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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 7 to 31 of 31. Go back in thread:
Posted by Nadezda on October 17, 2008, at 8:07:17
In reply to clarification » Jnew12, posted by azalea on October 16, 2008, at 22:20:04
The case that you reported is from 1965. If you're trying to warn someone about the possible risk of death from combining two meds, basing that on a lot more information than one case from 1965 would seem more helpful. There are singular cases of all sorts of unusual reactions to meds, especially maois. I'm also no expert, so I can't say whether a combination of nardil and adderall is safe or not in general. More likely, it should be prescribed by the individual case, by someone with some knowledge of the individual's reactions to meds. But while one needs to be careful with Maois, there are all sorts of proscribed drugs/foods out there which are safe for most people. This is not to say that there aren't foods/drugs that are dangerous, but that one-time or vague prohibitions don't contain enough information.
I did wonder, though, Jnew12, if any of your doctors is overseeing all your medications?. It really isn't a good idea to try things without consulting-- with an Maoi especially you could happen upon something that wouldn't be safe. You really shouldn't try to self- medicate. Just in case you have some sort of reaction, you need someone who can respond knowledgeably to your situation, which no one can if none of your physicians knows everything you're taking. I would choose one of them, and decide to work things out under his/her supervision.
Nadezda
Posted by Jnew12 on October 17, 2008, at 9:55:24
In reply to Re: clarification, posted by Nadezda on October 17, 2008, at 8:07:17
Please understand me. My one doctor is ignorant to MAOI's I am not sure if he has treated a single patient in his life. I know for a fact that I am the only patient of his on them right now because he told me so. I don't know if you would call this self medicating but I came in asking for Nardil because I told him all the message board I visit on anxiety (I visit alot) and told him my history of extreme Social Anxiety and ADD, and how I seen people on these boards helped out with SA with the drug NARDIL. Without hesitation he said he would give me anything I wanted (he must know I am a bad case because I told him the laundry list of other meds I been on) So, I asked him for Nardil, Benzo's (Klonopin for the morning, and Xanax as needed like my other psych did) and either Focalin, or Daytranna patch for ADD.
He asked me if I really wanted nardil, but did not try to get my to try something else like my other psych did. Of course I said yes, but told him I wanted parnate if this did not work and told him about the formulation and how it does not work as good, he looked at me crazy.
Then, he took out his little book looked Nardil up and seen that has food restriction. He told me I needed a list so I could sign so if anything happened he would not get sued. I said I seen the list on the internet many time, but still he made me sign it as the list was right in front of me and I agreed to adhere w/ food restrictions, and if I did it was my problem.
Then he checked on the ADD medication, and so that no stims are allowed to be prescribed with Nardil.
He saw that I had really bad ADD he made me do an evaluation before he found out nardil would clash with it, and I don't think he probally seen someone that bad..lol
I told him that stims have been done before with someone as treatment resistant as me before, but I think him being new to prescribing this medication, all he had to go by is his little boook.
He told me he would be happy to prescibe me either, I did not try to yank his chain too much, and I chose Nardil because I worry more about my depression, social anxiety more. Other people are the ones who complain on my ADD all the time, I just would like a med so people would stop complaining and maybe get energy.
So what I did is I had to go to a DOC as an emergency because I hurt my knee. But while I was there I brought up I had ADD and took meds as a child, and my granadpa was there to tell him all the bad things I do. Again I think he knew how important it was for me to be on medication, and was happy to help me. Except he gave me Adderal instead of Daytrana and Focalin, because that what he said he likes to prescribe.
I did not tell him about the Nardil because simply he did not ask, but then again I don't know if I would of told him, he seems like a real good guy and he want's me to to be there every two weeks to monitor me.
He also gave my grandparents (who I stay with right now) and my parents a before and after to fill out.
He also gave me one for my teacher it was somethling like a ridiculous 6 or 7 pages and there was no way I was going to give it to her. Then she brought me behind, and said that I had symptoms and I was talking out of line, and saying things that did not pertain to what I was doing and people were complaining. I told her that I had ADD, and my doc had something for her to fill out, but it was ridiculous long. She said she did not care she wanted to do it, she actually sounded happy to be involved for some reason, and if being on meds is going to get me a better grade, and have my teacher like me all the better.
At first in her class I did not talk at all because of Social Anxiety, but she said if you do not talk she will actually fail you for participation points. And now my ADD is making me want to stop talking or drop out.
I have been mixing Adderal 20mg XR for 5 days now without any negative side effect. Except yesterday I was falling in sleep alot in class, that might of been the klonopin I took before though.
If I did not have my head hurt for this long don't you think I am passed the stage of death due to nardil+adderal. All the cases I have seen which was not alot the people died in the first day of taking it, and like I said this is my 5th day. If I do feel a headache I will stop taking immeditaly matter of fact is there a med I can take to stop it if it does happen, there are meds for hypertensive crisis right?
So really, I am being monitored by both doctors, whether they both know what drugs I am taking or not. Even if did tell them don't you think there is anything they could do differently except give me less of each drug????
And my Psychatrist he does not really know much about this class of drug, I am sure some people on this board knows more than he does, the med has been stopped being used since like the 60's!
And, I know the guy who gives me adderal is intelligent, he seems to care, instead of just throwing a med at me he is trying to involve other people.
That is why I don't want to stop a good thing! I already have so much people involved now my teacher, filling out forms and checking if im doing better.
If I were to get off stimulants then that would pull a plug off of everything and people would get mad at me for chosing the Nardil over the ADD medication, because they think I need it. Like my grandpa I told him the interaction of the two could be possibly dangerous, he keeps on asking me why do you have to be on that nardil stuff!! I want my nardil!! But I don't want to die either, im so confused, what should I do??????????
Posted by jedi on October 17, 2008, at 12:24:25
In reply to Re: clarification, posted by Jnew12 on October 17, 2008, at 9:55:24
...
