![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 30. Go back in thread:
Posted by Quintal on August 20, 2007, at 17:28:32
In reply to My pdoc: 'After Nardil, that's it with meds. ECT', posted by Girlnterrupted78 on August 20, 2007, at 6:40:02
>So what exactly is the deal with this pdoc?
Unfortunately he sounds fairly typical of psychiatrists to me.
>Isn't there other choices besides Nardil?
Nardil can be augmented with stimulants, lithium, nortriptyline etc, and if that fails there are the other MAOIs to fall back on, and they too can be augmented.
>Isn't Parnate completely different from Nardil?
It's an MAOI and that's where the similarity ends. My pdoc made the same mistake with me. One of Nardil's metabolites raises GABA levels throughout the brain, whereas Parnate lowers GABA. There is evidence that Parnate is metabolized into small amounts of methamphetamine and PEA, and it tends to be stimulating and anorectic whereas Nardil tends to be sedating, slowing and fattening.
>Aren't blackouts a normal side effect of Nardil?
Yup.
>Isn't the rash RELATED to Nardil, if it appears 20 minutes after EACH dose of Nardil? Why is he in denial?
Seems very likely they're linked. Certainly worth investigating.
>I don't get it.
Arrogance? Laziness? Narcissism?
Q
Posted by Kathii on August 20, 2007, at 23:13:20
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » Girlnterrupted78, posted by Quintal on August 20, 2007, at 17:28:32
Have you checked to see what other components are in the Nardil (pills, capsules)? Maybe you're allergic to a filler or dye?
Could you schedule a time when you could take the Nardil at the beginning of your appointment, so the doctor could actually see the rash for himself?
Posted by FredPotter on August 21, 2007, at 0:05:01
In reply to Re: My pdoc: 'After Nardil, that's it with meds. ECT', posted by blueboy on August 20, 2007, at 16:31:23
I think lists of activities (if any) speak volumes - you are right. When I think back to when Nardil started working I changed my habits. I
Now get up at 6am
Read a while and have breakfast
Get to work at 8am
Work all day till 5 without taking naps
read books that have been sitting gathering dust for years
Practise piano
Write music
eat well
go to bed at 11pmbut sleep is shallow, there's no sexual feeling and I have slight weight gain
I think if someone has low blood pressure already then the postural hypertension could easily cause fainting. I think it's all on a continuum.
Is ECT really only temporary? Re other drugs, there are completely novel drugs like Tianeptine that could be tried.
Fred
Posted by Girlnterrupted78 on August 21, 2007, at 0:25:24
In reply to Re: My pdoc: 'After Nardil, that's it with meds. ECT', posted by stargazer2 on August 20, 2007, at 8:47:07
Thanks for your message, Stargazer.
>Sorry to hear your pdoc's stance on MAO's since it seems so obvious to me that Nardil has caused all of your side effects since they appeared after starting Nardil, right?
Yeah, that's correct. I find it so unbelievable that my pdoc could pretend nothing at all is related to Nardil, even when every symptom appeared for the FIRST time EVER after starting Nardil!?
Can't he just log online and read a few pages about Nardil? I mean, anyone with knowledge of the Internet can do that.. how come an MD who is prescribing the actual medication is incapable of reading a couple of pages about a medication he's prescribing? Shocking!!
>Do you have access to the package insert for Nardil? I think both the rash and blacking out are the direct cause of Nardil, perhaps they are dose related in your case.
I don't have access to the package insert, but I accessed the Pfizer website and found a pdf file on Nardil named:
"U.S. physician prescribing information for this medication."
http://media.pfizer.com/files/products/uspi_nardil.pdfIt says:
"All patients undergoing treatment with NARDIL should be closely followed for symptoms of postural hypotension. Hypotensive side effects have occurred in hypertensive as well as normotensive and hypotensive patients. Blood pressure usually returns to pretreatment levels rapidly when the drug is discontinued or the dosage is reduced."
