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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Huxley on August 15, 2010, at 19:32:29
Why do so many people discontinue them?
I always thought about them as a treatment because they seem to fit my profile, bad social anxiety with atypical depression. Particularly Nardil.So why do people stop them, I read back through the archives and see people on them and doing great but a couple of years down the track they are not taking them and are still here searching for a cure.
Is it because they poop out? Can you manage it with dose adjustments?
Or is it because of the side effects?
Posted by angels78 on August 15, 2010, at 19:50:23
In reply to If MAOIs are so good, posted by Huxley on August 15, 2010, at 19:32:29
Side effects usually weight gain and insomnia.
But if you have severe SP, it does work.
Posted by Huxley on August 15, 2010, at 21:08:12
In reply to Re: If MAOIs are so good » Huxley, posted by angels78 on August 15, 2010, at 19:50:23
> Side effects usually weight gain and insomnia.
> But if you have severe SP, it does work.Why is life full of unfair trade offs.
Does the weight gain hit everyone? What about low doses?Seems to be the only real option for SP.
Posted by linkadge on August 15, 2010, at 21:08:59
In reply to Re: If MAOIs are so good » Huxley, posted by angels78 on August 15, 2010, at 19:50:23
Well, Nardil supposedly has a euphoriant effect that can last a month or so. Maybe people equate this to the clinical effect of the drug.
I also agree that MAOI insomnia is pretty bad. On parnate, I got 4 hours on a good night. I grew tollerant to SSRI insomnia, not MAOI insomnia.
I just didn't think parnate was all that great a drug. It kind of made my mood worse.
Linkadge
Posted by shasling on August 15, 2010, at 21:25:11
In reply to Re: If MAOIs are so good, posted by linkadge on August 15, 2010, at 21:08:59
parnate rocks
Posted by bearfan on August 15, 2010, at 22:56:46
In reply to Re: If MAOIs are so good, posted by shasling on August 15, 2010, at 21:25:11
What type of depression does it 'rock' for? I rarely see people happy of their antidepressant treatment
Posted by Phillipa on August 16, 2010, at 0:25:53
In reply to Re: If MAOIs are so good, posted by bearfan on August 15, 2010, at 22:56:46
I mail with some who had intolerable side effects to maois like hypotension fell and broke back, spontaneous hypertensive crisis also and more. Phillipa
Posted by Huxley on August 16, 2010, at 0:33:40
In reply to Re: If MAOIs are so good, posted by Phillipa on August 16, 2010, at 0:25:53
> I mail with some who had intolerable side effects to maois like hypotension fell and broke back, spontaneous hypertensive crisis also and more. Phillipa
lol. Sounds like a great med!
Posted by Phillipa on August 16, 2010, at 19:18:04
In reply to Re: If MAOIs are so good, posted by Huxley on August 16, 2010, at 0:33:40
Believe it or not still takes it also. Phillipa
Posted by Huxley on August 16, 2010, at 23:19:56
In reply to Re: If MAOIs are so good » Huxley, posted by Phillipa on August 16, 2010, at 19:18:04
> Believe it or not still takes it also. Phillipa
I guess it is worth the trade off. They do sound like they can have an awful side effect profile, particularly Nardil. But does this mean that all get the side effects? Or most?
Posted by jedi on August 17, 2010, at 12:41:43
In reply to Re: If MAOIs are so good, posted by Huxley on August 16, 2010, at 23:19:56
> > Believe it or not still takes it also. Phillipa
>
> I guess it is worth the trade off. They do sound like they can have an awful side effect profile, particularly Nardil. But does this mean that all get the side effects? Or most?Hi Huxley,
The MAOIs are powerful medications that sometimes work for treatment resistant depression when all else fails. I have been on Nardil for over a decade and because of the side effects have tried many other combinations of medications. I have always gone back to Nardil and it has always worked for my major atypical depression and social anxiety.The major side effects for me are weight gain, insomnia, and delayed orgasm. At lower doses, for me - 60mg and under, these side effects are considerably less. When a MAOI works it often works well. I still have a residual level of dysthymia but the major depression is pretty much gone on Nardil. I have a prescription for 90mg but I can often get efficacy at 60mg. When I feel the depression starting to creep back, I will up the dosage to 75 or 90mg until it is controlled. Usually this is during really stressful times, this year being one of them. A very close friend had a heart attack, I had a hip replaced-major surgery, had some pretty severe financial difficulties and my Dad died a month ago. So up to 75mg until the crisis passes.