> If I were to get off stimulants then that would pull a plug off of everything and people would get mad at me for chosing the Nardil over the ADD medication, because they think I need it. Like my grandpa I told him the interaction of the two could be possibly dangerous, he keeps on asking me why do you have to be on that nardil stuff!! I want my nardil!! But I don't want to die either, im so confused, what should I do??????????Hi
In all honesty, you are playing a very dangerous game. Neither of your current doctors would prescribe the Nardil or stimulant if they knew you were taking the other. This type of combination should only be prescribed by ONE doctor who understands both medications and their interactions. That doctor is probably an expert psychopharmacologist. Combining stimulants with Nardil is far too dangerous for a layman.Please stop the stimulant at once, until you can find a doctor who can prescribe the combination safely.
I am a long term user of Nardil, 10+ years. I have mixed it with a lot of different medications. I've also almost died from interactions. You are playing with FIRE!
I care,
Jedi
Posted by azalea on October 17, 2008, at 12:42:06
In reply to You are playing with FIRE! » Jnew12, posted by jedi on October 17, 2008, at 12:24:25
I agree with Jedi. Please consider making an appointment with a specialist in psychopharmacology. Perhaps call the nearest medical school, ask for the psychiatry department, and see if they could recommend a doctor familiar with MAOIs.
> ...
> > If I were to get off stimulants then that would pull a plug off of everything and people would get mad at me for chosing the Nardil over the ADD medication, because they think I need it. Like my grandpa I told him the interaction of the two could be possibly dangerous, he keeps on asking me why do you have to be on that nardil stuff!! I want my nardil!! But I don't want to die either, im so confused, what should I do??????????
>
> Hi
> In all honesty, you are playing a very dangerous game. Neither of your current doctors would prescribe the Nardil or stimulant if they knew you were taking the other. This type of combination should only be prescribed by ONE doctor who understands both medications and their interactions. That doctor is probably an expert psychopharmacologist. Combining stimulants with Nardil is far too dangerous for a layman.
>
> Please stop the stimulant at once, until you can find a doctor who can prescribe the combination safely.
>
> I am a long term user of Nardil, 10+ years. I have mixed it with a lot of different medications. I've also almost died from interactions. You are playing with FIRE!
>
> I care,
> Jedi
>
Posted by Nadezda on October 17, 2008, at 16:46:44
In reply to Re: clarification, posted by Jnew12 on October 17, 2008, at 9:55:24
> ... My one doctor is ignorant to MAOI's I am not sure if he has treated a single patient in his life. ... . Without hesitation he said he would give me anything I wanted (he must know I am a bad case because I told him the laundry list of other meds I been on) So, I asked him for Nardil, Benzo's (Klonopin for the morning, and Xanax as needed like my other psych did) and either Focalin, or Daytranna patch for ADD.
>
> He asked me if I really wanted nardil, but did not try to get my to try something else like my other psych did. Of course I said yes, but told him I wanted parnate if this did not work and told him about the formulation and how it does not work as good, he looked at me crazy.
>
> Then, he took out his little book looked Nardil up and seen that has food restriction. He told me I needed a list so I could sign so if anything happened he would not get sued. I said I seen the list on the internet many time, but still he made me sign it as the list was right in front of me and I agreed to adhere w/ food restrictions, and if I did it was my problem.~~ And do you follow the food restrictions?
What other med interactions did this doctor tell you about?
This doctor, I hate to say it, sounds pretty irreponsible. If he would give you "anything" you wanted-- it has nothing to do with his idea about you, and everything to do with his commitment to practicing a certain kind of medicine. You need to be seen by someone who's familiar with Maois and has prescribed them before. What you don't want is a doctor who knows nothing about them, and gives you pretty much what you ask for, as long as you sign a statement saying he won't be sued.
This doctor, in other words, is worried about protecting himself, not you.
>
> Then he checked on the ADD medication, and so that no stims are allowed to be prescribed with Nardil.
>
> He saw that I had really bad ADD he made me do an evaluation before he found out nardil would clash with it, and I don't think he probally seen someone that bad..lol
>
> I told him that stims have been done before with someone as treatment resistant as me before, but I think him being new to prescribing this medication, all he had to go by is his little boook.
>
>...
> So what I did is I had to go to a DOC as an emergency because I hurt my knee. But while I was there I brought up I had ADD and took meds as a child, and my granadpa was there to tell him all the bad things I do. Again I think he knew how important it was for me to be on medication, and was happy to help me. Except he gave me Adderal instead of Daytrana and Focalin, because that what he said he likes to prescribe.
>
> I did not tell him about the Nardil because simply he did not ask,...~~ Actually, from what you say, you didn't tell him about the Nardil because you were afraid he wouldn't prescribe the stimulants.
>>
>
>
> I have been mixing Adderal 20mg XR for 5 days now without any negative side effect. Except yesterday I was falling in sleep alot in class, that might of been the klonopin I took before though.
>
> If I did not have my head hurt for this long don't you think I am passed the stage of death due to nardil+adderal. All the cases I have seen which was not alot the people died in the first day of taking it, and like I said this is my 5th day. If I do feel a headache I will stop taking immeditaly matter of fact is there a med I can take to stop it if it does happen, there are meds for hypertensive crisis right?
~~ Not, that's not right. If you feel a serious headache-- and/or your blood pressure elevates significantly and/or your heartbeat starts to be very fast,-- you should go to a hospital, ASAP. You are completely underestimating the seriousness of this. And your reasoning about five days etc, is incorrect. Even if you can tolerate a dose one two or three days, you may not be able to tolerate it on day six. It's not as if you started on a low dose of stimulant and slowly titrated up, under a doctor's supervision. You decided on a dose that you wanted-- and took it, and waited to see if anything went wrong.You don't know what might go wrong, how serious it could be, or what steps to take if a serious problem arises. This is not only self-medication, it's really risky behavior.
