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Hypotension, MAOI's, and Moclobemide

Posted by crazyvash on September 12, 2015, at 22:20:18

As an introduction, my current diagnosis is bipolar II. Which, like most people with the condition, I suffer from mostly the depression aspect. Fortunately, my hypomania and mixed states are under control with a combination of Lamictal and Seroquel. Although, when it comes to the depression, relief from that still alludes me. Unfortunately for me, the only antidepressants that work are the MAOI's. Granted, I am thrilled that something works at all, but the combined hypotension from the Seroquel, and currently EMSAM are making things very difficult. I have already tried switching the Seroquel around with various antipsychotics, but then I run into the situation of either the drug doesn't do the job (Risperdal, Abilify, Loxitane), or I run into hypotension problems again. (Saphris) I could try replacing the EMSAM with something like Nardil or Parnate, but according to my doctor, EMSAM is a little better with hypotension than the other two are. Also, having done this medication dance for a long time now, I am just getting tired of playing whack-a-mole. I have read before that taking salt tablets and/or fludrocortisone can help with this. I have mentioned this to my doctor, as he was unaware of this, so hopefully I'll have a way to "fix" this problem. I guess I'll find out what we'll try at the next appointment. If anyone has any similar experiences, I'd appreciate any information or suggestions.

Now why the subject title of moclobemide? Well, from my research, moclobemide doesn't have the issues with hypotension as much as the traditional MAOI's, so that's why I am interested. Also, if the salt tablets/fludrocortisone idea doesn't work, at least I have an alternative plan that I am working on.

Other than going to Canada and getting a prescription in that fashion, I have another question. Can a doctor from the United States legally write a prescription for an unapproved drug like moclobemide to have it filled at a foreign (Canada) mail order pharmacy? A recent phone conversation with my current doctor basically came down to that if I wanted the drug, then I'll have to go out of the country to get it. I am guessing he said this because he is on the careful side, but then again, maybe legally he can't do it even if he wanted to. I'll make sure to properly grill him next time. I have read about people that have supposedly gotten this medication who are U.S. citizens, so I am curious about how they went about this.

In the end, I guess I am looking for anyone that has gone through this issue of hypotension and any experiences that they have had with treating it. Worst case scenario, if I have to go to Canada to try out moclobemide, then so be it, but I would rather not.





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poster:crazyvash thread:1082410