Posted by Racer on April 18, 2008, at 9:43:59
In reply to Re: Racer, posted by cumulative on April 18, 2008, at 3:08:07
> Hey, you know, atypical depression is actually the most common form of depression.
I am aware of that -- it's also named atypical because it responds to MAOIs better than TCAs. I was apparently in my own little world last night, and too tired to make much sense.
>
> You say they're all (SSRIs) pretty effective ...Actually, what I meant to say is that ALL anti-depressants are about equal in terms of effectiveness, when looked at statistically. I think I said they were consistently effective, which didn't mean "pretty effective." The biggest differences have to do with side effect and safety profiles. It makes sense to me that doctors would look to the safest, most widely tolerated drugs first, and move on to other options after the first line drugs have failed.
This community is not typical of people taking anti-depressants. Just the fact that we have found our way here to learn more about the options shows we're atypical. For many doctors, someone asking for MAOIs is probably going to have to prove him/herself to be a good candidate for them -- maybe by following the diet in advance, maybe by showing that he/she can tolerate the adjustment phase difficulties on other drugs, maybe by trying higher doses of medications before giving up. Again -- it's not only about effectiveness.
There are many reasons my doctor won't prescribe an MAOI for me. One of them is that I admitted to my therapist that I wouldn't entirely object to Parnate, since it would make suicide so much easier. SSRIs are relatively safe in overdose. That's one reason they're first line drugs. Most people find the side effect profile tolerable, and the side effects are more a bother than a danger.
This is a subject I'm very sensitive about, by the way. I've posted questions here about specific medications my doctor is considering, and had responses saying I "should" go for Nardil instead. Even if I say that MAOIs are not options for me, I have still gotten responses saying I should find another doctor who will prescribe them -- even though there are very valid reasons for them to be off the table in my case. I have felt frustrated, because I cannot get any help with the question I'm asking, and because I start to feel as though I'm not welcome here because I believe my doctor's reasoning on this subject. My doctor prescribes MAOIs for many of his patients. He won't prescribe them for me, which I think is appropriate, knowing the facts of my case.
I worry about how people might feel if they tried an MAOI and didn't find it tolerable -- it seems as though every time I post something about tolerability of MAOIs, a lot of people post back that they're fine, that they're easy to take, that the diet "should not" cause *anyone* any problems, etc. That's not what studies have shown: most of the studies I've read comparing different classes -- including STAR*D, as I recall -- showed that MAOIs were effective and helpful and that many people couldn't continue taking them for tolerability issues. THAT is why they're not first line drugs. Despite the experiences of people here, for MANY PEOPLE out there -- including some on this board -- MAOIs are simply not appropriate, because they are not tolerable for everyone.
Frankly, the same can be said for pretty much ALL the antidepressants -- for me, the SSRI side effects are not tolerable, TCAs have been ineffective and intolerable, etc -- we're different, mileage varies, and so on.
I'm sorry I wasn't clear enough in my meaning last night. I hope this makes more sense.
poster:Racer
thread:823803
URL: http://www.dr-bob.org/babble/20080412/msgs/823993.html