>
> So really, I am being monitored by both doctors, whether they both know what drugs I am taking or not. Even if did tell them don't you think there is anything they could do differently except give me less of each drug????~~ No you are NOT being monitored by anyone, since neither doctor has the slightest idea that you're taking both contraindicated drugs together. One has outright said he wouldn't prescribe both, and the other is simply unaware of what you're doing-- and yes-- they might give you less. That is precisely the point.
>
> And my Psychatrist he does not really know much about this class of drug, I am sure some people on this board knows more than he does, the med has been stopped being used since like the 60's!
~~That's why you need a pdoc who knows more about the Nardil, as others have suggested.
>
> And, I know the guy who gives me adderal is intelligent, he seems to care, instead of just throwing a med at me he is trying to involve other people.~~You know the involvement of other people, no matter how intelligent, who know nothing about these drugs is irrelevant, right ?
>
> >
> If I were to get off stimulants then that would pull a plug off of everything and people would get mad at me for chosing the Nardil over the ADD medication, because they think I need it. Like my grandpa I told him the interaction of the two could be possibly dangerous, he keeps on asking me why do you have to be on that nardil stuff!! I want my nardil!! But I don't want to die either, im so confused, what should I do??????????
~~I'm pretty sure you know what you should do. You don't want to do it. I understand that you want to take adderall. But that doesn't change the fact that what you're doing is risky, and that while you may be fine, you may not be. You say you don't care about taking the adderall-- it's just to get other people to stop bothering you. That doesn't stack up with your actions-- you wouldn't take these risks, including misleading a doctor, doing what another doctor explicitly told you not to do, etc, if you didn't have some reason of your own to take the adderall.What you should do is this: stop taking the adderall. Find a pdoc who knows about Maois. Explain to him your situation and your symptoms and follow his advice about what meds to take. This may not be what you want to hear, but it is definitely what you should do.
Nadezda
Posted by Jnew12 on October 17, 2008, at 19:31:13
In reply to Re: You are playing with FIRE!, posted by azalea on October 17, 2008, at 12:42:06
I agree that the doctors should know that I am on with medications. But,
What if I print a bunch of articles out, which have been provided to me here thats show that Stimulants and Maoi can be safe in all studies I have read that are involving a certain group of people and some studies even have a lot of participants. The only study that seems to be negative is the only one you are showin and that only involves a single person who had a reaction right away, not after 5 days.All others, and personal reports here I have read show safety and effectivness regarding mixing Maoi's and Stimulants.
What about this?
What if he gives it to me after showing him those papers and telling him about here? If that before reading the papers I print, he said no- just because he read it was bad in his book. What happens if because after what I read here on this this site and came to the conclusion it was safe, and instead of getting him to give it to me I had to get it from another doc who agreed that I indeed have ADD and needed ADD medication give it to me. What if he reads that same papers read the same papers, and came to the conclusion it may be safe, like I did, and gives it to me, than how would that be different than now, other than him now knowing that I was taking adderal?If he does agrees to give it to me after I show him the printed information all that will change is that he knows that I am on it, and that his book is wrong in some cases, and that some people like me can take it.
In both cases he knows nothing that will make it more safe, or effective, and both cases I am taking it.
Now he may not know that I am taking it, but I am not getting negative results that one would need to stop taking it, only positive.
So, how is this going to be different than now, if he lets me use this medications instead of me taking it on my own?
What I am trying to say is the only thing that will change is the opinion of whether it is safe to take, letting my psych know makes the combination and safers, either dos finding one who will give it to me in my eyes.
Hasn't it already been ruled that in some cases it is allright to take, or am I missing something?
In positive regards to my doctor, even though right now I disagree w/ his choice that adderal is not safe w/ nardil I do not think, like some have mentioned he is a bad doc for giving me everything I want. I don't think he would give me everything I want anways, he is not right now giving me adderal and nardil. He is just giving me Nardil and Benzo's which I asked for and he told me no problems, and considering what I have been through, and how much meds I have taken, and the severity of my condition I think that makes him a good doc for giving them to me. My other doc would never give me Nardil, never, even after trying 6 medicines that did not work because he was too afraid of trying it. And so what if he makes me sign something saying I won't sue him if something does happen, all doctors are worried with being sued, and with this med there is a chance even if slim something may go wrong, atleast he is better than my other psych and actually willing to give me a med that can save my life.
So I you say I am playing with fire, but if what I read here, and on goverment, and scientific jounals are true and you can mix the two, I would say it's hardly a a fire, And a fire that can save my live, other than take it. The bigger fire right now seems to having social anxiety along with bad ADD.
If I do continue with these medications, that if I do, I only plan to stay on a low dose of adderal, not not take more than 60mg of nardil, and I am being monitored by both doc regularly, more than most docs due-twice a week.
I also have been monitoring my blood pressure with a program that records it everydays with a monitor machine. Everything it recorded has said to be normal but I had one day that said prehypertension that was today when I measured it, it was 117 over 82, but still I think that is pretty normal.
I have had pulse has been higher than 100 never going over 120 even when I exercise, I don't know if that is normal or not but I think a high pulse is pretty normal if you are on stims, I did not have a reader but I know my pulse was high when I was taking ritalin, and mixing ritalin w/ exercise would produce a high pulse.
The only side effect is that is not normal before is that I get really hot, is there a way to tell if this is out of the normal?
I also eat all the right food that I am supposed too, have never taken a restriced food.. I even go as far to scrap the cheese off sandwhiches although other say that some of the restrictions go to far. I would say I am over cautious, or cautious enough I would never do nothing I ever read was not ok. I also stay away from all restricted medication (other than adderal, because I read other taking it) and I have never taken a restricted over the counter medication, or herb. I do not have a death wish.
