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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by becksA on December 15, 2006, at 17:52:29
After reading Maxime's post, it got me to thinking...the one class of drug I've never tried to combat my hardcore social anxiety and moderate depression. I've always been leary of these drugs because of the diet regime and how careful you have to be.
My question is why would one start out trying drugs like Parnate and Nardil with all the complex dietary restrictions when you can take something like Maxime mentioned (Manerix, or something of the like). My first guess is that they are not as effective? Sort of a second option if you can't take the big ones i.e. nardil, parnate.....?I'm coming down off of 14mg klonopin daily and luckily i'm an extremely fast metabolizer and can do it quite quickly, and am down to 10 within a few weeks, but i'm feeling the anxiety start to kick back in. I'm leaning more and more to this MAOI class.
Please help differentiate?
Thanks
Posted by Maxime on December 15, 2006, at 19:06:13
In reply to MAOIs Reversable vs. Non, posted by becksA on December 15, 2006, at 17:52:29
Manerix usually isn't as effective as Parnate or Nardil. Not just for me, but for a lot of people.
I think Manerix might shoot your anxiety level through the roof as it's very stimulating. But like you said, everyone responds differently to meds.
I wonder if you aren't bipolar. Klonopin is the only benzo that can be used as a mood stabiliser. Have you ever tried Lithium or Depakote for your depression. Your anxiety MAY BE hypomania or mania. Just a thought. :)
Maxime
Maxime
> After reading Maxime's post, it got me to thinking...the one class of drug I've never tried to combat my hardcore social anxiety and moderate depression. I've always been leary of these drugs because of the diet regime and how careful you have to be.
> My question is why would one start out trying drugs like Parnate and Nardil with all the complex dietary restrictions when you can take something like Maxime mentioned (Manerix, or something of the like). My first guess is that they are not as effective? Sort of a second option if you can't take the big ones i.e. nardil, parnate.....?
>
> I'm coming down off of 14mg klonopin daily and luckily i'm an extremely fast metabolizer and can do it quite quickly, and am down to 10 within a few weeks, but i'm feeling the anxiety start to kick back in. I'm leaning more and more to this MAOI class.
>
> Please help differentiate?
>
> Thanks
Posted by yxibow on December 15, 2006, at 19:42:41
In reply to MAOIs Reversable vs. Non, posted by becksA on December 15, 2006, at 17:52:29
> After reading Maxime's post, it got me to thinking...the one class of drug I've never tried to combat my hardcore social anxiety and moderate depression. I've always been leary of these drugs because of the diet regime and how careful you have to be.
> My question is why would one start out trying drugs like Parnate and Nardil with all the complex Please help differentiate?
> dietary restrictions when you can take something like Maxime mentioned (Manerix, or something of the like). My first guess is that they are not as effective? Sort of a second option if you can't take the big ones i.e. nardil, parnate.....?
>
> I'm coming down off of 14mg klonopin daily and luckily i'm an extremely fast metabolizer and can do it quite quickly, and am down to 10 within a few weeks,I know we discussed this before but please be careful about this taper of high dosage benzodiazepines even -- and actually especially if you're a fast metabolizer, because you will feel the "need" for more medication actually. I'm sure you're doing it with your doctors say so but 14 to 10 in 2 weeks can be hard for someone with anxiety, which is what you're probably feeling a withdrawal from.
-- best wishes on it though
Posted by Quintal on December 15, 2006, at 20:01:37
In reply to MAOIs Reversable vs. Non, posted by becksA on December 15, 2006, at 17:52:29
I have similar problems to you becksA and have tried Manerix, Parnate and Marplan (among a *huge* variety of other ADs and benzos). Similar story with the Klonopin. The highest dose I took was 20mg (illicitly) but my usual dose was about 4mg.
Manerix is generally considered ineffective for SA. One South African study concluded it had about 80% efficiency and another failed to show any response at all. Manerix did not work for me and I took it for six months at 900mg. I was also taking Klonopin at the time and Manerix still caused insomnia. I wouldn't recommend it during benzo withdrawal for that reason.
I would recommend Nardil over Parnate, as Nardil has a metabolite called phenylethylidenehydrazine (!) which studies suggest boosts GABA levels in the brain, thereby supposedly exerting the main mechanism behind Nardil's anxiolytic effect. I guess this would come in useful during benzo withdrawal?
Parnate is good as an antidepressant and antipanic, but tends to be stimulating and may make anxiety worse if taken without a benzo. Marplan is generally considered to be a weaker version of Nardil.
http://www.socialfear.com/nardil_increases_brain_gaba.html
Good luck.
Q
Posted by psychobot5000 on December 15, 2006, at 21:53:52
In reply to Re: MAOIs Reversable vs. Non » becksA, posted by Quintal on December 15, 2006, at 20:01:37
I think Quintal's response is right on the money. As I understand it Nardil is generally considered the best MAOi for anxiety, and social anxiety. It does also seem to me like it's GABAergic effects would help with benzo withdrawal. Marplan is very similar, and though, as mentioned above, it may not be quite as strong, some say it's better for side-effects.
