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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by tecknohed on November 22, 2007, at 6:30:35
In reply to Re: How can I recognize a hypertesive crisis?, posted by Molitor on November 21, 2007, at 23:34:30
I would imagine that the stomache burning is caused by the same mechanism which happens in the brain, as the digestive system (esp. stomache) is full of neurotransmitter receptors including norepinephrine/noradrenalin receptors, which is the main resulting culprit for causing the hypertensive crises symptoms. The stomache actually contains MANY more such receptor sites that does the brain.
Hence the Molten Lava feeling.
Provigil is a potent noradrenergic drug & so is Parnate. I took Provigil without any problems with Nardil, even in excess of 600mg/day. Just shows that, like all groups of meds, MAOIs are NOT all the same. Of course WE'RE not all the same either!
take care,
teck
Posted by Molitor on November 23, 2007, at 3:48:19
In reply to Re: How can I recognize a hypertesive crisis? » Molitor, posted by tecknohed on November 22, 2007, at 6:30:35
The ironic part about Provigil is that it's not considered a classic "stimulant", and supposedly doesn't have any of the "bad" qualities of amphetamines, et al. This is why I was using it, because it should be safer than the alternatives.
Well, I'm calling shenanigans on that! I consider Provigil to be a stimulant just like any other, and it should be used with as much caution in combo with MAOIs as anything else. Perhaps MORE caution, since nobody knows exactly why it works.
Back to the Hypertensive Crises and the Molten Lava feeling. Whatever causes it, MAOI users need to be made aware of it. I probably had a lag of between 10-30 minutes between the Molten Lead and the headache, so if someone is getting this symptom, they should immediately think about getting to the emergency room. Having a BP monitor nearby is also a good idea. Even a cheap one is useful in determining if your blood pressure is soaring.
Also, another symptom I had that isn't mentioned much, was disorientation and confusion. MAOI users should carry a med alert card to hand the emergency wrokers, or better yet, have someone take them to the hospital to explain the situation. Lest you be treated as a bad drug trip, and sent to the back of the line.
Even with all that, when I was in the bed with all the monitors hooked up, I'd have a nurse come in and ask me stuff like what "ACE Inhibitor" I was taking, and who the doctor was that treated my hypertension (I have normal BP). She also kept telling me to lay down, but I swear I remember reading that I should NOT lay down, and it hurt MUCH more if I wasn't sitting up, so I kept sitting up even though the back of the hospital bed was reclined, which caused pain and cramping in my back/shoulder/arms. I never actually saw a doctor (although I think he was monitoring my vitals remotely), and to this day I don't believe they really understood what was going on. That's about the scariest part of the whole thing.
Posted by yxibow on November 23, 2007, at 12:56:57
In reply to Re: Initiating Nardil therapy tomorrow » Nardilstarted2007, posted by medweirdo on November 21, 2007, at 1:05:37
I understand we all have choices in life and I may make an euqally difficult one with Clozaril eventually but do people on here who have arrived at that point really arrive at Nardil and Marplan, etc, after trying only a few antidepressants or is it a a last case scenario?
I know that people who do take the class of medications have a good result but I just can't imagine carrying around the equivalent of a nitroglycerin container with nifedipine or clonidine or other HBP medications just because they ate some unknown ingredient at a restaurant.
With a worst case scenario, since MAOIs should be flushed out for 14 days, I'm imagining at least $31,200 to $52,000 in a combination of ER triage, rooms and possibly psych wards for that entire period to determine a better game plan.There is no warning, it just happens, immediately, a hypertensive crisis.
I must say Clozaril is not without its risks and expense but a body conscious person like myself could detect "not feeling well" and monitoring programs are very frequent.
Posted by Molitor on November 23, 2007, at 17:41:30
In reply to soy, posted by brooke484 on November 21, 2007, at 21:08:39
According to the dietary guidelines for Marplan, which has the most liberal guidelines of Marplan/Nardil/Parnate, it says about soy:
"Foods you cannot eat: Most Soybean products, including soy sauce and tofu"
"Foods you can eat: Soy Milk"
I avoid everything soy except for soybean oil, which I figure is the highly refined fat part of soy, and doesn't contain any proteins to cause problems. Too bad, because I don't really like meat, and I had to give up Garden Burgers and Boca Weenies and the like.
