![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Vincent_QC on November 22, 2008, at 8:32:54
I'm new on this board. So I will explain my case...that's a big one...
To do a short medical history, I'm 32 yo and I do social phobia with agoraphobia, panic attack, generalised anxiety and depression since i'm 19yo. I also have to mention that I was a fat kid and I endup at 18 yo with a morbid obesity problem...All my problems come from my chilhood and my low self-esteem and my body perception "image".
I try everything, I mean all the SSRI's, SNRI's, remeron, wellbutrin, TCAs, anticonvulsive drugs(Lyrica, gabapentin, topomax and others to not mention all...) and of course all the newer antipsychotics like Zyprexa, seroquel, risperdal...All I get was always a BIG weight gain (60 pounds on paxil years and years ago) but no improvement of my anxiety or my social phobia or even depression.
What is unusual in my case is that I had a gastric by-pass in 2001 (not the one very popular in the USA),it work more with the malabsorbtion (fat especially), they by-pass the first part of the intestine, so now I don't ingest fat and some others things. I go from 445 pounds to 180 in less than 1 year. I stay at this weight for a couple of years but since the begining of 2007 and the re-introduction of antidepressants in my life, I begin to gain weight again.
So you can understand that now I fear to a gain more pounds since i'm now at 220 pounds (40 more than in 2006). That weight gain give me a lot of extra anxiety and I feel more bad than before. I fear to not be able to return to a normal weight like before (180 will be ok).
So now here the problem... My new psychiatrist put me on "Parnate"...20mg/day for the first 2-3 weeks and a possible increase after...
By experience, I know that regular diet will not be effective, since the by-pass already do a good job...It's why I want to do a proteine "diet". But proteine whey powder or white eggs proteine powder are not safe with an MAOI...I try to find all the informations about that on the internet, I ask also my doctor and a lot of pharmacists and nobodies seem to know if it's dangerous or not. Some people say that's ok, others say to avoid all proteine podwer... I'm now confuse a lot.
In the begining of 2007, I was put for the first time on a MAOI...It was my last ressort, since that's hard to find a good doctor (in canada) who will prescribe them now. I'm lucky, my familly doctor is very open minded. So I begin the Nardil and I increased my dosage until I reach the 90 mg goal. After 1 1/2 months, I had to stop because I had a very bad hypotension problem and trust me a very bad one. I was not able to climb stairs without having problems with my vision and vertigo...so I just drop out the Nardil...I don't had the chance to see if it was good for all my problems or not. They only thing I remember is that I had less social phobia problems issue but I also remember that I gained weight on it. At the time, I was also on a "high" dose of Rivotril (8 mg day)...I'm now just on a 15-20 mg of Valium...Since I had a bad experience switching from long acting benzo to shorts acting ones (Xanax, Ativan, Serax)...I ended up at the hospital last summer because of them. Now i'm stable at a low dose of Valium and I don't want to increase my dosage again.
After that experience, I try others kind of mix , cipralex with ritalin to get more energy, because the cipralex dry up all my energy...so we encounter a side effect with another pill to give more energy but it was a big mistake... I also try cipralex with wellbutrin, prozac and remeron at the same time...But I ending with no improvement at all. I was always tired with no energy, no motivation and also a lot of anxiety especially on the social side of my life who is now non-existent.
Last week (18 november 2008), I had an appointment with a new psychiatrist and a very good one. We do a list of what I try...and we had only 3 pills that I don't try...So he decide to put me on the "Parnate" at 20 mg/day. He say that it have a more activating profile (but I don't feel it after 5 days...)...
So I have a lot of questions about that drug: Is it has effective than Nardil for social phobia and anxiety? I gain 40 pounds on the cipralex, can I will be able to loose it on the Parnate or I will continue to gain weight? Do you think that a 30 mg/day goal is really effective or I will have to take more? Also, for all what I read about the Parnate on the internet, it seem to take less time do have a benefict effects, so should I will have to wait 2 months before I see if it works or not? I already lost too much time trying pills so I that normal that I want to see some improvements soon. I also begin a cognitive therapy next week (CTB) for anxious problems...It's a 20 weeks therapy, based on my own profil and problems.
My last question is already mentionned somewhere on this board but nobodies seem to know the real answer...
I read that it's dangerous to take proteine powder, is that true? I know everything about the dangerous effect of tyramine, I follow the diet very well, since it's not a big deal for me...but I ask a pharmacist about that, he say that he was not sure. I know that soy proteine are to avoid...but whey proteine??? We try to take a look on the nutritional facts of a couple of brands and we found that a lot of them have some tyrosine or things like that, who seems to be a danger if I use it with an MAOI...
In fact, no one seem to know if it's dangerous or not. My psychiatrist don't know either. So i'm confuse now...I really want to loose weight rapidly, since I can't do a regular diet because I try it last year and I don't loose weight (maybe because of the by-pass)...The only way is to do a strict proteine diet.
Last spring, after the "Zoloft" experience (2 months on that), I gain another 20 pounds, so I do a proteine diet and I go down from 230 to 175 pounds in 2 months. I Was really happy like that. At the end of August, my old psychiatrist put me on "cipralex" and in less than one montht, I gain more than 20 pounds, after 2 months I gain another 20 pounds...it's why now i'm at 220 and it's also the reason why I want to return to a normal weight...so the proteine diet is the only real option I have. Yeah, I can eat just fresh meat, but the powder option is more easy to follow. On the other side, I want also to really make a try with the Parnate. After 5 days on it, I seem to tolarate it very well, normally I just feel all the bad side effects after the first dose I take (cipralex was the worst of them). They only side effect I have for now is a little headache, but I do regular migraine so i'm use to it. I also have my own machine for blood pressure, so I can take it regulary to see if my headache come from food I eat (tyramine content) or just a regular migraine.
