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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by psychlover on May 31, 2013, at 13:16:17
Hi, I have not posted on here for a number of years, mostly because I have not been depressed in about 5 years, but a few months ago, I realized I was sliding into a major depression and I knew I needed meds.
I went to see a very expensive psychiatrist who would prescribe me an MAOI, because I knew I had atypical depression and that EMSAM had worked for a while 5 years ago. He put me on Parnate. The side effects were intolerable -- insomnia, fatigue, constipation, inability to urinate, dry mouth -- and I didn't feel any better. After about 6 weeks I quit.
6 weeks later I asked for Emsam. Within 1 day I was feeling better. I had energy and much more importantly I was calm, happy, and not critical or angry at my wife, which is my default mode with her and has driven our marriage to the brink of collapse.
But right away I started having food interactions, despite the fact that the 6mg dosage of Emsam does not carry any dietary restrictions. A tablespoon of tamari (soy sauce) with my brown rice was the first thing to give me chest pain and send my blood pressure spiking. Then 2 days later after eating some edamame for dinner, my BP climbed to 179/96. The next day I was careful not to eat anything with even small amounts of tyramine, so I ate the food I made at our barbecue: ribs, steak, hamburgers, hot dogs. Shortly afterwards my BP zoomed up again, with my diastolic peaking at 99. Again on Wednesday I ate some salmon and my BP skyrocketed. I called the paramedics because of my chest pain, they said the EKG was fine and that I didn't need to go to the hospital, which I was happy to hear. And then this morning, I had a smoothie with kefir (I usually use soy milk, but I forgot kefir was fermented), and my BP shot up, no chest pain this time, but a splitting headache.
Why am I so sensitive to tyramine when I am taking a medication that at this dosage officially has no dietary restrictions and theoretically avoids any MAOI interactions in the gut? I do sometimes get panic attacks, but I don't think this is just about panic attacks. This seems to be definitely related to what I eat.
Any thoughts?
Thanks,
psychlover
Posted by damnthislife on May 31, 2013, at 14:26:45
In reply to Parnate didn't work -- Emsam hypertensive crisis, posted by psychlover on May 31, 2013, at 13:16:17
I cannot offer any advice since I'm only a novice with MAOI's but I hope that you continue to feel better and resolve the food interations!
Quick question... is lack of energy (tiredness) a big thing with your atypical depression? Do you also have the carb cravings when not on meds with your depression?
I'm just curious as to which MAOI to start first. My pdoc is down for either of the MAOI's.
Posted by Phillipa on May 31, 2013, at 18:48:38
In reply to Parnate didn't work -- Emsam hypertensive crisis, posted by psychlover on May 31, 2013, at 13:16:17
That is strange that the same med you did well on 5 years ago is causing this? Did you inform your doc? Could you have developed an intolerance now to Maois? Have not seen this posted before. I'm really sorry you are having these problems. Phillipa
Posted by Willful on May 31, 2013, at 19:36:20
In reply to Parnate didn't work -- Emsam hypertensive crisis, posted by psychlover on May 31, 2013, at 13:16:17
One reason, if these episodes have happened in quick succession is that you did have too much of something, before you noticed the effect-- but once you did notice, you had depleted your mao, which takes two weeks to completely reconstitute. So if you deplete it, and continue to eat or do things that cause tyramine reactions, the mao hasn't been replaced, and you'll continue to have episodes. Also of course, you also prolong the period you have to wait-- so if I were you, I'd assume that I did several things you never became aware of before the first episode. Then you needed to wait some good period of time before you could tolerate any type of fermented or spoiled food. Possibly at your cook-out there were things that were out for a while, and became slightly fermented from the heat.
Even on 6 mg, if you're sensitive to reactions, you can have enough things to cause an reaction--
So at the very least you should be very protective-- I don't know what you're eating-- there could be stuff around your kitchen that's causing it-- or it could be an atypical reaction to something-- I would review things there, and things that you're eating and see if you can determine anything.
Good luck with it.
Posted by SLS on June 1, 2013, at 5:09:22
In reply to Parnate didn't work -- Emsam hypertensive crisis, posted by psychlover on May 31, 2013, at 13:16:17
> 6mg dosage of Emsam does not carry any dietary restrictions
That's too bad. It really should. At that dosage, it still inhibits a significant amount of MAO-A. Otherwise, it wouldn't work as an antidepressant. Stop consuming tyramine, and you will avoid the pressor reaction.
There is not anything terribly special about Emsam in my opinion. I think its rate of producing a therapeutic response per capita is lower than those of Parnate and Nardil. You just happen to be in that minority of people who respond well to Emsam. You are extremely fortunate. Apparently, you will need to follow a MAOI diet, though. For me, this has been a small price to pay for improving my mental health.
1. Emsam works for you.
2. You react badly to tyramine while taking Emsam.
3. Don't ingest tyramine.
4. Live happily ever after.:-)
- Scott
Posted by psychlover on June 5, 2013, at 9:09:29
In reply to Re: Parnate didn't work -- Emsam hypertensive crisis, posted by Willful on May 31, 2013, at 19:36:20
Is that true? Once I have had one reaction, now it is easier to cross that threshold and have more reactions? That would seem to be the case, because while on Parnate for 6 weeks, I think I have only had one reaction (to miso soup), whereas since over the last week and a half it's been almost daily.
> One reason, if these episodes have happened in quick succession is that you did have too much of something, before you noticed the effect-- but once you did notice, you had depleted your mao, which takes two weeks to completely reconstitute. So if you deplete it, and continue to eat or do things that cause tyramine reactions, the mao hasn't been replaced, and you'll continue to have episodes. Also of course, you also prolong the period you have to wait-- so if I were you, I'd assume that I did several things you never became aware of before the first episode. Then you needed to wait some good period of time before you could tolerate any type of fermented or spoiled food. Possibly at your cook-out there were things that were out for a while, and became slightly fermented from the heat.
>
> Even on 6 mg, if you're sensitive to reactions, you can have enough things to cause an reaction--
>
> So at the very least you should be very protective-- I don't know what you're eating-- there could be stuff around your kitchen that's causing it-- or it could be an atypical reaction to something-- I would review things there, and things that you're eating and see if you can determine anything.
>
> Good luck with it.
Posted by psychlover on June 5, 2013, at 16:35:42
In reply to Re: Parnate didn't work -- Emsam hypertensive crisis, posted by psychlover on June 5, 2013, at 9:09:29
UPDATE
I just saw my cardiologist. He told me I should discontinue the medication, which seems reasonable if I continue to have these episodes of high blood pressure. When he checked my BP it as 140/100, which is definitely higher than normal (my normal BP is in the normal range). I have now been off Emsam for 9 days.
He also told me I don't need to be so worried if my BP goes up to 180/100 for a few hours. He said if it lasted a whole day I should call his office. I was surprised to hear that a BP reading this high was not so worrisome, since my reading about MAOIs and hypertensive crisis seemed to say that this number was more alarming.
This is the end of the thread.
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