Definition of POSTURAL HYPOTENSION:
Orthostatic hypotension (also known as postural hypotension, orthostatic intolerance and, colloquially, as head rush or a dizzy spell) is a sudden fall in blood pressure, typically greater than 20/10 mm Hg, that occurs when a person assumes a standing position, usually after a prolonged period of rest.
Symptoms, which generally occur after sudden standing, include dizziness, lightheadedness, headache, blurred or dimmed vision (possibly to the point of momentary blindness), and FAINTING. They are consequences of insufficient blood pressure and cerebral perfusion (blood supply).http://en.wikipedia.org/wiki/Postural_hypotension
There it is, right? From the Pfizer website itself!! How could he not read any info related to Nardil before prescribing?
> I can take 30 mg of Nardil but at 45 mg, I start to have enough negative effects that prevent me from increasing the dose any higher. My side effects are extreme gas pains, which cause me to double up, along with constipation. The blacking out effect has mostly gone away for me.
Wow. So you may never get the full effect of the medication with such a low dose.. My pdoc STARTED me on 45mgs, and once that didn't do much, took me straight to 90mgs. 30mgs might be way too low to actually work. Is there anything you can take for those side-effects, in order to be able to raise your dose? Sorry to hear about the side-effects.
> I have been thinking more and more about ECT out of desperation but I am too scared to try it. I think the right meds have just as much a chance of working as ECT does. Out of frustration and not finding a med to work, it is sometimes used as a last resort. But then many do not respond to this either and are they better or worse off for trying it? I don't know.
I would try other things before ECT. I do meditation (which believe it or not, when done right and reaching good concentration, has an amazing antidepressant effect.) It WORKS like if I had taken an antidepressant--and a free one at that!
But I need to figure out how to get that working better because sometimes I can't concentrate well enough to achieve the dramatic results I have achieved in the past.
> Your pdoc does not seem to know much about MAO's despite prescribing Nardil. Rather than say a rash or blacking out is not related to Nardil, a good MD would say something vague like "It may be related since I haven't had much experince with presribing Nardil" or "let me check the package insert"(If I can find the package insert, I'll send the link).
>
> Parnate supposedly works very differently than Nardil, as does Marplan. Success with one does not automatically mean you would have success with another as so many here can attest to.
>
> What are you leaning towards doing? I feel for you as this decision is not an easy one. Good luck with whatever you do...I will be following your posts.
>
> StargazerThank you Stargazer. I agree with most of what you wrote above. I honestly don't even know what I'm leaning towards. I will remain on Nardil for a while. I get the feeling that the blackouts are starting to diminish, and there's one VERY good thing about Nardil: I start feeling sleepy early at night (10-11pm) and I'm usually up by 5 or 6am. That's like a dream come true. I used to waste my days living with horrible insomnia--going to bed at 3am, getting up at 12pm, being unable to change my schedule in years. And suddenly, it's done!!
Anyway, I will probably explore a little more regarding meditation. When my friend told me about it, I thought it was BS. But it's been a year, and I can't stop going back to it when I'm depressed. I have no clue what it does, but it has the true effect of an antidepressant. So I guess I'm leaning toward doing research on this while still doing research on antidepressants until finding something that sounds just as good as Nardil used to sound--if that ever happens.
I'm starting to lose hope with medications though... I mean.. even if they work beautifully, we all know they might eventually poop-out, right? And then what? I'm very confused, and I really have no idea what I'll do next. So I will just do what I can (meditation and medication research) and will continue in therapy and visiting this website for support.
Thanks a lot for keeping in touch, I will also follow your case and hope the best for you!
GI78
Posted by cumulative on August 21, 2007, at 3:09:06
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » stargazer2, posted by Girlnterrupted78 on August 21, 2007, at 0:25:24
>I mean.. even if they work beautifully, we all know they might eventually poop-out, right? And then what? I'm very confused, and I really have no idea what I'll do next.
You use a different medication or go medication-free for a long while, then you try it again. Tolerance fades.
