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Re: pdoc making me jump hoops for maoi's

Posted by jerrympls on January 17, 2004, at 23:18:52

In reply to pdoc making me jump hoops for maoi's, posted by f l y on January 14, 2004, at 16:04:28

> i'm at 70mg parnate - having trouble w/ sleeping in and having a need to take naps even though i've had full nights sleep. my pdoc won't write a higher dose of parnate or a stim besides provigil (bad s/e) until he gets a second opinion from a more maoi experienced pdoc. i don't like the extra expense and time. there is a need for pdocs to get more up to date on maoi's.

I feel for you. It's too bad dr's are so scared of MAOI's. I would suggest going to a University research hospital if you can. The Doc's are eager to use MAOI's in certain cases and know everything about them - well, in my situtation that has been the case. At any rate, I thought these abstracts would help you regarding adding a stimulant to an MAOI:

1: J Clin Psychopharmacol. 1991 Apr;11(2):127-32.

CNS stimulant potentiation of monoamine oxidase inhibitors in treatment-refractory depression.

Fawcett J, Kravitz HM, Zajecka JM, Schaff MR.

Department of Psychiatry, Rush-Presbyterian-St. Luke's Medical Center, Chicago, llinois.

We report on our clinical experience with a combination of a CNS stimulant (either pemoline or dextroamphetamine) and a monoamine oxidase inhibitor (MAOI) for treating 32 depressed patients (mainly outpatients) refractory to standard antidepressant pharmacotherapy. This combination, though not approved by the FDA, appears to be safe and effective. Twenty-five (78%) of these patients experienced at least 6 months of symptom remission with a stimulant + MAOI combination. Many patients required adjunctive antidepressant treatment, including tricyclics and lithium. Side effects were not excessive, though 6 patients (3 unipolar and 3 bipolar) cycled to mania (N = 1) or hypomania (N = 5). None developed hypertensive crises. With properly motivated and complaint patients and careful clinical monitoring by the prescribing psychiatrist, stimulant potentiation of MAOIs may be a viable option for treatment-resistant depressed patients.

PMID: 2056139 [PubMed - indexed for MEDLINE]

2: J Clin Psychiatry. 1985 Jun;46(6):206-9.

Combined MAOI, TCA, and direct stimulant therapy of treatment-resistant depression.

Feighner JP, Herbstein J, Damlouji N.

Patients with "treatment resistant" depression who do not respond to standard methods or relapse over time have a moral and legitimate right to innovative therapy. Combined treatment with monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TCAs), and stimulants has been resisted by practitioners because of hypertensive and hyperthermic crises noted in certain cases This paper reports a case series demonstrating the safety and efficacy of adding a stimulant to an MAOI or to a combination of TCA and MAOI in the treatment
of intractable depression.

PMID: 3997787 [PubMed - indexed for MEDLINE]




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