This combination seems to be working perfect. And as I said I would hate to change it especially when nothing seems to point I am having a bad reaction. If I started to get hyperstension and or a headache I would go to a hospital as soon as I could.
Also like I said I have so much people tied up with my ADD med Adderal I even have my teacher filling out forms. She is happy that im on it too.
Everyone.
Do you know how hard it is to find a doctor to prescribe a MAOI?
Do you know how hard it can be to find a doctor to prescribe Adderal?
What about a MAOI and ADDERAL combined, I think I would having a better chance of hitting the lottery.
This board is the same boar who convinced me to taking it might be ok, this is the same place where I heard other member trying it, and now you are saying I am playing with fire, what about the rest here who tried it?
Arent they playing with fire too, or no just because there doctor is aware?
Like I said the combo of meds is working good for my social anxiety and ADD. To take away this combo would erase 10 years of trying to find the right combination and not being able to do so.
I will continue on taking it, I might stop BUT in the mean time I am going to show the Doctor the articles I got here, and also show him post by people who take the combination, if he does not agree. does anyone know a doctor in michigan willing prescribe both??
I guess if you guys think I am playing with fire too much, I will drop the Nardil, instead of the Adderal, even though it took so long to find someone willing to give it to me, and I am so happy that I got something that will actually work on Social Anxiety.I guess I continue to use Xanax/Klonopin for the Social Anxiety even though I wanted to cut down, so I don't get phsycially addicted again, but it's better than being dead.
Like, I said with the Adderal, without meds I have ADD so bad that I might flunk school if I dont get help. I have everyone wrapped up with my ADD meds, my parents, my grandparents, and teachers all filling out forms for me to give to my doctor. The teacher, and my grandparents are happy that I am taking this med because I guess my symptoms are irritating them, my teacher even told somebody.
If I quit Nardil I am giving up a pretty good psych, and I am going to probably get depressed, and have social anxiety again, which is going to be a problem for me.
If stop taking it because my psych wont give it to me, and I don't find a psych that will give it to me, continuing on with this improvment my chances are close to nill.
Posted by Phillipa on October 17, 2008, at 20:16:05
In reply to Re: You are playing with FIRE! - please reply, posted by Jnew12 on October 17, 2008, at 19:31:13
Seriously don't play with fire. Phillipa
Posted by Jnew12 on October 17, 2008, at 21:37:20
In reply to Re: You are playing with FIRE! - please reply » Jnew12, posted by Phillipa on October 17, 2008, at 20:16:05
Fine, as I have been doing some thinking, and all this measuring my blood pressure and worrying about a crisis is worrying me, it's bad enough I have to worry about food all the time, tommorow I am going to stop taking the Adderal, I was going to stop the Nardil, but I think that it is more important to me than the Adderal, I will miss the energy especially since that Nardil causes tirdness as a sideffect , but other than that it is more other people who liked the adderal, as they do not have to deal with my ADD which is annoying to them. I will tell my teacher to forget about filling out the paper for ADD meds as I am no longer wanting to be on the Adderal. That is going to be embarassing, especially since I told her I had ADD when I was taken away from people and questioned and pratically scolded because of my actions in class. She is going to think that I am not doing what other people want, and not caring about school. My grandparent are going to also not like my decsion because how how much I lose thig and accidentaly talk over not pay attnetion to other people. I try hard not to do this, but I guess I needed to be medicated because once I started the med they said I was doing much better. Also my depression was less.
Now that you guys got me scared, I hope I don't die in my sleep.
I guess in the long run its way harder to get someone prescribe you Nardil than a stimulant.
What if I gets bad and I show my psych the info on stimulants + MAOI and he does prescribe it.
Is this considered playing with fire still?
Boy, I enjoyed my short brush with fire!
Now if someone tells me I have to stop taking my buprenorphine and lyrica I am really going to go nuts!!
Posted by azalea on October 17, 2008, at 22:39:42
In reply to No Longer Playing with fire folks., posted by Jnew12 on October 17, 2008, at 21:37:20
Good decision to discontinue the Adderall.
As far as a psychiatrist in Michigan . . . if you are near UMich, a good place to start might be the UMich website:
http://www.psych.med.umich.edu/
To make an appointment, call: (734) 764-0231Alternatively, Michigan State has a psychiatry department.
http://www.psychiatry.msu.edu/clinic.html
Appointments can be made by contacting the Psychiatry Office at (517) 353-3070.> Fine, as I have been doing some thinking, and all this measuring my blood pressure and worrying about a crisis is worrying me, it's bad enough I have to worry about food all the time, tommorow I am going to stop taking the Adderal, I was going to stop the Nardil, but I think that it is more important to me than the Adderal, I will miss the energy especially since that Nardil causes tirdness as a sideffect , but other than that it is more other people who liked the adderal, as they do not have to deal with my ADD which is annoying to them. I will tell my teacher to forget about filling out the paper for ADD meds as I am no longer wanting to be on the Adderal. That is going to be embarassing, especially since I told her I had ADD when I was taken away from people and questioned and pratically scolded because of my actions in class. She is going to think that I am not doing what other people want, and not caring about school. My grandparent are going to also not like my decsion because how how much I lose thig and accidentaly talk over not pay attnetion to other people. I try hard not to do this, but I guess I needed to be medicated because once I started the med they said I was doing much better. Also my depression was less.
>
> Now that you guys got me scared, I hope I don't die in my sleep.
>
> I guess in the long run its way harder to get someone prescribe you Nardil than a stimulant.
>
> What if I gets bad and I show my psych the info on stimulants + MAOI and he does prescribe it.
>
> Is this considered playing with fire still?
>
> Boy, I enjoyed my short brush with fire!
> Now if someone tells me I have to stop taking my buprenorphine and lyrica I am really going to go nuts!!
