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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 Oliver71 on June 19, 2011, at 22:30:47
Hi,
I'm new and wanted to share my experience with an MAOI trial that I'll be starting next month. I've recently tapered off Prozac, which I've taken for the past few years with doses ranging from 40-100mg/day. I've also stopped Concerta, having taken 54mg for about the past 6 months. I'm currently tapering nortriptyline from 75mg at a rate of 25mg per week. Still taking 900mg lithium.
I guess I'd say I have treatment-resistant depression that ranges from mild to moderate, though that's pretty subjective. I have some symptoms of "atypical" depression, thus the MAOI trial, since other medications haven't helped enough. Based on the research I've done so far, Parnate sounds preferable to Nardil - fewer side effects.
Will keep you all posted on my experience.
Oliver
Posted by Lamdage on June 20, 2011, at 0:39:01
In reply to MAOI Trial, posted by Oliver71 on June 19, 2011, at 22:30:47
> Hi,
>
> I'm new and wanted to share my experience with an MAOI trial that I'll be starting next month. I've recently tapered off Prozac, which I've taken for the past few years with doses ranging from 40-100mg/day. I've also stopped Concerta, having taken 54mg for about the past 6 months. I'm currently tapering nortriptyline from 75mg at a rate of 25mg per week. Still taking 900mg lithium.
>
> I guess I'd say I have treatment-resistant depression that ranges from mild to moderate, though that's pretty subjective. I have some symptoms of "atypical" depression, thus the MAOI trial, since other medications haven't helped enough. Based on the research I've done so far, Parnate sounds preferable to Nardil - fewer side effects.
>
> Will keep you all posted on my experience.
>
> Oliver
>Hi Oliver,
welcome to psychobabble!
Parnate vs. Nardil: I think it really depends on the person taking it and the "flavor" of their depression. I wouldnt say Parnate has less side effects per se.
To me, Parnate was very uncomfortably pressuring. It has metabolites that act in a speedy way and tends to be more activating. Wasnt great for anxiety for me at all, but then again i didnt take it for much more than 10 days. (switched from nardil to parnate due to availability issues)
I believe to have heard that Parnate is a tad riskier than nardil with food reactions.Nardil is better for social anxiety imho.
What are your most bothersome symptoms?
Posted by Lamdage on June 20, 2011, at 0:41:22
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 0:39:01
And what side effect profile is preferable for you/what side effect would really bother you?
Insomnia, Weight gain? Hypotension? etc etc.
Posted by Terry8 on June 20, 2011, at 7:33:11
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 0:39:01
> Parnate vs. Nardil: I think it really depends on the person taking it and the "flavor" of their depression. I wouldnt say Parnate has less side effects per se.
>Agreed. Nardil has the reputation for causing more weight gain, but there are other side effects (spontaneous hypertension and insomnia, for example) more common to Parnate. Your doctor will (presumably) make the decision based on your symptoms -- better to go with the drug more likely to help your particular depression than the drug that seems like it has fewer side effects.
Good luck!
Posted by jms600 on June 20, 2011, at 8:08:35
In reply to MAOI Trial, posted by Oliver71 on June 19, 2011, at 22:30:47
> Hi,
>
> I'm new and wanted to share my experience with an MAOI trial that I'll be starting next month. I've recently tapered off Prozac, which I've taken for the past few years with doses ranging from 40-100mg/day. I've also stopped Concerta, having taken 54mg for about the past 6 months. I'm currently tapering nortriptyline from 75mg at a rate of 25mg per week. Still taking 900mg lithium.
>
> I guess I'd say I have treatment-resistant depression that ranges from mild to moderate, though that's pretty subjective. I have some symptoms of "atypical" depression, thus the MAOI trial, since other medications haven't helped enough. Based on the research I've done so far, Parnate sounds preferable to Nardil - fewer side effects.
>
> Will keep you all posted on my experience.
>
> Oliver
>Nardil seems to be the gold standard for anxiety. Just wish my doc would prescribe it to me.
Oliver - you're probably already aware, but just in case you're not, make sure your wash out period between Prozac and Parnate is a minimum of 5 weeks - Prozac stays in the body longer than other SSRIs.