Posted by Girlnterrupted78 on August 21, 2007, at 7:15:28
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E, posted by Racer on August 20, 2007, at 10:14:25
> What a maroon. EVERYTHING I've read about Nardil says that syncope is a known problem -- that it's even a fairly common problem. The rash? I don't know anything about that...
>
> Meanwhile, can you try printing out a bunch of short pieces -- a medscape search, or pubmed -- showing things like blackouts, etc, and then mail them to him before your next appointment? I don't think you should take them in and hand them to him -- for a variety of reasons -- but mailing them so he has a chance to read them at his leisure.That's actually a great idea, Racer. Thanks! I hope this won't put me at odds with him.
But I wonder if he will believe those websites. Last time I asked him if I could take Chromium as a supplement (because I had read it could help atypical depression,) he was a little sarcastic and said I shouldn't believe everything I read online. He said "did you read a double-blind study on that?" I said "YES, I did." He still was skeptical.
>
> I'm sorry you've found the doctor they had in mind when they came up with that joke about what do you call the guy who graduated last in his class at med school...I've noticed most clinics have these types of doctors. Unfortunately I cannot afford a private doctor, so I have to stick to this kind, and the others were just as bad, except besides being bad, they refused to prescribe Nardil, and everytime I mentioned my meds were not working, they would say: "You must go to therapy for this to work!" I was in therapy, so their comments were meaningless.
Thanks again
Posted by blueboy on August 21, 2007, at 11:41:04
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » stargazer2, posted by Girlnterrupted78 on August 21, 2007, at 0:25:24
I seem to have been confused here by your terminology. I thought when you said "blackout" you were talking about longer periods of unconsciousness or loss of memory.
If you are getting dizzy and possibly fainting, d'oh, of course it's the Nardil. Low blood pressure and/or postural hypotension is maybe the most common side effect.
Try telling your doctor that you get dizzy when you stand up and sometimes faint instead of "blackout". If I misunderstood, he could have. And if he can't imagine that dizziness and fainting are due to the Nardil, well, that's pretty much hopeless. All you could do, I guess, is outright challenge him by putting the Pfizer information in his face and demanding that he tell you what "postural hypotension" is, and why your fainting doesn't fit the bill.
Posted by Maxime on August 21, 2007, at 17:51:14
In reply to My pdoc: 'After Nardil, that's it with meds. ECT', posted by Girlnterrupted78 on August 20, 2007, at 6:40:02
I haven't read other people's response, so I am sorry if I repeat anything.
Your pdoc doesn' know what he is talking about. I was on Nardil and it made my blood pressure so low that I kept falling to the ground.
There are people who take meds and only get a rash if there is an increase in dosage or when too much has built up in the system = you don't get the rash right away.
Parnate is completly different from Nardil. Parnate worked for me, Nardil didn't. It's like saying all SSRIs are the same.
Can you find another pdoc?
Maxime
> I saw my pdoc two days ago and had a disappointing exchange.
>
> (1) First of all, he insisted that "Nardil does NOT cause blackouts or syncope. This must be another problem that I should address to my general doctor."
>
> I said "I already addressed it. My gral doctor said it must be a reaction to a medication I'm taking."
> Pdoc: "Nah."
>
> (2) Second: It turns out that my Nardil induced rash "is NOT caused by Nardil either." "You've been on Nardil for several weeks. It makes NO sense that NOW you get a rash. Nope, it's not Nardil."
>
> (3) Third: "Parnate is not a choice for you if Nardil fails. It's just another MAOI. They work the same way. If Nardil doesn't work for you, Parnate won't work either."
>
> (4) Fourth: "After Nardil, there's nothing else besides ECT, and you know we don't do that at this clinic."
>
> So what exactly is the deal with this pdoc? Isn't there other choices besides Nardil? Isn't Parnate completely different from Nardil? Aren't blackouts a normal side effect of Nardil? Isn't the rash RELATED to Nardil, if it appears 20 minutes after EACH dose of Nardil? Why is he in denial? I don't get it.
