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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 hearttransplant on July 23, 2012, at 21:02:27
Hi, new to these forums, although many here have sang praise of MAOIs, I understand why doctors would want to make sure that they exhausted their options before willing parting with a script for nardil or parnate. My questio to you all is, when are all options considered exhausted?
I have tried zoloft, cymbalta, geodon, klonopin, seroquel, Concerta, Vyvanse, Mirtazapine, Lexapro and Wellbutrin. I am planning to see my doc for some tweaks in my meds, and I was wondering if it was time I suggested trying an MAOI? BTW I was diagnosed officially with depression at 16 and I am now 22.
Posted by Meatwood_Flack on July 23, 2012, at 21:41:26
In reply to Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 21:02:27
Have you considered trying a tricyclic?
Posted by hearttransplant on July 23, 2012, at 22:43:39
In reply to Re: Taken these meds without success. MAOI time?, posted by Meatwood_Flack on July 23, 2012, at 21:41:26
Yea, I suspect that a TCA is next in line considering that I have given every other medication class a run. May I ask if anyone has had success with these? Or is there a whole section of TCA success threads that someone could point a psychobabble noob like me to?
Thanks for the quick reply btwHT
Posted by Phillipa on July 24, 2012, at 0:05:32
In reply to Re: Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 22:43:39
Are you new to babble? Are you from the USA or elsewhere? Phillipa
Posted by jedi on July 24, 2012, at 2:56:15
In reply to Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 21:02:27
Google tricyclic OR TCA site:dr-bob.org, I get 37,500 hits. They have been well discussed on this board. By the way, Google MAOI OR Nardil OR Parnate site dr-bob.org comes up with 56,900 hits. Lots of info out there.
Jedi
> Hi, new to these forums, although many here have sang praise of MAOIs, I understand why doctors would want to make sure that they exhausted their options before willing parting with a script for nardil or parnate. My questio to you all is, when are all options considered exhausted?
>
> I have tried zoloft, cymbalta, geodon, klonopin, seroquel, Concerta, Vyvanse, Mirtazapine, Lexapro and Wellbutrin. I am planning to see my doc for some tweaks in my meds, and I was wondering if it was time I suggested trying an MAOI? BTW I was diagnosed officially with depression at 16 and I am now 22.
Posted by SLS on July 24, 2012, at 15:42:59
In reply to Re: Taken these meds without success. MAOI time? » hearttransplant, posted by jedi on July 24, 2012, at 2:56:15
Hi Jedi.
:-)
Long time no see. How have you been?
I have been much improved since adding prazosin to my treatment regime at the beginning of the year.
Currently:
Parnate 80 mg
nortriptyline 150 mg
Lamictal 200 mg
Abilify 10 mg
lithium 300 mg
prazosin 8 mg.I know that this seems like quite a list, but it has been carefully honed over a period of several years. I could possibly do without the lithium and still maintain an antidepressant response, but I keep it in place to help prevent Alzheimers Disease. People with bipolar disorder have a significantly higher risk of developing it, and lithium might have a prophylactic effect. My intuition tells me that lithium is helping to prevent mood drift. At a relatively low dosage of 300 mg/day, lithium is less likely to damage kidneys or the thyroid gland.
Have a nice day.
- Scott
Posted by jedi on July 24, 2012, at 20:00:41
In reply to Re: Taken these meds without success. MAOI time? » jedi, posted by SLS on July 24, 2012, at 15:42:59
Hi Scott,
Your cocktail is so much more complicated than mine. I've watched you work on it over the years and I'm so glad that that hard work has paid off for you. I am lucky in that Nardil has always worked for my major depression. I still have some residual dysthymia but I've had that since my teenage years. Don't really expect it to go away. Hoping to get some major financial stuff taken care of, to lower my stress level, and maybe get down below my current 60mg per day of Nardil. Though, over the years, that seems to be the minimum effective dose for me.Good luck in the ongoing battle to beat the black hole into submission. Your posts are always interesting, though sometimes above my reading level. LOL
Be well Scott,
Jedi
> Hi Jedi.
>
> :-)
>
> Long time no see. How have you been?
>
> I have been much improved since adding prazosin to my treatment regime at the beginning of the year.
>
> Currently:
>
> Parnate 80 mg
> nortriptyline 150 mg
> Lamictal 200 mg
> Abilify 10 mg
> lithium 300 mg
> prazosin 8 mg.
>
> I know that this seems like quite a list, but it has been carefully honed over a period of several years. I could possibly do without the lithium and still maintain an antidepressant response, but I keep it in place to help prevent Alzheimers Disease. People with bipolar disorder have a significantly higher risk of developing it, and lithium might have a prophylactic effect. My intuition tells me that lithium is helping to prevent mood drift. At a relatively low dosage of 300 mg/day, lithium is less likely to damage kidneys or the thyroid gland.
>
> Have a nice day.
>
>
> - Scott
>
Posted by hearttransplant on July 24, 2012, at 20:27:55
In reply to Re: Taken these meds without success. MAOI time? » hearttransplant, posted by Phillipa on July 24, 2012, at 0:05:32
Hi Phillipa, yes, this thread was my first at Psychobabble. I am in fact located in the US, so I do have adequate access to psychiatric care and medication. I am seeing a psychiatrist right now. Appreciate the referral to other messages about MAOI's and stuff. My main question was, is it fair for me to ask to try an MAOI after giving the listed meds a run and being diagnosed with MDD for 6+ years?