I know, it's a long post, with a lot of questions, but i'm confuse a little bit.
Someone here take proteine powder with MAOI without having a hypersensitive crisis???
I know I can do a "try", mean that I can take a spoon...wait a couple of hours, take my blood pressure and see what happen (it can take more than 12 hours to have a reaction to tyramine)...but at the same time, I don't want to end-up at the hospital again...
What can I do?...
All good comments or experience is weelcome ;-)
Thanks in advance!!!
Posted by CaptainAmerica1967 on November 22, 2008, at 10:31:23
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 8:32:54
I've suffered from treatment resistant depression or refractory depression with anxiety for over twenty years and have tried everything ever used for depression/anxiety including a course of 70 electroconvulsive "shock" therapy treatments at the age of 19 which was four years after my depression/anxiety started.
The MAOI's are the best treatment in my opinion both personally and professionally as a physician assistant. Nardil (phenelzine) stopped working for me after 15-20 years of use maybe because it was reformulated? I'm now looking to start Parnate (tranylcypromine).
In answer to your question about protein power; I've used many protein powder mixes for all of that time while on Nardil and never had a reaction. I'm a lactovegetarin/body-builder and my main source of protein has been protein powders. I expect no difference with Parnate even though Parnate is said to be slightly more potentially reactive with tyramine.
Regards
Posted by Phillipa on November 22, 2008, at 12:52:21
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by CaptainAmerica1967 on November 22, 2008, at 10:31:23
No experience and seriously so sorry for all your problems but wanted to welcome you to babble. Hope you receive a lot of replies. Good Luck. Phillipa
Posted by Vincent_QC on November 22, 2008, at 16:03:38
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by CaptainAmerica1967 on November 22, 2008, at 10:31:23
Big thanks to CaptainAmerica1967 and also for Phillipa...
Yeah, it's the same thing for me, nothing seem to work well for all my problems. The only drug who work a little bit at the begining was the Clonazepam aka Rivotril....but I become addicted very fast so my doctor had to increase my dosage every month or so...I switch from one to another benzo after, Xanax, ativan...name them...I notice that the more addictive benzo are the one with the shortness half-life and the one who act faster on your system (Xanax is the worst of them). I never had a relief of my anxiety with a benzo since my addiction with Rivotril back at the end of 2005. I change for the Valium because it's less potent than Rivotril, you take it and forget it because it's a long acting drug. I use it only to prevent withdrawl symptoms...because the Valium never have an anxiolytic effect on me. I will try to reduce my dosage soon, if the Parnate work...
I think benzo activate my depression mood also and since I take them I have a lot of cognitive problems...loose of memory, difficulty to speak and find my words, muscle spams...Anyway's...
I also read that "Parnate" is slightly more potentially reactive with tyramine than "Nardil" but I also read that Parnate is more a reversible MAOI than a irreversible like the Nardil...I'm wondering if Parnate act also on the gaba receptor like Nardil???
I never think about trying Manerix (Moclobemide), it was one of the 3 last options I had...My doctor say it's not very helpfull for social phobia and anxiety. It's a reversible MAOI of type A, but it seem to not work very well. My doctor say that the recommended dosage of 600 mg have to be augmented to more than 900 mg to be slighty effective but he also say that it's not more helpfull than a regular SSRI for social phobia and anxiety...and at 900 mg or 1200, you need to follow the exact tyramine free diet, so I don't see the advantage of taking it over the Parnate or Nardil...
I write in my first post that I just begin the Parnate 5 days ago and I had no side effects...Well it seem that since this afternoon I feel more anxious, so I don't know if it's the pills or just my imagination...maybe it's the "activiting" profile of Parnate that begin to show up?...I hope not...
For the proteine powder, I think the best idea will be to wait a little bit, maybe after 2 weeks or 3 weeks at 20 mg. I think it's a better idea to wait and to follow the strict diet to reduce my anxiety level and forget the fact that I can do an hypersensitive crisis... I will try my proteine powder after that period and take my blood pressure often to see...I will also ask my doctor to prescribe a kind of "Antidote" in case of a hypersensitive crisis...I told me that it was possible but I say not at first. I see him monday morning so I will ask for it( I don't remember the name of the drug, sorry...).
So thanks everyone for your advise, that's really appreciate!
Posted by desolationrower on November 22, 2008, at 17:18:41
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 16:03:38
I think generally people on parnate also need a benzo, compared to nardil, as it does not have effect on gaba as nardil does. of course some people only need the antidepressant to have an effect.
Really, i think you might consider nardil with a stimulant or tca added, as they can increase blood pressure and might make such a drug work for you.
As far as diet...Protein power is ok on an MAOI. I drink whey protein no problem. The one thing to keep in mind is that protein shakes, especially whey, as quite quick digesting, unlike casien or meat which digest slowly and keep insulin levels low. Convenience is important, might want to think about a different protein source. Also, hopefully you have had tests done to see if you can find the reason for wieght gain...a problem like thyroid could be at the root.
bonne chance
-d/r
Posted by Maxime on November 22, 2008, at 17:24:40
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 8:32:54
Hi there! Are you in Quebec? I noticed the QC after your user name.I live in Quebec myself.