You can see it here:
http://validuspharma.com/dev/MarplanDietCard.pdfSince there's only a couple of thing on that chart, I'd take the soy recommendation very seriously. Also note that this is the chart for MARPLAN, not Nardil. Nardil has a stricter list, and when in doubt, I'd err on the side of safety and follow the list for the specific medication I'm taking.
Posted by tepi on November 25, 2007, at 12:54:02
In reply to Avoid Most Soybean Products, including Tofu., posted by Molitor on November 23, 2007, at 17:41:30
I have had only 1 HP crisys when I ate and spoiled big piece of chicken that was in the refrigerator for 2 weeks . Not sure It was spoiled because it tasted well, anyway I knew I should have not ate it.
For me was like a normal dinner , then I started to feel my heart beating a little quickly, fast breathing; time passed and I started to feel a big presure in the back side on my head that became worst every minute. All this happened like 1 hr an a half after my dinner .
I end up at the ER with a blood pressure of (150/200) .
Dr did not know MAOIS (not a surprise for me) so I told them to give me nifedipine.
I left the hospital 2 hrs left.
I have always been wondering if we could eat anything , and when we start to have the HP crisis just control it with nnifedipine. Sounds risky but just wonderingTepi
Posted by tecknohed on November 25, 2007, at 17:26:21
In reply to Re: How can I recognize a hypertesive crisis? » tecknohed, posted by Molitor on November 23, 2007, at 3:48:19
> The ironic part about Provigil is that it's not considered a classic "stimulant", and supposedly doesn't have any of the "bad" qualities of amphetamines, et al. This is why I was using it, because it should be safer than the alternatives.
>
> Well, I'm calling shenanigans on that! I consider Provigil to be a stimulant just like any other, and it should be used with as much caution in combo with MAOIs as anything else. Perhaps MORE caution, since nobody knows exactly why it works.I'm with you on this one. I definitely consider Provigil a stimulant too. It definitely has a 'kick' to it, especially during the first few days of usage. It also builded tolerance very quickly for me, just like any stim I've taken before. When I stopped I switched strait to bupropion but I've no doubt I'd have suffered withdrawal fatigue had I not made that switch so quickly.
> Also, another symptom I had that isn't mentioned much, was disorientation and confusion. MAOI users should carry a med alert card to hand the emergency wrokers, or better yet, have someone take them to the hospital to explain the situation. Lest you be treated as a bad drug trip, and sent to the back of the line.
>
> Even with all that, when I was in the bed with all the monitors hooked up, I'd have a nurse come in and ask me stuff like what "ACE Inhibitor" I was taking, and who the doctor was that treated my hypertension (I have normal BP). She also kept telling me to lay down, but I swear I remember reading that I should NOT lay down, and it hurt MUCH more if I wasn't sitting up, so I kept sitting up even though the back of the hospital bed was reclined, which caused pain and cramping in my back/shoulder/arms. I never actually saw a doctor (although I think he was monitoring my vitals remotely), and to this day I don't believe they really understood what was going on. That's about the scariest part of the whole thing.
I was treated very rudely when I went to the A&E. Was told to "HUSH" a few times when I was yelling in agony, as if they thought I was putting it on for attention or something, or maybe they thought I was a drug addict craving for a fix. VERY unpleasant & made me very angry! Like in your situation they obviously had little clue in what to do, even though I made it very clear what was going on & even made a few suggestions like giving me nifedepine.
Posted by stargazer2 on November 25, 2007, at 18:34:47
In reply to Re: HP crisis., posted by tepi on November 25, 2007, at 12:54:02
Tepi,
Would NEVER do to that as Nifedipine can drop your pressure the other way rather quickly and has to be monitored very closely. I was lucky in that I had my BP cuff ready to go, started at 230/130, laid on the BR floor to minimize any activity and just kept taking my BP and pulse every few minutes. Eventually it came down to 130/80 and I really felt relatively OK for what had happened.I have extremely low BP so the escalation to 230/130 made me fear a stroke if I couldn't get it under control.