>"I would recommend Nardil over Parnate, as Nardil has a metabolite called phenylethylidenehydrazine (!) which studies suggest boosts GABA levels in the brain, thereby supposedly exerting the main mechanism behind Nardil's anxiolytic effect. I guess this would come in useful during benzo withdrawal?"
___But I would like to add that the reason the unselective MAOis (with dietary restrictions) are used is that they are indeed more effective. Everyone responds differently, of course, but in one meta-analysis of antidepressants I read (which totaled over three thousand patients), the unselective MAOis achieved a better response than all other drugs, while moclobemide/manerix was THE ONLY drug to achieve (slightly) poorer results than the SSRIs. But I understand many in Europe still find it very useful.
To add, EMSAM is a version of another type of MAOi (the MAO-b selective type), that is probably more effective than moclobemide (though less than phenelzine, marplan, and parnate), but at low doses does not require dietary restrictions. But it's probably not as effective as Nardil for social anxiety.
Best of luck!
Posted by willyee on December 15, 2006, at 22:14:12
In reply to MAOIs Reversable vs. Non, posted by becksA on December 15, 2006, at 17:52:29
> After reading Maxime's post, it got me to thinking...the one class of drug I've never tried to combat my hardcore social anxiety and moderate depression. I've always been leary of these drugs because of the diet regime and how careful you have to be.
> My question is why would one start out trying drugs like Parnate and Nardil with all the complex dietary restrictions when you can take something like Maxime mentioned (Manerix, or something of the like). My first guess is that they are not as effective? Sort of a second option if you can't take the big ones i.e. nardil, parnate.....?
>
> I'm coming down off of 14mg klonopin daily and luckily i'm an extremely fast metabolizer and can do it quite quickly, and am down to 10 within a few weeks, but i'm feeling the anxiety start to kick back in. I'm leaning more and more to this MAOI class.
>
> Please help differentiate?
>
> ThanksI agree with bits and pieaces of all the responses,first KLONOPIN is noted as one of the few benzos that actualy act as a mood stablizer as well.
SO although u understandably want to come off/down,id say take ur time,not too many people have died from klonopin lol,and its prob helping still a lot.So taper slow and calmly.
Also google in detail parnate,BECAUSE parnate is actualy believed to be a REVERSABLE maoi,or partialy,unlike nardil,which really builds up in your system.
Not putting one over the other,but parnate would be the choice if you wanted a more reversable med.
Nardil,due to what effects it seems to have on gaba,would be the choice for anxiety.
Parnate you would almost surly have to contine to use strong benzo use,as parnate i just read the other night actualy causes a down regualtion in gaba,however again unlike nardil parnate will likly take effect faster,possably offer a high mood elevation effect,and most importantly be absent of some serious side effects of nardil,which seem to be.....weight gain,sexual problems,and i seen some problems with causing excess sweat but not to sure on it.
I really would rule out any other of the maois for now,and read into either parnate or nardil,as you seem to need the more harder mainline ones at this point,mayne when on one and feeling better,you can then look into the lighter maois such as the ones overseas.
Posted by elanor roosevelt on December 15, 2006, at 22:32:30
In reply to Re: MAOIs Reversable vs. Non, posted by willyee on December 15, 2006, at 22:14:12
the pharma companies are pushing to make a comeback with MAOI's
the reason my doctor and i decided on parnate was because of how quickly all the ssri's were melting down on me. seems like some people find success with MAOI's when SSRI's fail them
parnate was not for me
it "turned" on me and filled me with self-loathing at night
i woke up in despair each morning
was okay but never upbeat when medicated
stared into space if i stopped movingthe more i read here the more i realize a new med doctor
Posted by djmmm on December 16, 2006, at 10:30:24
In reply to MAOIs Reversable vs. Non, posted by becksA on December 15, 2006, at 17:52:29
> After reading Maxime's post, it got me to thinking...the one class of drug I've never tried to combat my hardcore social anxiety and moderate depression. I've always been leary of these drugs because of the diet regime and how careful you have to be.
> My question is why would one start out trying drugs like Parnate and Nardil with all the complex dietary restrictions when you can take something like Maxime mentioned (Manerix, or something of the like). My first guess is that they are not as effective? Sort of a second option if you can't take the big ones i.e. nardil, parnate.....?
>
> I'm coming down off of 14mg klonopin daily and luckily i'm an extremely fast metabolizer and can do it quite quickly, and am down to 10 within a few weeks, but i'm feeling the anxiety start to kick back in. I'm leaning more and more to this MAOI class.
>
> Please help differentiate?
>
> ThanksFirst off, Im so sorry that you have to deal with coming off 14mg of Klonopin...that must be horrible :( (I had problems coming off 4mg)
As far as the MAOIs, they worked wonders for me-- I suppose Nardil was slighlty more effective. I found that the stimulating effects of Parnate actually helped with certain aspects of my social anxiety. I felt more confident, and motivated-- which translated into feeling more pro-social. I was, however also taking Klonopin. Have you considered a mild stimulant? As for Manerix, I dont believe it has proven to be as effective for social phobia..
I've come to realize that social anxiety is very different from "typical anxiety" in that mild stimulants seem to be effective... so perhaps parnate, combined with a much lower dose of klonopin may be helpful...good luck!
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