I'm sorry that you are going through so much right now.
I don't think you will have a problem with the protein powder at all. I was on 110 mg of Parnate and used protein powder every morning in a home made smoothie and I never had a reaction. You really just have to worry about food sources that are fermented. I had two hypertensive experiences with Parnate - one with home made red wine and once from soy sauce that I ate by mistake.
Parnate doesn't work on the Gaba receptors like Nardil, but you could combine it with some clonazepam.
I also have a friend who has bad social anxiety and Parnate helped her so much. I hope it does the same for you.
Welcome to psycho babble!
Posted by Vincent_QC on November 22, 2008, at 17:26:35
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by CaptainAmerica1967 on November 22, 2008, at 10:31:23
I completly forget to talk about the "reformulation" of Nardil as well as the Parnate.
I ask severals doctors and pharmacists about that issue and the majority of them was not aware of the change in the formulation back in 2003. My new psychiatrist explain to me last week that they run out of stock in Canada back in 2003 but he was not aware of the new reforlumation...
Most of the people that I ask say that no difference was perceive in the efficacity of Nardil after the reformulation...But apparently, a lot of people seem to have the same problem and have to increase their dosage to reach the same effect reach with the old one...Also, at the same time, side effects seem to be more prominent with the new formulation, probably because of the augmentation of the dosage.
I know that they did the same with Parnate as well. So i'm not sure if it will be good for you or not to switch to Parnate over Nardil??? The coating hard-shell change to the soft one seem to be the main problem with parnate also.
I read the "new" Parnate facts sheet from the GSK compagny, the USA and the Canada formulations, both say that it's coating from a hard-shell made of wax and others inactive ingredients like that... But I look at my pills and it's not made with a hard shell. I cut one Parnate pill to see the difference and that's a soft sheel, mean that you have to swallow very fast the pill because it will disolve rapidly in your mouth. And i'm not talking about the bad taste...nothing compare to the New Nardil who taste like "old" red wine...Parnate taste is ok...
That's a lot frustrating to see that they do that change without notice even the doctors or the pharmacist.
I hope that i'm wrong with the parnate...I hope the change in the coat sheel will not change his effect...
Posted by Vincent_QC on November 22, 2008, at 17:36:04
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by desolationrower on November 22, 2008, at 17:18:41
Thanks ;-) Well, I will give a try for Parnate, if after 2 months I see no difference, maybe I will ask for the combo mix you said... Be back on the Nardil will not be a problem, but are you sure you can mix this with a TCA ( major gain weight on them generally) or a stimulant is a good idea??? And if I have to add a stimulant, witch one you recommend to me? I try the Ritalin and it was not very good, only about 1 hour of stimulation and after it's a pain in the *ss, you feel drained of all your energies...
6 months ago, I had a full check up of my blood and no thyroid problem was found, it was the target since my mom had a problem with that.
I just gain weight more fast than a normal person. One thing I notice also, every time i'm back on an antidepressant drug, I gain weight, but I also eat more, I smooke more cigarettes and I tend to drink more coffee...that's strange...
Posted by jedi on November 23, 2008, at 3:12:27
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 17:36:04
Hi Vincent_QC,
I've been on Nardil for most of the past eleven years. I augment it with 2mg of clonazepam for my social anxiety. The four times I've been off Nardil, my major depression has always returned. Congratulations on finding such a progressive doctor in Canada. I hear from others that it is pretty rare to find one who will prescribe an irreversible MAOI there. Good luck on getting a stimulant added to Parnate, though. I doubt if even the progressive doctors in Canada are going to go for that one. It can be done with an experienced psychopharmacologist leading the way.I know from experience that nortriptyline(major metabolite of amitriptyline, both TCAs) can be used safely with Nardil. At least by me. Some even suggest that tyramine reactions are more rare when a MAOI is combined with nortriptyline or other TCAs with little or no affect on serotonin(desipramine). I'm not going to test that one, however.
One of the 45+ medication trials I've been on is Parnate. I wanted to try it mainly because of weight gain from Nardil. Unfortunately, I had a rare spontaneous hypertensive event while on Parnate. My BP is borderline high 145/80 when not on a MAOI. Nardil actually helps me in that regard by lowering my BP by some 20 points to around 125/65. Keeps me off a beta blocker. Maybe with your hypotension the Parnate will work better for you.
In my opinion, you really need to go to the next level in your own knowledge when taking an irreversible MAOI. So many MDs and pharmacists, not to mention emergency medical technicians know so very little about the MAOIs. This is especially true in Canada where they prescribe more of the reversible MAOI moclobemide. I would really consider a braclet that says "Taking MAOI, Parnate - No meperidine". The usual brand name for meperidine in the US is Demerol. Meperidine can cause serotonin syndrome when combined with an irreversible MAOI. Almost all of the over the counter cold remedies are dangerous with irreversible MAOIs. Dextromethorphan can cause serotonin syndrome. Pseudoephedrine can cause a hypertensive crisis. I believe meperidine is the most dangerous. You can die from the combination. It is even more dangerous because it is often used as an emergency pain killer. If you are in an accident and not coherent or in shock, you may not be able to tell the EMT not to give you that shot of meperidine.