>
> I don't know what to do or what to say anymore. If Nardil fails, I will be left without treatment. This is the best and cheapest and closest clinic I've found so far, and this pdoc, although obstinate, is the only one that agreed to prescribe MAOIs in the last 4 years of searching, so I fear that if I switch, I will be even more limited in my med choices.
>
> I don't think I want to do ECT, does it even work for atypical (treatment-resistant) depression + social anxiety?
>
> Any comments appreciated.
Posted by girlnterrupted78 on August 22, 2007, at 7:13:41
In reply to Nardil - rash 20 mn later, posted by Kathii on August 20, 2007, at 23:13:20
I have no clue about whether I could be allergic to anything in the pills. I'm not knowledgeable about chemical ingredients, so it'd be impossible for me to figure it out.
But the rashes came when I was on 70mgs and I had it only once while on 60mgs. They don't happen every single time I take the med either. They happen sometimes, and sometimes they don't.
It's strange. Or maybe I just hadn't noticed them before? I just remember being at my desk, taking the pill, and 20 mins later, suddenly feeling really warm, especially in my chest, so just by coincidence I turned to look down and there it was.
My personal guess and intuition is that they appeared when lots of Nardil had accumulated inside of me. As I lowered the dose, they slowly disappeared. So I guess the only "allergy" would be to excessive amounts of Nardil in my body.
Not to mention that when I went up to 90mgs, I had even a worse reaction than the allergy. I had a pounding headache (right 20-30mins after each dose) that sent me to the ER thinking it could have been a hypertensive crisis. Without a doubt the worst headache in my life.
Thanks for your input
Posted by Quintal on August 22, 2007, at 11:04:46
In reply to Re: Nardil - rash 20 mn later » Kathii, posted by girlnterrupted78 on August 22, 2007, at 7:13:41
I wonder if Nardil acts as a vasodilator or something like that, as alcohol can? You know, how some people get warm and flushed after a few drinks, and their skin can go red and blotchy. Is it a raised rash with spots, or general redness?
Q
Posted by Quintal on August 22, 2007, at 11:06:38
In reply to Re: Nardil - rash 20 mn later » Kathii, posted by girlnterrupted78 on August 22, 2007, at 7:13:41
Posted by Racer on August 22, 2007, at 13:59:04
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » Racer, posted by Girlnterrupted78 on August 21, 2007, at 7:15:28
> >
> > Meanwhile, can you try printing out a bunch of short pieces -- a medscape search, or pubmed -- showing things like blackouts, etc, and then mail them to him before your next appointment?
>
> But I wonder if he will believe those websites.That's why I recommended just abstracts from pubmed or medscape -- abstracts from peer reviewed journals. If he doesn't believe those, well...
> >
> > I'm sorry you've found the doctor they had in mind when they came up with that joke about what do you call the guy who graduated last in his class at med school...
>
> I've noticed most clinics have these types of doctors. Unfortunately I cannot afford a private doctor,I've been there -- I was uninsured for a decade, and three years of therapy is getting me past the damage the last clinic did. I really and truly do understand, and I won't suggest that you have any alternatives because I do know better. The best I can recommend, is to offer up some abstracts from peer review journals, showing the specifics of your ideas -- syncope, hypotension, different effects of Parnate versus Nardil, etc.
The other thing that helped me a bit was a spreadsheet I had of all the meds I'd been on, side effects, benefits, length of time I was on them, dosages, etc. I made sure to list EVERY benefit I could think of, to be sure that the doctor wouldn't blame depression for clouding my perspective. I'm not sure that helped much, but at least I didn't have to try to remember what I'd taken while sitting there faced with a doctor who probably thought he should be in a fancy private practice.
I'm not a great patient, though. I know I didn't help myself by telling the doctor that I insisted on excellent care for my animals from their vets, and that I thought I should get care at least close to as good as that. Probably didn't help that I pointed out I didn't insist on equally good since it's so much harder to get into vet school than med school... So, after much personal experience, I don't recommend insulting your doctor... (Truly, I didn't mean to, and I think he understood. We both had animals going through health problems at the time...)