Posted by Oliver71 on June 20, 2011, at 8:58:00
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 0:41:22
> And what side effect profile is preferable for you/what side effect would really bother you?
>
> Insomnia, Weight gain? Hypotension? etc etc.Thanks for the welcome & responses!
When depressed I tend to overeat & oversleep, I feel very "slowed down", in a mental fog, & am easily overwhelmed even by simple tasks/problems. I tend to isolate myself and am plagued by very negative thoughts directed against myself. Depression tends to be more of an issue for me than anxiety.
Side effects that I haven't liked in the past include dry mouth, constipation, fine hand tremor, & weight gain.
Posted by Lamdage on June 20, 2011, at 9:38:07
In reply to Re: MAOI Trial » Lamdage, posted by Oliver71 on June 20, 2011, at 8:58:00
5!! weeks.. Sorry about this man. I suspect they designed it that way to keep more folks on the big business, prozac. 5 weeks is a anxiety provoking period of time.
a rant a day keeps the Dr away!
Posted by zonked on June 20, 2011, at 9:49:53
In reply to Re: MAOI Trial, posted by jms600 on June 20, 2011, at 8:08:35
> Nardil seems to be the gold standard for anxiety. Just wish my doc would prescribe it to me.Why won't he? If he's afraid of a HT crisis or serotonin syndrome, ask if you can sign a waiver...
-z
Posted by Terry8 on June 20, 2011, at 10:08:21
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 9:38:07
> 5!! weeks.. Sorry about this man. I suspect they designed it that way to keep more folks on the big business, prozac. 5 weeks is a anxiety provoking period of time.
>Ha, sounds like a good strategy -- we'll keep them on it by mandating a scarily-long washout period.
No, it's just that Prozac has a very long half-life, and its metabolite norfluxetine takes even longer to be eliminated. Norfluxetine's half-life is 9 days, so it takes around 36-45 days (4-5 half-lives) to get out of your system enough to be safe to start the MAOI... five weeks.
Posted by Terry8 on June 20, 2011, at 10:20:40
In reply to Re: MAOI Trial » Lamdage, posted by Oliver71 on June 20, 2011, at 8:58:00
> Side effects that I haven't liked in the past include dry mouth, constipation, fine hand tremor, & weight gain.
>
Our depressive symptoms are similar. As for the side effects, I have all those except the tremor on Partnate. I put on thirty pounds, have a mouth dryer than the Sahara, and should probably buy stock in Miralax one of these days (but at least a good friend picks up the giant double-pack for me at Costco when she goes). But I'm also willing to put up with these and other more problematic side effects (sleep/wake cycle and cardo-vascular problems) because it's worked on my depression when nothing else has.
Posted by Lamdage on June 20, 2011, at 12:50:06
In reply to Re: MAOI Trial, posted by Terry8 on June 20, 2011, at 10:20:40
I hope i didnt inspire new drug designs with this post. Who knows, maybe the enemy is already among us and reading here.
Posted by Lamdage on June 20, 2011, at 12:56:59
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 12:50:06
Oliver, your flavor of depression sounds like it could respond well to parnate.
But keep in mind not everyone gets the weight gain with nardil (i dont) and the way nardil helps comfort in social situations is sort of a miracle.
Nardil if you want to do it for the ladies! Its your decision. (and your doctors). also keep in mind what your doctor says could be motivated by his friendlyne$$ with either pfizer or smithkline. Thats just my thinking, im pretty disillusioned with this world.
Posted by Lamdage on June 20, 2011, at 12:58:42
In reply to Re: MAOI Trial, posted by Lamdage on June 20, 2011, at 12:56:59
Id go for parnate. Your condition is different than mine..
Posted by Pickles on July 27, 2011, at 20:05:50
In reply to MAOI Trial, posted by Oliver71 on June 19, 2011, at 22:30:47
Hi Oliver,
I've been involved with a study for a new MAOI (one that isn't binding so there are fewer food restrictions). I have to be honest, I'm not seeing much of a difference...wondering if I got the placebo (just my luck!)