Posted by azalea on October 17, 2008, at 23:02:07
In reply to No Longer Playing with fire folks., posted by Jnew12 on October 17, 2008, at 21:37:20
Michigan Psychiatric Society provides assistance in finding a psychiatrist in Michigan by phone or email during business hours. Please call 517-333-0838 or email mps@mpsonline.org
Posted by Jnew12 on October 18, 2008, at 9:32:42
In reply to pdocs in michigan » Jnew12, posted by azalea on October 17, 2008, at 23:02:07
yeah but do you really believe I will find one willing to prescribe a MAOI and a Stimulant...that is the you only read about in studies?? Do you know how hard it was to get a doc who would prescribe Nardil? I told my doctor who prescribes me buprenorphine that I wanted to take Nardil, and he couldn't believe the words that came out my mouth, he also told me that he himself would never prescribe it to me because of all the contradiction..I just hope it dont contradict with buprenorphine, because I have not told him I am on it yet because I have yet to see him since I got on Nardil, I am afraid he will take it away from me.
If my buprenorphine get taken away too, I am sorry nardil has got to go, or is it really that of a wonder drug?
Posted by Nadezda on October 18, 2008, at 10:39:27
In reply to Re: pdocs in michigan, posted by Jnew12 on October 18, 2008, at 9:32:42
In 1999, a study concluded that quite a few Michigan psychiatrists prescribed maois, although certainly not all.
Balon R, Mufti R, Arfken CL.
Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, UPC-Jefferson, Detroit, MI 48207, USA. rbalon@wayne.edu
OBJECTIVE: A survey examined prescribing practices for monoamine oxidase inhibitors (MAOIs) and explored reasons for the widely noted decline in their use. METHODS: A one-page questionnaire was sent in 1997 to 1,129 members of the Michigan Psychiatric Association. A total of 717 responses were received, for a response rate of 64 percent. Only data from the 573 psychiatrists who were currently practicing were used. RESULTS: Twelve percent of the respondents never prescribed MAOIs, 27 percent had not prescribed them for at least three years, and 17 percent had prescribed them from one to three years ago. Thirty percent of the respondents had prescribed an MAOI within the past three months, and 14 percent between three and 12 months ago. The most frequent reasons for not prescribing the drugs were side effects and interactions with other medications (46 percent), preference for other medications (30 percent), and dietary restrictions necessary for patients taking MAOIs (19 percent). Ninety-two percent of respondents believed that MAOIs were useful for atypical depression, 64 percent for major depression, 54 percent for melancholic depression, 56 percent for panic disorder, 44 percent for social phobia, 27 percent for dysthymia, 12 percent for obsessive-compulsive disorder, and 19 percent for posttraumatic stress disorder. However, only 2 percent said they would use MAOIs as their first-line treatment in atypical depression, and only 3 percent would use them a first-line treatment in social phobia. CONCLUSIONS: The results document the commonly held view that practicing psychiatrists believe MAOIs are efficacious but use them infrequently, primarily due to concerns about side effects and drug interactions.
~~~While 1999 is a bit in the past, I'd say Maois are having a comeback. Maybe I'm wrong, but if 44% had prescribed them within a year of the study, I find it hard to believe you couldn't find someone who would prescribe them now. I do think looking at University pdocs would give you a much better shot at finding people who would be knowledgeable
If you google articles, you should find pdocs who are doing research in this area-- who live in Michigan. They would be the best place to start.
You're making a really wise choice to stop the adderall for now. I hope you do go through with it. The right pdoc will help you control the ADD without subjecting you to the risks of taking things without his/her help.
Nadezda
Posted by jnew12 on October 18, 2008, at 11:39:38
In reply to Re: pdocs in michigan » Jnew12, posted by Nadezda on October 18, 2008, at 10:39:27
Wow I had no idea how much doctors actually prescribe this medication. My experience it was way easier to get benzo's or stimulants, and those are addicting, and I have addiction problems!
Maybe you right, maybe I could find a doc willing to prescribe a MAOI specially because I am on one, but a Maoi and a Stimulant?
I could show papers to my doc showing that other people prescribed the nardil and adderal together but, since he has know prior knowledge or history it so wouldnt that probably be a bad idea.
I don't know what to tell the doc that gave me adderal, I feel bad because I lied to him and told him I was on zoloft, and now he want's me to get a blood test, and I never told him I had hepatits C.. do you think it would be better to dump him?
And, also is the doctor who is prescribing me suboxone going to be upset the I am taking nardil along with suboxone?
He already told me he presonally would never prescribe it, but do you think he would be mad that I am taking, especially if they are contradicted.
My goal is to get rid of depression, and stay off drugs long enough so I can get treatment for Hepatits. The treatment is horrible and really grueling. They say the interferon makes a normal man deeply, deeply depressed.
With Nardil along with a depression/addiction medication I may be able to go through treatment now, I don't know last time the denied me saying my psychatric problems were to severe.
Posted by Phillipa on October 18, 2008, at 13:24:12
In reply to Re: You are playing with FIRE! - please reply, posted by Jnew12 on October 17, 2008, at 19:31:13
Didn't read last posts but please listen to Jedi as he is a true expert on combining Maoi's and all sorts of combos he knows his stuff. Listen to him and stop the add med now. Please? Phillipa
Posted by azalea on October 18, 2008, at 14:18:59
In reply to Re: pdocs in michigan(follow up hepatits and bupe), posted by jnew12 on October 18, 2008, at 11:39:38
Nardil is not recommended for people with liver disease. With hepatitis, Nardil may not be the best choice for you. Be sure to mention your hepatitis C when you get an appointment with a pdoc. There are other MAOIs that have a lower risk of liver problems.
> Wow I had no idea how much doctors actually prescribe this medication. My experience it was way easier to get benzo's or stimulants, and those are addicting, and I have addiction problems!
