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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by sowhysosad on April 10, 2009, at 16:12:14
Just pondering what med might dent my depression once again...
I'm contemplating MAOIs again, and was wondering:
Does anyone have experience of both tricyclics and MAOIs? Did you react badly to the norepinephrine boost from the tricyclic, with that characteristic sense of dread and heightened startle response?
If so, did you experience the same effects on an MAOI? Or did the serotonin and GABA boost level things out?
Posted by shasling on April 10, 2009, at 20:16:34
In reply to Increased anxiety on MAOI?, posted by sowhysosad on April 10, 2009, at 16:12:14
> Just pondering what med might dent my depression once again...
>
> I'm contemplating MAOIs again, and was wondering:
>
> Does anyone have experience of both tricyclics and MAOIs? Did you react badly to the norepinephrine boost from the tricyclic, with that characteristic sense of dread and heightened startle response?
>
> If so, did you experience the same effects on an MAOI? Or did the serotonin and GABA boost level things out?Maois can have some initial anxiety,but its kinda a good kinf,at least on parnate,one good thing however is benzos usualy treat overstimulation of maois quite effectly,usualy klonopin or xanax.
Posted by sowhysosad on April 10, 2009, at 21:35:37
In reply to Re: Increased anxiety on MAOI?, posted by shasling on April 10, 2009, at 20:16:34
Thanks shasling. Nardil is less stimulating than Parnate, I hear. I've read a theory in another thread that Nardil has less of an effect on norepinephrine and dopamine than Parnate, which might explain the difference (based on the ratio of MAO-A to MAO-B inhibition you'd guess).
Long-term benzos isn't an option in the UK as they just won't prescribe them for any length of time, but they might consider a couple of weeks' worth to help deal with startup anxiety.
I wonder how easy it is to convince a UK pdoc to prescribe an MAOI? Any posters in the UK who've used one?> Maois can have some initial anxiety,but its kinda a good kinf,at least on parnate,one good thing however is benzos usualy treat overstimulation of maois quite effectly,usualy klonopin or xanax.
Posted by SLS on April 11, 2009, at 6:50:18
In reply to Increased anxiety on MAOI?, posted by sowhysosad on April 10, 2009, at 16:12:14
> Just pondering what med might dent my depression once again...
>
> I'm contemplating MAOIs again, and was wondering:
>
> Does anyone have experience of both tricyclics and MAOIs? Did you react badly to the norepinephrine boost from the tricyclic, with that characteristic sense of dread and heightened startle response?
>
> If so, did you experience the same effects on an MAOI? Or did the serotonin and GABA boost level things out?Well, I don't know about serotonin or GABA being compensatory for norepinephrine (I shy away from simple abstractions), however, these two classes of drugs do affect me differently. The initial effect from tricyclics does often produce a strange sort of heightened state of arousal that can occasionally manifest as anxiety, but this usually passes. If it doesn't, you simply try another tricyclic if that is the class of drug you would like to focus on. Regarding MAOIs, the same caution must be taken not to let any initial anxiogenic psychotropic effects persuade you that the drug is no good for you. Parnate can cause some people to feel as if they are taking a stimulant at first. Again, this usually passes.
To generalize, the order of anxiogenesis might look something like this:
protriptyline > desipramine > imipramine > Parnate > nortriptyline > amitriptyline > Nardil > doxepin > trimipramine
Perhaps someone else with more knowledge can set this order more appropriately. It's just off the top of my head.
How long were you on a tricyclic before you discontinued it for the presence of intolerable anxiety?
- Scott
Posted by shasling on April 11, 2009, at 14:14:17
In reply to Re: Increased anxiety on MAOI?, posted by sowhysosad on April 10, 2009, at 21:35:37
> Thanks shasling. Nardil is less stimulating than Parnate, I hear. I've read a theory in another thread that Nardil has less of an effect on norepinephrine and dopamine than Parnate, which might explain the difference (based on the ratio of MAO-A to MAO-B inhibition you'd guess).
>
> Long-term benzos isn't an option in the UK as they just won't prescribe them for any length of time, but they might consider a couple of weeks' worth to help deal with startup anxiety.
>
> I wonder how easy it is to convince a UK pdoc to prescribe an MAOI? Any posters in the UK who've used one?
>
> > Maois can have some initial anxiety,but its kinda a good kinf,at least on parnate,one good thing however is benzos usualy treat overstimulation of maois quite effectly,usualy klonopin or xanax.
>
>Like sls said usualy the high stimulation which may cause some anxiety will likly be with parnate over nardil and some like it,regardless as you begin long term treatment on either maoi your likly to find anxiety benifits from both.
Nardil more over as it has a gaba producing effect,and parnate for one higher doses seem to cause anxiety relieaf,also its just being stated now that parnate affects gaba b,benzos gaba a,however my guess is since parnate affects gaba b adding a gaba b med such as bacoflen might produce a even more relaxing effect.
