SG
Posted by Phillipa on November 13, 2006, at 23:50:41
In reply to Re: MAO EXPERTS/USERS...On to ENSAM, posted by stargazer on November 13, 2006, at 22:52:53
Stargazer the worst side effect I've e-mailed with a lot of the EMSAM users is insomnia. So keep the seroquel. And the patch is sometimes removed at night to help avoid the insomnia. Hydrocorisone cream is used if you get a rash that isn't bad. And rotate the sites. A lot of babblers liked their upper back . Love Phillipa
Posted by psychobot5000 on November 14, 2006, at 17:05:20
In reply to NEED ADVICE...How to choose a MAO????????, posted by stargazer on November 11, 2006, at 8:14:14
Hi. I read that someone was wondering about the difference between the different MAOis and how they worked, so here's my attempt to sketch out the basics. Hope it's helpful.
____
MAO (MonoAmineOxidase) is a type of enzyme that metabolize/break down neurochemicals, by oxidizing them. The chemicals they break down are (mostly) serotonin, norepinephrine, and dopamine. All of these are thought to be important in depression, as well as other important brain function. The MAO inhibitors block the enzyme, preventing it from destroying these chemicals, and so creating higher levels all throughout the body.There are indeed two kinds of monoamine-oxidase: MAO-A and MAO-B. MAO-A breaks down serotonin and norepinephrine, while MAO-B breaks down dopamine--this is the main difference between the two. It is hard to summarize what each of these chemicals is used for because the subject is so damnably complicated, but broadly speaking, serotonin is thought to be involved in mood, anxiety, digestion, sleep, and other things. Norepinephrine/Noradrenaline (same thing) is involved in drive, wakefulness, heartrate, and much else. Dopamine is involved in memory, learning, movement, drive/motivation, pleasure...the list goes on.
The first antidepressants were unselective MAO inhibitors, meaning that they block BOTH MAO-A and MAO-B. (Nardil, Parnate and Marplan are all of this type) MAO is responsible for breaking down the chemical tyramie that is found in some foods, and causes dangerously increased heartrate and bloodpressure. Anyway, as long as a certain amount of -either- MAO-A or MAO-B is there, unblocked, in the gut, tyramine is prevented from flooding your system. Thus, moclobemide, a selective MAO-A inhibitor, which leaves MAO-b alone, is safe without dietary restrictions, and EMSAM, which prefers MAO-B greatly, is also safe in moderate doses. In either case (unless they are taken together), one half of the MAO is still available to keep your system safe.
So there are three main types of MAO inhibitors:
1) The old, powerful inhibitors of MAO A and B, Nardil, Parnate, and Marplan. Perhaps because of their dual action, these are the most powerful chemical antidepressants medicine has. They are also dangerous because of tyramine, of course.
2)Inhibitors of MAO-A--Moclobemide (not used in the United States) and others. Among the least powerful antidepressants, the focus on MAO-A means they would elevate levels of serotonin and noradrenaline only. This makes them similar to other antidepressants like tricyclics, though tricyclics affect these chemicals with a different mechanism.
3) Inhibitors of MAO-B--Like Selegiline EMSAM. They affect primarily MAO-B and thus, increase dopamine. When taken through the patch, EMSAM doesn't pass directly through the digestive system, and thus has less effect on digestive MAO. The 6mg dose is safe from tyramine interactions. The 9mg and 12mg MAY BE safe as well, however, not enough research has been conducted at that dose, so we don't know.
Another MAO-B inhibitor is Azilect/Rasagiline, which is cleared in the US for parkinson's disease. It has been little-studied in depression, but could (possibly) be as effective as selegiline, if used in high enough doses.
Each individual drug is different. For example, both Parnate/Tranylcypromine and Selegiline/EMSAM metabolise into amphetamine, giving them, and Parnate particularly, more of a peppy feeling, and maybe causing more insomnia. EMSAM has much less of this than oral selegiline, because it goes straight into the blood without being processed by the liver first, as oral is. Selegiline is also a dopamine reuptake-inhibitor, giving it some further impact on dopamine. Some posters on this site believe EMSAM from the patch is more energizing than the oral form, probably because there is a higher ratio of the original substance to the other stuff produced when it passes through the liver from the intestine.
Remember that Parnate is an unselective MAOi, and in fact is clearly the most dangerous in terms of hypertensive crises. Maybe this is because of the modest stimulant effect that automatically goes with it.
Nardil/Phenelzine is unselective (meaning it is not choosy about MAO-A or B) drug that is thought by some to be slightly more powerful than the others. It is especially useful in anxiety, possibly because it also increases levels of GABA in the brain. GABA is an 'inhibiting' neurochemical, the same chemical that diazepam, xanax, and the many other drugs effect. Phenelzine/Nardil is probably also better for sleep than Parnate. Marplan is similar to Phenelzine. It may be less powerful, and have less effect on GABA, but also fewer side-effects. Both of these can be damaging to the liver, though, so one needs to have blood-checks of liver enzymes while taking them.
