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Dr. Bob is Robert Hsiung, MD,
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Posted by NYCguy on January 2, 2007, at 23:23:28
In reply to Re: Are MAOIs worth it? » NYCguy, posted by laima on January 2, 2007, at 21:31:41
Hey laima,
Are you still tapering down on the Klonopin? How is that going? I've come down from 6mg to 1mg per day and I actually feel a lot sharper and I think my anxiety is about the same. Klonopin seemed to work well on my social anxiety but only when combined with an sri and a large dopamine infusion like a lot of diet coke or Adderall. Not really a sustainable or ideal strategy. By itself, the Klonopin dosen't do too much but slow me down.
Did you have anxiety problems to go along with depression and how would you say Emsam is helping on that front? I found that there were a couple days where I was really profoundly anxiety and depression free with the Emsam and the Klonopin, and another few days where I was really depressed(as I normally am.)
I've decided I'm going to try all three MAOIs if need be, staring with the Selegiline, then the Parnate, then the Nardil. I'm in the process of losing some weight that I put on from being so "atypically" depressed this last year, so I'll save the Nardil for last. And it won't be a worthwhile trial unless I commit to at least a full three months of whatever med I choose.
Okay! New Year's resolution complete! ;-)
> Do you think you'll give another MAOI a trial then? Maybe Emsam would be an easy one to revisit, because at least the food restrictions aren't such a big deal with it. I'd say it's definately weight-neutral, and I could have sworn I heard Parnate was, too. (But I haven't tried Parnate or any other MAOI other than oral selegeline.) I think it's the food and drug restrictions which keep the MAOIs from being as widely prescribed as other antidepressents- I think doctors get spooked that patients won't comply well, and then they've got a problem. (Can you imagine being a doctor and then your patient eats the wrong thing and feigns ingnorance or whatever?) I've read over and over that the MAOI class IS the best class for atypical depression. Emsam's working out alright for me, though my dose might go up and we are dinkering with augmentation strategies. Right now I'm on an Emsam-Adderall program which appears to be working out pretty well.
>
Posted by NYCguy on January 2, 2007, at 23:42:07
In reply to Re: Are MAOIs worth it? » NYCguy, posted by Quintal on January 2, 2007, at 21:49:17
Quintal, thanks for your response.
> >b)Are MAOIs a long term solution or are just going to work for a few months and then quit?
>
> That's a good question but one that can be applied to all antidepressants. If you're treatment resistant and looking for something else to try then I advise you give them a go.
>I guess I am treatment resistant in that I haven't found any sustainable way yet to rid myself of crippling social anxiety and pervasive atypical depression.
> >I've not tried them(yet), I just wonder if all the talk about them here is because people have tried everything else and the MAOIs are held up as some kind of "holy grail"... err... I mean... "gold standard."
>
> Then I suggest you try them and find out.
>
> QYour point is well taken. I will try them and find out for myself. I'm sorry if I came across with a negative vibe in the last post. I just get so anxious about these things that I'm afraid to even try them. I stew over it. I know that no ammount of "web knowlege" about these meds will ever help me get better, but giving them a fair trial them might lead to something really great.
Posted by Quintal on January 3, 2007, at 0:12:56
In reply to Re: Are MAOIs worth it? » Quintal, posted by NYCguy on January 2, 2007, at 23:42:07
>Your point is well taken. I will try them and find out for myself. I'm sorry if I came across with a negative vibe in the last post. I just get so anxious about these things that I'm afraid to even try them. I stew over it. I know that no amount of "web knowledge" about these meds will ever help me get better, but giving them a fair trial them might lead to something really great.
I was very anxious about trying the MAOIs at first too, but my pdoc was even more worried. I found them among the most tolerable of all meds I've taken though. The only one I haven't tried is Nardil which seems to have a more severe side effect profile but I'm looking into that.
Good luck.
Q
Posted by jedi on January 3, 2007, at 4:13:50
In reply to Are MAOIs worth it?, posted by UgottaHaveHope on January 2, 2007, at 18:10:34
> Are MAOIs worth all the restrictions? When you take them, do they feel very different than SSRIs? How? Are they a miracle drug? Michael
When they work, there is no other medication like them. I have been on 40+ combinations of meds and the only thing that has worked for my atypical depression and social anxiety is Nardil. I really wish Parnate would have worked for me because of the severe weight gain issues with Nardil. But even with the weight gain, daytime tiredness, food restrictions, insomnia, etc., Nardil is a blessing for me. When you've been in a fetal position, on the floor, in unbearable psychic pain, and one small step from death; a little weight gain is a small price to pay. The MAOI's are the bomb and you should try the others first; but when nothing else works, they are worth it. The food restrictions are very easy for me, the only thing I really miss are the aged cheeses. I am able to eat pizza(with mozzarella), drink bottled beer and whiskey in moderation, eat all fresh meats except liver(Yech!). I pretty much eat what I want, but I've been on Nardil for 10 years and I know what affects me. Watch all over the counter cold remedies. Read the labels; most will carry warnings about use with MAOIs; at least in the U.S. Canada is another story, where the reversible MAOIs predominate.