BTW, your BP was more likely 200/150 since the bottom number is never larger than the top number.
I'm lucky in that most of the No-No food are ones I don't really like except for cheese. Occasionally I will have a slice of pizza and be OK, but that is it, no aged cheese ever, so cream cheese is one of my biggest treats.
Stargazer
Posted by yxibow on November 26, 2007, at 4:51:11
In reply to Re: HP crisis./Tepi, posted by stargazer2 on November 25, 2007, at 18:34:47
> BTW, your BP was more likely 200/150 since the bottom number is never larger than the top number.
There are peculiar situations, mostly it seems for women, hormones, pregnancy when it can be purely high diastolic. This is rare though.
Posted by Nardilstarted2007 on November 28, 2007, at 17:11:55
In reply to Initiating Nardil therapy tomorrow, posted by medweirdo on November 20, 2007, at 13:18:45
> Do I need to take the pills on an empty stomach or with food?
>
> Thank you in advance.
Hi Medweirdo, Hows your advancement with Nardil? Have you upped your dose? How do you feel? any side effects?Let us know >NardilStarted2007
Posted by medweirdo on November 29, 2007, at 11:19:28
In reply to Re: Initiating Nardil therapy tomorrow » medweirdo, posted by Nardilstarted2007 on November 28, 2007, at 17:11:55
Hi, I'd uped my dose to 30mg after 4 days initiating Nardil and today after 8 days I increased the dose again to 45mg. I know I'm very impatient but my case is very severe right now. I'm having panick attacks that interfere me from studying. the only SE I feel is sleepiness (after 2 or 3 hours of consumption) so I think it would be better to take it before bed time?.
I pray for it to start already working, I feel really dead (not b/c nardil) and can't even think how I can survive for one more day.
:[
Posted by stargazer2 on November 29, 2007, at 12:29:45
In reply to Re: Initiating Nardil therapy tomorrow » Nardilstarted2007, posted by medweirdo on November 29, 2007, at 11:19:28
I would reommend you take 15 in the morning and 30 at night since a twice a day dosing is recommended. That is what I had to do when I started to decrease sleepiness. Hang in there,it will work...I started in May taking 40, then had a bit of a relapse in October and had to go up to 60, where I'm at now. It is working rather well for me and many others.
Stargazer
Posted by stargazer2 on November 29, 2007, at 12:31:57
In reply to Re: HP crisis./Tepi » stargazer2, posted by yxibow on November 26, 2007, at 4:51:11
Xyibow, what do you mean by "purely high diastolic", I never heard of that term...
SG
Posted by medweirdo on November 29, 2007, at 13:06:05
In reply to Re: Initiating Nardil therapy tomorrow/MedWierdo, posted by stargazer2 on November 29, 2007, at 12:29:45
> I would reommend you take 15 in the morning and 30 at night since a twice a day dosing is recommended. That is what I had to do when I started to decrease sleepiness. Hang in there,it will work...I started in May taking 40, then had a bit of a relapse in October and had to go up to 60, where I'm at now. It is working rather well for me and many others.
>
> StargazerThank you Stargazer. what you suggest is a good advice for me. I took all the three pills at once this morning (the p.d told me to take it early once a day) so I'll start to stick with it next time perhaps it might also help me sleep better.
Posted by yxibow on November 30, 2007, at 4:06:49
In reply to Re: HP crisis./xyibowi, posted by stargazer2 on November 29, 2007, at 12:31:57
> Xyibow, what do you mean by "purely high diastolic", I never heard of that term...
> SGe.g. 95/110. This is very rare. I don't know if there is a true medical term.
Posted by stargazer2 on November 30, 2007, at 7:04:53
In reply to Re: HP crisis./xyibowi » stargazer2, posted by yxibow on November 30, 2007, at 4:06:49
The scenerio you describe when the diastolic number is greater thn the systolic will never happen. Systolic is always higher than the diastolic although the two numbers can get close but never flip, i.e. 160/130.
95/110 will never occur, only 110/95.