As far as I know, the theories about deprenyl(selegiline) and phenylethylamine in depression are largely unsubstantiated in terms of hard evidence, but selegiline does indeed increase phenylethylamine levels a great deal, by preventing its breakdown. Because EMSAM/selegiline/deprenyl effects dopamine, as well as these other such chemicals, it COULD be more useful for depressive states with cognitive difficulty than the other MAOis--or at least it might help this stuff just as much with fewer side-effects.
I hope this helps explain some stuff,
P-bot
Posted by Phillipa on November 14, 2006, at 18:12:49
In reply to Some MAOi information..., posted by psychobot5000 on November 14, 2006, at 17:05:20
PR great job even I could understand. The problem is remembering. But I will remember that EMSAM affects dopamine. Thanks, Phillipa
Posted by stargazer on November 14, 2006, at 18:23:52
In reply to Some MAOi information..., posted by psychobot5000 on November 14, 2006, at 17:05:20
Pbot,
Thank you so much for that great summary of MAO stuff. I was able to read all of it and understand it so that helped. It's nice when that happens.
BTW, when I'm depressed which is most of time (dysthymia) I have cognitive difficulties. I used to be able to learn, read and focus. Over the past few years I have had more and more difficulty reading with minimal retention. I can't prioritize tasks or stay focused on anything. The biggest part of my depression is getting overwhelmed with details and not being able to feel in control of anything. I tell my husband that I can't remember things, lately I feel incapable of working because I don't trust that my brain functions normally. I still feel intelligent but I am unable to use it in any productive way. Even articulating what occurs is difficult since I have trouble explaining how it feels.
Interestingly, now that I'm off all meds except for seroquel(while awaiting the start of Emsam) I feel my brain is working better than it has in years. This tells me that the medications I have been on are not really helping med but making me feel "stupid", forgetting I'm depressed. I don't read much anymore due to my poor retention and focus. It really sucks.
I pray Emsam will allow me to retain my cognitive abilities and perhaps improve them, along with preventing depression from recurring.
Is that too much to ask from a med?
SG
Posted by Phillipa on November 14, 2006, at 20:03:37
In reply to Re: Some MAOi information..Great info Pbot., posted by stargazer on November 14, 2006, at 18:23:52
No not at all. And what did you come off of? I'm beginning to think like Link about the meds. Love Phillipa
Posted by josephine grandoni on November 14, 2006, at 21:17:28
In reply to Re: Some MAOi information..Great info Pbot. » stargazer, posted by Phillipa on November 14, 2006, at 20:03:37
This has been so informative..I take Parnate.. the general feeling about Parnate seems to be that it is not good? To SG, I understand that you feel you can't remember, but you don't come across that way in your writing...you are very articulate and sensitive. I think that it is exciting that you are trying the patch. Does anyone know a good doc in New York?
Posted by psychobot5000 on November 14, 2006, at 22:38:29
In reply to Re: Some MAOi information..Great info Pbot., posted by josephine grandoni on November 14, 2006, at 21:17:28
I'm not certain it's fair to say that Parnate isn't good, though I've never personally tried it. There are some babblers who like Nardil better, but several people prefer Parnate. It has the advantage of being less damaging to the liver, and of having generally fewer side-effects, according to my books and docs.
But you really, really need to watch out for tyramine on Parnate--more than with the other MAOIs--it's very important. And it seems to be the worst of them for insomia, as far as I can tell.
Posted by Phillipa on November 14, 2006, at 22:45:01
In reply to Re: Parnate, posted by psychobot5000 on November 14, 2006, at 22:38:29
That's what Ed_uk always wants me to try for my anxiety/depression. Love Phillipa wish he wasn't working I miss him
Posted by CrimsonVik on November 15, 2006, at 0:48:56
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » stargazer, posted by Phillipa on November 12, 2006, at 17:20:27
> They say on the 9mg and l2mg patch the dietary restrictions are there but not that many of the ex-users did it. I think most of the posters are off it from insomnia. I've followed it as I wanted to try it. Liked the idea of a patch. Love Phillipa
I don't have any Emsam insomnia. Started it the 1st.
Posted by Phillipa on November 15, 2006, at 18:47:24
In reply to Re: MAO EXPERTS/USERS...Recommendations?????? » Phillipa, posted by CrimsonVik on November 15, 2006, at 0:48:56
Really is it working for you? I so want to try it. And Stargazer started it today. Love Phillipa ps are you taking anything else with it or removing it at night? Trying to cover the bases from the past users.
Posted by elanor roosevelt on November 16, 2006, at 22:02:15
In reply to Re: Some MAOi information..Great info Pbot., posted by josephine grandoni on November 14, 2006, at 21:17:28
my meds doc in nyc is mad at me
i started to withdraw from parnate without asking
strage stuff
i stared a lot and go quiet and never laughed
then slowly this sadness and self-loathing seeped in and honestly my life is not in great shape so i was figuring i was a loser and that was making me sad
then the crying started everynight
i hate that -- when meds convice you the SEs are you
the crying has almost stopped 5 days into my washout and i don't wake up in a state of despair
bye bye parnate
another f**king med meltdown
anybody have a good meds doc in nyc?