Good luck,
Jedi
Posted by tensor on January 3, 2007, at 6:07:57
In reply to Re: Are MAOIs worth it? » NYCguy, posted by Quintal on January 3, 2007, at 0:12:56
How does selegiline (the oral version) compare to Nardil and Parnate? It works more on dopamine and is used for Parkinson's disease but that's all I know. It's also the only MAOI that can be prescripted here without a licence.
/Mattias
Posted by laima on January 3, 2007, at 8:39:14
In reply to Re: Are MAOIs worth it? » laima, posted by NYCguy on January 2, 2007, at 23:23:28
I'm actually off the klonopin, and it's been about 6 weeks or so. I'm very surprised that I feel LESS anxious now- my best guess is that while on it, I was probably experiencing withdrawal-like symptoms. Getting off of it wasn't easy, but the end of being on it wasn't so good, either. I used zyprexa for a few weeks while I was doing it, and that made it easier- but I didn't like zyprexa and got rid of it as soon as I could. Anxiety has definately been a huge problem with my depression. It seems largely in remission for now, and I really can't figure out how I did it...which is why I keep wondering if my use of klonopin was aggrevating it somehow. I've been using Emsam for a while- I really can't say if it's specifically HELPING with anxiety or not- but it's definately not hurting. Personally, when I feel better, more active, and more competent, I feel less anxious. A lot of my anxiety has to do with worrying about being depressed and incompetent. So indirectly both adderall and Emsam are helping with anxiety, the way I understand what's going on with me.
Posted by Quintal on January 3, 2007, at 9:56:11
In reply to Re: Are MAOIs worth it? » Quintal, posted by tensor on January 3, 2007, at 6:07:57
>How does selegiline (the oral version) compare to Nardil and Parnate? It works more on dopamine and is used for Parkinson's disease but that's all I know. It's also the only MAOI that can be prescripted here without a licence.
Selegiline felt nothing like Parnate, Marplan and moclobemide to me. It is a selective MAO-B inhibitor at doses <20mg and MAO-B has little effect on the breakdown of serotonin and nordrenaline, having more action on dopamine and phenethylamine. Generally speaking the non-selective irreversible MAOIs like Nardil, Parnate and Marplan have a much broader action across the range of neurotransmitters. Selegiline is worth trying as a first line MAOI but non-selective MAOIs are still definitely worth trying if you have a poor response to oral selegiline.
Q
Posted by tensor on January 3, 2007, at 9:58:54
In reply to Re: Are MAOIs worth it? » tensor, posted by Quintal on January 3, 2007, at 9:56:11
Posted by willyee on January 3, 2007, at 10:57:29
In reply to Re: Are MAOIs worth it?, posted by NYCguy on January 2, 2007, at 19:18:37
Lol just think,the pdr contains such minimal information,and the docs still refer to them.Hell we have access to the pdr through google.
Problem is these docs,like my parents,dont seem to be up on the new age,we need a new generation of younger docters who know how to access the extremly VAST information out there,the pdr is simply old and dusty.
> This is something I would like to know... I don't have problem with the strict diet... I just wonder if:
>
> a) Do they make everyone blow up and gain 8000 pounds like all the PDocs tell me?
>
> and,
>
> b)Are MAOIs a long term solution or are just going to work for a few months and then quit?
>
> I mean, lets be real. One time my PDoc opened up his PDR and Nardil wasn't even listed!?! If these things really work wonders... one would think they would be a bit more commonly prescribed. We can't ascribe all this to some giant no-profit-in it-conspiracy can we? Tons of people are on Lithium and Klonopin and no one is getting rich from them anymore.
>
> I've not tried them(yet), I just wonder if all the talk about them here is because people have tried everything else and the MAOIs are held up as some kind of "holy grail"... err... I mean... "gold standard."
Posted by blueberry1 on January 3, 2007, at 15:42:12
In reply to Are MAOIs worth it?, posted by UgottaHaveHope on January 2, 2007, at 18:10:34
I've never been on an maoi, except moclobemide which was aweful. I can only offer observations that I have seen here over the years, at remedyfind.com, and at pubmed.com.
The maois seem to be like anything else...50% to 60% response. Side effects for some people are nill, while for other people they are viscious. The drugs are miracles for some people, not helpful to some people, and cause worsening for some people.
Unfortunatley I think personal trial and error is the only way to tell. When maois do work real good for some people, they seem to not mind side effects or diet restrictions. Those things seem more bothersome when the drug isn't working very well.