>
> Maybe you right, maybe I could find a doc willing to prescribe a MAOI specially because I am on one, but a Maoi and a Stimulant?
>
> I could show papers to my doc showing that other people prescribed the nardil and adderal together but, since he has know prior knowledge or history it so wouldnt that probably be a bad idea.
>
> I don't know what to tell the doc that gave me adderal, I feel bad because I lied to him and told him I was on zoloft, and now he want's me to get a blood test, and I never told him I had hepatits C.. do you think it would be better to dump him?
>
> And, also is the doctor who is prescribing me suboxone going to be upset the I am taking nardil along with suboxone?
>
> He already told me he presonally would never prescribe it, but do you think he would be mad that I am taking, especially if they are contradicted.
>
> My goal is to get rid of depression, and stay off drugs long enough so I can get treatment for Hepatits. The treatment is horrible and really grueling. They say the interferon makes a normal man deeply, deeply depressed.
>
> With Nardil along with a depression/addiction medication I may be able to go through treatment now, I don't know last time the denied me saying my psychatric problems were to severe.
Posted by jnew12 on October 18, 2008, at 14:57:13
In reply to Re: You are playing with FIRE! - please reply » Jnew12, posted by Phillipa on October 18, 2008, at 13:24:12
This is getting real crazy, I think a psychatrist when I found out I got hepatitis but would not be able to get on treatment recommeneded nardil to me.
I just don't want to go mentioning things I don't have to because I have had doctor look at me different when I told them I had hepatitis because I am sorry when your my age and you have it 95% cases are from drugs, and they automaticaly look at you like a junkie. I should be fine anyways, I am not going to have hepatits my whole life, I am on treatment so I can get treatment. I just got hepatitis a year ago, so it's not like I have any bad live disease going on no liver failure, or scarring it's 20 years down the road, im sure nardil can not be worse than tylenol or alcohol.
Posted by Sigismund on October 18, 2008, at 15:46:47
In reply to heaptitis: no matter what here im messin wit fire!, posted by jnew12 on October 18, 2008, at 14:57:13
Hepatitis C is very variable in its effects, perhaps depending on the genotype.
Posted by Geegee on October 18, 2008, at 17:51:47
In reply to heaptitis: no matter what here im messin wit fire!, posted by jnew12 on October 18, 2008, at 14:57:13
> I just don't want to go mentioning things I don't have toI can understand not wanting to be stigmatized, however, both parties in a treatment relationship have responsibilities to each other to ensure that treatment is safe, effective, and appropriate. Your doctor is responsible for communicating treatment options to you including potential benefits and risks so that you can make an informed decision. In addition, he or she needs to coordinate your care with your other health care providers, as that care is all going in one place so to speak--you. As the patient side of a treating relationship, you are responsible for accurately communicating your history and current conditions, as well as all of the prescription and non-prescription medications you are taking. In addition, a patient is responsible for informing all treating physicians about other physician treating relationships and plans, as what one doctor prescribes and plans for you can and often is affected by whatever else you are taking and what other conditions you have. It takes both sides of the treatment relationship upholding their responsibilities to the other for ethical adn appropriate treatment to occur.
I do not think you can expect positive outcomes without holding up your end of the bargain. If a doctor fails to hold up his or her responsibilities to you, even if you keep yours, wouldn't that be likely to affect the outcome negatively? It works both ways.
gg
Posted by Nadezda on October 18, 2008, at 20:12:20
In reply to heaptitis: no matter what here im messin wit fire!, posted by jnew12 on October 18, 2008, at 14:57:13
Seriously, Jnew, you have a lot of complicated issues and in order to protect yourself and to get the best treatment you can, you need to find a first rate psychiatrist and then be completely honest, and work with him.
We all think we can reason logically from the information we have about drugs, but the bottom line is we're not trained physicians. One thing physicians have that we don't is clinical experience, which means they know all kind of details and ins and outs of how meds and illnesses can affect one another.
Another thing they have is a much deeper knowledge of physiology and organic chemistry-- which gives them much better instincts about how various drugs are going to work in our bodies.
and third, the ones that are experienced in a particular field have studied it for years, and know in great depth all sorts of information that we, as laymen, even highly intelligent and well read laymen can't even guess at.
It really isn't just a matter of logic-- well, my hepatitis is being treated, so it can't be that bad. Well, you can't draw that conclusion. That's a speculation, not a fact. Or, well, nardil can't be worse than tylenol or alcohol. Possibly. Or possibly not. But those are both bad for your liver, potentially. Two things that are bad for your liver, don't make another thing good or safe for your liver. Etc
Really, if you put effort into looking for a good pdoc, you can start getting your life together. And, as Geegee says, you need to tell your doctor the whole picture. Otherwise he can't help you.
You say-- well, if I tell him, he won't do this or that. First of all, you can look a little further to see if you can find a reputable doctor who thinks these things are safe, or that he knows how to handle prescribing them. Or you know what? Maybe it just isn't safe or helpful to you to take those things together. No matter what you'd like to be good for you to take, if it isn't good for you to take, it isn't. In which case, your best strategy is to figure out what will work, and get onto it safely and as soon as possible.
Nardil may be fine. Or it may not. But you simply cannot afford to be getting it from a doctor who doesn't know anything about it. Seriously. With hepatitis C complicating the picture, you have to be especially careful.
Nadezda
Posted by azalea on October 18, 2008, at 21:00:29
In reply to Re: heaptitis: no matter what here im messin wit fire! » jnew12, posted by Nadezda on October 18, 2008, at 20:12:20
Well said Nadezda and Geegee! I agree.
> Seriously, Jnew, you have a lot of complicated issues and in order to protect yourself and to get the best treatment you can, you need to find a first rate psychiatrist and then be completely honest, and work with him.