I've been able to take straight codeine, no problem, with Nardil. I was in British Columbia a few years ago and was buying some codeine for a cough, since you can't buy it over the counter in the US. I didn't have my reading glasses so I could not read the fine print on the label. Some of those labels, I swear you need a magnifying glass to read them anyway. So since I could not read the label, I asked the pharmacist if the medication was safe with Nardil. She assured me that it was perfectly safe. After a trip to the ER with a terrible headache and a huge spike in BP, I found out that the codeine was mixed with pseudoephedrine. If she didn't know of the danger, all she had to do was look it up on the computer to learn that the two meds should not be taken together. Anyway, now I only trust my own knowledge and research when eating any foods or taking any medication with Nardil.
I've been able to lose weight on a high protein diet and lots of exercise even while on Nardil. I once went from 310 pounds to 230 over a period of about nine months. The problem with high protein diets, is if you ever quit and go back to the carbohydrates, the weight comes back so fast it will make your head spin. As a general rule Parnate will not pack on the pounds like Nardil does.
Good luck and be well,
Jedi
> Thanks ;-) Well, I will give a try for Parnate, if after 2 months I see no difference, maybe I will ask for the combo mix you said... Be back on the Nardil will not be a problem, but are you sure you can mix this with a TCA ( major gain weight on them generally) or a stimulant is a good idea??? And if I have to add a stimulant, witch one you recommend to me? I try the Ritalin and it was not very good, only about 1 hour of stimulation and after it's a pain in the *ss, you feel drained of all your energies...
>
> 6 months ago, I had a full check up of my blood and no thyroid problem was found, it was the target since my mom had a problem with that.
>
> I just gain weight more fast than a normal person. One thing I notice also, every time i'm back on an antidepressant drug, I gain weight, but I also eat more, I smooke more cigarettes and I tend to drink more coffee...that's strange...
Posted by Mickapoo on November 23, 2008, at 5:49:21
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 8:32:54
> I read that it's dangerous to take proteine powder, is that true?
Vincent,
I am a fitness professional and I have at least 2 whey protein shakes per day. Never had a problem with them. I'm on Nardil 75 mg.
Posted by Mickapoo on November 23, 2008, at 6:03:21
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 8:32:54
They only side effect I have for now is a little headache, but I do regular migraine so i'm use to it.
Vincent,
I suffered from chronic tension headaches. Over the past 10 years or so was on Elavil (Amitryptiline) for prevention. It did work on reducing them, but still probably 10% of the time wasn't effective. However, my dr was telling me when he put me on Nardil that MAOIs can be used as a headache preventative. You can search migraine prophylaxis MAOI on Google and you will find information to back this up. Anyway, I went from having almost daily headaches to none at all. It's completely changed my life! So, this may be a "positive" side effect!From Wikipedia, for example (there are lots of other sources though):
"MAO inhibitors can also be used in providing an alternative for migraine prophylaxis."
Posted by Vincent_QC on November 23, 2008, at 9:24:03
In reply to Re: Parnate VS Nardil + Anxiety and social phobia » Vincent_QC, posted by Maxime on November 22, 2008, at 17:24:40
Hi Maxime!
Yeah, i'm from Quebec city. I'm happy to hear that i'm not alone in the same boat and thanks for your answer about the proteine powder!!! I appreciate it a lot!Well, since yesterday, I feel really strange. I do several panic attacks, I feel tired but at the same time I can't sleep...and i'm just at 20 mg of Parnate, I can't imagine being at 110 mg!!!
I see my psychiatrist tomorrow and I think we will give to the Nardil another try, since it's less activating than the Parnate. The hypotension problem appear only at 90 mg/day so I will ask to begin at 45 mg for a couple of weeks and see if we can up the dosage a little bit, maybe 60-75 mg /day...Do you think it will be effective at just only 75 mg???
Did you have a family doctor in Quebec city or a psychiatrist? I don'T know if you know that place, but i'm going to "Roy-Rousseau" hospital, near "Robert-Giffard" hospital in Beauport...i'm going there since more than 1 year, my familly doctor switch me there because he wanted me to get a "CTB therapy for anxious problems" and the one they give there is one of the best...I had to wait more than 8 months before I get a phone call from them and another 4 months before I got an appointment with my psychiatrist.
The first psychiatrist I had back in October 2007 was not very good...He put me on prozac, the only one SSRI I never try before and I had a very bad experience. The first month I was only at 10 mg, it was ok, after he put me on 20 mg and I begin to feel very overstress but after a couple of weeks I was ok...but no improve at all for my social phobia or anxious problem. He increase the dose at 30 mg and I had a teribble reaction and I had to stop everything cold turkey. I think I was becoming crazy on that drug. I don't gain weight on it but it was insane, tired as hell but at the same time very anxious and overstress with a lot of panic attacks. He change my pills for the Zoloft. I take it a couple of years ago but I never had any improve on it. We decide to give it another try. I reach the highest dosage you can have on it and I feel nothing at all, no augmentation of my anxiety and no improve on my social phobia, in fact I was worst than before. I was not able to get out of the house alone and like I say before, I gain a lot of weight on it. So in the spring of 2008, I stop it cold turkey also. After he put me on Effexor- xr...I take it also a couple of years ago. I increase my dose up to 300 mg/day, divided in 1 -75 mg in the morning, 1 at noon, 1 in the middle of the afternoon and one at night...because of my gastric by-pass and the fact it is a XR drug, I think my body never get the chance to absorbe all the drugs...so it why it never work...I also gain weight on it and I also increase a lot my anxiolytic intake at the same time...too much activating for me and no improve at all after 2 months...
