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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by NikkiT2 on September 25, 2003, at 13:27:10
My pdoc has suggested trying this.. he's given me two weeks to investigate!!!
Anyone have any experience with it??
The main concerns I have are the diet restrictions..
I was told not "too much" mature cheeses or formented soya... How much is too much?? I love mature chedders, and the soft cheese like Brie.. and eat a fair amount of chedder (about 200g a week, though I've been trying to cut down!!), and I also eat Tofu a couple of times a week.. Oh, and then theres Soy Sauce and Tamari..
Help!!!
Nikki x
Posted by Jon21 on September 25, 2003, at 14:43:10
In reply to Moclobemide, posted by NikkiT2 on September 25, 2003, at 13:27:10
Hi Nikki,
I've just completed my washout from moclobemide after taking 600mg for 5 months and am looking to try an older MAOI.
At first I felt a surge of energy and a definate uplift in mood, but sadly this faded away after the first two weeks. This seems to be a common reaction.
Regarding the dietary restrictions, I'm afraid a large cut down in cheese will be necesary to ensure safety. I never had any problems with what I would call a normal size adult portion of a tyramine-rich food. Foods containing soy and yeast extract were not a problem, although I'd avoid marmite ect. for safety's sake. I once accidentally ate a pizza with a variety of cheese toppings with no ill effect, though I never did this again and I wouldn't reccomend trying it.
The issue of how much is a small amount is something my psychiatrist raised - he reccomended avoiding the offending foods altogether. My own view is that a small and safe amount is one that is just enough to add flavour to a meal, not something that comprises like 50% cheese - and not a great chunk of cheddar!
I think drug interactions are more likely to be the main cause of hypertensive crises with moclobemide, rather than foods. Be careful of over-the-counter preparations.
I wish you well on moclobemide, if that is what you decide to take. Hope this has been useful.
Jon
Posted by NikkiT2 on September 25, 2003, at 15:02:43
In reply to Re: Moclobemide, posted by Jon21 on September 25, 2003, at 14:43:10
That there is NO way I could try this drug!!!
No way I could live without macaroni cheese, and pizza *lol*
Think I'm going to give Reboxatine a try instead!!
Oh, and I was diagnosed with high blood pressure 2 1/2 weeks ago (after a life time of low blood pressure!!!) so probably best to avoid it
Thanks
Nikki
Posted by JonW on September 25, 2003, at 19:15:36
In reply to You've convinced me » Jon21, posted by NikkiT2 on September 25, 2003, at 15:02:43
> That there is NO way I could try this drug!!!
>
> No way I could live without macaroni cheese, and pizza *lol*Hi Nikki,
You may not want to try this drug, but it should be because it appears somewhat less potent than other drugs, not for fear of an interaction with cheese. I urge you to search PubMed, and you will find that dietary tyramine is not a major concern with moclobemide. My experiences certainly confirm this. I have really tested moclobemide when it comes to dietary restrictions and drug-drug interactions. I've combined it with everything! I've devoured huge amounts of cheese without any problem. I love pizza, and eat it all the time. The only time I had an issue, was once I combined a lot of alcohol (I was drunk of my ass) while on aniracetam (effectively a stimulant) and smoked a lot of really good weed. I had a hypertensive crisis (wasn't I asking for one?), but it resolved itself within minutes. It was still very scary. Since then I tested different combinations of those three substances, aniracetam/weed/alcohol, to determine the problem. It turned out that aniracetam in combination with weed don't agree with me while on moclobemide. I've since combined huge amounts of weed and alcohol without aniracetam, and have never had a problem. I always took my blood pressure, and it was never of concern. I have since stopped aniracetam, not so I could smoke weed :) on moclobemide, but because it was making me irritable and agitated as stimulants tend to do that to me. By the way, I don't smoke or drink anymore as it seems to get in the way of the drug working... not to mention, getting anything done :)
I take 450mg of moclobemide. Have essentially no side-effects, and have had a response comparable to that of the SSRIs. There is reason to avoid moclobemide. It certainly appears to work for fewer people than other drugs. I mean, that's the impression you get. But search the web, search PubMed... you will find very little evidence, if any, of the lack of dietary restrictions causing problems. The only things to really avoid are MDMA, SSRIs, stimulants, etc. I've never had a problem with decongestants. If I were you, I'd give it some more thought... I personally have had an excellent response along with a handul of others, and without side-effects. Take a poll here and other places... inquire about peoples experience eating cheese while on moclobemide. I would be surprised if you find very many people, if any, who had problems. I'd even ask, Jon21. It doesn't sound as though he's had a problem with it, either. I think he's wise to be conservative, but in light of the evidence I believe his suggestion is overly cautious. I've pasted an abstract at the bottom of this post you may find of interest.