Posted by psychobot5000 on November 16, 2006, at 23:10:00
In reply to Re: Some MAOi information..Great info Pbot., posted by elanor roosevelt on November 16, 2006, at 22:02:15
I don't know any particular doc in NYC, but there have got to be some good ones--with such a huge population and so many well-to-do and prestigious people, NYC must have some of the best docs. Is there someone in psychiatry you could ask about who the psychopharmacology experts are there? ...It can be only a matter of finding them, after all.
Best of luck!
Posted by stargazer on November 17, 2006, at 10:00:01
In reply to Re: docs, posted by psychobot5000 on November 16, 2006, at 23:10:00
I get the feeling that because depression is still not openly talked about(except here) referrals and recommendations are not openly made like "my othopedist or my cardiologist"....I just had a flashback to the EF Hutton commercial...when someone was saying "my stockbroker is EF Hutton" and everyone around him leans toward him to hear the name. Replace that line with "my psychopharmacologist is Dr Feelgood" and see how many people pay attention.
Still looking for a name in CT. NYC is OK too.
Posted by josephine grandoni on November 17, 2006, at 16:22:47
In reply to Re: docs ...Not openly discussed d/i stigma still?, posted by stargazer on November 17, 2006, at 10:00:01
YOU are so right about that. Also
there are so many mediocre docs out there from which to choose. And whether they are good or bad, they all charge several hundred dollars for the first visit. Does anyone have any names? Don't go to DR Fieve on 5th Ave.
Posted by stargazer on November 17, 2006, at 17:41:01
In reply to Re: docs ...Not openly discussed d/i stigma still?, posted by josephine grandoni on November 17, 2006, at 16:22:47
Dr Fieve on 5th Ave, well quite the address...location doesn't mean everything. I'd rather see a doc out on a farm if they knew what they were doing and did it compassionately. We have tons of meds to medicate people but no one wants to take the time to really listen anymore. At least my doc is compassionate that's why I've gone to him for so long but I want another opinion on medication if the current plan fails...SG
Posted by josephine grandoni on November 17, 2006, at 19:33:00
In reply to Re: docs ...Not openly discussed d/i stigma still?, posted by stargazer on November 17, 2006, at 17:41:01
Is your Doc in New York?
Posted by Phillipa on November 17, 2006, at 19:43:33
In reply to Re: docs ...Not openly discussed d/i stigma still?, posted by stargazer on November 17, 2006, at 17:41:01
Stargazer you are so right no one has the time to listen anymore. And you're very lucky to have the doc you have. I'd ask for a recommendation from someone you know. I find my neighbors here are very open about psych meds. You just have to open the topic first then they will talk on and on. I know my next door neighbor takes lex and xanax and my across the steet ones. He's on wellbutrin, she takes zoloft, fentynl patch for a hip that need replacement. Her daughter is bipolar manic now and off her meds. And she met a girl who is bipolar and living there now too. and to top it off her brother is going through a divorce met this girl and now they are living there too as lovers. And this is an expensive neighborhood.But you don't know what goes on behind closed doors. Or call the hospital and get referrals. Love Phillipa and google phychopharmacologist as it sounds like its a psychiatrist.
Posted by elanor roosevelt on November 17, 2006, at 21:54:24
In reply to Re: docs ...Not openly discussed d/i stigma still? » stargazer, posted by Phillipa on November 17, 2006, at 19:43:33
i'll go back to my pdoc
i piss him off now and then
i am just a junkie at heart
i've left him a few times for the hotshots and for hundreds of dollars more they do me no good
his name is Michael Gray and he does have empathy as far as side effects
Posted by stargazer on November 18, 2006, at 0:30:56
In reply to Re: docs ...Not openly discussed d/i stigma still? » stargazer, posted by Phillipa on November 17, 2006, at 19:43:33
I don't talk about my "issues" with almost anyone outside of my close personal circle of family and friends and they would be clueless to make a recommendation. I never would ask a friend since I know the stigma exists and can affect you personally and professionally (still need to work). I had mentioned it to a few people in the past in a moment of weakness and it really came back to haunt me. I think its common to ask others for a general doc or a back specialist, but not for a shrink. People don't understand what true depression is and I find they try and minimize it or say they feel the same way, and they try and give you suggestions on what might help. Immediately I knowI shouldn'thave said anything. Keep your mouth shut I say to myself.
You have to be careful, people "mean well" but to me it feels "nosey". So I tell "no one" about my depression...just me, my doc, my dog and my husband with a rare occasional friend or family member I can really trust. Even my family has used it against me in anger.
Probably a little of the depressive paranoia at work but that is how I can go to work and "pretend" things are great, even if they suck some days.
I may just stick with my doc and if I need another doc I'll figure it out then. Tackle one thing at a time. They are doing the vagus nerve stim research up at UCONN so they must be doing something right. For some reason, I think I would trust UCONN over Yale, less elitist, more honest. I was never fond of Ivy league types, in my experience too much hype, not enough substance...SG
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