So I ended up at the hospital in the middle of July, I was totally addicted to Xanax pills. I had to take more than 8 mg a day of it, it's the double maximum dosage recommended. I think I reach the 12 mg/day at the end and I blend it often with "Clonazepam" also...since I had 2 bottles of them that I never use because I was switch from Clonazepam to Diazepam back in the summer of 2007...and I keep the Clonazepam pills just in case... At the hospital it was a total mess, I was at the psychiatrict departement at "L'enfant-Jesus" hospital...I wait there 3 days to be transfert to "Roy-Rousseau" hospital...All of this juste to make a drug rehabilitation with medical supervision...After 3 days, I sign a paper to leave the hospital, It was too much for me, being in the same room than others people who talked alone and things like that...it was one of the worst moment I live in my life...So I do my own drug reduction at home. I return to see my family doctor, he put me back on Valium, and I return to a normal intake of it alone, from 12 mg of Xanax to 20 mg of valium. It take 2 months to recover from it...I was not able to talk, I had a lot of muscle spams, I was totally lost, always very anxious to the point I was doing panic attacks 4 -5 times a day. But I reach my goal alone...It was hard but I do it.
The psychiatrist decide to try the "Cipralex" after...it was at the end of august. I was on 20mg for more than 2 months, I had a lot of side effects, migraine, a lot tired, always in the foog, another time no improve at all, just bad side effects and another weight gain. He add the Ritalin for more energy and less appetite...but It was not a good idea and not very effective also...He add Wellbutrin on that also and it was not effective at all...so I stop it cold turkey at the end of october...Note that this psychiatrist never prescribe a MAOI...he was against them in fact...telling me that if it was a new drug, it will never pass all the FDA or the Helth Canada exams...because it was too much dangerous...
My psychiatrist quit his job so I had an appointment last week with a new one... And thanks god , he seem to be very open minded with the old drugs like Nardil or Parnate...He said that he have a lot of patients on them. So i'm happy about that...He is also not very fast on the prescription paper...so he never increase the dosage fast. He like it when it's slow and I like it also...
So that's my complete story, at least the last year...
Tomorrow morning, I will ask him to change for the Nardil again, since it seem to be more good for social phobia, even if the new formulation is less effective than the old one... Last time I don't have the time to see all the benefict effects of the Nardil because I had too much hypotension, but like my new psychiatrist say, probably it was just because I increase my dosage too fast...He said that if I was put back on 75 mg or 60 mg , the hypotension problem will have probably diseapear....He say that with MAOI, it's a slow process...I think it's a best idea to take my time, do my therapy that begin this week also, and see what happen. I prefer to have to wait 3 months before I see some improvements than to drop out another time the drug because I just want to recover more fast!!! I have to learn my lesson now and accept the fact that It will take time...
At the same time, I don't want to stay in the same position for another year...I was leaving in Mtl between 2005 and 2007 for the school, I do 2 years at the UQAM university and I want to finish the last one... I had to return in Quebec city because at the end I was not able to going out of my appartement or to go to my class...
Well I write too much bla bla for nothing...
Posted by JadeKelly on November 24, 2008, at 1:19:55
In reply to Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 22, 2008, at 8:32:54
Hi Vincent,
Can only speak to effects of Parnate, I have not taken Nardil. I will say tho, I made my decision based on the evidence that points to wieght gain, sadation, but a better anxiety/social anxiety profile for Nardil.
Being depressed and lethargic (no anxiety) Parnate was a better fit for me. Parnate is known to be more stimulating (not sure what effect that would have on your anxiety), and good for Major depression. I believe BOTH Nardil and Parnate hit major depression. Parnate is also known for weight loss. While I did not need to lose, I WAS afraid of wieght gain on Nardil. I have now lost too much wieght on Parnate, and have to remember and force myself to eat. I've been on Parnate for 4 weeks and have lost around 12-15 lbs minimum. It would be more if I wasn't careful.
So, I'd say you have to look at the pros and cons. If your wieght is what causes your anxiety, I think Parnate is definately worth looking at.
One last, I was told protien shakes with soy are out, as are any protien shakes with tyromine/tyrosine. I was looking at an (old?) post where the guy's girlfriend made him a shake and he ended up at the hospital. Sounds like we both know how much fun that can be.
Good Luck!
~Jade
Posted by desolationrower on November 24, 2008, at 1:44:07
In reply to Re: Parnate VS Nardil + Anxiety and social phobia » Vincent_QC, posted by JadeKelly on November 24, 2008, at 1:19:55
argh, PROTEIN POWDER IS FINE.
It has tyrosine in it. Tyrosine is NOT tyramine. Tyrosine is a common amino acid. Tyramine is what causes hypertensive crises. It occurs in fermented foods. Whey or egg or whatever is not a fermented food. And don't eat soy protein, it tastes like plaster of paris.