I've read a lot about MAOI's but the food restrictions scare me...not so much the fact that I can't eat a lot of things that I like but more so, if I'm out to dinner and there's something in the food that I'm not aware of...scary. Who wants to be known as the person who died from the dreaded "cheese death"? ...no me! :)
Before I could start the study I had to ween myself off of Prozac...the though of being without an antidepressant for 4 weeks scared me but actually, I came to realize that Prozac really wasn't working for me. I felt better (less of a foggy feeling, same amount of depression) after I stopped.
I talked to the director (doctor) running the research about what I should take after the study is over...she recommended I look into something called Emsam. Going to do a bit of research on it now...
Good luck to you!
P.
Posted by desolationrower on July 30, 2011, at 21:42:15
In reply to Re: MAOI Trial, posted by Pickles on July 27, 2011, at 20:05:50
> Hi Oliver,
>
> I've been involved with a study for a new MAOI (one that isn't binding so there are fewer food restrictions). I have to be honest, I'm not seeing much of a difference...wondering if I got the placebo (just my luck!)
>
> I've read a lot about MAOI's but the food restrictions scare me...not so much the fact that I can't eat a lot of things that I like but more so, if I'm out to dinner and there's something in the food that I'm not aware of...scary. Who wants to be known as the person who died from the dreaded "cheese death"? ...no me! :)
>
> Before I could start the study I had to ween myself off of Prozac...the though of being without an antidepressant for 4 weeks scared me but actually, I came to realize that Prozac really wasn't working for me. I felt better (less of a foggy feeling, same amount of depression) after I stopped.
>
> I talked to the director (doctor) running the research about what I should take after the study is over...she recommended I look into something called Emsam. Going to do a bit of research on it now...
>
> Good luck to you!
>
> P.meaning it is reversable? i have been hoping the tissues specific MAOIs finally make it to market sometime.
-d/r
Posted by Pickles on August 2, 2011, at 12:01:45
In reply to Re: MAOI Trial, posted by desolationrower on July 30, 2011, at 21:42:15
> > Hi Oliver,
> >
> > I've been involved with a study for a new MAOI (one that isn't binding so there are fewer food restrictions). I have to be honest, I'm not seeing much of a difference...wondering if I got the placebo (just my luck!)
> >
> > I've read a lot about MAOI's but the food restrictions scare me...not so much the fact that I can't eat a lot of things that I like but more so, if I'm out to dinner and there's something in the food that I'm not aware of...scary. Who wants to be known as the person who died from the dreaded "cheese death"? ...no me! :)
> >
> > Before I could start the study I had to ween myself off of Prozac...the though of being without an antidepressant for 4 weeks scared me but actually, I came to realize that Prozac really wasn't working for me. I felt better (less of a foggy feeling, same amount of depression) after I stopped.
> >
> > I talked to the director (doctor) running the research about what I should take after the study is over...she recommended I look into something called Emsam. Going to do a bit of research on it now...
> >
> > Good luck to you!
> >
> > P.
>
> meaning it is reversable? i have been hoping the tissues specific MAOIs finally make it to market sometime.
>
> -d/rI obviously don't know the name of the drug I'm taking since it's still being tested but here is something I found on Wikipedia about Harmaline, another MAOI..."The reversibility means that, instead of binding permanently to MAO-A for weeks until the body replaces the MAO-A enzyme molecules, harmaline binds only transiently, so tyramine can be metabolized as well by competing with harmaline for the binding site on the enzyme. This means that the risk of a hypertensive crisis, a dangerous high blood pressure crisis from eating tyramine-rich foods such as cheese, is potentially lower with harmaline than with non-reversible MAOI's such as Nardil, especially after 24 hours following ingestion." So, with the test meds, we still have to be careful about what we eat but the list of foods to avoid is significantly shorter than the list for a binding MAOI.
I do have to say that I really hope I'm on the placebo...I've never taken an MAOI but I've heard/read that they do wonders for depression and social anxiety. I'm on my fifth week of a six week study and, although I do feel a bit better at times, I was expecting a lot more...
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