SG
Posted by yxibow on November 30, 2007, at 12:42:38
In reply to Re: HP crisis./95/110 will never happen, posted by stargazer2 on November 30, 2007, at 7:04:53
> The scenerio you describe when the diastolic number is greater thn the systolic will never happen. Systolic is always higher than the diastolic although the two numbers can get close but never flip, i.e. 160/130.
>
> 95/110 will never occur, only 110/95.
>
> SGI can't find the link, you're probably right, but... High Diastolic blood pressure regardless of the other measurement does indeed happen, to special groups of people on a rare basis, South Asian, etc.
Posted by stargazer2 on November 30, 2007, at 13:44:58
In reply to Re: HP crisis./95/110 will never happen » stargazer2, posted by yxibow on November 30, 2007, at 12:42:38
Yes, actually the diastolic is more indicative than the systolic of cardiac stress, but you will never see the diasolic number larger than the systolic, it just never occurs. If you find an article that says other wise, I will eat my hat...I don't wear one though...so I'll eat my show, YUK
SG
Posted by tecknohed on December 2, 2007, at 12:50:32
In reply to Re: Initiating Nardil therapy tomorrow/MedWierdo » stargazer2, posted by medweirdo on November 29, 2007, at 13:06:05
> Thank you Stargazer. what you suggest is a good advice for me. I took all the three pills at once this morning (the p.d told me to take it early once a day) so I'll start to stick with it next time perhaps it might also help me sleep better.
For anxiety, esp social anxiety its best to spread throughout the day as it will give you more even levels of its metabolite PEH (phenylethylidenehydrazine) which increases GABA, giving you a better balanced anxiolytic effect.
For 60mg, and if its not too much hassle you could take 15mg 4 x day. Then if and when you increase just add the extra dose(s) to the nightime dose to help avoid daytime sedation.
teck
Posted by brooke484 on December 2, 2007, at 14:31:50
In reply to Re: Initiating Nardil therapy tomorrow/MedWierdo » medweirdo, posted by tecknohed on December 2, 2007, at 12:50:32
I wanted to share this with you...
I switched from taking 15 mgs twice a day to taking 10 mgs three times a day and noticed that I wasn't having anymore lightheadedness. Even when running up my stairs. When I go to 40 mgs I'm going to take it 4 times a day and see how that goes. Splitting the dose really does help, at least with me anyway.
Too bad it isn't doing anything else...
brooke
Posted by tecknohed on December 2, 2007, at 17:49:08
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed, posted by brooke484 on December 2, 2007, at 14:31:50
> I wanted to share this with you...
>
> I switched from taking 15 mgs twice a day to taking 10 mgs three times a day and noticed that I wasn't having anymore lightheadedness. Even when running up my stairs. When I go to 40 mgs I'm going to take it 4 times a day and see how that goes. Splitting the dose really does help, at least with me anyway.
>
> Too bad it isn't doing anything else...
>
> brookeTalking about Marplan right?
You're right, alot of side effcts are dose related and can be solved simply by changing the dosing time or spreading it out more. I'm glad your dizziness has gone. Hopefully you can soon jump to 40mg+ and it'll kick in. Bear in mind though that you MAY have to wait a few weeks on the higher dose to get the desired responce.
Thankfully my mild dizziness was very short lived. The only side effect I'm now plagued with is complete anorgasmia. And although I trust it will resolve on its own after a few months or so its very fustrating, as you can imagine. You got this side effect at all? I'm sure my pdoc & I can solve the problem somehow, but I dont see him until end of Jan. Hopefully the Horny Goat Weed I ordered will help.
teck
Posted by brooke484 on December 2, 2007, at 21:03:50
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed » brooke484, posted by tecknohed on December 2, 2007, at 17:49:08
Your post made me laugh! That name is hilarious. I hope it works for you.