Posted by tensor on January 3, 2007, at 15:59:06
In reply to Re: Are MAOIs worth it?, posted by blueberry1 on January 3, 2007, at 15:42:12
Are MAOIs more prone to poop-out or lose efficacy than other classes?
/Mattias
Posted by Karen44 on January 3, 2007, at 21:58:42
In reply to Re: Are MAOIs worth it?, posted by NYCguy on January 2, 2007, at 19:18:37
Parnate worked very well for me for years, and I was even able to function off of it for a number of years as well. It gave me lots of energy (and so had to take only in the a.m.). I also lost weight on it. Parnate has amphetamine-like qualities.
Karen44
Posted by Quintal on January 4, 2007, at 0:45:27
In reply to Re: Are MAOIs worth it?, posted by Karen44 on January 3, 2007, at 21:58:42
>Parnate has amphetamine-like qualities.
The old Parnate methamphetamine metabolite debate? There's still much confusion over that but I found Parnate did have an amphetamine-like feel to it at high doses. Amphetamine metabolites have been found in the blood and urine of Parnate overdoses and people have posted here to say they have tested positive for amphetamines while taking Parnate.
At 120mg I had the dilated pupils, racing heart, erect nipples and gooseflesh characteristic of 'crystal meth'. I wonder if going back to it would help my fatigue?
Q
Posted by blueberry1 on January 4, 2007, at 5:30:38
In reply to Re: Are MAOIs worth it? » blueberry1, posted by tensor on January 3, 2007, at 15:59:06
> Are MAOIs more prone to poop-out or lose efficacy than other classes?
>
> /MattiasI do not have experience with maois but yes I have seen poopout occur with them, ranging anywhere from weeks to months to years. I do not know how the overall poopout potential compares to other antidepressants. I could be wrong but I assume it would be similar to other ADs, plus or minus a few percentage points.
Posted by djmmm on January 4, 2007, at 9:10:52
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 4, 2007, at 0:45:27
> >Parnate has amphetamine-like qualities.
>
> The old Parnate methamphetamine metabolite debate? There's still much confusion over that but I found Parnate did have an amphetamine-like feel to it at high doses. Amphetamine metabolites have been found in the blood and urine of Parnate overdoses and people have posted here to say they have tested positive for amphetamines while taking Parnate.
>
> At 120mg I had the dilated pupils, racing heart, erect nipples and gooseflesh characteristic of 'crystal meth'. I wonder if going back to it would help my fatigue?
>
> QI think some of the "amphetamine metabolite" confusion is because Parnate is so structurally similar to the amphetamines/pheynylethyamines, that the more "non-specific" drug tests pick it up-- as a false positive.
A lot of the physical effects of what you may attribute to an amphetamine metabolite, may simply be the result of a spike in blood pressure, or the catecholamine enhansing effects of Parnate itself. Im guessing, the amount of Amphetamine/Methamphetamine derived as a metabolite, would have to be VERY high to elicit a "meth-like" response (thus the reported presense of amphetamine metabolites in overdose)
Posted by Quintal on January 4, 2007, at 9:46:26
In reply to Re: Are MAOIs worth it?, posted by djmmm on January 4, 2007, at 9:10:52
>A lot of the physical effects of what you may attribute to an amphetamine metabolite, may simply be the result of a spike in blood pressure, or the catecholamine enhancing effects of Parnate itself.
Parnate certainly did increase my heart rate after each dose.
>Im guessing, the amount of Amphetamine/Methamphetamine derived as a metabolite, would have to be VERY high to elicit a "meth-like" response (thus the reported presense of amphetamine metabolites in overdose)
Even small amounts of methamphetamine/phenethylamine produced as metabolites could elicit a powerful response when MAO inhibition is high (as it is likely to be in people taking very high doses of Parnate) due to the synergistic sympathomimetic effect. I'm not aware of any studies giving precise data on the amounts of these metabolites but I will have a look.
This has been discussed at length on PB but I don't recall a definite conclusion. Maybe some of the older members will be able to add some insight? Parnate certainly feels like a powerful stimulant at high doses for many people whatever the underlying pharmacology may be.
Q
Posted by Karen44 on January 4, 2007, at 19:54:58
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 4, 2007, at 0:45:27
> >Parnate has amphetamine-like qualities.
>
> The old Parnate methamphetamine metabolite debate? There's still much confusion over that but I found Parnate did have an amphetamine-like feel to it at high doses. Amphetamine metabolites have been found in the blood and urine of Parnate overdoses and people have posted here to say they have tested positive for amphetamines while taking Parnate.
>
> At 120mg I had the dilated pupils, racing heart, erect nipples and gooseflesh characteristic of 'crystal meth'. I wonder if going back to it would help my fatigue?