I augment with 1mg of clonazepam, which I am trying to slowly reduce because of memory problems.
I think you will find that many people quit the MAOIs because of the initially severe side effects. Those that can stick through them can find long term success with these medications where other meds fail. I have seen people post on this board and others that have been on the irreversible MAOIs for decades. The same can not be said for very many other psychotropic medications. And it is not because they are cured and able to resume a normal existence. In my opinion, very few treatment resistant patients with severe depression are ever cured. I have been on 45+ different combinations of antidepressants and augmenters. Nardil is the only thing that has worked and baring some big breakthrough in depression treatment, I'm a lifer.
Be Well,
Jedi
Posted by sigismund on August 17, 2010, at 17:10:42
In reply to Re: If MAOIs are so good, posted by linkadge on August 15, 2010, at 21:08:59
>I just didn't think parnate was all that great a drug. It kind of made my mood worse.
What dose did you get up to, Link?
I suppose Parnate can be more pleasurable than mood elevating?
Posted by bleauberry on August 17, 2010, at 17:28:45
In reply to If MAOIs are so good, posted by Huxley on August 15, 2010, at 19:32:29
For some people maois are the only meds that work.
Dr Goodman of psychotropical.com favors parnate over many others, with a liking for zoloft+nortriptyline as well.
At forums where patients rate their meds, maois score in the low 4's on a 1 to 5 scale, with all other meds scoring in the low 3's.
In clinical trials maois didn't really show anything special over other choices, as seen in the STAR*D study.
I think it depends on the population. I think maybe the more meds someone has failed the better the potential for an maoi to work. But no guarantees in anything.
Posted by linkadge on August 17, 2010, at 19:51:48
In reply to Re: If MAOIs are so good » linkadge, posted by sigismund on August 17, 2010, at 17:10:42
I think I was on 60mg. I eventually came off after I suffered a spontanious hypertensive crisis. I was following the diet to a T.
I remember that my mood was dark, I wasn't sleeping much, at first it was pleasurable, but it started to make me feel very detached, almost psychotic - like something very serious was happening. I was very sensitive to world events - like an impending sense of doom. This ended when I stopped the drug. I actually had a rebound euphoria after stopping. I was in love with everybody and everything.
I was so high, I needed serquel to slow me down. I felt so good for at least a week after stopping. I thought I was cured. But the positive rebound effect eventually tapered off.
Linkadge
Posted by sigismund on August 17, 2010, at 20:06:27
In reply to Re: If MAOIs are so good, posted by linkadge on August 17, 2010, at 19:51:48
>I was very sensitive to world events - like an impending sense of doom
The hand of God?
(There was a song ages back that had an imposing tune and the words went
'Listen to the voice of Buddha
Saying stop your sericulture'.)I never really got above 10mg.
When I went to 20 I didn't feel better.
I suppose it was the serotonin kicking in with a little agitation. Perhaps it would have died down, but the insomnia would have remained.
Posted by Huxley on August 18, 2010, at 0:58:25
In reply to Re: If MAOIs are so good, posted by sigismund on August 17, 2010, at 20:06:27
So side effects and poop out seem to be the big problems.
Some people seem to not get the poop out is this correct?Do some confuse it for an initial eupohoria you get? Does it still work on the social anxiety after the intital euphoria wears off?
How bad is the weight gain on Nardil? Up there with Zyprexa? How bad is the insomnia?
Is it true that they settle down after 2-3 months?
From what I read I am a perfect candidate to take nardil. Atypical depression with dysthmia extreme rejection sensitivity and social anxiety.
I am hoping to detox from my other meds and if things don't improve after that I would be looking at Nardil or Parnate I think.
So many questions! Thanks for anyone taking the time to answer them.
This is the end of the thread.
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