>
> We all think we can reason logically from the information we have about drugs, but the bottom line is we're not trained physicians. One thing physicians have that we don't is clinical experience, which means they know all kind of details and ins and outs of how meds and illnesses can affect one another.
>
> Another thing they have is a much deeper knowledge of physiology and organic chemistry-- which gives them much better instincts about how various drugs are going to work in our bodies.
>
> and third, the ones that are experienced in a particular field have studied it for years, and know in great depth all sorts of information that we, as laymen, even highly intelligent and well read laymen can't even guess at.
>
> It really isn't just a matter of logic-- well, my hepatitis is being treated, so it can't be that bad. Well, you can't draw that conclusion. That's a speculation, not a fact. Or, well, nardil can't be worse than tylenol or alcohol. Possibly. Or possibly not. But those are both bad for your liver, potentially. Two things that are bad for your liver, don't make another thing good or safe for your liver. Etc
>
> Really, if you put effort into looking for a good pdoc, you can start getting your life together. And, as Geegee says, you need to tell your doctor the whole picture. Otherwise he can't help you.
>
> You say-- well, if I tell him, he won't do this or that. First of all, you can look a little further to see if you can find a reputable doctor who thinks these things are safe, or that he knows how to handle prescribing them. Or you know what? Maybe it just isn't safe or helpful to you to take those things together. No matter what you'd like to be good for you to take, if it isn't good for you to take, it isn't. In which case, your best strategy is to figure out what will work, and get onto it safely and as soon as possible.
>
> Nardil may be fine. Or it may not. But you simply cannot afford to be getting it from a doctor who doesn't know anything about it. Seriously. With hepatitis C complicating the picture, you have to be especially careful.
>
> Nadezda
Posted by Megz on October 24, 2008, at 21:27:55
In reply to Any MAOI + Methylphenidate, posted by JNew12 on October 16, 2008, at 10:55:30
I take 12 mg of Emsam (the MAOI patch) and 10-20 mg of Adderall 2-3 times a day. After trying just about every antidepressant (and many combinations), I've finally found something that works for me (depression, chronic fatigue syndrome and a slew of other diagnoses depending on the day/doc).
I have great trust and faith in my psychiatrist. While the MAOI alone provided much relief from my depression, it did not do enough to help my concentration problems. My doctor and I discussed at length the risks of adding a stimulant, including any symptoms to look out for and an action plan in case I developed any of them (ranging from sending him an e-mail to going to the ER, depending on severity). He has strictly supervised me while I've been on both drugs. For the first month and a half, I took my blood pressure twice a day (once before the Adderall and again an hour after taking it), e-mailed him my BP values once a week and came in every two weeks to double-check my BP and discuss any symptoms. After six months, I can report few side effects and great success.
The blood pressure is obviously a serious concern. When I took just Emsam, my blood pressure dropped from 120/80 to 110/70 (both considered normal). After adding the stimulant, I ranged from 120/75 (right before I'd take Adderall) to 125/75 (an hour later). After a few months, my blood pressure seemed to level off at about 120/75. I currently take my BP a couple of times a week and visit my doctor monthly.
I'm not saying MAOIs and stimulants are generally safe in combination. My doctor made it clear that there were risks involved, and I had to sign a release saying I'd been advised of the danger. However, we were both committed to carefully monitoring the situation so we could minimize the risks as much as possible. He even had me start with 5 mg of Adderall once a day (which does nothing for me) just to see what would happen the first week.
I don't know if the Emsam delivery method (being a patch) was a factor in the lack of problems I experienced. At my 12 mg dose, they recommend following all of the usual dietary restrictions (which aren't necessary at 6 mg). I've made no changes to my diet with Emsam, but I rarely consume foods with high tyramine content (pre-Emsam or now), so it wasn't much of an issue for me. I have reduced my coffee consumption to no more than two cups each morning, as any more than that elevates my heart rate and makes me anxious.
I'm sorry this is so long. A couple quick points:
- I was on Emsam for a year, starting at 6 mg and slowly working up to 12 mg, before adding the Adderall.
- I'd been on Adderall and Ritalin before the Emsam. We didn't try Ritalin this time because it had never worked as well for me.
- I don't know what effect an extended-release stimulant would have. My doctor thought it might have made my blood pressure more consistent - instead of the rise I experienced each time I took Adderall and the subsequent fall as it wore off. However, I'm kind of a wimp about taking pills, so I prefer the tablets to the XR capsules.I'm extremely lucky to have a psychiatrist who is committed to ensuring my safety while trying to find the best results. If we hadn't both been willing to invest the time and effort needed to monitor this, the risks would have been much higher.
Good luck.
Posted by azalea on October 24, 2008, at 21:55:48
In reply to Re: Any MAOI + Methylphenidate, posted by Megz on October 24, 2008, at 21:27:55
Thank you for sharing your experience. Your situation is an example of an informed patient and psychiatrist working together to achieve an optimal outcome.
> I take 12 mg of Emsam (the MAOI patch) and 10-20 mg of Adderall 2-3 times a day. After trying just about every antidepressant (and many combinations), I've finally found something that works for me (depression, chronic fatigue syndrome and a slew of other diagnoses depending on the day/doc).
>
> I have great trust and faith in my psychiatrist. While the MAOI alone provided much relief from my depression, it did not do enough to help my concentration problems. My doctor and I discussed at length the risks of adding a stimulant, including any symptoms to look out for and an action plan in case I developed any of them (ranging from sending him an e-mail to going to the ER, depending on severity). He has strictly supervised me while I've been on both drugs. For the first month and a half, I took my blood pressure twice a day (once before the Adderall and again an hour after taking it), e-mailed him my BP values once a week and came in every two weeks to double-check my BP and discuss any symptoms. After six months, I can report few side effects and great success.