-d/r
Posted by Vincent_QC on November 24, 2008, at 6:26:13
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by desolationrower on November 22, 2008, at 17:18:41
I just wanted to say thanks for everyone who answer to my questions, I really appreciate that ;-)
I'm going to my appointment this morning. What I can say is that Parnate make me feel so much anxious and nervous, to the point that I can't sleep and I do several panic attacks. I understand why they generally give it with an anxiolytic for anxious people and also why it work more well on depressive people with a lack of energy. In that respect, I don't belong to that group, mean that I'm a little bit depress but not because i'm a depressive person but because i'm tired of having social phobia that's paralyse my life since all that years.
I think the best idea will be to ask for Nardil, at least give it another try, but at a more low dosage than the one I had before (90 mg). Maybe I will avoid the hypotension orthostatic problem I had with it back in 2007.
I'm also happy to see that I will be able to do a "proteine" diet on Nardil, since my weight is a big part of my social phobia and anxious problems. Being more fat make me feel worst. I hate my body image, so I stop going outside of the house because I fear the judgment of the other, at the same time I feel guilty because I eat more and I gain weight, so my anxiety level is more high because I put a lot of pressure on my minds about the fact that I have to lost weight...You see, it's a big circle that never endind...Since some people write that Nardil generally cause weight gain, I know that I will have no choice to be back on a strict diet. I also know that after the diet with proteine shake, I will have to go slow on food, avoid all sugars and things like that since it's very easy to regain the weight very fast after. I do more than 6 times a strict diet like this before and I always return to the same weight a couple of months after, adding at the same time extra pounds. They only thing I will have to check often is my blood pressure, since a 600 calories diet is very strict, and Nardil lower the blood pressure, I will have to take salt more often during the day to be sure my blood pressure will not be to low and avoid at the same time hypotension generally present when you do a proteine diet...
Nardil increase gaba, so I will ask for it, since I have a problem with benzo abuse in the past, I don't want to increase my intake of valiums for now.
I just take 5 days of Parnate at 10-20mg day and I already see an augmentation of my intake of valiums, so I can't imagine going on a highest dose of Parnate for now. I also react really fast to all "antidepressants" drug, and most of the time, if I feel bad side effects on them at day 1, the side effect never fade away, even if I wait 2 months. So asking to switch from Parnate to Nardil after 1 week will not be a big issue I think. I hope my psychiatrist will understand why I give up so fast on Parnate and why I want Nardil now...
For the person who write that in Canada they give more Reversible MAOI like Manerix, I want to say that's true!!! Yeah, they are more safer than irreversible MAOI but the are less effective also. For depression, i'm sure it work well, but for social phobia and anxiety??? not sure...A lot of studies show a same rate of remission with Manerix than the one reach with regular SSRI's or SRNI's for anxiety and social phobia...and a higest remission rate with Nardil compare to Manerix.
I'm not interrested to loose my time again on something who will not work on me. I already loose too much time like this, it's time to give another try to Nardil, even if it take more than 2 months before I see some positive results, I will not give up this time. Going on a slow increase of the dosage will be a better idea than increase the dose to 90 mg/day in less than 4 weeks and having severe hypotension.
At the same time, someone here know if a 75 mg/day is an effective dose to treat social phobia with Nardil, or I will have to increase it to 90 mg/day? I know I ask the question yesterday...but I just want to be sure to make it right this time.
So again thanks everyone ;-) I will post an update about my situation soon.
Posted by Mickapoo on November 24, 2008, at 12:33:30
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by Vincent_QC on November 24, 2008, at 6:26:13
>At the same time, someone here know if a 75 mg/day is an effective dose to treat social phobia with Nardil, or I will have to increase it to 90 mg/day?
>Vincent,
My guess is that it really depends on the individual. I have heard of many receiving a positive effect from Nardil at 75 mg, but I've been on 75 mg for 12 weeks now and it hasn't helped my social phobia at all.Mickapoo
Posted by JadeKelly on November 24, 2008, at 12:33:42
In reply to Protein powder=OK, posted by desolationrower on November 24, 2008, at 1:44:07
> argh, PROTEIN POWDER IS FINE.
Why the "argh"?
I just re-checked the protien powder we have. Whey protein powder (at least some) have soybean in them.
Many protien powders get their protien from Soy.
We are not allowed to have soy with MAOI's.
>
Therefore, many protien powders are NOT fine. Maybe some are.It has tyrosine in it. Tyrosine is NOT tyramine. Tyrosine is a common amino acid. Tyramine is what causes hypertensive crises.
If I was misinformed here, I'm sorry. I thought from PDoc that Tyramine AND tyrosine were off limits when listed in ingredients.
It occurs in fermented foods. Whey or egg or whatever is not a fermented food. And don't eat soy protein, it tastes like plaster of paris.
>
> -d/r~Jade
Posted by Mickapoo on November 24, 2008, at 14:50:59
In reply to Re: Protein powder=OK, posted by JadeKelly on November 24, 2008, at 12:33:42
> > argh, PROTEIN POWDER IS FINE.
>
> Why the "argh"?
>
> I just re-checked the protien powder we have. Whey protein powder (at least some) have soybean in them.
>
> Many protien powders get their protien from Soy.
>
> We are not allowed to have soy with MAOI's.
> >
> Therefore, many protien powders are NOT fine. Maybe some are.
>
> It has tyrosine in it. Tyrosine is NOT tyramine. Tyrosine is a common amino acid. Tyramine is what causes hypertensive crises.
>
> If I was misinformed here, I'm sorry. I thought from PDoc that Tyramine AND tyrosine were off limits when listed in ingredients.