Sincerely
HT
Posted by Phillipa on July 24, 2012, at 21:08:12
In reply to Re: Taken these meds without success. MAOI time?, posted by hearttransplant on July 24, 2012, at 20:27:55
I would say it is. Have you considered EMSAM the patch? I just always liked the idea of something I could see. And no first bypass to the liver. Welcome to babble. Phillipa
Posted by hearttransplant on July 24, 2012, at 23:08:57
In reply to Re: Taken these meds without success. MAOI time? » hearttransplant, posted by Phillipa on July 24, 2012, at 21:08:12
Yes, I am perfectly open to something like emsam. I'd preferably like to use in the higher dosages to take advantage of both the MAO-A and MAO-B inhibition properties. Of course, the ideal scenario would be getting a script for Nardil because of all the good stories that I have read about it, but again that is up to my doc. This is assuming that she is open to the option in the first place. Thanks for the quick reply
Sincerely
HT
Posted by OHMatt on July 25, 2012, at 9:07:53
In reply to Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 21:02:27
> Hi, new to these forums, although many here have sang praise of MAOIs, I understand why doctors would want to make sure that they exhausted their options before willing parting with a script for nardil or parnate. My questio to you all is, when are all options considered exhausted?
>
> I have tried zoloft, cymbalta, geodon, klonopin, seroquel, Concerta, Vyvanse, Mirtazapine, Lexapro and Wellbutrin. I am planning to see my doc for some tweaks in my meds, and I was wondering if it was time I suggested trying an MAOI? BTW I was diagnosed officially with depression at 16 and I am now 22.Hi Hearttransplant,
I'm new to babble also, this is my 2nd post here.
I have felt the frustration of ADs not working also. Celexa didn't work for me, and Wellbutrin gave me an anaphylactic reaction.
I got 8 decent years out of Effexor XR however. Cymbalta elevated me but I didn't achieve "remission" even though I gave it a year. Pristiq (Effexor's cousin) gave me 3 decent years. After those good periods, on Effexor XR and Pristiq, dreaded Tachyphylaxis, aka Poop-Out.
I've been trying Zoloft the past 6 weeks now, and have been on 200 MG for 2 weeks. So far I don't feel "baseline" and the nausea from it is bad in the morning. The plus is the nausea is slowly shedding the Pristiq weight gain..
So the point to all of this is that since I didn't see Effexor or Pristiq on your list, if you PDoc is hesitant to go the Tricyclic or MAOI route, you might give Effexor or Pristiq a shot. Personally I would try the Effexor first, there are a large number of pill dosages available so it is easier to titrate on/off compared to the 2 choices (50/100) that Pristiq has.
Posted by papillon2 on July 26, 2012, at 0:49:17
In reply to Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 21:02:27
I see you haven't tried a tricyclic anti-depressant (TCA). I would try a TCA first before going to a MAOI.
Posted by hearttransplant on July 26, 2012, at 10:32:27
In reply to Re: Taken these meds without success. MAOI time?, posted by papillon2 on July 26, 2012, at 0:49:17
Right, I remember my doc bringing Tofranil as an option just recently. I think it might be time to give that a go.
Posted by novelagent on July 26, 2012, at 13:32:24
In reply to Taken these meds without success. MAOI time?, posted by hearttransplant on July 23, 2012, at 21:02:27
Read my post a bit above about "atypical depression" response-- I took oral selegiline before Emsam was approved in the US, along with DLPA, and I've been in remission ever since.
I would try Emsam at the MAOI-B dose (lower doses), and then go up to 9mg and use an MAOI diet if that doesn't work. But try Life Extension brand DLPA with it.
Nardil iisn't going to do anything at 9mg that Emsam can't.
> Hi, new to these forums, although many here have sang praise of MAOIs, I understand why doctors would want to make sure that they exhausted their options before willing parting with a script for nardil or parnate. My questio to you all is, when are all options considered exhausted?
>
> I have tried zoloft, cymbalta, geodon, klonopin, seroquel, Concerta, Vyvanse, Mirtazapine, Lexapro and Wellbutrin. I am planning to see my doc for some tweaks in my meds, and I was wondering if it was time I suggested trying an MAOI? BTW I was diagnosed officially with depression at 16 and I am now 22.
Posted by hearttransplant on July 26, 2012, at 22:00:26
In reply to Re: Taken these meds without success. MAOI time? » hearttransplant, posted by novelagent on July 26, 2012, at 13:32:24
Excuse my ignorance again, but I have one more question about MAOI's that only someone with experience can answer: When taking drugs with shorter half lives like ssris, wellbutrin etc, there would always be a window of time during the day that the medication sort of worked. Is this up and down cycle of serum concentration evident with MAOI's?
Sincerely
HT
Posted by novelagent on July 27, 2012, at 9:47:02
In reply to Re: Taken these meds without success. MAOI time?, posted by hearttransplant on July 26, 2012, at 22:00:26
You weren't maintaining a steady state in your bloodstream. One needs to take it at the same time of day each day. You can't just go about taking it at 7 AM one day and then 8:30 AM the next. It takes 4 days to achieve a steady state.
> Excuse my ignorance again, but I have one more question about MAOI's that only someone with experience can answer: When taking drugs with shorter half lives like ssris, wellbutrin etc, there would always be a window of time during the day that the medication sort of worked. Is this up and down cycle of serum concentration evident with MAOI's?
>
> Sincerely
> HT
This is the end of the thread.
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