Posted by sowhysosad on April 11, 2009, at 16:15:47
In reply to Re: Increased anxiety on MAOI?, posted by SLS on April 11, 2009, at 6:50:18
> How long were you on a tricyclic before you discontinued it for the presence of intolerable anxiety?
I was on imipramine at 150mg (and briefly 175mg) for 3 months Scott. I wouldn't describe it as anxiety as such. It was more a horrible edginess, like something awful was about to happen, and if the phone rang I'd jump out of my skin. The symptoms tallied almost exactly with what I read about elevated noradrenaline.
To make matters worse I didn't feel any positive effect on serotonin as I would normally get with a decent SSRI.
Posted by desolationrower on April 14, 2009, at 1:00:45
In reply to Re: Increased anxiety on MAOI? » SLS, posted by sowhysosad on April 11, 2009, at 16:15:47
i wonder if the hypotensive effect of MAOIs is also anxiolytic, there is less ability of body to cause sudden sympathetic arousal...
-d/r
Posted by sowhysosad on April 14, 2009, at 1:45:09
In reply to Re: Increased anxiety on MAOI?, posted by desolationrower on April 14, 2009, at 1:00:45
> i wonder if the hypotensive effect of MAOIs is also anxiolytic, there is less ability of body to cause sudden sympathetic arousal...
>
> -d/rInteresting theory. That would make a lot of sense.
Would I be right in saying - in contrast - that tricyclics increase your heart rate and BP (postural hypotension aside)?
Posted by fattoush on April 15, 2009, at 21:00:43
In reply to Re: Increased anxiety on MAOI? » SLS, posted by sowhysosad on April 11, 2009, at 16:15:47
Have you considered that this "edginess" may be dysphoric mania brought on by both the Tricyclics and the MAOIs? I took a very low dose of tricyclics for years as a migraine prophylactic, so did not get that effect because of the low dose I think. However, when I took SSRIs (years) then later went on the Emsam patch, I had these symptoms I could not quite articulate. It's only when psychiatrists started reconsidering their diagnoses en masse and renaming people as "on the bipolar spectrum," even without the old clear manic episodes, that I knew I had mixed states and dysphoric mania brought on by ADs. I feel an inner agitation, anxiety, edginess as you said, and just want to punch the walls or scream. I don't take ADs anymore and don't get those feelings. They were scary.
Posted by sowhysosad on April 15, 2009, at 22:21:06
In reply to Re: Increased anxiety on MAOI? » sowhysosad, posted by fattoush on April 15, 2009, at 21:00:43
Interesting idea fattoush. I've never really had those symptoms on SSRI's, just imipramine and to a lesser extent Remeron.
During my first assessment with a pdoc he was asking - in veiled language and layman's terms - if I'd ever had hypomanic episodes. He seemed to initially interpret my responses as a "yes", although I've never suspected I might be on the bipolar spectrum - just normal happiness and elevated energy.
> Have you considered that this "edginess" may be dysphoric mania brought on by both the Tricyclics and the MAOIs? I took a very low dose of tricyclics for years as a migraine prophylactic, so did not get that effect because of the low dose I think. However, when I took SSRIs (years) then later went on the Emsam patch, I had these symptoms I could not quite articulate. It's only when psychiatrists started reconsidering their diagnoses en masse and renaming people as "on the bipolar spectrum," even without the old clear manic episodes, that I knew I had mixed states and dysphoric mania brought on by ADs. I feel an inner agitation, anxiety, edginess as you said, and just want to punch the walls or scream. I don't take ADs anymore and don't get those feelings. They were scary.
Posted by fattoush on April 15, 2009, at 22:42:39
In reply to Re: Increased anxiety on MAOI?, posted by sowhysosad on April 15, 2009, at 22:21:06
Oh, I don't get happiness or energy. I wish. Still, I do better on mood stabiliziers than on ADs. I did not know that you could be severely depressed and sometimes feel happy or have energy. They should be added to that edginess feeling you talked about to arrive at a diagnosis. Think a little more about how you feel. Are you happy or giddy? Is it energy or hyperactivity? Not that you have to give up ADs, some people can combine them with a mood stabilizier.
Posted by sowhysosad on April 15, 2009, at 23:51:32
In reply to Re: Increased anxiety on MAOI? » sowhysosad, posted by fattoush on April 15, 2009, at 22:42:39
No, I meant when SSRI's kick in and the depression goes into remission. I think at first he was interpreting that as a hypomanic reaction, but I sincerely doubt it.
> Oh, I don't get happiness or energy. I wish. Still, I do better on mood stabiliziers than on ADs. I did not know that you could be severely depressed and sometimes feel happy or have energy. They should be added to that edginess feeling you talked about to arrive at a diagnosis. Think a little more about how you feel. Are you happy or giddy? Is it energy or hyperactivity? Not that you have to give up ADs, some people can combine them with a mood stabilizier.
Posted by fattoush on April 16, 2009, at 0:31:50
In reply to Re: Increased anxiety on MAOI?, posted by sowhysosad on April 15, 2009, at 23:51:32
Okay... Too bad.
This is the end of the thread.
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