>
> Q
Wow Q, I never took such a high dose of Parnate when I was on it. The most I was ever prescribed was 40 mg. I guess I am surprised that someone would prescribe such a high dose.After I had been on Parnate for a time and after I went back to graduate school, I researched about Parnate for my Psychopharmacology class. It certainly was energizing for me, and when I tried to split the dose and take half at night, I was too wound up.
Karen44
Posted by laima on January 4, 2007, at 20:22:58
In reply to Re: Are MAOIs worth it? » Quintal, posted by Karen44 on January 4, 2007, at 19:54:58
How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?
Posted by Karen44 on January 4, 2007, at 23:26:21
In reply to Re: Are MAOIs worth it?, posted by laima on January 4, 2007, at 20:22:58
>
> How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?I used to tell people I was taking a medication that would cause me to get sick if I ate cheeses, etc. I don't recall anyone why, and I don't remember anyone asking. I guess I would just say I have an imbalance that means I have to take this medication for the time being.
Karen44
Posted by jedi on January 4, 2007, at 23:37:35
In reply to Re: Are MAOIs worth it?, posted by laima on January 4, 2007, at 20:22:58
It is really no big deal for me, and I have been on Nardil for most of the past 10 years. I'll order a bottled Bud Light instead of the micro brews on tap (any tyramine excess is in the tap, not the beer). In a Mexican Restaurant I tell the waiter I can't eat cheddar and please use mozzeralla, no questions asked. There are really very few foods that I can't eat, but you would not call mine a strict MAOI diet. Most high tyramine foods like sauerkraut and liver, I don't like anyway. The only thing I really miss is aged cheeses. I use the MAOI diet short list posted by Elizabeth in 2001. Has any one heard anything of her in the past few years? I sure hope she went on to get well.
Link: http://www.dr-bob.org/babble/20010814/msgs/75408.htmlOf course, what works for me will not work for everybody. Baring some miracle of modern science, I will be on MAOIs for the rest of my life. The diet thing is really not that big of deal, when compared to the alternative of life threatening depression.
Take care,
Jedi
> How socially awkward is following a strict MAOI diet? Is it a huge deal at restaurants, parties, going out for a drink... What does one say to acquaintences about it, without launching into a description of a mood disorder and obscure, severe-sounding medication? Do people feel deprived, or live in fear of food? Or get used to it?
Posted by laima on January 5, 2007, at 8:08:29
In reply to Re: Are MAOIs worth it? » laima, posted by jedi on January 4, 2007, at 23:37:35
Thanks- so it sounds like one can make the diet into not such a major to-do, socially. That's good to know. We'll see now if I end up on a new MAOI (other than Emsam) or not.
Posted by tessellated on January 5, 2007, at 15:59:40
In reply to Re: Are MAOIs worth it? » Karen44, posted by Quintal on January 4, 2007, at 0:45:27
-people have posted here to say they have tested positive for amphetamines while taking Parnate.
i was one of those peeps.
david pearce puts it pretty well on the biopsychiatry.com site. i would say the non-selective MAOI's are not for the mild dysphoria. not because of SE's, but because of the profound alteration of one's chemistry.
to me nothing ever has quite felt like a lock and key solution.
they were as close to a near reversal of depression as anything i've experienced.only they metabolise strangely. working on cytokines as well, so both dosing schedule and amount are tricky. if there was a parnate SR or something i'd go back. i also suffered from either fatigue or borderline manic insomnia, with great moments tween. 100mg parnate and up turned me into something of a kinder gentler version of a dr.jeckyl. fun. but a little wild.
I had an amazing psychopharmacologist who categorized parnate and provigil as "smart drugs", and i agree. they are options to try prior to more potent stims and vastly less problematic.
Achieving a sustainable "golden mean" is a problem in general, but i think i've had the longest glimpses of it with MAOI's.
l8
> Q
Posted by tessellated on January 5, 2007, at 16:04:39
In reply to Re: Are MAOIs worth it?, posted by laima on January 5, 2007, at 8:08:29
re: diet
i ate practically everything on the not to list and never had a problem with hypertension only hypotension. i think there is a vast difference across populations.
Posted by deuce224 on January 6, 2007, at 2:55:58
In reply to Re: Are MAOIs worth it?, posted by NYCguy on January 2, 2007, at 19:18:37
i Have been on parnate for 9 months now and the only restrictions i have had in my diet were cheese related. slowly I learned that i could eat mozzarella no problem and have started eating small amounts of other cheeses. The key is to eat a small amount and then check your blood pressure. So basically the diet really isn't a problem.-joe
Posted by naughtypuppy on January 6, 2007, at 10:36:34
In reply to Re: Are MAOIs worth it?, posted by tessellated on January 5, 2007, at 16:04:39
I ate pretty well anything I wanted on Nardil. I had to be a little more careful with Parnate. The hypotension was the real problem.
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