Anyway, good luck with it. If you ask, some people here might be able to help you find articles about the differences between Nardil and Parnate -- the other issue would be much easier to find information on.
Posted by girlnterrupted78 on August 22, 2007, at 19:33:42
In reply to Re: Nardil - rash 20 mn later » girlnterrupted78, posted by Quintal on August 22, 2007, at 11:04:46
No, it is not raised or with spots, and it does not itch at all. I don't feel anything if I touch it either. It's just like a sunburn, but without the sting of a sunburn. Some parts are just red, and as it gets to the edges of the white skin, it looks like huge spots.
But again, it is just a red discoloration, no feeling to it. It only lasts like 5 minutes, then disappears.
The first time I saw it I was typing in my computer (at night) after taking Nardil.
I started feeling really warm and my heart started beating extremely fast and hard--I could even feel the pounding in my neck. Then I got extremely sleepy and fell asleep for like 5-10 minutes with my fingers in the keyboard.After that, it happened another 3-4 times. Then I lowered the dose (from 75mgs to 60mgs) and it disappeared.
Posted by Quintal on August 22, 2007, at 19:59:11
In reply to Re: Nardil - rash 20 mn later » Quintal, posted by girlnterrupted78 on August 22, 2007, at 19:33:42
It sounds like flushing to me, rather than a rash as such, since it's transient, associated with a sensation of warmth and drowsiness. I'm thinking the last part is particularly associated with GABA, and Nardil does elevate GABA. Flushing is associated with vasodilators, and vasodilators lower blood pressure. Nardil drastically lowers your blood pressure, and I assume that's because it acts as a vasodilator. Do you follow my line of thinking? Nardil might cause flushing in some people due to its GABAergic and vasodilator action, perhaps in a similar way that alcohol can cause flushing in some people after a large drink due to its GABAergic and vasodilator action.
I don't have any definite answers obviously, but it's my intuition that this is intense flushing brought on by Nardil for reasons known unto itself. If it were an allergic type response I would expect itching and a raised, angry rash, and other symptoms too. I'm not a doctor of course, so I may be completely and utterly wrong. It's a shame your RL doctor isn't much interested or I'd say he would be able to shed more light on that ;-)
Q
Posted by girlnterrupted78 on August 22, 2007, at 20:03:30
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » Girlnterrupted78, posted by Racer on August 22, 2007, at 13:59:04
Thanks, Racer.
> That's why I recommended just abstracts from pubmed or medscape -- abstracts from peer reviewed journals. If he doesn't believe those, well...
So I just go to pubmed or medscape, do a search, and all results come from peer reviewed journals, or is it mixed with other stuff? Sorry, never used those websites before. Is WebMD the same type of website as the ones you listed?
> I've been there -- I was uninsured for a decade, and three years of therapy is getting me past the damage the last clinic did.What kind of damage did they do, and who did the damage & how? Oh God. I can totally see that happening. They are so stupid sometimes. I haven't found a single psychiatrist I considered professional and truthful. Some will give you a horrible attitude when they realize you have a certain degree of knowledge.
>The best I can recommend, is to offer up some abstracts from peer review journals, showing the specifics of your ideas -- syncope, hypotension, different effects of Parnate versus Nardil, etc.
Thank you, I might try that, although at this point it would only serve to "prove the doc wrong." I already know what it is, and it probably makes no difference whether he admits I was right now. In fact, the syncope seems to be finally going away. I used to feel it very strong when I got off the subway and rushed up the stairs. Now I don't get it anymore.. I'm pretty happy about that.
> The other thing that helped me a bit was a spreadsheet I had of all the meds I'd been on, side effects, benefits, length of time I was on them, dosages, etc.Great idea. He hasn't tried to blame me yet. In fact, he didn't even check much--he seems either lazy, or too busy to bother. So for now I will bother him as little as possible and will just present the information that will help me get what I need. Which would be info on Parnate in a couple of months--that, if Nardil never kicks in.