Good Luck,
Jon :)--------------------------------------------------
Comparison of the pressor effect of tyramine after treatment with phenelzine and moclobemide in healthy male volunteers.Simpson GM, Gratz SS.
Department of Psychiatry, Medical College of Pennsylvania 19129.
This study was conducted to establish the safety, tolerability, side effects, and pressor effects of tyramine on subjects treated with moclobemide, a short-acting reversible and preferential monoamine oxidase inhibitor, and to compare these responses with the responses of subjects treated with phenelzine. Twelve healthy male volunteers participated. An oral tyramine sensitivity test was performed on all subjects 24 hours before the start of a 28-day open-label treatment with phenelzine or moclobemide. A tyramine challenge was performed on day 28 on four subjects treated with phenelzine. The mean dose of oral tyramine required to increase systolic blood pressure by 30 mm Hg was 15 mg. The mean dose of tyramine that produced a clinical response (day 28) in subjects treated with moclobemide was 240 mg. No subject receiving moclobemide responded clinically on day 31 after receiving hourly doses of 20, 40, 80, 160, and 320 mg, respectively. These findings suggest that moclobemide may be used without stringent dietary precautions.
--------------------------------------------------
Posted by cubbybear on September 26, 2003, at 4:24:32
In reply to Moclobemide, posted by NikkiT2 on September 25, 2003, at 13:27:10
> My pdoc has suggested trying this.. he's given me two weeks to investigate!!!
>
> Anyone have any experience with it??
>
> The main concerns I have are the diet restrictions..
>
>What are your real priorities? To feel better or to be able to eat the foods you want? Only you can decide that. But from my experience (and this is just my opinion), the Moclobemide was like poison and made my depression worse. IF that happens to you, you won't even be in the mood to go out for your favorite dishes. On the other hand, if diet restriction is the number one priority in your choice of meds and want no limits on certain foods at all, then you'll have to look elsewhere--forget about the MAOIs.
Posted by NikkiT2 on September 26, 2003, at 11:26:21
In reply to Re: You've convinced me » NikkiT2, posted by JonW on September 25, 2003, at 19:15:36
Thanks for that.. but I'm still very wary of it. I've been on SO many meds (28 different ones at last count!) and some of them have really made me ill.. So I really don't want to try one that *could* make me ill.
And having just been diagnosed with high blood pressure (my blood pressure has always been 90/70, and was tested at that just before my surgery 5 weeks ago, yet 2 weeks later it was 130/104, and last week was 138/108) I think its best to avoid any that could possibly raise it even higher.
He gave me the option of Reboxatine too, so think I will try that one first.
Thanks for your reply
Nikki
Posted by NikkiT2 on September 26, 2003, at 11:29:45
In reply to Re: Moclobemide » NikkiT2, posted by cubbybear on September 26, 2003, at 4:24:32
My priority is feeling better.. but at the moment I'm not willing to risk my physical health. I'm having a number of physical probkems going on at the moment, and so badly don't want to add to them.
And I don't go out to eat, I cook nearly all my food at home, using fresh ingredients 90% of the time.. but being vegetarian, Tofu and Cheese are things I eat fairly regularly.. cutting these out of my diet could be unhealthy for me in my opinion. And a vegetarian diet can be boring enough as it is!!! (And I'm not totally vegie, but my husband is, and when we moved in together, I made the agreement that I would not eat meat in the house)
Nikki
Posted by JonW on September 26, 2003, at 13:03:02
In reply to Re: You've convinced me » JonW, posted by NikkiT2 on September 26, 2003, at 11:26:21
> He gave me the option of Reboxatine too, so think I will try that one first.
