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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by jade k on July 22, 2010, at 9:16:32
Hello All,
This may not be a popular post but I'm posting it anyway. I'm noticing a few posters that have been deciding on their own what dose of MAOI to take and what to augment it with.
This is dangerous for many reasons. PLEASE be under the care of an experienced pdoc when using an MAIO, and when augmenting with anything.
Parnate and probably the other MAOI's can be dangerous for many people at high doses. Particularly when augmented.
At 80mg of Parnate and 40mg Dexedrine, while under the care of an experienced pdoc, I suffered a psychotic break. It was either the high dose of Parnate, or the added (augmented) Dexedrine that triggered it.
I have struggled over whether or not to post this, as I still believe MAOI's to be useful in TRD and MDD. In fact, I was in full remission for a time. However, people taking these meds need to be closely supervised and under a Pdoc's care. I strongly urge you NOT to take MAOI's without a pdoc monitoring you. What is the right dose for one person, could be dangerous for you. It must be done slowly, and augments thoroughly discussed with your Pdoc.
Geodon worked well for me as a remedy. Please treat MAOI's with the respect they deserve, and be "patient patients" :-)
Take Care,
~Jade Kelly
Posted by Phillipa on July 22, 2010, at 12:05:15
In reply to High Dose Parnate w/wo augment, posted by jade k on July 22, 2010, at 9:16:32
And all that and you write you were under the care of an experienced pdoc. So what does say for the pdoc? That even they do not know how a person may respond. Phillipa
Posted by jade k on July 22, 2010, at 12:58:22
In reply to Re: High Dose Parnate w/wo augment » jade k, posted by Phillipa on July 22, 2010, at 12:05:15
> And all that and you write you were under the care of an experienced pdoc. So what does say for the pdoc? That even they do not know how a person may respond. Phillipa
Thats the thing. You really never know how a particular person may react, or when, especially when they don't know whats happening.
~Jade
Posted by Roslynn on July 22, 2010, at 13:05:54
In reply to High Dose Parnate w/wo augment, posted by jade k on July 22, 2010, at 9:16:32
Oh no, can someone tell me, are the MAOIs known to trigger psychosis????? I am supposed to start up in a few weeeks.
Posted by jade k on July 22, 2010, at 13:35:30
In reply to Re: High Dose Parnate w/wo augment SCARED NOW!!, posted by Roslynn on July 22, 2010, at 13:05:54
> Oh no, can someone tell me, are the MAOIs known to trigger psychosis????? I am supposed to start up in a few weeeks.
My gosh! Didn't mean to scare you. Just wanting to let you, and others of course, know its important to be clear with you're pdoc and those around you as to the possible risks. That way, should you decide to do it, at least you'll be prepared (as prepared as one can be!)
I was caught off guard. You'll have to discuss all risks with your pdoc and then make an informed decision. I believe psychosis happens in a minority of patients, but all risks go up with dose I would assume.
~Jade
Posted by Willful on July 22, 2010, at 14:09:31
In reply to Re: High Dose Parnate w/wo augment SCARED NOW!! » Roslynn, posted by jade k on July 22, 2010, at 13:35:30
Hi, Roslyn.
I wouldn't be scared by jade's situation. It's quite rare. Psychosis is not a side effect of taking maois. I don't know what triggered jade's reaction but I can assure you that the likelihood of that is remote.
Anything can happen-- even with drugs that aren't particularly psychoactive-- .
I don't know what dose of an maoi you're planning to take, but I took a fairly high dose of parnate (90 mg/ day) and did fairly well on it. Because of a sensitivity to certain aspects of drugs, my pdoc didn't want to go higher-- but I trust that he would not have taken a risk that I would have a psychotic episode. (I'm doing much better on emsam, another maoi, also at a fairly high dose. )
As jade said, she doesn't know if it was the stimulant or the parnate or the combination that triggered her episode. So I really wouldn't take that as a warning. I think she was addressing the problem of people taking combinations of different meds that their psychiatrists haven't monitored-- that is, experimenting on their own with meds that they've gotten without supervision. This would be true of all psychiatric meds, but there are reasons why jade may have been particularly concerned about experimenting with maois, which as we know, have been involved in certain bad interactions with other drugs. As long as your psychiatrist is overseeing this, you really don't need to worry.
You and s/he will, I"m sure, be careful in watching your reactions-- to foods, or to the dose you're taking. You can trust yourself and your doctor to be aware of and able to handle whatever arises in a timely. way. As for psychotic breaks, I really don't think this is at all what you need to be concerned with.
Willful
Posted by Roslynn on July 22, 2010, at 17:11:04
In reply to Re: High Dose Parnate w/wo augment SCARED NOW!!, posted by Willful on July 22, 2010, at 14:09:31
Dear Willfull,
Thank you so much for your reply, you made me feel a lot better. I am nervous about starting the MAOI (I don't know if it will be Nardil or Parnate) but it is reassuring to read your message. I also took EMSAM, which had an effect but I was very allergic to the adhesive.
Thanks again,
Roslynn
> Hi, Roslyn.