> I'm not a great patient, though. I know I didn't help myself by telling the doctor that I insisted on excellent care for my animals from their vets, and that I thought I should get care at least close to as good as that.
Wow, that's some guts. Was he that bad? So did that end up damaging you as a patient? I've felt like saying worse things, but I'd only say them if and when I'm sure I'm moving on to a different doc. If it's my only resource, I'd keep my mouth shut!
> Anyway, good luck with it. If you ask, some people here might be able to help you find articles about the differences between Nardil and Parnate -- the other issue would be much easier to find information on.
Thanks a lot for your help.
Posted by Quintal on August 22, 2007, at 20:10:31
In reply to Re: Nardil - rash 20 mn later » Quintal, posted by girlnterrupted78 on August 22, 2007, at 19:33:42
Flushing is listed as an adverse effect of Nardil, usually as a sign of overdose.
I found one reference to flushing associated with Nardil in the PubMed archives:
____________________________________________________1: Can J Psychiatry. 1991 Jun;36(5):389.Links
Flushing reaction associated with the interaction of phenelzine and clonazepam.
Karagianis JL, March H.PMID: 1884345 [PubMed - indexed for MEDLINE]
__________________________________________________Unfortunately I don't have access to the full text. Are you taking clonazepam?
Q
Posted by girlnterrupted78 on August 22, 2007, at 21:56:32
In reply to Re: Nardil - rash 20 mn later » girlnterrupted78, posted by Quintal on August 22, 2007, at 20:10:31
Did you find 2 different articles on this?
First you say it's a sign of overdose, and then that it's an interaction with Clonazepam. Are there two different theories on flushing?
In my case, I am both, (a) taking Clonazepam, and (b) went up my dose (from 60mgs to 75mgs).
But I'm still taking Clonazepam (now down on 60mgs) and there hasn't been a flushing lately at all..
However, I don't take Clonazepam too often.
Mostly I take it when Nardil causes me to get anxious and my arms/hands shake, so I can't type or do certain things. 0.25mgs of Clonazepam will stop the shaking. I haven't shaken lately so I haven't taken it, but it does happen often enough.
I also have never taken a whole 0.5 pill except for once and I hated the way it makes me feel, kind of flat, dull and depressed.
But I really do suspect the overdose is the culprit:
First of all, it began around 4 days after I increased the dose (enough for too much Nardil to accumulate in my body).
The super-overdose (90mgs) also caused a side effect after exactly 4 days -- the splitting, pounding headache.
Both reactions disappeared immediately when I cut the dose down to 60mgs. I actually purposely missed 2 doses to bring the amount of Nardil down in my body, and then started clean the next day on 60mgs.
After bringing the doses down to 60mgs in both cases, both, the rash and the headache were gone.
Posted by Quintal on August 22, 2007, at 23:46:40
In reply to Re: Nardil - rash 20 mn later » Quintal, posted by girlnterrupted78 on August 22, 2007, at 21:56:32
>Did you find 2 different articles on this?
No.
>First you say it's a sign of overdose, and then that it's an interaction with Clonazepam. Are there two different theories on flushing?
I said flushing is listed as a sign of overdose (in patient/physician information leaflets) *and* I found one study on PubMed where Nardil was associated with flushing. There are probably multiple mechanisms involved with flushing. As I said earlier GABA may be one of the most important factors, and that would seem to correlate with the clonazepam interaction, i.e. excess GABA or something along those lines. A Google search of Nardil + flushing reveals many results, mostly patient/physician information leaflets and drug monographs. In all I examined, flushing was listed as a sign of overdose. A search of phenelzine + flushing on PubMed revealed only one result - the study I posted above.
>First of all, it began around 4 days after I increased the dose (enough for too much Nardil to accumulate in my body).
Yeah, that's what I thought too.
>Both reactions disappeared immediately when I cut the dose down to 60mgs. I actually purposely missed 2 doses to bring the amount of Nardil down in my body, and then started clean the next day on 60mgs.