>
> The blood pressure is obviously a serious concern. When I took just Emsam, my blood pressure dropped from 120/80 to 110/70 (both considered normal). After adding the stimulant, I ranged from 120/75 (right before I'd take Adderall) to 125/75 (an hour later). After a few months, my blood pressure seemed to level off at about 120/75. I currently take my BP a couple of times a week and visit my doctor monthly.
>
> I'm not saying MAOIs and stimulants are generally safe in combination. My doctor made it clear that there were risks involved, and I had to sign a release saying I'd been advised of the danger. However, we were both committed to carefully monitoring the situation so we could minimize the risks as much as possible. He even had me start with 5 mg of Adderall once a day (which does nothing for me) just to see what would happen the first week.
>
> I don't know if the Emsam delivery method (being a patch) was a factor in the lack of problems I experienced. At my 12 mg dose, they recommend following all of the usual dietary restrictions (which aren't necessary at 6 mg). I've made no changes to my diet with Emsam, but I rarely consume foods with high tyramine content (pre-Emsam or now), so it wasn't much of an issue for me. I have reduced my coffee consumption to no more than two cups each morning, as any more than that elevates my heart rate and makes me anxious.
>
> I'm sorry this is so long. A couple quick points:
> - I was on Emsam for a year, starting at 6 mg and slowly working up to 12 mg, before adding the Adderall.
> - I'd been on Adderall and Ritalin before the Emsam. We didn't try Ritalin this time because it had never worked as well for me.
> - I don't know what effect an extended-release stimulant would have. My doctor thought it might have made my blood pressure more consistent - instead of the rise I experienced each time I took Adderall and the subsequent fall as it wore off. However, I'm kind of a wimp about taking pills, so I prefer the tablets to the XR capsules.
>
> I'm extremely lucky to have a psychiatrist who is committed to ensuring my safety while trying to find the best results. If we hadn't both been willing to invest the time and effort needed to monitor this, the risks would have been much higher.
>
> Good luck.
Posted by JNew12 on October 27, 2008, at 2:39:21
In reply to hepatitis and Nardil » jnew12, posted by azalea on October 18, 2008, at 14:18:59
Hey, you three!
It's real late at night and I just wrote Phillipa a message, but the first part of it might as well be addressed, me to you three.
I want to thank you for calling me out and telling me how dangerous of a mix of nardil and adderall was. With pills I always took a stance like I was invincible, shoot I used to eat whole fentanyl patches. The mix I stopped once and I had a party w/ people I did not see in three years and wanted energy but had a very bad reaction, even though not a hypertensive crisis it easily could of happened I was going to save them, but now I am thinking I should flush them.
I always be fascinated with medicine, that is why this place interests me, but I don't think i truly respected pills, I thought I could do whatever I want, I can not count the time I played doctor. Matter of fact I used to Opiate addict maybe that why I never really learned to have a normal doctor patient relationship also because the trust was never there.
Shoot, I was happy if I came home with some scheduled, I probably knew of every drug to ask for that could potentate and make the other drugs stronger, and I did this mostly by lying. But, I am on suboxone now and through with addiction, and having to go from one doctor to another lying to maintain it (thank god).
Thanks for making me realize that there is responsibility on the patient too, I never really understood that. But, now I am suffering from major depression,social anxiety, and bad stomach problems. I could never understand why the most I could keep a doc was a month before. I am for the first time realizing that I need to tell my doctors everything including stuff I don't want to like addiction, and also tell each doctor about each doctor, and stop scoring the same meds from them each even if they are only xanax, or klonopins.
My main goals is not worrying about getting high anymore, but better.
I also realize I need to stop doing things because people have done it on the net and lived through it, i guess that me wanting to play doctor again.
I got four doctors now, the most I ever had and really want to feel well for once in my life, and I hope with my new attitude it will happen.
Thanks.
Posted by azalea on October 30, 2008, at 9:31:22
In reply to Jedi, Azalea, Nadezda, posted by JNew12 on October 27, 2008, at 2:39:21
Glad to hear you're on your way to getting better!
> Hey, you three!
>
> It's real late at night and I just wrote Phillipa a message, but the first part of it might as well be addressed, me to you three.
>
> I want to thank you for calling me out and telling me how dangerous of a mix of nardil and adderall was. With pills I always took a stance like I was invincible, shoot I used to eat whole fentanyl patches. The mix I stopped once and I had a party w/ people I did not see in three years and wanted energy but had a very bad reaction, even though not a hypertensive crisis it easily could of happened I was going to save them, but now I am thinking I should flush them.
>
> I always be fascinated with medicine, that is why this place interests me, but I don't think i truly respected pills, I thought I could do whatever I want, I can not count the time I played doctor. Matter of fact I used to Opiate addict maybe that why I never really learned to have a normal doctor patient relationship also because the trust was never there.
>
> Shoot, I was happy if I came home with some scheduled, I probably knew of every drug to ask for that could potentate and make the other drugs stronger, and I did this mostly by lying. But, I am on suboxone now and through with addiction, and having to go from one doctor to another lying to maintain it (thank god).
>
> Thanks for making me realize that there is responsibility on the patient too, I never really understood that. But, now I am suffering from major depression,social anxiety, and bad stomach problems. I could never understand why the most I could keep a doc was a month before. I am for the first time realizing that I need to tell my doctors everything including stuff I don't want to like addiction, and also tell each doctor about each doctor, and stop scoring the same meds from them each even if they are only xanax, or klonopins.
>
> My main goals is not worrying about getting high anymore, but better.
>
> I also realize I need to stop doing things because people have done it on the net and lived through it, i guess that me wanting to play doctor again.
>
> I got four doctors now, the most I ever had and really want to feel well for once in my life, and I hope with my new attitude it will happen.
>
> Thanks.
Posted by that_guy23 on November 18, 2008, at 8:54:50
In reply to Re: clarification, posted by Jnew12 on October 17, 2008, at 9:55:24
heres one article:
This is the end of the thread.
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