Yes, I was talking about Marplan. I've been on 35 mgs for about 4 days, so I'll try 40 mgs in another few days. If I still feel like crap by the time I see my doctor on the 15th, I'm quitting. Marplan hasn't done anything positive for me and it's been 12 weeks. :(
brooke
Posted by tecknohed on December 3, 2007, at 5:41:03
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed, posted by brooke484 on December 2, 2007, at 21:03:50
> Yes, I was talking about Marplan. I've been on 35 mgs for about 4 days, so I'll try 40 mgs in another few days. If I still feel like crap by the time I see my doctor on the 15th, I'm quitting. Marplan hasn't done anything positive for me and it's been 12 weeks. :(
>
> brooke
>Well, 60 mg is the max dose for Marplan & you've touched just over half that. Many people need 90mg Nardil before it kicks in. But if you can't take the side effcts then I dont blame you.
So if you quit whats next on your list? Could you not try augmenting the Marplan first? Even just to get you by untill you CAN increase the dose? Maybe some Provigil or something. By the time Provigil poops out (often after around a month with DAILY use) you may get away with hiting 50mg Marplan without negative effects. Or why not try your pdoc's lamotrigine suggestion?
Whatever you do I hope all goes well for you.
teck
Posted by brooke484 on December 3, 2007, at 11:20:31
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed » brooke484, posted by tecknohed on December 3, 2007, at 5:41:03
I guess I'm not going to quit taking it afterall. I just found out that my insurance shipped my three month supply of Marplan on Sat (not in 2 weeks like they told me). There is nothing I can do now so I guess I'm staying on it. And yes, I will probably try adding another drug to it. Either lamictal or deplin (if he lets me).
I'm just getting frustrated because I feel worse than I did without it and I hate all this waiting. I'm so out of it and I feel like I'm losing touch with reality and that is not a pleasant feeling if you get my drift. Derealization is hell.
brooke
Posted by tecknohed on December 3, 2007, at 17:01:31
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed, posted by brooke484 on December 3, 2007, at 11:20:31
> I guess I'm not going to quit taking it afterall. I just found out that my insurance shipped my three month supply of Marplan on Sat (not in 2 weeks like they told me). There is nothing I can do now so I guess I'm staying on it. And yes, I will probably try adding another drug to it. Either lamictal or deplin (if he lets me).
>
> I'm just getting frustrated because I feel worse than I did without it and I hate all this waiting. I'm so out of it and I feel like I'm losing touch with reality and that is not a pleasant feeling if you get my drift. Derealization is hell.
>
> brookeWhen did the derealization start? Was it already a part of your depression which has simply got worse because Marplan isn't working, or do you think Marplan is actually causing it?
Are you taking anything else, e.g. alcohol or cannabis? These can cause derealization. Mind you, so can antidepressants.
Do you think your pdoc is willing enough to treat your depression/anxiety more aggressively? And if so, are you willing to take the 'aggressive' treatment? You may well need more than Lamictal or Deplin. I myself GOT derealization from Lamictal. Was like drifting through mist every day. But we're all different I guess.
I bet a tricyclic would stomp out the derealization, especially one of the more NRI type ones. Provigil certainly would, for a while at least. A nootropic supplement could also do wonders - I take 2 myself, idebenone & vinpocetine.
Why not start a new thread explaining your exact current situation, asking what might help the derealization? Bet you'd get a few responces at least.
I know what this symptom/side effect feels like. I've had it on & off for years. I know its hell but something will snap you out of it.
Best of luck mate.
teck
Posted by brooke484 on December 3, 2007, at 21:03:08
In reply to Re: Initiating Nardil therapy tomorrow/tecknohed » brooke484, posted by tecknohed on December 3, 2007, at 17:01:31
I've had constant derealization since 1991 after a major panic attck, but went into remission from 1992-1994 when I took Imipramine (my story is somewhere around here, I'm sure). It's been with me every day since 1994 from the time I wake up until I go to bed. I just live with it, if you can call it living. And no, I do not drink or use drugs. I'm already high.
Marplan has made it worse, but I'm trying hard to stick with it and hope that one day I'll wake up and it won't be as intense. Because I'm such a "unique case," (as they call me) it's been hard for my doctors to treat. The one I see now is the first one who has used more than one drug at a time on me. All the others just gave me one.
I'm in bad shape, but somehow I've remained strong. We all have to be when dealing with this illness.
brooke
This is the end of the thread.
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