Well that's sounding like a very strong case for the overdose theory. Clonazepam probably exacerbated the problem, most likely through some GABAergic mechanism? I think you were put on a very rapid titration of Nardil too?
Dr. Ken Gillman says that Nardil may inhibit the enzymes that metabolize it, and this is dose-dependent, so the higher the dose, less Nardil is excreted, increasing the risk of overdose in the higher dosage range I would imagine.
__________________________________________________Phenelzine may be metabolised by acetylation which shows great genetic variation. The possible implication (research is still equivocal) of this is the dose may have to be greatly varied between patients depending on their genetic acetylater status. The data established for the structurally similar drug, isoniazid, is probably a model, particularly for their shared properties of neuropathy and hepatotoxicity (8-12).
A further difference and potential complication is that phenelzine has non-linear pharmacokinetics because it both blocks, and is metabolised by, monoamine oxidase (13-15).
Isoniazid is an inhibitor both CYP2C19 and CYP3A isoforms, this is the likely mechanism by which it slows the elimination of e.g. phenytoin, carbamazepine, diazepam, triazolam, and primidone. Slow acetylators may be at increased risk for adverse drug interactions, as the degree of inhibition is concentration dependent (16).
http://www.psychotropical.com/maois_full.shtml
__________________________________________________Q
Posted by girlnterrupted78 on August 22, 2007, at 23:46:55
In reply to Re: My pdoc: 'After Nardil, that's it with meds. E » Racer, posted by girlnterrupted78 on August 22, 2007, at 20:03:30
Efficacy and tolerability of tranylcypromine versus phenelzine: a double-blind study in antidepressant-refractory depressed inpatients.
BACKGROUND: The aim of this study was to examine whether phenelzine is a suitable alternative to tranylcypromine in antidepressant-resistant depression.
METHOD: A total of 77 severely depressed in-patients, meeting the DSM-IV criteria for major depressive disorder, who failed to respond to fixed plasma level treatment with either tricyclic antidepressants or fluvoxamine were withdrawn from psychotropic medication and included in a double-blind flexible-dose 5-week comparison of tranylcypromine and phenelzine.
RESULTS: Of the 77 patients, 67 (87%) completed the trial, of whom 35 (52%) responded. No significant differences in response between both drugs were observed.
Seventeen (44%) of 39 patients responded to tranylcypromine and 18 (47%) of 38 to phenelzine (> or = 50% reduction in Hamilton Rating Scale for Depression [HAM-D] score). The mean reduction in HAM-D score was 10.4 +/- 8.3 for the tranylcypromine sample versus 8.3 +/- 8.4 for the phenelzine-treated patients.
Only a few patients (10%) used concomitant psychotropic medication. A substantial number of patients experienced severe side effects, mainly dizziness, agitation, and insomnia; the incidence was the same in both samples (21%).
CONCLUSION: No difference in efficacy was observed between both monoamine oxidase inhibitors in a sample of patients with severe antidepressant-refractory depression. Phenelzine appears to be a suitable alternative to tranylcypromine.
Posted by Quintal on August 23, 2007, at 0:20:38
In reply to Re: Nardil vs Parnate Article - pdoc was right? » girlnterrupted78, posted by girlnterrupted78 on August 22, 2007, at 23:46:55
>Phenelzine appears to be a suitable alternative to tranylcypromine.
And vice versa one would imagine. The results of the study you posted show that would Nardil appear to be a suitable alternative for patients refractory to Parnate. It does not show that there are no clinical differences between the two. There are very important differences in terms of active metabolites, and therefore clinical effects. Ultimately therapy is most likely to benefit personality disorder, though not all patients can use therapy effectively, particularly those with undiagnosed borderline personality disorder.