>
> I wouldn't be scared by jade's situation. It's quite rare. Psychosis is not a side effect of taking maois. I don't know what triggered jade's reaction but I can assure you that the likelihood of that is remote.
>
> Anything can happen-- even with drugs that aren't particularly psychoactive-- .
>
> I don't know what dose of an maoi you're planning to take, but I took a fairly high dose of parnate (90 mg/ day) and did fairly well on it. Because of a sensitivity to certain aspects of drugs, my pdoc didn't want to go higher-- but I trust that he would not have taken a risk that I would have a psychotic episode. (I'm doing much better on emsam, another maoi, also at a fairly high dose. )
>
> As jade said, she doesn't know if it was the stimulant or the parnate or the combination that triggered her episode. So I really wouldn't take that as a warning. I think she was addressing the problem of people taking combinations of different meds that their psychiatrists haven't monitored-- that is, experimenting on their own with meds that they've gotten without supervision. This would be true of all psychiatric meds, but there are reasons why jade may have been particularly concerned about experimenting with maois, which as we know, have been involved in certain bad interactions with other drugs. As long as your psychiatrist is overseeing this, you really don't need to worry.
>
> You and s/he will, I"m sure, be careful in watching your reactions-- to foods, or to the dose you're taking. You can trust yourself and your doctor to be aware of and able to handle whatever arises in a timely. way. As for psychotic breaks, I really don't think this is at all what you need to be concerned with.
>
> Willful
Posted by Roslynn on July 22, 2010, at 17:27:52
In reply to Re: High Dose Parnate w/wo augment SCARED NOW!! » Roslynn, posted by jade k on July 22, 2010, at 13:35:30
Posted by inanimate peanut on July 22, 2010, at 22:59:36
In reply to High Dose Parnate w/wo augment, posted by jade k on July 22, 2010, at 9:16:32
I'm sorry that happened to you Jade, and that is very scary. MAOIs are very scary drugs. They interact with almost everything else and they're not well known for being stable members of the drug population. In my case, my doctor refused what I knew to be a safe and effective strategy of combining nortriptyline with Parnate. I couldn't find another doctor to do it. I tried everything my doctor wanted me to try first. My choice came down to "do I live miserably to do I at least try to feel better?" SO, I got the nortriptyline on my own. I try to minimize the risks as much as possible by knowing any signs of trouble and continually monitoring my vitals. So far, I've had two wonderful days. That makes it worth it. i would do it all again just to have those 2 days of feeling like a normal human being (almost). I know you're concerned about me and I appreciate how much you care. It means so much to me that you do care about someone you barely know. However, I'm fine. I'm safe at 70 for awhile and when the time is right I'll increase to try to have 2 more days of life. My life as it is isn't worth living. I'm willing to do whatever I can to change that, and I'm just down to the last few options that happen to be a little risky. If I pay for it, then that's the way it falls, but I don't expect that to be the case considering how smoothly it all has gone. Would I encourage others to do it? That's each person's choice. Desperate people do desperate things- just be smart enough to protect yourself the best that you can (and just live with the BP cuff 'scars' for a few weeks)
Posted by jade k on July 22, 2010, at 23:39:40
In reply to Re: High Dose Parnate w/wo augment, posted by inanimate peanut on July 22, 2010, at 22:59:36
Hi Peanut!
Thanks for the post. I know we all have to make our choices. I'm glad you are keeping in touch here and looks like you are researching a lot. Thats reasurring. Yes, I remember the cuff. And to be honest, it was hard to post my experience. But if it helps someone, well you know. So keep posting, seems like you're on the right track!
~Jade
ps-mail is on if you need anything :-)
Posted by linkadge on July 26, 2010, at 18:35:13
In reply to High Dose Parnate w/wo augment, posted by jade k on July 22, 2010, at 9:16:32
I suffered a psychotic break while on 40mg of parnate. That stuff's intense, and the insomnia sure wasn't making things better.
Linkadge
Posted by linkadge on July 26, 2010, at 18:36:43
In reply to Re: High Dose Parnate w/wo augment SCARED NOW!!, posted by Willful on July 22, 2010, at 14:09:31
Psychosis can be a side effect of taking MAOI's especially parnate which has amphetamine like properties. I think the MAO-B inhibition and subsequent massive elevations in PEA can make some people really paranoid too.
Linkadge
Posted by linkadge on July 26, 2010, at 18:40:14
In reply to Re: High Dose Parnate w/wo augment, posted by inanimate peanut on July 22, 2010, at 22:59:36
Just be careful inanimate penut. Nortriptyline takes a while to get out of your system. The metabolite is also more likely to cause cardiac side effects.
When I discontinued nortriptyline I still had elevated heart rate for days. Combining a NRI with an MAOI increases the cardiac risks.
Posted by benzo85 on August 4, 2010, at 18:15:04
In reply to High Dose Parnate w/wo augment, posted by jade k on July 22, 2010, at 9:16:32
Wow, 40mg dex + 80mg parnate.. that's a lot of amphetamine in the system!!
Don't see how a psychotic break wouldn't be possible!Take care,
This is the end of the thread.
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