Sounds like a good way to go. I'd definitely exhaust the more mainstream meds before going on an MAOI. Although, it definitely depends on the situation and the symptoms you're experiencing. One thing to note is that moclobemide and the other MAOIs actually lower blood pressure. If it weren't for that pesky risk of having a hypertensive crisis... Anyway, good luck with everytihng. I hope you find something that works for you!
Jon :)
Posted by Jon21 on September 26, 2003, at 15:35:31
In reply to Re: You've convinced me » NikkiT2, posted by JonW on September 26, 2003, at 13:03:02
Hi Nikki,
Your desicion not to take moclobemide is probably the best if you think you're going to have a hard time keeping to a low tyramine diet. I see my advice has been rated as conservative by another poster.
The advice I gave *was* deliberately on the conservative side. I too have combined moclobemide with large amounts 'forbidden foods', but I don't think it's good advice to post this as a general statement as it may mislead people into thinking they can ignore the restrictions altogether, which is definately dangerous. I don't want to be responsible for causing a serious reaction.Moclobemide didn't work for me, but I was taking it primarily for social anxiety; you don't mention your reason for taking it. One thing that worried me is that my depression began to resurface quite bad a few months into moclobemide therapy - something that has never happened while taking any other AD, and like you I've tried almost the whole lot besides the older MAOI's.
The MAOI's are likely to cause hypotension (low blood pressure) in daily use (except of course in the rare event of a hypertensive crisis), although this is usually occurs with the older MAOI's, not moclobemide. Your blood pressure is unlikely to be a problem if you did take moclobemide.
Jon
Posted by JonW on September 26, 2003, at 19:31:44
In reply to I didn't mean to convince you!!!, posted by Jon21 on September 26, 2003, at 15:35:31
> Your desicion not to take moclobemide is probably the best if you think you're going to have a hard time keeping to a low tyramine diet. I see my advice has been rated as conservative by another poster.
Hi Jon,
I hope you didn't take offense to my post in any way. I just wanted to present another viewpoint. In my opinion, the dietary restrictions of moclobemide are effectively non-existent. That's to say that taking the drug really doesn't cause one to alter their diet in any major way. But the risks are no less real, and one is certainly better safe than sorry.
Cool name,
Jon :)
Posted by Jon21 on September 27, 2003, at 12:09:19
In reply to Re: I didn't mean to convince you!!! » Jon21, posted by JonW on September 26, 2003, at 19:31:44
> Hi Jon,
> I hope you didn't take offense to my post in any way. I just wanted to present another viewpoint. In my opinion, the dietary restrictions of moclobemide are effectively non-existent. That's to say that taking the drug really doesn't cause one to alter their diet in any major way. But the risks are no less real, and one is certainly better safe than sorry.
>
> Cool name,
> Jon :)Hi Jon (this could get confusing!),
I didn't take offence to your comments. As I said, I deliberately kept my advice on the conservative side.
I too think that *dietary* restrictions on moclobemide are almost nil for most people, but there may be that one person that beomes very sensitive to tyramine, and aged cheeses are one of the worst offenders. That is why I was rather concerned about giving the all-clear to someone who regularly eats large amounts of cheese.Also to Nikki:
When my pdoc first suggested I try MAOI's when I was 18, I too thought OMG I'll never be able to live like that. The possibility of a hypertensive crisis also seemed terrifying at that time.
Somehow after all the failed drug trials and all the side-effects of everything I've tried in the last 4 years I figured that the MAOI's mightn't be so bad afterall.
I'm careful about what I eat, but after a few weeks you learn which meals you can safely prepare and from then on it's plain sailing. You can then start to experiment with small amounts of restricted foods (at your own risk of course!)Jon
This is the end of the thread.
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