Q
Posted by Phillipa on August 23, 2007, at 12:00:42
In reply to Re: Nardil - rash 20 mn later » Quintal, posted by girlnterrupted78 on August 22, 2007, at 21:56:32
One last thought do you take vitamins with niacin at the same time by any change as niacin causes hot rash on chest and head I took niacin years ago but it goes away in about 20minutes niacinamide doesn't cause the flushing and rash. Thought you might take a multi vitamin with some in it. Phillipa
Posted by Quintal on August 23, 2007, at 12:12:05
In reply to Re: Nardil - rash 20 mn later » girlnterrupted78, posted by Phillipa on August 23, 2007, at 12:00:42
Yeah, niacin can definitely cause flushing, but not at doses typically found in multivitamins for most people. Also, the flushing only appeared when GI was taking high doses of Nardil, and disappeared when she lowered the dose, strongly implicating Nardil overdose as the major contributing factor.
Q
Posted by Phillipa on August 23, 2007, at 19:51:46
In reply to Re: Nardil - rash 20 mn later » Phillipa, posted by Quintal on August 23, 2007, at 12:12:05
I used to supplement with extra niacin forget what for but it did cause the same reaction. Just another thought. Phillipa
Posted by Quintal on August 23, 2007, at 21:49:05
In reply to Re: Nardil - rash 20 mn later » Quintal, posted by Phillipa on August 23, 2007, at 19:51:46
It sounds as if you're very susceptible to niacin flushing Phillipa.
Q
Posted by blueboy on August 24, 2007, at 9:48:40
In reply to Re: Nardil vs Parnate Article - pdoc was right? » girlnterrupted78, posted by girlnterrupted78 on August 22, 2007, at 23:46:55
This looks like a pretty good study. However, let me point out a logical flaw: The study neither attempts to prove, nor proves, that people who do not improve when they take Nardil will (or will not) improve if they take Parnate. That just isn't what the study says.
In practical terms, the study lets a pdoc know that Nardil and Parnate have about an equal, 50% chance of being effective. It says nothing about whether or not some percentage of patients who have taken Nardil and have not shown improvement will improve if given Parnate.
Let me give an analogy. I'm going to do a double-blind study about giving testosterone or estrogen to random people who complain of infertility. Assume that 50% of the people respond favorably to estrogen, and 50% respond favorably to testosterone.
Does this mean that the people who did not improve on estrogen would not improve if given testosterone? Duh!
The chance that patients who were given Nardil and did not improve might respond to Parnate could be anywhere between 0% and 100%. The study just doesn't answer that question.
> Efficacy and tolerability of tranylcypromine versus phenelzine: a double-blind study in antidepressant-refractory depressed inpatients.
>
> BACKGROUND: The aim of this study was to examine whether phenelzine is a suitable alternative to tranylcypromine in antidepressant-resistant depression.
>
> METHOD: A total of 77 severely depressed in-patients, meeting the DSM-IV criteria for major depressive disorder, who failed to respond to fixed plasma level treatment with either tricyclic antidepressants or fluvoxamine were withdrawn from psychotropic medication and included in a double-blind flexible-dose 5-week comparison of tranylcypromine and phenelzine.
>
> RESULTS: Of the 77 patients, 67 (87%) completed the trial, of whom 35 (52%) responded. No significant differences in response between both drugs were observed.
>
> Seventeen (44%) of 39 patients responded to tranylcypromine and 18 (47%) of 38 to phenelzine (> or = 50% reduction in Hamilton Rating Scale for Depression [HAM-D] score). The mean reduction in HAM-D score was 10.4 +/- 8.3 for the tranylcypromine sample versus 8.3 +/- 8.4 for the phenelzine-treated patients.
>
> Only a few patients (10%) used concomitant psychotropic medication. A substantial number of patients experienced severe side effects, mainly dizziness, agitation, and insomnia; the incidence was the same in both samples (21%).
>
> CONCLUSION: No difference in efficacy was observed between both monoamine oxidase inhibitors in a sample of patients with severe antidepressant-refractory depression. Phenelzine appears to be a suitable alternative to tranylcypromine.
>
> http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15554763&ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
This is the end of the thread.
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