>
>
> It occurs in fermented foods. Whey or egg or whatever is not a fermented food. And don't eat soy protein, it tastes like plaster of paris.
> >
> > -d/r
>
> ~Jade
>
>Where did you read that any type of soy is off limits? I've only read to avoid soy sauce and I believe soy beans, but not plain soy. My protein powder has soy in it and I've never had a problem. I believe I posted here before about it and someone said it's "soy sauce" to be avoided, not absolutely all products containing soy.
Posted by desolationrower on November 24, 2008, at 17:02:18
In reply to Re: Protein powder=OK, posted by JadeKelly on November 24, 2008, at 12:33:42
> > argh, PROTEIN POWDER IS FINE.
>
> Why the "argh"?Ha, i just feel like i've been saying this a bunch and noone is listening. I just don't want bad info to sit here that someone might come across in the future.
> I just re-checked the protien powder we have. Whey protein powder (at least some) have soybean in them.
>
> Many protien powders get their protien from Soy.
>
> We are not allowed to have soy with MAOI's.
> >
> Therefore, many protien powders are NOT fine. Maybe some are.I'm not sure why whey would have soy in it, unless its a blended protein.
At any rate, the soy that is disallowed is fermented soy: soy sauce, black beans, miso soups, etc. Fresh soya is not a problem. It is when it sits and is fermented by bacteria, the tyrosine is decarboxylated into tyramine. The key thing is bacteria & time.
> If I was misinformed here, I'm sorry. I thought from PDoc that Tyramine AND tyrosine were off limits when listed in ingredients.
Tyrosine if a common amino acid. It is is meat, milk, etc. It is not a problem. In fact it is synthesized in the body if needed. It is used for many things, including production of thyroid hormones.
Now, i still don't recommend soya, as i think there are some outstanding issues wrt its affect on hormones, that I haven't looking into fully; it might be beneficial, or negative. Whey has health benefits, and it doesn't taste like ick. But i i don't think it is a problem with MAOI.
-d/r
Posted by JadeKelly on November 24, 2008, at 19:05:39
In reply to Re: Protein powder=OK, posted by desolationrower on November 24, 2008, at 17:02:18
> > > argh, PROTEIN POWDER IS FINE.
> >
> > Why the "argh"?
>
> Ha, i just feel like i've been saying this a bunch and noone is listening. I just don't want bad info to sit here that someone might come across in the future.
>
> > I just re-checked the protien powder we have. Whey protein powder (at least some) have soybean in them.
> >
> > Many protien powders get their protien from Soy.
> >
> > We are not allowed to have soy with MAOI's.
> > >
> > Therefore, many protien powders are NOT fine. Maybe some are.
>
> I'm not sure why whey would have soy in it, unless its a blended protein.
>
> At any rate, the soy that is disallowed is fermented soy: soy sauce, black beans, miso soups, etc. Fresh soya is not a problem. It is when it sits and is fermented by bacteria, the tyrosine is decarboxylated into tyramine. The key thing is bacteria & time.
>
> > If I was misinformed here, I'm sorry. I thought from PDoc that Tyramine AND tyrosine were off limits when listed in ingredients.
>
> Tyrosine if a common amino acid. It is is meat, milk, etc. It is not a problem. In fact it is synthesized in the body if needed. It is used for many things, including production of thyroid hormones.
>
> Now, i still don't recommend soya, as i think there are some outstanding issues wrt its affect on hormones, that I haven't looking into fully; it might be beneficial, or negative. Whey has health benefits, and it doesn't taste like ick. But i i don't think it is a problem with MAOI.
>
>
> -d/rd/r,
I understand your frustration, I'm new, what do I know. Well one, you may have seen on the board I had a hypertensive crisis that was either spontanious (pretty rare) or I missed something, 11 days into Parnate. You guys have taught me to be able to back up what I say. I looked up a sight that is actually on the board, the new food list I believe, it says specifically no tyrosine. I believe they mean listed in the ingredients.
They specifically say no Soy, and in another section they say no fermented soy.
My point is, practically speaking, I'm sure you are right, you know tons more than I do. But please know I don't just post things I think might be true. I'll ask my PDoc when I see him. You see it as "bad" info. I geuss I'd rather err on the side of caution for now.
Btw-I didn't have time to read all posts earlier so missed your shake comments. I would NEVER knowingly cross your opinion....yet.
Don't worry, I'll catch up. This is my first depression.
~Jade
Posted by desolationrower on November 24, 2008, at 20:25:55
In reply to Re: Protein powder=OK » desolationrower, posted by JadeKelly on November 24, 2008, at 19:05:39
> d/r,
>
> I understand your frustration, I'm new, what do I know. Well one, you may have seen on the board I had a hypertensive crisis that was either spontanious (pretty rare) or I missed something, 11 days into Parnate. You guys have taught me to be able to back up what I say. I looked up a sight that is actually on the board, the new food list I believe, it says specifically no tyrosine. I believe they mean listed in the ingredients.
>
> They specifically say no Soy, and in another section they say no fermented soy.
>
> My point is, practically speaking, I'm sure you are right, you know tons more than I do. But please know I don't just post things I think might be true. I'll ask my PDoc when I see him. You see it as "bad" info. I geuss I'd rather err on the side of caution for now.
>
> Btw-I didn't have time to read all posts earlier so missed your shake comments. I would NEVER knowingly cross your opinion....yet.
>
> Don't worry, I'll catch up. This is my first depression.
>
> ~Jade
>
>Well hey i'm sure i've been wrong before too. It good you're trying to help people out.
-d/r
Posted by JadeKelly on November 25, 2008, at 0:04:08
In reply to Re: Protein powder=OK » JadeKelly, posted by Mickapoo on November 24, 2008, at 14:50:59
I've not only read it many places, my PDoc told me no Soy. Soy milk is ok on the new list I believe, so some exceptions I geuss. I read an old pst about a guy, his girlfriend made him a strawberry soy protien shake for breakfast and he had a hypertensive crisis. Bulldog posted a list, its currently on the board with link. New diet I believe. If its not there I'll be happy to find it lots of other places. I'd love it if they're ok. I'm just afraid of htc.
~Jade
Posted by amee200 on December 28, 2008, at 22:33:28
In reply to Re: Parnate VS Nardil + Anxiety and social phobia » Vincent_QC, posted by Mickapoo on November 24, 2008, at 12:33:30
Hi
I am on Nardil now 60 mg and took Parnate from 1990-1996 at 30 mg. The Parnate definitely is activating and does make you more social and confident. As I have social anxiety and a tendency to avoid people, that was a good thing for me. But, it does exacerbate anxiety in people who suffer from it (like I do as well) so that was a downside. It also caused me to lose too much weight.
The Nardil is great for anxiety and does help with social anxiety as well, but the weight gain is a challenge. Both Parnate and NArdil cause extreme insomnia. I think both can work for helping those with SA, but if you have obsessive worrying as part of it and a lot of anxiety, Nardil is probably the better choice. Weight can be controlled, it just takes huge effort (just like the SSRI's, which I've also been on). Hope this helps.
Posted by Vincent_QC on December 29, 2008, at 10:56:15
In reply to Re: Parnate VS Nardil + Anxiety and social phobia, posted by amee200 on December 28, 2008, at 22:33:28
> Hi
>
> I am on Nardil now 60 mg and took Parnate from 1990-1996 at 30 mg. The Parnate definitely is activating and does make you more social and confident. As I have social anxiety and a tendency to avoid people, that was a good thing for me. But, it does exacerbate anxiety in people who suffer from it (like I do as well) so that was a downside. It also caused me to lose too much weight.
>
> The Nardil is great for anxiety and does help with social anxiety as well, but the weight gain is a challenge. Both Parnate and NArdil cause extreme insomnia. I think both can work for helping those with SA, but if you have obsessive worrying as part of it and a lot of anxiety, Nardil is probably the better choice. Weight can be controlled, it just takes huge effort (just like the SSRI's, which I've also been on). Hope this helps.""Hi Mickapoo,
I just post a new topic and it's something I write in it...I found the Parnate to be more effective for my social phobia, more than the Nardil in fact, but at the same time, it's worse for the general anxiety and panic disorder.For the weight lose, it will be a good thing on me, in fact I notice that I gain weight for now, not losing weight...I always gain weight on all the AD's I take. All the drugs who act on SE do this effect on me. Only Stimulants (Ritalin or Ponderall, before it was withdrawh from the market in 1997) make me loose some weight.
I'm now at 30mg of Parnate, wanted to be at 40mg yesterday but it was a mistake, I have to take more time between each increase step I think.
Nardil for me was not good for SA, apart from the hypotension and the lack of energy, I feel nothing on it. I only succed to reduce my amount of Rivotril I was taking at the time but that's it...and if I succeed to reduce it, it's probably because at the end, I was always inside my appartement, so no contact with the world outside really...and I was always in my bed...tired as hell... But I was not leaving the same life that I live now, so I don't know if it will be the same if I try it now??? I was a lot more overstress back then, leaving in another city, with no family near me, no friends...
Now that I move back to my home town, i'm in a more familiar city with some friends amd my family around me, I feel less alone and that's more easy to cope with life stress...At least, I know that I will not lack foods or things like that and it's a big plus and I have a minimum social life...I do a lot of efforts to go out each night, even just to take a coffee with my best friend, or just go shopping, things like that. Basic activities...
What I can say for now is that I found the Parnate more effective for SA...but it's just for me...It's seem to be less effective in SA for the others people. Nardil is the gold standard for SA, with it's gaba-b effect...Parnate seem to lack the gaba-b effect of Nardil...maybe it's why it's more stimulating than Nardil...but I prefer to be a little bit more stimulate than too much tired. At least I can move a little bit more and stay awake at daytime...
I think both drugs have there advantages and disadvantages. Since we are all differents, we don't react the same on drugs.
Insomnia is not a problem for me, I was already like this before I start the Parnate or the Nardil back in 2007. I suffer from insomnia since a lot of years...I think the fact that I wotked at night time for 10 years make me loosing my natural sleep cycle and I never succeed to return to this normal sleep cycle. I was used to work Saturday night until 2 AM, return home, take a shower, sleep 2 hours and return to work from 7AM to 4PM...it was my normal schedule for weekend work, at week I was working always at night (3:30PM to 12 or 2 AM...), I had differents hours each time, I do a lot of overtimes...
Well, I wish you a good luck with the Nardil...and thanks for your answer ;-) I hope that everything is fine for you now!!!
Have a nice day!
Vincent ;-)
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.